Ekbom syndrome - cultural aspects from a clinical case

2011 ◽  
Vol 26 (S2) ◽  
pp. 471-471
Author(s):  
M. Olari ◽  
G. Le Vacon ◽  
M. Follet
Keyword(s):  
Social Vulnerability ◽  
Senile Dementia ◽  
Clinical History ◽  
Laboratory Evaluation ◽  
Thyroid Function Tests ◽  
Nigerian Women ◽  
Delusional Parasitosis ◽  
Cultural Aspects ◽  
Glucose Levels ◽  
Ekbom Syndrome

IntroductionEkbom syndrome is a delusional parasitosis in which the patient has the delusion of infestation by parasites. This condition might occur in concordance with senile dementia or cerebrovascular disease, but it is also present in mood disorders or schizophrenia.ObjectivesTo present a clinical description of a delusional parasitosis that appeared in a young nigerian women after she immigrated in France.AimsOur case is suggestive for showing that delusional parasitosis might develop in circumstances of social vulnerability such as the immigration and might have different cultural aspects.MethodsWe present the case of a 29 years old nigerian women that developed a delusional parasitosis 3 years after her arrival in France. The diagnosis was based on a carefully detailed clinical history, an MMSE was also applied. In order to exclude secondary causes an extensive laboratory evaluation was performed including: complete blood cell count, liver, renal and thyroid function tests, serum electrolytes and glucose levels, vitamin B12, folate, iron studies, coproanalysis, neuroimaging.ResultsThe patient had all laboratory and neuroimaging tests normal. She presented a delusional parasitosis and she described an infestation with multiple intestinal worms. She was capable of describing them and their movements under the skin and also in all the organs. She described dracunculiasis and three more different species that are commonly present in Nigeria, she never mentioned lice or mites.ConclusionsEkbom syndrome is a delusion of hallucinatory mechanism that might have different cultural presentations and could be favored by social vulnerability such as immigration.

Immunoglobulin replacement for primary immunodeficiency: Indications for initiating and continuing treatment

2021 ◽  
Vol 42 (6) ◽  
pp. 489-494 ◽  
Author(s):  
Richard L. Wasserman
Keyword(s):  
Replacement Therapy ◽  
Primary Immunodeficiency ◽  
New Products ◽  
Relevant Literature ◽  
Clinical History ◽  
Laboratory Evaluation ◽  
Burden Of Care ◽  
Continue Treatment ◽  
Immunoglobulin Replacement Therapy ◽  
Immunoglobulin Replacement

Background: Immunoglobulin replacement therapy (IGRT) is the foundation of treatment for the majority of patients with primary immunodeficiency. Clinical history and laboratory evaluation define the patients for whom IGRT is necessary and appropriate. During the 70 years since the first patient was treated, new products have led to the development of several modes of administration that facilitate the individualization of treatment that enables the optimization of care. Objective: The objective was to explain the assessment of candidates for IGRT and approaches to reevaluating recipients of IGRT to decide on the need to continue treatment and to review the approaches to optimize IGRT. Methods: The relevant literature was reviewed in the context of the author's experience supervising > 20,000 IGRT treatments over a 40-year period. Results: Providing the most appropriate form of IGRT for individual patients ameliorates disease and lessens the burden of care for patients with primary immunodeficiency. Conclusion: IGRT is safe and effective when used to treat patients with primary immunodeficiency who meet established and appropriate clinical and laboratory criteria.

scholarly journals AspergillusThyroiditis: A Complication of Respiratory Tract Infection in an Immunocompromised Patient

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Madiha M. Alvi ◽  
David S. Meyer ◽  
Nicholas J. Hardin ◽  
James G. deKay ◽  
Annis M. Marney ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Immunocompromised Patient ◽  
Needle Aspiration ◽  
Acute Onset ◽  
Laboratory Evaluation ◽  
Thyroid Function Tests ◽  
Anterior Neck ◽  
Physical Findings ◽  
Opiate Analgesics ◽  
Overt Hyperthyroidism

