scholarly journals Non allergic simple eosinophilic pneumonia: Löffler syndrome: A case report study

2008 ◽  
Vol 61 (11-12) ◽  
pp. 643-646 ◽  
Author(s):  
Ivana Meta-Jevtovic ◽  
Miroslav Tomovic ◽  
Slavica Mojsilovic ◽  
Marina Petrovic
Keyword(s):  
Case Report ◽  
Bronchial Asthma ◽  
Allergic Bronchopulmonary Aspergillosis ◽  
Eosinophilic Pneumonia ◽  
Unknown Etiology ◽  
Caucasian Woman ◽  
Low Grade ◽  
Radiographic Findings ◽  
Therapy Regimen ◽  
History Of

Introduction L?ffler syndrome is an acute, pneumonia of unknown etiology. This disease is not often associated with bronchial asthma. In its asymptomatic form, this disease is reversible, transient, self-limited with no requests for specific therapy regimen. In the symptomatic form, as well as during its progression, treatment with steroids is very effective. Furthermore, in both acute eosinophilic and idiopathic chronic eosinophilic form, this kind of therapy ensures survival. Case report The case of a 53-year-old Caucasian woman was presented with 2-month history of low grade fever, shortness of breath, cough and reduced exercise tolerance. Although she had an allergic accident on insects in history, non allergy reactions as well as an obstructive disease with that kind of origin were not detected on admission. The diagnosis of simple eosinophilic pneumonia (SEP) (L?ffler's syndrome) was confirmed by transbronchial biopsy and by sternal testing. The peripheral blood eosinophilia with pulmonary eosinophilic infiltrates on X ray chest radiography were observed during clinical examination. Biopsy specimen of the lung parenchym showed changes associated with L?ffler's syndrome. The diagnosis was, also, confirmed according to the radiographic findings of unilateral migratory infiltrates consistent pneumonia. Discussion Churg Strauss syndrome (CSS) has to be considered in this differential diagnosis. Frequently, this disease has extrinsic bronchial asthma with eosinophilic pneumonia in history; asthma is often associated with allergic bronchopulmonary aspergillosis. In the reported case, treatment with steroids resulted in a marked clinical improvement compared to nonsteroid therapy.

MO167AN UNUSUAL COURSE OF A 2,8 DHA CRYSTAL INDUCED NEPHROPATHY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Nicole Nourié ◽  
Hussein Nassereddine ◽  
Micheline Mia Kotait ◽  
Sarah Mouawad ◽  
Hiba Azar
Keyword(s):  
Renal Biopsy ◽  
Creatinine Level ◽  
Unknown Etiology ◽  
Positive Pressure ◽  
Crystal Formation ◽  
Low Grade ◽  
Pressure Therapy ◽  
Metabolic Encephalopathy ◽  
History Of ◽  
Aprt Deficiency

Abstract Background and Aims 2, 8 dihydroxyadenine (DHA) deposition is a less known etiology of crystal-induced nephropathy, caused by a deficiency in a purine salvage enzyme, the adenine phosphoribosyl transferase (APRT). DHA is an insoluble molecule in urine leading to crystal formation, tubular obstruction or stone formation. The disease manifests as a history of urolithiasis, chronic kidney disease and even loss of renal allograft when the disease is undiagnosed in native kidneys. The cornerstone of treatment is the inhibition of xanthine dehydrogenase reducing thus the formation of 2,8-DHA and its renal excretion. Method A 59-year-old obese Lebanese male patient, born to a consanguineously married couple, was admitted to another hospital with desaturation, a history of progressive shortness of breath and a creatinine level of 2,8 mg/dl. He had no hypertension nor diabetes. His family history was positive for a sister with ESRD of unknown etiology. He was discharged on oxygen and continuous airway positive pressure therapy for severe obstructive sleep apnea. His renal function deteriorated leading to a creatinine level of 9.8 mg/dl three months later. There were no signs of systemic disease, no gross hematuria, no fluid overload. His blood pressure was normal. Laboratory work up showed anemia, low grade proteinuria, intermittent microscopic hematuria and negative serological and immunological workup. Kidney ultrasound showed normal size kidneys with no evidence of collecting system dilatation or urolithiasis. Due to this atypical presentation, the patient was admitted for a renal biopsy with a creatinine level of 11 mg/dl upon admission. Results The renal biopsy showed tubulo-interstitial nephritis associated with numerous brown-green crystals by Haematoxylin and eosin of various shapes birefringent under polarized light with the characteristic “maltese cross”. Crystals were found within tubular lumens and cytoplasm, interstitium, and macrophages. These findings were characteristic of 2,8 DHA crystals deposition in the kidney. The patient was started on 120 mg of Febuxostat with a low purine and high fluid diet. A genetic testing showed a pathogenic homozygous variant in the APRT gene which causes an amino acid change from Glycine to Aspartate at position 63. Two weeks later the patient was admitted to the ICU with pneumonia, respiratory failure, a creatinine of 9 mg/dl and severe metabolic encephalopathy. He received 4 sessions of hemodialysis followed by an improvement in his kidney function with a creatinine level down to 3.2 mg/dl a month after his discharge and he remains off dialysis until now. Conclusion Around 400 cases are currently recognized worldwide, emphasizing the under recognition of this autosomal recessive disease. Considering that the homozygoty causing a complete APRT deficiency should range between 1/50 000 and 1/100 000 cases, this would translate in at least 80 000 cases worldwide. The variant found in our patient has previously been described as disease causing for APRT deficiency in four cases. Reviewing the phenotype of these cases we find differences in terms of presentation and evolution, highlighting the variability in the APRT deficiency phenotype and underlining the fact that no correlation between phenotype and genotype was reported to date even for the same type of mutation. This case report shows us that the initiation of an adequate therapy is necessary even at advanced stages of the disease since it can improve our kidney outcome.

