A rare case of cerebral tuberculosis and paraneoplastic encephalitis

2020 ◽  
Vol 10 (6) ◽  
pp. 152-154
Author(s):  
Bhavika Kakadia DO
Keyword(s):  
Medial Temporal Lobe ◽  
Multidisciplinary Approach ◽  
Limbic Encephalitis ◽  
Treatment Options ◽  
Immunoglobulin Therapy ◽  
Young Female ◽  
Disseminated Tuberculosis ◽  
Paraneoplastic Encephalitis ◽  
Cerebral Tuberculosis ◽  
Radiographic Presentation

Voltage gated potassium channel (VGKC) antibodies are seen in many conditions including limbic encephalitis. It typically involves medial temporal lobe, and in rare instances, bilateral cerebellar lobes. Patients can present with seizures and often with alerted mental status and hallucinations. Cerebral tuberculosis (TB)tends to prefer posterior fossa and patients typically present with headache, seizures, and confusion. However, there is no particular association between VGKC encephalitis and disseminated tuberculosis. Presence of both may limit treatment options for paraneoplastic encephalitis. We present a case of a young female with disseminated TB who was also found to have atypical radiographic presentation of TB encephalitis/meningitis and VGKC antibody concerning for paraneoplastic encephalitis. The patient received treatment with steroids and immunoglobulin therapy along with treatment for disseminated tuberculosis. Overall, treatment of paraneoplastic encephalitis is limited in the presence of disseminated TB and a multidisciplinary approach should be used and clinical improvement should be monitored.

Safety of a Clozapine Trial Following Quetiapine-Induced Leukopenia: A Case Report

2019 ◽  
Vol 14 (1) ◽  
pp. 80-83 ◽  
Author(s):  
Asma H. Almaghrebi
Keyword(s):  
Treatment Options ◽  
Young Female ◽  
Similar Reaction ◽  
Careful Monitoring ◽  
Treatment Resistant ◽  
Blood Cell Count ◽  
Antipsychotic Medications ◽  
Case Presentation ◽  
Clozapine Treatment ◽  
History Of

Background: The clozapine-derivative quetiapine has been shown in some cases to cause leukopenia and neutropenia. Case Presentation: We reported on a case of a young female diagnosed with treatment-resistant schizophrenia. After failed trials of three antipsychotic medications and despite a history of quetiapineinduced leukopenia, clozapine treatment was introduced due to the severity of the patient’s symptoms, the limited effective treatment options, and a lack of guidelines on this issue. Result: Over a ten-week period of clozapine treatment at 700 mg per day, the patient developed agranulocytosis. Her white blood cell count sharply dropped to 1.6 &#215; 10<sup>9</sup> L, and her neutrophils decreased to 0.1 &#215; 10<sup>9</sup> L. There had been no similar reaction to her previous medications (carbamazepine, risperidone, and haloperidol). Conclusion: The safety of clozapine in a patient who has previously experienced leukopenia and neutropenia with quetiapine requires further investigation. Increased attention should be paid to such cases. Careful monitoring and slow titration are advisable.

scholarly journals Rheumatic Immune-Related Adverse Events—A Consequence of Immune Checkpoint Inhibitor Therapy

Biology ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 561
Author(s):  
Anca Bobircă ◽  
Florin Bobircă ◽  
Ioan Ancuta ◽  
Alesandra Florescu ◽  
Vlad Pădureanu ◽  
...  
Keyword(s):  
Immune System ◽  
Adverse Events ◽  
Immune Checkpoint ◽  
Multidisciplinary Approach ◽  
Malignant Tumors ◽  
Checkpoint Inhibitors ◽  
Treatment Options ◽  
Cancer Cell Growth ◽  
Inhibitory Mechanisms ◽  
Checkpoint Inhibitor Therapy