A 59-year-old male with past medical history significant for non-Hodgkin’s lymphoma status after chemotherapy presented with acute onset of neck pain, odynophagia, and dysphagia associated with subjective fever, chills, and dyspnea. Physical findings included a temperature of 38.4°C, hypertension, and tachycardia. Patient was found to have anterior neck tenderness. Laboratory evaluation revealed neutropenia. The patient was started on empiric antibacterial and antiviral therapy and continued on home prophylactic antifungal treatment. Thyroid function tests revealed overt hyperthyroidism. A thyroid ultrasound showed heterogeneous echotexture without discrete nodules. Subacute thyroiditis was treated with methylprednisolone, metoprolol, and opiate analgesics. Patient’s antibacterial, antifungal, and antiviral treatments were broadened. A fine needle aspiration was not conducted. The patient’s condition deteriorated rapidly over his brief hospital course and he expired. Autopsy showed fungal thyroiditis secondary to disseminated invasiveAspergillus. This report describes the presentation of fungal thyroiditis secondary to disseminated invasiveAspergillusoriginating from the respiratory tract. The authors review the diagnostic challenges, pathophysiology, and treatment of this condition.

scholarly journals Prevalence of Sub-Clinical Hypothyroidism in Diagnosed Cases of Gallstone Disease

2021 ◽  
pp. 207-212
Author(s):  
C. Kamalakkhannan
Keyword(s):  
Gallstone Disease ◽  
Gall Stone ◽  
Clinical History ◽  
Gallstone Formation ◽  
Stone Disease ◽  
Thyroid Function Tests ◽  
Age Group ◽  
Medical College ◽  
Gall Stone Disease ◽  
A Prospective Study

Thyroid issues have long been debated as a possible cause of gall stone disease. The link between hypothyroidism and gallstone disease could be explained in a variety of ways. The main objective of this study is to determine the prevalence of hypothyroidism in gallstone patients and to rule out hypothyroidism as a probable cause of gallstone formation. A prospective study was conducted in surgical wards of Department of surgery sree balaji medical college from 2016 to 2017. All patients were evaluated using a comprehensive clinical history and examination, as well as suitable investigations such as abdominal USG, thyroid function tests, and lipid profiles. Out of 22 patients 19 patients (86.4%) had normal TSH, 2 patients (9.1%) had increased TSH, 1 patient (4.5%) had decreased TSH. Raised TSH was more in the AGE Group of 61- 75 years, which is comparable to other studies. Out of 22 patients, (100%) had normal T3 levels. 19 patients (86.4%) had normal T4 levels and Ultrasound examination of neck, 2 patients (9.1%) had decreased T4 level and 1 patient (4.5%) had increased T4 levels and 3 patients (13.6%) had abnormal Ultrasound Neck findings. Hence In this Study Cholelithiasis is most commonly seen in Females of age group of 41-60 years and prevalence of raised TSH level in cholelithiasis patient was 9% and most were found in the age group of 61-80 years.

scholarly journals Hypoglycemia due to insulin autoimmune syndrome (Hirata’s disease): a rare cause of hypoglycaemia

2021 ◽  
Vol 8 (8) ◽  
pp. 1220
Author(s):  
Het V. Patel ◽  
Sunil Kumar ◽  
Kalpesh Moradiya ◽  
Vidhi Shah
Keyword(s):  
Nutrition Therapy ◽  
Serum Glucose ◽  
Insulin Antibodies ◽  
Laboratory Evaluation ◽  
Hyperinsulinemic Hypoglycemia ◽  
Lifestyle Modifications ◽  
Glucose Levels ◽  
Insulin Autoimmune Syndrome ◽  
Autoimmune Syndrome ◽  
Recurrent Hypoglycaemia

Although the most common cause of recurrent hypoglycaemia is diabetes mellitus as patient is on antidiabetic medications which can be prevented by modification of antidiabetic doses, nutrition therapy and lifestyle modifications. Some endogenous hyperinsulinemic conditions like insulinoma, functional beta cell disorders and insulin autoimmune syndromes, hormonal deficiencies can cause serious and sometimes life threatening hypoglycaemia. So further laboratory evaluation like plasma/serum glucose levels, c-peptide levels, insulin levels, insulin antibodies and imaging studies are needed to evaluate unexplained hypoglycaemia. Here we report a case of insulin autoimmune syndrome in a 67 year old Indian male who had presented to us with multiple episodes of spontaneous hypoglycaemia. On further workup, the patient was found to have endogenous hyperinsulinemic hypoglycemia. As the patient’s abdominal imaging revealed no apparent cause of EHH, on further evaluation he came positive for insulin antibodies. Patient was diagnosed as IAS and he was given frequent small meals and complex carbohydrate diet and he had improved symptomatically. The incidence of IAS is most common in Japan and very few cases have been reported from India, so it should be kept in differential diagnosis of recurrent hypoglycaemia.

