scholarly journals Lymphocytic hypophysitis presenting as a visual threatening sellar mass and its complete recovery with oral steroids: think beyond surgery

2013 ◽  
Vol 3 (2) ◽  
pp. 9
Author(s):  
Pramila Dharmshaktu ◽  
Mahaveer Singh ◽  
Dinesh Dhanwal
Keyword(s):  
Complete Recovery ◽  
Lymphocytic Hypophysitis ◽  
Sellar Mass ◽  
Oral Steroids

Novel strategy to treat a case of recurrent lymphocytic hypophysitis using rituximab

2012 ◽  
Vol 116 (6) ◽  
pp. 1318-1323 ◽  
Author(s):  
Matthew Schreckinger ◽  
Todd Francis ◽  
Gary Rajah ◽  
Jay Jagannathan ◽  
Murali Guthikonda ◽  
...  
Keyword(s):  
B Cell ◽  
Lymphocytic Hypophysitis ◽  
Neurological Deficits ◽  
Sellar Mass ◽  
Short Course ◽  
Autoimmune Condition ◽  
Cd20 Antibody ◽  
Novel Strategy ◽  
Anti Cd20 ◽  
The Right

Lymphocytic hypophysitis is an uncommon autoimmune condition that often results in significant morbidity. Although most cases resolve spontaneously or after a short course of steroids, rarely, refractory cases can cause persistent neurological deficits despite aggressive medical and surgical management. A 41-year-old woman presented with progressive visual loss in the left eye and was found to have a sellar mass. She underwent transsphenoidal surgery because of lesion enlargement. Histopathology was consistent with adenohypophysitis with B-cell predominance. Despite steroid treatment, her neurological condition worsened and she experienced loss of vision in the right eye. Craniotomy with decompression of the right optic nerve was performed. Her condition improved initially, but she continued to have progressive visual compromise over the following months. She was therefore treated with rituximab, a monoclonal antibody against B cells. Her vision improved significantly within a few weeks. There was no clinical or radiographic exacerbation 2 years after starting immunotherapy. Rituximab, an anti-CD20 antibody that specifically depletes B lymphocytes, can be an effective treatment strategy for patients with steroid-refractory, B cell–predominant lymphocytic hypophysitis.

Posterior reversible encephalopathy syndrome (PRES) presenting as Status Epilepticus in a case of Autoimmune Hemolytic Anemia (AIHA): A Case report

2021 ◽  
Vol 12 (6) ◽  
pp. 102-106
Author(s):  
Sameera Dronamraju ◽  
Shilpa Gaidhane ◽  
Aayush Somani ◽  
Sourya Acharya
Keyword(s):  
Status Epilepticus ◽  
Hemolytic Anemia ◽  
Posterior Reversible Encephalopathy Syndrome ◽  
Autoimmune Hemolytic Anemia ◽  
Vasogenic Edema ◽  
Complete Recovery ◽  
Young Female ◽  
Posterior Reversible Encephalopathy ◽  
Oral Steroids ◽  
Reversible Encephalopathy

Posterior reversible encephalopathy syndrome (PRES) is a neurotoxic state, caused by imbalance in autoregulation of posterior cerebral circulation. We report a case of young female, presented at emergency department with complains of nausea, vomiting and generalized tonic clonic seizures prior to admission. During the course of hospital stay patient landed in status epilepticus which was treated appropriately. Patient’s magnetic resonance imaging (MRI) was done which had classical features of vasogenic edema in occipital and parietal region, suggestive of PRES. She was a known case of autoimmune hemolytic anemia thatwas treated with multiple blood transfusions and low dose oral steroids. She was discharged after complete resolution of symptoms with the advice to follow up in medicine outpatient department. Our case describes about autoimmune hemolytic anemia in which occurrence of PRES is uncommon. Early diagnosis and robust treatment can prevent permanent damage to the brain, and is often associated with complete recovery.

scholarly journals Left Lateral Cervical Mass with Draining Sinuses

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Stylianos A. Michaelides ◽  
George D. Bablekos ◽  
Avgerinos-Romanos Michailidis ◽  
Efthalia Gkioxari ◽  
Stephanie Vgenopoulou ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Extrapulmonary Tuberculosis ◽  
Cervical Lymphadenopathy ◽  
Complete Recovery ◽  
Tuberculous Lymphadenitis ◽  
Male Smoker ◽  
Oral Steroids ◽  
Cervical Swelling ◽  
Uncommon Case ◽  
Physical Findings

