scholarly journals Atypical euthyroid presentation of Steroid Responsive Encephalopathy with Associated Thyroiditis

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Vineeth Bhogadi ◽  
Arlene Kelly-Wiggins
Keyword(s):  
Autoimmune Disease ◽  
Functional Decline ◽  
Unknown Origin ◽  
Rapid Onset ◽  
Mri Findings ◽  
Case Presentation ◽  
Antithyroid Antibodies ◽  
Physician Awareness ◽  
Psychiatric Conditions ◽  
Variable Presentation

Introduction Steroid-responsive encephalopathy with associated thyroiditis (SREAT) is an autoimmune disease associated with antithyroid antibodies. Its clinical features are variable, ranging from sudden focal neurologic deficits to progressive sub-acute cognitive decline and thus, can mimic a host of other neurological and psychiatric conditions. Case Presentation We present the case of a previously healthy 62-year-old female with rapid onset neurocognitive and functional decline. EEG and MRI findings were consistent with an encephalopathy of unknown origin. Serologic findings revealed elevated antithyroid antibodies but were otherwise insignificant. Conclusion Steroid-responsive encephalopathy with associated thyroiditis is typically a diagnosis of exclusion but should always be considered in cases of encephalopathy of unknown origin. The disorder is often underdiagnosed due to its variable presentation and poorly understood pathophysiology, but prognosis can be significantly improved with greater physician awareness and prompt management with corticosteroids.

Hair Growth in a Patient with Alopecia Areata on Tocilizumab

2021 ◽  
pp. 1-5
Author(s):  
Chloe J. Walker ◽  
Kelly E. Flanagan ◽  
James T. Pathoulas ◽  
Isabel Pupo Wiss ◽  
Maryanne M. Senna
Keyword(s):  
Monoclonal Antibody ◽  
Autoimmune Disease ◽  
Hair Loss ◽  
Alopecia Areata ◽  
Interleukin 6 ◽  
Hair Growth ◽  
Posterior Uveitis ◽  
Case Presentation ◽  
Antibody Targeting ◽  
Growth Changes

<b><i>Introduction:</i></b> Tocilizumab (TCZ), a recombinant humanized antihuman monoclonal antibody targeting interleukin-6 (IL-6) signaling, is often utilized in the management of autoimmune disease. Few reports have demonstrated hair growth changes in patients on TCZ. <b><i>Case Presentation:</i></b> Herein, we review the literature and report a 21-year-old woman with progressive alopecia areata (AA) presenting with AA improvement while on TCZ for concomitant posterior uveitis. <b><i>Discussion:</i></b> Our case demonstrates the potential ability of TCZ to disrupt IL-6 signaling involved in AA, leading to hair loss and regrowth.

scholarly journals HMGB1, anti-HMGB1 antibodies, and ratio of HMGB1/anti-HMGB1 antibodies as diagnosis indicator in fever of unknown origin

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Mingkun Chen ◽  
Li Zhu ◽  
Miao Xue ◽  
Rongrong Zhu ◽  
Liling Jing ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Autoimmune Disease ◽  
Serum Concentration ◽  
Malignant Tumor ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Healthy Control Group ◽  
Control Group ◽  
Elisa Kit ◽  
Healthy Control

AbstractTo evaluate the feasibility of serum HMGB1, anti-HMGB1 antibodies, and HMGB1/anti-HMGB1 ratio as a diagnosis indicator of initial clinical classification in patients with fever of unknown origin (FUO). Ninety-four patients with classical FUO and ninety healthy controls were enrolled in this study. The subjects’ clinical data and serum were collected. The serum concentration of HMGB1 was detected by a commercial HMGB1 ELISA kit, while the serum concentration of anti-HMGB1 antibodies were detected by an in-house built anti-HMGB1 antibodies ELISA kit and further confirmed by immunoblotting. According to the hospital diagnosis on discharge, ninety-four FUO patients were divided into four groups, Infectious disease subgroup, autoimmune disease subgroup, malignant tumor subgroup, and undetermined subgroup. The concentrations of HMGB1 in the infectious disease subgroup and autoimmune disease subgroup were higher than those in the malignant tumor subgroup, undetermined subgroup, and healthy control group. The concentration of anti-HMGB1 antibodies in autoimmune disease subtype group was higher than those in other subgroups as well as healthy control group. According to the distribution of HMGB1 and anti-HMGB1 in scatter plots of the patients with FUO, we found that the ratio of serum HMGB1/anti-HMGB1 is an ideal clinical indicator for differential diagnosis of different subtypes of FUO. The best cut-off was 0.75, and the sensitivity, specificity, and AUC were 66.67%, 87.32%, and 0.8, respectively. Correlation analysis showed that serum concentration of HMGB1 was moderately correlated with CRP in infectious diseases subgroup, and the serum concentration of anti-HMGB1 antibodies was strongly correlated with erythrocyte sedimentation rate in autoimmune disease subgroup. Our study had showed that serum HMGB1/anti-HMGB1 antibodies ratio can help clinicians identify FUO subtypes, thereby avoiding many unnecessary examinations and tests, and improving the effectiveness of clinical diagnosis and treatment of FUO.

