Evans Syndrome: A Case Report

Evans syndrome, a combined clinical condition of autoimmune haemolytic anaemia (AHA) and idiopathic thrombocytopaenic purpura (ITP) and has non-specific pathogenesis. The clinical cases are extremely rare, since only 4% of AHA or ITP are incorporated with Evans. It is distinguished from differentials, such as lupus, IgA deficiency, and acquired immunodeficiency, by peripheral blood film, bone marrow, Coombs test, and coagulation profile. A case of adult female from Pabna, Bangladesh is documented in this report. She complained of high grade intermittent fever, exertional dyspnea, icteric skin and sclera. Other features included mild splenomegaly, dark urine, and profuse sweating after fever. Investigation reports were consistent with AHA and ITP, with normal coagulation and viral profile. However, the patient was treated with corticosteroids, platelet and blood transfusion. And in follow-up visits, there was a pattern of gradual decline in erythrocyte sedimentation rate (ESR) and reticulocyte count, with normalization of haemoglobin, red cell, and white cell count. No association with other diseases was found in this case. Bangladesh Med J. 2018 Jan; 47 (3): 37-40

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Haematology

10.1093/med/9780199609628.003.0008 ◽

2014 ◽

Author(s):

Murray Longmore ◽

Ian B. Wilkinson ◽

Andrew Baldwin ◽

Elizabeth Wallin

Keyword(s):

Iron Deficiency Anaemia ◽

Sickle Cell Anaemia ◽

White Cell Count ◽

Pernicious Anaemia ◽

Blood Film ◽

Bleeding Disorders ◽

Macrocytic Anaemia ◽

Sideroblastic Anaemia ◽

Anaemia Of Chronic Disease ◽

Peripheral Blood Film

On the taking of blood and of holidaysAnaemiaIron-deficiency anaemiaAnaemia of chronic diseaseSideroblastic anaemiaThe peripheral blood filmThe differential white cell countMacrocytic anaemiab12 deficiency and pernicious anaemiaAn approach to haemolysisCauses of haemolysisSickle-cell anaemiaThalassaemiaBleeding disorders...

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THE PERIPHERAL BLOOD FILM

Journal of Clinical Pathology ◽

10.1136/jcp.21.6.788-b ◽

1968 ◽

Vol 21 (6) ◽

pp. 788-788

Author(s):

A. G. Signy

Keyword(s):

Peripheral Blood ◽

Blood Film ◽

Peripheral Blood Film

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Laparoscopic Resection of Cholecystocolic Fistula and Subtotal Cholecystectomy by Tri-Staple in a Type V Mirizzi Syndrome

Case Reports in Hepatology ◽

10.1155/2016/6434507 ◽

2016 ◽

Vol 2016 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Fahri Yetişir ◽

Akgün Ebru Şarer ◽

Hasan Zafer Acar ◽

Omer Parlak ◽

Basar Basaran ◽

...

Keyword(s):

Laparoscopic Resection ◽

Normal Liver ◽

Liver Function Tests ◽

Mirizzi Syndrome ◽

Intermittent Fever ◽

Subtotal Cholecystectomy ◽

Type V ◽

First Time ◽

Cholecystocolic Fistula

The Mirizzi syndrome (MS) is an impacted stone in the cystic duct or Hartmann’s pouch that mechanically obstructs the common bile duct (CBD). We would like to report laparoscopic subtotal cholecystectomy (SC) and resection of cholecystocolic fistula by the help of Tri-Staple™in a case with type V MS and cholecystocolic fistula, for first time in the literature. A 24-year-old man was admitted to emergency department with the complaint of abdominal pain, intermittent fever, jaundice, and diarrhea. Two months ago with the same complaint, ERCP was performed. Laparoscopic resection of cholecystocolic fistula and subtotal cholecystectomy were performed by the help of Tri-Staple. At the eight-month follow-up, he was symptom-free with normal liver function tests. In a patient with type V MS and cholecystocolic fistula, laparoscopic resection of cholecystocolic fistula and SC can be performed by using Tri-Staple safely.

