scholarly journals E-Cigarette or Vaping Product Use-Associated Lung Injury (EVALI) Mimicking COVID-19 Disease

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Jose A. Rodriguez ◽  
Alejandra A. Roa ◽  
Juan C. Lemos-Ramirez
Keyword(s):  
White Blood Cells ◽  
Vital Signs ◽  
South Florida ◽  
Respiratory Pathogen ◽  
High Dose ◽  
Reactive Protein ◽  
Patient Reported ◽  
Empiric Antibiotic ◽  
The Usa ◽  
History Of

Background. Coronavirus 2 (SARS-CoV-2) is the virus associated with the coronavirus disease (COVID-19) causing a pandemic worldwide in 2020. There are other noninfectious diseases that can present exactly as COVID-19, and the management and approach are completely different, hence the importance of understanding and having a wide differential in patients presenting with similar characteristics. Case Report. A 23-year-old male, with a history of childhood asthma, presented to the Emergency Department in a hospital in south Florida in the USA with complaints of a 2-day duration of subjective fever, chills, dry cough, dyspnea, and myalgia. His vital signs were blood pressure 135/65 mmHg, temperature 39°C, pulse 134 bpm, respiratory rate 22 breaths per minute, and saturation of oxygen 96% in room air. Laboratory analysis was significant for white blood cells 15.3 × 10 3 /μL, ALT 69 U/L, AST 66 U/L, ferritin 375.6 ng/mL, C-reactive protein 27.70 mg/dL, and procalcitonin 1.43 ng/mL. A respiratory pathogen panel (RPP) and a SARS-CoV-2 test were both negative. The patient was given empiric antibiotic treatment and hydroxychloroquine. Two more tests for SARS-CoV-2 were negative, and the patient reported that he smoked marijuana through an e-cigarette. The patient was started on high-dose steroids, and symptoms improved. Conclusion. COVID-19 is an emergent lung disease that is affecting the population worldwide; many other noninfectious diseases can mimic its presentations and laboratory characteristics; the importance of having a broad differential diagnosis especially in causing confusion during pandemic times is valuable in the management of patients with such presentations, such as EVALI, and glucocorticoids will be indicated in this circumstances.

929 Not Another Abscess - A Case of Streptococcal Myositis Misdiagnosed as a Right Axillary Abscess

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
O Oyende ◽  
J Jackman
Keyword(s):  
White Cell Count ◽  
General Surgeon ◽  
High Dose ◽  
General Anaesthetic ◽  
Microbiological Analysis ◽  
Reactive Protein ◽  
Affected Tissue ◽  
Life Threatening ◽  
History Of ◽  
High Degree

Abstract Introduction Streptococcal myositis is a rare form of infectious myositis caused by Lansfield A beta-haemolytic streptococci. It is characterised by rapidly spreading inflammation that can result in severe systemic toxicity and necrosis of the affected tissue if not diagnosed and aggressively treated. Presentation We report a case of a 42-year-old male who presented with a one-week history of worsening right axillary swelling that progressed to painful swelling of his arm. Inflammatory markers were significantly elevated with a white cell count of 17 ×109/L and C-reactive protein of 212 mg/L. On examination, a fluctuant axillary swelling was appreciated, and a decision was made for incision and drainage under general anaesthetic. Intraoperative aspiration of his arm revealed copious purulent fluid prompting intraoperative orthopaedic consult and exploration of the anterior compartment in which there was extensive involvement of the biceps muscle. The microbiological analysis revealed gram-positive cocci in chains, and microbiology advice sought for tailoring of antibiotic regimen. He has recovered well. Discussion Though uncommon, the emergency general surgeon should have a high degree of suspicion when evaluating soft tissue infections to avert potentially disastrous outcomes. Conclusion Early diagnosis, aggressive management with high-dose intravenous antibiotics, and surgical debridement are principles to treat this rare, life-threatening infection.

scholarly journals Chondrosternal Arthritis in Infant: An Unusual Entity

2014 ◽  
Vol 2014 ◽  
pp. 1-4
Author(s):  
Athina Nikolarakou ◽  
Dana Dumitriu ◽  
Pierre-Louis Docquier
Keyword(s):  
Clinical Symptoms ◽  
Therapeutic Option ◽  
White Blood Cells ◽  
Laboratory Data ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
History Of ◽  
Local Tenderness ◽  
Wait And See