scholarly journals Biotin Supplementation Creates the Misleading Diagnosis of Secondary Adrenal Insufficiency

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A120-A121
Author(s):  
Hooman Motahari ◽  
Soumya Thumma ◽  
Lakshmi Menon
Keyword(s):  
Adrenal Insufficiency ◽  
Laboratory Testing ◽  
Daily Intake ◽  
Chronic Fatigue ◽  
Water Soluble ◽  
Laboratory Evaluation ◽  
Thyroid Function Tests ◽  
Secondary Adrenal Insufficiency ◽  
Hormone Levels ◽  
Biotin Supplementation

Abstract Introduction: Biotin (vitamin B7) is a water-soluble vitamin and an essential cofactor for the metabolism of fatty acids, glucose, and amino acids. Cases of biotin interference with laboratory testing have been described, most of which involve interference with thyroid function tests. Interference with gonadal steroids, adrenal, and pituitary hormones are rare. We report a case of T3 thyrotoxicosis in which biotin supplementation created the appearance of secondary adrenal insufficiency (AI). Case: A 66-year-old woman was referred for the evaluation of low TSH. She had chronic fatigue, low libido, and dizziness on standing. Vitals were stable with BP 135/64 mmHg and BMI 23.5. No evidence of mucosal or cutaneous hyperpigmentation. Laboratory evaluation revealed low ACTH <5 (7.2–63.3 pg/mL), low morning cortisol 3.8 and high DHEA-S 174 (13–130 ug/dL). TSH was low at 0.32 (0.32–5.60 uIU/mL) with normal prolactin and appropriately elevated FSH and LH. The labs raised concern for secondary AI. Cosyntropin stimulation test (CST) was done with a peak cortisol of 17.4 ug/dL. In the setting of suppressed ACTH and failed CST, she was started on Hydrocortisone therapy. Subsequently, CT of abdomen was obtained due to high DHEA-S which showed normal appearance of both adrenals. Pituitary MRI was normal. A detailed review of the medication list revealed that the patient was taking a Biotin containing multivitamin. Repeat labs 1 week after stopping biotin showed normalization of ACTH 13.8 (7.2–63.3). Repeat CST showed a peak cortisol response of 24 ug/dL. Hydrocortisone was discontinued and the patient remained stable on subsequent follow-ups, without the need for further glucocorticoid replacement therapy. Thyroid lab abnormalities persisted after biotin cessation which led to the diagnosis of T3 thyrotoxicosis, the treatment of which caused resolution of the patient’s symptoms. Discussion: The recommended daily intake of biotin for adults is 30 µg/d. Many over-the-counter products, specifically those marketed for hair, skin, and nail growth, contain biotin 100-fold higher than the recommended intake. Biotin interference with competitive immunoassays can cause falsely elevated hormone levels, whereas biotin interference with immunometric “sandwich” assays falsely lowers hormone levels. In our case, low ACTH was clinically misleading, prompting numerous unnecessary radiographic and laboratory testing and treatment with hydrocortisone. The US Food and Drug Administration issued a safety communication regarding biotin interference with laboratory tests. Education and communication between laboratorians, providers, and patients play an important role in investigating potential lab interference and the need for alternative lab assays for an accurate diagnosis. Patients should be asked to stop taking biotin supplements for at least 48 hours prior to specimen collection if possible.

