scholarly journals Granulomatosis with Polyangiitis Presenting as Pauci-Immune Crescentic Glomerulonephritis in Pregnancy

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Ryan Kunjal ◽  
Raafat Makary ◽  
Andreea Poenariu
Keyword(s):  
Crescentic Glomerulonephritis ◽  
Granulomatosis With Polyangiitis ◽  
African American Woman ◽  
Hyperemesis Gravidarum ◽  
American Woman ◽  
Reproductive Age ◽  
Urine Sediment ◽  
Cutaneous Manifestations ◽  
First Case ◽  
In Pregnancy

Antineutrophil cytoplasmic antibody (ANCA) associated vasculitis rarely affects females of reproductive age. A 28-year-old African American woman presented at 8 weeks of gestation with intractable vomiting attributed to hyperemesis gravidarum. She was found to have acute kidney injury that was unresponsive to vigorous fluid resuscitation and urine sediment examination was suggestive of an underlying glomerulonephritis. Serum c-ANCA and PR3 were elevated and there was no peripheral eosinophilia. During her course she also developed one episode of small volume hemoptysis with right upper lobe infiltrates on CT Chest. There were no cutaneous manifestations of vasculitis or upper respiratory symptoms. Renal biopsy revealed a pauci-immune crescentic glomerulonephritis (PICGN). The diagnosis was consistent with granulomatosis with polyangiitis (GPA). Management initially comprised teratogen sparing agents; steroids, intravenous immunoglobulin; and plasma exchange. The response was suboptimal and she became dependent on daily renal replacement therapy. Ultimately the pregnancy was terminated allowing for traditional treatment approaches with dramatic effect. This is the first case of GPA presenting as PICGN in pregnancy and highlights the challenges of its management.

scholarly journals Ciprofloxacin-Induced Thrombotic Thrombocytopenic Purpura: A Case of Successful Treatment and Review of the Literature

2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Hafiz Rizwan Talib Hashmi ◽  
Gilda Diaz-Fuentes ◽  
Preeti Jadhav ◽  
Misbahuddin Khaja
Keyword(s):  
Thrombotic Thrombocytopenic Purpura ◽  
African American Woman ◽  
American Woman ◽  
Successful Outcome ◽  
Peripheral Smear ◽  
Thrombocytopenic Purpura ◽  
Aggressive Management ◽  
First Case ◽  
High Index Of Suspicion ◽  
Elevated Lactate

A 49-year-old African American woman was admitted to our hospital with abdominal pain, nausea, vomiting, lethargy, and confusion. She was receiving ciprofloxacin for a urinary-tract infection prior to admission. Laboratory examination revealed anemia, thrombocytopenia, elevated lactate dehydrogenase, and serum creatinine. Peripheral smear showed numerous schistocytes, and the patient was diagnosed with thrombotic thrombocytopenic purpura (TTP). Ciprofloxacin was identified as the offending agent. The patient received treatment with steroids and plasmapheresis, which led to rapid clinical recovery. This is the first case to our knowledge of successfully treated ciprofloxacin-induced TTP; previously reported cases had fulminant outcomes. Quinolones are an important part of the antibiotic armamentarium, and this case can raise awareness of the association between quinolones and TTP. A high index of suspicion for detection and early and aggressive management are vitally important for a successful outcome.

Meningitis and Hepatitis Complicating Intravenous Immunoglobulin Therapy

1996 ◽  
Vol 30 (10) ◽  
pp. 1115-1116 ◽  
Author(s):  
Andrew F. Shorr ◽  
Kent E. Kester
Keyword(s):  
African American Woman ◽  
American Woman ◽  
Ivig Therapy ◽  
Immunoglobulin Therapy ◽  
Intravenous Immunoglobulin Therapy ◽  
Autoimmune Syndrome ◽  
First Case ◽  
Acute Meningitis ◽  
Direct Toxicity ◽  
Infectious Etiology

OBJECTIVE: To report a case of concomitant meningitis and hepatitis complicating the use of intravenous immune globulin (IVIG). CASE SUMMARY: A 39-year-old African-American woman with an autoimmune syndrome developed both acute meningitis and hepatitis following administration of IVIG. These resolved over several days and left no sequellae. DISCUSSION: This represents the first case of concomitant acute meningitis and hepatitis associated with IVIG. Thorough microbiologic and serologic evaluation of the patient failed to demonstrate an infectious etiology. We postulate that our patient's syndrome resulted from direct toxicity of IVIG. CONCLUSIONS: Both acute meningitis and hepatitis may simultaneously complicate IVIG therapy. The specific mechanism remains unclear.

