MO309SARS COV2 INFECTION COMPLICATING CRYOGLOBULINEMIC VASCULITIS WITH RENAL INVOLVEMENT

Abstract Background and Aims Cryoglobulinaemic vasculitis (CV) leading to clinically apparent skin lesions, and in some cases also to internal organ involvement such as renal involvement. The SARS Cov2 infection in this field is very serious and in the case of our patient the outcome was fatal. The aim of this work is to highlight the particularities of CV in this case Case presentation We report a case of a 62-year-old woman followed since 2014 for CV type 1 IgG Lambda revealed by vascular purpura and nasal septal perforation. the etiological assessment was negative. Hepatitis C virus serology was negative. A corticosteroid therapy at a dose of 1 mg/kg/day was started with partial improvement. Then the cyclophosphamide at a dose of 150 mg/d was added with a fairly good clinical result but stopped for hemorrhagic cystitis. Chlorominophene was started at a dose of 6 mg/d and then reduced to 4 mg/d for leuconeutropenia but the peripheral arterial manifestations (acrocyanosis of the limbs and ears) were not treated. The evolution was marked by the appearance of renal failure (creatinine 482.33 umol/l) associated with proteinuria at 1.32 g/24h. An outbreak of cryoglobulinemia was suspected. Plasma exchange was discussed as a therapeutic alternative and the patient was scheduled for a renal biopsy. However, the patient became febrile with the appearance of a dry cough and the presence of a biological inflammatory syndrome (CRP at 72). A SARS-CoV-2 PCR was completed which was positive. Therefore, she was put on antibiotic therapy (Azythromycin and Cefotaxime) associated with vitamin therapy and anticoagulant treatment. The patient was stable in terms of respiration and hemodynema, but her renal function worsened and progressed well under hydration. In addition, she presented with a slippage syndrome and she was died Conclusion The natural history of CV is not predictable and strongly depends on concomitant diseases and complications and response to treatment. The SARS Cov2 infection can complicate its evolution. There is no association has been described between them to our knowledge

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Complicated cutaneous leishmaniasis caused by an imported case of Leishmania tropica in Japan: a case report

Tropical Medicine and Health ◽

10.1186/s41182-021-00312-4 ◽

2021 ◽

Vol 49 (1) ◽

Author(s):

Hiroyuki Kitano ◽

Chizu Sanjoba ◽

Yasuyuki Goto ◽

Kazumasa Iwamoto ◽

Hiroki Kitagawa ◽

...

Keyword(s):

Cutaneous Leishmaniasis ◽

Skin Lesions ◽

Leishmania Tropica ◽

Case Presentation ◽

Imported Case ◽

Imported Cases ◽

History Of ◽

Hematoxylin And Eosin ◽

Polymerase Chain ◽

Positive Results

Abstract Background Leishmaniasis is not endemic in Japan, and imported cases are rare. However, there are increasing concerns regarding imported cases of cutaneous leishmaniasis from endemic countries to Japan. This report describes a case of imported cutaneous leishmaniasis that was diagnosed and treated in Japan. Case presentation A 53-year-old Pakistani man presented with skin lesions on both malleoli of his right ankle and the dorsum of the left foot. The skin lesions manifested as erythematous nodules surrounding an ulcer in the center of the lesion. The lesions of the malleoli of his right ankle each measured 3 × 3 cm, and the lesion on the top of his left foot measured 5 × 4 cm. He had been living and working in Japan but had a history of a visit to Pakistan for about 2 months in 2018. The skin lesions were biopsied. Giemsa and hematoxylin and eosin staining of biopsy samples showed amastigotes of Leishmania in macrophages, and the presence of Leishmania was confirmed by skin tissue culture. Polymerase chain reaction using biopsy specimens identified Leishmania parasites, and DNA sequence analysis revealed that the species was Leishmania tropica. The patient was treated with intravenous liposomal amphotericin B for 6 days. The erythema disappeared, and the erythematous nodules resolved within 3 weeks. Conclusion This is the first report of imported cutaneous leishmaniasis caused by L. tropica from Pakistan, and it is interesting that all three testing modalities showed positive results in this case.

