scholarly journals Mycobacterium chelonae Cutaneous Infection: A Challenge for an Internist

2021 ◽  
Author(s):  
Margarida Gaudencio ◽  
André Carvalho ◽  
Maria Inês Bertão ◽  
Ivo Barreiro ◽  
Maria Isabel Bessa ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Immunosuppressive Therapy ◽  
Clinical Presentation ◽  
Immune Status ◽  
Cutaneous Infection ◽  
Cutaneous Lesions ◽  
Mycobacterium Chelonae ◽  
Adequate Treatment ◽  
Cutaneous Infections ◽  
Resistant Strains

Cutaneous infections caused by the Mycobacterium chelonae complex show a heterogeneous clinical presentation, which varies according to the patient’s immune status. Most standard antimycobacterials have no effect against these species. Clarithromycin alone was shown to provide adequate treatment, although resistance has been reported. Consequently, the literature supports multi-drug therapy to combat resistant strains. Here, we describe the case of a 59-year-old man under systemic immunosuppressive therapy who developed cutaneous lesions whose evolution was highly suggestive of atypical infection.

IMMUNE STATUS OF EPSTEIN - BARR VIRUS-INFECTED CHILDREN WITH SECRETORY MIDDLE OTITIS

2020 ◽  
pp. 60-64
Author(s):  
Alina Volodymyrivna Chumakova ◽  
Yuliia Viktorivna Lozova
Keyword(s):  
Otitis Media ◽  
Epstein Barr Virus ◽  
Immune Status ◽  
Enzyme Analysis ◽  
Comprehensive Treatment ◽  
Upper Respiratory Tract ◽  
Adequate Treatment ◽  
Barr Virus ◽  
Cell Immunity ◽  
Epstein Barr

Recently the role of herpes viruses in an aggravation of inflammatory diseases of the upper respiratory tract, in particular, herpes simplex virus and Epstein − Barr virus, has become increasingly evident in otorhynolaryngology practice. To determine the extent of infection with Epstein − Barr virus and to study the immunogram of the first level for the children with secretory otitis media, 48 patients aged 3−9 years were examined for the purpose of an adequate treatment. Infection was revealed by serological diagnosis (enzyme immunoassay) with the determination of IgM to capsid complex (VCA) and IgG to early antigen (EA). Level 1 immunograms were also determined by immune enzyme analysis. Children with secretive middle otitis (22.9 %) were infected with Epstein − Barr virus, corresponding to an acute phase of the disease, as well as they had a reduce cell immunity. All children received comprehensive treatment for secretory middle otitis. It was concluded about the need for children with middle otitis to be screened for an infection with the Epstein−Barr virus and treated conservatively by an immunologist. Key words: secretory middle otitis media, etiology of Epstein − Barr virus, immune status of children, treatment.

scholarly journals Atypical Clinical Presentation of Laryngopharyngeal Reflux: A 5-Year Case Series

2021 ◽  
Vol 10 (11) ◽  
pp. 2439
Author(s):  
Jerome R. Lechien ◽  
Stéphane Hans ◽  
Francois Bobin ◽  
Christian Calvo-Henriquez ◽  
Sven Saussez ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Laryngopharyngeal Reflux ◽  
Case Series ◽  
Clinical Findings ◽  
Aerodigestive Tract ◽  
Common Disease ◽  
Upper Aerodigestive Tract ◽  
Suppurative Otitis Media ◽  
Adequate Treatment ◽  
Atypical Clinical Presentation

