Hypereosinophilia: a rare cause of stroke and multiorgan dysfunction

2021 ◽  
Vol 14 (10) ◽  
pp. e242619
Author(s):  
Kapil L Barbind ◽  
Revanth Boddu ◽  
KP Shijith ◽  
Kundan Mishra
Keyword(s):  
Ischaemic Stroke ◽  
Early Treatment ◽  
Eosinophil Count ◽  
Hypereosinophilic Syndrome ◽  
Renal Involvement ◽  
Rare Presentation ◽  
Laboratory Abnormality ◽  
Multiorgan Dysfunction ◽  
Life Threatening ◽  
Limiting Condition

Eosinophilia can occur due to a plethora of allergic, infective, neoplastic and idiopathic conditions. Hypereosinophilic syndrome (HES) is characterised by sustained eosinophilia and multiorgan dysfunction in the absence of an identifiable cause. It may range from a self-limiting condition to a rapidly progressive life-threatening disorder, of which ischaemic stroke is a rare presentation. Such episodes can rarely be the presenting manifestation, and may develop before any other laboratory abnormality or organ involvement. We report a case of HES presented with multiorgan (neurological and renal) involvement, managed successfully with steroids and cytoreductive therapy. High initial absolute eosinophil count can be a clue to the diagnosis and early treatment should be initiated in such patients, to prevent fatal outcomes.

scholarly journals Benign Subcutaneous Nodules and Hypereosinophilic Syndrome: A Rare Presentation of an Uncommon Entity

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Rimesh Pal ◽  
Uday Yanamandra ◽  
Prasanna Kumar ◽  
Nirmalya Banerjee
Keyword(s):  
Eosinophil Count ◽  
Index Case ◽  
Hypereosinophilic Syndrome ◽  
Low Grade ◽  
Rare Presentation ◽  
Angiolymphoid Hyperplasia ◽  
The Past ◽  
Absolute Eosinophil Count ◽  
Oral Corticosteroids ◽  
History Of

A 40-year-old gentleman presented with a history of multiple swellings involving his face, scalp, left axilla, back, and right thigh for the past 8 years. For the last 6 months, he developed intermittent low-grade fever, anorexia, weight loss, and gradually worsening breathlessness. On evaluation, the patient was found to have abnormally elevated absolute eosinophil count. Workup for the etiology of eosinophilia was unrewarding. All investigations related to an underlying myeloproliferative disorder were negative. Hence, a clinical possibility of angiolymphoid hyperplasia with eosinophilia (ALHE) was kept which was confirmed on histopathology. In the absence of other causes of hypereosinophilia, a clinical diagnosis of “associated hypereosinophilic syndrome” secondary to ALHE was made. He was managed with oral corticosteroids. The absolute eosinophil count reduced markedly, while the swellings showed a more gradual response, shrinking in size by about 50% following two months of therapy. The index case thus highlights a rather unusual presentation of ALHE.

scholarly journals Renal Abscess Caused by Salmonella Typhi

2015 ◽  
Vol 7 (02) ◽  
pp. 121-123 ◽  
Author(s):  
Amarjeet Kaur ◽  
Smita Sarma ◽  
Navin Kumar ◽  
Sharmila Sengupta
Keyword(s):  
Enteric Fever ◽  
Renal Involvement ◽  
Hepatic Abscess ◽  
Clinical History ◽  
Salmonella Typhi ◽  
The Body ◽  
Renal Abscess ◽  
Rare Presentation ◽  
Life Threatening ◽  
History Of

ABSTRACT Salmonella typhi is a true pathogen, which is capable of causing both intestinal and extraintestinal infections. Unusual presentations of Salmonella should always be kept in mind as this organism can cause disease in almost any organ of the body. S. typhi has been reported to cause the life-threatening infections such as meningitis, endocarditis, myocarditis, empyema, and hepatic abscess. Renal involvement by S. typhi is a relatively rare presentation. We report a case of renal abscess caused by S. typhi in an afebrile, 10-year-old child who did not have any clinical history of enteric fever. To our knowledge, this is the first reported case of isolation of S. typhi from the renal abscess, and interestingly this isolate was found to be resistant to quinolones.

