Agranulocytosis Associated with Waldenström Macroglobulinemia

2018 ◽  
Vol 140 (1) ◽  
pp. 42-45 ◽  
Author(s):  
Iuliana Vaxman ◽  
Daniel Shepshelovich ◽  
Lucille Hayman ◽  
Pia Raanani ◽  
Meir Lahav
Keyword(s):  
Case Report ◽  
Febrile Neutropenia ◽  
Medical History ◽  
Case Reports ◽  
Neutropenic Fever ◽  
Severe Neutropenia ◽  
Past Medical History ◽  
Waldenström Macroglobulinemia ◽  
Waldenstrom Macroglobulinemia ◽  
History Of

Currently, there are only 2 case reports of Waldenström macroglobulinemia (WM) associated with severe neutropenia. This is a case report of a woman with a past medical history of WM who presented with neutropenic fever. The patient’s febrile neutropenia resolved after RCD chemotherapy (cyclophosphamide 750 mg/m2, dexamethasone 20 mg, and rituximab 375 mg/m2). Fourteen days after administration, the neutrophil level had started to rise and normalized after 6 days. To the best of our knowledge, this is the 3rd reported case of agranulocytosis due to WM.

Safety and Efficacy of Various Intravenous Insulin Infusion Rates in Patients With and Without Diabetes Presenting With Hypertriglyceridemia

2022 ◽  
pp. 106002802110701
Author(s):  
Francisco Ibarra ◽  
Kaitlyn Loi ◽  
Ann W. Vu
Keyword(s):  
Medical History ◽  
Insulin Infusion ◽  
Case Reports ◽  
Retrospective Chart Review ◽  
Acute Management ◽  
Past Medical History ◽  
Safety And Efficacy ◽  
Intravenous Insulin ◽  
Number Of Patients ◽  
History Of

Background The use of IV insulin infusions in the acute management of hypertriglyceridemia has only been evaluated in small observational studies and case reports. Objective To evaluate the safety and efficacy of IV insulin infusions in the acute management of hypertriglyceridemia. Methods This was a retrospective chart review of adult patients who received an IV insulin infusion for the acute management of hypertriglyceridemia. The primary efficacy and safety outcomes were the number of patients who achieved a triglyceride level <500 mg/dL and experienced hypoglycemia (<70 mg/dL), respectively. A subgroup analysis was performed to compare outcomes between patients with and without diabetes, in addition to the IV insulin infusion rate received. Results In the total population (n = 51), there were no statistically significant differences between the insulin intensity groups in the number of patients who achieved TG levels <500 mg/dL. Compared to patients with a past medical history of diabetes, more patients without a past medical history of diabetes achieved triglyceride levels <500 mg/dL (14% vs 53%, respectively, P < 0.001). The number of hypoglycemic events observed in patients with and without a past medical history of diabetes were 5 (14%) and 4 (27%), respectively ( P = 0.023). Conclusion and Relevance Our findings suggest that patients who present with lower initial TG levels are more likely to achieve TG levels <500 mg/dL. To minimize the risk of hypoglycemia providers should consider prescribing a concomitant dextrose infusion and limiting IV insulin infusion rates ≤ 0.075 units/kg/h.

scholarly journals Unmasking of Neurosarcoidosis

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A618-A618
Author(s):  
Sharini Venugopal ◽  
Binita Neupane ◽  
Mahesh Nepal ◽  
Luis F Chavez
Keyword(s):  
Diabetes Insipidus ◽  
Medical History ◽  
Case Reports ◽  
Rare Complication ◽  
Case Series ◽  
Primary Hypothyroidism ◽  
Past Medical History ◽  
Water Excretion ◽  
History Of ◽  
Glucocorticoid Deficiency