The aim of the present study is to describe an uncommon case of tuberculous lymphadenitis (TL) in a symptomless 89-year-old male smoker patient, who presented at the emergency department of our hospital with left lateral cervical swelling with draining sinuses. No other clinical symptoms or physical findings were observed at admission. An elevated erythrocyte sedimentation rate (ESR) and a small calcified nodule in chest CT were the only abnormal findings. Pus samples from sinuses were examined and confirmed tuberculosis which was in agreement with surgical pathology of lymph nodes. A four- (4-) drug antituberculous regimen was administered. After an initial remission of his symptoms, the patient presented an exacerbation of the cervical swelling with draining sinuses necessitating addition of oral steroids. TL can be symptomless presenting a paradoxical reaction during treatment. The uniqueness of our case lies in the patient’s advanced age, which is uncommon with cervical lymphadenopathy as a form of extrapulmonary tuberculosis, as well as in the administration of oral steroids to resolve the neck’s clinical deterioration. The patient had a complete recovery and was free of disease after completion of his six-month antituberculous chemotherapy.

scholarly journals A case report of lymphocytic hypophysitis

2021 ◽  
Vol 12 ◽  
pp. 263
Author(s):  
Stephen Yu ◽  
Ramakrishna Bethanabatla ◽  
Ahmed Taha
Keyword(s):  
Differential Diagnosis ◽  
Rare Condition ◽  
Lymphocytic Hypophysitis ◽  
Reproductive Age ◽  
Case Description ◽  
Clinical Correlation ◽  
Resonance Imaging ◽  
Sellar Mass ◽  
Mri Findings ◽  
Magnetic Resonance Imaging Mri

Background: Lymphocytic hypophysitis (LH) is a rare condition that mostly affects women of the reproductive age. Because it is infrequently encountered, it is not often considered as a differential diagnosis of sellar masses. The diagnosis is made clinically with the aid of magnetic resonance imaging (MRI) and should be considered if the patient has endocrine derangements in addition to a sellar mass. Case Description: A 37-year-old female presents with a complaint of headaches and CT imaging showed a sellar mass. She was also being investigated simultaneously by the endocrine department and was diagnosed with panhypopituitarism. She proceeded to surgery for a presumed pituitary adenoma but histopathology returned as LH. Conclusion: It is important to have a wide differential diagnosis when managing pituitary masses. Clinical correlation with atypical MRI findings is useful to determine the diagnosis of LH.

scholarly journals Rheumatoid Meningitis a Rare Extra-Articular Manifestation of Rheumatoid Arthritis: Report of 6 Cases and Literature Review

2020 ◽  
Vol 9 (6) ◽  
pp. 1625
Author(s):  
Mélanie Trabelsi ◽  
Xavier Romand ◽  
Mélanie Gilson ◽  
Mathieu Vaillant ◽  
Pierre-André Guerne ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Lumbar Puncture ◽  
Clinical Symptoms ◽  
Complete Recovery ◽  
High Rate ◽  
High Dose ◽  
Biologic Dmards ◽  
Oral Steroids ◽  
Fluid Attenuated Inversion Recovery ◽  
Rheumatoid Meningitis

Objectives. Central neurological manifestations of rheumatoid arthritis (RA) like rheumatoid meningitis (RM) are rare, little known and have a high rate of morbi-mortality. METHODS. We described six cases of RM that were directly related to RA activity after exhaustive assessment. RESULTS. They were mainly women, aged of 50 to 69. All were positive for anti-cyclic citrullinated peptide antibodies and half for rheumatoid factors. RA activity, duration, and treatments were heterogeneous including oral steroids, conventional synthetic disease modifying anti-rheumatic drugs (DMARDs) and biologic DMARDs. Symptoms were various, with acute or progressive beginning; main were: generalized or focal seizure (4/6), fever (3/6), headaches (3/6), and frontal syndrome (2/6). Imaging lesions were four leptomeningitis, one pachymeningitis, and one association of both. MRI usually showed hypersignal in various territories in T2-FLAIR (fluid attenuated inversion recovery) mode, and enhancement in T1-weighted mode after gadolinium injection. All patients had lumbar puncture that found sterile cerebrospinal fluid, no neoplasic cell, elevated cell count in 5/6 cases and elevated proteins concentration in 3/6 cases. Cerebral biopsy was possible for three patients, and definitively confirmed the diagnosis of aseptic lepto- or pachymenintis, excluding vasculitis and lymphoma. Different treatments were used like intravenous high dose steroids, immunoglobulins or biologic DMARDs, with variable clinical and imaging outcome: one death, one complete recovery, and four recoveries with sequelae. Conclusions. Clinical symptoms, imaging, lumbar puncture, and serological studies are often nonspecific, only histologic examination can confirm the diagnosis of RM. Any central neurological manifestation in RA patients, even in quiescent and ancient RA, should warn the physician.

