scholarly journals Rhino–orbito–cerebral mucormycosis following penetrating keratoplasty

2019 ◽  
Vol 2019 (11) ◽  
Author(s):  
Lina H Raffa
Keyword(s):  
Wide Spectrum ◽  
Rapid Evolution ◽  
Serum Glucose ◽  
Rapid Progression ◽  
Corneal Transplant ◽  
Cranial Nerve Involvement ◽  
Rare Presentation ◽  
Uncontrolled Diabetes ◽  
Extensive Debridement ◽  
High Index Of Suspicion

Abstract Rhino–orbito–cerebral mucormycosis (ROCM) is a potentially devastating fungal infection with a significant fatality rate. Early diagnosis and prompt management are crucial to ensure a favorable outcome due to the recognized rapid progression. This case is a rare presentation of ROCM in a patient with uncontrolled diabetes following a corneal transplant. The procedure required early surgical resection in the first 30 hours of hospitalization. The patient received wide-spectrum antibiotics and antifungal treatment and underwent extensive debridement of the necrotic area. A high index of suspicion is needed to diagnose ROCM. Any diabetic patient with sinonasal disease and/or cranial nerve involvement, irrespective of their serum glucose or glycated hemoglobin levels, is a candidate for prompt evaluation to exclude mucormycosis. The rapid evolution of our case highlights the importance of treating ROCM promptly and aggressively.

Granulomatosis with polyangiitis presenting as pancreatic disease

2021 ◽  
Vol 14 (3) ◽  
pp. e241033
Author(s):  
Jessie Jia Tao ◽  
Arnav Agarwal ◽  
Ari Benjamin Cuperfain ◽  
Christian Pagnoux
Keyword(s):  
Granulomatosis With Polyangiitis ◽  
Epigastric Pain ◽  
Delayed Diagnosis ◽  
Pancreatic Disease ◽  
Small Vessel Vasculitis ◽  
High Dose ◽  
Rapid Progression ◽  
Radiographic Evidence ◽  
High Index Of Suspicion ◽  
Parenchymal Lung

Granulomatosis with polyangiitis (GPA) is a rare necrotising small vessel vasculitis typically associated with oronasal, pulmonary and renal manifestations. Pancreatic disease is an exceedingly rare initial presentation and is associated with delayed diagnosis and rapid progression. We discuss a 66-year-old woman presenting with epigastric pain, elevated lipase and radiographic evidence of focal pancreatitis. She had no relevant medical history and no lithiasis seen on imaging. Pertinent findings include strawberry gingivitis, positive proteinase-antineutrophil cytoplasm antibody (98% specificity) and focal nodular parenchymal lung lesions on CT chest—all of which are consistent with a diagnosis of GPA. She was promptly started on high-dose steroids which resulted in significant clinical and biochemical improvement. Cyclophosphamide was added once biopsy confirmed the absence of malignancy. In order to optimise the clinical outcomes of GPA, physicians must keep a wide differential and high index of suspicion in the setting of unexplained pancreatitis with systemic features.

scholarly journals Rare Presentation of Self-Limiting Kikuchi–Fujimoto Disease in Relapsing Nature

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Karo Servatyari ◽  
Hero Yazdanpanah ◽  
Chamara Dalugama
Keyword(s):  
Lymph Nodes ◽  
Wide Spectrum ◽  
Clinical Manifestations ◽  
Cervical Lymphadenopathy ◽  
Excision Biopsy ◽  
Presentation Of Self ◽  
Rare Presentation ◽  
Cervical Lymph Nodes ◽  
One Year ◽  
Loss Of Appetite

Background. Kikuchi–Fujimoto disease (KFD) is a rare, benign, and self-limiting disease that is commonly associated with cervical lymphadenopathy and fever. The disease has a wide spectrum of clinical manifestations, and definitive diagnosis is based on the histological appearance in the excision biopsy of the lymph nodes. Recurrence of KFD is reported rarely. Case Presentation. A 56-year-old Iranian woman with a background history of thrombocytopenia presented with fever, malaise, loss of appetite, and weight loss with cervical lymphadenopathy. The excision biopsy of the cervical lymph nodes confirmed the diagnosis of KFD, and she made a full recovery with improvement of symptoms, regression of cervical lymph nodes, and normalization inflammatory markers. One year after remission, she presented with similar clinico-biochemical profile, and repeat biopsy confirmed KFD. Conclusion. Although the rate of recurrence of the disease is very low, the treating physician should consider the possibility and confirm it histologically.

