Successful Treatment of Refractory Aquagenic Pruritus with Naltrexone

2005 ◽  
Vol 9 (5) ◽  
pp. 215-216 ◽  
Author(s):  
Sarah Ingber ◽  
Paul D. Cohen
Keyword(s):  
Protein Electrophoresis ◽  
Endogenous Opiates ◽  
X Ray ◽  
Multiple Treatment ◽  
Blood Tests ◽  
Underlying Causes ◽  
Bath Water ◽  
Chest X Ray ◽  
Polycythemia Rubra Vera ◽  
Uvb Phototherapy

Background: Aquagenic pruritus is an intense prickling sensation that develops in affected individuals immediately after contact with water at any temperature. It is most commonly associated with polycythemia rubra vera. Common but often ineffective treatments include anticholinergics and antihistamines. Other moderately successful treatments include capsaicin cream, UVB phototherapy, and sodium bicarbonate bath water. Objective: In this case report we describe a 55-year-old female with severe itching following showers. Underlying causes were ruled out with a series of blood tests, a chest X-ray, and serum protein electrophoresis. After multiple treatment failures, her itching was relieved with naltrexone. Conclusion: Endogenous opiates, like naltrexone, can modify pruritus by influencing the peripheral and central sensation of itch. It has been found to be successful in suppressing the perception of pruritus from many diverse origins including aquagenic pruritus.

The Endgame

2021 ◽  
pp. 79-83
Author(s):  
Martha Gershun ◽  
John D. Lantos
Keyword(s):  
Blood Pressure ◽  
Glucose Tolerance ◽  
Kidney Function ◽  
Antihypertensive Medication ◽  
Salt Intake ◽  
Psychological Screening ◽  
X Ray ◽  
Blood Tests ◽  
Kidney Paired Donation ◽  
Chest X Ray

This chapter begins with detailing the author's final results following her three-day grueling tests for glucose tolerance, psychological screening, kidney function, EKG, and a chest X-ray. The author found out that there was an issue with her blood pressure. It then outlines the four available choices she could take: to end the process, to lose some weight and reduce salt intake and retest in a few months, to start on a very low dose of antihypertensive medication and retest in two weeks, and finally, to take her current results to the Transplant Selection Committee and hope for the best. Ultimately, the chapter presents an alternative plan, to become part of the Kidney Paired Donation program, if the new blood tests ruled the author unable to donate directly to the intended recipient.

scholarly journals Pleuritic chest pain: infection, infarction or musculoskeletal?

2002 ◽  
Vol 1 (2) ◽  
pp. 64-66
Author(s):  
S Gill ◽  
◽  
A Pope ◽  
Keyword(s):  
Pulmonary Embolism ◽  
Chest Pain ◽  
Initial Presentation ◽  
Pulmonary Emboli ◽  
Pleuritic Chest Pain ◽  
X Ray ◽  
Blood Tests ◽  
Chest X Ray ◽  
Initial Blood ◽  
D Dimer

A 52 year old patient, originally thought to have musculoskeletal chest pain was found to have features consistent with infective pleurisy on initial blood tests and chest x-ray, with a negative d-dimer indicating a low likelihood of pulmonary embolism. Two weeks later he represented with continued symptoms and investigations revealed extensive pulmonary emboli, which were thought to have developed after his initial presentation.

073 Alemtuzumab induced allergic inflammatory syndrome (ALIAS) with eosinophilic acalculous cholecystitis: a report of two cases

2018 ◽  
Vol 89 (6) ◽  
pp. A30.1-A30 ◽  
Author(s):  
Ariadna Fontes-Villalba ◽  
John DE Parratt
Keyword(s):  
Antibiotic Therapy ◽  
Clinical Signs ◽  
Young Patients ◽  
Lower Lobe ◽  
Acalculous Cholecystitis ◽  
X Ray ◽  
Blood Tests ◽  
Chest X Ray ◽  
The Right ◽  
Inflammatory Syndrome

