scholarly journals Crusted scabies in patients with long-term use of oral corticosteroid with different underlying diseases – case series

2019 ◽  
Author(s):  
Cut Shelma Maharani ◽  
Densy Violina Harnanti ◽  
Hasnikmah Mappamasing ◽  
Septiana Widyantari ◽  
S. Sawitri ◽  
...  
Keyword(s):  
Host Response ◽  
Oral Corticosteroid ◽  
Case Series ◽  
Sarcoptes Scabiei ◽  
Severe Form ◽  
History Of ◽  
Crusted Scabies ◽  
Underlying Diseases ◽  
Thick Crust

People with a weakened immune system may develop the severe form of scabies called crusted scabies. We have two cases of female patients with history of using long-term oral corticosteroid and then developing scabies infection. The first patient had other comorbidities which caused her become more susceptible while the second patient had been diagnosed with bullous pemphigoid. Both patients complained thick crust on some parts of their bodies, accompanied with itchy papules. Based on microscopic examination from lesion scraping, we found the adult form of sarcoptes scabiei and crusted scabies diagnosis was established. The lesions were improving when they got combination of topical sulfur precipitate, salicylic acid, and permethrine 5%. Crusted scabies is characterized by hyperkeratosis and crusting of the skin due to the profuse proliferation of mites resulting from an altered host response. Combination of topical antiscabies and keratolytic can make the crusts thinner and improve topical absorption.

scholarly journals Acne Conglobata Associated with Hidradenitis Suppurativa, Disorders of Follicular Occlusion (Case Report)

2015 ◽  
Vol 15 (2) ◽  
pp. 30-34
Author(s):  
K. Pecova
Keyword(s):  
Hidradenitis Suppurativa ◽  
Severe Form ◽  
Term Treatment ◽  
Acne Conglobata ◽  
Long Term Treatment ◽  
Associated Symptoms ◽  
History Of ◽  
Inflammatory Bowel ◽  
Prepubertal Age

Abstract The author is presenting the case of a 23-year-old female patient with a severe form of acne conglobata, with the first symptoms of the disease occurring as far back as the prepubertal age. In the past year the disease has combined with hidradenitis suppurativa (to be referred to henceforth as “HS”), Hurley stage I, in the axillae and both sides of the inguinal region, with a family history of acne conglobata (both her mother and brother were affected). Further examinations ruled out inflammatory bowel disease because of a lack of further associated symptoms, except for sideropenic anaemia (lesser form) and lower serum values of vitamin D. Up until now the disease has been resistant to treatment, including the long-term treatment of methylprednisolone in combination with isotretinoid as well as dapsone and antibiotics.

scholarly journals An Elderly Long-Term Care Resident with Crusted Scabies

2015 ◽  
Vol 26 (1) ◽  
pp. 39-40 ◽  
Author(s):  
Matthew Sandre ◽  
Filip Ralevski ◽  
Neil Rau
Keyword(s):  
Host Response ◽  
Nutritional Deficiencies ◽  
Rapid Reduction ◽  
Term Care ◽  
Delay In Diagnosis ◽  
Common Skin ◽  
Altered Immune Response ◽  
Skin Conditions ◽  
Crusted Scabies

Crusted scabies is a highly contagious form of scabies. Altered immune response, nutritional deficiencies and modified host response are all risk factors for crusted scabies. The authors report a case involving a patient found to have a chronic maculopapular, erythematous rash with large hyperkeratotic, white and grey plaques on the soles of both feet. An ultimate diagnosis of crusted scabies was reached after a delay in diagnosis suspected to be caused by the similarity in appearance to more common skin conditions such as psoriasis. After topical permethrin was unsuccessful, intermittent dosing of oral ivermectin resulted in a rapid reduction in cutaneous plaques.

scholarly journals Successful Parathyroidectomy May Not Resolve Hypercalciuria in Patients With Primary Hyperparathyroidism

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A226-A226
Author(s):  
Neriy Izkhakov ◽  
Heranmaye Prasad ◽  
Nicholas John Vernetti ◽  
Samer Nakhle
Keyword(s):  
Primary Hyperparathyroidism ◽  
Serum Calcium ◽  
Clinical Case ◽  
Case Series ◽  
Urinary Calcium ◽  
Long Term Effects ◽  
Normal Range ◽  
History Of ◽  
Average Serum

