scholarly journals Bartonella henselaeInfection: An Uncommon Mimicker of Autoimmune Disease

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Despoina N. Maritsi ◽  
Diagoras Zarganis ◽  
Zoi Metaxa ◽  
Georgia Papaioannou ◽  
George Vartzelis
Keyword(s):  
Clinical Laboratory ◽  
Imaging Features ◽  
Immunocompetent Host ◽  
X Ray ◽  
Systemic Involvement ◽  
Night Sweats ◽  
History Of ◽  
Chest X Ray ◽  
Systemic Symptoms ◽  
Immunocompetent Patients

We present a case of a seven-year-old immunocompetent female patient who developed systemic symptoms mimicking an autoimmune rather than an infectious disease. The patient presented with rash, biquotidian fever, night sweats, and arthralgias. There was no antecedent history of cat contact. Investigations showed increased inflammatory markers, leukocytosis, thrombocytosis, hypercalcemia, and raised angiotensin-converting enzyme. Interferon-gamma releasing assay for tuberculosis infection was negative. Abdominal imaging demonstrated multifocal lesions of the liver and spleen (later proved to be granulomata), chest X-ray showed enlarged hilar lymph nodes, and ophthalmology review revealed uveitis. Clinical, laboratory, and imaging features pointed towards sarcoidosis. Subsequently, raised titers (IgM 1 : 32, IgG 1 : 256) againstBartonellaconfirmed the diagnosis ofB. henselaeinfection. She was treated with gentamycin followed by ciprofloxacin; repeat investigations showed complete resolution of findings. The presence of hepatic and splenic lesions in children with bartonellosis is well documented. Our case, however, exhibited certain unusual findings such as the coexistence of acute ocular and systemic involvement in an immunocompetent host. Serological testing is an inexpensive and effective way to diagnose bartonellosis in immunocompetent patients; we suggest that bartonella serology is included in the baseline tests performed on children with prolonged fever even in the absence of contact with cats in countries where bartonellosis is prevalent.

Lingual Dystonia Treated with Botulinum Toxin - A Case Report

1970 ◽  
Vol 24 (2) ◽  
pp. 75-78
Author(s):  
MA Hayee ◽  
QD Mohammad ◽  
H Rahman ◽  
M Hakim ◽  
SM Kibria
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin A ◽  
Botulinum Toxin Type A ◽  
Botulinum Toxin Type ◽  
X Ray ◽  
Medical College ◽  
Lingual Dystonia ◽  
History Of ◽  
Chest X Ray

A 42-year-old female presented in Neurology Department of Sir Salimullah Medical College with gradually worsening difficulty in talking and eating for the last four months. Examination revealed dystonic tongue, macerated lips due to continuous drooling of saliva and aspirated lungs. She had no history of taking antiparkinsonian, neuroleptics or any other drugs causing dystonia. Chest X-ray revealed aspiration pneumonia corrected later by antibiotics. She was treated with botulinum toxin type-A. Twenty units of toxin was injected in six sites of the tongue. The dystonic tongue became normal by 24 hours. Subsequent 16 weeks follow up showed very good result and the patient now can talk and eat normally. (J Bangladesh Coll Phys Surg 2006; 24: 75-78)

scholarly journals Urinothorax Caused by Xanthogranulomatous Pyelonephritis

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
Waiel Abusnina ◽  
Hazim Bukamur ◽  
Zeynep Koc ◽  
Fauzi Najar ◽  
Nancy Munn ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Obstructive Uropathy ◽  
Xanthogranulomatous Pyelonephritis ◽  
Robot Assisted ◽  
Rare Form ◽  
X Ray ◽  
History Of ◽  
Chest X Ray ◽  
Tract Infections

Xanthogranulomatous pyelonephritis is a rare form of chronic pyelonephritis that generally afflicts middle-aged women with a history of recurrent urinary tract infections. Its pathogenesis generally involves calculus obstructive uropathy and its histopathology is characterized by replacement of the renal parenchyma with lipid filled macrophages. This often manifests as an enlarged, nonfunctioning kidney that may be complicated by abscess or fistula. This case details the first reported case of xanthogranulomatous pyelonephritis complicated by urinothorax, which resolved on follow-up chest X-ray after robot-assisted nephrectomy.

scholarly journals Hoarseness of Voice as a Rare Presentation of Tuberculosis: A Case Report Study