scholarly journals Leptospirosis presenting as severe cardiogenic shock: A case report

2018 ◽  
Vol 19 (4) ◽  
pp. 351-353
Author(s):  
E Forbat ◽  
MJ Rouhani ◽  
C Pavitt ◽  
S Patel ◽  
R Handslip ◽  
...  
Keyword(s):  
Case Report ◽  
Cardiogenic Shock ◽  
Social History ◽  
Rare Case ◽  
Clinical Course ◽  
Unknown Origin ◽  
Case Presentation ◽  
Pyrexia Of Unknown Origin ◽  
Severe Cardiogenic Shock ◽  
Infectious Illness

Background Leptospirosis is a rare infectious illness caused by the Spirochaete Leptospira. It has a wide-varying spectrum of presentation. We present a rare case of severe cardiogenic shock secondary to leptospirosis, in the absence of its common clinical features. Case presentation A 36-year-old woman presented to our unit with severe cardiogenic shock and subsequent multi-organ failure. Her clinical course was characterised by ongoing pyrexia of unknown origin with concurrent cardiac failure. She was initially managed with broad-spectrum antibiotics and inotropes. Percutaneous cardiac biopsy excluded major causes of myocarditis. On day 21 after presentation, she was found to be IgM-positive for leptospirosis. Conclusions This is a rare case of severe cardiogenic shock secondary to leptospirosis infection. The case also highlights the importance of obtaining a thorough social history when assessing a patient with an unusual presentation, as clues can often be missed.

scholarly journals Incidental Findings of Brugada Syndrome Type-1 and Epsilon-Like Pattern in Otherwise Healthy Man: a Case Report

2022 ◽  
Author(s):  
Brian Mendel ◽  
Valerie Dirjayanto ◽  
Radityo Prakoso ◽  
Sisca Siagian
Keyword(s):  
Brugada Syndrome ◽  
Unknown Origin ◽  
Initial Assessment ◽  
Structural Abnormality ◽  
Bundle Branch Block ◽  
Case Presentation ◽  
Electrophysiology Study ◽  
Esc Guidelines

Abstract Background: Brugada Syndrome (BrS) and arrhythmogenic right ventricle dysplasia (ARVD) are rare cardiomyopathies predisposing to sudden cardiac death (SCD). Comprehending the electrocardiographic features of these cardiomyopathies are crucial especially in emergency settings.Case presentation: A 25-year old medical student presented with no complaints, but had episodes of syncope, chest pain, and palpitations of unknown origin 10 years ago. The initial assessment showed stable hemodynamics. During examination, the ECG demonstrated incomplete right bundle branch block, Brugada-type 1 pattern, with signs of Epsilon wave. The following year, assessment of the ECG was repeated and findings were found suggestive of Brugada syndrome, although his echocardiography showed no structural abnormality. According to ESC guidelines, asymptomatic Brugada patients should undergo electrophysiology study.Conclusion: Careful follow-up with electrophysiology study is recommended for this patient in order to identify the likelihood of true Brugada and suitability for radiofrequency ablation or implantation of implantable cardioverter defibrillator (ICD).

scholarly journals An Unusual Cause of Severe Immunosuppression

2015 ◽  
Vol 10 (3) ◽  
Author(s):  
Karan Bami MD ◽  
Winnie Chan MD ◽  
Oren Steen MD ◽  
Ally PH Prebtani MD ◽  
Nishma Singhal MD
Keyword(s):  
Diabetes Mellitus ◽  
Adrenocorticotropic Hormone ◽  
Opportunistic Infections ◽  
Clinical Status ◽  
Hormone Secretion ◽  
Unknown Origin ◽  
Rapid Onset ◽  
Bk Virus ◽  
Bilateral Adrenalectomy ◽  
Ectopic Adrenocorticotropic Hormone