scholarly journals The Comparative Toxicity of 10 Microcystin Congeners Administered Orally to Mice: Clinical Effects and Organ Toxicity

Toxins ◽  
2020 ◽  
Vol 12 (6) ◽  
pp. 403 ◽  
Author(s):  
Neil Chernoff ◽  
Donna Hill ◽  
Johnsie Lang ◽  
Judy Schmid ◽  
Thao Le ◽  
...  
Keyword(s):  
Algal Blooms ◽  
Morphological Changes ◽  
Wide Spectrum ◽  
Serum Levels ◽  
Serum Glucose ◽  
Oral Exposure ◽  
Clinical Effects ◽  
Clinical Changes ◽  
Induced Changes ◽  
Dose Response Study

Microcystins (MCs) are common cyanobacterial toxins that occur in freshwaters worldwide. Only two of the >200 MC variants have been tested for potential toxicity after oral exposure. This paper reports on the toxicity of 10 different MC congeners identified in algal blooms, microcystin-LR (MCLR), MCLA, MCLF, MCLW, MCLY, MCRR, [Asp3]MCRR, [Asp3,Dhb7]MCRR, MCWR, and MCYR after single administrations to BALB/c mice. In a preliminary MCLR dose–response study of 3 to 9 mg/kg doses, ≥5 mg/kg induced clinical changes, increased serum levels of ALT, AST, and GLDH, liver congestion, increased liver/body weight ratios, and reduced serum glucose and total protein. Based on the extent of these effects, the 10 congeners were administered as single 7 mg/kg oral doses and toxicity evaluated. The greatest toxicity was observed with MCLA and MCLR including a high percentage of moribundity. In addition to eliciting effects similar to those listed above for MCLR, MCLA also induced serum alterations indicative of jaundice. MCLY, and MCYR induced changes like those noted with MCLR, but to lesser extents. MCLW and MCLF exhibited some serum and morphological changes associated with hepatic toxicity, while there were few indications of toxicity after exposures to MCRR, [Asp3]MCRR, [Asp3,Dhb7]MCRR, or MCWR. These data illustrate a wide spectrum of hepatic effects and different potencies of these MC congeners.

scholarly journals A Case of Rituximab-Induced Necrotizing Fasciitis and a Review of the Literature

2017 ◽  
Vol 2017 ◽  
pp. 1-5
Author(s):  
Abdullateef Abdulkareem ◽  
Ryan S. D’Souza ◽  
Oluwaseun Shogbesan ◽  
Anthony Donato
Keyword(s):  
Necrotizing Fasciitis ◽  
Lymphocytic Leukemia ◽  
Rapid Progression ◽  
Skin Infections ◽  
Review Of The Literature ◽  
Clostridium Septicum ◽  
B Cell Malignancies ◽  
Knee Amputation ◽  
Left Lower Extremity ◽  
Extensive Debridement

Necrotizing fasciitis is a fulminant soft tissue infection characterized by rapid progression and high mortality. Rituximab is a generally well-tolerated immunosuppresive medication used for B-cell malignancies and some rheumatological disorders. We report a case of a 69-year-old male with chronic lymphocytic leukemia who suffered necrotizing fasciitis of his left lower extremity secondary to Clostridium septicum 7 weeks after treatment with rituximab. Despite immediate intravenous antimicrobial therapy and emergent fasciotomy with extensive debridement, his hospital course was complicated by septic shock and he required an above-the-knee amputation. Physicians need to be aware of the possibility of necrotizing fasciitis in patients presenting with skin infections after rituximab therapy.

scholarly journals Bullosis Diabeticorum: Rare Presentation in a Common Disease

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Vineet Gupta ◽  
Neha Gulati ◽  
Jaya Bahl ◽  
Jaswinder Bajwa ◽  
Naveen Dhawan
Keyword(s):  
Sudden Onset ◽  
Common Disease ◽  
Type I ◽  
Rare Presentation ◽  
Diabetic Vasculopathy ◽  
Diabetes Mellitus Type I ◽  
Uncontrolled Diabetes ◽  
History Of ◽  
Skin Biopsies ◽  
Bullosis Diabeticorum

