scholarly journals Atypical Presentation of PKDL due toLeishmania infantumin an HIV-Infected Patient with Relapsing Visceral Leishmaniasis

2014 ◽  
Vol 2014 ◽  
pp. 1-3 ◽  
Author(s):  
Benedetto Maurizio Celesia ◽  
Bruno Cacopardo ◽  
Daniela Massimino ◽  
Maria Gussio ◽  
Salvatore Tosto ◽  
...  
Keyword(s):  
Visceral Leishmaniasis ◽  
Hiv Infection ◽  
Leishmania Infantum ◽  
Plasma Cells ◽  
Case Reports ◽  
Case Series ◽  
Skin Lesions ◽  
Secondary Prophylaxis ◽  
Complete Disappearance ◽  
Cutaneous Lesions

We describe the case of an Italian patient with HIV infection who developed an atypical rash resembling post-kala-azar dermal leishmaniasis (PKDL) when receiving liposomal Amphotericin B (L-AMB) for secondary prophylaxis of visceral leishmaniasis (VL). At the time of PKDL appearance, the patient was virologically suppressed but had failed to restore an adequate CD4+ T-cell count. Histology of skin lesions revealed the presence of a granulomatous infiltrate, with lymphocytes, plasma cells, and macrophages, most of which containedLeishmaniaamastigotes. Restriction fragment length polymorphism-polymerase chain reaction was positive forLeishmania infantum. Paradoxically, cutaneous lesions markedly improved when a new relapse of VL occurred. The patient received meglumine antimoniate, with a rapid clinical response and complete disappearance of cutaneous rash. Unfortunately, the patient had several relapses of VL over the following years, though the interval between them has become wider after restarting maintenance therapy with L-AMB 4 mg/kg/day once a month. Even if rare, PKDL due toLeishmania infantummay occur in Western countries and represents a diagnostic and therapeutic challenge for physicians. The therapeutic management of both PKDL and VL in HIV infection is challenging, because relapses are frequent and evidence is often limited to small case series and case reports.

scholarly journals Cutaneous manifestations of COVID-19 in Mexican patients: A case series and review of literature

2021 ◽  
Vol 9 ◽  
pp. 2050313X2199719
Author(s):  
Juan Carlos Palomo-Pérez ◽  
Maria Elisa Vega-Memije ◽  
David Aguilar-Blancas ◽  
Erik González-Martínez ◽  
Lucia Rangel-Gamboa
Keyword(s):  
Respiratory Symptoms ◽  
Case Series ◽  
Signs And Symptoms ◽  
Skin Lesions ◽  
World Health ◽  
Medical Community ◽  
Atypical Pneumonia ◽  
Cutaneous Lesions ◽  
Cutaneous Manifestations ◽  
Mexican Patients

China officially recognized atypical pneumonia outbreak in December 2019; on 11 March 2020, the World Health Organization declared COVID-19 as a pandemic that is produced by a new coronavirus, named SARS-CoV-2, of rapid transmissibility, which can be asymptomatic, with mild to severe respiratory symptoms, and with cardiovascular, neurological, gastrointestinal, and cutaneous complications. Considering that the pandemic prolonged more than initially expected was prognostic, it is essential for the medical community to identify the signs and symptoms of COVID-19. Thus, this work’s objectives were to present cases of cutaneous lesions observed in COVID-19 Mexican patients. We register cutaneous lesions in COVID-19 patients referred from internal medicine and otorhinolaryngology services to dermatology. We presented four interesting cases with cutaneous lesions, including exanthema morbilliform, urticaria, chilblains, ecchymosis, and facial edema, and review the available literature. The most frequent cutaneous markers are rash, chilblains, and urticaria. Skin lesions may be the first manifestation of COVID-19, accompany initial respiratory symptoms, or appear during the disease course. Symptoms associated with vascular changes (livedo reticularis and vasculitis) are considered of poor prognosis.