Ectopic adrenocorticotropic hormone secretion (EAS) is a rare cause of endogenous Cushing’s syndrome and is associated with immunosuppression and opportunistic infections. We report the case of a person who presented with rapid onset of hypertension, diabetes mellitus, and severe hypokalemia in the context of significantly elevated adrenocorticotropic hormone (ACTH) levels and marked hypercortisolism. Subsequent investigations led to a diagnosis of EAS without an identifiable source. Her clinical status continued to deteriorate despite medical management of her hypercortisolemia, thus an urgent bilateral adrenalectomy was performed. This patient’s course was complicated by multiple opportunistic infections with cytomegalovirus, Pneumocystis jirovecii (PJP), Mycobacterium tuberculosis and possibly BK virus. To the best of our knowledge, this is the first description of this specific constellation of opportunistic infections in the setting of EAS. Our case highlights the need to consider multiple and rare opportunistic infections while managing EAS and supports early bilateral adrenalectomy in critically ill patients with EAS of unknown origin.

Surgical Treatment of a Symptomatic Diaphyseal Tibiofibular Synostosis in a Professional Rugby Player: A Case Report and Literature Review

2021 ◽  
pp. 1-7
Author(s):  
Guillaume Mirouse ◽  
Houssam Bouloussa ◽  
Hervé Silbert ◽  
Emad Lotfalizadeh ◽  
Arnaud Dubory
Keyword(s):  
Conservative Treatment ◽  
Recovery Time ◽  
Sport Activity ◽  
Unknown Origin ◽  
Rugby Player ◽  
Interosseous Membrane ◽  
Case Presentation ◽  
Senior Patients ◽  
Return To Competition

Context: Diaphyseal tibiofibular synostosis (DTS) is a rare pathology with unknown origin especially occurring in intensive sport athletes. No therapeutic guideline has been well established in the literature. Case Presentation: A rare case of DTS in a 26-year-old professional rugby player has been described. A 5-month exhaustive conservative treatment including physiotherapy and oral medication has been achieved but failed. Management and Outcomes: Following the conservative treatment failure, the DTS has been widely removed including the adjacent interosseous membrane, and the patient could return to competition at the same level after 5 months of convalescence. No recurrence has been revealed at a 35-month follow-up at least. Conclusion: In accordance with the literature data and even if the pathophysiology remains obscure, resection of DTS seems to be the adapted treatment to allow and to reduce professional athletes’ recovery time at the same sport level. The resection including a part of the tibiofibular interosseous membrane could avoid the occurrence of recurrence. Conservative treatment should be reserved for senior patients with a low sport activity.

scholarly journals Eosinophilic Gastroenteritis with a Relapsing and Remitting Course with Presence of Autoimmune Antibodies

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Chathuranga Lakmal Fonseka ◽  
Sunali Nanayakkara ◽  
S. D. A. L. Singhapura ◽  
H. M. M. Herath ◽  
C. K. Bodinayake
Keyword(s):  
Autoimmune Disease ◽  
Ascitic Fluid ◽  
Peripheral Blood ◽  
Elimination Diet ◽  
Eosinophilic Gastroenteritis ◽  
Normal Diet ◽  
Parasitic Disease ◽  
Case Presentation ◽  
Autoimmune Antibodies ◽  
Uncommon Disease

Background. Eosinophilic gastroenteritis (EGE) is an uncommon disease characterized by eosinophilic infiltration of the digestive tract, which occurs due to an uncertain aetiology. Although autoimmune diseases can later present as EGE, it is unusual for EGE to have positive autoimmune antibodies without the presence of an overt autoimmune disease. Case presentation. We report a 38-year-old previously healthy man who presented with abdominal discomfort and loose stools with pleural and peritoneal effusions progressing over several weeks. His investigations revealed severe eosinophilia in peripheral blood and ascitic fluid, and a laparoscopic full-thickness biopsy from the ileum demonstrated infiltration of eosinophils in all three layers of the intestine. There were no clinical features or investigations suggestive of parasitic disease, other diseases associated with eosinophilia, or autoimmune disease. Further investigations showed a highly positive ANA, positive p-ANCA, but did not meet the criteria to diagnose a specific autoimmune disease. The eosinophilia responded to an elimination diet with gradual resolution of eosinophilia and effusions, and once it reappeared after introduction of a normal diet. Conclusion. EGE presenting as peripheral blood and ascitic fluid eosinophilia with the presence of pleural and/or peritoneal effusions is uncommon. Eosinophilic gastroenteritis can be associated with autoantibody positivity without any evidence of overt autoimmune disease manifestations. Elimination diet can be used as a potential option to prevent recurrences of EGE.

