scholarly journals Neoehrlichia mikurensis Causing Thrombosis and Relapsing Fever in a Lymphoma Patient Receiving Rituximab

2021 ◽  
Vol 9 (10) ◽  
pp. 2138
Author(s):  
Johanna Sjöwall ◽  
Kristian Kling ◽  
Miguel Ochoa-Figueroa ◽  
Helene Zachrisson ◽  
Christine Wennerås
Keyword(s):  
Clinical Presentation ◽  
Laboratory Data ◽  
Relapsing Fever ◽  
Endemic Region ◽  
Northern Asia ◽  
Delay In Diagnosis ◽  
Tick Borne Disease ◽  
Delay Of Diagnosis ◽  
Multiple Symptoms ◽  
Neoehrlichia Mikurensis

Neoehrlichia (N.) mikurensis, an intracellular tick-borne bacterium not detected by routine blood culture, is prevalent in ticks in Scandinavia, Central Europe and Northern Asia, and may cause long-standing fever, nightly sweats, migrating pain, skin rashes and thromboembolism, especially in patients treated with rituximab. The multiple symptoms may raise suspicion of both infection, inflammation and malignancy, and lead in most cases to extensive medical investigations across many medical specialist areas and a delay of diagnosis. We describe a complex, albeit typical, case of neoehrlichiosis in a middle-aged splenectomised male patient with a malignant lymphoma, receiving treatment with rituximab. The multifaceted clinical picture associated with this tick-borne disease is addressed, and longitudinal clinical and laboratory data, as well as imaging, are provided. Longstanding relapsing fever in combination with thrombosis in superficial and deep veins in an immunocompromised patient living in a tick-endemic region should raise the suspicion of the emerging tick-borne disease neoehrlichiosis. Given the varied clinical presentation and the risk of delay in diagnosis and treatment, we believe it is important to raise clinicians’ awareness of this emerging infection, which is successfully treated with doxycycline.

scholarly journals 398. Description of a Large Pediatric Lyme Arthritis Cohort in an Endemic Region

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S203-S204
Author(s):  
Ancil J Abney ◽  
Megan Reinhard ◽  
Bazak Sharon
Keyword(s):  
Clinical Setting ◽  
Clinical Presentation ◽  
Laboratory Data ◽  
Chronic Arthritis ◽  
Lyme Arthritis ◽  
Steady Increase ◽  
Medical Organization ◽  
Endemic Region ◽  
Laboratory Findings ◽  
High Index Of Suspicion

Abstract Background In endemic areas, Lyme arthritis (LA) is a leading cause of joint swelling. Due to the shared inflammatory nature and common clinical features, acute LA is often misdiagnosed as septic arthritis (SA) while recurrent disease is at times difficult to differentiate from other causes of chronic arthritis. In Minnesota, there has been a steady increase in cases of Lyme disease. This has not been met by a clear guideline and there is no consensus for the management of pediatric arthritis. In this context, we sought to characterize the epidemiology and clinical presentation of a large local cohort. Methods This is a retrospective review of medical charts from children with confirmed LA, presented at a large academic medical organization in the Upper Midwest between January 2011 to December 2017. Demographic, clinical, and laboratory data were collected and analyzed. Results Lyme arthritis was confirmed in 109 children. Acute presentation was more common (67) while the rest (42) had either persistence or reoccurrence of symptoms [Figure 1]. Elevated inflammatory markers and synovial pleocytosis were common, unlike fever and refusal to bear weight which were seen occasionally [Figure 2]. Seasonal distribution and the clinical setting for initial presentation as well as admissions are summarized in Figure 3. The knee was involved in all but 2 patients, both had acute monoarthritis (elbow and hip) [Figure 4]. Conclusion LA causes a spectrum of disease, is seen year round, and across the clinical setting continuum. Acute knee monoarthritis is the most common presentation (54% in our cohort) and is often misdiagnosed as SA leading to unnecessary hospitalizations and aggressive interventions. This occurs more frequently at the ED setting and for children with significant synovial pleocytosis. When evaluating a child with arthritis, laboratory findings are none specific and should be used in caution. Pediatric providers in endemic regions, especially those in primary, hospital, or emergency care must be familiar with the clinical presentation and have a high index of suspicion for LA in order to prevent mismanagement. Disclosures All authors: No reported disclosures.