The advent of immunotherapy has changed the management and therapeutic methods for a variety of malignant tumors in the last decade. Unlike traditional cytotoxic chemotherapy, which works by interfering with cancer cell growth via various pathways and stages of the cell cycle, cancer immunotherapy uses the immune system to reduce malignant cells’ ability to escape the immune system and combat cell proliferation. The widespread use of immune checkpoint inhibitors (ICIs) over the past 10 years has presented valuable information on the profiles of toxic adverse effects. The attenuation of T-lymphocyte inhibitory mechanisms by ICIs results in immune system hyperactivation, which, as expected, is associated with various adverse events defined by inflammation. These adverse events, known as immune-related adverse events (ir-AEs), may affect any type of tissue throughout the human body, which includes the digestive tract, endocrine glands, liver and skin, with reports of cardiovascular, pulmonary and rheumatic ir-AEs as well. The adverse events that arise from ICI therapy are both novel and unique compared to those of the conventional treatment options. Thus, they require a multidisciplinary approach and continuous updates on the diagnostic approach and management.

scholarly journals Epiphysiodesis for the treatment of tall stature and leg length discrepancy

2021 ◽  
Author(s):  
Madeleine Willegger ◽  
Markus Schreiner ◽  
Alexander Kolb ◽  
Reinhard Windhager ◽  
Catharina Chiari
Keyword(s):  
Surgical Planning ◽  
Multidisciplinary Approach ◽  
Treatment Options ◽  
Bone Age ◽  
Leg Length Discrepancy ◽  
Tall Stature ◽  
Complication Rates ◽  
Leg Length ◽  
Growth Prediction ◽  
Length Discrepancy

SummaryPainful orthopedic conditions associated with extreme tall stature and leg length discrepancy (LLD) include back pain and adopting bad posture. After failure of conservative treatment options, blocking of the growth plates (epiphysiodesis) around the knee emerged as gold standard in patients with tall stature and LLD in the growing skeleton. Surgical planning includes growth prediction and evaluation of bone age. Since growth prediction is associated with a certain potential error, adequate planning and timing of epiphysiodesis are the key for success of the treatment. LLD corrections up to 5 cm can be achieved, and predicted extreme tall stature can be limited. Percutaneous epiphysiodesis techniques are minimally invasive, safe and efficient methods with low complication rates. In general, a multidisciplinary approach should be pursued when treating children and adolescents with tall stature.

scholarly journals ASSESSMENT OF MENSTRUAL HEALTH AND ANALGESICS USAGE IN YOUNG AGE WOMEN

2019 ◽  
pp. 38-42
Author(s):  
ALMOHAMMADI AMEEN ◽  
JUNAID SUHAIL ◽  
SHORBATLI LOUJAIN ◽  
AL-SOMALI AMAL
Keyword(s):  
Severe Pain ◽  
Treatment Options ◽  
Cross Sectional Study ◽  
Young Female ◽  
Cross Sectional ◽  
Over The Counter ◽  
Young Females ◽  
Menstrual Health ◽  
Menstrual Irregularities ◽  
Lifestyle Pattern

Objective: The study focuses on assessing the incidence of menstrual irregularity among young women and the factors for a disturbance with the rationale to assess the use of analgesic drugs during Premenstrual Syndrome (PMS). Methods: A cross-sectional study was used. A total of 2500 randomly selected young female between the age of 11 and 30 y completed the study questionnaire to assess lifestyle pattern, variations in menstrual pattern, perceived stress, and to capture information about their menstrual cycle and related problems. In addition, the questionnaire assessed the use of analgesics for PMS. Results: 2481 participants completed the questionnaire. The mean age of participants’ menarche was 12.85±1.432 y. The prevalence of menstrual irregularities was 25.0 % (n=621) and about 8.5% (n=211) of respondents had severe pain that was not relieved by the use of analgesics. On the other hand, 50.9 % (n=1262) reported severe pain that was relieved by analgesics. A total of 1279 (51.6 %) of participants in this study used Over The Counter (OTC) analgesics to relieve PMS. Conclusion: Dysmenorrhea is the most common complaint among young females in Saudi Arabia. Low Body Mass Index (BMI), sedentary lifestyle, stress and early age of menarche are the most important factors associated with menstrual irregularities. Proper education programs and awareness among young girls about their menstrual health, and the provision of guidance in choosing effective analgesics and treatment options for dysmenorrhea are highly recommended.

