Cicatricial Pemphigoid Diagnosed by the Use of Indirect Immunofluorescence

Background: A thorough work-up is paramount in the accurate diagnosis of oral erosive diseases. Objective: A case of pemphigoid with negative direct immunofluorescence but positive indirect immunofluorescence is presented. Methods and Results: A 77-year-old man presented with erosions of the oral and glans mucosa and with esophageal stenosis. Histologic examination revealed nonspecific mucositis. Indirect immunofluorescence was characteristic of pemphigoid. Conclusion: This case illustrates the importance of performing a complete diagnostic work-up in the evaluation of patients with oral erosive disease.

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Degree of Histologic Inflammation in Lupus Erythematosus and Direct Immunofluorescence Results: Red and Inflamed Lesions Do Not Increase the Chances of Getting a Bright Band

Journal of Cutaneous Medicine and Surgery ◽

10.2310/7750.2012.12032 ◽

2013 ◽

Vol 17 (1) ◽

pp. 22-26 ◽

Cited By ~ 4

Author(s):

Tawny Hung ◽

Richard Ian Crawford ◽

Magdalena Martinka

Keyword(s):

Lupus Erythematosus ◽

Inflammatory Activity ◽

Direct Immunofluorescence ◽

Bright Band ◽

Hematoxylin And Eosin ◽

Diagnostic Work ◽

Work Up ◽

Histopathologic Findings ◽

Diagnostic Work Up

Background: In the diagnostic work-up of lupus erythematosus (LE), direct immunofluoresence (DIF) examination could be helpful. Classically, clinically red lesions are targeted by clinicians in the hope of yielding an informative DIF result. However, the investigative correlation between the degree of inflammation and DIF positivity has never been published in the literature. Objective: In this study, we sought to discover if histologically inflamed lesions correlated with DIF positivity results. Method: We studied 112 lesions histologically consistent with LE and correlated the degree of histologic inflammation on the DIF hematoxylin and eosin-stained biopsy with DIF positivity. The degree and location of the inflammation, as well as the involvement of the dermoepidermal interface, were documented. Results: A positive lupus band test was defined as the presence of either (1) granular IgG alone ± other immunoglobulins and/or C3 or (2) granular IgM or Ig A plus other immunoglobulins ± C3. Fifty-four of 112 (48%) cases had positive DIF (DIF+) results, 26 of 112 (23%) had negative DIF (DIF-) results, and 32 of 112 (29%) had nonspecific DIF patterns. Of the DIF+ cases, 41 of 54 (76%) showed some degree of inflammation, whereas 25 of 26 (96%) DIF- cases had inflammation ( p − .60). Most of the biopsies in the study (85%) were inflamed, but the degree and location of the inflammation had no influence on DIF+ results. The intensity of the DIF+ band further failed to show any relationship with the degree of inflammation. Conclusion: The level of inflammatory activity in a clinical lesion fails to correlate with DIF positivity. Furthermore, other common histopathologic findings of LE are not predictive of DIF results.

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Primary Tumours of the Spine: Differential Diagnosis, Epidemiology and Diagnostic Work Up

10.28962/01.3.134 ◽

2017 ◽

Author(s):

Stefano Boriani ◽

Luca Boriani

Keyword(s):

Differential Diagnosis ◽

Diagnostic Work ◽

Work Up ◽

Diagnostic Work Up

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Clinical Presentation and Diagnostic Work Up in Spinal Trauma

10.28962/01.3.107 ◽

2017 ◽

Author(s):

Emiliano Vialle

Keyword(s):

Clinical Presentation ◽

Spinal Trauma ◽

Diagnostic Work ◽

Work Up ◽

Diagnostic Work Up

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Stroke masquerading as cardiac arrest: the artery of Percheron

BMJ Case Reports ◽

10.1136/bcr-2020-238681 ◽

2021 ◽

Vol 14 (1) ◽

pp. e238681

Author(s):

Megan Quetsch ◽

Sureshkumar Nagiah ◽

Stephen Hedger

Keyword(s):

Cardiac Arrest ◽

Clinical Assessment ◽

Altered Consciousness ◽

Cognitive Changes ◽

Consciousness Level ◽

Artery Of Percheron ◽

Conscious Level ◽

Diagnostic Work ◽

Work Up ◽

Diagnostic Work Up

The artery of Percheron (AOP) is a rare arterial variant of the thalamic blood supply. Due to the densely packed collection of nuclei it supplies, an infarction of the AOP can be devastating. Here we highlight a patient who had an AOP stroke in the community, which was initially managed as cardiac arrest. AOP strokes most often present with vague symptoms such as reduced conscious level, cognitive changes and confusion without obvious focal neurology, and therefore are often missed at the initial clinical assessment. This case highlights the importance of recognising an AOP stroke as a cause of otherwise unexplained altered consciousness level and the use of MRI early in the diagnostic work-up.