Unusual cutaneous lesions in two patients with visceral leishmaniasis and HIV infection

1999 ◽  
Vol 41 (5) ◽  
pp. 847-850 ◽  
Author(s):  
Robert Colebunders ◽  
Katrien Depraetere ◽  
Thomas Verstraeten ◽  
Julian Lambert ◽  
Esther Hauben ◽  
...  
Keyword(s):  
Visceral Leishmaniasis ◽  
Hiv Infection ◽  
Cutaneous Lesions

scholarly journals Cryptococcosis in pregnancy and the postpartum period: Case series and systematic review with recommendations for management

2019 ◽  
Vol 58 (3) ◽  
pp. 282-292
Author(s):  
Katelyn A Pastick ◽  
Elizabeth Nalintya ◽  
Lillian Tugume ◽  
Kenneth Ssebambulidde ◽  
Nicole Stephens ◽  
...  
Keyword(s):  
Survival Rate ◽  
Pregnant Women ◽  
Amphotericin B ◽  
Cryptococcal Meningitis ◽  
Treatment Guidelines ◽  
Case Reports ◽  
Case Series ◽  
First Trimester ◽  
Secondary Prophylaxis ◽  
Fetal Survival

Abstract Cryptococcal meningitis causes 15% of AIDS-related deaths. Optimal management and clinical outcomes of pregnant women with cryptococcosis are limited to case reports, as pregnant women are often excluded from research. Amongst pregnant women with asymptomatic cryptococcosis, no treatment guidelines exist. We prospectively identified HIV-infected women who were pregnant or recently pregnant with cryptococcosis, screened during a series of meningitis research studies in Uganda from 2012 to 2018. Among 571 women screened for cryptococcosis, 13 were pregnant, one was breastfeeding, three were within 14 days postpartum, and two had recently miscarried. Of these 19 women (3.3%), 12 had cryptococcal meningitis, six had cryptococcal antigenemia, and one had a history of cryptococcal meningitis and was receiving secondary prophylaxis. All women with meningitis received amphotericin B deoxycholate (0.7–1.0 mg/kg). Five were exposed to 200–800 mg fluconazole during pregnancy. Of these five, three delivered healthy babies with no gross physical abnormalities at birth, one succumbed to meningitis, and one outcome was unknown. Maternal meningitis survival rate at hospital discharge was 75% (9/12), and neonatal/fetal survival rate was 44% (4/9) for those mothers who survived. Miscarriages and stillbirths were common (n = 4). Of six women with cryptococcal antigenemia, two received fluconazole, one received weekly amphotericin B, and three had unknown treatment courses. All women with antigenemia survived, and none developed clinical meningitis. We report good maternal outcomes but poor fetal outcomes for cryptococcal meningitis using amphotericin B, without fluconazole in the first trimester, and weekly amphotericin B in place of fluconazole for cryptococcal antigenemia.

scholarly journals Leprosy in Refugees and Migrants in Italy and a Literature Review of Cases Reported in Europe between 2009 and 2018

2020 ◽  
Vol 8 (8) ◽  
pp. 1113
Author(s):  
Anna Beltrame ◽  
Gianfranco Barabino ◽  
Yiran Wei ◽  
Andrea Clapasson ◽  
Pierantonio Orza ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Wide Spectrum ◽  
Case Reports ◽  
Case Series ◽  
Skin Lesions ◽  
Clinical Suspicion ◽  
High Risk Population ◽  
European Guidelines ◽  
Eye Involvement ◽  
Multibacillary Leprosy

Leprosy is a chronic neglected infectious disease that affects over 200,000 people each year and causes disabilities in more than four million people in Asia, Africa, and Latin America. The disease can appear with a wide spectrum of clinical forms, and therefore the clinical suspicion is often difficult. Refugees and migrants from endemic countries affected by leprosy can remain undiagnosed in Europe due to the unpreparedness of clinicians. We retrospectively describe the characteristics of 55 refugees/migrants with a diagnosis of leprosy established in Italy from 2009 to 2018. Continents of origin were Africa (42%), Asia (40%), and South and Central America (18%). The symptoms reported were skin lesions (91%), neuropathy (71%), edema (7%), eye involvement (6%), fever (6%), arthritis (4%), and lymphadenopathy (4%). Seven patients (13%) had irreversible complications. Overall, 35% were relapses and 66% multibacillary leprosy. Furthermore, we conducted a review of 17 case reports or case series and five nationwide reports, published in the same decade, describing 280 migrant patients with leprosy in Europe. In Europe, leprosy is a rare chronic infectious disease, but it has not completely disappeared. Diagnosis and treatment of leprosy in refugees and migrants from endemic countries are a challenge. European guidelines for this neglected disease in this high-risk population would be beneficial.