Primary arthritis of chondrosternal joint is very rare and occurs in infants less than 18 months of age. Presentation is most often subacute but may be acute. Child presents with a parasternal mass with history of fever and/or local signs of infection. Clinical symptoms vary from a painless noninflammatory to a painful mass with local tenderness and swelling, while fever may be absent. Laboratory data show low or marginally raised levels of white blood cells and C-reactive protein, reflecting, respectively, the subacute or acute character of the infection. It is a self-limiting affection due to the adequate immune response of the patient. Evolution is generally good without antibiotherapy with a progressive spontaneous healing. A wait-and-see approach with close follow-up in the first weeks is the best therapeutic option.

scholarly journals Lipid Emulsion Treatment in Tricyclic Antidepressant Poisoning in Children: An Observational Cohort Study

2021 ◽  
pp. 14-17
Author(s):  
Esra Türe ◽  
Fatih Akın ◽  
Abdullah Yazar ◽  
Ahmet Osman Kılıç
Keyword(s):  
Vital Signs ◽  
Cardiovascular Complications ◽  
Pediatric Emergency ◽  
Tricyclic Antidepressant ◽  
High Dose ◽  
History Of ◽  
Observational Cohort ◽  
Poisoning In Children ◽  
Conduction Disorder ◽  
Basic Treatment

Tricyclic antidepressant (TCA) poisonings are among the most common childhood poisonings because of being cheap and readily available. In this manuscript, we aimed to share our experience with Intravenous lipid emulsions (ILE) treatment in addition to basic treatment steps and discussion of effectiveness of treatment in cases of poisoning caused by high-dose TCA intake. From the patients under 18 years of age who admitted to Pediatric Emergency Department due to drug intoxication between January 2014 and December 2019; those who had history of exposure to TCAs were included in our study. In conclusion of examination of six-year patient records, it was determined that there were a total of 619 intoxication cases and 108 (17.4%) of these were TCA poisoning. 21 (19.4%) patients who had hypotension, tachycardia and ECG changes which were refractory to all basic treatment steps were administered ILE. After ILE treatment, a marked improvement was observed in patients’ clinical and ECG findings, as well as vital signs. Early administration of ILE treatment in emergency departments for cases with hypotension, conduction disorder, dysrhythmia or widened QRS which are refractory to sodium bicarbonate is thought to prevent potential cardiovascular complications.

Relapsing polychondritis: an unusual cause of sore throat, painful ear swelling and bilateral costal margin pain

2021 ◽  
Vol 14 (2) ◽  
pp. e238646
Author(s):  
Shuang Wang ◽  
Christopher Chi ◽  
Dan Xu ◽  
Yujin Ye
Keyword(s):  
Sore Throat ◽  
Relapsing Polychondritis ◽  
High Dose ◽  
Costal Margin ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Erythrocyte Sedimentation ◽  
Auricular Chondritis ◽  
Minimal Improvement ◽  
History Of

A 54-year-old Chinese woman presented with a 3-month history of sore throat and dry cough, which was treated as chronic pharyngitis with minimal improvement. One month ago, she presented with painful right ear swelling without signs or symptoms of otitis media or otitis externa. She was treated with antibiotics and antiviral drugs without any improvement. Two weeks prior to her presentation to hospital, she developed bilateral costal margin pain with raised C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), mild chronic pharyngitis and painful right ear swelling. All other investigations including bloods and imaging were non-specific. Her painful right auricle swelling prompted the diagnosis of relapsing polychondritis (RP), which was supported by clinical improvement with high-dose corticosteroids. RP is a clinical diagnosis with non-specific inflammation of affected cartilage. It is a diagnosis of exclusion and early diagnosis can be made by the most common presenting feature of auricular chondritis.

Comprehensive Arthritis Referral Study — Phase 2: Analysis of the Comprehensive Arthritis Referral Tool

2014 ◽  
Vol 41 (10) ◽  
pp. 1980-1989 ◽  
Author(s):  
Andrew E. Thompson ◽  
Sara L. Haig ◽  
Nicole G.H. LeRiche ◽  
Gina Rohekar ◽  
Sherry Rohekar ◽  
...  
Keyword(s):  
Referral And Consultation ◽  
Study Phase ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Included Patient ◽  
Patient Reported ◽  
History Of ◽  
Early Inflammatory Arthritis ◽  
Duration Of Disease ◽  
Referral Tool

