Pearls and pitfalls: Cold-induced urticaria

2020 ◽  
Vol 41 (4) ◽  
pp. 301-304
Author(s):  
David C. Mari ◽  
Taylor A. Banks
Keyword(s):  
Differential Diagnosis ◽  
Complex Disease ◽  
Clinical Course ◽  
Disease Process ◽  
Rapid Onset ◽  
Periodic Syndrome ◽  
Younger Patients ◽  
Systemic Reactions ◽  
Pertinent Information ◽  
Underlying Mechanisms

Background: Cold-induced urticaria can take place either due to direct cold exposure, cryoglobulinemia, or genetic component (such as cryopyrin-associated periodic syndrome), which leads to the rapid onset of urticaria and/or angioedema. It is more common in younger patients and more likely to affect females compared with males. Objective: To increase awareness of such systemic reactions of anaphylaxis and provide a focused review of the differential diagnosis, underlying mechanisms, broad workup, and management of this disease process for allergy/immunology fellows, residents, general physicians, and general practitioners. Methods: Pertinent information was included from the patient's clinical course. Also, a review of the available literature to include additional references that were obtained by using the works cited in the most up-to-date reviews was completed. Results: A case of a patient with cold-induced urticaria with common sequela was presented, followed by a discussion of the pathophysiology, diagnosis and its differential diagnosis, workup, and management. Conclusion: Cold-induced urticaria is a complex disease with several different catalysts. Providers should be aware of the different forms of cold-induced urticaria and recognize the risk for anaphylaxis in this patient population. Pearls and pitfalls of the diagnosis and management are provided.

A case report of pancreatitis-panniculitis-polyarthritis syndrome – an unusual but serious presentation of pancreatic disease

2019 ◽  
Vol 65 (1) ◽  
pp. 19-23
Author(s):  
João Paulo Castro ◽  
Gabriel Atanásio ◽  
Maria Ana Canelas ◽  
André Ferreira ◽  
Ana Rita Barbosa ◽  
...  
Keyword(s):  
Clinical Course ◽  
Early Recognition ◽  
Clinical Investigation ◽  
Disease Process ◽  
Rapid Onset ◽  
Pancreatic Disease ◽  
Steady Improvement ◽  
Intraosseous Fat ◽  
Clinical Triad ◽  
Intraosseous Fat Necrosis

The clinical triad of peripheral cutaneous erythematous nodules, oligo or polyarthritis with intraosseous fat necrosis in the setting of pancreatic disease defines a rare entity called pancreatitis-panniculitis-polyarthritis syndrome. The early recognition of this triad is critical due to its high mortality rate and the rapid onset of osseous and articular disabilities. We describe the clinical course of a 54-year-old patient with complaints of weight loss and fever who presented to our hospital with signs of polyarthritis and appendicular erythematous cutaneous nodules. Clinical investigation revealed high inflammatory and pancreatic enzymes levels. Cutaneous biopsy and articular MRI showed evidence of peripheral necrosis. After a thorough investigation, a diagnosis of panniculitis-polyarthritis-pancreatitis syndrome was established. Treatment was initiated, and a slow but steady improvement was observed. Further complications of the disease process were observed. This case highlights the importance of recognising the association between panniculitis and polyarthritis with pancreatic disease in order to improve outcomes.

scholarly journals Lipschütz Ulcer: An Unusual Diagnosis that Should Not be Neglected

2021 ◽  
Vol 43 (05) ◽  
pp. 414-416
Author(s):  
Daniela Alexandra Gonçalves Pereira ◽  
Eliana Patrícia Pereira Teixeira ◽  
Ana Cláudia Martins Lopes ◽  
Ricardo José Pina Sarmento ◽  
Ana Paula Calado Lopes
Keyword(s):  
Emergency Department ◽  
Differential Diagnosis ◽  
Clinical Course ◽  
Malignant Tumors ◽  
Sudden Onset ◽  
Drug Reactions ◽  
Genital Ulceration ◽  
Sexually Transmitted ◽  
Inflammatory Processes ◽  
Genital Ulcers

AbstractThe diagnosis of genital ulcers remains a challenge in clinical practice. Lipschütz ulcer is a non-sexually transmitted rare and, probably, underdiagnosed condition, characterized by the sudden onset of vulvar edema along with painful necrotic ulcerations. Despite its unknown incidence, this seems to be an uncommon entity, with sparse cases reported in the literature. We report the case of an 11-year-old girl who presented at the emergency department with vulvar ulcers. She denied any sexual intercourse. The investigation excluded sexually transmitted infections, so, knowledge of different etiologies of non-venereal ulcers became essential. The differential diagnoses are extensive and include inflammatory processes, drug reactions, trauma, and malignant tumors. Lipschütz ulcer is a diagnosis of exclusion. With the presentation of this case report, the authors aim to describe the etiology, clinical course, and outcomes of this rare disease, to allow differential diagnosis of genital ulceration.