Abstract Introduction: Central diabetes insipidus is a rare complication of neurosarcoidosis. In patients with concomitant adrenal insufficiency (AI), the symptoms of Diabetes Insipidus (DI) can be masked. Case: A 55-year-old female with past medical history of sarcoidosis presented to the hospital with hematemesis, nausea and dizziness. She has a past medical history of cardiac sarcoidosis that was revealed on a PET scan done before 10 years for which she was being treated with methotrexate and prednisone. She was off prednisone for a year prior to hospitalization. She underwent an upper endoscopy that showed diffusely erythematous gastric mucosa in the antrum. She was also hypotensive on admission, and she received packed red blood transfusions after which her sodium increased from 145mmol/L to 165mmol/L (Normal: 135-145mmol/L) in 48 hours. Further workup revealed persistent hypernatremia and urine osmolality was 75mOsm/kg H2O. (Normal: 50-1200mOsm/kg H2O). She was also hypoglycemic and hypotensive requiring multiple fluid boluses throughout her hospitalization. This prompted us to perform a random cortisol that came back at 2.1ug/dl (Normal: 3-23ug/dl) and 1.8ug/dl on two occasions. Cortisol Stimulation test was subsequently ordered, but was done only at 30 minutes, and Cortisol increased from 1.8ug/dl to 6.3ug/dl. Free thyroxine was 0.5 ng/dl (Normal: 0.9-1.8 ng/dl) and her TSH was 7.58uIU/ml (Normal: 0.55-4.78uIU/ml). MRI of the brain revealed extensive areas of extra-axial supra-sellar/infundibular nodular homogeneous intense enhancement that is most consistent with neuro-sarcoid. She was started on prednisone 40 mg daily, Desmopressin 0.05 mg twice daily, and levothyroxine as well. Her sodium level normalized and was 137mmol/L at discharge. She followed up later with outpatient Endocrinology and reported around 90lbs weight gain and no more episodes of nausea or vomiting or epistaxis or lightheadedness. Conclusion: The involvement of the hypothalamic-pituitary axis in sarcoidosis is extremely rare and attributes to &lt; 1% of patients with a sellar mass. Small case series have shown that hypogonadism is the most common endocrine abnormality followed by DI. Our patient had a long-standing history of sarcoidosis with her pituitary dysfunction unmasked only on admission for other causes. She did not manifest any symptoms of DI or AI. There have been case reports where the symptoms of DI are masked due to underlying glucocorticoid deficiency. There have been theories that glucocorticoid deficiency impairs renal water excretion by both ADH (Anti-diuretic hormone) dependent and ADH independent pathways. Another notable feature in our case is that our patient presented with primary hypothyroidism. In fact, sarcoidosis has been commonly implicated in auto-immune polyglandular syndromes type 3, which can present with auto-immune thyroiditis more so in females.

Impaired Extension of the Digits due to Bilateral Idiopathic Intrinsic Contracture: A Case Report

2019 ◽  
Vol 24 (03) ◽  
pp. 383-385
Author(s):  
Yuki Kawasaki ◽  
Soichi Ejiri ◽  
Michiyuki Hakozaki ◽  
Shinichi Konno
Keyword(s):  
Eating Disorder ◽  
Case Report ◽  
Surgical Treatment ◽  
Conservative Treatment ◽  
Medical History ◽  
Rare Condition ◽  
Tendon Sheath ◽  
Past Medical History ◽  
Thenar Muscle ◽  
History Of

Idiopathic intrinsic contracture (IIC) with no history of trauma, ischemia, or spasticity is extremely rare. We report herein a case of impaired extension of the digits due to bilateral IICs occurred in a 30-year-old woman with a past medical history of eating disorder and amenorrhea. Although no previous case has been reported in the literature, eight similar cases of IIC have been presented at Japanese domestic conferences. In these eight cases and the present case, resection of the thenar muscle cords and unilateral resection of the lateral band were effective. Since IIC in patients with an eating disorder is a rare condition, it would be treated conservatively at first as tendon sheath inflammation or locking. However, this condition may be resistant to conservative treatment, and surgical treatment should be considered in such cases.

