scholarly journals Propylthiouracil-induced lupus-like or vasculitis syndrome

2012 ◽  
Vol 7 ◽  
Author(s):  
Cuneyt Tetikkurt ◽  
Mehmet Yuruyen ◽  
Seza Tetikkurt ◽  
Nihal Bayar ◽  
Imran Ozdemir
Keyword(s):  
Pleural Effusion ◽  
Clinical Manifestations ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Diagnostic Challenge ◽  
Drug Induced ◽  
Exertional Dyspnea ◽  
Laboratory Findings ◽  
Left Pleural Effusion ◽  
Antihistone Antibody

A 27 year old female with Graves’ disease presented with fever, exertional dyspnea and polyarthralgia. Erythema nodosum had occured three months earlier. The patient declared irregular use of propylthiouracil (PTU) for the last 8 months. Neutropenia and microscopic hematuria developed in the second week of admission. Chest X-ray showed inhomogenous pulmonary opacities, left pleural effusion and cardiomegaly. Computed tomography (CT) revealed multiple subpleural nodules, left pleural effusion, pericardial effusion, enlarged mediastinal and axillary lymph nodes. Bronchoalveolar lavage (BAL) cytology demonstrated hemosiderin laden macrophages. Histopathologic examination of the transbronchial biopsy specimen revealed a nonspecific inflammation. Serum was positive for ANA, P-ANCA, MPO-ANCA, PR3-ANCA and negative for anti-ds-DNA, C-ANCA, C3, C4 and antihistone antibody. All symptoms resolved in two months after PTU withdrawal and starting steroid treatment. The same clinical manifestations recurred when the patient used PTU erronously one month after discharge. This is a case of PTU induced-autoimmune disease in whom the accurate distinction between drug-induced-lupus (DIL) and vasculitis was not possible due to the significant overlap of clinical and laboratory findings causing a significant diagnostic challenge for the chest physician.

scholarly journals Refractory pleural effusion as a rare complication of pulmonary vascular stenosis induced by fibrosing mediastinitis: a case report and literature review

2021 ◽  
Vol 49 (5) ◽  
pp. 030006052110100
Author(s):  
Suqiao Yang ◽  
Jianfeng Wang ◽  
Jifeng Li ◽  
Kewu Huang ◽  
Yuanhua Yang
Keyword(s):  
Pleural Effusion ◽  
Rare Complication ◽  
Clinical Manifestations ◽  
Pulmonary Vein Stenosis ◽  
Pulmonary Artery Stenosis ◽  
Heart Catheterization ◽  
Tissue Mass ◽  
Fibrosing Mediastinitis ◽  
Extrinsic Compression ◽  
Left Pleural Effusion

Fibrosing mediastinitis (FM) is a progressive, life-threatening disease characterized by extrinsic compression of mediastinal bronchovascular structures, and the clinical manifestations largely depend upon the affected structures. Pleural effusion is rarely reported in patients with FM. We herein describe a 70-year-old man who presented with recurrent breathlessness and refractory left pleural effusion. He was misdiagnosed with and treated for tuberculous pleurisy for several months. Thoracentesis revealed a transudative pleural effusion, and a contrast-enhanced computed tomography scan of the thorax showed an extensive mediastinal soft tissue mass consistent with FM. Pulmonary angiography demonstrated pulmonary artery stenosis on the right side and pulmonary vein stenosis mainly on the left side. After measurement of the pulmonary arterial pressure by right heart catheterization, the patient was diagnosed with pulmonary hypertension associated with FM. He underwent balloon angioplasty and stent implantation of the stenosed pulmonary vessels, which led to long-term improvement in his breathlessness and pleural effusion. Our systematic review of the literature highlights that pleural effusion can be an uncommon complication of FM and requires careful etiological differentiation.

scholarly journals Hodgkin Lymphoma Mimicking Inflammatory Breast Carcinoma: A Rare Case with Diagnostic Challenge and Novel Treatment

2019 ◽  
Vol 2019 ◽  
pp. 1-6
Author(s):  
Eleni Thodou ◽  
Maria Befani ◽  
George Triantafyllidis ◽  
Theodosia Choreftaki ◽  
George Kanellis ◽  
...  
Keyword(s):  
Breast Carcinoma ◽  
Hodgkin Lymphoma ◽  
Needle Aspiration ◽  
Salvage Chemotherapy ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Severe Toxicity ◽  
Antibody Drug Conjugate ◽  
Diagnostic Challenge ◽  
Inflammatory Breast Carcinoma

