scholarly journals Brain cryptococcoma in immunocompetent patient. A case report

2020 ◽  
Vol 31 (4) ◽  
pp. 353-356
Author(s):  
Luiz Gabriel Gonçalves Cherain ◽  
Carollayne Mendonça Rocha ◽  
Marcos Antônio de Oliveira ◽  
Denis Batista Pereira ◽  
Michelli Bárbara Pinto ◽  
...  
Keyword(s):  
Immunocompetent Patient ◽  
Human Populations ◽  
Histopathological Analysis ◽  
Case Presentation ◽  
Immunological Status ◽  
Neurosurgical Treatment ◽  
Late Treatment ◽  
The Central Nervous System ◽  
Parasitic Load

Cryptococcosis commonly associated with immunosuppressed individuals is an infection caused by Cryptococcus neoformans/var. gattii. This infection has high mortality worldwide. C. neoformans inhabits the lung, later spreading to the Central Nervous System (CNS) which is the most significant site in the clinical manifestation of the disease. However, the prevalence in the CNS is low in immunocompetent individuals. Case presentation: A 42-year-old woman presented only headache, nausea, vomiting and simple partial epileptic seizure. Neuroimaging showed an expansive hypointense frontal lesion and a neurosurgical treatment was proposed, confirmed by histopathological analysis. Discussion: The exposure to C. neoformans among human populations is almost ubiquitous. The immunological status of the patient, the parasitic load and the virulence of the infectious strain are fundamental for the progression of the pathology. The balance of these factors is decisive for the prognosis. Currently, treatment is limited and consists of long term antifungal therapy. Conclusion: In this case, the necessity of differential diagnosis like brain tumors (e.g.: lymphoma and glioblastoma multiforme), resulting in poor prognosis and late treatment is seen. A neurosurgical approach should be instituted as soon as possible when pharmacological treatment is ineffective.

scholarly journals Steroid responsive cavernous sinus syndrome due to Rosai-Dorfman disease: beyond Tolosa-Hunt syndrome – a case report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Paulo Ribeiro Nóbrega ◽  
Pedro Gustavo Barros Rodrigues ◽  
Isabelle de Sousa Pereira ◽  
Carolina de Figueiredo Santos ◽  
Gunter Gerson ◽  
...  
Keyword(s):  
Cavernous Sinus ◽  
Cranial Nerves ◽  
Case Presentation ◽  
Cavernous Sinus Syndrome ◽  
Hunt Syndrome ◽  
Rosai Dorfman Disease ◽  
The Central Nervous System ◽  
Term Response ◽  
Nonspecific Inflammation

Abstract Background The term “Tolosa-Hunt syndrome” (THS) has been used to refer to painful ophthalmoplegia associated with nonspecific inflammation of the cavernous sinus and many processes can result in a similar clinical picture, including infectious, inflammatory and neoplastic diseases. Rosai-Dorfman disease (RDD) is a lymphoproliferative disorder that rarely affects the central nervous system. We report a case of isolated CNS Rosai-Dorfman disease involving the cavernous sinus and presenting as “Tolosa-Hunt syndrome”. Case presentation Our patient presented with horizontal diplopia due to impairment of cranial nerves III, IV and VI and a stabbing/throbbing headache predominantly in the left temporal and periorbitary regions. There was a nonspecific enlargement of the left cavernous sinus on MRI and the patient had a dramatic response to steroids. Biopsy of a frontal meningeal lesion was compatible with RDD. Conclusions We highlight the importance of including Rosai-Dorfman disease as a differential diagnosis in cavernous sinus syndrome and demonstrate a satisfactory long-term response to steroid treatment in this disease.