IntroductionAlemtuzumab, a humanised monoclonal antibody directed at CD52, is a highly active treatment for multiple sclerosis (MS) that induces rapid depetion of circulating lymphocytes. Infusion-associated reactions and autoimmune disorders are established adverse effects. We describe two cases of alemtuzumab associated allergic inflammatory syndrome involving the lungs and gallbladder in two young patients after their first course of Alemtuzumab.Case 1 A 26 year old female with relapsing-remitting MS (RRMS) received her first course of alemtuzumab. On the fourth day of treatment, she developed bronchospasm, chest pain and an interstitial infiltrate in the right lower lobe on chest X-ray. She had right upper quadrant pain and a positive Murphy’s sign and ‘gallbladder sludge’ on ultrasound. Blood tests showed lymphopenia and eosinophilia. The patient was diagnosed with acalculous cholecystitis. Antibiotic therapy was initiated but laparoscopic cholecystectomy was required. The pathology demonstrated eosinophilic cholecystitis.Case 2 A 29 year old man with RRMS was switched to alemtuzumab due to positive JCV antibody status. He had an episode of hemoptysis on the fifth day of the infusion. Two days later, haemoptysis was accompanied by chest tightness. Physical examination revealed a palpable liver and positive Murphy sign. Blood tests were remarkable for abnormal liver enzymes. Signs of interstitial changes in the right lower lobe were observed on a chest X-ray. The patient was diagnosed with acalculous cholecystitis and antibiotic therapy was initiated. The infiltrate resolved and the clinical signs quickly improved.ConclusionThe characteristics of this condition are acute onset (within days of alemtuzumab) and non-infective inflammation of the lung (right lower lobe in these cases) and gallbladder. The pathology in one case indicates this is likely to be a drug related, allergic phenomenon with extensive eosinophilic infiltration of the gallbladder.

scholarly journals Clinical course of a 66-year-old man with an acute ischaemic stroke in the setting of a COVID-19 infection

2020 ◽  
Vol 13 (8) ◽  
pp. e235920 ◽  
Author(s):  
Saajan Basi ◽  
Mohammad Hamdan ◽  
Shuja Punekar
Keyword(s):  
Respiratory Symptoms ◽  
Clinical Course ◽  
Throat Swab ◽  
Cerebral Infarct ◽  
Medical Team ◽  
Healthcare Staff ◽  
Oxygen Requirement ◽  
X Ray ◽  
Blood Tests ◽  
Chest X Ray

A 66-year-old man was admitted to hospital with a right frontal cerebral infarct producing left-sided weakness and a deterioration in his speech pattern. The cerebral infarct was confirmed with CT imaging. The only evidence of respiratory symptoms on admission was a 2 L oxygen requirement, maintaining oxygen saturations between 88% and 92%. In a matter of hours this patient developed a greater oxygen requirement, alongside reduced levels of consciousness. A positive COVID-19 throat swab, in addition to bilateral pneumonia on chest X-ray and lymphopaenia in his blood tests, confirmed a diagnosis of COVID-19 pneumonia. A proactive decision was made involving the patients’ family, ward and intensive care healthcare staff, to not escalate care above a ward-based ceiling of care. The patient died 5 days following admission under the palliative care provided by the medical team.

scholarly journals Medical Image of the Month: Cavitating Pseudomonas aeruginosa Pneumonia

2021 ◽  
Vol 23 (5) ◽  
pp. 126-128
Author(s):  
Grigory Kildaze ◽  
Keyword(s):  
Medical Image ◽  
White Blood Cells ◽  
Chronic Obstructive ◽  
Past Medical History ◽  
C Reactive Protein ◽  
Obstructive Pulmonary Disease ◽  
X Ray ◽  
Reactive Protein ◽  
Blood Tests ◽  
Chest X Ray