scholarly journals Subungual Glomus Tumor- Clinical Presentation And Treatment

2014 ◽  
Vol 3 (2) ◽  
pp. 45-48 ◽  
Author(s):  
Shyamal Chandra Debnath ◽  
Suman Kumar Roy ◽  
RR Kairy
Keyword(s):  
Soft Tissue ◽  
Soft Tissue Tumor ◽  
Clinical Presentation ◽  
Glomus Tumor ◽  
Rare Condition ◽  
Surgical Excision ◽  
Tissue Mass ◽  
Delay In Diagnosis ◽  
Nail Deformity

Glomus tumor is a rare condition and constitutes only 1 % of all soft tissue tumor of body. Glomus tumor is familiar for its unusual presentation and long standing symptoms due to delay in diagnosis. Authors have presented the clinical behavior and treatment of 7 patients with subungual soft tissue mass. Following surgical excision, all patients cured of symptoms, at the end of follow up, no recurrence occurred; post operative nail deformity was insignificant. DOI: http://dx.doi.org/10.3329/bdjps.v3i2.18250 Bangladesh Journal of Plastic Surgery July 2012, 3(2): 45-48

Relationships between Clinical Presentation, Serology, Histology, and Duodenal Deposits of Tissue Transglutaminase Antibodies in Pediatric Celiac Disease

2018 ◽  
Vol 36 (5) ◽  
pp. 369-376 ◽  
Author(s):  
Nurit Loberman-Nachum ◽  
Michael Schvimer ◽  
Camila Avivi ◽  
Iris Barshack ◽  
Avishay Lahad ◽  
...  
Keyword(s):  
Celiac Disease ◽  
Immunohistochemical Staining ◽  
Clinical Presentation ◽  
Tissue Transglutaminase ◽  
Mucosal Damage ◽  
High Serum ◽  
Tissue Transglutaminase Antibodies ◽  
Antibody Levels ◽  
Age Range ◽  
Multiple Symptoms

Background: The clinical, histological, and serological spectrum of celiac disease (CD) vary widely. We aimed to examine relationships between symptoms, serum anti-tissue transglutaminase antibodies (tTG) levels, mucosal damage, and mucosal anti-tTG deposits in pediatric CD. Methods: A retrospective single-center, cohort study of children referred for endoscopy with suspected CD during 2011–2014. We retrieved the clinical data, blindly reviewed duodenal biopsies, and performed immunohistochemical staining for anti-tTG deposits. Patients were classified as monosymptomatic or polysymptomatic. Mucosal anti-tTG deposits were classified according to the location of deposits, dominant intensity, maximal intensity, and percentage of stained area. Results: Of 252 patients with confirmed CD, complete data were available for 100: 37 males in the age range 1.3–16.7 with median 4.0 years. Monosymptomatic patients (n = 54) presented at an older age than polysymptomatic patients (1.3–15.5, median 8.1 vs. 1.3–16.7, median 6.3 years, p = 0.026). Marsh 2–3c was more prevalent in polysymptomatic patients (93 vs. 78%, p = 0.028). The intensity of mucosal anti-tTG deposits correlated with serum anti-tTG levels but not with the clinical presentation. Conclusions: Multiple symptoms and high serum anti-tTG antibody levels correlated with mucosal damage in children with CD. The role of immunohistochemical staining for intestinal anti-tTG mucosal deposits in the diagnosis of borderline CD is not yet established.

Complete Bilateral Brachial Plexus Injury from Rhabdomyolysis and Compartment Syndrome: Surgical Case Report

2018 ◽  
Vol 17 (2) ◽  
pp. E68-E72 ◽  
Author(s):  
Daniel A Tonetti ◽  
Ivan S Tarkin ◽  
Kiran Bandi ◽  
John J Moossy
Keyword(s):  
Brachial Plexus ◽  
Compartment Syndrome ◽  
Clinical Presentation ◽  
Brachial Plexus Injury ◽  
Laboratory Data ◽  
Surgical Decompression ◽  
Sensory Function ◽  
Resonance Imaging ◽  
Pectoralis Muscles ◽  
Prolonged Immobilization