Metastasectomy for Stage IVA Colon Cancer: Does the Type of Treating Institution Make a Difference?

2021 ◽  
pp. 000313482110233
Author(s):  
Shinho T. Kang ◽  
Ryan Moran ◽  
Lala Hussain ◽  
Hamza Guend ◽  
Erik M. Dunki-Jacobs ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Liver Metastasis ◽  
Complex Disease ◽  
Academic Research ◽  
Disease Process ◽  
Tumor Location ◽  
Colon Resection ◽  
Academic Community ◽  
Metastatic Colon Cancer ◽  
Isolated Liver

Treatment of metastatic colon cancer has evolved over time. More evidence has been emerging in recent years supporting metastasectomy in selected patients. We sought to elucidate whether the type of institution—community, comprehensive community, academic/research, and integrated cancer network—would have an effect on patient outcome, specifically those colon cancer patients with isolated liver metastasis. This retrospective cohort study queried the National Cancer Database (NCDB) from 2010 to 2014 for patients who were 18 years of age or older with stage IVA colon cancer with isolated liver metastasis. We then performed uni- and multivariate analyses comparing patients based on such factors as age, tumor characteristics, primary tumor location, rate of chemotherapy, and type of treating institution. Patients who came from regions of higher income, receiving chemotherapy, and presenting to an academic/research hospital were more likely to undergo metastasectomy. Median survival was longest at academic/community hospitals at 22.4 months, 6 to 7 months longer than the other three types of institutions. Factors positively affecting survival included receiving chemotherapy, presenting to an academic/research institution, and undergoing metastasectomy, all at P < .05. In our study, the rate of metastasectomy was more than double at academic/research institutions for those with stage IVA colon cancer with isolated liver metastasis. Prior studies have quoted a mere 4.1% synchronous colon resection and metastasectomy. Our findings suggest that we should maintain multidisciplinary approach to this complex disease process and that perhaps it is time for us to consider regionalization of care in treating metastatic colon cancer.

Chiari Malformation Presenting in Adults: A Surgical Experience in 127 Cases

Neurosurgery ◽  
1983 ◽  
Vol 12 (4) ◽  
pp. 377-390 ◽  
Author(s):  
Walter Joseph Levy ◽  
Laura Mason ◽  
Joseph F. Hahn
Keyword(s):  
Chiari Malformation ◽  
Complex Disease ◽  
Pathological Condition ◽  
Disease Process ◽  
Central Canal ◽  
Surgical Anatomy ◽  
Long Run ◽  
Long Term Follow Up ◽  
History Of

Abstract We reviewed 127 patients who were operated upon for adult presentation Chiari malformation and made six conclusions: (a) The clinical examination remains crucial in the diagnosis. (b) The surgical anatomy is highly varied. (c) Syrinxes can be missed on preoperative contrast studies. (d By a conservative grading system, we determined that 46%; of the patients improved during long term follow-up. One-quarter deteriorated over the long run in spite of any treatment. (e) The overall results did not differ whether the treatment was plugging of the central canal plus decompression or decompression alone. (f) In patients with progression, plugging of the central canal obtained superior results. A review of the literature shows that the natural history of this complex disease process has not been established. This history is needed to identify the course of what may be several important factors that lead to the pathological condition in this disease.

scholarly journals Beyond Natriuretic Peptides for Diagnosis and Management of Heart Failure

2017 ◽  
Vol 63 (1) ◽  
pp. 211-222 ◽  
Author(s):  
Nasrien E Ibrahim ◽  
James L Januzzi
Keyword(s):  
Heart Failure ◽  
Renal Dysfunction ◽  
Complex Disease ◽  
Disease Process ◽  
Clinical Information ◽  
Matrix Remodeling ◽  
Injury Death ◽  
Societal Burden ◽  
Myocardial Stretch ◽  
Novel Biomarkers