Extranodal Hodgkin lymphoma involving the breast is infrequent. Most cases reported in the literature were diagnosed by histology after lumpectomy. We present a Hodgkin lymphoma mimicking inflammatory breast carcinoma in a 57-year-old woman. The diagnosis was performed by fine-needle aspiration (FNA) of the breast lesion and the axillary lymph nodes with rapid on-site evaluation followed by immunocytochemistry, and it was confirmed by histology. The patient after first-line chemotherapy developed relapse/refractory disease. Salvage chemotherapy regimens were applied with poor results and severe toxicity. Total remission was achieved with monotherapy of brentuximab vedotin, a novel anti-CD30-targeted antibody drug conjugate. This is a unique case of breast HL with misleading clinical presentation initially diagnosed by cytology. FNA as a minimally invasive diagnostic tool was crucial in avoiding unnecessary breast surgery and further delay of chemotherapy. It is also the first report highlighting the importance of this novel immunotherapy in the management of refractory Hodgkin lymphoma with breast involvement.

Volume formation of the orbit in hemoblastosis

2021 ◽  
Vol 22 (1) ◽  
pp. 114-117
Author(s):  
M. N. Ponomareva ◽  
◽  
I. N. Pakhirko ◽  
I. A. Arefieva ◽  
E. S. Klimov ◽  
...  
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Clinical Case ◽  
Soft Tissues ◽  
Clinical Manifestations ◽  
Pain Syndrome ◽  
Hodgkin's Lymphoma ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Non Hodgkin’S Lymphoma ◽  
Non Hodgkin's Lymphoma

Hematology is the most important branch of practical medicine, thanks to significant advances in the diagnosis and treatment of hemoblastosis. The earlier the timely complex treatment is started, the better the vital prognosis and fewer complications. Aim.To present a clinical case of volumetric orbit formation in a 67-year-old man with hemoblastosis. Materials and methods. A retrospective analysis of the dynamics of the development of clinical manifestations and diagnostics of the volume formation of the orbit in a patient born in 1954 was carried out. Results. The patient suffers from diffuse non-Hodgkin’s lymphoma, unspecified, with lesions of the axillary lymph nodes on both sides, the soft tissues of the chest on the right, and the peritoneum. Chronic pain syndrome. The diagnosis was made in the oncological dispensary, where he was in 28.12.2020. Complaints from the organ of vision appeared on 09.01.2021, but the patient was not examined by an ophthalmologist. The immunohistochemical study of 15.01.2021 confirmed the morphological picture of the lymphoproliferative disease, but the patient did not receive specialized antitumor therapy, and therefore the ophthalmic symptoms continued to increase, vision loss and pain syndrome increased. Regarding the above complaints, the patient went to the emergency room of ophthalmological care. Computed tomography of the brain and orbits was performed in addition to standard ophthalmological examinations. The formation of the left orbit with exophthalmos was diagnosed. Conclusion. This clinical case shows that in male patients, aged 67 years, the ophthalmological manifestations of non-Hodgkin’s lymphoma may be metastasis to the orbit with a gradual increase in the clinical picture (displacement of the eyeball, movement restrictions, exophthalmos), for 2 weeks, while maintaining visual functions (visual acuity 0.7-0.8) and the occurrence of conjunctivitis.

scholarly journals Felinosis: the elusive-cat scratch disease

2019 ◽  
Vol 5 (2) ◽  
pp. 511
Author(s):  
S. Arulmozhi ◽  
Sithananda Kumar ◽  
Shilpa Divakaran ◽  
Susy Sophia Kurian ◽  
Mary Kurien
Keyword(s):  
Lymph Nodes ◽  
Children And Adolescents ◽  
Chronic Inflammation ◽  
Male Patient ◽  
Bartonella Henselae ◽  
Clinical Manifestations ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Cat Scratch Disease ◽  
Suppurative Lymphadenitis

<p class="abstract">Cat-scratch disease or felinosis is an infection caused by <em>Bartonella henselae</em> which is characterized by chronic inflammation of the lymph nodes. It is one of the causes of regional, unilateral adenitis in children and adolescents. Axillary lymph nodes followed by cervical, pre-auricular and submandibular lymph nodes are the most common sites of involvement. We report a 14 year old male patient with cat scratch disease in whom the initial clinical manifestations were indistinguishable from those of acute bacterial suppurative lymphadenitis.</p>

scholarly journals Epidemiology, Clinical and Laboratory Manifestations, and Outcomes of Brucellosis Among 104 Patients in Referral Hospitals of Tehran, Iran