Abstract BACKGROUND AND IMPORTANCE Acute bilateral brachial plexus injury is rare and usually a result of traction injury. Immediate operative intervention is reserved for rare cases of ongoing compression of the plexus; the role for acute decompression of the brachial plexus secondary to compartment syndrome has not been previously described. In this report, we describe the technique and role for urgent brachial plexus decompression. CLINICAL PRESENTATION A 32-yr-old man presented with acute complete bilateral brachial plexus palsy due to focal rhabdomyolysis and brachial plexus compression after a night of excess alcohol and methadone ingestion. He had complete loss of motor and sensory function from C5 to T1, with the exception of partial sensory sparing of the C5 dermatome. Magnetic resonance imaging demonstrated diffuse muscular edema of the supraclavicular and infraclavicular fossae in addition to the pectoralis muscles and the deltoids bilaterally. He underwent urgent surgical decompression of his supraclavicular and infraclavicular fossae with fasciotomies of the pectoral muscles and the anterior deltoids, allowing direct visualization and decompression of the entire brachial plexus resulting in a near-complete functional recovery. CONCLUSION Neurosurgeons should include brachial plexus compression due to compartment syndrome in the differential diagnosis of patients with acute upper extremity weakness, particularly when associated with prolonged immobilization and/or substance abuse. Prompt surgical decompression should be performed in these patients if imaging and laboratory data suggest compartment syndrome and resultant neurological deficit.

scholarly journals Aetiology, Clinical Presentation, and Outcome of Meningitis in Patients Coinfected with Human Immunodeficiency Virus and Tuberculosis

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Smita Bhagwan ◽  
Kogieleum Naidoo
Keyword(s):  
South Africa ◽  
Human Immunodeficiency Virus ◽  
Tuberculous Meningitis ◽  
Clinical Presentation ◽  
Case Series ◽  
Antituberculous Therapy ◽  
Endemic Region ◽  
Neck Stiffness ◽  
Immunodeficiency Virus ◽  
Poor Outcomes

We conducted a retrospective review of confirmed HIV-TB coinfected patients previously enrolled as part of the SAPiT study in Durban, South Africa. Patients with suspected meningitis were included in this case series. From 642 individuals, 14 episodes of meningitis in 10 patients were identified. For 8 patients, this episode of meningitis was the AIDS defining illness, with cryptococcus (9/14 episodes) and tuberculosis (3/14 episodes) as the commonest aetiological agents. The combination of headache and neck stiffness (78.6%) was the most frequent clinical presentation. Relapsing cryptococcal meningitis occurred in 3/7 patients. Mortality was 70% (7/10), with 4 deaths directly due to meningitis. In an HIV TB endemic region we identified cryptococcus followed by tuberculosis as the leading causes of meningitis. We highlight the occurrence of tuberculous meningitis in patients already receiving antituberculous therapy. The development of meningitis heralded poor outcomes, high mortality, and relapsing meningitis despite ART.

scholarly journals 397. Operative Intervention in Pediatric Lyme Arthritis Increases Healthcare Resource Utilization Without Improved Outcomes

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S203-S203
Author(s):  
Andrew R Tout ◽  
Andrew J Nowalk ◽  
Brian T Campfield
Keyword(s):  
Antibiotic Therapy ◽  
Septic Arthritis ◽  
Transition Period ◽  
Laboratory Data ◽  
Operative Intervention ◽  
Lyme Arthritis ◽  
Endemic Region ◽  
Operative Debridement ◽  
The Impact

Abstract Background Lyme arthritis commonly presents as an acute inflammatory monoarticular arthritis, frequently challenging to distinguish from septic arthritis. While management for Lyme arthritis focuses on antibiotic therapy, septic arthritis requires operative debridement plus antibiotic therapy. Delay in Lyme serology results may complicate decisions on surgical intervention in Lyme endemic areas. During the transition period of western Pennsylvania to a Lyme endemic region many children ultimately diagnosed with Lyme arthritis were managed by operative intervention due to diagnostic ambiguity. The impact of an operative intervention on outcomes of pediatric Lyme arthritis is unknown. Methods We conducted a retrospective chart review from 2008 to 2018 of patients admitted to UPMC Children’s Hospital of Pittsburgh and diagnosed with Lyme arthritis. We recorded the clinical presentation, laboratory data, details of hospitalization and follow-up, costs and outcome after therapy to compare the impact of antibiotic therapy alone (non-operative group) vs. antibiotics plus operative debridement (operative group). Results We identified 164 patients admitted for management of arthritis with the eventual diagnosis of Lyme arthritis. Fifty-two patients underwent operative debridement in addition to antibiotic therapy. Operative debridement plus antibiotics was associated with increased duration of admission, increased the cost of hospitalization, and increased PICC line placement compared with antibiotics alone. In patients for whom follow-up information was available, resolution of symptoms was documented in 62 of 66 patients in the non-operative group and 46 of 47 patients in the operative group with a median duration to symptom resolution of 17 and 23 days,, respectively. Conclusion Operative debridement for pediatric patients with Lyme arthritis was associated with increased cost and duration of hospitalization, and a greater number of procedures, while being similarly efficacious to non-operative management with antibiotic therapy alone. Disclosures All authors: No reported disclosures.