Background: Laryngopharyngeal reflux (LPR) is a common disease in otolaryngology characterized by an inflammatory reaction of the mucosa of the upper aerodigestive tract caused by digestive refluxate enzymes. LPR has been identified as the etiological or favoring factor of laryngeal, oral, sinonasal, or otological diseases. In this case series, we reported the atypical clinical presentation of LPR in patients presenting in our clinic with reflux. Methods: A retrospective medical chart review of 351 patients with LPR treated in the European Reflux Clinic in Brussels, Poitiers and Paris was performed. In order to be included, patients had to report an atypical clinical presentation of LPR, consisting of symptoms or findings that are not described in the reflux symptom score and reflux sign assessment. The LPR diagnosis was confirmed with a 24 h hypopharyngeal-esophageal impedance pH study, and patients were treated with a combination of diet, proton pump inhibitors, and alginates. The atypical symptoms or findings had to be resolved from pre- to posttreatment. Results: From 2017 to 2021, 21 patients with atypical LPR were treated in our center. The clinical presentation consisted of recurrent aphthosis or burning mouth (N = 9), recurrent burps and abdominal disorders (N = 2), posterior nasal obstruction (N = 2), recurrent acute suppurative otitis media (N = 2), severe vocal fold dysplasia (N = 2), and recurrent acute rhinopharyngitis (N = 1), tearing (N = 1), aspirations (N = 1), or tracheobronchitis (N = 1). Abnormal upper aerodigestive tract reflux events were identified in all of these patients. Atypical clinical findings resolved and did not recur after an adequate antireflux treatment. Conclusion: LPR may present with various clinical presentations, including mouth, eye, tracheobronchial, nasal, or laryngeal findings, which may all regress with adequate treatment. Future studies are needed to better specify the relationship between LPR and these atypical findings through analyses identifying gastroduodenal enzymes in the inflamed tissue.

scholarly journals Sporotrichoid-Like Spread of Cutaneous Mycobacterium chelonae in an Immunocompromised Patient

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Daria Marley Kemp ◽  
Anusha G. Govind ◽  
Jun Kang ◽  
Caroline C. Brugger ◽  
Young C. Kauh
Keyword(s):  
Lupus Erythematosus ◽  
Soft Tissues ◽  
Immunocompromised Patient ◽  
Immunocompromised Patients ◽  
Systemic Lupus ◽  
Mycobacterium Chelonae ◽  
Cutaneous Infections ◽  
Subcutaneous Nodules ◽  
Immunosuppressive Medications ◽  
Atypical Presentations

Mycobacterium chelonae is a rapidly growing mycobacterium found in water and soil that can cause local cutaneous infections in immunocompetent hosts but more frequently affects immunocompromised patients. Typically, patients will present with painful subcutaneous nodules of the joints or soft tissues from traumatic inoculation. However, exhibiting a sporotrichoid-like pattern of these nodules is uncommon. Herein, we report a case of sporotrichoid-like distribution of cutaneous Mycobacterium chelonae in a patient with systemic lupus erythematosus on significant immunosuppressive medications. Clinicians treating immunocompromised patients should be cognizant of their propensity to develop unusual infections and atypical presentations.

Influence of Obesity on Clinical Manifestations and Response to Therapy in Cutaneous Leishmaniasis caused by Leishmania braziliensis

2021 ◽  
Author(s):  
Tainã Lago ◽  
Lucas Carvalho ◽  
Mauricio Nascimento ◽  
Luiz H Guimarães ◽  
Jamile Lago ◽  
...  
Keyword(s):  
Cutaneous Leishmaniasis ◽  
Clinical Presentation ◽  
Clinical Manifestations ◽  
Healing Time ◽  
Response To Therapy ◽  
Leishmania Braziliensis ◽  
Cutaneous Lesions ◽  
Cytokine Levels ◽  
Cure Rates ◽  
The Impact

Abstract Background Cutaneous leishmaniasis (CL) caused by L. braziliensis is characterized by a single ulcer or multiple cutaneous lesions with raised borders. Cure rates below 60% are observed in response to meglumine antimoniate therapy. We investigated the impact of obesity on CL clinical presentation and therapeutic response. Methods A total of 90 age-matched CL patients were included (30 obese, 30 overweight and 30 with normal BMI). CL was diagnosed through documentation of L. braziliensis DNA by PCR or identification of amastigotes in biopsied skin lesion samples. Serum cytokine levels were determined by chemiluminescence. Antimony therapy with Glucantime (20mg/kg/day) was administered for 20 days. Results Obese CL patients may present hypertrophic ulcers rather than typical oval, ulcerated lesions. A direct correlation between BMI and healing time was noted. After one course of Antimony, cure was achieved in 73% of patients with normal BMI, 37% of overweight subjects, yet just 18% of obese CL patients (p<0.01). Obese CL cases additionally presented higher leptin levels than overweight patients or those with normal BMI (p<0.05). Conclusions Obesity modifies the clinical presentation of CL and host immune response, and is associated with greater failure to therapy.