Monitoring and Dosing of Argatroban in a Patient With Antiphospholipid Syndrome

2020 ◽  
pp. 001857872094676 ◽  
Author(s):  
Karli Dooling ◽  
Bradley Haan
Keyword(s):  
Medical History ◽  
Antiphospholipid Syndrome ◽  
Case Reports ◽  
Fixed Dose ◽  
Past Medical History ◽  
Bleeding Events ◽  
Heparin Induced Thrombocytopenia ◽  
History Of

Background: This case reports outlines argatroban dosing and necessary dose adjustments in a 56 year-old male with a past medical history of antiphospholipid syndrome and heparin-induced thrombocytopenia. Method: Argatroban was initiated as a fixed dose of 0.5 µg/kg/min with all initial aPTTs above goal. Argatroban was held for a procedure and re-initiated at 0.25 µg/kg/min. The dose was increased or decreased by 25% from the current rate based on supratherapeutic and subtherapeutic aPTTs, respectively. Results: The patient remained on argatroban for 6 total days, while achieving goal aPTT levels with no VTE or bleeding events. Conclusion: Our patient represents the first reported case of monitoring argatroban with aPTTs in an individual with APS.

scholarly journals Brucellosis Presenting with Pericarditis: Case Report and Literature Review

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Fábio Lopes Pedro ◽  
Fernanda Paula Franchini ◽  
Leonardo Muraro Wildner
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Medical History ◽  
English Literature ◽  
Testicular Tumor ◽  
Past Medical History ◽  
Medical English ◽  
Rare Manifestation ◽  
History Of

Pericarditis is a rare manifestation during the course of brucellosis. This paper describes a case of pericarditis associated with brucellosis in a 31-year-old veterinary physician with a past medical history of testicular tumor and reviews the cases of pericarditis associated with brucellosis in medical English literature.

scholarly journals A rare case of renal infarction due to heroin and amphetamine abuse: case report

2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Suhail Khokhar ◽  
Daniela Garcia ◽  
Rajesh Thirumaran
Keyword(s):  
Case Report ◽  
Medical History ◽  
Kidney Injury ◽  
Coagulation Cascade ◽  
Chronic Obstructive ◽  
Renal Infarction ◽  
Past Medical History ◽  
Amphetamine Abuse ◽  
History Of ◽  
Renal Infarct

Abstract Background Renal infarctions as a result of recreational drug use are rare and are commonly associated with cocaine use. Although amphetamines have a similar mechanism of action as cocaine, there are few reports linking them to ischemic events, and only one to renal infarction. Similarly, few reports link heroin use with infarcts, but never in the kidney. Although uncommon, several mechanisms have been implicated in heroin and amphetamine-induced infarction, including vasculopathy, vasculitis and the activation of the coagulation cascade. Case Presentation 47-year-old female with a past medical history of non-intravenous heroin and amphetamine abuse, chronic obstructive pulmonary disease, hypertension, hyperlipidemia presented with right lower extremity swelling and rash, which was diagnosed as cellulitis and treated appropriately. Incidentally, the patient was found to have an acute kidney injury and further workup identified multiple renal infarcts in the right kidney. The patient had no past medical history of clotting disorders. Blood culture and urine cultures were sterile; autoimmune and hypercoagulable workup were negative. Urinalysis was unremarkable. Urine toxicology was only positive for opiates and amphetamines, which were thought to be the most likely cause of the renal infarct. Patient was lost to outpatient follow up due to noncompliance, but returned to the hospital for re-emergence of her cellulitis, during which no new infarcts were discovered, and the previous renal infarct had scarred over. Conclusion There are very few reports of heroin and amphetamine-induced infarctions. This case report describes a rare but important complication of heroin/amphetamine abuse that could be easily overlooked.

scholarly journals Vestibular neuritis caused by severe acute respiratory syndrome coronavirus 2 infection diagnosed by serology: Case report

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110132
Author(s):  
Alexandra Halalau ◽  
Madalina Halalau ◽  
Christopher Carpenter ◽  
Amr E Abbas ◽  
Matthew Sims
Keyword(s):  
Case Report ◽  
Severe Acute Respiratory Syndrome ◽  
Medical History ◽  
Cranial Nerve ◽  
Respiratory Illness ◽  
Vestibular Neuritis ◽  
Past Medical History ◽  
Significant Past Medical History ◽  
Eighth Cranial Nerve ◽  
Male Physician