Peritonitis in Peritoneal Dialysis

2002 ◽  
Vol 25 (4) ◽  
pp. 249-260 ◽  
Author(s):  
C.G. Voinescu ◽  
R. Khanna
Keyword(s):  
Peritoneal Dialysis ◽  
Drug Toxicity ◽  
Infectious Complication ◽  
Clinical Presentation ◽  
Laboratory Data ◽  
Future Research ◽  
Death Rates ◽  
Gram Negative ◽  
Dialysis Solution ◽  
Prevention Methods

Peritonitis, an infectious complication of peritoneal dialysis, continues to account for much of the morbidity associated with this techniques. The clinical presentation and laboratory data used in diagnosis the peritonitis, as well as its differential diagnosis will be reviewed in this article. The distribution of pathogens is an important outcome determinant, Gram-negative infections being associated with greater rates of catheter loss and higher death rates. Among the five routes of peritoneal contamination, intraluminal and periluminal contamination account for most of the infections. Due to the two prevention methods implemented in the care of the PD population, the incidence of peritonitis has decreased over the last two decades. The recommendations for empiric treatment of peritonitis have changed over the years, as more was learnt about antibiotic resistance and drug toxicity. Future research to address enteric peritonitis, as well as biocompatible dialysis solution or biocompatible catheter materials is needed to further reduce the incidence of PD peritonitis.

Midcavitary Tako-Tsubo syndrome in cancer patients.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e14011-e14011 ◽  
Author(s):  
Dana Ionescu ◽  
Danielle Stone ◽  
James Stone ◽  
Jean-Bernard Durand ◽  
Juan Lopez-Mattei ◽  
...  
Keyword(s):  
Cancer Therapy ◽  
Cancer Patients ◽  
Diagnostic Criteria ◽  
Clinical Presentation ◽  
Laboratory Data ◽  
Left Ventricular ◽  
Cardiac Biomarkers ◽  
Cancer Center ◽  
Published Data ◽  
Left Ventriculography

e14011 Background:Variants of the classic Tako-tsubo syndrome or stress induced cardiomyopathy (SC) includes mid ventricular or basal left ventricular wall motion abnormalities. Midcavitary dyskinesia and ballooning is considered a unique presentation, and there is no published data showing midcavitary involvement in cancer patients. Methods: All cancer patients who fulfilled the diagnostic criteria for SC at MD Anderson Cancer Center over a 6–year period were included in the study. We selected and retrospectively reviewed the medical records of 8 patients who had midcavitary SC. Clinical presentation, ECG, laboratory data, transthoracic echocardiogram and left ventriculography results were reviewed. Results: Out of30 cancer patients who fulfilled the diagnostic criteria for SC, 8 patients (26.7%) (4 females, 4 men, mean age 57.37 yo) had midcavitary SC. 62,5 % patients were diagnosed with a solid malignancy. Trigger factors for midcavitary SC were: systemic infection (3 patients with neutropenia), emotional stress (2 patients), chemotherapy (1 patient undergoing treatment with Ibrutinib), and surgical interventions (3 patients). Clinical presentation included chest pain (37.5%), shortness of breath (50%) and non specific symptoms (12.5%). T wave inversion was the most common electrocardiographic presentation (37.5 %), followed by ST elevation (25 %). All patients had changes of the cardiac biomarkers (BNP mean 2224. 4 pg/dl, TN I mean 2. 8 ng/dl, CK-MB mean 14 ng/dl) and significant LV dysfunction (LVEF < 50%). All patients underwent coronary angiography which showed no obstructive CAD; left ventriculography identified basilar and apical hyperkinesis and midventricular hypokinesia. Cancer therapy was interrupted; aspirin and beta blockers were initiated in all patients. The most common complications of midcavitary SC were: respiratory failure requiring intubation (37, 5%), pulmonary edema (25%), and hypotension (25%). No cardiac deaths were registered. None of the patients experienced recurrence of SC. Conclusions: Mid cavitary SC remains a rare entity, and raises further questions about the causal association between the mid cavitary involvement and cancer, and its impact on cancer therapy and overall survival in this cohort of patients.