A 27-year-old African American male presented with a sudden onset of blisters. He had a past medical history of uncontrolled diabetes mellitus type I, diabetic vasculopathy, and neuropathy. The physical examination revealed nonerythematous skin denudations on both elbows and lateral aspect of arm bilaterally. Investigations which included skin biopsies confirmed the diagnosis of bullosis diabeticorum. The bullae were treated with hydrotherapy and healed with no complications in 4 weeks. We present this case to illustrate the rare occurrence of diabetic bulla in a diabetic patient especially with poor glycemic control. The case is also a reminder of the importance of diabetes screening in nondiabetic patients who are diagnosed with diabetic bulla.

scholarly journals Hobnail variety of papillary cell carcinoma thyroid mimicking a thyroglossal cyst: a rare presentation

2019 ◽  
Vol 6 (6) ◽  
pp. 2198
Author(s):  
K. S. Ravishankar ◽  
Atreya M. Subramanian
Keyword(s):  
Braf V600e Mutation ◽  
Braf V600e ◽  
Papillary Thyroid ◽  
Thyroglossal Cyst ◽  
Tongue Protrusion ◽  
Rare Presentation ◽  
Clinical Presentations ◽  
High Index Of Suspicion ◽  
Extensive Surgery ◽  
Aggressive Variant

The hobnail variant of papillary thyroid carcinoma (HVPTC) is a newly described aggressive variant relative to that of the classical PTC. There have been genetic markers like the BRAF V600E mutation associated with more aggressiveness and a higher rate of recurrence and mortality. Here we discuss a case of thyroid swelling which clinically resembled a thyroglossal cyst due to movement of the swelling with tongue protrusion. Imaging indicated a multilobulated cystic swelling arising from the thyroid gland. FNAC was suggestive of colloid goitre. Total thyroidectomy was done and histopathology revealed HVPTC.HVPTC is an aggresive variant and if diagnosed preoperatively may warrant more extensive surgery. One must also have a high index of suspicion for thyroid swellings that are large with variable clinical presentations (including mutiple septations) as they may appear benign on FNAC but may prove to be malignant on histopathology.

scholarly journals Ileal volvulus due to ascaris lumbricoides: a diagnosis revisited

2019 ◽  
Vol 6 (2) ◽  
pp. 614
Author(s):  
Ipseet Mishra ◽  
Sudip Haldar ◽  
Souvik Paul
Keyword(s):  
Ascaris Lumbricoides ◽  
Wide Spectrum ◽  
Primary Anastomosis ◽  
Abdominal Distension ◽  
Exploratory Laparotomy ◽  
Small Bowel Volvulus ◽  
Clinical Presentations ◽  
Life Threatening ◽  
High Index Of Suspicion ◽  
Early Surgical Intervention

Ascariasis infestation is a common helminthic disease in developing countries with a wide spectrum of clinical presentations, one of which can be acute abdomen. Small bowel volvulus is a serious life-threatening emergency. The aetiology may be primary as is often seen in Africa and Asia, while in Western countries other predisposing conditions usually initiate the volvulus. Ascariasis is highly prevalent in India and so, a myriad of different presentations is quite obvious. Here the authors have reported a case of a 6year old boy presenting with features of acute intestinal obstruction-central abdominal pain, repeated vomiting and abdominal distension. After evaluation with abdominal radiography and ultrasonography, exploratory laparotomy was planned. A secondary ileal volvulus compact with worms of ascaris lumbricoides was found. Resection of non-viable ileum was done after evacuation of worms by enterotomy followed by primary anastomosis. Prompt clinical diagnosis, a high index of suspicion for complications and early surgical intervention are critical in minimizing morbidity in cases of Intestinal Ascariasis.

scholarly journals Successional occurrence of two papulosquamous disorders in HIV positive patient: a rare case report

2021 ◽  
Vol 7 (6) ◽  
pp. 869
Author(s):  
Nitika Sanjay Deshmukh ◽  
Ravindranath Brahmadeo Chavan ◽  
Anil Prakash Gosavi ◽  
Supriya Ashok Kachare
Keyword(s):  
Case Report ◽  
Lichen Planus ◽  
Lupus Erythematosus ◽  
Rare Condition ◽  
Discoid Lupus Erythematosus ◽  
Rare Presentation ◽  
Rare Case Report ◽  
Autoimmune Conditions ◽  
Atypical Presentations ◽  
High Index Of Suspicion