Vestibular neuritis is a disorder selectively affecting the vestibular portion of the eighth cranial nerve generally considered to be inflammatory in nature. There have been no reports of severe acute respiratory syndrome coronavirus 2 causing vestibular neuritis. We present the case of a 42-year-old Caucasian male physician, providing care to COVID-19 patients, with no significant past medical history, who developed acute vestibular neuritis, 2 weeks following a mild respiratory illness, later diagnosed as COVID-19. Physicians should keep severe acute respiratory syndrome coronavirus 2 high on the list as a possible etiology when suspecting vestibular neuritis, given the extent and implications of the current pandemic and the high contagiousness potential.

scholarly journals Past medical history of tumors other than meningioma is a negative prognostic factor for tumor recurrence in meningiomas WHO grade I

2021 ◽  
Author(s):  
Annamaria Biczok ◽  
Philipp Karschnia ◽  
Raffaela Vitalini ◽  
Markus Lenski ◽  
Tobias Greve ◽  
...  
Keyword(s):  
Medical History ◽  
Tumor Recurrence ◽  
Clinical History ◽  
Study Endpoint ◽  
Past Medical History ◽  
Who Grade ◽  
Increased Risk ◽  
History Of ◽  
Meningioma Recurrence ◽  
The Impact

Abstract Background Prognostic markers for meningioma recurrence are needed to guide patient management. Apart from rare hereditary syndromes, the impact of a previous unrelated tumor disease on meningioma recurrence has not been described before. Methods We retrospectively searched our database for patients with meningioma WHO grade I and complete resection provided between 2002 and 2016. Demographical, clinical, pathological, and outcome data were recorded. The following covariates were included in the statistical model: age, sex, clinical history of unrelated tumor disease, and localization (skull base vs. convexity). Particular interest was paid to the patients’ past medical history. The study endpoint was date of tumor recurrence on imaging. Prognostic factors were obtained from multivariate proportional hazards models. Results Out of 976 meningioma patients diagnosed with a meningioma WHO grade I, 416 patients fulfilled our inclusion criteria. We encountered 305 women and 111 men with a median age of 57 years (range: 21–89 years). Forty-six patients suffered from a tumor other than meningioma, and no TERT mutation was detected in these patients. There were no differences between patients with and without a positive oncological history in terms of age, tumor localization, or mitotic cell count. Clinical history of prior tumors other than meningioma showed the strongest association with meningioma recurrence (p = 0.004, HR = 3.113, CI = 1.431–6.771) both on uni- and multivariate analysis. Conclusion Past medical history of tumors other than meningioma might be associated with an increased risk of meningioma recurrence. A detailed pre-surgical history might help to identify patients at risk for early recurrence.

Bing-Neel syndrome: A case reports

2020 ◽  
pp. 107815522098342
Author(s):  
Sinan Demircioğlu ◽  
Pembe Oltulu ◽  
Ganime D Emlik ◽  
Atakan Tekinalp ◽  
Özcan Çeneli
Keyword(s):  
Kinase Inhibitor ◽  
Case Reports ◽  
Rare Complication ◽  
Brain Biopsy ◽  
High Dose ◽  
Waldenström Macroglobulinemia ◽  
Dose Methotrexate ◽  
Waldenstrom Macroglobulinemia ◽  
Bruton Tyrosine Kinase ◽  
Methotrexate Treatment

Introduction Bing-Neel syndrome (BNS) is a rare complication of of Waldenström macroglobulinemia (WM) identified by involvement of central nervous system (CNS) lymphoplasmacytic cells. Case report We present a patient who was diagnosed with Bing-Neel syndrome four years after the diagnosis of Waldenström macroglobulinemia. Management & outcome The patient was admitted with neurological symptoms. There were lesions associated with WM involvement on brain imaging. The diagnosis was made by brain biopsy. High dose methotrexate treatment was given. Discussion CNS infiltrating agents such as fludarabine, methotrexate and cytarabine are often used in BNS treatment. Ibrutinib, which is a new bruton tyrosine kinase inhibitor, has recently started to be used in BNS treatment, as it has been shown to be effective and penetrate the CNS.

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