scholarly journals Adult presentation of multisystem inflammatory syndrome (MIS) associated with recent COVID-19 infection: lessons learnt in timely diagnosis and management

2021 ◽  
Vol 14 (10) ◽  
pp. e243114
Author(s):  
Qiang Yao ◽  
Laura Waley ◽  
Natasha Liou
Keyword(s):  
Ethnic Minority ◽  
Corticosteroid Therapy ◽  
Inflammatory Markers ◽  
Similar Case ◽  
Case Reports ◽  
Adult Woman ◽  
Diagnosis And Management ◽  
Inflammatory Syndrome ◽  
Symptoms And Signs ◽  
Adult Presentation

Multisystem inflammatory syndrome in adults (MIS-A) is an uncommon and under-recognised postinfectious manifestation that presents 4–6 weeks after COVID-19 infection. Patients affected tend to be young or middle-aged, from ethnic minority backgrounds and previously healthy. In addition to high fever and myalgia, there are a myriad of extrapulmonary symptoms and signs, including cardiac, gastrointestinal, neurological and dermatological involvement. Cardiovascular shock and markedly raised inflammatory markers are prominent features, while significant hypoxia is uncommon. Patients respond well to corticosteroid therapy, but failure of clinicians to recognise this recently identified phenomenon, which can mimic common conditions including sepsis, could delay diagnosis and treatment. Here we present a case of MIS-A in an adult woman, compare her presentation and management with other similar case reports, and reflect on how clinicians can learn from our experiences.

Multisystem Inflammatory Syndrome (MIS-C) in Neonates (MIS-N) Following Maternal SARS CoV-2 COVID-19 Infection

2021 ◽  
Author(s):  
Satyan Lakshminrusimha ◽  
Mark Hudak ◽  
Victoria Dimitriades ◽  
Rosemary Higgins
Keyword(s):  
Current Literature ◽  
Case Reports ◽  
Maternal Infection ◽  
Diagnosis And Management ◽  
Inflammatory Syndrome ◽  
Post Infectious

Children present with multisystem inflammatory syndrome (MIS-C), a post-infectious syndrome presenting a few weeks following an acute SARS CoV-2 infection. A few case reports of neonates presenting with a similar syndrome following maternal infection have been reported. This article summarizes the current literature and outlines the controversies surrounding the diagnosis and management of MIS-C in neonates (MIS-N).

Diagnosis and Management of the Double Orifice Mitral Valve: Three Case Reports

2005 ◽  
Vol 8 (4) ◽  
pp. E236-E240 ◽  
Author(s):  
Omer Faruk Dogan ◽  
Metin Demircin ◽  
Tevfik Karagoz
Keyword(s):  
Mitral Valve ◽  
Case Reports ◽  
Diagnosis And Management ◽  
Double Orifice

scholarly journals Extreme Elevation of Alkaline Phosphatase in a Pregnancy Complicated by Gestational Diabetes and Infant with Neonatal Alloimmune Thrombocytopenia

2016 ◽  
Vol 2016 ◽  
pp. 1-3 ◽  
Author(s):  
Svjetlana Lozo ◽  
Amir Atabeygi ◽  
Michael Healey
Keyword(s):  
Alkaline Phosphatase ◽  
Gestational Diabetes ◽  
Similar Case ◽  
Case Reports ◽  
Alloimmune Thrombocytopenia

There have been few case reports of isolated elevation of alkaline phosphatase beyond the normal physiologic amount with subsequent return to baseline after delivery. Here we present a similar case of extreme elevation of alkaline phosphatase in a pregnancy complicated by gestational diabetes and subsequently by neonatal alloimmune thrombocytopenia (NAIT).

scholarly journals Adjuvant corticosteroid therapy in hepatosplenic candidiasis-related IRIS

2012 ◽  
Vol 4 (1) ◽  
pp. e2012018 ◽  
Author(s):  
Cengiz Bayram ◽  
Ali Fettah ◽  
Nese Yarali ◽  
Abdurrahman Kara ◽  
Fatih Mehmet Azik ◽  
...  
Keyword(s):  
Corticosteroid Therapy ◽  
Immune Reconstitution ◽  
Inflammatory Responses ◽  
Clinical Symptoms ◽  
Lymphoblastic Leukemia ◽  
Laboratory Findings ◽  
Hepatosplenic Candidiasis ◽  
Cell Acute Lymphoblastic Leukemia ◽  
Inflammatory Syndrome ◽  
Standard Risk

Hepatosplenic candidiasis (HSC) is a form of invasive fungal infection that occurs most commonly in patients with acute leukemia treated with chemotherapy and requires protracted antifungal therapy. Immune reconstitution inflammatory syndrome (IRIS) is best characterized as a dysregulated inflammatory responses triggered by rapid resolution of immunosuppression.We present a child diagnosed with standard-risk precursor B cell-acute lymphoblastic leukemia who developed HSC and Candida-related IRIS during recovery of neutropenia associated with induction chemotherapy. Addition of corticosteroid therapy to antifungal treatment is associated with the resolution of the clinical symptoms and laboratory findings

