scholarly journals Case Report: Rehabilitation for Lower Extremity Pain Due to Venous Stasis in a Patient With Multisystem Inflammatory Syndrome in Children

2022 ◽  
Vol 9 ◽  
Author(s):  
Tokio Kinoshita ◽  
Yukihide Nishimura ◽  
Yasunori Umemoto ◽  
Yumi Koike ◽  
Ken Kouda ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Compression Therapy ◽  
Pulse Therapy ◽  
The Body ◽  
Lower Limbs ◽  
Venous Stasis ◽  
Steroid Pulse ◽  
Multiple Organs ◽  
Inflammatory Syndrome ◽  
Elastic Bandage

Recently, it was reported that children recovering from coronavirus disease (COVID-19) developed multisystem inflammatory syndrome in children (MIS-C), which causes severe inflammation in multiple organs of the body. Because MIS-C is a new disease, the pathophysiology and prognosis are unknown. Owing to a lack of studies on this subject, we herein provide information on rehabilitation for children with MIS-C. A 12-year-old male patient presented with systemic inflammatory symptoms after approximately 2 months since recovery from COVID-19. He was treated with cyclosporine and steroid pulse therapy after admission to our hospital. His general condition improved significantly within approximately 1 week. Thereafter, his lower legs turned dark purple and he experienced intense pain whenever the lower limbs hung below the heart, such as in the sitting position. The patient was referred to the rehabilitation department, as he had difficulties during standing and walking. Because the symptoms improved with elevation of the lower extremities, we considered that the pain was related to venous stasis. The pain reduced when an elastic bandage was applied for the prevention of venous stasis; therefore, exercise therapy was implemented while the patient wore the elastic bandage. The patient's lower extremity symptoms improved in 10 days. He was discharged after 16 days and could independently perform activities of daily living (ADL). The mechanism underlying the patient's pain could not be determined; however, rehabilitation was effective when combined with compression therapy using an elastic bandage.

scholarly journals Eosinophilic Granulomatosis with Polyangiitis Presenting with Myocarditis as an Initial Symptom: A Case Report and Review of the Literature

2021 ◽  
pp. 329-333
Author(s):  
Kanako Kurihara ◽  
Jun Tsugawa ◽  
Shinji Ouma ◽  
Toshiyasu Ogata ◽  
Mikiko Aoki ◽  
...  
Keyword(s):  
Granulomatosis With Polyangiitis ◽  
Nerve Biopsy ◽  
Pulse Therapy ◽  
Sural Nerve Biopsy ◽  
Lower Limbs ◽  
Rapid Progression ◽  
Eosinophilic Granulomatosis With Polyangiitis ◽  
Initial Symptom ◽  
Steroid Pulse ◽  
Eosinophilic Granulomatosis

A 66-year-old woman with a history of bronchial asthma had shortness of breath and fatigue upon mild exercise. She was diagnosed as congestive heart failure. A blood test showed eosinophilia without the presence of anti-neutrophil cytoplasmic antibody (ANCA), and a myocardial biopsy specimen revealed eosinophilic infiltration in the myocardium. Eosinophilia was improved when she was administered short-term methylprednisolone. After that, she had numbness and pain in her lower limbs with re-elevation of eosinophils. She had dysesthesia and hypalgesia in the distal part of the limbs. Sural nerve biopsy revealed axonal degeneration and thickness of the arterial wall, indicating a diagnosis of eosinophilic granulomatosis with polyangiitis (EGPA). Two courses of steroid pulse therapy were performed, resulting in marked improvement of her sensory symptoms. ANCA-negative EGPA might be associated with myocarditis and peripheral neuropathy. A sufficient immunotherapy should have been considered to prevent rapid progression.

scholarly journals A cross sectional study to evaluate the clinical presentation in multisystem inflammatory syndrome in children

2021 ◽  
Author(s):  
Ambika Sood ◽  
Pancham Kumar ◽  
Rakesh Sharma ◽  
Deepak Sharma ◽  
Sanya Sharma
Keyword(s):  
Clinical Presentation ◽  
Cross Sectional Study ◽  
Study Data ◽  
The Body ◽  
Sectional Study ◽  
Cross Sectional ◽  
Medical College ◽  
Multiple Organs ◽  
Gandhi Medical College ◽  
Inflammatory Syndrome