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Concomitant hepatic tuberculosis and hepatocellular carcinoma: a case report and review of the literature

BMC Surgery ◽

10.1186/s12893-020-01021-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Hind S. Alsaif ◽

Ali Hassan ◽

Osamah Refai ◽

Khaled Awary ◽

Haitham Kussaibi ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Malignancy ◽

Ct Guided ◽

Case Presentation ◽

Hepatic Tuberculosis ◽

Ct Guided Biopsy ◽

History Of ◽

Abdominal Examination ◽

Peripheral Arterial ◽

High Index Of Suspicion

Abstract Background Hepatocellular carcinoma (HCC) is the most common primary liver malignancy that is strongly associated with chronic liver disease. Isolated hepatic tuberculosis is an uncommon type of tuberculosis. Concomitant occurrence of both conditions is extremely rare. Case presentation We report the case of a 47-year-old man who presented with fever and abdominal pain for 3 months prior to presentation. He reported a history of anorexia and significant weight loss. Abdominal examination revealed a tender, enlarged liver. Abdominal computed tomography (CT) demonstrated a solid heterogeneous hepatic mass with peripheral arterial enhancement, but no venous washout, conferring a radiological impression of suspected cholangiocarcinoma. However, a CT-guided biopsy of the lesion resulted in the diagnosis of concomitant HCC and isolated hepatic tuberculosis. Conclusion A rapid increase in tumor size should draw attention to the possibility of a concomitant infectious process. Clinicians must have a high index of suspicion for tuberculosis, especially in patients from endemic areas, in order to initiate early and proper treatment.

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P087 Polyarteritis nodosa: a case report

Rheumatology ◽

10.1093/rheumatology/keab722.079 ◽

2021 ◽

Vol 60 (Supplement_5) ◽

Author(s):

A Azirar ◽

A Ghannam ◽

A Elaouli ◽

M Rkain ◽

N Benaajiba ◽

...

Keyword(s):

Polyarteritis Nodosa ◽

Skin Lesions ◽

Lower Limbs ◽

Periarteritis Nodosa ◽

Minimal Effective Dose ◽

First Child ◽

History Of ◽

Inflammatory Syndrome ◽

Made In

Abstract Background Polyarteritis nodosa is a necrotizing vasculitis of small and medium caliber arteries. Rarely described in children, its pathophysiology is complex and remains poorly elucidated. Two main forms were described in the literature: cutaneous and visceral. Material and results We report the cases of two boys, aged of 7 and 11 years old. They had a history of recurrent sore throat with a recurrent aphthosis in the 11-year-old child. Both boys presented with polyarthralgias, myalgias, polymorphous skin lesions made of livedo reticularis with subcutaneous nodosa on the lower limbs in the first child and distal necrosis of the toes with oedema of the lower limbs in the second. Patients suffered also of cough evolving in a context of alteration of the general state made of fever and asthenia. A biological inflammatory syndrome was present in both children and the skin histology confirmed periarteritis nodosa. The evolution was marked by the disappearance of arthralgias and myalgias after a corticosteroid-based treatment with progressive dose reduction until minimal effective dose. Conclusion The diagnosis of Polyarteritis nodosa should be made in any child presenting with the following signs: fever, altered general condition, myalgias, arthralgias and skin manifestations. The prognosis is usually benign but long-term surveillance is necessary.

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A Complex Renal Cyst: It Is Time to Call the Oncologist?

International Journal of Nephrology ◽

10.4061/2011/893985 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Antonio Granata ◽

Antonio Basile ◽

Giuseppe Alessandro Bruno ◽

Alberto Saita ◽

Mario Falsaperla ◽

...

Keyword(s):

