Eosinophilic vasculitis: an inhabitual and resistant manifestation of a vasculitis

VASA ◽  
2010 ◽  
Vol 39 (4) ◽  
pp. 344-348 ◽  
Author(s):  
Jandus ◽  
Bianda ◽  
Alerci ◽  
Gallino ◽  
Marone
Keyword(s):  
Skin Biopsy ◽  
Intravenous Iron ◽  
Small Vessel Vasculitis ◽  
High Dose ◽  
Raynaud Phenomenon ◽  
The Third ◽  
Left Elbow ◽  
Right Hand ◽  
The Right ◽  
Trunk Skin

A 55-year-old woman was referred because of diffuse pruritic erythematous lesions and an ischemic process of the third finger of her right hand. She was known to have anaemia secondary to hypermenorrhea. She presented six months before admission with a cutaneous infiltration on the left cubital cavity after a paravenous leakage of intravenous iron substitution. She then reported a progressive pruritic erythematous swelling of her left arm and lower extremities and trunk. Skin biopsy of a lesion on the right leg revealed a fibrillar, small-vessel vasculitis containing many eosinophils.Two months later she reported Raynaud symptoms in both hands, with a persistent violaceous coloration of the skin and cold sensation of her third digit of the right hand. A round 1.5 cm well-delimited swelling on the medial site of the left elbow was noted. The third digit of her right hand was cold and of violet colour. Eosinophilia (19 % of total leucocytes) was present. Doppler-duplex arterial examination of the upper extremities showed an occlusion of the cubital artery down to the palmar arcade on the right arm. Selective angiography of the right subclavian and brachial arteries showed diffuse alteration of the blood flow in the cubital artery and hand, with fine collateral circulation in the carpal region. Neither secondary causes of hypereosinophilia nor a myeloproliferative process was found. Considering the skin biopsy results and having excluded other causes of eosinophilia, we assumed the diagnosis of an eosinophilic vasculitis. Treatment with tacrolimus and high dose steroids was started, the latter tapered within 12 months and then stopped, but a dramatic flare-up of the vasculitis with Raynaud phenomenon occurred. A new immunosupressive approach with steroids and methotrexate was then introduced. This case of aggressive eosinophilic vasculitis is difficult to classify into the usual forms of vasculitis and constitutes a therapeutic challenge given the resistance to current immunosuppressive regimens.

scholarly journals Bilateral Multiple Metacarpal Head Avascular Necrosis: A Case Report

2016 ◽  
Vol 101 (9-10) ◽  
pp. 473-477 ◽  
Author(s):  
Wengang Li ◽  
Biao Liu ◽  
Jun Song ◽  
Yan Liu ◽  
Haoyu Liu ◽  
...  
Keyword(s):  
Avascular Necrosis ◽  
Middle Finger ◽  
Left Hand ◽  
The Third ◽  
Metacarpal Head ◽  
Right Hand ◽  
Satisfactory Clinical Result ◽  
Slight Limitation ◽  
The Right

Avascular necrosis of the metacarpal head is a rare disease. We herein report a case with varying degrees of lesions in the third and fourth metacarpal heads of the right hand and the third metacarpal head of the left hand. The patient was a 37-year-old male right-handed mechanical worker who presented with persistent dull pain in the right hand after labor work for more than a year. The 3 lesions in this patient were treated differently based on their clinical imaging manifestations. The neurologic function of the right hand recovered by the 18-month follow-up; only a slight limitation remained in the right middle finger. This is the first report of 1 patent who received 2 different treatment methods simultaneously and both provided a satisfactory clinical result.

scholarly journals NCMP-23. PEMBROLIZUMAB-ASSOCIATED CD8+ VASCULITIC MONONEURITIS MULTIPLEX IN A PATIENT WITH MESOTHELIOMA: FIRST CASE REPORT

2020 ◽  
Vol 22 (Supplement_2) ◽  
pp. ii127-ii127
Author(s):  
Michaela Baldauf ◽  
Kapauer Monika ◽  
Jörger Markus ◽  
Flatz Lukas ◽  
Regulo Rodriguez ◽  
...  
Keyword(s):  
Case Report ◽  
Checkpoint Inhibitors ◽  
Axonal Neuropathy ◽  
Immunosuppressive Treatment ◽  
Small Vessel ◽  
Small Vessel Vasculitis ◽  
High Dose ◽  
Mononeuritis Multiplex ◽  
First Case ◽  
The Right

