scholarly journals Successful use of TNFα blockade in a severe case of idiopathic non-granulomatous ulcerative jejunoileitis associated with thrombotic thrombocytopenic purpura

2019 ◽  
Vol 6 (1) ◽  
pp. e000252 ◽  
Author(s):  
Fabian Braun ◽  
Victor Suarez ◽  
Johanna Dinter ◽  
Stefan Haneder ◽  
Alexander Quaas ◽  
...  
Keyword(s):  
Clinical Course ◽  
Gastrointestinal Symptoms ◽  
Unknown Origin ◽  
Severe Case ◽  
Tnf Alpha ◽  
Wall Thickening ◽  
Plasma Exchange Therapy ◽  
Alpha Blockade ◽  
Progressive Weight Loss ◽  
Ulcerative Jejunoileitis

We describe the case of 50-year-old female patient who presented with severe gastrointestinal symptoms and progressive weight loss of unknown origin. Shortly after admission, she developed an acute flare of thrombotic thrombocytopaenic purpura (TTP) that had to be treated by plasma exchange therapy and rituximab administration. While the signs of TTP subsided, the gastrointestinal symptoms worsened with abdominal cramps, massive gastric retention, malnourishment and a stenosis due to extensive inflammation and wall thickening of the small bowel. Extensive diagnostic efforts yielded no specific cause, so the patient—based on the histopathological findings—was diagnosed with idiopathic non-granulomatous ulcerative jejunoileitis. Following a highly complicated clinical course over several months, successful remission of the inflammatory activity and recovery of the patient could be obtained by TNF-alpha blockade.

scholarly journals Pediatric COVID-19 and the Factors That May Mitigate Its Clinical Course

2020 ◽  
Vol 10 (01) ◽  
pp. e137-e140
Author(s):  
Mosaad Abdel-Aziz ◽  
Nada M. Abdel-Aziz ◽  
Dina M. Abdel-Aziz ◽  
Noha Azab
Keyword(s):  
Clinical Features ◽  
Clinical Symptoms ◽  
Clinical Course ◽  
Clinical Manifestations ◽  
Gastrointestinal Symptoms ◽  
Angiotensin Converting Enzyme 2 ◽  
Compulsory Vaccination ◽  
Specific Factors ◽  
Novel Coronavirus ◽  
Radiographic Data

AbstractThe clinical manifestations of novel coronavirus disease 2019 (COVID-19) vary from mild flu-like symptoms to severe fatal pneumonia. However, children with COVID-19 may be asymptomatic or may have mild clinical symptoms. The aim of this study was to investigate clinical features of pediatric COVID-19 and to search for the factors that may mitigate the disease course. We reviewed the literature to realize the clinical features, laboratory, and radiographic data that may be diagnostic for COVID-19 among children. Also, we studied the factors that may affect the clinical course of the disease. Fever, dry cough, and fatigue are the main symptoms of pediatric COVID-19, sometimes flu-like symptoms and/or gastrointestinal symptoms may be present. Although some infected children may be asymptomatic, a recent unusual hyperinflammatory reaction with overlapping features of Kawasaki's disease and toxic shock syndrome in pediatric COVID-19 has been occasionally reported. Severe acute respiratory syndrome-coronvirus-2 (SARS-CoV-2) nucleic acid testing is the corner-stone method for the diagnosis of COVID-19. Lymphocyte count and other inflammatory markers are not essentially diagnostic; however, chest computed tomography is highly specific. Factors that may mitigate the severity of pediatric COVID-19 are home confinement with limited children activity, trained immunity caused by compulsory vaccination, the response of the angiotensin-converting enzyme 2 receptors in children is not the same as in adults, and that children are less likely to have comorbidities. As infected children may be asymptomatic or may have only mild respiratory and/or gastrointestinal symptoms that might be missed, all children for families who have a member diagnosed with COVID-19 should be investigated.

scholarly journals Leptospirosis presenting as severe cardiogenic shock: A case report

2018 ◽  
Vol 19 (4) ◽  
pp. 351-353
Author(s):  
E Forbat ◽  
MJ Rouhani ◽  
C Pavitt ◽  
S Patel ◽  
R Handslip ◽  
...  
Keyword(s):  
Case Report ◽  
Cardiogenic Shock ◽  
Social History ◽  
Rare Case ◽  
Clinical Course ◽  
Unknown Origin ◽  
Case Presentation ◽  
Pyrexia Of Unknown Origin ◽  
Severe Cardiogenic Shock ◽  
Infectious Illness