Fatal Pneumocystis jirovecii pneumonia in a non-immunocompromised patient with alcohol-related liver cirrhosis

2019 ◽  
Vol 64 (4) ◽  
pp. 148-153 ◽  
Author(s):  
Nicholas J Hadfield ◽  
Subothini Selvendran ◽  
Michael P Johnston
Keyword(s):  
Risk Factors ◽  
Liver Cirrhosis ◽  
Hiv Infection ◽  
Alcoholic Hepatitis ◽  
Case Reports ◽  
Fatal Case ◽  
Case Series ◽  
Pneumocystis Jirovecii ◽  
Pneumocystis Jirovecii Pneumonia ◽  
Acute Alcoholic Hepatitis

This report presents the fatal case of a 63-year-old man with a new presentation of liver cirrhosis, presumed concurrent acute alcoholic hepatitis and development of Pneumocystis jirovecii pneumonia. The patient had none of the traditional immunosuppressing risk factors associated with Pneumocystis jirovecii pneumonia such as corticosteroid use, haematological malignancy or HIV infection. In the literature, there are two case reports and a case series of two patients which describe the development of Pneumocystis jirovecii pneumonia in acute alcoholic hepatitis. However, all of these previously described cases include identifiable risk factors – namely corticosteroid use and HIV infection. This case suggests that special consideration should be given to Pneumocystis jirovecii pneumonia as a cause of opportunistic infection in acute alcoholic hepatitis.

scholarly journals Visceral Leishmaniasis in pregnancy and vertical transmission: A systematic literature review on the therapeutic orphans

2021 ◽  
Vol 15 (8) ◽  
pp. e0009650
Author(s):  
Prabin Dahal ◽  
Sauman Singh-Phulgenda ◽  
Brittany J. Maguire ◽  
Eli Harriss ◽  
Koert Ritmeijer ◽  
...  
Keyword(s):  
Visceral Leishmaniasis ◽  
Pregnant Women ◽  
Amphotericin B ◽  
Vertical Transmission ◽  
Liposomal Amphotericin ◽  
Case Reports ◽  
Case Series ◽  
Liposomal Amphotericin B ◽  
Cochrane Central Register ◽  
In Pregnancy

Background Reports on the occurrence and outcome of Visceral Leishmaniasis (VL) in pregnant women is rare in published literature. The occurrence of VL in pregnancy is not systematically captured and cases are rarely followed-up to detect consequences of infection and treatment on the mother and foetus. Methods A review of all published literature was undertaken to identify cases of VL infections among pregnant women by searching the following database: Ovid MEDLINE; Ovid Embase; Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials; World Health Organization Global Index Medicus: LILACS (Americas); IMSEAR (South-East Asia); IMEMR (Eastern Mediterranean); WPRIM (Western Pacific); ClinicalTrials.gov; and the WHO International Clinical Trials Registry Platform. Selection criteria included any clinical reports describing the disease in pregnancy or vertical transmission of the disease in humans. Articles meeting pre-specified inclusion criteria and non-primary research articles such as textbook, chapters, letters, retrospective case description, or reports of accidental inclusion in trials were also considered. Results The systematic literature search identified 272 unique articles of which 54 records were included in this review; a further 18 records were identified from additional search of the references of the included studies or from personal communication leading to a total of 72 records (71 case reports/case series; 1 retrospective cohort study; 1926–2020) describing 451 cases of VL in pregnant women. The disease was detected during pregnancy in 398 (88.2%), retrospectively confirmed after giving birth in 52 (11.5%), and the time of identification was not clear in 1 (0.2%). Of the 398 mothers whose infection was identified during pregnancy, 346 (86.9%) received a treatment, 3 (0.8%) were untreated, and the treatment status was not clear in the remaining 49 (12.3%). Of 346 mothers, Liposomal amphotericin B (L-AmB) was administered in 202 (58.4%) and pentavalent antimony (PA) in 93 (26.9%). Outcomes were reported in 176 mothers treated with L-AmB with 4 (2.3%) reports of maternal deaths, 5 (2.8%) miscarriages, and 2 (1.1%) foetal death/stillbirth. For PA, outcomes were reported in 88 mothers of whom 4 (4.5%) died, 24 (27.3%) had spontaneous abortion, 2 (2.3%) had miscarriages. A total of 26 cases of confirmed, probable or suspected cases of vertical transmission were identified with a median detection time of 6 months (range: 0–18 months). Conclusions Outcomes of VL treatment during pregnancy is rarely reported and under-researched. The reported articles were mainly case reports and case series and the reported information was often incomplete. From the studies identified, it is difficult to derive a generalisable information on outcomes for mothers and babies, although reported data favours the usage of liposomal amphotericin B for the treatment of VL in pregnant women.

