scholarly journals The Abnormal Imaging of SARS-CoV-2: A Predictive Measure of Disease Severity

2021 ◽  
Vol 8 ◽  
Author(s):  
Shangwen Pan ◽  
Huaqing Shu ◽  
Yaxin Wang ◽  
Ruiting Li ◽  
Ting Zhou ◽  
...  
Keyword(s):  
Left Lung ◽  
Clinical Manifestations ◽  
Chloride Ions ◽  
Lesion Area ◽  
Fourth Level ◽  
Radiographic Score ◽  
Significant Difference ◽  
History Of ◽  
Critical Patients ◽  
First Time

To investigate the characteristics of SARS-CoV-2 pneumonia and evaluate whether CT scans, especially at a certain CT level, could be used to predict the severity of SARS-CoV-2 pneumonia. In total 118 confirmed patients had been enrolled. All data including epidemiological, clinical characteristics, laboratory results, and images were collected and analyzed when they were administrated for the first time. All patients were divided into two groups. There were 106 severe/critical patients and 12 common ones. A total of 38 of the patients were women. The mean age was 50.5 ± 11.5 years. Overall, 80 patients had a history of exposure. The median time from onset of symptoms to administration was 8.0 days. The main symptoms included fever, cough, anorexia, fatigue, myalgia, headaches, and chills. Lymphocytes and platelets decreased and lactate dehydrogenase increased with increased diseased severity (P < 0.05). Calcium and chloride ions were decreased more significantly in severe/critical patients than in common ones (P < 0.05). The main comorbidities were diabetes, chronic cardiovascular disease, and chronic pulmonary disease, which occurred in 47 patients. In all 69 patients had respiratory failure, which is the most common SARS-CoV-2 complication, and liver dysfunction presented in 37 patients. Nine patients received mechanical ventilation therapy. One patient received continuous blood purification and extracorporeal membrane oxygenation (EMCO) treatments. The average stay was 18.1 ± 10.8 days. Four patients died. The median of the radiographic score was four in common, and five in the severe/critical illness, which was a significant difference between the two groups. The radiographic score was in negative correlation with OI (ρ = −0.467, P < 0.01). The OI in severe/critically ill cases decreased significantly as the disease progressed, which was related to the lesion area in the left lung and right lungs (ρ = 0.688, R = 0.733). OI, the lesion area in the left lung and right lungs, lymphocytes, etc. were associated with different degrees of SARS-CoV-2 pneumonia (P < 0.05). The lesion area in both lungs were possible predictive factors for severe/critical cases. Patients with SARS-CoV-2 pneumonia showed obvious clinical manifestations and laboratory result changes. Combining clinical features and the quantity of the lesion area in the fourth level of CT could effectively predict severe/critical SARS-CoV-2 cases.

scholarly journals Levels of TB-IGRA may help to differentiate between intestinal tuberculosis and Crohn’s disease in patients with positive results

2020 ◽  
Vol 13 ◽  
pp. 175628482092200
Author(s):  
Yujie Zhao ◽  
Meilin Xu ◽  
Liang Chen ◽  
Zhanju Liu ◽  
Xiaomin Sun
Keyword(s):  
Weight Loss ◽  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Intestinal Tuberculosis ◽  
Clinical Manifestations ◽  
Final Analysis ◽  
Interferon Gamma Release Assay ◽  
Significant Difference ◽  
History Of ◽  
Diagnosis Criteria

