INCREASINGLY COMMON PRESENTATION OF EXTRANODAL BURKITTS LYMPHOMA WITH SURPRISINGLY RAISED PLEURAL/ASCITIC FLUID ADENOSINE DEAMINASE LEVELS

2021 ◽  
pp. 48-51
Author(s):  
Gunjan S Dalal ◽  
Jyoti Jain ◽  
Atul Singh Rajput
Keyword(s):  
Adenosine Deaminase ◽  
Burkitt Lymphoma ◽  
Primary Effusion Lymphoma ◽  
Case Series ◽  
Acute Onset ◽  
Rational Approach ◽  
Common Presentation ◽  
Burkitts Lymphoma ◽  
Non Hodgkins Lymphoma ◽  
Patient Prognosis

Acute onset polyserositis as a presentation of Non Hodgkins lymphoma(NHL) occurs in 20% of individuals.(1-4) Etiology being a jumble between an Extranodal Burkitt lymphoma(ENBL),a pyothorax associated lymphoma and a primary effusion lymphoma as a cause of such effusions.(5) We report a case series of 5 such patients of NHL,four of which received chemotherapy with standard CHOP regimen.However,all patients succumbed.The common ndings of strikingly raised uid adenosine deaminase(ADA) levels in all of these effusions establishes a possible etiopathological link(ENBL).(6) An immunocompetent status renders primary effusion lymphoma unlikely which also has high uid ADA levels.This case series proposes a rational approach towards such cases of suspected ENBL presenting with acute onset lymphocytic polyserositis and a negative HIV antibody status with enormously raised uid ADA levels thereby permitting timely institution of chemotherapy for a better patient prognosis.

scholarly journals Clinical and angioarchitectural characteristics of spinal vascular malformations of the cervical spine

2020 ◽  
Vol 32 (5) ◽  
pp. 755-762 ◽  
Author(s):  
Waleed Brinjikji ◽  
Elisa Colombo ◽  
Giuseppe Lanzino
Keyword(s):  
Cervical Spine ◽  
Lower Extremity ◽  
Clinical Presentation ◽  
Vascular Malformations ◽  
Case Series ◽  
Acute Onset ◽  
Lower Extremity Weakness ◽  
Arteriovenous Fistulas ◽  
Spinal Vascular Malformations ◽  
Interventional Neuroradiologist

OBJECTIVEVascular malformations of the cervical spine are exceedingly rare. To date there have been no large case series describing the clinical presentation and angioarchitectural characteristics of cervical spine vascular malformations. The authors report their institutional case series on cervical spine vascular malformations diagnosed and treated at their institution.METHODSThe authors retrospectively reviewed all patients with spinal vascular malformations from their institution from January 2001 to December 2018. Patients with vascular malformations of the cervical spine were included. Lesions were characterized by their angioarchitectural characteristics by an interventional neuroradiologist and endovascular neurosurgeon. Data were collected on clinical presentation, imaging findings, treatment outcomes, and long-term follow-up. Descriptive statistics are reported.RESULTSOf a total of 213 patients with spinal vascular malformations, 27 (12.7%) had vascular malformations in the cervical spine. The mean patient age was 46.1 ± 21.9 years and 16 (59.3%) were male. The most common presentations were lower-extremity weakness (13 patients, 48.1%), tetraparesis (8 patients, 29.6%), and lower-extremity sensory dysfunction (7 patients, 25.9%). Nine patients (33.3%) presented with hemorrhage. Fifteen patients (55.6%) had modified Rankin Scale scores of 0–2 at the time of diagnosis. Regarding angioarchitectural characteristics, 8 patients (29.6%) had intramedullary arteriovenous malformations (AVMs), 5 (18.5%) had epidural arteriovenous fistulas (AVFs), 4 (14.8%) had paraspinal fistulas, 4 (14.8%) had mixed epidural/intradural fistulas, 3 (11.1%) had perimedullary AVMs, 2 (7.4%) had dural fistulas, and 1 patient (3.7%) had a perimedullary AVF.CONCLUSIONSThis retrospective study of 27 patients with cervical spine vascular malformations is the largest series to date on these lesions. The authors found substantial angioarchitectural heterogeneity with the most common types being intramedullary AVMs followed by epidural AVFs, paraspinal fistulas, and mixed intradural/extradural fistulas. Angioarchitecture dictated the clinical presentation as intradural shunts were more likely to present with hemorrhage and acute onset myelopathy, while dural and extradural shunts presented as either incidental lesions or gradually progressive congestive myelopathy.