Background: MIS-C as a disease has varied symptoms and signs that affect multiple organs and systems in the body. The present study aimed to describe the clinical presentation among children admitted as a case of multisystem inflammatory syndrome in children in Indira Gandhi Medical College, Shimla.Methods: We conducted a cross sectional study of children with MIS-C from January to July 2021, in the pediatric ward of Indira Gandhi Medical College Shimla in Himachal Pradesh. All children admitted with a diagnosis of MISC were included in the study. Data regarding clinical presentation was extracted and analyzed using Epi Info V7 software.Results: In the present study, a total of 31 children diagnosed and admitted as a case of multisystem inflammatory syndrome in children (MIS-C) were included. Mean age of these children was 7.12±4.78 years. Among the total 16 (51.6%) were males while 15 (48.4%) were females. All 31 patients had presented with fever and 13 (41.9%) patients had fever with rash. 5 (16.1%) had cough, 1 (3.2%) child presented with hematemesis, 18 (58.1%) had tachypnea at presentation and 15 (48.4%) patients had respiratory distress. 16 (51.6%) children had complaints of vomiting, 1 (3.2%) presented with bleeding diathesis and 12 (38.7%) had hematuria, 5 (16.1%) had seizures and 8 (25.8%) presented with encephalopathy. 19 (61.3%) children had hypotension, 15 (48.4%) had hepatomegaly and 15 (48.4%) had splenomegaly.Conclusions: It is very essential to characterize this syndrome to fully understand its spectrum, therefore we need to be continuously watchful for its varied clinical presentations, both for ensuring an early diagnosis and treatment of patients suffering from MIS-C.

A Man with Simultaneous Occurrence of Acute Lower Extremity Arterial Embolization and Acute Myocardial Infarction: A Case Report

2020 ◽  
Author(s):  
Liangyuan Lu ◽  
Yanyan Xue ◽  
Yalei Han ◽  
Tongxin Bao ◽  
Jing Xue ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Lower Extremity ◽  
Arterial Embolization ◽  
Lower Limbs ◽  
Simultaneous Occurrence ◽  
Arterial Embolism ◽  
Multiple Organs ◽  
History Of ◽  
The Right

Abstract Background: Spontaneous co-occurrence of acute myocardial infarction (AMI) and acute lower extremity arterial embolism (ALEAE) has rarely been reported.Case presentation: A 44-year-old male with a history of 4 years of type1 diabetes was admitted to hospital when he suddenly experienced severe pain in his right lower limb and felt tightness in the left anterior chest area. Ultrasonography revealed distal occlusion of the right superficial femoral artery. ECG showed acute anterior interstitial myocardial infarction. After conservative treatment for 2 days, the patient had severe necrosis of lower limbs and secondary injury of multiple organs. Hemodialysis and heparin anticoagulant therapy were performed before amputation. Twelve days after the operation, the patient's condition was stable and he was transferred out of ICU.Conclusions: Emergency amputation and multidisciplinary approaches may offer a chance for survival if patents lost the opportunity for early treatment.

scholarly journals New technologies in vascular rehabilitation

2021 ◽  
pp. 11-15
Author(s):  
Prosperi Loris ◽  
Barassi Giovanni ◽  
Supplizi Marco ◽  
Giancola Alessandra ◽  
Di Matteo Celeste ◽  
...  
Keyword(s):  
New Technologies ◽  
Compression Therapy ◽  
Intermittent Pneumatic Compression ◽  
The Body ◽  
Lower Limbs ◽  
Before And After ◽  
Important Health ◽  
Primary Lymphedema ◽  
Total Body ◽  
Group B