scholarly journals Diagnostic Dilemma of Sarcoidosis: A Case Report Masquerading as Tuberculosis

2017 ◽  
Vol 28 (1) ◽  
pp. 50-52
Author(s):  
Shaymal Sarkar ◽  
Md Daharul Islam ◽  
Marwa Kashem Muna ◽  
SM Tajdit Rahman ◽  
Md Azizul Hoque ◽  
...  
Keyword(s):  
Case Report ◽  
Joint Pain ◽  
Unknown Etiology ◽  
Activated Macrophages ◽  
Multisystem Disorder ◽  
Diagnostic Dilemma ◽  
Present Case Report ◽  
History Of ◽  
Anti Tubercular Therapy ◽  
Normal Architecture

Sarcoidosis is a chronic multisystem disorder of unknown etiology characterized by formation of granulomata within affected organs and consequent distortion of their normal architecture. Typically, these are non-caseating epithelioid granulomata involving organized collections of activated macrophages and T lymphocytes. In countries where tuberculosis is endemic, sarcoidosis is often misdiagnosed and mistreated as tuberculosis. We present case report of a 47-year-old female who presented with 2 years history of recurrent, multiple nodules with occasional joint pain & fever and had received anti-tubercular therapy without any improvement. A diagnosis of sarcoidosis is made finally and she was managed accordingly.Bangladesh J Medicine Jan 2017; 28(1) : 50-52

scholarly journals A Physiotherapeutic Approach Along with Bronchodilators to Control Bronchial Asthma in a 35 Year Old Adult: A Case Report

2021 ◽  
pp. 121-125
Author(s):  
Nupur Thombare ◽  
Madhumita Yadav ◽  
Pratik Phansopkar
Keyword(s):  
Chest Pain ◽  
Bronchial Asthma ◽  
Past History ◽  
Common Disease ◽  
Low Grade ◽  
It Use ◽  
Postural Drainage ◽  
Old Adult ◽  
Night Sweats ◽  
History Of

Background: Bronchial asthma is a common disease characterized by the generalized narrowing of intrapulmonary airways accompanied by breathlessness and wheezing, which differs in severity spontaneously or as a result of treatment. Asthma is caused by bronchial wall inflammation and constriction due to the hyper-reactivity of their smooth muscle, resulting in a series of spasmodic wheezing attacks and shortness of breath (SOB). Case description: The patient was a 35 year old female presented with a complaint of dry cough with mucoid expectoration and chest pain since 3 weeks. The cough was progressive and aggravating while walking or while doing any sort of activity and it use to relieve at rest. She also complained of Modified Medical Research Council (MMRC) grade 2 breathlessness along with palpitation while doing household work. She had chest pain while coughing on left side over the 2nd intercostal space which was gradually progressive and 7/10 on VAS. She also had low grade fever, cold with chills and night sweats. The patient had a history of seasonal variation, dust allergies and biomass exposure. She was given medications but was not relieved so she was referred for physiotherapy. Physiotherapy treatment was started. Patients sleep was disturbed. The patient had no past history. Family history is not present. Diagnosis: The patient was diagnosed with bronchial asthma. Outcomes & conclusion: This case study showed that breathing exercise, postural drainage and proper relaxation of the patient may reduce the symptoms associated with bronchial asthma also the peak flow values may increase with breathing retraining. Pain reduces with reduction in cough and episodes of dyspnoea. Also educating the patient about prevention of asthmatic episodes help the patient in many ways. Along with bronchodilators physiotherapy plays an integral part in treating the patient with bronchial asthma.