scholarly journals Treatment of COVID-19 pneumonia and acute respiratory distress with ramatroban, a thromboxane A2 and prostaglandin D2 receptor antagonist: A 4-Patient Case Series Report

2021 ◽  
Author(s):  
Martin L. Ogletree ◽  
Kate Chander Chiang ◽  
Rashmi Kulshreshta ◽  
Aditya Agarwal ◽  
Ashutosh Agarwal ◽  
...  
Keyword(s):  
Respiratory Distress ◽  
Organ Failure ◽  
Viral Infections ◽  
Pulmonary Veins ◽  
D2 Receptor ◽  
Case Series ◽  
Acute Onset ◽  
Lipid Mediator ◽  
Prostaglandin D2 ◽  
Th2 Immune Response

Abstract COVID-19 associated pneumonia and acute respiratory distress syndrome are characterized by a lipid mediator storm with massive increases in lung and systemic thromboxane A2 >> prostaglandin D2. Thromboxane A2 is a potent vasoconstrictor of pulmonary veins >> arteries, and thereby promotes an increase in pulmonary capillary pressures, transudation of fluid into the alveolar space, pulmonary edema and ARDS. Thromboxane A2 also increases vascular permeability, contracts bronchial smooth muscle, triggers and amplifies platelet activation, and promotes a prothrombotic state. PGD2 promotes a Th2 immune response that is atypical for viral infections and inhibits antiviral defense by suppressing interferon λ expression. D-dimers, urinary 11-dehydro-TxB2, and IL-13, a Th2 cytokine, have emerged as key biomarkers of severity and organ failure in COVID-19. Ramatroban is an orally bioavailable, potent, dual antagonist of the thromboxane A2 (TPr) and PGD2 (DPr2) receptors. We report use of ramatroban in 4 COVID-19 outpatients, 22 to 87 years of age, with acute onset / worsening of respiratory distress and hypoxemia. All four patients experienced decrease in respiratory distress and increase in SpO2, within hours of the first dose and thereby avoided hospitalization. By the 5th day all 4 patients had complete resolution of respiratory distress and hypoxemia. Ramatroban (Baynas®, Bayer Yakuhin Ltd., Japan) has an established safety profile, having been indicated in Japan for the treatment of allergic rhinitis for over 20 years. As a broncho-relaxant, anti-vasospastic, anti-thrombotic and immunomodulator, ramatroban addresses the fundamental pathophysiologic mechanisms underlying respiratory and critical organ failure in COVID-19, and therefore merits urgent clinical trials that might impact the ongoing pandemic.

scholarly journals Suspected botulism outbreak after the consumption of vegetarian pâté in the south of Viet Nam

2021 ◽  
Vol 5 ◽  
pp. 257
Author(s):  
Le Quoc Hung ◽  
Vo Ngoc Anh Tho ◽  
Do Thi Ngoc Khanh ◽  
Vo Thi Thanh Hien ◽  
Jeremy N. Day ◽  
...  
Keyword(s):  
Early Recognition ◽  
Specific Treatment ◽  
Case Series ◽  
Acute Onset ◽  
Viet Nam ◽  
Food Hygiene ◽  
High Clinical Suspicion ◽  
Cranial Nerve Palsies ◽  
Life Threatening ◽  
Botulinum Neurotoxins

Botulism and other botulinum neurotoxins-producing clostridia  are potentially life-threatening diseases caused by toxins produced by Clostridium botulinum. Here we reported a case series of six patients who presented with botulism following ingestion of commercially made pâté. The key features of presentation were acute onset of bilateral cranial nerve palsies and symmetrical descending weakness in the absence of fever resulting in the need for mechanical ventilation in all six patients. The clinical diagnosis of botulism was confirmed through the identification of C. botulinum from the suspected food source.  Given that botulinum antitoxin was not available in Vietnam at the time, and their severe status, all patients received a trial of plasma exchange therapy, but no clear benefit was seen. Due to its rarity, diagnosing botulism is a challenge, demanding high clinical suspicion. Successful outcomes depend upon early recognition and rapid initiation of specific treatment with botulinum antitoxin. There is a need to improve global access to antitoxin.  These cases, the first in Viet Nam, serve as a reminder of the need to maintain the highest possible food hygiene and preservation practices.