Lymphedema of lower limbs represents an important health problem, characterized by the necessity to identify new methods of treatment. The aim of this study was to evaluate the efficacy of the treatment with Lymphatic Kinesiology Taping (LKT) or Intermittent Pneumatic Compression therapy (IPC) on a homogeneous group of 40 women affected by primary lymphedema within stage 2 of lower limbs, comparing the two methods. Patients were equally and randomly divided into a group A subjected to application of LKT and group B subjected to IPC. All patients were evaluated through electric bioimpedentiometry (analysis of Total Body Water and Extracellular Water) and circumferential measurement of lower limbs through a measurement tape, both before and after the protocol (T0 and T1). Both treatment groups highlighted an improvement of the lymphedema, with a marked reduction of volume of lower limbs and a better hydric balance of the body. LKT and IPC can be considered as viable options for the treatment of primary lymphedema within stage 2 of lower limbs.

scholarly journals A Case of Large Sarcoid Choroidal Granuloma Treated with Steroid Pulse Therapy

2020 ◽  
Vol 11 (1) ◽  
pp. 112-119
Author(s):  
Takatoshi Kobayashi ◽  
Nanae Takai ◽  
Takaki Sato ◽  
Rei Tada ◽  
Eri Maruyama ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Pulse Therapy ◽  
Epithelioid Cell ◽  
The Body ◽  
Steroid Pulse Therapy ◽  
Whole Body ◽  
Large White ◽  
Cervical Lymph Nodes ◽  
Steroid Pulse ◽  
Choroidal Granuloma

Purpose: To report a case of large sarcoid choroidal granuloma that was successfully treated with steroid pulse therapy. Case Report: A 38-year-old man presented with the primary complaint of decreased visual acuity (VA) in his left eye. Upon examination, a large white protruding lesion of 10 × 8 papilla diameter in size was observed in the macular region, and slightly temporal to it, in the patient’s left eye. Whole-body contrast-enhanced computed tomography performed for differential diagnosis detected numerous enlarged lymph nodes throughout the body, including the bilateral hilar regions. Sarcoidosis was diagnosed by biopsy of the right cervical lymph nodes showing noncaseating epithelioid cell granuloma. The fundus lesion was found to be a choroidal granuloma caused by sarcoidosis, and steroid pulse therapy was started. The granuloma was considerably decreased, and the VA in the left eye improved to 0.7 after 2 months. Conclusion: Steroid pulse therapy was found to be effective as an initial treatment for a large sarcoid choroidal granuloma.

scholarly journals Probable progressive multifocal leukoencephalopathy-immune reconstitution inflammatory syndrome with immunosuppressant dose reduction following lung transplantation: a case report and literature review

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Kazuhiro Ishii ◽  
Fumiko Yamamoto ◽  
Shinsuke Homma ◽  
Yoshinori Okada ◽  
Kazuo Nakamichi ◽  
...  
Keyword(s):  
Lung Transplantation ◽  
Immune Reconstitution ◽  
Brain Mri ◽  
Pulse Therapy ◽  
Brain Lesions ◽  
Cerebral White Matter ◽  
Mri Findings ◽  
Steroid Pulse ◽  
Cell Counts ◽  
Inflammatory Syndrome

Abstract Background Progressive multifocal leukoencephalopathy (PML) is a rapidly developing demyelinating disease in the cerebral white matter and is often caused by JC polyomavirus (JCV). PML after lung transplantation is rare and has a poor prognosis, with no established therapies. Reducing the patient’s immunosuppressant doses, thereby restoring immunity, could be used to treat PML. However, some patients develop immune reconstitution inflammatory syndrome (IRIS) with this treatment, an immune-induced inflammatory response to JCV that results in serious neuronal damage. We herein report a case of a 60-year-old female who suffered from PML 5 years after lung transplantation, had worsened brain lesions thought to be related to PML-IRIS at the time of immunosuppressant reduction, and missed treatment opportunities. Case presentation A 60-year-old female developed PML 5 years after lung transplantation. Fluid-attenuated inversion recovery and diffusion-weighted brain magnetic resonance imaging (MRI) revealed multiple high-signal lesions, mainly in the cerebral white matter. Polymerase chain reaction found 0.32 million copies/mL of JCV in the cerebrospinal fluid. Thus, she was given a diagnosis of PML. Mycophenolate mofetil and tacrolimus dosages were reduced, and CD4-positive cell counts and the blood concentration of each immunosuppressant were monitored. Mefloquine was also orally administered at a daily dose of 275 mg for 3 days and was then administered at a dose of 275 mg per week. Although the patient’s CD4-positive cell counts increased and her immune system recovered, her symptoms and brain MRI findings worsened. We suspected PML progression or a transition to PML-IRIS. Steroid pulse therapy to suppress the inflammatory lesions was not possible but was retrospectively indicated. The patient rapidly began to exhibit akinetic mutism and died 4 months after the onset of neurologic symptoms. Conclusions When neurologic symptoms and abnormal brain MRI findings are noted during immune recovery, it is often difficult to distinguish between progressed PML and PML-IRIS. However, the pathogenesis of brain lesions usually involves inflammation and immune-reactive mechanisms for JCV. Steroid pulse therapy, which can reduce inflammation, should thus be administered in organ transplantation cases with differential diagnoses including PML-IRIS.