Autoimmune haemolytic anaemia associated with P. vivax malaria

2018 ◽  
Vol 49 (1) ◽  
pp. 54-55 ◽  
Author(s):  
Sunil Taneja ◽  
Neha Agarwal
Keyword(s):  
Blood Transfusion ◽  
Haemolytic Anaemia ◽  
Vivax Malaria ◽  
Complete Recovery ◽  
Severe Anaemia ◽  
Autoimmune Haemolytic Anaemia ◽  
Incompatibility Group ◽  
Oral Steroids ◽  
Cross Matching

Autoimmune haemolytic anaemia due to malaria or following its treatment with artesunate is rare. A child presented with severe anaemia after being treated with artesunate for P. vivax malaria. Blood transfusion was difficult as cross-matching showed major incompatibility; group O negative blood under the cover of steroids was transfused. Oral steroids were given for six weeks. The patient made a complete recovery.

scholarly journals The Coexistence of an Intrasellar Adenoma, Lymphocytic Hypophysitis, and Primary Pituitary Lymphoma in a Patient with Acromegaly

2011 ◽  
Vol 2011 ◽  
pp. 1-6 ◽  
Author(s):  
Jose Hernan Martinez ◽  
Mariel Davila Martinez ◽  
Marcos Mercado de Gorgola ◽  
Luis F. Montalvo ◽  
Jaime E. Tome
Keyword(s):  
Pituitary Adenoma ◽  
B Cell Lymphoma ◽  
Tolerance Test ◽  
Lymphocytic Hypophysitis ◽  
Laboratory Evaluation ◽  
Oral Glucose ◽  
Sellar Mass ◽  
Presumptive Diagnosis ◽  
Pituitary Lymphoma ◽  
Visual Disturbances

The concomitant presence of three histopathologically different entities in the pituitary gland is a rare occurrence. Most publications identify at least two distinct pathologies, mainly, a pituitary adenoma coexisting with a second intrasellar lesion. We present a case of a 71-year-old female referred for evaluation and treatment of acromegaly. Questioning revealed she was experiencing facial palsy, visual disturbances, and syncopal spells for several weeks. When laboratory evaluation showed elevated somatomedin (IGF-I) levels and an oral glucose tolerance test failed to demonstrate any suppression of her growth hormone (GH) values, an MRI of the pituitary revealed a sellar mass. A presumptive diagnosis of pituitary adenoma was established. The patient underwent transsphenoidal resection of the sellar mass, which proved to be a large B-cell lymphoma (Stage I-E) associated with areas of adenoma and lymphocytic hypophysitis.

Optic Neuritis During Lactation: A Case Series

2020 ◽  
pp. 089033442097049
Author(s):  
Johnson Jeslin ◽  
C. Seetharaman ◽  
Virna M. Shah
Keyword(s):  
Optic Neuritis ◽  
Demyelinating Disease ◽  
Case Series ◽  
Rare Condition ◽  
Complete Recovery ◽  
High Dose ◽  
Oral Steroids ◽  
Optic Neuritis Treatment Trial ◽  
Intravenous Steroids ◽  
Sudden Blindness

Background Optic neuritis is a rare condition that can lead to sudden blindness and also could be a precursor to multiple sclerosis. When it occurs postpartum during lactation, it is called lactation optic neuritis. Main issue We present four cases of optic neuritis in lactating mothers, two of which had additional features of demyelinating disease upon neurological imaging. Management All participants were treated with high dose intravenous steroids followed by 11 days of oral steroids, per the optic neuritis treatment trial, which led to complete recovery of vision. Two participants with demyelinating disease on magnetic resonance imaging scans were advised to wean, because of a need for immunosuppressive therapy later. Conclusion Optic neuritis during lactation should be suspected following acute loss of vision. Prompt referral to an ophthalmologist is mandated for early diagnosis and treatment to prevent long-term co-morbidities.

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