Value of Preoperative MRI and Examination under Anesthesia for Differentiating Complete from Partial Anterior Cruciate Ligament Tears

2018 ◽  
Vol 32 (07) ◽  
pp. 620-623 ◽  
Author(s):  
Leonardo Cavinatto ◽  
Sunny Gupta ◽  
Craig Morgan ◽  
Arthur R. Bartolozzi
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Treatment Options ◽  
Case Series ◽  
Single Bundle ◽  
Partial Tears ◽  
Prospective Case Series ◽  
Magnetic Resonance Imaging Mri ◽  
Anterior Cruciate ◽  
Patient Prognosis

AbstractPartial tears of the anterior cruciate ligament (ACL) recently regained attention due to a better understanding of the two distinct bundles of the ligament and the possibility of single-bundle reconstruction procedures. An accurate diagnosis is important as it influences treatment options and patient prognosis. The aim of this study was to evaluate the value of examination under anesthesia (EUA) and magnetic resonance imaging (MRI) for differentiating partial from complete ACL tears. For this purpose, this prospective case series included 95 consecutive patients undergoing primary ACL reconstruction surgeries. MRI, EUA, and MRI combined with EUA were performed preoperatively, and results were compared with arthroscopy. Our data showed that ACL lesions were diagnosed as partial tears in 42.1% (n = 40) of EUA, 23.2% (n = 22) of MRI, and 11.6% (n = 11) of arthroscopies. EUA and MRI demonstrated sensitivity of 100 and 90.1%, and specificity of 65.5 and 85.6%, respectively. Combined EUA and MRI demonstrated sensitivity of 100% and specificity of 83.1%. Our study revealed that preoperatively MRI and EUA may help surgeons early identify partial ACL tears and influence treatment decisions.

scholarly journals Acute Flaccid Myelitis Cases Presenting During a Spike in Respiratory Enterovirus D68 Circulation: Case Series From a Single Pediatric Referral Center.

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S305-S306 ◽  
Author(s):  
Samia Naccache ◽  
Jeffery Bender ◽  
Jay Desai ◽  
Tam Van ◽  
Lindsay Meyers ◽  
...  
Keyword(s):  
Case Series ◽  
Acute Onset ◽  
Case Definition ◽  
Rt Pcr ◽  
Significant Past Medical History ◽  
Upper Respiratory Infection ◽  
Acute Flaccid Myelitis ◽  
Enterovirus D68 ◽  
Ebv Dna ◽  
Work Up