Objective.Rheumatologists triage referrals to assess those patients who may benefit from early intervention. We describe a referral tool and formally evaluate its sensitivity for urgent and early inflammatory arthritis (EIA) referrals.Methods.All referrals received on a standardized referral tool were reviewed by a rheumatologist and, based on the information conferred, assigned a triage grade using a previously described triage system. Each referral was also dichotomized as suspected EIA or not. After the initial rheumatologic assessment, the diagnosis was recorded and a consultation grade, blinded to referral grade, was assigned to each case. Agreement between referral and consultation grades was assessed. A regression analysis was performed to determine factors that predicted truly urgent referrals including EIA.Results.We evaluated 696 referrals. A total of 210 (30.2%) were categorized as urgent at the time of consultation. The referral tool was able to successfully detect 169 of these referrals (sensitivity 80.5%, specificity 79.4%). EIA occurred in 95 (13.6%); of those referrals, 86 were correctly classified as urgent at the time of triage (sensitivity 90.5%, specificity 69.6%). Items that helped correctly discriminate urgent or EIA referrals included patient age < 60, duration of disease, morning stiffness, patient-reported joint swelling, a personal or family history of psoriasis, urgency as rated by referring physician, prior assessment by a rheumatologist, elevated C-reactive protein, and a positive rheumatoid factor.Conclusion.A 1-page referral tool that includes parts completed by the referring physician and patient has good sensitivity to detect urgent referrals including EIA.

scholarly journals A Case of Rare Autoimmune Pancytopenia Due to Graves’ Disease

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A908-A909
Author(s):  
Ally Wen Wang ◽  
Geeti Mahajan ◽  
Aaron Etra ◽  
Shira R Saul
Keyword(s):  
Bone Marrow ◽  
Rare Complication ◽  
Hematopoietic Cells ◽  
Graves Disease ◽  
High Dose ◽  
Thyroid Function Tests ◽  
Molecular Abnormalities ◽  
Radioiodine Ablation ◽  
Patient Reported ◽  
History Of

Abstract Introduction: Graves’ disease has been associated with cytopenias, most commonly anemia. Pancytopenia is a rare complication and is not often encountered. Case Presentation: A 54-year-old woman with history of multiple sclerosis on alemtuzumab was referred for abnormal thyroid function tests. At the initial visit, the patient reported a 20-pound unintentional weight loss, tremors, sweating and heat intolerance. She was 3 years post-menopausal and had no history of recent viral illness, contrast exposure or family history of thyroid disease. Physical exam revealed an anxious appearing woman with fine tremors in both hands, hyperreflexia but no lid lag or exophthalmos. Labs included TSH &lt;0.005 uIU/mL (0.400-4.2), free T4 2.89 ng/dL (0.80-1.50), TSH receptor binding antibody 8.24 IU/L (&lt; 2.00), TSI 7.27 IU/L (&lt;0.56), WBC 2900/uL (4500-11000), ANC 1746/uL (1900 - 8000), hemoglobin 11.4 g/dL (11.7-15.0) and platelet 207,000/uL (150,000-450,000). Thyroid ultrasound noted sub-centimeter hypoechoic/cystic nodules and 24-hour thyroid uptake showed 56.4% symmetric uptake (upper limit of normal 30%). Due to leukopenia, the patient was started on propranolol and underwent radioiodine ablation with 14.8 mCI. Two weeks later, she reported easily bruising and gum bleeding and her blood work was significant for pancytopenia. The patient was referred to hematology and two bone marrow samples were obtained. Though MDS/MPN was initially suspected based on atypia in both specimens, there were no immunophenotypic, cytogenetic or molecular abnormalities suggesting a neoplastic process. Instead the patient was thought to have autoimmune pancytopenia secondary to Graves’ and the atypia was believed to be secondary to peripheral consumption. She was started on prednisone 1 mg/kg/day with resolution of her cytopenias. Discussion: Graves’ disease has been associated with hematological abnormalities including isolated anemia (the most common), thrombocytopenia or leukopenia. Pancytopenia is an uncommon complication and is rarely described in the literature. The exact mechanism remains unclear, but may be related to either reduced production of hematopoietic cells from the bone marrow or increased destruction of mature hematopoietic cells due to autoantibodies. Since thyroid hormones are known to increase erythropoietin, this leads to an exaggerated consumption of iron, folic acid and vitamin B12 and can cause various forms of anemias. Leukopenia may be secondary to immunologic destruction whereas thrombocytopenia may be due to antiplatelet antibodies or increased splenic sequestration. Pancytopenia is rare. Our patient was treated with high dose prednisone with resolution of her pancytopenia, which suggests an autoimmune process as the mechanism. Our case showcases a rare complication of Graves’ disease and highlights that high dose steroid therapy may improve cytopenias associated with this condition.