scholarly journals Myelodysplastic Syndrome Clinically Presenting with the “Classic TTP Pentad”

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Santiago Fabián Moscoso Martínez ◽  
Evelyn Carolina Polanco Jácome ◽  
Elizabeth Guevara ◽  
Vijay Mattoo
Keyword(s):  
Myelodysplastic Syndrome ◽  
Clinical Presentation ◽  
Renal Involvement ◽  
Medical Emergency ◽  
Complete Blood Cell Count ◽  
Blood Cell Count ◽  
Thrombocytopenic Purpura ◽  
Life Saving ◽  
Threatening Condition ◽  
Life Threatening

The clinical presentation of myelodysplastic syndrome (MDS) is not specific. Many patients can be asymptomatic and can be detected only due to an abnormal complete blood cell count (CBC) on routine exam or for other reasons while others can be symptomatic as a consequence of underlying cytopenias. Thrombotic thrombocytopenic purpura (TTP) usually is suspected under the evidence of microangiopathic hemolytic anemia (MAHA) and thrombocytopenia and because it is a life-threatening condition (medical emergency) immediate initiation of plasmapheresis could be life-saving. The following case illustrates an unusual presentation of MDS in a patient who came in to the emergency room with the classic TTP “pentad” of fever, renal involvement, MAHA, mental status changes, and thrombocytopenia. We will focus our discussion in the clinical presentation of this case.

scholarly journals Acute Suppurative Thyroiditis in an Intravenous Drug User with a Preexisting Goiter

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Nikhil Yegya-Raman ◽  
Tabitha Copeland ◽  
Payal Parikh
Keyword(s):  
Drug User ◽  
Intravenous Drug User ◽  
Neck Mass ◽  
Subacute Thyroiditis ◽  
Suppurative Thyroiditis ◽  
First Case ◽  
Life Threatening ◽  
Acute Suppurative Thyroiditis ◽  
Limiting Condition ◽  
Iv Drug Use

Acute suppurative thyroiditis (AST) is an uncommon, potentially life-threatening cause of a rapidly enlarging neck mass. It may present similarly to subacute thyroiditis, a relatively benign and self-limiting condition. We report a case of AST in an adult intravenous (IV) drug user with a preexisting goiter who presented with a left forearm abscess that grew methicillin-sensitive Staphylococcus aureus. In this particular case, clinical suspicion for AST was high. As a result, early IV antibiotic therapy was initiated, and this led to rapid clinical improvement furthermore preventing airway compromise. To our knowledge, this is the first case of AST in the literature resulting from likely hematogenous spread in the setting of IV drug use and a preexisting goiter. Overall, this case highlights the importance of assessing risk factors for AST in patients whose presentations may seem more typical of subacute thyroiditis. Such an approach will lead to timely diagnosis and treatment to avoid potentially devastating consequences.

scholarly journals Parasitic hypereosinophilia in childhood: a diagnostic challenge

2018 ◽  
Vol 10 (1) ◽  
pp. 2018034
Author(s):  
Roberto Antonucci ◽  
Nadia Vacca ◽  
Giulia Boz ◽  
Cristian Locci ◽  
Rosanna Mannazzu ◽  
...  
Keyword(s):  
Eosinophil Count ◽  
Hypereosinophilic Syndrome ◽  
Igg Antibodies ◽  
Diagnostic Challenge ◽  
Etiological Diagnosis ◽  
Maximum Value ◽  
History Of ◽  
Diagnostic Work ◽  
Patient’S History ◽  
Work Up

Severe hypereosinophilia (HE) in children is rare, and its etiological diagnosis is challenging. We describe a case of a 30-month-old boy, living in a rural area, who was admitted to our Clinic with a 7-day history of fever and severe hypereosinophilia. A comprehensive diagnostic work-up could not identify the cause of this condition. On day 6, the rapidly increasing eosinophil count (maximum value of 56,000/mm3), the risk of developing hypereosinophilic syndrome, and the patient’s history prompted us to undertake an empiric treatment with albendazole.The eosinophil count progressively decreased following treatment. On day 13, clinical condition and hematological data were satisfactory, therefore the treatment was discontinued and the patient was discharged. Three months later, anti-nematode IgG antibodies were detected in patient serum, thus establishing the etiological diagnosis. In conclusion, an empiric anthelmintic treatment seems to be justified when parasitic hypereosinophilia is strongly suspected, and other causes have been excluded.

