scholarly journals Coxsackie Virus Induced Graves’ Disease in an Immunocompetent Patient

Author(s):  
Wesley Tang, DO, MPH ◽  
Sulagna Das, MD ◽  
Zoltán Krudy, MD

Enteroviruses, such as Coxsackie virus, have been implicated in the past as a pathogen associated with subacute thyroiditis, also known as de Quervain’s thyroiditis. Less commonly are viruses associated with autoimmune thyroid diseases such as Hashimoto’s thyroiditis and Graves’ disease. We present a case of a healthy 43 year old female who presented to the emergency department complaining of several months of weakness, nausea, loose bowel movements, anxiousness, and shortness of breath. Physical exam revealed tachycardia, tremors, and a non-tender thyroid gland to palpation. Skin exam showed a rash on the palms of her hands and soles of her feet bilaterally with dark papules, suggestive of Hand, foot, and mouth disease. Laboratory workup would reveal an undetectable thyroid stimulating hormone (TSH), and levels of T3 & T4 too high to quantify. Thyroid receptor antibodies would return as positive, diagnostic of Graves’ disease. Coxsackie virus (the causative agent of Hand, foot, and mouth disease) IgM titers also returned positive suggesting recent infection. Although the etiology of Graves’ disease is still not clear, this case report provides evidence that environmental triggers such as Coxsackie viral infection may be involved in its pathogenesis.

1983 ◽  
Vol 27 (11) ◽  
pp. 929-935 ◽  
Author(s):  
Asao Itagaki ◽  
Junko Ishihara ◽  
Kyo Mochida ◽  
Yoshihiro Ito ◽  
Koichi Saito ◽  
...  

2019 ◽  
Vol 14 (2) ◽  
pp. 84-88
Author(s):  
Suha N. Al-Wakeel ◽  
Khansa A. Al Rubiae ◽  
Suha N. Al-Wakeel ◽  
Basil M. Hanoudi

Background: Hand, foot, and mouth disease is viral disease caused commonly by coxsackie virus A16 virus. It is a mild disease and children usually recover with no specific treatment within 7 to 10 days. Rarely, this illness may be associated with aseptic meningitis were patient may need hospitalization. Objective: To determine significance of clinical features of hand, foot and mouth disease. Methods: A cross sectional study of cases with clinical features of hand, foot and mouth disease visiting the dermatological consultation unit of Al Kindy teaching hospital. Sampling was for Zyona and Edressi Quarter patients over the period of 1st December 2017 to 30th of November 2017. Aim: To determine significance of clinical features of hand, foot and mouth disease Results: The mean age of patients (100 patients) was 29.99 months. Males were 65 (65%) and females were 35 (35%), (P 0.23). Tenderness of skin lesions, Malaise and decreased Appetite were the most frequent symptoms. Winter months illness was common .Cases were diagnosed two days before seeking medical help, while home contact of patients was most common place for infection transmission .Involvement of palms and soles was universal and indifferent (100%). Groin was more commonly affected (67%), (P 0.015). Fever was present in 81%.


2017 ◽  
Vol 40 (2) ◽  
pp. 115-119 ◽  
Author(s):  
Probir Kumar Sarkar ◽  
Nital Kumar Sarker ◽  
Md Abu Tayab

Hand, foot, and mouth disease (HFMD) also known as vesicular stomatitis with exanthema, first reported in New Zealand in 1957 is caused by Coxsackie virus A16 (CVA16), human enterovirus 71 (HEV71) and occasionally by other HEV-A serotypes, such as Coxsackie virus A6 and Coxsackie virus A10, are also associated with HFMD and herpangina. While all these viruses can cause mild disease in children, EV71 has been associated with neurological disease and mortality in large outbreaks in the Asia Pacific region over the last decade. It is highly contagious and is spread through direct contact with the mucus, saliva, or feces of an infected person. This is characterized by erythrematous papulo vesicular eruptions over hand, feet, perioral area, knee, buttocks and also intra-orally mostly in children, typically occurs in small epidemics usually during the summer and autumn months. HFMD symptoms are usually mild and resolve on their own in 7 to 10 days. Treatment is symptomatic but good hygiene during and after infection is very important in preventing the spread of the disease. Though only small scale outbreaks have been reported from United States, Europe, Australia Japan and Brazil for the first few decade, since 1997 the disease has conspicuously changed its behavior as noted in different Southeast Asian countries. There was sharp rise in incidence, severity, complications and even fatal outcomes that were almost unseen before that period. There are reports of disease activity in different corners of India since 2004, and the largest outbreak of HFMD occurred in eastern part of India in and around Kolkata in 2007and Bhubaneswar, Odisha in 2009. In recent years there are cases of HFMD have been seen in Bangladesh also. Although of milder degree, continuous progress to affect larger parts of the neighboring may indicate vulnerability of Bangladesh from possible future outbreaks.Bangladesh J Child Health 2016; VOL 40 (2) :115-119


