scholarly journals A Challenging Twist in Pulmonary Renal Syndrome

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Rajaie Namas ◽  
Bernard Rubin ◽  
Wamidh Adwar ◽  
Alireza Meysami
Keyword(s):  
African American Woman ◽  
High Titer ◽  
Pulmonary Hemorrhage ◽  
American Woman ◽  
Acute Onset ◽  
Multiple Organ ◽  
Normocytic Anemia ◽  
Necrotizing Glomerulonephritis ◽  
Renal Vasculitis ◽  
Intravenous Steroids

Case. We report a rare case of hydralazine-induced anti-neutrophil cytoplasmic antibody-associated vasculitis. A 75-year-old African American woman with history of high blood pressure on hydralazine for 3 years presented with acute onset of shortness of breath and hemoptysis. Lab workup revealed a severe normocytic anemia and a serum creatinine of 5.09 mg/dL (baseline 0.9). Bronchoscopy demonstrated active pulmonary hemorrhage. A urine sample revealed red cell casts and a renal biopsy demonstrated pauci-immune, focally necrotizing glomerulonephritis with small crescents consistent with possible anti-neutrophil cytoplasmic antibody-positive renal vasculitis. Serologies showed high-titer MPO-ANCA and high-titer anti-histone antibodies. She was treated with intravenous steroids and subsequently with immunosuppression after cessation of hydralazine. The patient was subsequently discharged from hospital after a rapid clinical improvement.Conclusion. Hydralazine-induced anti-neutrophil cytoplasmic antibody-positive renal vasculitis is a rare adverse effect and can present as a severe vasculitic syndrome with multiple organ involvement. Features of this association include the presence of high titer of anti-myeloperoxidase anti-neutrophil cytoplasmic antibody with multiantigenicity, positive anti-histone antibodies, and the lack of immunoglobulin and complement deposition. Prompt cessation of hydralazine may be sufficient to reverse disease activity but immunosuppression may be needed.

A Case of Thyrotoxic Periodic Paralysis With Respiratory Failure in an African American Woman

2015 ◽  
Vol 24 (3) ◽  
pp. 264-267 ◽  
Author(s):  
Denise L. Shields
Keyword(s):  
African American ◽  
Respiratory Failure ◽  
African American Woman ◽  
American Woman ◽  
Periodic Paralysis ◽  
Acute Onset ◽  
Thyrotoxic Periodic Paralysis ◽  
Young Males ◽  
Demographic Group ◽  
Potassium Replacement

Thyrotoxic periodic paralysis is an acute endocrine emergency characterized by hyperthyroidism, profound muscle weakness and/or paralysis, and hypokalemia that is not due to potassium deficiency. Typically described in young males of Asian descent, it is becoming increasingly recognized outside of this demographic group and is believed to be an underrecognized cause of symptomatic hypokalemia. Thyrotoxic periodic paralysis usually manifests as acute onset of symmetrical distal extremity weakness and is treated with careful potassium replacement and nonselective β-blockers. In this case, a 43-year-old African American woman with thyrotoxic periodic paralysis had recurrent lower extremity myopathy and acute respiratory failure precipitated by noncompliance with treatment for Graves disease.

scholarly journals Hydralazine Induces Myeloperoxidase and Proteinase 3 Anti-Neutrophil Cytoplasmic Antibody Vasculitis and Leads to Pulmonary Renal Syndrome

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Gaurav Agarwal ◽  
Ghayyath Sultan ◽  
Sherry L. Werner ◽  
Claudia Hura
Keyword(s):  
Systemic Vasculitis ◽  
High Titer ◽  
Pulmonary Hemorrhage ◽  
Kidney Injury ◽  
Necrotizing Glomerulonephritis ◽  
Threatening Condition ◽  
Life Threatening ◽  
Pulmonary Renal Syndrome ◽  
One Year

We report a case of hydralazine-induced ANCA-associated glomerulonephritis with pulmonary hemorrhage. A 62-year-old Hispanic man with hypertension, who was being treated with hydralazine 100 mg three times a day for four and half years, presented to the hospital with severe anemia. He had acute kidney injury and urinalysis showed proteinuria, dysmorphic RBCs, and rare RBC cast. CT scan of the chest revealed bilateral pulmonary ground-glass infiltrates. Transbronchial biopsy was consistent with pulmonary hemorrhage. Serologic tests showed high titer PR3 ANCA and, to a lesser extent, MPO ANCA. Kidney biopsy revealed focal segmental necrotizing glomerulonephritis with crescents, without evidence of immune complex deposits. Hydralazine was discontinued and the patient was treated with corticosteroids and intravenous cyclophosphamide. At one-year follow-up, he had no symptoms and anemia had resolved. Kidney function improved dramatically. Serology showed undetectable PR3 ANCA and minimally elevated MPO ANCA. To our knowledge, hydralazine-associated PR3 ANCA has not been previously reported. The possibility of ANCA systemic vasculitis should be included in the differential diagnosis of any patient with hydralazine use and pulmonary renal syndrome. This is a potentially life threatening condition requiring prompt cessation of the drug and treatment with glucocorticoids and immunosuppression.