Aim: The aim of this study was to investigate the significance of positive tuberculosis interferon gamma release assay (TB-IGRA) in the differential diagnosis of intestinal tuberculosis (ITB) and Crohn’s disease (CD) patients, and to find a suitable threshold to help distinguishing CD from tuberculosis (TB), so as to provide better recommendations for clinical treatment. Methods: A retrospective study was performed including 484 patients who underwent TB-IGRA testing for suspected CD or ITB treated in the Shanghai Tenth People’s Hospital of Tongji University between January 2015 and May 2018. According to the diagnostic criteria, 307 patients, including 272 CD and 35 ITB patients, were recruited for the final analysis. We comprehensively and systematically collected their clinical manifestations, and analyzed the influence of TB-IGRA values referring to diagnosis criteria, and the possible causes of false positives. The receiver operator characteristic (ROC) curve and the cut-off value were applied to distinguish between ITB and CD patients. Results: Of the 56 patients with suspected CD enrolled, 23 were finally diagnosed with CD and 33 with ITB. In patients with TB-IGRA ⩾ 100 pg/ml, 4 cases were CD and 29 cases were ITB, while 19 cases were CD and 4 cases were ITB in patients with TB-IGRA < 100 pg/ml ( p < 0.05). TB-IGRA ⩾ 100 pg/ml indicated a high possibility of TB infection, with a sensitivity of 88% and a specificity of 74%. Three out of the four CD patients with TB-IGRA ⩾ 100 pg/ml had a history of tuberculosis, while only 1 of the 19 CD patients with TB-IGRA < 100 pg/ml had a history of tuberculosis ( p < 0.05). The average duration of ITB was 7 months, and that of CD was 46.8 months, thus a significant difference ( p < 0.05) was observed. Perianal lesions such as anal fistula or abscess were found in all CD patients. Among ITB patients, 8 out of 15 patients with TB-IGRA ⩾ 400 pg/ml experienced weight loss, while only 1 out of 18 patients with TB-IGRA < 400 pg/ml underwent weight loss ( p < 0.05). Conclusion: Patients with CD have longer duration of disease, and perianal lesions are more common in CD. ITB patients with TB-IGRA ⩾ 400 pg/ml experience weight loss more readily, which indicates that TB-IGRA value may be correlated positively with the severity of ITB. In patients with CD and ITB, TB-IGRA = 100 pg/ml may be a cut-off value of TB-IGRA. For patients with TB-IGRA ⩾ 100 pg/ml, it is recommended to use diagnostic anti-TB treatment first. Comprehensive analysis and judgment are required for patients with TB-IGRA from 14 pg/ml to 99 pg/ml. TB-IGRA false positivity may occur in patients with a history of TB infection.

Risk Factors for Clinical Manifestations in Patients with Factor V Leiden and Prothrombin Gene Mutations.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 4090-4090
Author(s):  
Maria Teresa De Sancho ◽  
Nickisha Berlus ◽  
Jacob H. Rand
Keyword(s):  
Risk Factors ◽  
Family History ◽  
Clinical Characteristics ◽  
Clinical Manifestations ◽  
Gene Mutations ◽  
Factor V Leiden ◽  
Factor V ◽  
Female Hormones ◽  
Significant Difference ◽  
History Of