2021 ◽  
Vol 16 (2) ◽  
Author(s):  
Amirreza Keyvanfar ◽  
Shahnaz Sali ◽  
Amir Zamani
Keyword(s):  
Treatment Failure ◽  
Financial Burden ◽  
Delayed Diagnosis ◽  
Clinical Manifestations ◽  
Diagnostic Challenge ◽  
Laboratory Findings ◽  
Elevated Alkaline Phosphatase ◽  
Cross Sectional ◽  
Dairy Consumption ◽  
Phone Calls

Background: Brucellosis is the most common zoonotic disease in Iran, imposing a significant financial burden on the healthcare system. The diversity of non-specific clinical manifestations of this disease can lead to misdiagnosis or delayed diagnosis. Therefore, it is important to pay attention to other aspects of this disease. Objectives: This study aimed to determine the epidemiology, clinical and laboratory manifestations, and outcomes of brucellosis. Methods: In this cross-sectional study, brucellosis patients, admitted to three hospitals, affiliated to Shahid Beheshti University of Medical Sciences (Tehran, Iran) from April 2015 to September 2020, were examined. The patients' medical records were reviewed for epidemiological, clinical, and laboratory findings. The outcomes of the disease were evaluated by phone calls. Results: Of the 104 patients included in this study, 53.8% were male, and 46.2% were female. The mean age of the patients was 43.07 ± 18.521 years. Unpasteurized dairy consumption and contact with livestock were reported in 60.6 and 27.9% of the patients, respectively. Also, 23.1% of the patients had high-risk occupations. The most common symptoms included fever (80.8%), chills (58.7%), backache (55.8%), and sweating (51%). The most common complication was osteoarticular involvement (21.2%), followed by neurobrucellosis (6.7%). Elevated alkaline phosphatase (89.7%), anemia (67.3%), increased C-reactive protein (57.7%), and increased erythrocyte sedimentation rate (48.1%) were common laboratory findings. The rates of improvement, treatment failure, and relapse were 86.9, 9.1, and 4%, respectively. There was no significant relationship between the rate of improvement and the antibiotic regimen. However, the most common cause of treatment failure was the patient’s poor compliance with treatment. Conclusions: The diversity of non-specific clinical manifestations of brucellosis is a diagnostic challenge. Therefore, physicians must request laboratory tests to evaluate brucellosis after taking a precise epidemiological and clinical history of suspected cases.

scholarly journals Description of patient with telangiectasis and palmar erythema without any structural liver changes or changes of liver laboratory parameters due to treatment of Her -2 -positive breast cancer with Ado-Trastuzumab-Emtansine

2021 ◽  
Vol 11 (2) ◽  
pp. 169-172
Author(s):  
Andre Manov MD ◽  
Weston Truman DO ◽  
Alex Chao DO ◽  
Amanpreet Kaur MD
Keyword(s):  
Breast Cancer ◽  
Metastatic Breast ◽  
Normal Liver ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Trastuzumab Emtansine ◽  
Drug Induced ◽  
Indirect Bilirubin ◽  
Palmar Erythema ◽  
Her 2

Ado- Trastuzumab-Emtansine is approved by EMA and FDA for treatment of HER-2-positive metastatic breast cancer. The drug combines the cytotoxic activity of emtansine with trastuzumab [1,2,3]. Here we are describing 50- year old woman with 3-ple positive left breast cancer with metastasis to left axillary lymph nodes treated with the drug. The patient had normal liver and spleen structure on CT of the abdomen with I.V. contrast, along with a normal liver function test. However she did have a mild elevation of her indirect bilirubin after the initiation of the drug. Despite the normal liver and spleen and absence of Cirrhosis the patient developed drug induced spider angiomas on the upper chest, upper back, shoulders along with palmar erythema. The association of the Ado-Trastuzumab-Emtansine with spider angiomas and palmar erythema in those with normal liver and spleen function, with only a mild elevation of indirect bilirubin is discussed in the article [1].

scholarly journals DRESS syndrome without eosinophilia induced by Carbamazepine: A case report