Ayurvedic Management of Type-2 diabetes mellitus on Insulin- A Case Study

2020 ◽  
Vol 6 (2) ◽  
pp. 66-68
Author(s):  
Dimpal Gill ◽  
◽  
Raja Ram Mahto ◽  
Rama Kant Yadava ◽  
◽  
...  
Keyword(s):  
Case Report ◽  
Clinical History ◽  
Glucose Levels ◽  
Number Of Patients ◽  
Normal Glucose ◽  
Health Significance ◽  
Ayurvedic Treatment ◽  
Sugar Levels ◽  
Lukewarm Water

Background: This case report is based on our experience to treat, with Ayurveda drugs, a case of diabetic type -2 who was put on insulin and how Ayurvedic treatment has given him relief and maintain normal glucose levels with no associated complications. Brief case report: A 38 year’s male patient with clinical history of DMT2.Who was taking 32(20/12) units of insulin/day in 2 divided doses. The prakriti (nature) of this patient was Kapha-Pitta. By considering the Dosha and Dusya, a judicial combination of 4 primary Ayurveda drugs- Gudmar, Jamun, Nagarmotha, Sudarshan was advised to take orally in morning and evening with lukewarm water. Observations: At the beginning, his HbA1c was 11.1%. and after taking the prescribed Ayurvedic treatment along with insulin for 12 weeks, his HbA1c level reduced to 5.6%. At this stage, the insulin was withdrawn and patient continued on Ayurvedic treatment and monitored on weekly interval. After the Ayurveda treatment, need of further insulin or oral hypoglycemic agent drugs was not felt. His HbA1c was regularly monitored and it has come to normal range with improved quality of life. Conclusion: The prescribed combination of 4 drugs showed good response by maintaining normal blood sugar levels in DMT2 case, even after withdrawing insulin after 12 weeks of initial ayurvedic treatment. However, if this study is conducted in large number of patients it would help to understand the public health significance of this finding.

Ekbom's Syndrome: Worms of the Mind

2016 ◽  
Vol 1 (3) ◽  
pp. 123-125
Author(s):  
Saurabh Jaiswal ◽  
Rohit K Srivastava
Keyword(s):  
Case Report ◽  
Atypical Antipsychotic ◽  
International Classification Of Diseases ◽  
International Classification ◽  
Delusional Disorder ◽  
Delusional Parasitosis ◽  
Classification Of Diseases ◽  
Ekbom Syndrome ◽  
The Mind

ABSTRACT Delusional parasitosis (DP), also known as Ekbom syndrome, is a rare, monosymptomatic psychosis where the person has an unshakable belief (i.e., delusion) of being infested with parasites. A detailed activity of the offending parasite like crawling, biting, burrowing is often given by the patients. It is commonly observed among patients over the age of 50. International Classification of Diseases (ICD) 10th revision defines this disorder as “delusional disorder.” We are presenting a case report of a patient suffering from DP, who was successfully treated on atypical antipsychotic olanzapine, together with psychoeducation and counseling. How to cite this article Jaiswal A, Jaiswal S, Srivastava RK. Ekbom's Syndrome: Worms of the Mind. Int J Adv Integ Med Sci 2016;1(3):123-125.

scholarly journals Delusional parasitosis (Ekbom syndrome) – a psychodermatologic disorder

2021 ◽  
Vol 108 (2) ◽  
pp. 160-168
Author(s):  
Jagoda Stroynowska-Kosik ◽  
Sandra Zyzak ◽  
Ewelina Biało-Wójcicka
Keyword(s):  
Delusional Parasitosis ◽  
Ekbom Syndrome

Right frontal meningioma presenting as delusional parasitosis

2021 ◽  
Vol 14 (10) ◽  
pp. e245249
Author(s):  
Kavitha Konnakkaparambil Ramakrishnan ◽  
Lavanya Mohan ◽  
Jwala Jasha Jacob ◽  
Roopasree Gopinath
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Old Age ◽  
Psychiatric Symptoms ◽  
Clinical History ◽  
Midline Shift ◽  
Delusional Parasitosis ◽  
Central Nervous System Tumours ◽  
Detailed Clinical History

Central nervous system tumours can occasionally present with psychiatric symptoms as the only manifestation and can often pose diagnostic challenges. A man in his early 60s presented to the psychiatry outpatient department with delusional parasitosis. His old age and an episode of urinary and faecal incontinence made the clinician consider neuroimaging at the very first visit itself. He was detected to have a right frontal meningioma with features of intracranial hypertension with midline shift, and he underwent emergency surgery. His delusional symptoms completely resolved after surgery and did not recur during the follow-up period of 2.5 years. A right frontal meningioma presenting as delusional parasitosis has probably not been reported in the literature before, and the case is being reported to highlight the rarity of its presentation, the importance of eliciting a detailed clinical history and the need for early neuroimaging in these cases.

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