scholarly journals Multiple Myeloma - Atypical Presentation - Clinicopathological Correlation

2021 ◽  
Vol 10 (40) ◽  
pp. 3526-3532
Author(s):  
Emani Usha Bhargavi ◽  
Vaddadi Suresh
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Plasma Cells ◽  
Wide Spectrum ◽  
Case Series ◽  
Malignant Neoplasm ◽  
Routine Practice ◽  
Cutaneous Lesions ◽  
Clinical Presentations ◽  
Case Series Study

BACKGROUND Multiple myeloma, malignant neoplasm of plasma cells producing monoclonal para protein is one of the most common haematological malignancies we see in our routine practice. Multiple myeloma has varied and diverse clinical presentations, of which most common clinical features will be anaemia, bone pain, fever, fatigue, weight loss, paraesthesia, renal failure, pathological fractures, cutaneous lesions, etc. We hereby, present a series of multiple myeloma cases with unusual presentation over a period of 3 years. The purpose of the study was to evaluate the unusual and rare clinicohaematological presentation in patients with multiple myeloma. METHODS In this case series study, we reviewed bone marrow aspirate & / or biopsy slides in our hospital from January 2017 to January 2020. Patients diagnosed with multiple myeloma were selected. Patients’ clinical information, haematological and other findings were obtained from the medical records department and compiled, and correlation was done. RESULTS We came across a total of 9 cases of multiple myeloma with very unusual and rare clinical presentations. A thorough clinical, radiological, haematological, biochemical and histopathological correlation was done before giving a final diagnosis in these cases. Rare cutaneous and other involvement of multiple myeloma was noted. CONCLUSIONS Multiple myeloma is the most common malignancy with comparatively poor prognosis. However, early diagnosis of multiple myeloma always helps the clinician in improving the outcome and has been shown to have better prognosis. The present case series is an attempt to understand the clinico-pathological correlation, wide spectrum of clinical presentation and associated rarity of presentations. KEY WORDS Myeloma; Lytic Lesions; Bone Marrow

scholarly journals Characterization of a case series of Mastocytosis in a health care center in Cali, Colombia

2021 ◽  
Author(s):  
Daniela Marulanda Sandoval ◽  
Oscar Felipe Borja Montes ◽  
Jose Leonel Zambrano Urbano ◽  
Rigoberto Gomez Gutierrez
Keyword(s):  
World Literature ◽  
Case Reports ◽  
Care Center ◽  
Clinical Manifestations ◽  
Case Series ◽  
Poor Response ◽  
Skin Lesions ◽  
Serum Tryptase ◽  
Health Care Center

Abstract Mastocytosis is a group of rare diseases, which correspond to neoplasms of the myeloid lineage. In Colombia there are only case reports and so far there are no studies of greater extension. We conducted a case series in which an active search was made for patients with a diagnosis of mastocytosis, either cutaneous (CM) or systemic (SM), from the total number of consultations between June 2004 and June 2019 in the reference hemato-oncologic center ("mastocytosis"). A total of 4 cases of CM and 3 cases of SM were identified. The most frequent clinical manifestations were skin lesions, which were present in 100% of patients; of these hyperpigmented macules were the most frequent findings. Serum tryptase (TS) levels were found to be elevated in 67% (2/3) of patients with DM. Both TS levels and mean absolute eosinophils were higher in patients with MS. In this case series we found a higher frequency of extracutaneous involvement, and in general a very poor response to the management. The findings of this series are comparable to those reported in world literature.

scholarly journals New-onset cutaneous sarcoidosis under tocilizumab treatment for giant cell arteritis: a quasi-paradoxical adverse drug reaction. Case report and literature review