2015 ◽  
Vol 82 (4) ◽  
pp. 235-241
Author(s):  
E. Navarro Moreno ◽  
D. Almagro López ◽  
R. Jaldo Jiménez ◽  
M.C. del Moral Campaña ◽  
G. Árbol Fernández ◽  
...  

2020 ◽  
Vol 66 (5) ◽  
pp. 24-30
Author(s):  
E. A. Panfilova ◽  
L. P. Kruk ◽  
M. P. Isaeva ◽  
P. O. Osmanova ◽  
F. A. Bostanova ◽  
...  

The main autoimmune thyroid diseases are Hashimoto's thyroiditis (HT) and Graves' disease (GD). Despite the significant differences in a pathogenesis and a clinical picture between HT and GD, the literature describes the cases of the conversion of one autoimmune disease to another, which, according to one version, is associated with a change in the balance between the levels of a stimulating and blocking antibodies to the thyroid-stimulating hormone receptor. At the same time, there are more frequent observations of the transition of GD to HT, and much less often describe, on the contrary, the development of GD against the background of HT. The article presents a clinical case of the conversion of HT to GD. A detailed algorithm of the conservative management according to the «block-replace» scheme is described, indicating the results of laboratory and instrumental examination. At the time of describing the clinical case, the result of the treatment can be considered successful. The predictors such as a low level of the thyroid-stimulating hormone receptor and thyroid volume before discontinuation of the thyrostatic therapy suggest a low risk of the recrudescence of GD.According to the authors, the phenomenon of the conversion of one autoimmune thyroid disease to another, in addition to the scientific interest, is important for the practitioners, since a timely change in the diagnostic paradigm can significantly change the treatment strategy and the favorably affect the prognosis of disease, preventing the development of complications.


2014 ◽  
Vol 41 (3) ◽  
pp. 273-274 ◽  
Author(s):  
Hisashi Nomura ◽  
Shohei Egami ◽  
Hiroko Kasai ◽  
Tomoaki Yokoyama ◽  
Atsushi Fujimoto ◽  
...  

2020 ◽  
Vol 9 (5) ◽  
pp. 263-268
Author(s):  
Yasmine Abdellaoui ◽  
Dimitra Magkou ◽  
Sofia Bakopoulou ◽  
Ramona Zaharia ◽  
Marie-Laure Raffin-Sanson ◽  
...  

Introduction: Resistance to thyroid hormone beta (RTHβ) is a rare disease with an autosomal dominant transmission. Diagnosis may be challenging especially in patients with hyper- or hypothyroidism. Case Presentation: A 31-year-old male patient with suppressed thyroid-stimulating hormone (TSH), elevated free thyroxine and free triiodothyronine, along with high thyroid receptor antibodies was diagnosed with Graves’ disease. Benzylthiouracil was started. One month later, reduced sensitivity to thyroid hormones was suspected because of persistently high thyroid hormone levels contrasting with high TSH level. Molecular analysis highlighted a 10c.1357C>T p.P453S mutation in the thyroid hormone receptor beta gene (THRB). RTHβ was diagnosed. Several relatives also had RTHβ (the mother, the young son, and 2 out of 3 siblings). Autoimmune hypothyroidism was present in the mother, whereas 2 out of 3 siblings had asymptomatic autoimmunity. Discussion/Conclusion: Both Graves’ disease and autoimmune hypothyroidism were described in patients with RTHβ. We show here for the first time that autoimmune hypo- and hyperthyroidism may coexist in kindred with RTHβ. Seven previously published cases of Graves’ disease and RTHβ were retrieved and analyzed. Treatments and thyroid hormone level targets are discussed as well as the possible link between RTHβ and autoimmune thyroid diseases.


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