Dependent Erythema of the Legs Associated With Mild Autonomic Nervous System Dysfunction

2017 ◽  
Vol 21 (6) ◽  
pp. 556-558
Author(s):  
Bahar Bahrani ◽  
Christopher S. Sladden
Keyword(s):  
Literature Search ◽  
Chronic Diarrhea ◽  
Autonomic Nervous System Dysfunction ◽  
Erect Posture ◽  
Case Presentation ◽  
Sympathetic Dysfunction ◽  
Full Physical Examination ◽  
History Of ◽  
Artery Disease ◽  
Shed Light

Introduction: Dependent erythema or rubor is an erythematous discoloration of the limbs, most commonly associated with peripheral artery disease. We present a case of florid dependent erythema, associated with additional autonomic symptoms. Methods: Examination and full workup of a 16-year-old healthy girl with an 8-year history of dependent erythema, chronic diarrhea, and mild hyperhidrosis. A literature search was performed to review any similar cases and generate a differential diagnosis. Results: Examination of our patient showed symmetrical, asymptomatic fiery to dusky erythematous patches of the lower legs and feet, with intermittent areas of pallor. These florid changes occurred with erect posture. Resolution to near normal occurred within minutes when the patient was in the supine position. Full physical examination revealed mild erythema and hyperhidrosis of the hands. Conclusions: To our knowledge, there have been no reports of painless dependent rubor associated with sympathetic dysfunction. Literature search reports a few cases of gravitational erythema and angiodyskinesia. This case presentation is most likely part of the spectrum of dependent erythema and may shed light on the underlying aetiology.

scholarly journals Insidious coronary artery disease in a young patient with polyarteritis nodosa: a case report and literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hong Huang ◽  
Yanjun Gong ◽  
Li Guo ◽  
Zhuoli Zhang
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Young Patient ◽  
Coronary Arteries ◽  
Left Main Coronary Artery ◽  
Screening Strategy ◽  
Acute Phase Reactants ◽  
Case Presentation ◽  
History Of ◽  
Artery Disease

Abstract Background Polyarteritis nodosa (PAN) is a relatively rare systemic necrotizing vasculitis that typically affects medium-sized arteries. Although myocardial ischemia may occur due to involvement of the coronary arteries, overt myocardial infarction is uncommon. Case presentation A 22-year-old Chinese man experiencing chest pain for 7 months was admitted to our hospital. Consistently, the pain tended to last for a few minutes and then spontaneously subside. He had 7-year history of “stable” PAN. Coronary angiography revealed slight plaque infiltration of the left main coronary artery; however occlusion of all the three major coronary arteries with multiple aneurysms. A stent was implanted into the obtuse margin branch artery which was 95% stenosis, and then the chest pain was alleviated. Considering that the occlusion of coronary arteries was due to insidious vasculitis, prednisone 50 mg/day and methotrexate 15 mg/week were reinitiated, in combination with anti-angina medications. Conclusions We report a young patient with insidious occlusion of three main coronary arteries under the circumstance of stable PAN for 7 years, suggesting the necessity of assessing the heart, in spite of normal acute phase reactants. The appropriate screening strategy needs to be studied.

scholarly journals Brown Bowel Syndrome Is a Rare and Commonly Missed Disease: A Case Report and Literature Review

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Joaquin Ponce-Zepeda ◽  
Wenchang Guo ◽  
Giorgioni Carmen ◽  
Daniel Moon Kim ◽  
Gregory C. Albers ◽  
...  
Keyword(s):  
Vitamin E ◽  
Small Bowel ◽  
Chronic Diarrhea ◽  
Muscularis Propria ◽  
Mitochondrial Damage ◽  
Vitamin E Deficiency ◽  
Case Presentation ◽  
History Of ◽  
Resected Small Bowel