Benign ano-rectal disorders

2017 ◽  
Vol 10 (5) ◽  
pp. 253-261
Author(s):  
James Kynaston
Keyword(s):  
Primary Care ◽  
High Index ◽  
Diagnosis And Management ◽  
High Index Of Suspicion ◽  
Adult Presentation ◽  
Surgical Referral

Benign ano-rectal disorders are a common adult presentation to primary care; they also generate a significant number of secondary referrals. The exact prevalence of these conditions is difficult to determine, due to under-reporting of symptoms, which patients can find embarrassing and difficult to disclose. It can be challenging to distinguish between different ano-rectal disorders which present with similar symptoms. A high index of suspicion is required to detect serious malignant pathology. The aim of this article is to outline the epidemiology, pathophysiology, diagnosis and management of common benign ano-rectal disorders in primary care. The indications for surgical referral and important cancer referral guidelines are included.

scholarly journals Immune Reconstitution Inflammatory Syndrome with Recurrent Paradoxical Cerebellar HIV-Associated Progressive Multifocal Leukoencephalopathy

Pathogens ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 813
Author(s):  
Paola Frattaroli ◽  
Teresa A. Chueng ◽  
Obinna Abaribe ◽  
Folusakin Ayoade
Keyword(s):  
Progressive Multifocal Leukoencephalopathy ◽  
Immune Reconstitution Inflammatory Syndrome ◽  
Immune Reconstitution ◽  
People Living With Hiv ◽  
Rare Presentation ◽  
Diagnosis And Management ◽  
Art Initiation ◽  
Cerebellar Lesions ◽  
Living With Hiv ◽  
Inflammatory Syndrome

Progressive multifocal leukoencephalopathy (PML), presenting as immune reconstitution inflammatory syndrome (IRIS), is a known complication of antiretroviral therapy (ART) in people living with HIV (PLWH). Typically preceded by ART initiation, IRIS may appear simultaneously/unmasked (PML-s-IRIS) or as a delayed/worsening/paradoxical (PML-d-IRIS) presentation of known PML disease. Primary cerebellar tropism continues to be a rare presentation, and paradoxical cerebellar involvement of PML-IRIS syndrome can be a challenge for both diagnosis and management. Steroids have been suggested as a possible therapy in severe cases but the duration of steroid therapy remain elusive. Our case is that of a 34-year-old man with newly diagnosed HIV simultaneously found to have cerebellar PML. His PML lesions however worsened after initiation of ART (PML-d-IRIS) with evidence of increased intracranial pressure. Despite initial favorable response to a short duration of steroids, he had multiple recurrence of his PML lesions after steroids were discontinued. The presence of predominant cerebellar lesions and the question of how long steroids should be provided to prevent or minimize PML recurrence is the highlight of our case. This report emphasizes the need for more controlled studies to assist clinicians in the optimal diagnosis and management of PML-IRIS in PLWH.

scholarly journals Presenting Psychiatric and Neurological Symptoms and Signs of Brain Tumors before Diagnosis: A Systematic Review

2021 ◽  
Vol 11 (3) ◽  
pp. 301
Author(s):  
Fatima Ghandour ◽  
Alessio Squassina ◽  
Racha Karaky ◽  
Mona Diab-Assaf ◽  
Paola Fadda ◽  
...  
Keyword(s):  
Brain Tumors ◽  
Psychiatric Symptoms ◽  
Case Reports ◽  
Neurological Symptoms ◽  
World Health ◽  
Exclusion Criteria ◽  
Comprehensive Description ◽  
Brain Tumor Diagnosis ◽  
Health Organization ◽  
Symptoms And Signs

Brain tumors can present with various psychiatric symptoms, with or without neurological symptoms, an aspect that complicates the clinical picture. However, no systematic description of symptoms that should prompt a neurological investigation has been provided. This review aims to summarize available case reports describing patients with brain tumors showing psychiatric symptoms before brain tumor diagnosis, in order to provide a comprehensive description of these symptoms as well as their potential relationship with delay in the diagnosis. A systematic literature review on case reports of brain tumors and psychiatric symptoms from 1970 to 2020 was conducted on PubMed, Ovid, Psych Info, and MEDLINE. Exclusion criteria comprised tumors not included in the World Health Organization (WHO) Classification 4th edition and cases in which psychiatric symptoms were absent or followed the diagnosis. A total of 165 case reports were analyzed. In a subset of patients with brain tumors, psychiatric symptoms can be the only manifestation or precede focal neurological signs by months or even years. The appearance of focal or generalized neurological symptoms after, rather than along with, psychiatric symptoms was associated with a significant delay in the diagnosis in adults. A timely assessment of psychiatric symptoms might help to improve early diagnosis of brain tumors.