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Overt Lower Gastrointestinal Bleeding and Pseudotumor: A Rare Presentation of Cytomegalovirus Infection

Case Reports in Medicine ◽

10.1155/2017/9732967 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 3

Author(s):

Akanksha Agrawal ◽

Deepanshu Jain ◽

Sameer Siddique

Keyword(s):

Highly Active Antiretroviral Therapy ◽

The Body ◽

Cmv Infection ◽

Rare Presentation ◽

Multiple Organs ◽

Highly Active ◽

History Of ◽

Acquired Immunodeficiency ◽

Immunodeficiency Syndrome

Cytomegalovirus (CMV) is a ubiquitous organism which can infect multiple organs of the body. In an immunocompromised patient, it can have a myriad of gastrointestinal manifestations. We report a case of recurrent hematochezia and concomitant pseudotumor in an AIDS (acquired immunodeficiency syndrome) patient attributable to CMV infection. A 62-year-old man with a history of AIDS, noncompliant with highly active antiretroviral therapy (HAART), presented with bright red blood per rectum. Index colonoscopy showed presence of multiple ulcers, colonic stenosis, and mass-like appearing lesion. Biopsy confirmed CMV infection and ruled out malignancy. Cessation of dual antiplatelet therapy and compliance with HAART lead to clinical cessation of bleeding and endoscopic healing of ulcers with complete resolution of colon mass on follow-up colonoscopy.

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Inflammation and psychopathology in children following PICU admission: an exploratory study

Evidence-Based Mental Health ◽

10.1136/ebmental-2018-300027 ◽

2018 ◽

Vol 21 (4) ◽

pp. 139-144 ◽

Cited By ~ 5

Author(s):

Giorgia Caspani ◽

Georgina Corbet Burcher ◽

M Elena Garralda ◽

Mehrengise Cooper ◽

Christine M Pierce ◽

...

Keyword(s):

Lymphocyte Count ◽

Exploratory Study ◽

Psychiatric Symptoms ◽

White Cell Count ◽

Post Traumatic Stress ◽

Reactive Protein ◽

Behavioural Difficulties ◽

And Gender ◽

Emotional And Behavioural Difficulties

BackgroundSurvivors of critical illness in childhood commonly display subsequent psychiatric symptoms including emotional and behavioural difficulties, and manifestations of post-traumatic stress disorder (PTSD). Anomalies in inflammatory profiles are an established finding in these childhood psychiatric conditions.ObjectiveThis exploratory study aimed to investigate whether abnormal peripheral blood inflammatory markers measured during paediatric intensive care unit (PICU) admission were associated with psychiatric symptoms after discharge.MethodsWe performed a prospective observational cohort study on 71 children with septic illness, meningoencephalitis and other critical disorders admitted to two PICUs between 2007 and 2010. 3–6 months following discharge, subjects were assessed for global psychiatric risk (ie, presence of emotional and behavioural difficulties on the parental Strengths and Difficulties Questionnaire (SDQ)), and for PTSD risk using the child-rated Impact of Events Scale (IES-8). Inflammatory and related biological markers were transcribed from PICU admission notes (white cell count, lymphocytes, neutrophils, C reactive protein (CRP), platelets, fibrinogen and lactate).FindingsGlobal psychiatric risk at follow-up was associated with abnormal lymphocyte count during admission (χ2=6.757, p=0.014, n=48). In children with sepsis, partial correlation analyses controlling for age and gender highlighted associations between (i) SDQ scores and low lymphocyte count (r=−0.712; p=0.009, n=14), and (ii) IES-8 score and high CRP levels (r=0.823; p=0.006, n=11). These associations remained after correction for multiple comparisons.ConclusionThese results support the hypothesis that acute inflammation may play a role in determining the development of psychopathology following PICU admission.Clinical implicationsIf the findings are replicated, they may help to better highlight which children are at risk of post-PICU psychopathology and appropriately target follow-up.

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Case Report: The Cox-Maze IV Procedure in the Mirror: The Use of Three-Dimensional Printing for Pre-operative Planning in a Patient With Situs Inversus Dextrocardia

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.722413 ◽

2021 ◽

Vol 8 ◽

Author(s):

Long Song ◽

Chengming Fan ◽

Hao Zhang ◽

Hongduan Liu ◽

Chukwuemeka Daniel Iroegbu ◽

...