Background. Brown bowel syndrome (BBS) is a rare gastrointestinal condition, and vitamin E deficiency has been considered to be a main contributor. However, vitamin E deficiency has been found in only a few patients throughout the published literature studies and its cutoff lab value for diagnosis is not entirely clarified. Case Presentation. A 56-year-old female patient with a history of congenital bowel obstruction (repaired at birth) presented with bloating, abdominal pain, and chronic diarrhea. Endoscopy identified unremarkable gastrointestinal mucosa except a few small polyps in the colon. A partial obstruction was detected by a small bowel follow-through series and then confirmed by CT scan. The resected small bowel was significantly dilated with a thickened brown wall and extensive serosal adhesion. Microscopic examination revealed unremarkable mucosa, but dense granular brown pigments were identified in the cytoplasm of the smooth muscle cells in the muscularis propria. These deposits resulted to be lipofuscin, and BBS was diagnosed. The patient was asymptomatic at 9-month follow-up after surgery without vitamin E supplement. Conclusion. Mitochondrial damage with lipofuscin deposition is at the root of BBS pathogenesis. Any etiology associated with mitochondrial damage can cause this disease, and vitamin E deficiency is just one of them. Dysmotility from extensive serosal adhesion could be a possible etiology for this patient. Due to overlapping symptoms, lipofuscin deposition primarily in the muscularis propria, and unclear serum value of vitamin E, this syndrome is often missed in routine clinical practice from the superficial biopsy. A transmural biopsy is necessary for a definite diagnosis.

scholarly journals Trans-septal course of anomalous left main coronary artery originating from single right coronary ostium presenting with atrial fibrillation in a severely obese patient: a case report

2020 ◽  
Vol 72 (1) ◽  
Author(s):  
Armando Ugo Cavallo ◽  
Emanuele Muscogiuri ◽  
Marco Forcina ◽  
Antonio Colombo ◽  
Flavio Fiore ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Left Coronary Artery ◽  
Invasive Coronary Angiography ◽  
Interventricular Septum ◽  
Case Presentation ◽  
Severely Obese ◽  
History Of ◽  
Artery Disease ◽  
The Right

Abstract Background To present a case of anomalous origin of the left coronary artery evaluated with invasive coronary angiography (ICA) and ECG-gated coronary computed tomography (CCT). Case presentation A patient (55 years old, male) with a past medical history of respiratory failure and atrial fibrillation underwent ICA to rule out coronary artery disease. Subsequently, the patient underwent ECG-gated CCT to evaluate a suspected anomalous aortic origin of the left coronary artery, since the interventional cardiologist was not able to properly identify the left coronary artery and its distal branches. CCT showed left coronary artery originating from the right coronary Valsalva sinus, coursing within the interventricular septum and emerging at the middle segment of the interventricular sulcus, where the left anterior descending and circumflex arteries originated. Conclusion The case we presented highlights the value of ECG-gated CCT in the evaluation of coronary anomaly anatomy and thus risk stratification derived by proper coronary anatomy assessment. Although ICA was not helpful in the diagnosis, it also has a pivotal role regarding the therapeutic management of this condition.

scholarly journals Takotsubo cardiomyopathy complicating acute pancreatitis: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
John Yeh ◽  
James Carroll
Keyword(s):  
Coronary Artery Disease ◽  
Acute Pancreatitis ◽  
Takotsubo Cardiomyopathy ◽  
Rare Complication ◽  
Obstructive Coronary Artery Disease ◽  
Case Presentation ◽  
Coronary Syndrome ◽  
History Of ◽  
Artery Disease ◽  
Delays In Diagnosis

Abstract Background Acute pancreatitis as a trigger of Takotsubo cardiomyopathy has been infrequently described in the literature. Misdiagnosis of this phenomenon can often occur due to overlap in symptomology, particularly in those outside of the usual patient demographic. Case presentation A 27-year-old man with a history of alcohol abuse presented with epigastric and chest pain. Electrocardiography showed ischemic changes, and laboratory workup revealed elevated lipase and troponin. He was diagnosed with acute pancreatitis and managed presumptively as acute coronary syndrome. Subsequent coronary angiography was negative for obstructive coronary artery disease, and left ventriculography demonstrated basal hyperkinesis and apical akinesis, characteristic of Takotsubo cardiomyopathy. Conclusions Takotsubo cardiomyopathy is a rare complication of acute pancreatitis. Increased awareness of this phenomenon is required to prevent delays in diagnosis and avoid unnecessary interventions and complications.