scholarly journals Hyperthyroidism with Biventricular Heart Failure and Cirrhotic Transformation of the Liver

2018 ◽  
Vol 2018 ◽  
pp. 1-4 ◽  
Author(s):  
Rashmi Dhital ◽  
Shivani Vyas ◽  
Priyadarshani Sharma ◽  
Theresa Lynn ◽  
Oreoluwa Oladiran ◽  
...  
Keyword(s):  
Early Recognition ◽  
Treatment Options ◽  
Young Female ◽  
Good Prognosis ◽  
Thyroid Peroxidase ◽  
Free T4 ◽  
Gradual Improvement ◽  
Fluid Analysis ◽  
Cardiac Cirrhosis ◽  
Congestive Liver

Cardiovascular symptoms remain the most common presenting features and leading causes of death in hyperthyroidism. We report a young female with reported thyroid disease and medication noncompliance presenting with atrial fibrillation, severe atrioventricular regurgitation, severely dilated right heart with reduced function, and moderate pulmonary hypertension (PH), which was further complicated by congestive liver injury with ascites and pancytopenia. Thyroid work-up revealed suppressed TSH, elevated free T4 and T3 along with elevated anti-thyroglobulin antibodies, thyroid peroxidase antibodies, and thyroid-stimulating immunoglobulin, suggesting Graves’ thyrotoxicosis. Ultrasound of the abdomen was suggestive of liver cirrhosis and ascites, which was thought to be cardiac cirrhosis, after multiple negative work-ups for alternate causes of cirrhosis. Ascitic fluid analysis revealed portal hypertension as the cause. The patient was restarted on antithyroid medication with gradual improvement of thyroid function and in clinical and echocardiogram findings. In contrast to primary PH that carries a poor prognosis and has limited treatment options, PH due to Graves’ disease carries a good prognosis with prior reports of resolution after appropriate treatment, emphasizing the importance of early recognition. Also, unlike cirrhosis caused by alcohol or viral hepatitis, the effect of cardiac cirrhosis on overall prognosis has not been clearly established.

scholarly journals Anti-voltage-gated potassium channel complex antibody–mediated limbic encephalitis: a case report of a 53-year-old man admitted to intensive care psychiatric unit with psychotic mania

2020 ◽  
Vol 33 (4) ◽  
pp. e100196
Author(s):  
Homayun Shahpesandy ◽  
Rosemary Mohammed-Ali ◽  
Ahmed Oladosu ◽  
Tarik Al-Kubaisy ◽  
Moses Anene ◽  
...  
Keyword(s):  
Potassium Channel ◽  
Medial Temporal Lobe ◽  
Short Term Memory ◽  
Limbic Encephalitis ◽  
Neuropsychiatric Symptoms ◽  
Autoimmune Encephalitis ◽  
Clonic Seizure ◽  
Neurological Symptoms ◽  
Psychiatric Symptomatology ◽  
Voltage Gated

Limbic encephalitis represents a cluster of autoimmune disorders, with inflammation in the medial temporal lobe characterised by subacute onset of neuropsychiatric symptoms such as anxiety, affective symptoms, psychosis, short-term memory impairment as well as faciobrachial and grand mal seizures. We aim to present a case of a 53-year-old man with positive anti–voltage-gated potassium channel (VGKC) complex antibodies who initially presented with symptoms of psychotic mania. Six weeks post-psychiatric symptomatology, he presented with neurological symptoms such as faciobrachial jerking and tonic-clonic seizure. The patient had no previous psychiatric history and was initially treated with psychotropic medications. Our experience emphasises the fact that limbic encephalitis is not easy to identify as most patients initially present with psychiatric symptomatology than neurological symptoms. Furthermore, immunological and laboratory testing takes a rather long time to determine the diagnosis. What is more, few psychiatrists consider autoimmune nature of the neuropsychiatric presentation. Therefore, it is important to consider autoimmune encephalitis in patients with new-onset psychosis or mania who also present with neurological symptoms at some stage of their illness. Characteristic indicators of autoimmune encephalitis include neurological symptoms such as facial twitching, seizures, confusion and cognitive decline.