Abstract Background In 2014, a global outbreak of Enterovirus D68 (EV-D68) caused severe respiratory disease and was associated with an increase in acute flaccid myelitis (AFM) cases. Despite heightened surveillance, both EV-D68 detection and AFM reporting dropped in 2015. As AFM reporting increased in 2016, we sought to better understand AFM and EV-D68 epidemiology at our institution. Methods Chart review of clinical presentation and workup was conducted on patients meeting the case definition for AFM for 2015-16. To determine EV-D68 prevalence at CHLA, samples positive for Rhinovirus/Enterovirus (RV/EV) by FilmArray® Respiratory Panel (FA-RP) in September 2016 were screened for EV-D68 by RT-PCR. Results were compared with a research algorithm developed within the FilmArray®Trend epidemiology software. After establishing accurate EV-D68 prediction, the algorithm was used on historic FA-RP assays to measure EV-D68 prevalence at CHLA in 2015 and 2016. Results 7 patients with a median age of 3.3 years and no significant past medical history presented with AFM between July 15 - October 15, 2016, while none were identified in 2015. All had acute onset patchy weakness involving mostly the upper limbs and grey matter involvement on MRI. 6/7 reported fever/upper respiratory infection prior to AFM onset. CSF from 7/7 was negative by FilmArray®meningitis/encephalitis Panel and 2/7 were positive for EBV DNA. Further work up on CSF and blood were negative. 4/7 (57.1%) patients were RV/EV positive from respiratory samples and 3 were confirmed as EV-D68 by RT-PCR. IVIG was given in 7/7 cases. Patients were discharged after an average of 8.8 (4.8-13.6) days. The FilmArray Trend monitoring revealed that during the time of AFM presentation in 2016, 226/778 patients tested for respiratory viruses by the FA-RP were positive for RV/EV. Of those, 29.2% (66/226) were positive for EV-D68 compared with 0.02% (2/224) over the same period in 2015. Conclusion As shown by CDC surveillance data, we saw a resurgence of AFM cases in 2016 compared with 2015. All 7 patients identified were previously healthy and had persistent weakness at discharge. Cases were accompanied by increases in circulating respiratory EV-D68. Further investigation of the correlation between EV-D68 resurgence and AFM is warranted. Disclosures L. Meyers, BioFire Diagnostics: Employee, Salary. J. Jones, Biofire Diagnostics LLC: Employee, Salary. J. Dien Bard, BioFire: Consultant and Investigator, Research grant and Speaker honorarium.

Choroidal neovascularisation triggered multiple evanescent white dot syndrome (MEWDS) in predisposed eyes

2017 ◽  
Vol 102 (7) ◽  
pp. 971-976 ◽  
Author(s):  
Thibaud Mathis ◽  
Benoit Delaunay ◽  
Armelle Cahuzac ◽  
Vivien Vasseur ◽  
Martine Mauget-Faÿsse ◽  
...  
Keyword(s):  
Case Series ◽  
Congenital Toxoplasmosis ◽  
Acute Onset ◽  
Functional Responses ◽  
Retinal Tissue ◽  
White Dot Syndrome ◽  
Atrophic Scar ◽  
The Mean ◽  
Endothelial Growth Factor

BackgroundMultiple evanescent white dot syndrome (MEWDS) is an inflammatory disease that can be associated with choroidalneovascularisation (CNV). However, few studies in the literature have described the occurrence of MEWDS in association with CNV. This paper discusses whether CNV can trigger MEWDS in a predisposed eye.MethodsA retrospective multicentric case series of six eyes in six patients with acute onset of MEWDS and evidence of previous CNV was conducted between January 2015 and January 2017. All patients underwent ophthalmic examination including multimodal imaging at baseline and during follow-up.ResultsThe mean age was 32.2±12.2 years. The majority of patients were women (5/1). In each case, MEWDS was diagnosed during a recurrence or occurrence of CNV secondary to choriocapillaritis, central serous chorioretinopathy or atrophic scar, presumably due to congenital toxoplasmosis. All patients were treated with intravitreal injections of antivascular endothelial growth factor (anti-VEGF) with good anatomical and functional responses (mean gain of 0.3±0.31logMAR). The mean duration of follow-up was 13.5±10.65 months.ConclusionThis study highlights a sequence in the development of MEWDS, following the occurrence or recurrence of CNV. CNV may trigger MEWDS, possibly due to the proinflammatory environment created by the retinal tissue surrounding the CNV.

Prognostic Factors and Outcomes in Primary Effusion Lymphoma in HIV-Infected Patients: A Single Center Experience

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 5415-5415 ◽  
Author(s):  
Shiraj Sen ◽  
Eileen Marley ◽  
Harris V. Naina
Keyword(s):  
Prognostic Factors ◽  
Median Survival ◽  
Conflicts Of Interest ◽  
Primary Effusion Lymphoma ◽  
Case Reports ◽  
Case Series ◽  
Human Herpesvirus ◽  
Cd4 Count ◽  
Serum Lactate Dehydrogenase ◽  
Hiv Viral Load