scholarly journals Leukemia Cutis in a 32-Year-Old Male with Acute Myeloid Leukemia

2019 ◽  
Vol 9 (2) ◽  
pp. 133-135
Author(s):  
Meher Afsun ◽  
Rokon Uddin ◽  
Md Abu Baker ◽  
Iftekhar Ahmed
Keyword(s):  
Acute Myeloid Leukemia ◽  
Male Patient ◽  
Myeloid Leukemia ◽  
Clinical Presentation ◽  
Systemic Disease ◽  
Cutaneous Manifestation ◽  
Cutaneous Lesions ◽  
Initial Manifestation ◽  
Leukemia Cutis ◽  
Acute Myeloid

Leukemia cutis (LC) is a rare cutaneous manifestation of leukemia. Clinical presentation of the disease differs among patients depending on types. LC can precede, follow, occur simultaneously with, or present in the absence of the systemic leukemia. Leukemic involvement of the skin may appear as initial manifestation of recurrence or dissemination of systemic disease. Here we report a case of a 32-year-old male patient known to have acute myeloid leukemia with multiple cutaneous lesions diagnosed as LC. J Enam Med Col 2019; 9(2): 133-135

scholarly journals Childhood Arterial Ischaemic Stroke: Clinical Presentation, Risk Factors and Management

2020 ◽  
Vol 40 (02) ◽  
pp. 165-173
Author(s):  
Lucia Gerstl ◽  
Michaela V. Bonfert ◽  
Florian Heinen ◽  
Martin Olivieri ◽  
Andreas Sebastian Schroeder ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Clinical Presentation ◽  
Stroke Care ◽  
Individual Risk ◽  
Social Environments ◽  
Adequate Treatment ◽  
Care Structure ◽  
Life Threatening ◽  
Arterial Ischaemic Stroke ◽  
Work Up

AbstractChildhood arterial ischaemic stroke (AIS) is a rare, but potentially life-threatening event which requires early diagnosis and adequate treatment. The reported significant time delay to childhood AIS diagnosis may be associated with low awareness, the more nonspecific clinical presentation as well as difficult clinical differentiation to more common “stroke mimics” and a less established “acute care structure” with delayed access to proper neuroimaging. Compared with adult stroke care, experiences with acute reperfusion therapies like thrombolysis and mechanical thrombectomy are promising but limited and not based on clinical trials. The etiological work-up is absolutely essential, as the child's individual risk profile determines acute management, secondary prevention, risk of recurrence and outcome. Follow-up care should be organized in a multidisciplinary setting covering all bio-psycho-social aspects to achieve the best integration of the child into its educational, later professional and social environments.

scholarly journals Significance of Histopathology in Leprosy Patients with 1–5 Skin Lesions with Relevance to Therapy

2011 ◽  
Vol 3 (01) ◽  
pp. 021-024 ◽  
Author(s):  
S Veena ◽  
Prakash Kumar ◽  
Shashikala P. ◽  
Gurubasavaraj H. ◽  
H R Chandrasekhar ◽  
...  
Keyword(s):  
Drug Therapy ◽  
Skin Lesion ◽  
Skin Lesions ◽  
Clinicopathological Correlation ◽  
Adequate Treatment ◽  
Duration Of Therapy ◽  
Tuberculoid Leprosy ◽  
Leprosy Patients ◽  
Skin Biopsies ◽  
Severity Of The Disease