scholarly journals Unique Presentation and Management Approach of Pleural Solitary Fibrous Tumor

2019 ◽  
Vol 2019 ◽  
pp. 1-4 ◽  
Author(s):  
Tarek Aridi ◽  
Ayman Tawil ◽  
Mohamad Hashem ◽  
Joe Khoury ◽  
Roy A. Raad ◽  
...  
Keyword(s):  
Solitary Fibrous Tumor ◽  
Multidisciplinary Approach ◽  
Young Female ◽  
Therapeutic Interventions ◽  
Management Approach ◽  
X Ray ◽  
Chest X Ray ◽  
Fibrous Tumor ◽  
Routine Chest ◽  
Uncommon Tumor

Solitary fibrous tumor (SFT) of the pleura is an uncommon tumor that is often discovered incidentally on a routine chest X-ray. We report a case of a young female with a large, sessile, hypervascularized SFT of the pleura presenting with cardiopulmonary shock to a rural hospital with limited therapeutic interventions. We propose, in this case report, a unique multidisciplinary approach for the management of such a critical patient and the safe resection of the tumor.

scholarly journals Tarsal Coalition of the Cuneiforms in an Elite Athlete: A Case Report

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0023
Author(s):  
Alexander J. Johnson ◽  
Eric Gokcen
Keyword(s):  
Conservative Management ◽  
Treatment Options ◽  
Young Female ◽  
Current Case ◽  
Orthopedic Surgeons ◽  
Clinical Literature ◽  
Ct Evaluation ◽  
Motion Mri ◽  
Cadaver Studies ◽  
High Level

Category: Midfoot/Forefoot, Sports Introduction/Purpose: Tarsal coalitions are a relatively common, often asymptomatic disorder with an incidence of 1-6% in clinical studies and 11-13% in cadaver studies. Calcaneonavicular, followed by talonavicular, are the most common forms of coalitions, but a variety of other coalitions have been described in radiographic, anatomic, and clinical literature. Despite the varied research that has focused on the topic in recent decades, there are no identified reports of cuneiform to cuneiform coalition in the literature. Methods: The authors present the unique case of medial and intermediate cuneiform coalition in a young female track athlete. A 19 year old female Division 1 hurdler presented with 1 year of atraumatic midfoot pain limiting her ability to compete. Despite evaluation by multiple orthopedic surgeons, the etiology of the pain was undetermined, and she had failed multiple conservative treatment options. Her exam revealed diffuse midfoot tenderness and increased midfoot pain with twisting motion. MRI and CT evaluation showed coalition between medial and intermediate cuneiforms with early degenerative changes. Ultrasound guided injection in this area resulted in relief of symptoms, confirming the diagnosis. The patient underwent coalition release and medial- intermediate cuneiform arthrodesis. Results: Postoperatively the patient underwent a period of nonweightbearing then progressed back to activity. CT scan confirmed solid arthrodesis and she was cleared to return to track competition. She successfully returned to competitive collegiate hurdling 11 months after surgery while noting only occasional discomfort in the foot. Conclusion: With no previous reports identified in the literature, cuneiform to cuneiform coalitions are a rare clinical entity. It is likely that the patient in the current case experienced symptoms related to this pathology because of her high level athletic participation. After failing conservative management, the patient experienced a good outcome after coalition release and arthrodesis. Although it is likely that patients with similar pathology who fail conservative management may expect similarly positive outcomes, review of future cases will help further define the optimal treatment for this condition.

scholarly journals 36-Year-Old Female with Catastrophic Antiphospholipid Syndrome Treated with Eculizumab: A Case Report and Review of Literature