scholarly journals Tolosa-Hunt: Case Report

2021 ◽  
Author(s):  
Lília Tereza Diniz Nunes ◽  
Flávia S. Silva ◽  
Karyme G. Aota ◽  
Maria Beatriz Miranda S. B. de Assis ◽  
João Fellipe B. Bento ◽  
...  
Keyword(s):  
Case Report ◽  
Cavernous Sinus ◽  
Clinical Care ◽  
Cranial Nerves ◽  
Rare Condition ◽  
Unknown Etiology ◽  
Specific Diagnosis ◽  
Hunt Syndrome ◽  
Diagnosis By Exclusion ◽  
History Of

Context: Tolosa-Hunt Syndrome (STH) is a rare condition with unknown etiology, it affects both genders equally. It is manifested by inflammation of the cavernous sinus and involvement of some cranial nerves pairs. Case report: MSR, 39 years, male, diver in the mining zone, history of recurrent otitis with acute pain and gradual hearing loss that progressed. He was admitted to the General Hospital of Palmas with symptoms of retrorbital headache. After physical exams it was found an ophthalmoplegia with right amaurosis and ipsilateral pain. The neurological examination showed a right eye with loss of photomotor reflex and presence of consensual reflex and eyelid ptosis. After 38 days in hospital, a probable septic thrombosis of the cavernous sinus was found, antibiotic and corticosteroids therapy was initiated. The patient also reports significant improvement in headache and partially in vision, he is currently hospitalized with clinical care and antibiotic therapy, awaiting results of the image examination report. Conclusions: Painful ophthalmoplegia in most cases is not diagnosed as STH. The differential diagnosis for this pathology is most often through brain magnetic ressonance and the ICHD-3 beta diagnostic criteria, STH should be suspected, but it is still necessary to close the diagnosis by exclusion, due to the lack of a specific diagnosis.

scholarly journals EP01 Post COVID-19 reactive arthritis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Rosemary Waller ◽  
Elizabeth Price ◽  
Sara Carty ◽  
Azeem Ahmed ◽  
David Collins
Keyword(s):  
Case Report ◽  
Family History ◽  
Reactive Arthritis ◽  
De Novo ◽  
Adaptive Immune System ◽  
Normal Liver ◽  
Full Blood Count ◽  
System Response ◽  
Low Grade ◽  
History Of

Abstract Case report - Introduction We present what we believe to be the first reported case of post COVID-19 reactive arthritis, in a previously medically well 16-year-old with no past or family history of inflammatory arthritis. Case report - Case description Our patient was a previously medically fit 16-year-old of Caucasian origin who tested positive for COVID-19 in late March 2020. She developed with a 4-day illness with fever, cough, and myalgia from which she made a full and uncomplicated recovery. Ten days later she developed a new erythematous itchy rash on her legs, trunk, and face and a progressive polyarthralgia affecting her MCPs, wrists, shoulders, hips, and knees. The rash typically lasted for 2 days at one site and was non-scarring. This was associated with a low-grade fever. There were no associated mouth ulcers, photosensitivity, alopecia, Raynaud’s, GI disturbance or respiratory symptoms. She had no relevant family history of autoimmunity, psoriasis or inflammatory bowel disease or travel history and had been prescribed no new medications. On examination, she had an erythematous rash on the face in a non malar distribution. She had multiple tender joints without definite synovitis. Cardiovascular, respiratory, gastroenterology and neurological examinations were unremarkable. Investigations revealed a normal full blood count and CRP<1 with normal liver and renal function tests. Her urinalysis was unremarkable. Immunology was negative for ANA, ANCA and rheumatoid factor. Immunoglobulins were normal. Two weeks later her symptoms were fully resolved. Case report - Discussion Coronaviruses are single-stranded RNA viruses with nearly 30 strains recognised to infect humans. They induce both an innate and adaptive immune system response. It is hypothesised that a dysregulated innate system response, leading to a prolonged adaptive response triggers damaging inflammation and a potential cytokine storm. This is associated with poor outcome during primary viral infection. Variations in this immune response, with different underlying HLA genotypes could lead to other post infectious immune mediated phenomena, such as Paediatric Multisystem Inflammatory Syndrome - Temporally associated with COVID-19. There is a European registry collating data about patients with known rheumatic diseases who are admitted with COVID-19. There is emerging data regarding Paediatric Inflammatory Multisystem Syndrome - Temporally associated with SARS-CoV-2 (PIMS-TS). There is a growing suggestion that a subgroup of patients is developing a COVID-19 associated post viral fatigue syndrome. We suggest that a registry to collect information on de novo autoimmune diseases presenting post COVID-19 is also commenced. Case report - Key learning points COVID-19 infection is associated with a wide variety of sequalae, including rheumatological ones. Classic post viral Reactive arthritis has been seen. A registry to collect information on de novo autoimmune presentations would be highly informative.