Keyword(s):

Atrial Fibrillation ◽

Situs Inversus ◽

Three Dimensional ◽

Holter Monitoring ◽

Uneventful Recovery ◽

Exertional Dyspnea ◽

Three Dimensional Printing ◽

Operative Planning ◽

Dimensional Printing

The safety and efficacy of the Cox-Maze IV procedure (CMP-IV) for situs inversus dextrocardia patients with atrial fibrillation is yet to be determined. Herein, we present the case of a 39-year-old male patient admitted to our cardiac center following progressive exertional dyspnea. The patient was diagnosed with situs inversus dextrocardia, severe mitral regurgitation, and paroxysmal atrial fibrillation. A three-dimensional (3D) heart model printing device embedded with designated ablation lines was used for pre-operative planning. Mitral valvuloplasty, CMP-IV, and tricuspid annuloplasty were performed. The patient had an uneventful recovery and was in sinus rhythm during a 12-month follow-up period using a 24-h Holter monitoring device. The case herein is one of the first to report on adopting the CMP-IV procedure for situs inversus dextrocardia patients with complex valvuloplasty operation. In addition, the 3D printing technique enabled us to practice the Cox-maze IV procedure, given the patient's unique cardiac anatomy.

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A Young Lady Presenting with Fever, Polyarthralgia and Breathlessness - A Case Report

Bangladesh Heart Journal ◽

10.3329/bhj.v30i1.28135 ◽

2016 ◽

Vol 30 (1) ◽

pp. 33-36

Author(s):

Khandker Md Nurus Sabah ◽

Abdul Wadud Chowdhury ◽

Mohammad Shahidul Islam ◽

Mohammed Abaye Deen Saleh ◽

Jannatul Ferdous ◽

...

Keyword(s):

Mitral Regurgitation ◽

Antiphospholipid Syndrome ◽

Young Lady ◽

Antiphospholipid Antibody ◽

Intermittent Fever ◽

Clinically Significant ◽

Generalized Lymphadenopathy ◽

Positive Direct ◽

Cardiac Manifestations

Heart valve abnormalities are the most frequent cardiac manifestations in patients with antiphospholipid syndrome (APS) with or without systemic lupus erythrematosus (SLE) though clinically significant valvulopathy occurs rarely. Here, we present a case of a 20-year-old young lady presenting with intermittent fever and polyarthralgia for 2 weeks, breathlessness for 1 week and bilateral leg swelling for 3 days. On examination, moderate anaemia, high blood pressure, generalized lymphadenopathy and evidence of mitral regurgitation was found. She had Hb% 8.5 gm/dl with high ESR. In Doppler echocardiography, there was MVP with mitral regurgitation (MR) grade III. Transeosophageal echocardiography revealed features of type A Libman- Sacks (LS) endocarditis along with MVP and MR. Unfortunately; she had strongly positive ANA, positive anti ds-DNA, positive direct coombs test & positive antiphospholipid antibody (aPL) IgG with low C3 level & proteinuria. On the basis of clinical presentation and laboratory reports, a diagnosis of SLE with secondary antiphospholipid syndrome (APS) with LS endocarditis with secondary MVP with coombs positive haemolytic anaemia was made. For treatment purpose, she was transferred to the department of Rheumatology. After 1 month during her follow-up visit, she was improved clinically & echocardiogracally.Bangladesh Heart Journal 2015; 30(1) : 33-36

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A Female with Evans Syndrome Presented with Pancytopenia

Journal of Enam Medical College ◽

10.3329/jemc.v10i2.53537 ◽

2021 ◽

Vol 10 (2) ◽

pp. 114-117

Author(s):

Md Rezaul Karim Chowdhury ◽

Md Haroon Ur Rashid ◽

Md Mahbub Hossain ◽

Shafayet Hossain Riyan

Keyword(s):

Oral Prednisolone ◽

Low Grade ◽

Evans Syndrome ◽

First Line ◽

Indirect Bilirubin ◽

First Line Therapy ◽

Line Therapy ◽

Immune Neutropenia ◽

Chronic Course

Evans syndrome is an uncommon haematological disorder characterised by autoimmune haemolytic anaemia (AIHA), immune thrombocytopenia (ITP) and/or immune neutropenia. It may occur in all ethnic groups, all ages and has no sex predilection. The direct antiglobulin test (DAT) is almost invariably positive. This condition generally runs a chronic course and is characterised by frequent exacerbations and remissions. Corticosteroids and/or intravenous immunoglobulin (IVIG) are the most commonly used first line therapy. Here we report a case of a female who presented with severe shortness of breath, palpitation and low grade fever and on examination she was found severely pale and mildly icteric. Her CBC and PBF showed pancytopenia. Indirect bilirubin and LDH were raised and direct Coomb’s test was positive. She was labeled as a case of Evans syndrome and responded to oral prednisolone. On subsequent follow-up her haematological profiles remained normal. J Enam Med Col 2020; 10(2): 114-117

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