Abstract Primary effusion lymphoma (PEL) is a human herpesvirus 8-associated non-Hodgkin lymphoma (NHL) that predominantly develops in serous body cavities leading to recurrent lymphomatous effusions. It is poorly understood and very uncommon, accounting for only 3% of all HIV-related NHL. While outcomes have improved in patients with HIV-associated NHL since the widespread use of HAART, the prognosis of PEL remains very poor and median survival is less than 6 months. This study reports our institution’s experience with PEL over the past decade. Between 2004 and 2014, we treated 8 patients with HIV-associated PEL. All patients were male. The median age was 46.5 years old (range 35-63), three were Caucasian, four were Hispanic, and one was African-American. The primary site of involvement was pericardial in 3 patients, pleural in 3 patients, and extra-cavitary in 2 patients. All patients were Ann Arbor stage IV at the time of diagnosis. The mean LDH and CD4 count at time of diagnosis was 625 U/L and 161 cells/mm3, respectively. Of the eight patients identified with PEL, four have achieved complete remission (CR). Prognostic factors associated with achieving CR include compliance with HAART therapy prior to PEL diagnosis as well as lower serum lactate dehydrogenase (LDH) levels (202±30 versus 1049±290, p=.03). Patients achieving CR also had a higher average CD4 count (228±93 versus 95±35, p=.22) at time of diagnosis. Median survival is nearly 6 years for those in CR whereas it was 32 days in patients that died (one from an acute stroke, one from septic shock, and two from progressive disease). All patients who achieved CR had previously diagnosed HIV whereas two of the four who died were previously undiagnosed with HIV. Interestingly, pericardial sites of involvement were associated with significantly better outcomes as compared to pleural sites in our case series, as well. There was no association between outcome and HIV viral load, duration of HIV infection prior to PEL diagnosis, or presence of AIDS-defining illnesses. The patients achieving CR were treated with HAART in addition to Hyper-CVAD (1a-3b) or 6 cycles of CHOP or EPOCH. In addition, two patients received bortezomib as initial therapy. Given its rarity, our knowledge of PEL relies heavily on case reports and small case series. Here we report our institution’s experience with PEL, identify LDH and CD4 as possible prognostic factors in PEL, and suggest bortezomib-based chemotherapy as an effective treatment option in HIV-associated PEL. Disclosures No relevant conflicts of interest to declare.

FRI0259 A Case Series of Adenosine Deaminase 2 Deficient Patients Emphasizing Genotype-Phenotype Correlations

2015 ◽  
Vol 74 (Suppl 2) ◽  
pp. 518.2-518
Author(s):  
E.D. Batu ◽  
O. Karadag ◽  
E.Z. Taskiran ◽  
U. Kalyoncu ◽  
I. Aksentijevich ◽  
...  
Keyword(s):  
Adenosine Deaminase ◽  
Case Series ◽  
Adenosine Deaminase 2

scholarly journals Interdigital Tinea: The Forerunner of Infectious Eczematoid Dermatitis

2020 ◽  
Vol 4 (4) ◽  
pp. 353-356
Author(s):  
Kyle R Bhatia ◽  
Robert T Brodell ◽  
Ashish C Bhatia ◽  
Chelsea S Mockbee
Keyword(s):  
Immune Response ◽  
Hypersensitivity Reaction ◽  
Primary Infection ◽  
Tinea Pedis ◽  
Acute Onset ◽  
Common Presentation ◽  
Streptococcal Species ◽  
Purulent Drainage ◽  
Source Management ◽  
Infectious Source

Infectious eczematoid dermatitis (IED) is defined as an acute, eczematous eruption that occurs secondary to autosensitization to purulent drainage from a primary infected site. The condition is believed to develop when bacterial products, most often the result of Staphylococcal or Streptococcal species, act as haptens and stimulate an immune response. IED typically manifests as a plaque with associated vesicles and pustules surrounding drainage from a central infectious source, or as oozing, erythema, crusting, and scaling spreading peripherally from a central infectious source. Management of IED includes both targeting the causative primary infection and suppressing the immune response producing a hypersensitivity reaction. This report details two cases. Case 1 describes a common presentation of tinea pedis. Case 2 is that of a 28 year-old-male who presented with an acute onset tender, pruritic, weeping rash after wearing boots for two straight days, and who was subsequently diagnosed and treated for IED.

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