scholarly journals Eosinophilic pneumonia induced by lettuce: A case report

2021 ◽  
Author(s):  
Reina Sekiya ◽  
Tatsuya Nagano ◽  
Tatsuya Moriyama ◽  
Aki Kawaguchi ◽  
Takafumi Fukui ◽  
...  
Keyword(s):  
Case Report ◽  
Ground Glass Opacity ◽  
Lavage Fluid ◽  
Immunoblot Analysis ◽  
High Serum ◽  
Eosinophilic Pneumonia ◽  
Low Grade ◽  
Lung Field ◽  
First Case ◽  
Igg Binding

Abstract Background: Lettuce (Lactuca sativa) belongs to the Composite family and is a vegetable widely consumed globally. Although lettuce is extensively cultivated and consumed, lettuce-associated occupational allergy is rarely reported. Herein, we are reporting a case of eosinophilic pneumonia induced by lettuce for the first time.Case presentation: A 56-year-old female lettuce farmer was admitted to the hospital with a low-grade fever, worsening cough, and dyspnoea. A blood test revealed eosinophilia and a high serum IgE concentration. A chest X-ray taken on admission showed an infiltrative shadow in the upper lung field. Chest CT revealed patchy ground glass opacity on the upper lung field and thickening of the bronchial wall. The bronchoalveolar lavage fluid contained 8% eosinophils. The IgG-binding proteins that reacted with the patient’s sera were identified by immunoblot analysis. She was diagnosed as lettuce induced eosinophilic pneumonia and was treated with prednisolone, and her symptoms and radiological findings improved. Wearing a mask and reducing the amount of the crop improved her symptoms the following year.Conclusions: This is the first case report about lettuce-induced eosinophilic pneumonia which occurred in a lettuce farmer. The avoidance from antigen is quite useful in this patient.

Vulvar Sarcoidosis: Case Report and Review of the Literature

2013 ◽  
Vol 17 (4) ◽  
pp. 287-290 ◽  
Author(s):  
Caridad Vera ◽  
Deana Funaro ◽  
Danielle Bouffard
Keyword(s):  
Differential Diagnosis ◽  
Case Report ◽  
Foreign Body Reaction ◽  
Unknown Etiology ◽  
Review Of The Literature ◽  
Perianal Region ◽  
Multiple Organs ◽  
Granulomatous Lesions ◽  
History Of ◽  
Hilar Adenopathy

Background: Sarcoidosis is a multisystemic disorder of unknown etiology that can affect multiple organs, including the lungs, skin, and eyes. Vulvar sarcoidosis has anecdotally been reported. Objective: The aim of this article is to describe a case of vulvar sarcoidosis and review the few cases that have been reported. Methods: We report the case of a 39-year-old woman who presented to the dermatologist with a 2-year history of vulvar pruritus. Results: Examination revealed infiltrated plaques on the vulva and perianal region. The biopsy demonstrated well-defined, nonnecrotizing granulomas in the dermis. Further investigation revealed hilar adenopathy consistent with sarcoidosis. The patient responded well to topical corticosteroids. Conclusion: In the presence of granulomatous lesions of the genital region, infectious causes, foreign body reaction, Crohn disease, and sarcoidosis should be part of the differential diagnosis.