Hydatid Cyst ◽

Hydatid Disease ◽

Rare Case ◽

Renal Cyst ◽

Renal Involvement ◽

Case Presentation ◽

Magnetic Resonance Scan ◽

History Of ◽

The Right ◽

Vague Abdominal Pain

Introduction. Hydatid disease is a cyclozoonotic parasitic infestation caused by the cestodeEchinococcus granulosus. The cysts mainly arise in the liver (50 to 70%) or lung (20 to 30%), but any other organ can be involved, in abdominal and pelvic locations, as well as in other less common sites, which may make both diagnosis and treatment more complex. Isolated renal involvement is extremely rare.Case Presentation. We report a rare case of isolated renal hydatid disease in a 71-year-old man with a history of vague abdominal pain, anemia, fever, and microhematuria. Ultrasonographic examination revealed a complex cyst in the right kidney, including multiple smaller cysts with internal echoes. A magnetic resonance scan of the abdomen confirmed the findings, and hydatid cyst disease was diagnosed. Right nephrectomy was performed, and microscopic examination confirmed the diagnosis of hydatid cyst. Albendazole, 10 mg/kg per day, was given for 4 weeks (2 weeks preoperatively and 2 weeks postoperatively).Conclusion. Isolated primary hydatidosis of the kidney should always be considered in the differential diagnosis of any cystic renal mass, even in the absence of accompanying involvement of liver or other visceral organs.

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Pyoderma Gangrenosum-like ulceration as a presenting feature of pediatric Granulomatosis with Polyangiitis

10.21203/rs.3.rs-74888/v1 ◽

2020 ◽

Author(s):

Rotem Semo Oz ◽

Oluwakemi Onajin ◽

Liora Harel ◽

Rotem Tal ◽

Tomas Dallos ◽

...

Keyword(s):

Pyoderma Gangrenosum ◽

Granulomatosis With Polyangiitis ◽

Skin Lesions ◽

Response To Treatment ◽

Newly Diagnosed ◽

Rare Presentation ◽

Case Presentation ◽

Appropriate Treatment ◽

The Mean ◽

Systemic Symptoms

Abstract Background: Granulomatosis with polyangiitis (GPA) is an anti-neutrophilic cytoplasmic antibody-associated vasculitis affecting small to medium-sized vessels and involves most commonly the kidneys and the respiratory tract. Skin involvement can be seen in up to 50% of children with GPA and is the initial presenting symptom in 7.7%. Pyoderma gangrenosum (PG)-like ulcers are rarely described as a skin manifestation in GPA and very few cases have been reported previously in children. Case presentation: We describe 3 new pediatric cases of GPA with PG-like ulcerations. The mean age at first symptom was 15 years. Two patients had PG-like ulceration as their initial presentation; additional symptoms eventually led to the diagnosis of GPA 2-24 months later. In 1 case, proteinase 3 (PR3) was negative when first tested, but converted to positive when systemic symptoms emerged, in the other 2 cases PR3 was positive at presentation. All 3 patients had prominent facial lesions. None of the patients responded to treatment with antibiotics or medications commonly used to manage PG, including corticosteroids and cyclosporine. All patients had excellent responses to rituximab. An electronic database literature review was performed and 4 previously reported cases were identified. We assessed the clinical characteristics, serology, and response to treatment of 4 previously reported and newly diagnosed cases. Conclusion: PG-like ulceration is a rare presentation of pediatric GPA which may precede classic systemic GPA symptoms. The predominance of facial ulcer, granulomatous and neutrophilic inflammation on skin biopsy and lack of response to PG treatments are characteristic of GPA-associated PG-like ulcers. Our review suggests that treatment with rituximab may be needed to improve the skin lesions. Recognizing that PG-like ulcerations can occur in pediatric GPA may result in timely diagnosis, appropriate treatment and improved prognosis.

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Canine adenovirus type 1 causing neurological signs in a 5-week-old puppy

BMC Veterinary Research ◽

10.1186/s12917-019-2173-5 ◽

2019 ◽

Vol 15 (1) ◽

Author(s):

Samuel J. Hornsey ◽

Hélène Philibert ◽

Dale L. Godson ◽

Elisabeth C. R. Snead

Keyword(s):

Inclusion Bodies ◽

Clinical Signs ◽

Adenovirus Type ◽

Intranuclear Inclusion ◽

Case Presentation ◽

Neurological Signs ◽

History Of ◽

The Brain ◽

Timely Reminder

Abstract Background Infectious canine hepatitis is a rarely encountered disease, that is caused by Canine Adenovirus-1. Clinical signs can vary dramatically, and neurological signs are rarely seen. Neurological manifestation of this disease is rarely reported in the veterinary literature. Case presentation A 5-week-old, male entire Husky cross puppy presented for a one-day history of abnormal neurological behaviour (circling, ataxia, vocalization and obtund mentation). The puppy was euthanized shortly after presentation due to rapid deterioration. Histopathology raised concerns for Canine Adenovirus 1 (CAdV-1) based on vasculitis in the brain and intranuclear inclusion bodies in endothelial cell and hepatocytes; immunohistochemistry on brain tissue confirmed CAdV-1 infection. Conclusions This report discusses possible routes of infection and manifestations of adenovirus infections causing neurologic signs. It also provides a timely reminder that CAdV-1 should be considered a differential in unvaccinated dogs that present with neurological signs. Further studies are required to better understand the neurotrophic tendencies of this virus.