2019 ◽  
Vol 7 (19) ◽  
pp. 3262-3264
Author(s):  
Taher Felemban ◽  
Abdullah Ashi ◽  
Abdullah Sindi ◽  
Mohannad Rajab ◽  
Zuhair Al Jehani
Keyword(s):  
Laryngeal Carcinoma ◽  
Incidental Finding ◽  
Chain Reaction ◽  
Rare Presentation ◽  
Case Presentation ◽  
X Ray ◽  
History Of ◽  
Chest X Ray ◽  
Polymerase Chain ◽  
Laryngeal Tuberculosis

BACKGROUND: Having hoarseness of voice as the first clinical manifestation of tuberculosis is rare. This atypical presentation causes some confusion since other more common conditions, such as laryngeal carcinoma, present similarly and might require more invasive tests to confirm the diagnosis. CASE PRESENTATION: A 38-year-old male presented to the otorhinolaryngology clinic with a four-month history of change in voice. Laryngoscopy demonstrated a right glottic mass, raising suspicion of laryngeal cancer. The computed tomography showed a mass and incidental finding of opacities in lung apices. Chest x-ray demonstrated findings suggestive of tuberculosis. Polymerase chain reaction and culture of sputum samples confirmed the diagnosis and the patient was started on anti-tuberculosis treatment. CONCLUSION: Despite accounting for only 1% of pulmonary tuberculosis cases and having a similar presentation to laryngeal carcinoma, we recommend considering laryngeal tuberculosis when evaluating hoarseness of voice in endemic areas.

scholarly journals Ventilator-associated pneumonia in neonates: the role of point of care lung ultrasound

2020 ◽  
Vol 180 (1) ◽  
pp. 137-146
Author(s):  
Nora Tusor ◽  
Angela De Cunto ◽  
Yousef Basma ◽  
John L. Klein ◽  
Virginie Meau-Petit
Keyword(s):  
Lung Disease ◽  
Chronic Lung Disease ◽  
Lung Ultrasound ◽  
Clinical Laboratory ◽  
Control Group ◽  
Ventilator Associated Pneumonia ◽  
Lung Pathology ◽  
Rater Agreement ◽  
X Ray ◽  
Chest X Ray

AbstractNo consensus exists regarding the definition of ventilator-associated pneumonia (VAP) in neonates and reliability of chest X-ray (CXR) is low. Lung ultrasound (LU) is a potential alternative diagnostic tool. The aim was to define characteristics of VAP in our patient population and propose a multiparameter score, incorporating LU, for VAP diagnosis. Between March 25, 2018, and May 25, 2019, infants with VAP were identified. Clinical, laboratory and microbiology data were collected. CXRs and LU scans were reviewed. A multiparameter VAP score, including LU, was calculated on Day 1 and Day 3 for infants with VAP and for a control group and compared with CXR. VAP incidence was 10.47 episodes/1000 ventilator days. LU and CXR were available for 31 episodes in 21 infants with VAP, and for six episodes in five patients without VAP. On Day 1, a VAP score of > 4, and on Day 3 a score of > 5 showed sensitivity of 0.94, and area under the curve of 0.91 and 0.97, respectively. AUC for clinical information only was 0.88 and for clinical and CXR 0.85.Conclusion: The multiparameter VAP score including LU could be useful in diagnosing VAP in neonates with underlying lung pathology. What is Known:• Ventilator associated pneumonia (VAP) is common in infants on the neonatal unit and is associated with increased use of antibiotics, prolonged ventilation and higher incidence of chronic lung disease.• Commonly used definitions of VAP are difficult to apply in neonates and interpretation of chest X-ray is challenging with poor inter-rater agreement in patients with underlying chronic lung disease. What is New:• The multiparameter VAP score combining clinical, microbiology and lung ultrasound (LU) data is predictive for VAP diagnosis in preterm infants with chronic lung disease.• LU findings of VAP in neonates showed high inter-rater agreement and included consolidated lung areas, dynamic bronchograms and pleural effusion.

scholarly journals Roflumilast succeeds where traditional therapy fails: a case report

2015 ◽  
Vol 79 (3-4) ◽  
Author(s):  
Gabriella Guarnieri
Keyword(s):  
Inhaled Corticosteroids ◽  
Chronic Obstructive ◽  
High Dose ◽  
Welding Fumes ◽  
Obstructive Pulmonary Disease ◽  
Once Daily ◽  
X Ray ◽  
Clinical Control ◽  
History Of ◽  
Chest X Ray