Not always eosinophilic esophagitis – intramural pseudodiverticulosis of the esophagus – a case report and literature review

2020 ◽  
Vol 58 (12) ◽  
pp. 1201-1207
Author(s):  
Thomas Frieling ◽  
Christian Kreysel ◽  
Michael Blank ◽  
Dorothee Mülle ◽  
Philipp Euler ◽  
...  
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Eosinophilic Esophagitis ◽  
Esophageal Stenosis ◽  
Barium Swallow ◽  
Caucasian Woman ◽  
Literature Overview ◽  
Sex Risk ◽  
History Of ◽  
Esophageal Intramural Pseudodiverticulosis

Abstract Background Intramural pseudodiverticulosis of the esophagus (EIPD) is a rare disease leading to dysphagia, chest pain, and weight loss. The diagnosis is difficult, and the disease can be confounded with eosinophilic esophagitis (EoE). We present a patient with esophageal intramural pseudodiverticulosis and a literature review. Case report The 45-year-old white caucasian woman with a history of nicotine and alcohol abuse had progressive hoarseness and severe dysphagia for solid food. Esophagogastroduodenoscopy (EGD) showed proximal esophageal stenosis, thrush esophagitis, and mucosal alteration with trachealization suspicious of EoE. However, repeated bouginage EGD and barium swallow revealed typical signs of esophageal intramural pseudodiverticulosis (EIPD). The patient was treated successfully by bougingage, acid suppression, and antifungal therapy. The literature analysis revealed the characteristics of EIPD according to age, sex, risk factors, and therapy modalities. Conclusion The case report and the literature overview suggest that EIPD can be confounded with EoE.

An unusual middle-ear mass

2009 ◽  
Vol 124 (1) ◽  
pp. 108-110 ◽  
Author(s):  
M Muller ◽  
I Zammit-Maempel ◽  
J Hill ◽  
B Wilkins
Keyword(s):  
Case Report ◽  
Papillary Carcinoma ◽  
Middle Ear ◽  
Endolymphatic Sac ◽  
Low Grade ◽  
Complete Replacement ◽  
Glomus Tympanicum ◽  
History Of ◽  
Petrous Temporal Bone ◽  
One Year

AbstractObjective:We describe a case of endolymphatic sac tumour confined to the middle ear, which radiologically mimicked a glomus tympanicum, in a 58-year-old woman with tinnitus.Case report:A 58-year-old woman presented with a one-year history of right-sided tinnitus. The clinical, radiological and surgical features were felt to be in keeping with a glomus tympanicum. However, the histopathological picture was that of a low grade papillary carcinoma of the endolymphatic sac, i.e. an endolymphatic sac tumour.Conclusion:Endolymphatic sac tumours are classically locally aggressive and centred around the petrous temporal bone. Further growth results in complete replacement of the mastoid and petrous pyramid by tumour. To the best of our knowledge, there have been no previous reports of an endolymphatic sac tumour located solely within the hypo- and epitympanum of the middle ear.

scholarly journals NON-NEOFORMANS CRYPTOCOCCEMIA IN A PATIENT WITH HODGKIN’S LYMPHOMA

2018 ◽  
Vol 11 (12) ◽  
pp. 7 ◽  
Author(s):  
Chuan Hun Ding ◽  
Norhidayah Kamarudin
Keyword(s):  
Case Report ◽  
Hodgkin’S Lymphoma ◽  
Histopathological Examination ◽  
Yeast Cells ◽  
Hodgkin's Lymphoma ◽  
Low Grade ◽  
Cryptococcus Laurentii ◽  
History Of ◽  
Microscopic Morphology ◽  
Relative Scarcity

Cryptococcemia attributed to non-neoformans cryptococci has not received much attention due to the relative scarcity of reported cases. The primary aim of this case report is to highlight several notable characteristics of Cryptococcus laurentii. A 35-year-old woman presented with a right supraclavicular mass and a history of low-grade fever. A yeast was isolated from her blood. It formed cream-colored colonies which turned yellowish after 72 h of incubation and had a microscopic morphology of elongated budding yeast cells. Its identity was confirmed to be C. laurentii through carbohydrate assimilation testing (ID 32 C). The patient responded clinically to fluconazole and cleared the cryptococcemia. She was subsequently diagnosed with Hodgkin’s lymphoma through histopathological examination of the supraclavicular mass.

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