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Marianna Strakhan ◽  
Mariana Hurtado-Sbordoni ◽  
Nahun Galeas ◽  
Kamila Bakirhan ◽  
Karenza Alexis ◽  
...  
Keyword(s):  
Antiphospholipid Syndrome ◽  
Treatment Options ◽  
Immunoglobulin Therapy ◽  
High Rate ◽  
Catastrophic Antiphospholipid Syndrome ◽  
Laboratory Findings ◽  
Intravenous Immunoglobulin Therapy ◽  
Short Period ◽  
Threatening Condition ◽  
Life Threatening

Catastrophic antiphospholipid syndrome (CAPS) is a rare but potentially life-threatening condition characterized by diffuse vascular thrombosis, leading to multiple organ failure developing over a short period of time in the presence of positive antiphospholipid antibodies (aPL). CAPS is a severe form of antiphospholipid syndrome, developing in about 1% of cases of classic antiphospholipid syndrome, manifesting as microangiopathy, affecting small vessels of multiple organs. It is acute in onset, with majority of cases developing thrombocytopenia and less frequently hemolytic anemia and disseminated intravascular coagulation. Lupus anticoagulant and anticardiolipin antibodies have been reported as predominant antibodies associated with CAPS. Treatment options often utilized in CAPS include anticoagulation, steroids, plasma exchange, cyclophosphamide therapy, and intravenous immunoglobulin therapy. Even though the reported incidence of this condition is considered to be low, the mortality rate is approaching 50%. The high rate of mortality should warrant greater awareness among clinicians for timely diagnosis and treatment of this life-threatening condition. Studies have shown that complement activation plays a key role in the pathogenesis of aPL mediated thrombosis in CAPS. We report a case of a 36-year-old female admitted with clinical and laboratory findings consistent with CAPS successfully treated with eculizumab, a terminal complement inhibitor.

scholarly journals Spondylodiscitis Caused by Aspergillus Species

Diagnostics ◽  
2021 ◽  
Vol 11 (10) ◽  
pp. 1899
Author(s):  
Christos Koutserimpas ◽  
Ifigeneia Chamakioti ◽  
Symeon Naoum ◽  
Konstantinos Raptis ◽  
Kalliopi Alpantaki ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Multidisciplinary Approach ◽  
Surgical Intervention ◽  
Treatment Options ◽  
Standard Of Care ◽  
Clinical Challenge ◽  
Life Threatening ◽  
The Mean ◽  
Magnetic Resonance Imaging Mri ◽  
Mean Time

Background: Spondylodiscitis caused by Aspergillus spp. is a rare but life-threatening clinical entity. However, a consensus on diagnostic criteria and most effective medical management is still missing. The present study is a review of all published cases of spondylodiscitis caused by Aspergillus spp., in an effort to elucidate epidemiology, patients’ characteristics, andand the medical and surgical treatment options and their effectiveness. Methods: A thorough review of all existing spondylodiscitis cases caused by Aspergillus was performed. Data regarding demographics, responsible fungus, time between symptoms’ onset and firm diagnosis, antifungal treatment (AFT), surgical intervention, andand the infection’s outcome were investigated. Results: A total of 118 Aspergillus spondylodiscitis cases, yielding 119 Aspergillus spp. isolates, were identified in the literature. The patients’ mean age was 40.6 years. Magnetic resonance imaging (MRI) (after its introduction) indicated the diagnosis in most cases (66.7%), while definite diagnosis was established through cultures in the majority of cases (73.7%). Aspergillus fumigatus was isolated in most cases (73; 61.3%), followed by Aspergillus flavus (15; 12.6%) andand Aspergillus nidulans and terreus (7; 5.9%, each). The mean time between symptoms’ onset and diagnosis was 5.7 months. Amphotericin B was the preferred antifungal regiment (84 cases; 71.2%), followed by voriconazole (31; 26.3%), and the mean AFT duration was 6.1 months. The final outcome was successful in 93 cases (78.8%). Furthermore, 77 patients (65.3%) underwent surgery. Conclusions: Spondylodiscitis caused by Aspergillus spp. represents a clinical challenge, requiring a multidisciplinary approach. The present review has shown that prolonged AFT has been the standard of care of the studied cases, while surgical treatment seems to play an important role in selected patents.

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