Probable neurosarcoidosis presenting as acute on chronic otorrhoea: a difficult diagnosis

2020 ◽  
Vol 13 (11) ◽  
pp. e237676
Author(s):  
Shaan N Somani ◽  
Alexander L Schneider ◽  
Kevin C Welch ◽  
Borislav A Alexiev ◽  
Akihiro J Matsuoka
Keyword(s):  
African American Woman ◽  
American Woman ◽  
Symptomatic Improvement ◽  
Oral Steroid ◽  
Progressive Hearing Loss ◽  
Presumptive Diagnosis ◽  
Unilateral Headache ◽  
Intravenous Antibiotics ◽  
Intravenous Steroids ◽  
Work Up

An elderly African American woman presented to our clinic following 9 months of right-sided unilateral headache, otorrhoea and progressive hearing loss. Despite treatment with topical and oral antibiotics, her clinical condition worsened, and imaging showed mastoid coalescence with an associated subgaleal abscess. She underwent right mastoidectomy and was discharged 3 days later on broad-spectrum intravenous antibiotics despite negative operative cultures. Six weeks later, she was hospitalised with diplopia secondary to a right lateral rectus palsy. Imaging showed abscess resolution but progressive bony remodelling and enhancement of the lateral extending into anterior skull base. Chest CT demonstrated upper lobe predominant pulmonary micronodules, and mastoid biopsy on revision surgery was notable for non-caseating granulomas. Further extensive work-up could not identify an alternative cause, and a presumptive diagnosis of neurosarcoidosis was made. The patient was initiated on intravenous steroids, experienced symptomatic improvement and was thereafter transitioned to oral steroid taper on discharge.

scholarly journals Cytophagic Histiocytic Panniculitis (CHP) in a Patient with SLE Found after Autopsy: When a Rash Is “Complicated!”

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Hafsa Abbas ◽  
Ahsan Aslam ◽  
Muhammad Saad ◽  
Masooma Niazi ◽  
Sridhar Chilimuri
Keyword(s):  
Adipose Tissue ◽  
African American Woman ◽  
American Woman ◽  
High Dose ◽  
Clinical Disorder ◽  
Severe Pancytopenia ◽  
Bag Cells ◽  
Cytophagic Histiocytic Panniculitis ◽  
Intravenous Steroids ◽  
Bean Bag

Introduction. Cytophagic histolytic panniculitis (CHP) is a clinical disorder characterized by nodular panniculitis of the subcutaneous adipose tissue. It was first described in 1980 by Winkelmann. Histologically it is described as an infiltration of the adipose tissue by T- lymphocytes and phagocytic macrophages (also known as “bean bag cells”). Most of the cases are reported under the age of 50 and is a rare cause of panniculitis. We report a case of CHP in a young patient who presented to our emergency room (ER). Case Summary. A 39-year-old African American woman who presented to our hospital with lethargy, progressive confusion, and generalized rash involving both lower extremities of 1 week duration. She had a history of pancytopenia and focal proliferative and membranous lupus nephritis classes 3 and 5. Her physical examination was remarkable for bilateral lower extremity pitting edema and a desquamating rash on both of her legs. The Nicolsky sign was positive. She was noted to be hypotensive and was started on intravenous fluids and broad spectrum antibiotics. Routine laboratory tests revealed severe pancytopenia, with a hemoglobin of 3.9 g/dl, white blood cell count 600/ul, and platelet count of 11000/ul. Within an hour of arrival to the ER she developed acute respiratory failure. She was intubated and placed on mechanical ventilation. She developed shock requiring vasopressors. No imaging could be done due to her unstable condition. Four hours after her initial presentation she developed asystole and expired. Postmortem histopathology of the adipose tissue revealed CHP. Conclusion. CHP can be rapidly fatal. The treatment involves high dose of intravenous steroids and immunosuppressants such as cyclosporine.

Merle’s travel: A Quest For Completeness In Paule Marshall’s The chosen place, the timeless people.

2019 ◽  
Vol 5 (4) ◽  
pp. 36-42
Author(s):  
Dr. K. Radah ◽  
G. Gayathri
Keyword(s):  
African American ◽  
Social Context ◽  
African American Women ◽  
African American Woman ◽  
American Woman ◽  
Community Level ◽  
Dominant Culture ◽  
True Self ◽  
American Women ◽  
Human Need

African American women have been silenced and kept ignorant by the dominant culture and it is the human need to create and maintain a true self in a social context. However, such an endeavor becomes an ordeal for those who are doubly oppressed, for those who are muted and mutilated physically and psychically through the diabolic crossfire of caste/race, sex and colonialism. This paper focuses on, an African American Woman, throughout her journey of life, seeking completeness in terms of family, society and community level.