Abstract Factor V Leiden (FVL) and prothrombin G20210A gene mutations are the most prevalent hereditary thrombophilias (HT). Carriers of these HT are at greater risk for developing thromboembolic events (TEE) and/or pregnancy complications (PC) compared to non-carriers, but not all carriers develop clinical manifestations. We retrospectively analyzed the risk factors (RF) for clinical manifestations of all subjects who tested positive for FVL and/or PG20210A gene mutations in our hematology clinic between January 2000 and July 2006. Symptomatic carriers (cases) and asymptomatic carriers (controls) were compared. Cases were defined as having had a TEE (venous and/or arterial) or a PC (pregnancy loss (PL), preeclampsia, abruption placenta and intrauterine growth restriction). Data analyzed included secondary RF for thrombosis, use of female hormones (FH), family history of thrombosis (FHT), and the presence of other thrombophilias. During the study period, 197 subjects were fully evaluable; 9 were excluded due to insufficient data. The clinical characteristics are shown in Table 1. Of the 85 venous thromboses (VT), 59 (69%) had DVT and/or PE, 10 (12%) had superficial thrombophlebitis, 9 (11%) intra-abdominal thrombosis, 2 (2%) cerebral VT, 2 (2%) had retinal VT and 3 (4%) had &gt; 1 site of VT. Of the 25 arterial thromboses (AT), 11 (44%) were CVA, 7 (28%) had TIA, 6 (24%) had other AT, and 1 (4%) had an MI. Of the 52 cases with PL, 27 (52%) were early recurrent 1st trimester PL, 8 (15%) were 2nd or 3rd trimester PL, 4 (8%) had infertility and 13 (25%) had both PL and infertility. Of the 5 PC, 3 were abruption placenta, 1 preeclampsia and 1 had &gt; 1 PC. The most common RF was the presence of &gt; 1 secondary RF (Table 2). There was no significant difference between cases and controls regarding the use of FH, FHT, and presence of other thrombophilias. Fertility medications were used by 12 (10%) of cases vs. 1 (2%) of controls. Antiphospholipid (aPL) antibody-positivity was the most prevalent concurrent thrombophilic factor and occurred in 18 of cases (12%) vs. 2 (4%) of controls. Cases and controls were similar regarding gender, age, family history of thrombosis, and presence of other thrombophilias. In summary, fertility medications and aPL antibodies appear to be significant risk factors for clinical manifestations in cases. Larger multicenter studies are warranted to identify additional RF in carriers of these HT. Clinical Characteristics Cases (n=145) Controls (n=52) *85 heterozygous, 6 homozygous, **29 heterozygous, 2 homozygous, ***37 heterozygous, 2 homozygous, ****100% heterozygous Mean Age, yr [+/−SD] 44+/−13 42+/−13 Gender, female 115 (79%) 42 (81%) FVL 91 (63%)* 31 (60%)** PG20210A 39 (27%)*** 18 (35%)**** FVL + PG20210A 15 (10%) 3 (6%) VT 85 (59%) --- AT 25 (17%) --- PC and infertility (female carriers, n=115) 57 (50%) --- Risk Factors Cases (n=145) Controls (n=52) p value Includes obesity, postoperative period, pregnancy, puerperium, long airplane flight, smoking, hypertension, hypercholesterolemia, and immobilization; **oral contraceptives, hormone replacement therapy, selective estrogen receptor modulators, progesterone OC, fertility medications Secondary RF* 74 (51%) 15 (29%) 0.265 NS Use of female hormones**, n=115 59 (51%) 21 (50%) 0.478 NS Family history of thrombosis 73 (50%) 34 (65%) 0.252 NS Other thrombophilias 60 (41%) 21 (40%) 0.232 NS

scholarly journals Analysis of recipient and graft survival after primary and second kidney transplantation

2021 ◽  
Vol 23 (2) ◽  
pp. 21-29
Author(s):  
A. V. Pinchuk ◽  
N. V. Shmarina ◽  
I. V. Dmitriev ◽  
V. E. Vinogradov ◽  
A. I. Kazantsev
Keyword(s):  
Kidney Transplantation ◽  
Graft Survival ◽  
Survival Rates ◽  
Term Survival ◽  
Kidney Recipients ◽  
Significant Difference ◽  
History Of ◽  
First Time ◽  
Older Recipients

Objective: to evaluate the 1- and 5-year graft and recipient survival after primary and second kidney transplantation, to compare the outcomes depending on the age of recipients.Material and methods. The treatment outcomes for 364 patients who underwent kidney transplantation at Sklifosovsky Research Institute of Emergency Care, Moscow over the period from 2007 to 2019. Of these, 213 patients underwent kidney transplantation for the first time, while 151 patients were having a second transplantation. We analyzed the effect of previous transplants, as well as the age of the recipients on long-term survival rates.Results. No significant difference in 1- and 5-year survival of kidney recipients after primary and second transplantations was found. In contrast, the long-term graft survival significantly depended on this criterion and turned out to be significantly higher after primary transplantations. The 1- and 5-year survival of older recipients was lower than the survival of younger recipients after primary and second kidney transplantation. The 1-year graft survival after primary kidney transplantation was higher in young recipients than in older recipients of the same group, however, but there were no significant differences in the 5-year graft survival. After second transplantations, there were no significant differences in the 1- and 5-year graft survival depending on the age of recipients.Conclusion. A history of previous transplantation is an important factor in kidney transplantation outcome, which must be taken into account in clinical practice.