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To and TAFRO – a cryptic cause of acute renal failure: a case report

BMC Nephrology ◽

10.1186/s12882-022-02660-7 ◽

2022 ◽

Vol 23 (1) ◽

Author(s):

N. Shah ◽

T. Davidson ◽

C. Cheung ◽

K. Keung

Keyword(s):

Bone Marrow ◽

Early Recognition ◽

Renal Involvement ◽

Tertiary Hospital ◽

Renal Lesion ◽

Case Presentation ◽

Tafro Syndrome ◽

Renal Histology ◽

Night Sweats ◽

History Of

Abstract Background TAFRO syndrome is a rare clinical subtype of idiopathic multicentric Castlemans disease characterised by thrombocytopenia, anasarca, myelofibrosis, renal dysfunction, and organomegaly. Renal involvement is common, sometimes requiring temporary renal replacement therapy. Due to the associated thrombocytopenia, renal biopsies are rarely performed limiting descriptions of the renal histopathology in this condition. This case describes a patient with TAFRO syndrome and the associated renal histology. Case presentation A 49-year-old Caucasian man presented to a tertiary hospital in Sydney with a six- week history of malaise, non-bloody diarrhoea, progressive shortness of breath, and drenching night sweats. A progressive bicytopenia and renal function decline necessitating temporary dialysis prompted a bone marrow aspirate and trephine, as well as a renal biopsy respectively. This noted a hypercellular bone marrow with increased granulopoiesis, reduced erythropoiesis, and fibrosis, with renal histology suggesting a thrombotic microangiopathic-like glomerulopathy. Alternate conditions were excluded, and a diagnosis of TAFRO syndrome was made. Glucocorticoids and rituximab were initiated with rapid renal recovery, and normalisation of his haematologic parameters achieved at six months. Conclusion This case describes an atypical thrombotic microangiopathy as the predominant histologic renal lesion in a patient with TAFRO syndrome. This was responsive to immunosuppression with glucocorticoids and rituximab, highlighting the importance of early recognition of this rarely described condition.

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Management skin manifestation of multisystem inflammatory syndrome associated with SARS-CoV-2

Virology Journal ◽

10.1186/s12985-021-01736-4 ◽

2022 ◽

Vol 19 (1) ◽

Author(s):

Yeter Eylul Bayram ◽

Dilek Yildiz-Sevgi ◽

Ayse Yavuz ◽

Merve Cancetin ◽

Mehmet Yavuz Gurler

Keyword(s):

Joint Pain ◽

Skin Lesions ◽

Laboratory Findings ◽

Case Presentation ◽

Patient Morbidity ◽

Disease Condition ◽

The Usa ◽

Serious Disease ◽

Clinical Conditions ◽

Inflammatory Syndrome

Abstract Background Multisystem inflammatory syndrome (MIS), which develops after a past covid-19 infection. MIS can be described in different tissue inflammation, including the heart, lung, kidney, brain, skin, eye, and or gastrointestinal organs at the presence of COVID-19. Initially, MIS was described in Europe in children infected with SARS-CoV-2, then it was recently seen in the USA in 2020. MIS is a rare but serious disease condition associated with COVID-19 that can affect children (MIS-C) and adults (MIS-A). Case presentation A 44-year-old male who showed MIS-A in 59-day after his first covid-19 contact history. The patient presented to our emergency department with complaints of high fever, nausea, weakness, redness of the eyes, headache, and joint pain. On the second day of his hospitalization, a maculopapular skin lesion was seen in most of the skin. His fever could not be controlled even given paracetamol and broad effective antibiotics. His clinical, radiological, and laboratory findings showed that he had MIS-A. The patient was given intravenous pulse methylprednisolone and intravenous immunoglobulin (IVIG). These treatments, then, resulted in improvement of his clinical conditions, including fever and skin lesions, on the second day of the treatment. The patient was discharged in 14 days after the treatment. Conclusion This report indicated that diagnosis and treatment of MIS-A could result in reducing patient morbidity and mortality.