ABSTRACT Background: Patients with 1-5 skin lesions are clinically categorized as paucibacillary for treatment purposes. For betterment and adequate treatment of patients, this grouping needs further study. Aim: To study a group of leprosy patients with 1-5 skin lesions, compare clinical details with histopathological findings and bacteriological status of the skin to evaluate the relevance of this grouping. Materials and Methods: Two-year study involving 31 patients of leprosy with 1-5 skin lesions was included in this study. A number of skin lesions were recorded. Skin biopsies were taken in all patients. The biopsies were evaluated for the type of pathology and acid fast bacilli (AFB) status. Results: Of 31 patients, 19 (61.2%) had single skin lesion, 7 (22.5%) had two lesions, 4 (12.9%) had three lesions, and only one (3.22%) had four lesions, there were no patients with five lesions. Of the 31 patients, 30 (96.7%) were clinically diagnosed as borderline tuberculoid and one patient (3.22%) has tuberculoid leprosy. Skin smears were negative for AFB in all patients. The histological diagnoses were: TT 1 (3.22%), BT 24 (77.41%), and IL 6 (19.2%). AFB were found in 2 (6.45%) out of 31 skin biopsies. Clinicopathological correlation was 76.6% in the BT group. Conclusion: Tissue biopsy findings in 1-5 skin lesions which were not considered relevant for treatment purposes until now should be given a status in the categorization and assessment of severity of the disease. The significance of finding of AFB and histopathology of multibacillary (MB) type of leprosy in tissue biopsies, in patients grouped as PB should be resolved so that patients could be given the drug therapy and duration of therapy they warrant.

scholarly journals ’Carcinoma en cuirasse' in the neck: extremely unusual initial presentation of gastric cancer

2019 ◽  
Vol 12 (4) ◽  
pp. e228418 ◽  
Author(s):  
Madhu Rajeshwari ◽  
Pirabu Sakthivel ◽  
Kapil Sikka ◽  
Deepali Jain
Keyword(s):  
Gastric Cancer ◽  
Clinical Presentation ◽  
Cutaneous Metastasis ◽  
Initial Presentation ◽  
Cutaneous Lesions ◽  
Internal Malignancy ◽  
Metastatic Lesions ◽  
Unusual Form ◽  
Rare Phenomenon ◽  
Visceral Malignancy

Cutaneous metastasis from visceral malignancy is a relatively rare phenomenon. It is even rarer to have cutaneous lesions as the first mode of clinical presentation in such malignancies. The lesions are usually nodular, although they can have varied appearances. Common sites of primaries include breast, lung, colorectum, kidney, ovary, and headandneck. We report an unusual form of cutaneous metastasis in the neck, known as ‘carcinoma en cuirasse’, in an elderly man that subsequently led to the diagnosis of an occult gastric cancer. Our case highlights the importance of recognising cutaneous metastatic lesions early, as they may herald the diagnosis of an occult internal malignancy.

Acute kidney injury in the cancer patient

2015 ◽  
Author(s):  
Gilbert W. Moeckel ◽  
Veena Manjunath ◽  
Mark A. Perazella
Keyword(s):  
Acute Kidney Injury ◽  
Cancer Patients ◽  
Clinical Presentation ◽  
Kidney Tissue ◽  
Hospital Setting ◽  
Kidney Injury ◽  
Direct Effects ◽  
Significant Morbidity ◽  
Adequate Treatment ◽  
Kidney Lesions

Acute kidney injury in cancer patients is a complicated clinical condition associated with significant morbidity and mortality, especially in the hospital setting. Cancer patients may develop a variety of different kidney lesions that impair not only immediate survival but also limit the adequate treatment of the underlying malignant process. This poses a significant challenge for clinicians.The mechanisms that lead to acute kidney injury in cancer patients are similar to those seen in non-cancer patients. Moreover, significant morbidity is seen in association with chemotherapy, as well as through direct effects of the cancer on the kidney (i.e. obstruction, infiltrate).This chapter reviews the clinical presentation of the most common malignancies that affect the kidney, discusses their pathologic manifestations in kidney tissue, and reviews options for the clinical management of cancer patients with acute kidney injury.

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