Abstract INTRODUCTION Immunotherapy, especially with immune checkpoint inhibitors (ICPI), has increasingly become an attractive treatment modality for various types of cancers. However, many patients develop ICPI-associated autoimmune adverse events such as pneumonitis, colitis or rarely neurological syndromes. Large and medium vessel vasculitis haS only occasionally been reported. Here we report the first case of ICPI-associated mononeuritis multiplex in a patient with malignant mesothelioma, caused by a histological proven small vessel vasculitis. CASE REPORT A 61-year old female developed subacute progressive painful and asymmetric sensorimotor deficits on distal extremities. Electrophysiologically, signs of a severe axonal neuropathy of both legs and the right arm were found, and swellings of the corresponding nerves were seen upon nerve ultrasound exam. The clinical and electrophysiological findings were reminiscent of mononeuritis multiplex. Laboratory work up including CSF examination was normal. More than two years prior to developing peripheral nerve deficits, the patient had been diagnosed with malignant pleural mesothelioma and treated with the anti-PD1 monoclonal antibody pembrolizumab on progression after chemotherapy. Biopsy of the right sural nerve revealed a small vessel vasculitis with a lymphocyte predominance of CD8+ T cells over CD4+ T as well as B lymphocytes. Despite discontinuation of pembrolizumab and immunosuppressive treatment (high dose methylprednisone, cyclophosphamide) complemented by opioid therapy, painful allodynia persisted. CONCLUSION ICPI-associated autoimmune disorders also include small vessel vasculitis with rare phenotypes such as mononeuritis multiplex. Further studies are required to improve our understanding of the link between ICPIs, and the pathogenic process leading to vasculitis, as well as to optimize treatment options for those rare diseases.

Oxyrhynchus Papyrus 2390 and Early Spartan History

1967 ◽  
Vol 87 ◽  
pp. 62-73 ◽  
Author(s):  
F. D. Harvey
Keyword(s):  
The Other ◽  
Large Fragment ◽  
Royal Family ◽  
Left Hand ◽  
The Third ◽  
Right Hand ◽  
Other Hand ◽  
Reliable Source ◽  
Fourth Volume ◽  
The Right

In 1957 Mr Lobel published, in the twenty-fourth volume of the Oxyrhynchus Papyri, a large fragment of a commentary on the Spartan poet Alcman. It is the second column of this papyrus which I propose to discuss; lines 13 to 22 give us some information about the Spartan royal family, and lines 22 to 25 seem to be saying something about the Spartan tribal organisation. Unfortunately, however, much of the left-hand side of the column is missing at this point; and when, from line 22, we do at last have a few letters from the left-hand side, we are faced with a gap running up the right-hand side as well. Because of this, it will be necessary to spend some time in an attempt to discover what the papyrus said, what it might have said, and what it could not possibly have said. Until this is done, no historical conclusions can safely be drawn.Before starting on an examination of the text, however, it would be as well to state what can be known about the author of the commentary. We can be certain that he had the work of previous scholars before him. In line 4 he refers to Theon, the Augustan grammarian, and in line 5 to Tyrannion; there were two grammarians of that name, and we cannot tell which he means (Lobel 54). Furthermore, in line 28, τῶν λοιπῶν is best taken as meaning ‘the other commentators’ (see p. 70). Whether or not he was an intelligent man is a question on which it is better not to dogmatise. He is capable of interpretative remarks of dubious value (lines 9–13, with Lobel ad loc.). There is certainly a muddle in the third column, which may indicate stupidity on the part of the commentator, or carelessness on the part of the scribe. We should not assume too readily that what he says is the gospel truth about early Sparta. On the other hand, we should remember that he might be working from a reliable source.

scholarly journals The Bias toward the Right Side of Others Is Stronger for Hands than for Feet

Symmetry ◽  
2021 ◽  
Vol 13 (1) ◽  
pp. 146
Author(s):  
Chiara Lucafò ◽  
Daniele Marzoli ◽  
Przemysław Zdybek ◽  
Gianluca Malatesta ◽  
Federico Smerilli ◽  
...  
Keyword(s):  
Attentional Bias ◽  
Relative Strength ◽  
Lower Limbs ◽  
The Third ◽  
Left Handed ◽  
Right Hand ◽  
The Right

As shown by a series of previous studies, ambiguous human bodies performing unimanual or unipedal actions tend to be perceived more frequently as right-handed or right-footed rather than left-handed or left-footed, which indicates a perceptual and attentional bias toward the right side of others’ body. However, none of such studies assessed whether the relative strength of such a bias differs between the upper and lower limbs. Indeed, given that the prevalence of right-handedness is slightly larger than that of right-footedness, and given that hands provide more information than feet as regards both communicative and aggressive acts, it is plausible that the bias toward the right side of human bodies should be stronger for the hand than for the foot. We performed three experiments in each of which participants had to indicate the rotating direction (revealing the perceived handedness/footedness) of ambiguous human figures with either one limb (arm or leg) or two limbs (one arm and the contralateral leg) extended. The hypothesized advantage of the right hand over the right foot was found in both the second and the third experiment.