Abstract Background: Hypercalciuria, with twenty-four-hour urinary calcium of >400 mg/day, is one of the indications for parathyroidectomy in patients with primary hyperparathyroidism. We report five cases where hypercalciuria is not resolved following a successful parathyroidectomy (normalization of serum calcium) in such patients. Here resolution of hypercalciuria is defined as twenty-four-hour urinary calcium of less than 200 mg/day. Clinical Case: This is a case series of five patients who remained hypercalciuric at 6 to 19 months after successful parathyroidectomy. Pre-parathyroidectomy, average PTH was 95 pg/dL (Min 69 pg/dL, Max 120 pg/dL), average serum calcium was 11.0 mg/dL (min 10.3 mg/dL, max 12.0 mg/dL), and average twenty-four-hour urinary calcium was 455 mg/day (min 386 mg/day, max 551 mg/day). Calcium levels were corrected to normal range post-parathyroidectomy and remained in normal range. However, hypercalciuria did not resolve. Post-parathyroidectomy, average PTH was 44 pg/dL (min 25 pg/dL, max 69 pg/dL), average serum calcium was 9.6 mg/dL (min 9.3 mg/dL, max 9.8 mg/dL), and average twenty-four-hour urinary calcium was 284 mg/day (min 201 mg/day, max 376 mg/day). Two patients who had history of nephrolithiasis prior to parathyroidectomy continued to develop nephrolithiasis at six and sixteen months after successful parathyroidectomy. Conclusions: This case series showed that hypercalciuria may not resolve following a successful parathyroidectomy in patients with primary hyperparathyroidism and elevated twenty-four-hour urinary calcium at 6 to 19 months after surgery. Further observations to evaluate long term effects of parathyroidectomy on hypercalciuria is needed.

Treatment of refractory Aspergillus otomycosis with voriconazole: case series and review

2014 ◽  
Vol 128 (6) ◽  
pp. 547-551 ◽  
Author(s):  
Hsu-Chueh Ho ◽  
Shih-Hsuan Hsiao ◽  
Cheng-Yung Lee ◽  
Chen-Chi Tsai
Keyword(s):  
Medical Records ◽  
Therapeutic Option ◽  
Demographic Data ◽  
Local Treatment ◽  
Case Series ◽  
Surgical Debridement ◽  
Underlying Diseases ◽  
Lost To Follow Up

AbstractBackground:Voriconazole is a broad-spectrum azole exhibiting strong anti-Aspergillus activity and good long-term tolerance. However, the evidence for voriconazole efficacy against refractory Aspergillus otomycosis is weak.Method:We reviewed the medical records of patients with Aspergillus otomycosis treated with voriconazole from January 2008 to June 2012 in a Taiwanese regional hospital. Demographic data and information regarding underlying diseases, clinical features, treatment and outcome were assessed.Results:In total, 14 cases of Aspergillus otomycosis were treated with voriconazole, including 5 patients with Aspergillus invasive otitis externa. All patients had failed to respond to local treatment, antibiotics or topical agents. One case was lost to follow up. The symptoms of two patients recurred after voriconazole treatment: one patient received a second 12-week course of voriconazole and was cured; and symptoms of the other patient recurred after a second 12-week course of voriconazole, leading to surgical debridement. The remaining 11 patients were cured by voriconazole treatment without extensive surgical debridement.Conclusion:This study demonstrates that voriconazole can be a very effective and convenient therapeutic option for the management of refractory Aspergillus otomycosis.

Jugular Bulb Anomalies Involving the Internal Auditory Canal: A Case Series

2021 ◽  
pp. 000348942199015
Author(s):  
Tiffany P. Hwa ◽  
Qasim Husain ◽  
Jason A. Brant ◽  
Anil K. Lalwani
Keyword(s):  
Magnetic Resonance Imaging ◽  
Internal Auditory Canal ◽  
Case Series ◽  
Jugular Bulb ◽  
Resonance Imaging ◽  
Retrospective Case ◽  
Long Term Follow Up ◽  
History Of

Objective: Jugular bulb abnormalities (JBA) such as high riding jugular bulb and jugular bulb diverticulum can extend or erode into the middle and inner ear. In this report, we report on a series of 6 patients with jugular bulb anomalies involving the internal auditory canal (IAC). Methods: A retrospective case series. Results: Six females, ages 6 to 63 presenting with myriad of otologic symptoms including hearing loss, tinnitus, balance disturbance, fullness, and otalgia were discovered to have JB eroding into IAC. Computerized tomography, but not Magnetic Resonance Imaging, was able to identify IAC erosion by a significantly enlarged JB. Conclusion: A significantly enlarged JB eroding into the IAC maybe congenital or acquired. It can present with a variety of common otologic symptoms. Long term follow-up is needed to determine the natural history of JB anomalies involving the IAC and need for intervention.