Abstract BACKGROUND Heart failure (HF) is a complex syndrome with an enormous societal burden in terms of cost and morbidity and mortality. Natriuretic peptide (NP) testing is now widely used to support diagnosis, prognostication, and management of patients with HF, but NPs come with limitations, including vulnerability to the presence of obesity, atrial fibrillation, and renal dysfunction, for example. Beyond the NPs, novel biomarkers may supplement traditional clinical and laboratory testing to improve understanding of the complex disease process of HF, and possibly to personalize care for those affected through better individual phenotyping. CONTENT In this review we discuss novel biomarkers by dividing them into categories based on major pathophysiologic pathways they represent including myocardial stretch/stress, cardiac extracellular matrix remodeling, cardiomyocyte injury/death, oxidative stress, inflammation, neurohumoral activation, and renal dysfunction. SUMMARY Given the limitations of NPs, along with the complex physiology in HF, it is logical to consider utilization of novel biomarkers providing orthogonal biological and clinical information. Several novel HF biomarkers have shown promise but have substantial expectations to meet before being used clinically. Nonetheless, it is reasonable to expect the future lies in the application of multibiomarker panels for the improvement in management of HF and the personalization of care.

scholarly journals Application of microRNA Database Mining in Biomarker Discovery and Identification of Therapeutic Targets for Complex Disease

2020 ◽  
Vol 4 (1) ◽  
pp. 5
Author(s):  
Jennifer L. Major ◽  
Rushita A. Bagchi ◽  
Julie Pires da Silva
Keyword(s):  
Complex Disease ◽  
Biomarker Discovery ◽  
Ischemia Reperfusion Injury ◽  
Ischemia Reperfusion ◽  
Expression Patterns ◽  
Therapeutic Targets ◽  
Human Diseases ◽  
Mirna Expression Data ◽  
Artery Disease ◽  
Underlying Mechanisms

Over the past two decades, it has become increasingly evident that microRNAs (miRNA) play a major role in human diseases such as cancer and cardiovascular diseases. Moreover, their easy detection in circulation has made them a tantalizing target for biomarkers of disease. This surge in interest has led to the accumulation of a vast amount of miRNA expression data, prediction tools, and repositories. We used the Human microRNA Disease Database (HMDD) to discover miRNAs which shared expression patterns in the related diseases of ischemia/reperfusion injury, coronary artery disease, stroke, and obesity as a model to identify miRNA candidates for biomarker and/or therapeutic intervention in complex human diseases. Our analysis identified a single miRNA, hsa-miR-21, which was casually linked to all four pathologies, and numerous others which have been detected in the circulation in more than one of the diseases. Target analysis revealed that hsa-miR-21 can regulate a number of genes related to inflammation and cell growth/death which are major underlying mechanisms of these related diseases. Our study demonstrates a model for researchers to use HMDD in combination with gene analysis tools to identify miRNAs which could serve as biomarkers and/or therapeutic targets of complex human diseases.

Characteristics, outcomes, and risk factors of ICANS after axicabtagene ciloleucel: Does age matter?

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. e19556-e19556
Author(s):  
Kitsada Wudhikarn ◽  
Radhika Bansal ◽  
Arushi Khurana ◽  
Matthew Hathcock ◽  
Michael Ruff ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Older Patients ◽  
Clinical Course ◽  
International Prognostic Index ◽  
Age Groups ◽  
Central Nervous System Involvement ◽  
Microvascular Disease ◽  
B Cell Lymphoma ◽  
Younger Patients

e19556 Background: CD19 chimeric antigen receptor T cell therapy possesses unique side effects including cytokine release syndrome (CRS) and immune effector cell associated neurotoxicity syndrome (ICANS). Age is a major risk factor for ICANS. However, whether ICANS in older patients is different compared to younger patients is unknown. Herein, we report clinical course, outcomes and risk factors for ICANS in older patients with large B cell lymphoma (LBCL) treated with axicabtagene ciloleucel (axi-cel). Methods: We comprehensively reviewed detailed clinical courses of ICANS in 78 adult patients with LBCL treated with axi-cel between June 2016 and October 2020. Incidence, manifestation, risk factors, treatment, and outcomes of ICANS were compared between patients age ≥60 (n=32) and <60 (n=46) years old. Results: Baseline characteristics were comparable between older and younger patients except higher proportion of high international prognostic index and underlying cerebral microvascular disease in older patients. ICANS was observed in 16 patients in the older and 24 patients in the younger age group, with a 30-day incidence of 52% and 50%, respectively. Median time to CRS and ICANS were similar between 2 age groups. The most common initial neurological findings included aphasia, dysgraphia and encephalopathy in both age groups. Table summarizes the characteristics, clinical course and interventions of ICANS in older and younger patients. In Cox regression model, the presence of CRS was the only factor associated with ICANS in both age groups. Age, history of central nervous system involvement and cerebral microvascular disease were not associated with ICANS. Importantly, all patients had complete resolution of ICANS. No elderly patients in our cohort experienced seizure as a manifestation of ICANS. Conclusions: In our study, older age was not a risk factor for ICANS. CRS was the only factor associated with ICANS in both younger and older patients. Incidence, clinical course and neurological outcomes of ICANS in older patients treated with axi-cel were comparable to younger patients. [Table: see text]