scholarly journals ANTERIOR PLACENTA POSITION AS A CAUSING FACTOR OF PRE-ECLAMPSIA

2021 ◽  
pp. 191-196
Author(s):  
L. I. Berlinska ◽  
V. G. Marichereda ◽  
O. M. Pavlovska ◽  
Y. Y. Petrovskiy
Keyword(s):  
Pregnant Women ◽  
Cystatin C ◽  
Statistical Significance ◽  
Prognostic Significance ◽  
Clinical Manifestations ◽  
Maternity Hospital ◽  
Serum Cystatin C ◽  
Prognostic Accuracy ◽  
Significant Difference ◽  
History Of

The aim of the study – to determine the frequency of preeclampsia in pregnant females with anterior location of the placenta and to determine the prognostic significance when combined with a marker of acute renal damage – cystatin C level. Materials and Methods. In 2018–2020, a prospective cohort study that enrolled 91 pregnant women at their second trimester of gestation was conducted at Maternity Clinic and Obstetric Hospital of Maternity Hospital No. 2, Odesa. The group with the anterior location of the placenta consisted of 47 (51.65 %) pregnant women and 44 (48.35 %) had the posterior location of the placenta. Assessment of serum cystatin C was performed in women without clinical manifestations of PE at the second or third trimester of gestation (18–36 weeks), the average term was (32.22±0.41) weeks of pregnancy (p=0.011). Results and Discussion. 28.57 % of pregnant women were subsequently diagnosed with preeclampsia (PE), of whom 19 (20.88 %) had anterior and 7 (7.69 %) posterior placenta location. Body mass index (BMI) before pregnancy, age, and height: no statistically significant difference observed between groups (p> 0.05). Analysis of maternal factors of PE in relation to the anterior location of the placenta: odds ratio (OR) higher than 1.0 was noted for combination with obesity (OR 2.38 (95 % CI 0.75–7.53)), the age over 35 years (OR 1.01 (95 % CI 0.41–2.49)) and history of PE during previous pregnancy (OR 1.38 (95 % CI 0.21–9.01)), but no statistical significance was observed (р˃0.05). When analyzing cystatin C values over 1.0 mmol/l relative to the anterior location of the placenta, the OR was 3.92 (95 % CI 1.45–10.57), sensitivity 84.09 %, specificity 42.55 %, accuracy 62.64 % were reported, p=0.011. When analyzing the frequency of preeclampsia in the anterior location of the placenta, the OR was 3.59 (95 % CI 1.32 - 9.71), sensitivity 84.09 %, specificity 40.43 %, accuracy 61.54 % were reported with statistical significance p=0.019. Conclusions. The risk of preeclampsia in patients with the anterior location of the placenta increases by 3.59 times with a prognostic accuracy of 61.54 %. To increase the prognostic significance for the detection of preeclampsia in women with anterior location of the placenta, it is recommended to assess the serum level of cystatin C.

scholarly journals Histamine Intolerance: Clinical Characterization and Determination of Serum Diamine Oxidase (Dao) in a Series of Cases and Controls

2020 ◽  
Author(s):  
Peralta Teresa ◽  
Bastías Carla ◽  
Camila Beltran-Ortiz ◽  
Durán Magdalena ◽  
Ramos Verónica ◽  
...  
Keyword(s):  
Diamine Oxidase ◽  
Clinical Manifestations ◽  
Histamine Intolerance ◽  
Significant Difference ◽  
History Of ◽  
Ige Mediated ◽  
Average Serum ◽  
Excessive Accumulation