scholarly journals Subungual and ungual scabies: avoiding severe presentation in high-risk patients

2018 ◽  
Vol 11 (1) ◽  
pp. bcr-2018-225623
Author(s):  
Omer Last ◽  
Jensen Reckhow ◽  
Ben Bogen ◽  
Mati Rozenblat
Keyword(s):  
High Risk ◽  
Complete Resolution ◽  
Sarcoptes Scabiei ◽  
Severe Form ◽  
Aggressive Treatment ◽  
Body Contact ◽  
Risk Patients ◽  
Topical Treatments ◽  
Crusted Scabies ◽  
Nail Involvement

Scabies is a pruritic disorder caused by Sarcoptes scabiei var. hominis infestation of the skin. Transferred by close body contact, scabies is endemic within nursing homes and among poor and overcrowded populations. Crusted scabies is a severe form of disease, characterised by a large, thick, crusted eruption with significant mite infestation. We report a patient hospitalised with crusted scabies that had massive nail involvement. A 79-year-old female patient with multiple comorbidities and several recent prior scabies diagnoses presented with agitation and dystrophic fingernails; scabies mites were found embedded in and below the nail keratin. Aggressive treatment resulted in complete resolution, with notable improvements in mental status. Crusted scabies with nail involvement is extremely rare and may be more likely to develop from initially subclinical infestation sites. It is important to consider this potential presentation, as standard topical treatments may prove ineffective when there is deep nail involvement.

scholarly journals Proton Therapy for Vaginal Reirradiation

2016 ◽  
Vol 3 (2) ◽  
pp. 320-326 ◽  
Author(s):  
Yun Rose Li ◽  
Maura Kirk ◽  
Lilie Lin
Keyword(s):  
Proton Therapy ◽  
Case Series ◽  
Term Treatment ◽  
Gynecologic Cancers ◽  
Vaginal Carcinoma ◽  
Long Term Treatment ◽  
Long Term Follow Up ◽  
Late Treatment ◽  
History Of

Abstract Primary or recurrent gynecologic cancers in operable patients with a history of prior pelvic radiation are typically treated with surgery based on the risk of late toxicities historically associated with reirradiation. A number of studies have demonstrated that, compared with conventional radiation therapy (RT) using photons, proton therapy (PT) offers dosimetric advantages for patients with gynecologic cancers by reducing radiation dose to healthy tissues. Thereby, we expect that, in appropriately selected cases, PT may reduce long-term treatment-related morbidities without compromising treatment efficacy. Herein, we describe the treatment planning, technique, and long-term follow-up of a patient who was treated with PT for a primary vaginal carcinoma nearly 30 years after a prior course of pelvic RT. Using this case, we illustrate the utility and advantages of PT in the treatment of cancers that occur at less favorable sites, adjacent to normal structures with low radiation tolerance, or in paients with a history of prior irradiation. Additionally, we provide a brief discussion and review of literature of prior case series of pelvic reirradiation, illustrating the value of identifying treatment approaches that can reduce treatment-related morbidities, particularly late treatment toxicities.

scholarly journals Long-Term MRI Findings of Muslin-Induced Foreign Body Granulomas after Aneurysm Wrapping

2014 ◽  
Vol 20 (1) ◽  
pp. 67-73 ◽  
Author(s):  
Lee-Anne Slater ◽  
Ronil V. Chandra ◽  
Michael Holt ◽  
Andrew Danks ◽  
Winston Chong
Keyword(s):  
Foreign Body ◽  
Case Series ◽  
Mri Findings ◽  
Invasive Treatment ◽  
Mri Features ◽  
Apparent Diffusion ◽  
Rim Enhancement ◽  
History Of ◽  
Arterial Aneurysms