SALMONELLA SPONDYLITIS IN NON-SICKLE CELL PATIENTS

2001 ◽  
Vol 05 (04) ◽  
pp. 253-260
Author(s):  
PO-QUANG CHEN ◽  
SHU-HUA YANG ◽  
CHANG-CHOU YEN ◽  
WEN-JER CHEN ◽  
TIFFANY T. F. SHIH
Keyword(s):  
Antibiotic Treatment ◽  
Sickle Cell ◽  
Clinical Symptoms ◽  
Laboratory Data ◽  
Clinical Manifestations ◽  
Positive Culture ◽  
Surgical Debridement ◽  
Treatment Modalities ◽  
Endemic Region ◽  
Treatment Comparison

This article was a retrospective study of Salmonella spondylitis in seven non-sickle cell anemic patients. The objective of this study was to clarify the clinical manifestations of spinal infection by Salmonella, and to select the proper method of treatment. Comparison with the reported 25 cases in the literature was also attempted. The clinical symptoms and signs, laboratory data, bony images, treatment modalities and outcomes were documented, and compared with the 25 cases in the English literatures. The patients all suffered from insidious onset of low back pain, with progressive increasing intensity. Leucocytosis (>9000) and body temperature elevation (>37°C) were noted in four cases. Positive cultures were mainly obtained from blood (5 cases) and surgical specimens (one case) before treatment. One patient also had positive culture in the stool and urine. Six patients underwent surgical debridement of the infected foci, while one patient received antibiotic treatment only. The outcome was good in the uncomplicated cases. One patient with concurrent aortic aneurysm died of sepsis. We stress that Salmonella infection can be found in the apparently healthy persons. In the endemic region, high suspicion is needed. Surgical debridement, bone grafting and two months of antibiotic treatment are recommended.

scholarly journals Factors causing delay in diagnosis of head and neck malignancy

2018 ◽  
Vol 4 (3) ◽  
pp. 708
Author(s):  
Anushree R. Bajaj ◽  
Shahnaz Sheikh ◽  
Samir Joshi ◽  
Bhalchandra Paike
Keyword(s):  
Head And Neck ◽  
Psychological Factors ◽  
Head And Neck Malignancy ◽  
Head And Neck Malignancies ◽  
Delay In Diagnosis ◽  
Neck Malignancy ◽  
Diagnosis Of Cancer ◽  
Ultimate Outcome ◽  
Fear And Anxiety ◽  
Delay Of Diagnosis

<p class="abstract"><strong>Background:</strong> Besides etiological factors there are lots of other factors which are responsible for the delay of diagnosis in head and neck malignancies. These include socio-demographic, institutional and other psychological factors. The aim of our article was to emphasize the importance of these unexplored factors in the delay of diagnosis of head and neck malignancies and make an effort to reduce those.</p><p class="abstract"><strong>Methods:</strong> A total of 40 cases of head and neck malignancies in ENT ward of DUPMC hospital were studied. A retrospective study was undertaken using proper history taking and analysis of the patients.  </p><p class="abstract"><strong>Results:</strong> The factors causing delay in the diagnosis were found to delay due to psychological and behavioral 32.5%, delay due to symptom recognition 87.5%, delay due to socio demographic 45%, practioner delay-10%, hospital delay-5%.</p><p class="abstract"><strong>Conclusions:</strong> Measures must be taken to reduce the factors causing deal in diagnosis like, Fear and anxiety about ultimate outcome of cancer should be allayed through various media and stress should be laid on fact that early detection can alter outcome of cancer so as to induce the patient to seek medical help early. Facilities for diagnosis of cancer should be available at accessible centre and only treatment should be left to certain specialized centers.</p>

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