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Death of unknown cause? Post-mortem diagnosis of fulminant course of an EBV-associated secondary hemophagocytic lymphohistiocytosis

memo - Magazine of European Medical Oncology ◽

10.1007/s12254-021-00701-9 ◽

2021 ◽

Author(s):

Josia Fauser ◽

Stefan Köck ◽

Eberhard Gunsilius ◽

Andreas Chott ◽

Andreas Peer ◽

...

Keyword(s):

Immune Response ◽

Case Report ◽

Macrophage Activation ◽

Post Mortem ◽

Life Threatening ◽

Appropriate Therapy ◽

Diagnostic Work ◽

Work Up ◽

Diagnostic Work Up ◽

Secondary Hemophagocytic Lymphohistiocytosis

SummaryHLH is a life-threatening disease, which is characterized by a dysregulated immune response with uncontrolled T cell and macrophage activation. The often fulminant course of the disease needs a fast diagnostic work-up to initiate as soon as possible the appropriate therapy. We present herein the case of a 71-year-old patient with rapidly progressive hyperinflammatory syndrome, which post mortem resulted in the diagnosis of EBV-associated HLH. With this case report, we intend to highlight the relevance of the HScore in the diagnosis of HLH, to create a greater awareness for EBV as a trigger of HLH, and to demonstrate the importance of treating EBV-associated HLH as early as possible.

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COVID-19 lung injury as a primer for immune checkpoint inhibitors (ICIs)-related pneumonia in a patient affected by squamous head and neck carcinoma treated with PD-L1 blockade: a case report

Journal for ImmunoTherapy of Cancer ◽

10.1136/jitc-2020-001870 ◽

2021 ◽

Vol 9 (2) ◽

pp. e001870

Author(s):

Angelo Dipasquale ◽

Pasquale Persico ◽

Elena Lorenzi ◽

Daoud Rahal ◽

Armando Santoro ◽

...

Keyword(s):

Lung Injury ◽

Head And Neck ◽

Checkpoint Inhibitors ◽

Experimental Therapy ◽

Common Mechanism ◽

Nasopharyngeal Swab ◽

Immune Mediated ◽

Diagnostic Work ◽

Work Up ◽

Diagnostic Work Up

By the beginning of the global pandemic, SARS-CoV-2 infection has dramatically impacted on oncology daily practice. In the current oncological landscape, where immunotherapy has revolutionized the treatment of several malignancies, distinguishing between COVID-19 and immune-mediated pneumonitis can be hard because of shared clinical, radiological and pathological features. Indeed, their common mechanism of aberrant inflammation could lead to a mutual and amplifying interaction.We describe the case of a 65–year-old patient affected by metastatic squamous head and neck cancer and candidate to an experimental therapy including an anti-PD-L1 agent. COVID-19 ground-glass opacities under resolution were an incidental finding during screening procedures and worsened after starting immunotherapy. The diagnostic work-up was consistent with ICIs-related pneumonia and it is conceivable that lung injury by SARS-CoV-2 has acted as an inflammatory primer for the development of the immune-related adverse event.Patients recovered from COVID-19 starting ICIs could be at greater risk of recall immune-mediated pneumonitis. Nasopharyngeal swab and chest CT scan are recommended before starting immunotherapy. The awareness of the phenomenon could allow an easier interpretation of radiological changes under treatment and a faster diagnostic work-up to resume ICIs. In the presence of clinical benefit, for asymptomatic ICIs-related pneumonia a watchful-waiting approach and immunotherapy prosecution are suggested.