Muslin-induced foreign body granulomas are rare delayed complications after wrapping of intracranial aneurysms. Few small case series have been reported, with a paucity of documented MRI findings. In addition, there are no reports on long-term radiological appearances or temporal evolution of conservatively managed patients. We thus report on the long-term radiological and clinical follow-up of two patients with asymptomatic muslin-induced foreign body granulomas after wrapping of recurrent middle cerebral arterial aneurysms. Both patients were successfully managed conservatively and remain asymptomatic three and six years after diagnosis of their granulomas. A literature review confirms that MRI features of muslin-induced foreign body granuloma are typical. Features include focal areas of elevated T2 signal with increased diffusion-weighted signal and thin rim enhancement. To the best of our knowledge, this is the first report to confirm that there is a corresponding reduction in apparent diffusion coefficient, as typical in an intracranial abscess. Thus a history of aneurysm wrapping is critical for diagnosis. Accurate clinical recognition of this exuberant inflammatory response will avoid misdiagnosis as pyogenic abscess or tumor and prevent unnecessary or invasive treatment.

Children With Trisomy 21 and Lennox-Gastaut Syndrome With Predominant Myoclonic Seizures

2021 ◽  
pp. 088307382110260
Author(s):  
Matthew Macdonald ◽  
Jacqueline Crawford ◽  
Anita N. Datta
Keyword(s):  
Trisomy 21 ◽  
Case Series ◽  
Severe Form ◽  
Seizure Type ◽  
Pediatric Epilepsy ◽  
Retrospective Case ◽  
Spike Wave Discharges ◽  
Long Term Prognosis ◽  
Atypical Absence

Introduction: Lennox-Gastaut syndrome is a severe form of pediatric epilepsy that is classically defined by a triad of drug-resistant seizures, including atonic, tonic, and atypical absence seizures; slow spike-and-wave discharges and paroxysmal fast activity on electroencephalography (EEG); and cognitive and behavioral dysfunction. In the vast majority, Lennox-Gastaut syndrome develops in patients with an identified etiology, including genetic or structural brain abnormalities. Long-term prognosis is generally poor with progressive intellectual deterioration and persistent seizures. At present, there are few reported cases of Lennox-Gastaut syndrome and trisomy 21 in the literature. To further delineate the spectrum of epilepsy in trisomy 21, we reviewed children with trisomy 21 and Lennox-Gastaut syndrome at one center over 28 years. Methods: This is a retrospective case series. At our institution, all EEG results are entered into a database, which was queried for patients with trisomy 21 from 1992 to 2019. Pertinent electroclinical data was obtained from medical records. Results: Of 63 patients with trisomy 21 and epilepsy, 6 (10%) had Lennox-Gastaut syndrome and were included in the study. Four of the 6 patients were male and 5 of 6 had neuroimaging, which was normal. Follow-up ranged from 3 to 20 years. Notably, 5 of 6 had predominant myoclonic seizures throughout the course of their epilepsy, associated with generalized spike-wave discharges, <100 milliseconds. Conclusion: We observed myoclonic seizures to be a predominant seizure type in patients with trisomy 21, suggestive that trisomy 21 patients may have a unique pattern of Lennox-Gastaut syndrome.

scholarly journals The importance of sleep apnea index determination using 24h ECG analysis in patients with heart rhythm disorders

2014 ◽  
Vol 71 (11) ◽  
pp. 1049-1054
Author(s):  
Aleksandra Grdinic ◽  
Zoran Stajic ◽  
Aleksandar Grdinic ◽  
Zarko Vucinic ◽  
Violeta Randjelovic-Krstic ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Case Series ◽  
Heart Rhythm ◽  
Software Systems ◽  
Ecg Analysis ◽  
Heart Rhythm Disorders ◽  
History Of ◽  
Possible Cause

Background/Aim. A possible cause of malignant heart rhythm disorders is the syndrome of sleep apnea (periodic cessation of breathing during sleep longer than 10 seconds). Recent 24h ECG software systems have the option of determination ECG apnea index (AI) based on the change in voltage of QRS complexes. The aim of the study was to determine the significance of AI evaluation in routine 24-hour Holter ECG on a group of 12 patients. Methods. We presented a total of 12 consecutive patients with previously documented arrhythmias and the history of breathing disorders during night. They were analyzed by 24 h ECG (Medilog AR 12 plus Darwin), that is able to determine AI. Results. We presented a case series of 12 patients, 8 men and 4 women, mean age 58.75 years and the average AI 5.78. In the whole group there was a trend of increasing prevalence of complex rhythm disorders with increasing of AI and increased frequency of arrhythmias in the night phase vs day phase. Conclusion. Determination of AI using routine long term (24 h) ECG analysis is important because sleep apnea can be successfully treated as an etiological or contributing factor of arrhythmias.

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