scholarly journals White matter abnormalities of the brain: similar to multiple sclerosis in adolescence

2021 ◽  
Vol 10 (5) ◽  
pp. e44610515231
Author(s):  
Dilceu Silveira Tolentino Júnior ◽  
Sandra Neres Santos ◽  
Aquiles Castro Araújo ◽  
Arlanjo Bispo de Sousa Marques ◽  
Kleise Pinheiro Farias ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
White Matter ◽  
Neuromyelitis Optica ◽  
Pulse Therapy ◽  
The Body ◽  
Lower Limbs ◽  
Adolescent Male ◽  
Clinical Feature ◽  
Serological Examination ◽  
Brain White Matter

Also known as Devic's disease, neuromyelitis optica (NMO) is an autoimmune inflammatory disease that affects the central nervous system, considerably similar to multiple sclerosis (MS). This study aimed to compare the similarities of the clinical feature presented with similar cases found in the medical literature, addressing the symptoms, diagnosis, and treatment. This is a descriptive, retrospective, and qualitative study, done through the technique of direct observation. An adolescent male patient came to our service complaining of weakness in the lower limbs and urinary retention and, subsequently, urinary incontinence, during hospitalization. After undergoing magnetic resonance imaging of the skull, a large lesion with a demyelinating characteristic was evident through the T2 and FLAIR sequences, hyperintense in the white matter of the right cerebral hemisphere, with the exuberant enhancement of the contrasted image. Subsequently, he presented weakness in the left dimidium of the body, with progressive worsening in some days, with the impossibility of walking. The treatment was initiated with pulse therapy of methylprednisolone and interferon beta, obtaining an excellent clinical control of the disease. Thus, diagnostic confirmation was only possible thanks to the identification of a single brain white matter lesion through imaging and serological examination, which constituted a tool of great importance for the differential diagnosis that made it possible to exclude multiple sclerosis and allowed the establishment of timely treatment for neuromyelitis optica.

Aspergillus Spondylodiscitis After Spinal Stenosis Surgery: A Case Report

2020 ◽  
Vol 5 (3 And 4) ◽  
pp. 155-160
Author(s):  
Mohsen Aghapoor ◽  
◽  
Babak Alijani Alijani ◽  
Mahsa Pakseresht-Mogharab ◽  
◽  
...  
Keyword(s):  
Antifungal Drugs ◽  
The Body ◽  
Lower Limbs ◽  
Lumbar Pain ◽  
Case Presentation ◽  
Delay In Diagnosis ◽  
Death Case ◽  
Therapeutic Results ◽  
History Of ◽  
Probable Diagnosis

Background and Importance: Spondylodiscitis is an inflammatory disease of the body of one or more vertebrae and intervertebral disc. The fungal etiology of this disease is rare, particularly in patients without immunodeficiency. Delay in diagnosis and treatment of this disease can lead to complications and even death. Case Presentation: A 63-year-old diabetic female patient, who had a history of spinal surgery and complaining radicular lumbar pain in both lower limbs with a probable diagnosis of spondylodiscitis, underwent partial L2 and complete L3 and L4 corpectomy and fusion. As a result of pathology from tissue biopsy specimen, Aspergillus fungi were observed. There was no evidence of immunodeficiency in the patient. The patient was treated with Itraconazole 100 mg twice a day for two months. Pain, neurological symptom, and laboratory tests improved. Conclusion: The debridement surgery coupled with antifungal drugs can lead to the best therapeutic results.

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