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Sarcoidosis: A nationwide registry-based study of incidence, prevalence and diagnostic work-up

Respiratory Medicine ◽

10.1016/j.rmed.2021.106548 ◽

2021 ◽

pp. 106548

Author(s):

Melina Gade Sikjær ◽

Ole Hilberg ◽

Rikke Ibsen ◽

Anders Løkke

Keyword(s):

Nationwide Registry ◽

Diagnostic Work ◽

Work Up ◽

Diagnostic Work Up ◽

Incidence Prevalence

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Long-Term Follow-Up of Thyroid Incidentalomas Visualized with 18F-Fluorodeoxyglucose Positron Emission Tomography—Impact of Thyroid Scintigraphy in the Diagnostic Work-Up

Diagnostics ◽

10.3390/diagnostics11030557 ◽

2021 ◽

Vol 11 (3) ◽

pp. 557

Author(s):

Kirsten Korsholm ◽

Michala Reichkendler ◽

Louise Alslev ◽

Åse Krogh Rasmussen ◽

Peter Oturai

Keyword(s):

Emission Tomography ◽

Thyroid Scintigraphy ◽

Fdg Uptake ◽

Positron Emission ◽

Pet Ct ◽

18F Fdg ◽

Diagnostic Work ◽

Fdg Pet Ct ◽

Work Up ◽

Diagnostic Work Up

Our objective was to evaluate the frequency of malignancy in incidental thyroidal uptake on 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) in a cohort of Danish patients, and furthermore to evaluate the impact of thyroid scinti-graphy in the diagnostic work-up. All whole-body PET/CT reports from 1 January 2010 to 31 December 2013 were retrospectively reviewed and further analyzed if visually increased thyroidal FDG uptake was reported. Patient electronic files were searched for further thyroid evaluation. Of 13,195 18F-FDG-PET/CT scans in 9114 patients, 312 PET/CT reports mentioned incidental thyroid FDG-uptake, and 279 patients were included in the study (3.1%). The thyroid was further investigated in 137 patients (49%), and 75 patients underwent thyroid scintigraphy. A total of 57 patients had a thyroid biopsy and 21 proceeded to surgery. Surgical specimens displayed malignancy in 10 cases, and one thyroid malignancy was found by autopsy. Hence, 11 patients were diagnosed with thyroid malignancies among 279 patients with incidental thyroid 18F-FDG uptake (3.9%). In 34 patients, a biopsy was avoided due to the results of the thyroid scintigraphy. We conclude that patients with thyroid incidentalomas can benefit from further diagnostic work-up including a thyroid scintigraphy.

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General practitioner use of D-dimer in suspected venous thromboembolism: historical cohort study in one geographical region in the Netherlands

BMJ Open ◽

10.1136/bmjopen-2018-026846 ◽

2019 ◽

Vol 9 (5) ◽

pp. e026846 ◽

Cited By ~ 1

Author(s):

Angel M R Schols ◽

Eline Meijs ◽

Geert-Jan Dinant ◽

Henri E J H Stoffers ◽

Mariëlle M E Krekels ◽

...

Keyword(s):

Cohort Study ◽

General Practitioner ◽

Clinical Assessment ◽

Geographical Region ◽

Historical Cohort ◽

Diagnostic Work ◽

Work Up ◽

Diagnostic Work Up ◽

D Dimer

ObjectivesTo investigate how many general practitioner (GP)-referred venous thromboembolic events (VTEs) are diagnosed during 1 year in one geographical region and to investigate the (urgent) referral pathway of VTE diagnoses, including the role of laboratory D-dimer testing.DesignHistorical cohort study.SettingGP patients of 47 general practices in a demarcated geographical region of 161 503 inhabitants in the Netherlands.ParticipantsWe analysed all 895 primary care patients in whom either the GP determined a D-dimer value or who had a diagnostic work-up for suspected VTE in a non-academic hospital during 2015.Primary and secondary outcome measuresThe primary outcomes of this study were the total number of VTEs per year and the diagnostic pathways—including the role of GP determined D-dimer testing—of patients urgently referred to secondary care for suspected VTE. Additionally, we explored the use of an age-adjusted D-dimer cut-off.ResultsThe annual VTE incidence was 0.9 per 1000 inhabitants. GPs annually ordered 5.1 D-dimer tests per 1000 inhabitants. Of 470 urgently GP-referred patients, 31.3% had a VTE. Of those urgently referred based on clinical assessment only (without D-dimer testing), 73.8% (96/130) had a VTE; based on clinical assessment and laboratory D-dimer testing yielded 15.0% (51/340) VTE. Applying age-adjusted D-dimer cut-offs to all patients aged 50 years or older resulted in a reduction of positive D-dimer results from 97.9% to 79.4%, without missing any VTE.ConclusionsAlthough D-dimer testing contributes to the diagnostic work-up of VTE, GPs have a high detection rate for VTE in patients who they urgently refer to secondary care based on clinical assessment only.

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