Herbal Medicine for Glioblastoma: Current and Future Prospects

2020 ◽  
Vol 16 (8) ◽  
pp. 1022-1043
Author(s):  
Imran Khan ◽  
Sadaf Mahfooz ◽  
Mustafa A. Hatiboglu
Keyword(s):  
Cell Proliferation ◽  
Survival Rates ◽  
Standard Of Care ◽  
Natural Compounds ◽  
Treatment Modalities ◽  
Normal Brain ◽  
The Central Nervous System ◽  
Cycle Regulation ◽  
Immense Potential

Background: Glioblastoma is one of the most aggressive and devastating tumours of the central nervous system with short survival time. Glioblastoma usually shows fast cell proliferation and invasion of normal brain tissue causing poor prognosis. The present standard of care in patients with glioblastoma includes surgery followed by radiotherapy and temozolomide (TMZ) based chemotherapy. Unfortunately, these approaches are not sufficient to lead a favorable prognosis and survival rates. As the current approaches do not provide a long-term benefit in those patients, new alternative treatments including natural compounds, have drawn attention. Due to their natural origin, they are associated with minimum cellular toxicity towards normal cells and it has become one of the most attractive approaches to treat tumours by natural compounds or phytochemicals. Objective: In the present review, the role of natural compounds or phytochemicals in the treatment of glioblastoma describing their efficacy on various aspects of glioblastoma pathophysiology such as cell proliferation, apoptosis, cell cycle regulation, cellular signaling pathways, chemoresistance and their role in combinatorial therapeutic approaches was described. Methods: Peer-reviewed literature was extracted using Pubmed, EMBASE Ovid and Google Scholar to be reviewed in the present article. Conclusion: Preclinical data available in the literature suggest that phytochemicals hold immense potential to be translated into treatment modalities. However, further clinical studies with conclusive results are required to implement phytochemicals in treatment modalities.

scholarly journals Septic shock due to Yersinia pseudotuberculosis infection in an adult immunocompetent patient: a case report and literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Takehiro Hashimoto ◽  
Ryuichi Takenaka ◽  
Haruka Fukuda ◽  
Kazuhiko Hashinaga ◽  
Shin-ichi Nureki ◽  
...  
Keyword(s):  
Septic Shock ◽  
Therapeutic Strategy ◽  
Yersinia Pseudotuberculosis ◽  
Immunocompromised Host ◽  
Immunocompetent Patient ◽  
Case Presentation ◽  
Gram Negative ◽  
Old Japanese ◽  
The Right ◽  
Immunocompetent Patients

Abstract Background Yersinia pseudotuberculosis infection can occur in an immunocompromised host. Although rare, bacteremia due to Y. pseudotuberculosis may also occur in immunocompetent hosts. The prognosis and therapeutic strategy, especially for immunocompetent patients with Y. pseudotuberculosis bacteremia, however, remains unknown. Case presentation A 38-year-old Japanese man with a mood disorder presented to our hospital with fever and diarrhea. Chest computed tomography revealed consolidation in the right upper lobe with air bronchograms. He was diagnosed with pneumonia, and treatment with intravenous ceftriaxone and azithromycin was initiated. The ceftriaxone was replaced with doripenem and the azithromycin was discontinued following the detection of Gram-negative rod bacteria in 2 sets of blood culture tests. The isolated Gram-negative rod bacteria were confirmed to be Y. pseudotuberculosis. Thereafter, he developed septic shock. Doripenem was switched to cefmetazole, which was continued for 14 days. He recovered without relapse. Conclusions We herein report a case of septic shock due to Y. pseudotuberculosis infection in an adult immunocompetent patient. The appropriate microorganism tests and antibiotic therapy are necessary to treat patients with Y. pseudotuberculosis bacteremia.

scholarly journals COVID-19 related mortality in post-operative cardiac surgical patients

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Azhar Hussain ◽  
Amina Khalil ◽  
Priyanka Kolvekar ◽  
Prity Gupta ◽  
Shyamsunder Kolvekar
Keyword(s):  
Cardiac Surgery ◽  
Long Term Outcomes ◽  
Case Presentation ◽  
Elective Cardiac Surgery ◽  
The United Kingdom ◽  
Global Pandemic ◽  
Cardiac Operations ◽  
Related Mortality