The case of a 72-year-old man with a long history of chronic obstructive pulmonary disease (COPD, patient D according to Guidelines GOLD 2013) in a subject professionally exposed to welding fumes is presented. Diagnosis was based on symptoms and spirometry and confirmed by chest X-ray examination. Since 1997 the patient has been under different therapies, including high-dose inhaled corticosteroids and bronchodilators, with poor clinical control and frequent exacerbations. Roflumilast 500 μg once daily was started in January 2012 and patient’s respiratory symptoms, number of exacerbations and spirometry values have gradually improved since then. Roflumilast was an effective treatment in this case of difficult to treat severe COPD.

Molluscum-Like Papules as a Presentation of Early Papulonecrotic Tuberculid in Association with Nodular Tuberculid in a Male with Asymptomatic Active Pulmonary Tuberculosis

2015 ◽  
Vol 19 (2) ◽  
pp. 159-162 ◽  
Author(s):  
Rachel Asiniwasis ◽  
Maha T. Dutil ◽  
Scott Walsh
Keyword(s):  
Pulmonary Tuberculosis ◽  
Early Stage ◽  
Induced Sputum ◽  
Simultaneous Occurrence ◽  
Antituberculous Therapy ◽  
X Ray ◽  
Active Pulmonary Tuberculosis ◽  
History Of ◽  
Chest X Ray ◽  
Histopathologic Findings

Background/Objectives The clinical and histopathologic findings of a rare simultaneous occurrence of papulonecrotic tuberculid and nodular tuberclid in a patient with active but asymptomatic pulmonary tuberculosis are presented. Papulonecrotic tuberculid was observed at a very early stage, presenting as molluscum-like lesions. This has been described once in the literature. This was observed in conjunction with lesions compatible with the rare clinicopathologic variant of nodular tuberculid. Critical to the diagnosis of active pulmonary tuberculosis was the use of induced sputum testing, which confirmed the diagnosis despite the lack of a cough and a chest x-ray negative for active tuberculosis. Methods/Results A 40-year-old male presented with a 2-week history of fever and a skin eruption consisting of molluscum-like papules on the ears, arms, and abdomen and nodules on his legs. Biopsies from both lesions were consistent with papulonecrotic and nodular tuberculid, respectively. Despite the lack of any respiratory symptoms, induced sputum grew Mycobacterium tuberculosis, and the lesions resolved on antituberculous therapy. Conclusions and Relevance Tuberculids are rare in Western countries but must be considered in the differential diagnosis of eruptions in patients from endemic countries. An active tuberculous focus must be sought out.

scholarly journals Aggravation and deliberation over lung herniation

2019 ◽  
Vol 12 (5) ◽  
pp. e229225
Author(s):  
Michelle N Lee ◽  
Luke T Surry ◽  
David M Ferraro
Keyword(s):  
Influenza A ◽  
Surgical Repair ◽  
Caucasian Woman ◽  
Pleuritic Chest Pain ◽  
X Ray ◽  
Lung Herniation ◽  
Left Posterior ◽  
History Of ◽  
Chest X Ray ◽  
Lateral Chest

A Caucasian woman aged 58 years with history of asthma and surgically repaired congenital diaphragmatic hernia presented to the emergency department (ED) with persistent cough, pleuritic chest pain, shortness of breath, in spite of recent treatment for influenza A virus. On physical examination, a large bulge was protruding from her left posterior thorax. She was found to have a large abnormal radiographic lucency on lateral chest X-ray posterior to the thoracic cavity, confirmed with chest CT to represent a large lung herniation in between the left seventh and eighth ribs. The patient was evaluated by a thoracic surgeon and offered surgical repair but ultimately decided on conservative management which to date has been ineffective.

scholarly journals Differentiating influenza from COVID-19 in patients presenting with suspected sepsis

2020 ◽  
Author(s):  
Valentino D’Onofrio ◽  
Eveline Van Steenkiste ◽  
Agnes Meersman ◽  
Luc Waumans ◽  
Reinoud Cartuyvels ◽  
...  
Keyword(s):  
Clinical Laboratory ◽  
Leukocyte Count ◽  
Multivariable Logistic Regression Model ◽  
Suspected Sepsis ◽  
Early Management ◽  
X Ray ◽  
Empiric Antibiotic ◽  
Observational Cohort ◽  
Chest X Ray ◽  
Lower Temperature