Questioning Role of Hypochloremia in Bronchopulmonary Dysplasia

PEDIATRICS ◽  
1986 ◽  
Vol 78 (6) ◽  
pp. 1173-1173
Author(s):  
JEFFREY M. PERLMAN ◽  
JEFF DAWSON
Keyword(s):  
Bronchopulmonary Dysplasia ◽  
Metabolic Alkalosis ◽  
Complex Disease ◽  
Disease Process ◽  
Control Group ◽  
Study Group

In Reply.— We appreciate the interest in our report published in Pediatrics (1986;77:212-216). The three letters raise similar questions, and in response we would like to make three points. First, including the two infants in the control group who died with the infants in the study group still resulted in significant differences between the two groups regarding duration of furosemide (Lasix) therapy, hypochloremia, or metabolic alkalosis (P &gt; .001). Second (as noted in our discussion), bronchopulmonary dysplasia is a complex disease process.

IDIOPATHIC HISTIOCYTOSIS

PEDIATRICS ◽  
1961 ◽  
Vol 28 (2) ◽  
pp. 307-327
Author(s):  
Harold A. Oberman
Keyword(s):  
Poor Prognosis ◽  
Soft Tissues ◽  
Clinical Course ◽  
Eosinophilic Granuloma ◽  
Disease Process ◽  
Foam Cells ◽  
Tissue Eosinophilia ◽  
Ultimate Outcome ◽  
Eosinophilic Granuloma Of Bone ◽  
Microscopic Findings

The clinical and pathologic aspects of 40 cases of eosinophilic granuloma of bone, Hand-Schüller-Christian disease and Letterer-Siwe disease have been reviewed. These cases were unified by a localized or generalized histiocytic proliferation. However, they could not be subdivided accurately on the basis of either clinical or microscopic findings. Histologically there was inconstant correlation of foam cells, tissue eosinophilia and fibrosis with clinical course. Nevertheless there was a suggestion that the presence of a homogeneous histiocytic infiltrate, with no eosinophils or foam cells, pointed to a poor prognosis, whereas the presence of large aggregates of eosinophils augured a more favorable course. With some exceptions, those patients presenting with disease confined to bone had little tendency toward dissemination, whereas those presenting with visceral on soft tissue lesions and generalized maculopapular skin eruptions usually died after a rapid course. Patients with skeletal and visceral or soft tissues lesions at onset had a variable outcome, with marked hepatomegaly and generalized cutaneous involvement being poor prognostic signs. It is concluded that these conditions probably represent various manifestations of a single disease process and that clinical assessment of rapidity of progression is the best guide to ultimate outcome.

Acute Bilateral Blindness in the Setting of Sudden Onset of Bilateral Proptosis and Ophthalmoplegia: A Case Report With Literature Review

2021 ◽  
pp. 10.1212/CPJ.0000000000001090
Author(s):  
sara zarei ◽  
Phuong Vo ◽  
Christian Sam ◽  
Robert W Crow ◽  
Charles Stout ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Visual Pathway ◽  
Rapid Onset ◽  
Sudden Onset ◽  
Acute Onset ◽  
Posterior Chamber ◽  
Ischemic Optic Neuropathy ◽  
Radiographic Findings ◽  
Underlying Pathophysiology ◽  
Eye Retina

ABSTRACTPurposeof review: Acute bilateral blindness has an extensive differential diagnosis that requires a careful history and physical exam to narrow down. In this paper we discuss the pathophysiology and radiographic findings of each possible diagnosis for acute bilateral blindness.Recent findings:Visual pathology with respect to bilateral blindness can be broadly broken down into three anatomic categories: media (i.e. the anterior and posterior chamber of the eye), retina, and neural visual pathway. Possible causes of rapid onset bilateral blindness include bilateral occipital infarcts, endogenous bacterial endophthalmitis, orbital cellulitis, orbital compartment syndrome, cavernous sinus thrombophlebitis, thyroid disease and bilateral non-arteritic ischemic optic neuropathy.Summary:In this case we present a patient with acute onset of bilateral blindness, in addition to bilateral ophthalmoplegia, proptosis, and orbital chemosis. We believe this rare case of acute bilateral blindness is thought provoking and aids in the understanding of the differential diagnosis and underlying pathophysiology of visual loss.

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