Myocarditis and diaphragmatic rhabdomyolysis with respiratory failure in a patient with metastatic melanoma treated with Nivolumab

2021 ◽  
pp. 107815522110674
Author(s):  
Cinzia Baldessari ◽  
Giuseppe Pugliese ◽  
Marta Venturelli ◽  
Stefano Greco ◽  
Leonardo Ferrara ◽  
...  
Keyword(s):  
Adverse Event ◽  
Metastatic Melanoma ◽  
Checkpoint Inhibitors ◽  
Vital Signs ◽  
High Dose ◽  
Diaphragmatic Dysfunction ◽  
Acute Rhabdomyolysis ◽  
Clinical Benefits ◽  
History Of ◽  
Diaphragmatic Weakness

Introduction Immunotherapy dramatically changed history of melanoma patients with a clinical benefit never seen before. Nevertheless, severe and unexpected adverse effects can occur, fortunately rarely. Case presentation We reported the case of a 75-year-old male patient affected by metastatic melanoma who developed myocarditis and acute rhabdomyolysis with secondary diaphragmatic dysfunction and consequent pulmonary restrictive syndrome after Nivolumab monotherapy. Blood tests and ultrasonography of the diaphragm revealing left hypokinesis suggested a Nivolumab-related rhabdomyolysis, as an immune-mediated adverse event. The rhabdomylolysis involved the diaphragm with consequent diaphragmatic weakness and respiratory distress. Mangement & outcome The patient had a slow but slight and progressive improvement of symptoms and vital signs post-treatment with high-dose corticosteroids. Discussion With this case report, we want to highlight the importance of rapid recognition and treatment of rare and unexpected, but potential serious immune-related adverse events. These events might happen despite the remarkable clinical benefits of immune checkpoint inhibitors. We do not know which patients will benefit from these therapies and why, when and in which cases adverse event will occur: we must not lower our attention.

scholarly journals A History of Preterm Delivery Is Associated with Aberrant Postpartal MicroRNA Expression Profiles in Mothers with an Absence of Other Pregnancy-Related Complications

2021 ◽  
Vol 22 (8) ◽  
pp. 4033
Author(s):  
Ilona Hromadnikova ◽  
Katerina Kotlabova ◽  
Ladislav Krofta
Keyword(s):  
Preterm Delivery ◽  
Expression Profiles ◽  
White Blood Cells ◽  
Microrna Expression ◽  
Spontaneous Preterm Birth ◽  
Antenatal Corticosteroids ◽  
Protein Levels ◽  
Reactive Protein ◽  
History Of ◽  
Prelabor Rupture Of Membranes