Self-Reflective Insights on What I Have Learned in an Evolving Academic Career Model: Accounting Scholarship, Administration, and Diversity

2018 ◽  
Vol 33 (3) ◽  
pp. 5-16 ◽  
Author(s):  
Carolyn M. Callahan
Keyword(s):  
African American Woman ◽  
Academic Career ◽  
American Woman ◽  
Vantage Point ◽  
Business College ◽  
Personal Experiences ◽  
Career Model ◽  
Accounting Model ◽  
The Impact

ABSTRACT In this paper, I offer personal insights based on my experiences (thus far) in an evolving academic accounting career model. While I value all aspects of an academic career responsibilities (teaching, research, and service), this narrative focuses primarily on the role of accounting scholarship and, broadly, the impact of diversity on the same. I offer these perspectives and personal experiences from the unique vantage point as an African American woman, focused first on contributing to top-tired accounting scholarship, and more recently on roles as an administrator of an accounting department and business college. While my academic journey is unique by objective measures (often dubbed “trailblazing” by others), I offer suggestions that may be useful to any academic who is dedicated to success in our field. Given the evolving accounting model and challenges ahead, my overriding goal remains to encourage junior accounting colleagues to persevere, as an accounting academic career is richly rewarding.

Extra-nodal Rosai-Dorfman Disease Confined to Breast

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S41-S42
Author(s):  
E Ozluk ◽  
R Shackelford
Keyword(s):  
Plasma Cells ◽  
African American Woman ◽  
American Woman ◽  
Lymphocytic Infiltration ◽  
Needle Aspiration ◽  
Left Breast ◽  
Unknown Etiology ◽  
Diagnostic Challenge ◽  
Ductal Cells ◽  
Rosai Dorfman Disease

Abstract Introduction/Objective First described by Rosai and Dorfman in 1969, Rosai-Dorfman Disease (RDD) is an uncommon, idiopathic, reactive lymph node process with an unknown etiology. It may involve extra-nodal organs including the skin, bone, soft tissue, and eyes. However, breast involvement is rare and RDD confined to breast without nodal involvement is extremely uncommon. Methods Here we present a case of RDD confined to breast. The patient was a 51-year-old African American woman who was found to have an irregular, solid left breast mass on routine mammogram, which had speculated irregular margins and measured of 37.0 x 32.0 x 32.0 mm. She did not have any symptoms, nor any palpable lymph nodes. The clinician stated that the lesion was highly suspicious for a breast malignancy and requested a fine needle aspiration (FNA) of the mass, followed by total excision. Results An FNA was interpreted as atypical histiocytic cells in a mixed lymphoid background. Histopathologic examination revealed an ill-defined mass with sheets of histiocytes, plasma cells, and a mixed lymphocytic population, with occasional germinal centers. Some of the histiocytes were spindle shaped and associated with storiform collagen deposition. The histiocytes had single and multiple nuclei and exhibited occasional emperipolesis. Immunohistochemical staining with S100 diffusely highlighted the histiocytes, whereas CD1a was negative. CD3 and CD20 immunostains were positive for mixed-type lymphocytic infiltration. Cytokeratin staining was performed and reassuringly stained only the benign ductal cells. A diagnosis of RDD of the breast was made, based on these histopathologic findings. Conclusion We report an example of an extra-nodal RDD involving the mammary gland that was initially suspected to be breast carcinoma. RDD may still be a diagnostic challenge, especially in a patient with suspected carcinoma. It is the pathologist’s role to lead the clinician to the proper diagnosis and render a correct histopathologic diagnosis.

scholarly journals False elevations in urinary metanephrines: under-recognised pitfall with 24-hour urinary volume collection

2021 ◽  
Vol 14 (2) ◽  
pp. e241147
Author(s):  
Terry Shin ◽  
Thanh Duc Hoang ◽  
Mary Thomas Plunkett ◽  
Mohamed K M Shakir
Keyword(s):  
African American Woman ◽  
Urine Volume ◽  
American Woman ◽  
Secondary Hypertension ◽  
Reference Laboratory ◽  
Urine Collection ◽  
Urinary Volume ◽  
Normal Limits ◽  
Incorrect Diagnosis ◽  
Urinary Metanephrines

One pitfall in 24-hour urine collection is the input of incorrect urinary volume by the reference laboratory. This may lead to an incorrect diagnosis of pheochromocytoma or paraganglioma. A 48-year-old African-American woman was seen in the clinic for an elevated 24-hour urine metanephrine screen during workup for secondary hypertension. Urine volume was found to be incorrectly inputted by the lab as 9750 mL rather than 975 mL. The urinary metanephrines were then recalculated and the 24-hour urinary metanephrines resulted within normal limits. This case highlights this unique and potentially under-recognised error in testing with 24-hour urine volume collection.

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