Abstract Introduction. Histamine intolerance (HIT) is a pathology with an estimated prevalence of 1% in which there is an imbalance between the intake of histamine via the digestive tract and the body's ability to degrade it. This results in an excessive accumulation of histamine that determines the appearance of gastrointestinal, skin, respiratory and neurological symptoms. The enzyme responsible for degrading histamine in the extracellular space is diamine oxidase (DAO); therefore, HIT is caused due to a deficit in the concentration and/or in the activity of this enzyme. Because histamine is the main mediator of the classic symptoms of IgE-mediated allergic reactions, it is difficult to differentiate a true allergy from HIT since it has basically the same clinical manifestations. Objectives. The objective of this study was to perform a clinical characterization of patients with HIT and to determine the usefulness of quantifying serum DAO concentration in the diagnosis of HIT. Method: Twenty-two patients over the age of 18 with a history of histamine intolerance were recruited, in whom IgE-mediated food allergy was ruled out, and 22 healthy patients. Both groups were surveyed and serum DAO concentration was determined. Results: Middle-aged women predominated in the population with HIT. They described a wide variety of symptoms, with a dominance of abdominal pain, bloating, diarrhea, flushing, urticaria, itching, headache and dysmenorrhea. When comparing the average serum DAO concentration in the population with HIT (10.686 U/ml) with the average obtained in the control population (20.664 U/ml), there was a significant difference (p < 0.003). Conclusion. The determination of serum DAO concentration is a useful tool for the diagnosis of HIT.

scholarly journals Congenital Anomalies of the Kidney and Urinary Tract in Children with Congenital Heart Defects

2020 ◽  
Vol 45 (2) ◽  
pp. 307-313
Author(s):  
Dapeng Jiang ◽  
Qi Wang ◽  
Zhengzhou Shi ◽  
Jie Sun
Keyword(s):  
Urinary Tract ◽  
Congenital Heart Defects ◽  
Congenital Anomalies ◽  
Congenital Heart ◽  
Medical Center ◽  
Heart Defects ◽  
Clinical Manifestations ◽  
Number Of Patients ◽  
Significant Difference ◽  
History Of

Background/Aims: To investigate the incidence and clinical characteristics of congenital anomalies of the kidney and urinary tract (CAKUT) in children with congenital heart defects (CHD). Methods: We retrospectively analyzed the clinical data of children with CHD with CAKUT admitted to the Shanghai Children’s Medical Center affiliated with the Shanghai Jiao Tong University School of Medicine between September 2018 and March 2019. Patients underwent routine examinations for liver, kidney, and coagulation function, and urinary tract ultrasonography, and we summarized patients’ clinical manifestations and imaging abnormalities. Results: A total of 1,410 children with CHD were diagnosed and treated in our hospital. The total number of patients with abnormal urogenital systems was 104, and hydronephrosis was the most common abnormality, followed by vesicoureteral reflux and duplication of the kidney and ureter. The overall prevalence of CAKUT was 7.4%. There was no statistically significant difference for maternal age, sex, parity, gestational age, and history of medication during pregnancy between the patients with CAKUT and those without CAKUT. Conclusion: The incidence of CAKUT in our patients with CHD was significantly higher than that in the general population. We recommend urinary ultrasonography as a routine examination for children with CHD for early detection of CAKUT, to avoid missed diagnoses, and to initiate appropriate treatment.

scholarly journals The Association between EEG Abnormality and Behavioral Disorder: Developmental Delay in Phenylketonuria

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Parvaneh Karimzadeh ◽  
Mohammad Reza Alaee ◽  
Hadi Zarafshan
Keyword(s):  
Developmental Delay ◽  
Behavioral Disorders ◽  
Clinical Manifestations ◽  
Behavioral Disorder ◽  
Screening Tests ◽  
Eeg Abnormalities ◽  
Significant Difference ◽  
Epileptic Discharges ◽  
History Of