This prospective cross-sectional case-control study investigated the postpartal gene expression of microRNAs associated with diabetes/cardiovascular/cerebrovascular diseases in the peripheral white blood cells of women with anamnesis of preterm prelabor rupture of membranes (n = 58), spontaneous preterm birth (n = 55), and term delivery (n = 89) by a quantitative reverse transcription polymerase chain reaction. After pregnancies complicated by preterm prelabor rupture of membranes or spontaneous preterm birth, mothers showed diverse expression profiles for 25 out of 29 tested microRNAs (miR-1-3p, miR-16-5p, miR-17-5p, miR-20a-5p, miR-20b-5p, miR-21-5p, miR-23a-3p, miR-24-3p, miR-26a-5p, miR-29a-3p, miR-100-5p, miR-103a-3p, miR-125b-5p, miR-126-3p, miR-130b-3p, miR-133a-3p, miR-143-3p, miR-145-5p, miR-146a-5p, miR-181a-5p, miR-195-5p, miR-199a-5p, miR-221-3p, miR-499a-5p, and miR-574-3p). The earliest gestational ages at delivery and the lowest birth weights of newborns were associated with the highest postpartal levels of the previously mentioned microRNAs in maternal peripheral white blood cells. Administration of tocolytic drugs in order to prolong pregnancy, used in order to administer and complete a full course of antenatal corticosteroids, was associated with alterations in postpartal microRNA expression profiles to a lesser extent than in women with imminent delivery, where there was insufficient time for administration of tocolytics and antenatal corticosteroids. Overall, mothers who did not receive tocolytic therapy (miR-24-3p and miR-146a-5p) and mothers who did not receive corticosteroid therapy (miR-1-3p, miR-100-5p, and miR-143-3p) had increased or showed a trend toward increased postpartal microRNA expression when compared with mothers given tocolytic and corticosteroid therapy. In addition, mothers with serum C-reactive protein levels above 20 mg/L, who experienced preterm labour, showed a trend toward increased postpartal expression profiles of miR-143-3p and miR-199a-5p when compared with mothers with normal serum C-reactive protein levels. On the other hand, the occurrence of maternal leukocytosis, the presence of intra-amniotic inflammation (higher levels of interleukin 6 in the amniotic fluid), and the administration of antibiotics at the time of preterm delivery had no impact on postpartal microRNA expression profiles in mothers with a history of preterm delivery. Likewise, the condition of the newborns at the moment of birth, determined by Apgar scores at 5 and 10 min and the pH of cord arterial blood, had no influence on the postpartal expression profiles of mothers with a history of preterm delivery. These findings may contribute to explaining the increased cardiovascular risk in mothers with anamnesis of preterm delivery, and the greater increase of maternal cardiovascular risk with the decrease of gestational age at delivery. Women with preterm delivery in their anamnesis represent a high-risk group with special needs on a long-term basis, with a need to apply preventive and therapeutic interventions as early as possible.

Immune Tolerance in Hemophilia-Principal Results from the International Registry

1994 ◽  
Vol 72 (01) ◽  
pp. 155-158 ◽  
Author(s):  
G Mariani ◽  
A Ghirardini ◽  
R Bellocco
Keyword(s):  
Immune Tolerance ◽  
Survival Curve ◽  
Multivariate Logistic Regression Analysis ◽  
High Dose ◽  
Free Survival ◽  
International Registry ◽  
Kaplan Meier ◽  
The Usa ◽  
History Of ◽  
Low Levels

Summary40 Hemophilia Centers from the USA, Canada, Europe and Japan referred to the International Registry 204 patients with haemophilia A, treated by Immune Tolerance (IT) Protocols over the past two decades because of the presence of an inhibitor to FVIII. 82% of the patients were high responders, while IT was started with low levels of inhibitor (<10 BU) in most (57.3%) of the cases. 69 patients (33.8%) were given the highest FVIII dosage (≥200 IU/kg/day), 71 (34.8%) intermediate dosages (50 - <200) and 64 (31.4%) the lowest dosages (<50). Of 158 patients persevering with treatment long enough to judge the outcome thereof, 107 (67.7%) achieved tolerance, 12 (7,6%) had a partial response, while 39 (24.7%) did not respond. Multivariate logistic regression analysis showed that two variables were independently associated with the highest probability of success: the use of high dose protocols (≥100 IU/kg/day) (p <.0001) and the presence of low levels of inhibitor (<10 BU) at enrollment (p = .004). The Kaplan-Meier inhibitor-free survival curve showed that tolerance is longlasting: only 1 out of 107 patients relapsed and the longest documented tolerant patient has been inhibitor-free for 16 years. 129 hemophiliacs were HIV Ab-negative at enrollment; of the 118 HIV-screened after the treatment, 18 (13.9%) were found to be HIV Ab-positive. IT can indeed modify the natural history of inhibitors to FVIII in hemophilia.

An unusual cause of meningitis

2005 ◽  
Vol 4 (3) ◽  
pp. 106-107
Author(s):  
T.M. Pasha ◽  
◽  
K. Trower ◽  
D. Bhatia ◽  
H.K. Thaker ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Elbow Joint ◽  
Vital Signs ◽  
Left Elbow ◽  
Normal Limits ◽  
The Usa ◽  
History Of ◽  
Background History ◽  
Disease Modifying ◽  
One Year

A 57 year old man patient presented with fever and frontal headache. He had a background history of sero-positive rheumatoid arthritis which was well controlled on immunomodulatory disease modifying anti-rheumatoid drugs (DMARDS) including methotrexate and leflunomide. Six months earlier he had returned from Massachussetts in the USA after a one year period of residence there. On examination his vital signs were within normal limits and he was afebrile with a temperature of 36.1o C. His left elbow joint was warm, tender and swollen; examination was otherwise normal.

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