2021 ◽  
Vol 8 (3) ◽  
pp. 1083-1089
Author(s):  
Slobodan Janković ◽  
Biljana Popovska-Jovičić ◽  
Radiša Pavlović ◽  
Radica Živković-Zarić
Keyword(s):  
Case Report ◽  
Lymph Nodes ◽  
Maculopapular Rash ◽  
Hypersensitivity Syndrome ◽  
Organ Damage ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Hepatocellular Injury ◽  
Dress Syndrome ◽  
Drug Induced

Introduction: Drug rash with eosinophilia and systemic symptoms (DRESS syndrome) is a rare, severe, systemic, drug-induced hypersensitivity syndrome, the most frequently associated with anticonvulsants. Case Report: A 35-years-old woman with a history of depression and hypothyroidism developed fever 39.5°C, enlarged, painful neck and axillary lymph nodes, slight facial edema around the mouth, confluent maculopapular rash, and laboratory signs of hepatocellular injury, leukocytosis and lymphopenia, but with normal eosinophil count. The syndrome was evident two weeks after starting carbamazepine, and gradually decreased after withdrawal of this drug and introduction of corticosteroid therapy. Conclusion: If a patient is taking carbamazepine and develops skin rash as well as fever and swollen lymph nodes, the physician should always check for internal organ damage and possible DRESS syndrome.

scholarly journals Episcleritis Related to Drug-Induced Lupus Erythematosus following Infliximab Therapy: A Case Report

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Irini P. Chatziralli ◽  
Evgenia Kanonidou ◽  
Alexandros Chatzirallis ◽  
Prodromos Dimitriadis ◽  
Petros Keryttopoulos
Keyword(s):  
Case Report ◽  
Lupus Erythematosus ◽  
Drug Exposure ◽  
Clinical Manifestations ◽  
Infliximab Therapy ◽  
Drug Induced ◽  
Laboratory Findings ◽  
Ocular Disorders ◽  
Main Message

Drug-induced lupus erythematosus is defined as a lupus-like syndrome temporally related to continuous drug exposure which resolves after discontinuation of the offending drug. Herein, we describe a patient with distinct clinical manifestations of anti-TNF-associated DILE related to infliximab therapy. The patient exhibited clinical and laboratory findings of lupus-like illnesses as well as ocular disorders, such as episcleritis. The main message is that the symptoms of DILE should not be overlooked, although sometimes other systematic conditions may underlie them. As a result, it is very important for the clinicians to evaluate the symptoms of DILE and manage appropriately these cases.

scholarly journals Ewing’s sarcoma: an uncommon breast tumor

2014 ◽  
Vol 4 (2) ◽  
Author(s):  
Sawsen Meddeb ◽  
Mohamed Salah Rhim ◽  
Mouna Kouira ◽  
Sarra Mestiri ◽  
Mohamed Bibi ◽  
...  
Keyword(s):  
Ewing’S Sarcoma ◽  
Ewing's Sarcoma ◽  
Histopathological Examination ◽  
Radical Mastectomy ◽  
Lower Limbs ◽  
Axillary Lymph Nodes ◽  
Axillary Lymph ◽  
Diagnostic Challenge ◽  
Children And Young Adults ◽  
Lymph Nodes Dissection

Ewing’s sarcoma/primitive neuroectodermal tumors (EWS/PNET) are rare malignant and aggressive tumors, usually seen in the trunk and lower limbs of children and young adults. They are uncommon in the breast. We report a case of a 43-year-old woman who developed a painless breast mass. An initial core needle biopsy concluded to a fibrocystic dystrophy contrasting with a rapidly growing mass; thus a large lumpectomy was done. Diagnosis of primary PNET of the breast was established, based on both histopathological examination and immunohistochemical findings. Surgical margins were positive, therefore, left modified radical mastectomy with axillary lymph nodes dissection was performed. The patient was given 6 cycles of adjuvant chemotherapy containing cyclophosphamide, adriamycin and vincristine. Twenty months later, she is in life without recurrence or metastasis. EWS/PNET may impose a diagnostic challenge. Indeed, mammography and ultrasonography features are non specific. The histopathological pattern is variable depending on the degree of neuroectodermal differentiation. Immuno-phenotyping is necessary and genetic study is the only confirmatory tool of diagnosis showing a characteristic cytogenetic anomaly; t (11; 22) translocation.

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