scholarly journals Cyclosporine-Associated Leukoencephalopathy in a Case of Sympathetic Ophthalmitis

2016 ◽  
Vol 7 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Mizuki Tagami ◽  
Atsushi Azumi
Keyword(s):  
Trough Level ◽  
Immunosuppressive Agent ◽  
Cortical Blindness ◽  
High Signal ◽  
Mri Findings ◽  
Case Presentation ◽  
Normal Limits ◽  
Normal Ranges ◽  
Sympathetic Ophthalmitis ◽  
Reversible Encephalopathy

Purpose: Cyclosporine (CsA) is currently widely used as a primary immunosuppressive agent in ocular disease, particularly in severe uveitis. Posterior reversible encephalopathy syndrome (PRES) is a significant complication of CsA therapy. However, there are no reports of the occurrence of PRES in response to the treatment of uveitis in the ophthalmological area. Case Presentation: We report a case with CsA-associated PRES. A 70-year-old woman with sympathetic ophthalmitis was treated with 50 mg/day of CsA for 1 week. However, the trough level in her blood was too low; thus, we increased the dose to 100 mg/day of CsA with prednisolone. She had headaches, hypertension (systolic blood pressure 180-200 mm Hg), loss of consciousness for several hours, and reduced limb movement, and her MRI showed a high signal intensity in both posterior lobes, consistent with PRES. Examination of the cerebrospinal fluid indicated that it was within normal limits. Her CsA trough level in the blood was within normal ranges on the day of the attack. Her symptoms gradually improved over the next several days; however, she presented with cortical blindness, which lasted for several weeks. Finally, she returned to her baseline values from before the attack. Her MRI findings showed that PRES had essentially disappeared. Conclusion: PRES is not directly associated with the dosage of CsA administered; however, in general, it is well known that PRES can affect strongly immunosuppressed cases undergoing organ and bone marrow transplantation. Nevertheless, our CsA dose was only 100 mg (1.8 mg/kg). In this study, we report on the occurrence of PRES after the administration of CsA to treat sympathetic ophthalmia. To our knowledge, PRES can also occur after the administration of a small dose of CsA; thus, ophthalmologists using CsA should carefully observe the systemic conditions of CsA-treated patients.

scholarly journals Extensive eye-oral-bronchial mucosal nodules with eosinopgillia: a rare case report and literature review

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Lujin Wu ◽  
Qianru Leng ◽  
Yan Wang ◽  
Daowen Wang ◽  
Danlei Yang
Keyword(s):  
Biopsy Specimen ◽  
Rare Case ◽  
Unknown Origin ◽  
Neoplastic Disease ◽  
Multisystem Disease ◽  
Case Presentation ◽  
Large Numbers ◽  
Detailed Medical History ◽  
Mucous Membranes ◽  
Rare Case Report

Abstract Background Mucosal nodules can be caused by infection, inflammation and neoplastic disease. Many noninfectious diseases, such as eosinophilia, amyloidosis, sarcoidosis, Wegener’s granuloma, langerhans cell histiocytosis etc., are associated with the formation of multisytem mucosal nodules, especially significant bronchial lesions. Detailed medical history, comprehensive metabolic profile, biopsy specimen and imaging examinations are required for differentiating among these disorders. The process of diagnosis and treatment of our patient’s mucosal nodules was challenging, which could be helpful to similar cases. Case presentation We represent a case of a 29-year-old woman with plentiful nodules of unknown origin on extensive mucous membranes. Biopsy specimen reports inflammatory lesions with large numbers of neutrophils, lymphocytes, and varying degrees of eosinophils. Treatment of anti-infection, anti-tussive and anti-allergic was ineffective, but glucocorticoid showed great improvement to her symptoms. Conclusion We experienced a rare case with plentiful nodules of unknown origin on extensive mucous membranes. She may be a specific phenotype of eosinophilia or may be a novel multisystem disease with respiratory system as the primary symptom. The diagnosis of our patient remains unclear, but tentative glucocorticoid therapy was beneficial.

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