Abstract Background COVID-19 has caused a global pandemic of unprecedented proportions. Elective cardiac surgery has been universally postponed with only urgent and emergency cardiac operations being performed. The National Health Service in the United Kingdom introduced national measures to conserve intensive care beds and significantly limit elective activity shortly after lockdown. Case presentation We report two cases of early post-operative mortality secondary to COVID-19 infection immediately prior to the implementation of these widespread measures. Conclusion The role of cardiac surgery in the presence of COVID-19 is still very unpredictable and further studies on both short term and long term outcomes are warranted.

scholarly journals Uncommon manifestations of a rare disease: a case of autoimmune GFAP astrocytopathy

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hong Di ◽  
Yue Yin ◽  
Ruxuan Chen ◽  
Yun Zhang ◽  
Jun Ni ◽  
...  
Keyword(s):  
Rare Disease ◽  
Hormone Secretion ◽  
White Matter Lesions ◽  
Signs And Symptoms ◽  
Careful Examination ◽  
Case Presentation ◽  
Inappropriate Antidiuretic Hormone Secretion ◽  
Contrast Enhanced ◽  
The Central Nervous System ◽  
Magnetic Resonance Imaging Mri

Abstract Background Manifestations of intractable hyponatremia and hypokalemia in autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy have been rarely reported. Case presentation A 75-year-old male patient presented as the case of syndrome of inappropriate antidiuretic hormone secretion (SIADH) and intractable hypokalemia, showed fever, fatigue, and mental disorders. Signs and symptoms of meningoencephalitis, ataxia, and cognitive abnormalities. Magnetic resonance imaging (MRI) revealed multiple white matter lesions of the central nervous system. He had GFAP-IgG in the cerebrospinal fluid (CSF). After treatment with corticosteroids, his symptoms were alleviated gradually, and the level of electrolytes was normal. However, head contrast-enhanced MRI + susceptibility-weighted imaging (SWI) showed a wide afflicted region, and the serum GFAP-IgG turned positive. Considering the relapse of the disease, ha was treated with immunoglobulin and mycophenolate mofetil (MMF) to stabilize his condition. Conclusion This case showed a rare disease with uncommon manifestations, suggesting that careful examination and timely diagnosis are essential for disease management and satisfactory prognosis.

scholarly journals Self-buffering capacity of a human sulfatase for central nervous system delivery

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yi Wen ◽  
Nazila Salamat-Miller ◽  
Keethkumar Jain ◽  
Katherine Taylor
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Buffering Capacity ◽  
The Self ◽  
High Concentration ◽  
Formulation Design ◽  
The Central Nervous System ◽  
Therapeutic Enzymes ◽  
Intrathecal Space

AbstractDirect delivery of therapeutic enzymes to the Central Nervous System requires stringent formulation design. Not only should the formulation design consider the delicate balance of existing ions, proteins, and osmolality in the cerebrospinal fluid, it must also provide long term efficacy and stability for the enzyme. One fundamental approach to this predicament is designing formulations with no buffering species. In this study, we report a high concentration, saline-based formulation for a human sulfatase for its delivery into the intrathecal space. A high concentration formulation (≤ 40 mg/mL) was developed through a series of systematic studies that demonstrated the feasibility of a self-buffered formulation for this molecule. The self-buffering capacity phenomenon was found to be a product of both the protein itself and potentially the residual phosphates associated with the protein. To date, the self-buffered formulation for this molecule has been stable for up to 4 years when stored at 5 ± 3 °C, with no changes either in the pH values or other quality attributes of the molecule. The high concentration self-buffered protein formulation was also observed to be stable when exposed to multiple freeze–thaw cycles and was robust during in-use and agitation studies.

scholarly journals Fibromuscular dysplasia with recurrence after “long-term” following percutaneous transcatheter renal angioplasty: two case reports with a review of 26 patients

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Shuntaro Oribe ◽  
Takafumi Toyohara ◽  
Eikan Mishima ◽  
Takehiro Suzuki ◽  
Koichi Kikuchi ◽  
...  
Keyword(s):  
Fibromuscular Dysplasia ◽  
Age Of Onset ◽  
Case Reports ◽  
Case Presentation ◽  
Renal Angioplasty ◽  
Long Term Follow Up ◽  
Percutaneous Transluminal Renal Angioplasty ◽  
The Difference