scholarly journals A Follicular Stimulating Hormone Secreting Adenoma

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A565-A565
Author(s):  
Mary De Croos ◽  
John Vender ◽  
Ghada Elshimy ◽  
Maximillian Stachura
Keyword(s):  
African American Woman ◽  
American Woman ◽  
Biologically Active ◽  
Reproductive Age ◽  
Ovarian Cysts ◽  
Rapid Decline ◽  
Surgical Removal ◽  
Reproductive Age Women ◽  
Follicular Stimulating Hormone ◽  
Stimulating Hormone

Abstract A gonadotroph secreting pituitary adenoma, a rare endocrinopathy, is often overlooked due to ambiguous symptoms leading to other diagnoses, such as ovarian hyperstimulation syndrome (OHSS). A 53 year old African American woman presented for evaluation of a 4 month history of right hemianopsia. Her past medical history included a total hysterectomy and bilateral oophorosalpingectomy for recurrent ovarian cysts 11 years prior. Initial MRI:4.1x3.6x3.9 cm pituitary macroadenoma with prechiasmtic optic nerve compression. Initial laboratory studies: follicular stimulating hormone (FSH) level 186.83 mIU/mL (RR:23.0-116.3 mIU/mL) and luteinizing hormone (LH) 14.44 mIU/mL (RR:15.9-54.0 mIU/mL). Other pituitary labs were unremarkable. Debulking surgery was performed to relieve mass effect; pathology showed an FSH immunoreactive adenoma. Postoperatively, FSH was 2.55 mIU/mL and LH was 0.75 mIU/mL. The prevalence of pituitary adenomas is 80-100 per 100,000 persons; 15-30% are non-functional. The majority of gonadotroph adenomas are difficult to identify because they may not produce biologically active hormones. Clinically functioning gonadotroph adenomas are very rare, often macroadenomas when found, most often found in reproductive age women, and preferentially secrete FSH. In reproductive age women, a FSH secreting adenomas may present clinically with OHSS, with multiple large ovarian cysts found on ultrasound for menstrual or pelvic complaints as seen in our patient. While OHSS is a known complication of assisted reproductive procedures, spontaneous OHSS is atypical and suggests need for evaluation of a FSH-secreting adenoma. Men may present with macroorchidism. Children may present with precocious puberty. The treatment of choice is surgical removal of the adenoma, normalizing FSH to an age appropriate level. When OHSS is present, this results in a rapid decline in estradiol level and regression of ovarian cysts. Medical treatment, if surgery is contraindicated, is limited to cabergoline, which can initially decrease FSH and estradiol levels. In patients with normal pituitary function, gonadotropin-releasing hormone agonists acutely stimulate LH and FSH, thereby desensitizing GnRH receptors and decreasing gonadotropin secretion. In patients with FSH-secreting adenomas, they may have a persistent stimulatory effect, and in rare cases, result in pituitary apoplexy. Tumors that cannot be completely surgically removed may be treated by adjuvant radiotherapy or radiosurgery.

Human Herpesvirus-8–Positive Microvenular Hemangioma in POEMS Syndrome

2003 ◽  
Vol 127 (8) ◽  
pp. 1034-1036 ◽  
Author(s):  
S. David Hudnall ◽  
Tiansheng Chen ◽  
Kelty Brown ◽  
Tiffany Angel ◽  
Mary R. Schwartz ◽  
...  
Keyword(s):  
Endothelial Cells ◽  
African American Woman ◽  
American Woman ◽  
Human Herpesvirus ◽  
Castleman Disease ◽  
Human Herpesvirus 8 ◽  
Herpesvirus 8 ◽  
First Case ◽  
Initial Symptoms ◽  
Night Sweats

Abstract We report a case of POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome in a 55-year-old African American woman in which human herpesvirus-8 (HHV-8) was demonstrated within rare lymphocytes in a Castleman disease lymph node biopsy and numerous endothelial cells and lymphocytes in a microvenular hemangioma skin biopsy. Initial symptoms and findings of night sweats, weight loss, anorexia, generalized lymphadenopathy, and hemangiomas improved after chemotherapy with cyclophosphamide and prednisone. However, in the year following the initial diagnosis, the patient suffered from recurrent bouts of night sweats, gastroparesis, and lymphadenopathy, which required further treatment with plasmapheresis, cyclophosphamide, prednisone, and rituximab. One year later, the patient is asymptomatic but has persistent gammopathy. Although HHV-8 has previously been detected in POEMS-associated Castleman disease tissue, to our knowledge, this is the first case report in which HHV-8 has been directly demonstrated within the endothelial cells of a POEMS-associated hemangioma.

scholarly journals Abscopal effect in pulmonary carcinoid tumor following ablative stereotactic body radiation therapy: a case report