Background. Brain defect leading to developmental delay is one of the clinical manifestations of phenylketonuria. The aim of this study was to evaluate the association between EEG abnormality and developmental delay/behavioral disorders in phenylketonuria. Patients and Methods. 105 phenylketonuria patients, who were diagnosed through newborn screening tests or during follow-up evaluation, were enrolled. Patients who were seizure-free for at least six months before the study were included. The developmental score were evaluated by the ASQ questionnaire (age-stage questionnaire) and the test of child symptom inventory-4 (CSI-4), respectively. Results. 55 patients had a history of seizure more than 6 months before the study. Seventy had abnormal EEG (cases) and 35 had normal EEG (controls). There was no significant difference between mean phenylalanine levels in the abnormal and normal EEG groups at the time of diagnosis, after six months and at our evaluation. Distribution of DQ level in the abnormal and normal EEG groups revealed a significant difference. An abnormal EEG was associated with a higher percentage of low DQ levels. Conclusion. Paroxysmal epileptic discharges in PKU patients are important. Treatment of these EEG abnormalities may affect developmental scores or may lead to correction of some behavioral disorders in patients.

scholarly journals Comparison of Percutaneous and Open Surgical Techniques for First-Time Peritoneal Dialysis Catheter Placement in the Unbreached Peritoneum

2015 ◽  
Vol 35 (5) ◽  
pp. 576-585 ◽  
Author(s):  
Samar Medani ◽  
Wael Hussein ◽  
Mohamed Shantier ◽  
Robert Flynn ◽  
Catherine Wall ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Abdominal Surgery ◽  
Surgical Techniques ◽  
Complication Rates ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Catheter Survival ◽  
Significant Difference ◽  
History Of ◽  
First Time

BackgroundThe percutaneous Seldinger method of peritoneal dialysis catheter (PDC) insertion has gained favor over recent years whereas traditionally it was reserved for patients considered not fit for general anesthesia. This blind technique is believed to be less safe, and is hence avoided in patients with previous laparotomy incisions. Reports on the success of this method may therefore be criticized for selection bias. In those with no prior abdominal surgery the optimal method of insertion has not been established.MethodsWe retrospectively reviewed the outcomes of first-time PDC placements comparing the percutaneous (group P) and surgical (group S) insertion techniques in patients without a history of previous abdominal surgery in a single center between January 2003 and June 2010. We assessed catheter survival at 3 and 12 months post-insertion and compared complication rates between the two groups.ResultsA total of 63 percutaneous and 64 surgical catheter insertions were analyzed. No significant difference was noted in catheter survival rates between group P and group S (86.2% vs 80% at 3 months, p = 0.37; and 78.3% vs 71.2% at 12 months, p = 0.42 respectively). Early and overall peritonitis rates were similar (5% vs 5.3%; p = 1, and 3.5 vs 4.9 episodes per 100 patient-months; p = 0.13 for group P and group S respectively). There were also no significant differences between the two groups in exit site leaks (15.9% in group P vs 6.3% in group S; p = 0.15), poor initial drainage (9.5% in group P vs 10.9% in group S, p = 0.34) or secondary drainage failure (7.9% in group P vs 18.8% in group S, p = 0.09).ConclusionThis study illustrates the success and safety of percutaneous PDC insertion compared with the open surgical technique in PD naive patients without a history of prior abdominal surgery. Catheter survival was favorable with percutaneous insertion in this low-risk patient population but larger prospective studies may help to determine whether either method is superior. The percutaneous technique can be recommended as a minimally invasive, cost-effective procedure that facilitates implementing an integrated care model in nephrology practice.

scholarly journals O que Sabem os Viajantes Portugueses Sobre Malária? Avaliação Pré-Consulta de Medicina de Viagem