<p class="abstract">Presentation of two papulosquamous disorders in a same individual is rare condition till date. Independently, psoriasis and Lichen planus (LP) are common inflammatory skin conditions affecting around 2-3% and 1% of HIV (Human immune deficiency) positive population respectively. As reviewed in the literature, psoriasis may be independently associated with other autoimmune conditions like vitiligo, alopecia areata, lichen planus, and discoid lupus erythematosus. In this article, we presented a case report of a HIV seropositive patient who suffered from psoriasis and lichen planus. The coexistence of psoriasis and lichen planus in one individual is rare and underreported in literature. Psoriasis or lichen planus may be the presenting feature of HIV infection and tends to be more severe, to have atypical presentations. Psoriasis and lichen planus can be coexistent or successionally appear one after other in one individual though rare presentation. High index of suspicion is always required while dealing with papulosquamous lesions in PLHIV.</p><p> </p>

scholarly journals Case series of mucormycosis occurring in patients of COVID-19

2021 ◽  
Vol 9 (6) ◽  
pp. 1746
Author(s):  
Drashti J. Patel ◽  
Paras G. Patel ◽  
Purvi P. Patel ◽  
BrijeshKumar Sapariya ◽  
Moxa B. Parmar ◽  
...  
Keyword(s):  
Virus Disease ◽  
Organ Transplant ◽  
Case Series ◽  
Fungal Species ◽  
Invasive Infection ◽  
Uncontrolled Diabetes ◽  
Wide Range ◽  
Life Threatening ◽  
High Index Of Suspicion ◽  
Hospital Acquired

Mucormycosis is an umbrella term used for diseases caused by many non-septate filamentous fungal species which is caused by sub-phylum Mucormycotina. It is an acute opportunistic and aggressive fulminant invasive infection that can occur in immunocompromised patients, such as uncontrolled diabetes, renal failure, organ transplant, long-term corticosteroid and immunosuppressive therapy, AIDS, malignancy and corona virus disease 2019 (COVID 19) infections. Mucormycosis is now third most common invasive mycoses after candidiasis and aspergillosis. The COVID-19 infection is characterised by wide range of disease patterns, ranging from mild to life-threatening pneumonia. Many bacterial and fungal co-infections may exist and may be associated with preexisting morbidity or may develop as a hospital-acquired infection such as ventilator-associated pneumonia. Extensive use of corticosteroids and broad-spectrum antibiotics lead to exacerbation of preexisting disease. The aim of this study is to identify the risk factors along with high index of suspicion, early diagnosis and aggressive management of mucormycosis.

IgG4-related pancreatitis: an uncommon cause of hyperglycaemia

2020 ◽  
Vol 13 (4) ◽  
pp. e234331
Author(s):  
David M Williams ◽  
Asif Nawaz ◽  
Brijesh Srivastava ◽  
Lindsay George
Keyword(s):  
Weight Loss ◽  
Clinical Presentation ◽  
Liver Function Tests ◽  
Rapid Progression ◽  
Metabolic Disturbances ◽  
Multisystem Disease ◽  
Igg4 Related Disease ◽  
Serum Igg4 ◽  
Upper Abdominal ◽  
High Index Of Suspicion

Hyperglycaemia is one of the most common metabolic disturbances encountered in clinical practice, with an important differential diagnosis. We report a case of a 72-year-old woman referred to diabetes services with rapidly increasing blood glucose and weight loss despite oral hypoglycaemic therapy. She reported mild upper abdominal discomfort and liver function tests were deranged, prompting further investigation. Abdominal imaging demonstrated a diffusely enlarged pancreas and subsequent investigations noted a markedly raised serum IgG4. She was diagnosed with IgG4-related pancreatitis and swiftly responded to steroid therapy. Secondary causes of diabetes should be considered in people with atypical presentation such as weight loss or rapid progression to insulin use. While IgG4-related disease is rare, its varied clinical presentation as a result of its multiorgan involvement requires a high index of suspicion. This case highlights the importance of a detailed diagnostic work-up and describes an unusual clinical presentation of this increasingly recognised multisystem disease.

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