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Samuel A. Kareff ◽  
Jonathan W. Lischalk ◽  
Rebecca Krochmal ◽  
Chul Kim
Keyword(s):  
Radiation Therapy ◽  
Stereotactic Body Radiation Therapy ◽  
African American Woman ◽  
American Woman ◽  
Lower Lobe ◽  
Antigen Expression ◽  
Abscopal Effect ◽  
Pulmonary Carcinoid ◽  
Stereotactic Body Radiation ◽  
First Case

Abstract Background The abscopal effect was described as early as the 1950s, when untreated tumors demonstrated a response after radiation therapy was delivered to an untreated, distant site. The mechanisms underlying this global response to otherwise localized therapy remain unknown, though there is increasing evidence that increased antigen expression following ablative radiotherapy may play a role. Case presentation We report a case of a 69-year-old African American woman with a history of metastatic typical pulmonary carcinoid with multiple lung nodules who had a significant decrease in size of an untreated left upper lobe nodule after stereotactic body radiation therapy to an oligoprogressive left lower lobe lesion. Conclusions To our knowledge, this report describes the first case of an abscopal effect in a typical pulmonary carcinoid. Further research is needed regarding the mechanisms responsible for this finding and the role of combining radiation therapy and cancer immunotherapy in patients with pulmonary carcinoid tumors.

THYROTOXICOSIS IN PREGNANCY

2013 ◽  
Vol 24 (2) ◽  
pp. 108-128 ◽  
Author(s):  
H V WRIGHT ◽  
D J WILLIAMS
Keyword(s):  
Hyperemesis Gravidarum ◽  
Type I Diabetes ◽  
Normal Pregnancy ◽  
Conclusive Evidence ◽  
Reproductive Age ◽  
Physiological Adaptation ◽  
Thyroid Peroxidase ◽  
Type I ◽  
Increased Risk ◽  
In Pregnancy

Thyrotoxicosis affects approximately 1:500 women of reproductive age. Untreated or poorly controlled thyrotoxicosis in pregnancy is associated with significant maternal and perinatal morbidity. Recognition and diagnosis of new onset thyrotoxicosis in pregnancy can be challenging as many of the symptoms can be misattributed to physiological adaptation of normal pregnancy. Women with hyperemesis gravidarum (HG) often have biochemical, but not clinical evidence of thyrotoxicosis, which does not need treatment with anti-thyroid drugs (ATDs). For women with clinical thyrotoxicosis, uncertainty regarding the risks of teratogenicity due to ATDs has led to new guideline recommendations for their use in pregnancy. Women with autoimmune diseases such as type I diabetes and who have thyroid peroxidase antibodies (TPOAb) are at an increased risk of developing postpartum thyroiditis, which can result in permanent hypothyroidism. This review summarises the management of thyrotoxicosis in pregnancy and highlights controversial areas for which conclusive evidence is still lacking.

Merle’s travel: A Quest For Completeness In Paule Marshall’s The chosen place, the timeless people.

2019 ◽  
Vol 5 (4) ◽  
pp. 36-42
Author(s):  
Dr. K. Radah ◽  
G. Gayathri
Keyword(s):  
African American ◽  
Social Context ◽  
African American Women ◽  
African American Woman ◽  
American Woman ◽  
Community Level ◽  
Dominant Culture ◽  
True Self ◽  
American Women ◽  
Human Need

African American women have been silenced and kept ignorant by the dominant culture and it is the human need to create and maintain a true self in a social context. However, such an endeavor becomes an ordeal for those who are doubly oppressed, for those who are muted and mutilated physically and psychically through the diabolic crossfire of caste/race, sex and colonialism. This paper focuses on, an African American Woman, throughout her journey of life, seeking completeness in terms of family, society and community level.

Self-Reflective Insights on What I Have Learned in an Evolving Academic Career Model: Accounting Scholarship, Administration, and Diversity

2018 ◽  
Vol 33 (3) ◽  
pp. 5-16 ◽  
Author(s):  
Carolyn M. Callahan
Keyword(s):  
African American Woman ◽  
Academic Career ◽  
American Woman ◽  
Vantage Point ◽  
Business College ◽  
Personal Experiences ◽  
Career Model ◽  
Accounting Model ◽  
The Impact

ABSTRACT In this paper, I offer personal insights based on my experiences (thus far) in an evolving academic accounting career model. While I value all aspects of an academic career responsibilities (teaching, research, and service), this narrative focuses primarily on the role of accounting scholarship and, broadly, the impact of diversity on the same. I offer these perspectives and personal experiences from the unique vantage point as an African American woman, focused first on contributing to top-tired accounting scholarship, and more recently on roles as an administrator of an accounting department and business college. While my academic journey is unique by objective measures (often dubbed “trailblazing” by others), I offer suggestions that may be useful to any academic who is dedicated to success in our field. Given the evolving accounting model and challenges ahead, my overriding goal remains to encourage junior accounting colleagues to persevere, as an accounting academic career is richly rewarding.

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