scholarly journals Halo Nevi Are Not Trivial: About 2 Young Patients of Regressed Primary Melanoma That Simulates Halo Nevi

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
S. De Schrijver ◽  
I. Theate ◽  
O. Vanhooteghem
Keyword(s):  
Literature Search ◽  
Case Reports ◽  
Young Patients ◽  
Primary Melanoma ◽  
Rare Condition ◽  
Warning Signs ◽  
Spontaneous Bleeding ◽  
Case Presentation ◽  
Detailed History ◽  
History Of

Background. Halo nevi are often considered benign, and the possibility of malignancy is not always clear to practitioners. We present two case reports suggesting that a halo nevus appearance can be seen in melanoma, even in young adults. A literature search for halo nevi revealing melanoma shows that this is a very rare condition. Case presentation. This report of two young patients indicates the importance of obtaining a detailed history to detect warning signs such as itching, pain, spontaneous bleeding, and previous alterations according to the patient, including a previously totally black colour in an already fully regressed melanoma. Conclusions. The risk of a halo nevus being malignant is higher if there is only one unique halo nevus and no personal or familial history of vitiligo. We postulate that a regressing atypical nevus or a regressing melanoma may be induced by an immunologic reaction as halo nevus type of clinical picture.

scholarly journals Delayed positive COVID19 nasopharyngeal test, a case study with clinical and pathological correlation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lei Zhang ◽  
Syam P. Vunnamadala ◽  
Shigeo Yagi ◽  
Riffat Meraj ◽  
Michele Carbone
Keyword(s):  
Upper Airway ◽  
Nasopharyngeal Swab ◽  
Igg Antibody ◽  
Case Presentation ◽  
Ventilator Dependence ◽  
History Of ◽  
Bronchodilator Treatment ◽  
Artery Disease ◽  
Tract Damage

Abstract Background There are various reasons for delayed positive nasopharyngeal PCR tests for coronavirus disease 2019 (COVID19) in not only asymptomatic but also severely diseased patients. The pathophysiological attributes are not known. We explore this possibility through a case report. Case presentation A 64-year-old male with history of pulmonary fungal infection, asthma and chronic pulmonary obstructive disease (COPD), diabetes, coronary artery disease presented with shortness of breath, fever and chest image of ground opacity, reticular interstitial thickening, highly suspicious for COVID19. However, nasopharyngeal swab tests were discordantly negative for four times in two weeks, and IgG antibody for COVID19 was also negative. However, serum IgE level was elevated. No other pathogens are identified. His symptoms deteriorated despite corticosteroid, antibiotics and bronchodilator treatment. Bronchoalveolar lavage (BAL) and open lung wedge biopsy were performed for etiology diagnosis. They demonstrated COVID19 viral RNA positive fibrosing organizing pneumonia with respiratory tract damage characterized by suspicious viral cytopathic effect, mixed neutrophilic, lymphoplasmacytic, histiocytic and eosinophilic inflammation and fibrosis besides expected asthma and COPD change. One week later, repeated COVID19 nasopharyngeal tests on day 40 and day 49 became positive. Conclusion Our case and literature review indicate that allergic asthma and associated high IgE level together with corticosteroid inhalation might contribute to the delayed positive nasopharyngeal swab in upper airway; COPD related chronic airways obstruction and the addition of fibrosis induced ventilator dependence and poor prognosis in COVID19 pneumonia, and should be therapeutically targeted besides antiviral therapy.

Associations of coronary and peripheral artery disease with presence, expansion, and rupture of abdominal aortic aneurysm – a grin without a cat!