Background Leptospirosis is a rare infectious illness caused by the Spirochaete Leptospira. It has a wide-varying spectrum of presentation. We present a rare case of severe cardiogenic shock secondary to leptospirosis, in the absence of its common clinical features. Case presentation A 36-year-old woman presented to our unit with severe cardiogenic shock and subsequent multi-organ failure. Her clinical course was characterised by ongoing pyrexia of unknown origin with concurrent cardiac failure. She was initially managed with broad-spectrum antibiotics and inotropes. Percutaneous cardiac biopsy excluded major causes of myocarditis. On day 21 after presentation, she was found to be IgM-positive for leptospirosis. Conclusions This is a rare case of severe cardiogenic shock secondary to leptospirosis infection. The case also highlights the importance of obtaining a thorough social history when assessing a patient with an unusual presentation, as clues can often be missed.

scholarly journals COVID-19, MERS and SARS with Concomitant Liver Injury—Systematic Review of the Existing Literature

2020 ◽  
Vol 9 (5) ◽  
pp. 1420 ◽  
Author(s):  
Michał Kukla ◽  
Karolina Skonieczna-Żydecka ◽  
Katarzyna Kotfis ◽  
Dominika Maciejewska ◽  
Igor Łoniewski ◽  
...  
Keyword(s):  
Systematic Review ◽  
Liver Injury ◽  
Clinical Course ◽  
Meta Analysis ◽  
Gastrointestinal Symptoms ◽  
Intensive Care Treatment ◽  
The Novel ◽  
Massive Necrosis ◽  
Novel Coronavirus ◽  
Elevated Transaminases

The novel coronavirus SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection has been predominantly linked to respiratory distress syndrome, but gastrointestinal symptoms and hepatic injury have also been reported. The mechanism of liver injury is poorly understood and may result as a consequence of viral hepatitis, systemic inflammatory response, gut barrier and microbiome alterations, intensive care treatment or drug toxicity. The incidence of hepatopathy among patients with coronavirus disease 2019 (COVID-19) is unclear, but studies have reported liver injury in patients with SARS and Middle East respiratory syndrome (MERS). We aimed to systematically review data on the prevalence of hepatic impairments and their clinical course in SARS and MERS Coronaviridae infections. A systematic literature search (PubMed/Embase/Cinahl/Web of Science) according to preferred reporting items for systematic review and meta-analysis protocols (PRISMA) was conducted from database inception until 17/03/2020 for studies that evaluated the incidence of hepatic abnormalities in SARS CoV-1, SARS CoV-2 and MERS infected patients with reported liver-related parameters. A total of forty-three studies were included. Liver anomalies were predominantly mild to moderately elevated transaminases, hypoalbuminemia and prolongation of prothrombin time. Histopathology varied between non-specific inflammation, mild steatosis, congestion and massive necrosis. More studies to elucidate the mechanism and importance of liver injury on the clinical course and prognosis in patients with novel SARS-CoV-2 infection are warranted.

scholarly journals CLINICAL SPECTRUM OF SCRUB TYPHUS IN A TERTIARY CARE HOSPITAL AT EASTERN INDIA

2018 ◽  
Vol 11 (5) ◽  
pp. 351 ◽  
Author(s):  
Srikant Kumar Dhar ◽  
Sobhitendu Kabi ◽  
Chandan Das ◽  
Swati Samant ◽  
Debasmita Tripathy ◽  
...  
Keyword(s):  
Scrub Typhus ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Gastrointestinal Symptoms ◽  
Unknown Origin ◽  
Immunoglobulin M ◽  
Care Hospital ◽  
Diagnostic Features ◽  
Laboratory Findings ◽  
Pyrexia Of Unknown Origin