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Pyoderma gangrenosum-like ulceration as a presenting feature of pediatric granulomatosis with polyangiitis

Pediatric Rheumatology ◽

10.1186/s12969-021-00564-8 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Rotem Semo Oz ◽

Oluwakemi Onajin ◽

Liora Harel ◽

Rotem Tal ◽

Tomas Dallos ◽

...

Keyword(s):

Pyoderma Gangrenosum ◽

Granulomatosis With Polyangiitis ◽

Skin Lesions ◽

Response To Treatment ◽

Proteinase 3 ◽

Newly Diagnosed ◽

Rare Presentation ◽

Case Presentation ◽

Appropriate Treatment ◽

Systemic Symptoms

Abstract Background Granulomatosis with polyangiitis (GPA) is an anti-neutrophilic cytoplasmic antibody-associated vasculitis affecting small to medium-sized vessels and involves most commonly the kidneys and the respiratory tract. Skin involvement can be seen in up to 50% of children with GPA and is the initial presenting symptom in 7.7%. Pyoderma gangrenosum (PG)-like ulcers are rarely described as a skin manifestation in GPA and very few cases have been reported previously in children. Case presentation We describe 3 new pediatric cases of GPA with PG-like ulcerations. The median age at first symptom was 15 years. Two patients had PG-like ulceration as their initial presentation; additional symptoms eventually led to the diagnosis of GPA 2–24 months later. In 1 case, proteinase 3 (PR3) was negative when first tested, but converted to positive when systemic symptoms emerged; in the other 2 cases PR3 was positive at presentation. All 3 patients had prominent facial lesions. None of the patients responded to treatment with antibiotics or medications commonly used to manage PG, including corticosteroids and cyclosporine. All patients had excellent responses to rituximab. An electronic database literature review was performed and 4 previously reported cases were identified. We assessed the clinical characteristics, serology, and response to treatment of the previously reported and our newly diagnosed cases. Conclusion PG-like ulceration is a rare presentation of pediatric GPA which may precede classic systemic GPA symptoms. The predominance of facial ulcer, granulomatous and neutrophilic inflammation on skin biopsy and lack of response to PG treatments are characteristic of GPA-associated PG-like ulcers. Our review suggests that treatment with rituximab may be needed to improve the skin lesions. Recognizing that PG-like ulcerations can occur in pediatric GPA may result in timely diagnosis, appropriate treatment and improved prognosis.

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Pretibial myxedema in a euthyroid patient: a case report

Thyroid Research ◽

10.1186/s13044-021-00096-z ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Rediet Ambachew ◽

Tizita Yosef ◽

Aklilu M. Gebremariam ◽

Lishan Demere ◽

Theodros Aberra ◽

...

Keyword(s):

Case Reports ◽

Skin Lesions ◽

Thyroid Function Tests ◽

Thyroid Disorder ◽

Rare Presentation ◽

Case Presentation ◽

Normal Thyroid Function ◽

History Of ◽

Euthyroid Patient ◽

Pretibial Myxedema

Abstract Background Pretibial myxedema also known as localized myxedema, thyroid dermopathy, or infiltrative dermopathy and rarely as localized mucinosis is an infrequent manifestation of Graves’ disease. It can appear before, during, or after the thyrotoxic state. Euthyroid pretibial myxedema is a rare presentation with few case reports in the literature. This case highlights the importance of considering pretibial myxedema when characteristic skin lesions are observed in a euthyroid patient. Case presentation A 72-year old male Ethiopian patient with a very rare presentation of biopsy-proven pretibial myxedema in a euthyroid state without history of thyroid disease and absence of thyroid autoimmune markers. Resolution of skin lesion was achieved after topical corticosteroid application. Conclusion Absence of history of thyroid disorder and normal thyroid function tests should not exclude the diagnosis of pretibial myxedema.

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