AbstractThere is a need for a quick assessment of severely ill patients presenting to the hospital. The objectives of this study were to identify clinical, laboratory and imaging parameters that could differentiate between influenza and COVID-19 and to assess the frequency and impact of early bacterial co-infection. A prospective observational cohort study was performed between February 2019 and April 2020. A retrospective cohort was studied early in the COVID-19 pandemic. Patients suspected of sepsis with PCR-confirmed influenza or SARS-CoV-2 were included. A multivariable logistic regression model was built to differentiate COVID-19 from influenza. In total, 103 patients tested positive for influenza and 110 patients for SARS-CoV-2, respectively. Hypertension (OR 6.550), both unilateral (OR 4.764) and bilateral (OR 7.916), chest X-ray abnormalities, lower temperature (OR 0.535), lower absolute leukocyte count (OR 0.857), lower AST levels (OR 0.946), higher LDH (OR 1.008), higher ALT (OR 1.044) and higher ferritin (OR 1.001) were predictive of COVID-19. Early bacterial co-infection was more frequent in patients with influenza (10.7% vs. 2.7%). Empiric antibiotic usage was high (76.7% vs. 84.5%). Several factors determined at presentation to the hospital can differentiate between influenza and COVID-19. In the future, this could help in triage, diagnosis and early management. Clinicaltrial.gov Identifier: NCT03841162

scholarly journals A Fatal Case of COVID-19 in an Infant with Severe Acute Malnutrition Admitted to a Paediatric Ward in Niger

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Alido Soumana ◽  
Aboubacar Samaila ◽  
Lamine Mahaman Moustapha ◽  
Moumouni Kamaye ◽  
Balkissa Daouda ◽  
...  
Keyword(s):  
Nasal Swab ◽  
Severe Acute Malnutrition ◽  
Fatal Case ◽  
Acute Malnutrition ◽  
Rt Pcr ◽  
X Ray ◽  
Laboratory Confirmation ◽  
History Of ◽  
Chest X Ray ◽  
The Right

While there have been very few fatal cases, SARS-CoV-2 has been reported in paediatric patients. This study aims to describe a fatal case of COVID-19 in a child with severe acute malnutrition. The eight-month-old child presented with fever, diarrhoea, and difficulty in breathing. The mother of the child had fever and shortness of breath four weeks before she died. Physical examination revealed lethargy, dehydration, and severe weight loss with a weight of 5 kg at a height of 78 cm tall. The weight-for-height index was less than three Z-scores, which corresponds to severe acute malnutrition. The pulmonary examination revealed moderate respiratory distress, and the chest X-ray presented features suggestive of pneumonia in the right lung area. In the context of the COVID-19 outbreak in Niger and the circumstances of the mother’s death, a nasal swab was taken for laboratory confirmation. Treatment provided to the child included intranasal oxygen, antibiotics, and a dietary program with therapeutic milk. The child died 48 hours after his admission. The history of contact with a SARS-CoV-2 suspect or positive patient should lead to screening for infection by using RT-PCR. It is important to investigate malnutrition as a potential risk factor for severe SARS-CoV-2 infection and resultant mortality.

Evidence-Based Mini-Review: Are Systemic Corticosteroids an Effective Treatment for Acute Pain in Sickle Cell Disease?

Hematology ◽  
2010 ◽  
Vol 2010 (1) ◽  
pp. 416-417 ◽  
Author(s):  
L. Vandy Black ◽  
Wally R. Smith
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Adjunctive Treatment ◽  
Cell Disease ◽  
X Ray ◽  
Systemic Corticosteroids ◽  
Potential Efficacy ◽  
History Of ◽  
Chest X Ray ◽  
Pain Crisis

Abstract An 18-year-old African-American male with sickle cell disease (SCD) is admitted to the hospital with a vaso-occlusive pain crisis affecting his chest and right upper extremity. He has a history of asthma but does not have a fever or respiratory symptoms, and a chest X-ray is negative for an infiltrate. He is treated with intravenous fluids and morphine. You are asked about the potential efficacy of systemic corticosteroids as an adjunctive treatment for pain control.

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