 Objective: Our hospital, tertiary care hospital in the capital of the state of Odisha, had been witnessing pyrexia of unknown origin, associated with breathlessness, renal, and liver impairment, which did not respond to high antibiotics but to doxycycline; therefore, the present study was undertaken to identify whether scrub typhus is the etiological agent, and thereafter, their characteristic features were further evaluated as an effort in supporting its diagnoses and treating patients accordingly.Methods: A total of 65 adult patients (age >15 years) admitted with pyrexia between April 2015 and October 2017 were evaluated. Immunoglobulin M (IgM) scrub typhus test was done in all these patients. IgM scrub typhus test positive samples were included in the study and various clinical parameters analyzed.Results: Of the 65 patients included in the study, all were found to be positive for IgM antibodies against Orientia tsutsugamushi. The cases were seen mainly in the months between September and November. The common symptoms found were fever, myalgia, breathlessness, rash, and abdominal pain and rarely altered sensorium. The diagnostic features like eschar were found in 23% patients. Nearly, two-thirds of patients had fever more than 7 days and myalgia (76.92%), headache (58.46%). The most common complications were renal failure (20%) followed by pneumonia (10.76%). Laboratory findings of high C-reacting protein (89.23%) and leukocytosis are found in 35.38%.Conclusion: Our results showed that scrub typhus should be considered in the differential diagnosis of pyrexia of unknown origin associated with breathlessness, myalgia, rash, gastrointestinal symptoms, hepatorenal syndrome, or acute respiratory distress syndrome. Empirical treatment with doxycycline may be given in the cases with strong suspicion of scrub typhus.

Effect of TNF-alpha blockade on coagulopathy, survival and endothelial activation in xenoperfused porcine kidneys

2013 ◽  
Vol 20 (1) ◽  
pp. 55-55
Author(s):  
Wolf Ramackers ◽  
Lars Friedrich ◽  
Andreas Tiede ◽  
Sabine Bergmann ◽  
Clemens Bockmeyer ◽  
...  
Keyword(s):  
Endothelial Activation ◽  
Tnf Alpha ◽  
Alpha Blockade

A case of aseptic abscesses syndrome treated with corticosteroids and TNF-alpha blockade

2013 ◽  
Vol 23 (1) ◽  
pp. 195-199 ◽  
Author(s):  
Tomoyuki Ito ◽  
Naoko Sato ◽  
Hajime Yamazaki ◽  
Tadashi Koike ◽  
Iwao Emura ◽  
...  
Keyword(s):  
Tnf Alpha ◽  
Alpha Blockade

TNF-alpha Blockade Improves Early Tendon-to-Bone Healing in a Rat Rotator Cuff Repair Model (SS-10)

2009 ◽  
Vol 25 (6) ◽  
pp. e5-e6 ◽  
Author(s):  
Lawrence V. Gulotta ◽  
David Kovacevic ◽  
Frank A. Cordasco ◽  
Scott A. Rodeo
Keyword(s):  
Rotator Cuff ◽  
Bone Healing ◽  
Rotator Cuff Repair ◽  
Tnf Alpha ◽  
Alpha Blockade ◽  
Cuff Repair

Legacy and current understanding of the often-misunderstood Foix-Alajouanine syndrome

2009 ◽  
Vol 111 (5) ◽  
pp. 902-906 ◽  
Author(s):  
Andrew S. Ferrell ◽  
R. Shane Tubbs ◽  
Leslie Acakpo-Satchivi ◽  
John P. Deveikis ◽  
Mark R. Harrigan
Keyword(s):  
Spinal Cord ◽  
Venous Thrombosis ◽  
Unknown Origin ◽  
Vascular Lesion ◽  
Clinical Syndrome ◽  
Wall Thickening ◽  
Central Feature ◽  
Type I ◽  
Initial Report ◽  
Luminal Narrowing

Foix-Alajouanine syndrome has become a well-known entity since its initial report in 1926. The traditional understanding of this clinical syndrome is as a progressive spinal cord venous thrombosis related to a spinal vascular lesion, resulting in necrotic myelopathy. However, spinal venous thrombosis is extremely rare and not a feature of any common spinal vascular syndrome. A translation and review of the original 42-page French report revealed 2 young men who had presented with progressive and unrelenting myelopathy ultimately leading to their deaths. Pathological analysis demonstrated endomesovasculitis of unknown origin, including vessel wall thickening without evidence of luminal narrowing, obliteration of cord vessels, or thrombosis. Foix and Alajouanine also excluded the presence of intramedullary arteriovenous malformations. At the time, dural arteriovenous fistulas (dAVFs) had not been described, and therefore this type of lesion was not specifically sought. In retrospect, it seems possible that both patients had progressive myelopathy due to Type I dAVFs. In the decades since that original report, numerous authors have included spinal cord venous thrombosis as a central feature of Foix-Alajouanine syndrome. The inclusion of thrombosis in the clinical picture of this syndrome is not only incorrect but may leave one with the impression of therapeutic futility, thus possibly preventing successful surgical or endovascular therapy.

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