Adrenal pheochromocytoma with involvement of aorta and left renal artery: salvaged with adrenalectomy and nephrectomy

2021 ◽  
Vol 14 (9) ◽  
pp. e244297
Author(s):  
Shekhar Sathaye ◽  
Kalpesh Mahesh Parmar ◽  
Santosh Kumar ◽  
Pulkit Rastogi
Keyword(s):  
Renal Artery ◽  
Renal Involvement ◽  
Renal Tissue ◽  
Preoperative Imaging ◽  
Beta Blockade ◽  
Left Renal Artery ◽  
Rare Entity ◽  
Rare Presentation ◽  
Adrenal Pheochromocytoma

Large adrenal pheochromocytomas encasing the renal artery are a rare entity. The management of such challenging cases is surgical resection. The involvement of renal tissue and renal artery may necessitate meticulous dissection and concomitant nephrectomy. Here, we present a case of 41-year-old man diagnosed with left adrenal pheochromocytoma with complete encasement of left renal artery and partial encasement of aorta. Open left adrenalectomy and nephrectomy was performed after adequate preoperative optimisation. The patient is doing well at 6-month follow-up. Large adrenal pheochromocytoma with renal involvement is a rare presentation and requires optimal preoperative imaging, adequate preoperative alpha and beta blockade and meticulous surgical technique.

Stridor: a rare presentation of motor neuron disease

2021 ◽  
Vol 14 (7) ◽  
pp. e241923
Author(s):  
Brian Gordon ◽  
Eimear Joyce ◽  
Timothy J Counihan
Keyword(s):  
Motor Neuron ◽  
Motor Neuron Disease ◽  
Vocal Cord ◽  
Poor Response ◽  
Vocal Cord Palsy ◽  
Pharmacological Therapy ◽  
Rare Presentation ◽  
Emergency Tracheostomy ◽  
Life Threatening ◽  
History Of

A 74-year-old farmer presented to the emergency department with a subacute history of progressive dyspnoea, wheeze and dysphonia. He was treated for an exacerbation of asthma with poor response to pharmacological therapy. Investigation of dysphonia via laryngoscopy identified a bilateral vocal cord palsy. Subsequently, the patient developed an episode of life-threatening stridor and hypercapnic respiratory failure requiring an emergency tracheostomy. Neurology input identified evidence of widespread muscle fasciculations on clinical examination. MRI of the brain and cervical spine were unremarkable. Electromyogram testing identified changes of acute denervation in several limbs consistent with a diagnosis of motor neuron disease (MND). Bilateral vocal cord palsy has been rarely reported in the literature as the heralding symptom resulting in the diagnosis of MND. In patients with a subacute onset of dysphonia, dyspnoea and stridor, MND should be a differential diagnosis.

Impact on the family

2021 ◽  
pp. 111-125
Author(s):  
Veronica Dussel ◽  
Barbara Jones
Keyword(s):  
Social Care ◽  
Family Members ◽  
Well Being ◽  
Family Unit ◽  
Health And Social Care ◽  
The Family ◽  
Threatening Condition ◽  
Life Threatening ◽  
Limiting Condition ◽  
The Impact

In this chapter, we will focus on the importance of caring for the family of a child with a life-limiting condition (LLC) or life-threatening condition as a unit, each of the family members being integral to the well-being and care of the others. We recognize that the family unit itself is embedded within a wider context including the health and social care system, and more broadly within its society and culture. We discuss the concept of family, exploring the impact of having a child with an LLC, and how families adjust to this. We then expand on considerations about how to offer effective and timely support and help. We have included parents’ narratives with the aim of adding depth to the discussion, and in recognition of the truth of families’ own experiences.

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