2019 ◽  
Vol 11 ◽  
pp. 1759720X1984179 ◽  
Author(s):  
Rosaria Del Giorno ◽  
Alfonso Iodice ◽  
Cristina Mangas ◽  
Luca Gabutti
Keyword(s):  
Case Report ◽  
Clinical Response ◽  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Case Reports ◽  
Skin Lesions ◽  
Cutaneous Sarcoidosis ◽  
Cutaneous Lesions ◽  
Topical Corticosteroids ◽  
New Onset

Background: New-onset sarcoidosis has been previously described in three case reports in patients affected by rheumatoid arthritis treated with tocilizumab (TCZ). The existence of a cause–effect mechanism between the biological treatment and the onset of the illness is still being debated. Patient concerns: A 74-year-old woman was diagnosed with giant cell arteritis (GCA). The first-line treatment with glucocorticoids; and the second-line with methotrexate and low-dose glucocorticoids were stopped due to multiple pathological vertebral fractures and insufficient biological and clinical response. The cytotoxic agent, cyclophosphamide, was then introduced and in turn stopped, because of gastrointestinal side effects. Thereafter a treatment with TCZ was begun. The patient experienced good clinical response; however, 8 months later she developed painful hyper-pigmented reddish cutaneous micronodular lesions localized to the abdomen and thorax. A cutaneous biopsy was performed, and histological analysis showed noncaseating epithelioid granulomas in the hypodermis. The diagnosis of cutaneous sarcoidosis was made. Interventions: Topical corticosteroids were administered and, as requested by the patient, TCZ was discontinued with slow but complete resolution of the skin lesions. After TCZ discontinuation however, the GCA flared and the patient’s symptoms and biological abnormalities reappeared. Thus, after a 6-month suspension, TCZ was re-administered. At 2 months later the skin lesions compatible with cutaneous sarcoidosis reappeared. Topical corticosteroids were once again prescribed and as suggested by the patient the TCZ posology was reduced. The patient’s symptoms disappeared, and the cutaneous lesions resolved. Lessons: The time elapsed from TCZ treatment start and the onset of cutaneous sarcoidosis, as well as its recurrence after TCZ suspension and rechallenge supported the diagnosis of a drug-induced reaction. To the best of our knowledge, this case report represents the first instance of cutaneous sarcoidosis most likely induced by TCZ in patients affected by GCA. In addition, our case emphasizes that although TCZ in monotherapy confirms to be an effective treatment for GCA, further immunological disorders could be unmasked, and the discussed side effect of the drug could be dose-dependent.

scholarly journals Acute Myeloid Leukemia in Patients Living with HIV Infection: Several Questions, Fewer Answers

2020 ◽  
Vol 21 (3) ◽  
pp. 1081
Author(s):  
Fabio Forghieri ◽  
Vincenzo Nasillo ◽  
Francesca Bettelli ◽  
Valeria Pioli ◽  
Davide Giusti ◽  
...  
Keyword(s):  
Acute Myeloid Leukemia ◽  
Hiv Infection ◽  
Myeloid Leukemia ◽  
Case Reports ◽  
Case Series ◽  
People Living With Hiv ◽  
Hematopoietic Stem ◽  
Molecular Features ◽  
Living With Hiv ◽  
Acute Myeloid

Both human immunodeficiency virus (HIV) infection and acute myeloid leukemia (AML) may be considered relatively uncommon disorders in the general population, but the precise incidence of AML in people living with HIV infection (PLWH) is uncertain. However, life expectancy of newly infected HIV-positive patients receiving anti-retroviral therapy (ART) is gradually increasing, rivaling that of age-matched HIV-negative individuals, so that the occurrence of AML is also expected to progressively increase. Even if HIV is not reported to be directly mutagenic, several indirect leukemogenic mechanisms, mainly based on bone marrow microenvironment disruption, have been proposed. Despite a well-controlled HIV infection under ART should no longer be considered per se a contraindication to intensive chemotherapeutic approaches, including allogeneic hematopoietic stem cell transplantation, in selected fit patients with AML, survival outcomes are still generally unsatisfactory. We discussed several controversial issues about pathogenesis and clinical management of AML in PLWH, but few evidence-based answers may currently be provided, due to the limited number of cases reported in the literature, mainly as case reports or small retrospective case series. Prospective multicenter clinical trials are warranted to more precisely investigate epidemiology and cytogenetic/molecular features of AML in PLWH, but also to standardize and further improve its therapeutic management.

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