VASA ◽  
2017 ◽  
Vol 46 (3) ◽  
pp. 151-158 ◽  
Author(s):  
Hisato Takagi ◽  
Takuya Umemoto
Keyword(s):  
Abdominal Aortic Aneurysm ◽  
Aortic Aneurysm ◽  
Peripheral Artery Disease ◽  
Literature Search ◽  
Systematic Literature Search ◽  
Peripheral Artery ◽  
Epidemiological Evidence ◽  
Abdominal Aortic ◽  
Artery Disease ◽  
Meta Analyses

Abstract. Both coronary and peripheral artery disease are representative atherosclerotic diseases, which are also known to be positively associated with presence of abdominal aortic aneurysm. It is still controversial, however, whether coronary and peripheral artery disease are positively associated with expansion and rupture as well as presence of abdominal aortic aneurysm. In the present article, we overviewed epidemiological evidence, i. e. meta-analyses, regarding the associations of coronary and peripheral artery disease with presence, expansion, and rupture of abdominal aortic aneurysm through a systematic literature search. Our exhaustive search identified seven meta-analyses, which suggest that both coronary and peripheral artery disease are positively associated with presence of abdominal aortic aneurysm, may be negatively associated with expansion of abdominal aortic aneurysm, and might be unassociated with rupture of abdominal aortic aneurysm.

Investigating the Dynamics of Suicidal Ideation

Crisis ◽  
2018 ◽  
Vol 39 (1) ◽  
pp. 65-69 ◽  
Author(s):  
Nina Hallensleben ◽  
Lena Spangenberg ◽  
Thomas Forkmann ◽  
Dajana Rath ◽  
Ulrich Hegerl ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Small Sample Size ◽  
Unipolar Depression ◽  
Small Sample ◽  
History Of ◽  
Severity Of Depression ◽  
Ecological Momentary ◽  
Depressive Episodes ◽  
Ema Method ◽  
Shed Light

Abstract. Background: Although the fluctuating nature of suicidal ideation (SI) has been described previously, longitudinal studies investigating the dynamics of SI are scarce. Aim: To demonstrate the fluctuation of SI across 6 days and up to 60 measurement points using smartphone-based ecological momentary assessments (EMA). Method: Twenty inpatients with unipolar depression and current and/or lifetime suicidal ideation rated their momentary SI 10 times per day over a 6-day period. Mean squared successive difference (MSSD) was calculated as a measure of variability. Correlations of MSSD with severity of depression, number of previous depressive episodes, and history of suicidal behavior were examined. Results: Individual trajectories of SI are shown to illustrate fluctuation. MSSD values ranged from 0.2 to 21.7. No significant correlations of MSSD with several clinical parameters were found, but there are hints of associations between fluctuation of SI and severity of depression and suicidality. Limitations: Main limitation of this study is the small sample size leading to low power and probably missing potential effects. Further research with larger samples is necessary to shed light on the dynamics of SI. Conclusion: The results illustrate the dynamic nature and the diversity of trajectories of SI across 6 days in psychiatric inpatients with unipolar depression. Prediction of the fluctuation of SI might be of high clinical relevance. Further research using EMA and sophisticated analyses with larger samples is necessary to shed light on the dynamics of SI.

Aspergillus Spondylodiscitis After Spinal Stenosis Surgery: A Case Report

2020 ◽  
Vol 5 (3 And 4) ◽  
pp. 155-160
Author(s):  
Mohsen Aghapoor ◽  
◽  
Babak Alijani Alijani ◽  
Mahsa Pakseresht-Mogharab ◽  
◽  
...  
Keyword(s):  
Antifungal Drugs ◽  
The Body ◽  
Lower Limbs ◽  
Lumbar Pain ◽  
Case Presentation ◽  
Delay In Diagnosis ◽  
Death Case ◽  
Therapeutic Results ◽  
History Of ◽  
Probable Diagnosis

Background and Importance: Spondylodiscitis is an inflammatory disease of the body of one or more vertebrae and intervertebral disc. The fungal etiology of this disease is rare, particularly in patients without immunodeficiency. Delay in diagnosis and treatment of this disease can lead to complications and even death. Case Presentation: A 63-year-old diabetic female patient, who had a history of spinal surgery and complaining radicular lumbar pain in both lower limbs with a probable diagnosis of spondylodiscitis, underwent partial L2 and complete L3 and L4 corpectomy and fusion. As a result of pathology from tissue biopsy specimen, Aspergillus fungi were observed. There was no evidence of immunodeficiency in the patient. The patient was treated with Itraconazole 100 mg twice a day for two months. Pain, neurological symptom, and laboratory tests improved. Conclusion: The debridement surgery coupled with antifungal drugs can lead to the best therapeutic results.

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