2018 ◽  
Vol 31 (12) ◽  
pp. 714
Author(s):  
Joana Cepeda ◽  
Paula Milheiro-Oliveira ◽  
Cândida Abreu
Keyword(s):  
Higher Education ◽  
Travel Medicine ◽  
Real Life ◽  
Clinical Manifestations ◽  
Average Percentage ◽  
Significant Difference ◽  
University Degree ◽  
First Time ◽  
Degree Level ◽  
De Medicina

Introduction: The knowledge of transmission, prevention and symptoms of malaria is essential for travellers’ safety. In real life, what do Portuguese travellers know about malaria before a Travel Medicine consultation? How can we, through this consultation, improve their knowledge?Material and Methods: Before an appointment with a specialist in Travel Medicine, 80 adult travellers filled a questionnaire that included demographic aspects, characteristics of the trip and knowledge about malaria. Data were analysed using descriptive statistics and multifactorial variance analysis.Results: The travellers’ ages fell in the range 20 - 80 years, 51% were male and 74% of the travellers had a university degree level of education. For 74% of the travellers, this was the first Travel Medicine consultation. Half of the travellers planed trips lasting no more than 14 days, mainly for tourism. The average percentage of correct answers about malaria given by a traveller was 63%. Travellers who had previously attended a Travel Medicine appointment exhibit a statistically significant difference in knowledge comparing to those who attend Travel Medicine appointment for the first time, and this was more evident in the sample composed of travellers without higher education. The clinical manifestations and prevention had the lowest number of correct answers among the travellers.Discussion: These travellers appear to have good knowledge about malaria but some misconceptions prevail.Conclusion: The Travel Medicine consultation seems important to raise awareness in the population about malaria, particularly for travellers without higher education. The prevention and the recognition of malaria symptoms must be prioritized during Travel Medicine consultations and the information given adapted to the traveller’s characteristics.

scholarly journals Challenging diagnosis of leprosy in a psychotic homeless patient with atypical clinical manifestations: an interesting case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hendra Gunawan ◽  
Reyshiani Johan ◽  
Pati Aji Achdiat ◽  
Oki Suwarsa
Keyword(s):  
Sural Nerve ◽  
Skin Diseases ◽  
Histopathological Examination ◽  
Clinical Manifestations ◽  
Interesting Case ◽  
Granulomatous Reaction ◽  
Case Presentation ◽  
History Of ◽  
First Time ◽  
Reversal Reaction

Abstract Background A decision to diagnose certain skin diseases in patient undergoing psychotic break is challenging; this includes establishing the diagnosis of leprosy. Diagnosis of leprosy is established if there is at least one of the three cardinal signs of leprosy. Histopathological examination is not a gold standard, but remains useful in atypical or clinically suspicious cases. Case presentation We report for the first time, an interesting case of leprosy with atypical clinical manifestations in a psychotic homeless male with unknown history of present illness. Upon examination, hypopigmented macules, hyperpigmented macules, and plaques were observed, with unclear sensation impairment. Peripheral nerve thickening and acid-fast bacilli from slit-skin smear were not found. Histopathological examination from hypopigmented macule on the upper right limb showed no granulomatous reaction and other histopathological features of leprosy. Although the condition did not fulfill the cardinal signs of leprosy, we found lagophthalmos, claw hands, pseudomutilation of fingers and toes. Therefore, the diagnosis of suspected leprosy was established. The patient was hospitalized and attempts to administer oral rifampicin and clofazimine were made. Several days after treatment, annular erythematous macules appeared on the patient’s face, abdomen, and back. Histopathological examination results on sample taken from erythematous macule and right sural nerve were consistent with the diagnosis of leprosy with reversal reaction. Conclusion In certain conditions, histopathological examination of the skin and nerves are a highly rewarding test in establishing a diagnosis of leprosy.

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