Abstract Background Fibromuscular dysplasia (FMD) often causes renal artery stenosis with renovascular hypertension. Recent clinical outcomes encourage percutaneous transluminal renal angioplasty (PTRA) to treat FMD; however, the necessary follow-up period remains unclear. Moreover, previous studies have not revealed the difference in the period until recurrence between two major types of FMD—multifocal and focal. Case presentation We describe two patients with multifocal FMD who developed hypertension during their teenage years and had recurrence of FMD > 10 years after PTRA. We further examined the types of FMD and age of onset in 26 patients who underwent PTRA. The period until recurrence of multifocal FMD was longer than that of focal FMD. Moreover, patients with early-onset multifocal FMD are likely to have a delayed recurrence after PTRA compared to other types. Conclusions Our report suggests that patients with multifocal FMD, especially those with onset at an early age, may need long-term follow-up for at least ≥ 10 years.

scholarly journals Large papillary fibroelastoma of right atrium, an unusual case of respiratory distress in a young man

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yan Le Ho ◽  
Pui Fong Ng ◽  
Sotheenathan Krishinan ◽  
Basheer Ahamed Abdul Kareem
Keyword(s):  
Right Atrium ◽  
Clinical Manifestations ◽  
Clinical Information ◽  
Interatrial Septum ◽  
Papillary Fibroelastoma ◽  
Case Presentation ◽  
Intracardiac Masses ◽  
The Right ◽  
Embolic Risk

Abstract Background Papillary fibroelastomas are rare but benign cardiac tumour that are often found on cardiac valvular surfaces. Their clinical manifestations ranging from clinically asymptomatic to substantial complications that are usually secondary to systemic embolism. Multiple theories have been proposed to explain the pathophysiology of its formation. Case presentation We reported a rare case of large papillary fibroelastoma in the right atrium of a young gentleman which was complicated with pulmonary embolism. Transthoracic echocardiography identified a large pedunculated mass measuring 3.4cmX3.4cmX2cm in right atrium with stalk attached to interatrial septum. The intracardiac mass was resected surgically, which revealed papillary fibroelastoma in histology examination. Conclusion Differential diagnosis of intracardiac masses requires clinical information, laboratory tests and imaging modalities including echocardiography. Incidentally discovered papillary fibroelastomas are treated on the basis of their sizes, site, mobility and potential embolic complications. Due to the embolic risk inherent to intraacardiac masses, surgical resection represents an effective curative protocol in treating both symptomatic and asymptomatic right sided and left sided papillary fibroelastomas, with excellent long term postoperative prognosis.

scholarly journals Phenylketonuria and juvenile idiopathic arthritis: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ting Ting Zhu ◽  
Jin Wu ◽  
Li Yuan Wang ◽  
Xiao Mei Sun
Keyword(s):  
Juvenile Idiopathic Arthritis ◽  
Case Report ◽  
Autoimmune Diseases ◽  
Hip Joint ◽  
Metabolic Disorder ◽  
Rare Case ◽  
Molecular Data ◽  
Methotrexate Therapy ◽  
Case Presentation

Abstract Background Phenylketonuria (PKU) is a genetic metabolic disorder in which patients have no ability to convert phenylalanine to tyrosine. Several autoimmune diseases have been reported to combine with PKU, co-existent of PKU and Juvenile Idiopathic Arthritis (JIA) has not been presented. Case presentation The girl was diagnosed with PKU at the age of 1 month confirmed by molecular data. At the age of 3.5 years, she presented with pain and swelling of her right ankle, right knee, and right hip joint. After a serial of examinations, she was diagnosed with JIA and treated with a nonsteroidal anti-inflammatory drug. Conclusions We report a rare case of a 4-year-old girl with PKU and JIA, which supports a possible interaction between PKU and JIA. Long-term metabolic disturbance may increase the susceptibility to JIA. Further chronic inflammation could alter the metabolism of tryptophan and tyrosine to increase blood Phe concentration. In addition, corticosteroid and methotrexate therapy for JIA may increase blood Phe concentration.

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