scholarly journals Dedica votiva di Archino nel santuario di Oropo

Axon ◽  
2019 ◽  
Author(s):  
Maria Barbara Savo
Keyword(s):  
The Third ◽  
Right Hand ◽  
The Right

Pentelic marble table with a brief dedicatory inscription of a patient, Archinos, found in the Amphiaraos sanctuary in Oropos during the excavations of Leonardos. The pinax, in relief, shows three significant moments of the postulant’s stay in the shrine. The narration begins on the left, where Amphiaraos is represented (with greater size if compared to the patient) intent to intervene with an instrument on Archinos’ right shoulder. Below is a scene of enkoimeterion, where Archinos, lying on a kline, is overhung by the sacred snake and touched on the right shoulder. The third image of the patient represents him at the right end of the pinax and seems to be looking and pointing at the votive table on the stele with his right hand: it is an offer as a sign of gratitude to the god.

A New Military Strength Report on Papyrus

1977 ◽  
Vol 67 ◽  
pp. 50-61 ◽  
Author(s):  
J. D. Thomas ◽  
R. W. Davies
Keyword(s):  
New York ◽  
Kind Permission ◽  
Roman Army ◽  
The Third ◽  
Right Hand ◽  
The Subject ◽  
Military Strength ◽  
The Right ◽  
Brooklyn Museum

The document which forms the subject of this article is from the collection of papyri in the Brooklyn Museum, New York. It is published here by kind permission of the Museum authorities in advance of its appearance as no. 24 in the Catalogue of Brooklyn Museum Papyri, which is being prepared by Dr. John Shelton. We are very grateful to Dr. Shelton for drawing our attention to this papyrus and for generously allowing us, because of its exceptional importance, to publish it separately in this article.The papyrus contains a Latin document relating to a unit of the Roman army stationed in Egypt. It is written in three columns on the recto of a piece of papyrus measuring approximately 27 × 18 cm. The verso, which according to Dr. Shelton contains a Greek private letter, has no apparent connection. Although the papyrus shows damage on all four sides, it is probable that the right-hand edge is preserved in lines 12 f. of the third column (see the notes ad loc). As it can be demonstrated that not much is lost at the left of the first column, what survives is likely to be the greater part of the original width. All three columns are incomplete at both top and bottom, and the loss here is much harder to estimate. Format and date are discussed in detail in section iv. It is here sufficient to say that it belongs in or near the year A.D. 215, and that in content it closely resembles two known papyri classed as pridiana, which have recently been re-edited as RMR 63 and 64.

Clinical Diagnosis of Mood Disorders

1988 ◽  
Vol 34 (11) ◽  
pp. 2370-2370 ◽  
Author(s):  
A John Rush
Keyword(s):  
Nitrogen Atom ◽  
Stationary Phase ◽  
Mood Disorders ◽  
Clinical Diagnosis ◽  
Dextran Sulfate ◽  
Reagent Solution ◽  
The Third ◽  
Hand Column ◽  
Right Hand ◽  
The Right

Abstract Vol 34: p 813: In the fifth full paragraph in column 2, the second sentence should read "In 1934, von Meduna, a Hungarian psychiatrist..." (instead of 1983), and in the third sentence "1983" should read "1938." In the acknowledgements section to this paper, "MH-4115" should read "MH-41115." p 1018: Add Richard A. Patrick to this list of authors' names. p 1113: second column, 14th line from bottom, "32.1%" should read "10.9%" and, in the next line, "consistent" should read "inconsistent." Two lines further down, "60.7%" should read "18.5%" (see Letter by M. R. Hammer, in press). p 1493: It is stated (column 2, third paragraph) that a DB-1701 column does not contain a nitrogen atom in its stationary phase. This is incorrect. The Phase is a 14% cyanopropylphenylsiloxane polymer. p 1541: In the first full sentence in the right-hand column, "similarly higher" should read "similar." p 1629: In the right-hand column, the second-to-last paragraph, the ninth line from the bottom should read "...0.5 mL of a reagent solution containing, per liter, 10 g of dextran sulfate (500 000 Da) and 0.5 mol of MgCL2" p 1945: In line 6, column three, "0.65" should "0.965." p 2148: Add I. Morales to this list of authors' names.

Errata

1992 ◽  
Vol 438 (1904) ◽  
pp. 605-605 ◽  
Keyword(s):  
The Third ◽  
Right Hand ◽  
The Right

Page 177, equation (4.12) should read ∫ t 2 t 1 w ¯ d t ≤ 0. Page 177, inequality (4.13) should read ∫ t 2 t 1 ρ -i T · L d t ≥ 0. Page 181, equation (7.7) should read β · = F T γ . Page 191, line 4 above equation (11.1) should read: ‘where c and m ¯ are ...’ Page 192, last term in equation (11.6) should be e i x Te i . Page 192, the third term on the right-hand side of equation (11.7) should be v.

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