scholarly journals Axillary Web Syndrome in Breast Cancer: A Prevalent But Under-Recognized Postoperative Complication

Breast Care ◽  
2018 ◽  
Vol 13 (2) ◽  
pp. 129-132 ◽  
Author(s):  
Susan R. Harris
Keyword(s):  
Breast Cancer ◽  
Cohort Studies ◽  
Systematic Reviews ◽  
Nurse Practitioners ◽  
Case Reports ◽  
Case Series ◽  
Diagnosis And Management ◽  
Oncology Nurse ◽  
Management Interventions ◽  
Axillary Web Syndrome

The purpose of this review is to define axillary web syndrome (AWS) and describe its diagnosis and management. The following databases were searched through July 2017: PubMed, EMBASE (OvidSP), Cumulative Index for Nursing and Allied Health Literature, Physiotherapy Evidence Database, and Cochrane Database of Systematic Reviews. Search terms included ‘axillary web syndrome', ‘axillary cording', and ‘lymphatic cording'. 49 articles were identified; 8 did not relate to breast cancer, and 3 were not in English. Of the remaining articles, the majority were case reports, case series, or descriptive reviews. 2 systematic reviews were located as well as 1 randomized trial, 6 prospective cohort studies, and 2 retrospective cohort studies. Although a common sequela after axillary surgery for breast cancer staging, AWS has been poorly described in the medical literature as to the underlying pathophysiology, diagnosis, and management. Interventions range from patient education and simple reassurance that the syndrome will resolve spontaneously to active physical or manual therapies to maintain upper extremity range-of-motion, especially adequate motion for undergoing radiation therapy. Oncologists, breast surgeons, family physicians, and oncology nurse practitioners that work with patients with breast cancer should educate them about this prevalent complication and inform them preoperatively about what to anticipate.

scholarly journals Acute Pancreatitis: An Atypical Presentation

2017 ◽  
Vol 11 (2) ◽  
pp. 359-363 ◽  
Author(s):  
Omar Nadhem ◽  
Omar Salh
Keyword(s):  
Acute Pancreatitis ◽  
Abdominal Pain ◽  
Case Reports ◽  
Case Series ◽  
Normal Serum ◽  
Intravenous Fluids ◽  
Serum Enzyme ◽  
Serum Lipase ◽  
Upper Abdominal ◽  
Symptoms And Signs

Acute pancreatitis is an important cause of acute upper abdominal pain. Because its clinical features are similar to a number of other acute illnesses, it is difficult to make a diagnosis only on the basis of symptoms and signs. The diagnosis of acute pancreatitis is based on 2 of the following 3 criteria: (1) abdominal pain consistent with pancreatitis, (2) serum lipase and/or amylase ≥3 times the upper limit of normal, and (3) characteristic findings from abdominal imaging. The sensitivity and specificity of lipase in diagnosing acute pancreatitis are undisputed. However, normal lipase level should not exclude a pancreatitis diagnosis. In patients with atypical pancreatitis presentation, imaging is needed. We experienced two cases of acute pancreatitis associated with normal serum enzyme levels. Both patients were diagnosed based on clinical and radiological evidence. They were successfully treated with intravenous fluids and analgesics with clinical and laboratory improvement. The importance of this case series is the unlikely presentation of acute pancreatitis. We believe that more research is needed to determine the exact proportion of acute pancreatitis patients who first present with normal serum lipase, since similar cases have been seen in case reports.

scholarly journals Spontaneous liver rupture in a pregnant woman associated with HELLP syndrome

2019 ◽  
Vol 24 (3) ◽  
pp. 132-138
Author(s):  
T. M. Bunyatov ◽  
I. A. Kozlov ◽  
B. N. Gurmikov ◽  
Yu. A. Stepanova ◽  
V. S. Shirokov ◽  
...  
Keyword(s):  
Hellp Syndrome ◽  
Similar Case ◽  
Case Reports ◽  
Endovascular Embolization ◽  
Syndrome Patient ◽  
Liver Rupture ◽  
Right Hepatic Artery ◽  
Appropriate Treatment ◽  
Threatening Condition ◽  
Life Threatening

Spontaneous liver rupture is rare and highly dangerous, life-threatening condition occurring in 1–2% of pregnant women with preeclampsia and eclampsia. There are more than 100 similar case reports in the literature. It is believed that liver rupture is caused by HELLP syndrome as one of the signs of preeclampsia. The results of surgical treatment is still unsatisfactory. Appropriate treatment strategy is absent because of rareness of this condition. It is presented case report of a woman with spontaneous liver rupture associated with HELLP syndrome. Patient underwent perihepatic tamponade, endovascular embolization of right hepatic artery followed by right-sided hemihepatectomy.

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