No abstract available. Article truncated after 150 words. A 56-year-old woman presented with cough and shortness of breath to hospital. She had a temperature of 39.2°C and had recently completed course of steroids and antibiotics for exacerbation of chronic obstructive pulmonary disease (COPD). She was an active smoker of 15 cigarettes/day for about 40 years. No other past medical history was noted. On examination she had left-sided crepitations and oxygen saturations of 90% on room air. Chest x-ray (CXR) (Fig 1:A) showed features of background emphysema with upper lobe peripheral bullae, larger on the left. Dense left peri-hilar consolidation was also described. SARS-CoV-2 swab was negative. White blood cells (WBC) were raised at 16.9x109/L and C-reactive protein (CRP) at 331 mg/L. The rest of the blood tests were unremarkable. CURB-65 score was zero but treatment was commenced with intravenous (IV) amoxicillin & oral clarithromycin in view of level of CRP and CXR findings. On Day 4 of admission …

Tuberculosis: Diagnostic Challenges in Rural Africa

Praxis ◽  
2019 ◽  
Vol 108 (15) ◽  
pp. 991-996
Author(s):  
Ngisi Masawa ◽  
Farida Bani ◽  
Robert Ndege
Keyword(s):  
Extrapulmonary Tuberculosis ◽  
X Ray ◽  
Molecular Tests ◽  
Rural Settings ◽  
Chest X Ray ◽  
Screening Questions ◽  
Rural Africa ◽  
Tb Diagnostics ◽  
Strip Test ◽  
Urine Strip

Abstract. Tuberculosis (TB) remains among the top 10 infectious diseases with highest mortality globally since the 1990s despite effective chemotherapy. Among 10 million patients that fell ill with tuberculosis in the year 2017, 36 % were undiagnosed or detected and not reported; the number goes as high as 55 % in Tanzania, showing that the diagnosis of TB is a big challenge in the developing countries. There have been great advancements in TB diagnostics with introduction of the molecular tests such as Xpert MTB/RIF, loop-mediated isothermal amplification, lipoarabinomannan urine strip test, and molecular line-probe assays. However, most of the hospitals in Tanzania still rely on the TB score chart in children, the WHO screening questions in adults, acid-fast bacilli and chest x-ray for the diagnosis of TB. Xpert MTB/RIF has been rolled-out but remains a challenge in settings where the samples for testing must be transported over many kilometers. Imaging by sonography – nowadays widely available even in rural settings of Tanzania – has been shown to be a useful tool in the diagnosis of extrapulmonary tuberculosis. Despite all the efforts and new diagnostics, 30–50 % of patients in high-burden TB countries are still empirically treated for tuberculosis. More efforts need to be placed if we are to reduce the death toll by 90 % until 2030.

Lingual Dystonia Treated with Botulinum Toxin - A Case Report

1970 ◽  
Vol 24 (2) ◽  
pp. 75-78
Author(s):  
MA Hayee ◽  
QD Mohammad ◽  
H Rahman ◽  
M Hakim ◽  
SM Kibria
Keyword(s):  
Botulinum Toxin ◽  
Botulinum Toxin A ◽  
Botulinum Toxin Type A ◽  
Botulinum Toxin Type ◽  
X Ray ◽  
Medical College ◽  
Lingual Dystonia ◽  
History Of ◽  
Chest X Ray

A 42-year-old female presented in Neurology Department of Sir Salimullah Medical College with gradually worsening difficulty in talking and eating for the last four months. Examination revealed dystonic tongue, macerated lips due to continuous drooling of saliva and aspirated lungs. She had no history of taking antiparkinsonian, neuroleptics or any other drugs causing dystonia. Chest X-ray revealed aspiration pneumonia corrected later by antibiotics. She was treated with botulinum toxin type-A. Twenty units of toxin was injected in six sites of the tongue. The dystonic tongue became normal by 24 hours. Subsequent 16 weeks follow up showed very good result and the patient now can talk and eat normally. (J Bangladesh Coll Phys Surg 2006; 24: 75-78)

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