Taichi Omachi, T. Shimo, Takahide Nakano, Masaya Takahashi, J. Takaya
Posterior reversible encephalopathy syndrome (PRES) usually presents with rapid onset of symptoms, including headache, seizure, altered level of consciousness, and visual disturbance [1]. The disorder is common in patients with renal disease and often coexists with conditions such as hypertension, exposure to immunosuppressive drugs. The pathophysiological mechanisms underlying PRES are not fully understood; however, the most common mechanism is related to increasing blood pressure causing failure of brain autoregulation.
{"title":"Posterior reversible encephalopathy syndrome: pitfalls of T2 shine through in MRI","authors":"Taichi Omachi, T. Shimo, Takahide Nakano, Masaya Takahashi, J. Takaya","doi":"10.15761/ccrr.1000459","DOIUrl":"https://doi.org/10.15761/ccrr.1000459","url":null,"abstract":"Posterior reversible encephalopathy syndrome (PRES) usually presents with rapid onset of symptoms, including headache, seizure, altered level of consciousness, and visual disturbance [1]. The disorder is common in patients with renal disease and often coexists with conditions such as hypertension, exposure to immunosuppressive drugs. The pathophysiological mechanisms underlying PRES are not fully understood; however, the most common mechanism is related to increasing blood pressure causing failure of brain autoregulation.","PeriodicalId":72607,"journal":{"name":"Clinical case reports and reviews","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67447811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Muhammad, K. Mohmmed, Manal Shahid, Muhammad Haris shah, R. Abbas
IgA vasculitis is commonly presenting as small vessel vasculitis in pediatric age group, while the occurrence in adults has been rarely reported. The diagnosis can be easily missed in adult patients. A high degree of suspicion and performing a biopsy of involved tissue along with immuno-fluorescence studies in suspected cases are mandatory to establish the diagnosis. Presence of Leukocytoclastic vasculitis with IgA deposition in biopsied tissue is pathognomonic finding for IgA vasculitis. Clinical manifestations can be seen in the skin, joints, gastrointestinal tract, and kidneys. Very unusual presentations it may involve pulmonary system [3].
{"title":"Adult outset of IgA vasculitis with pulmonary and renal involvement","authors":"S. Muhammad, K. Mohmmed, Manal Shahid, Muhammad Haris shah, R. Abbas","doi":"10.15761/ccrr.1000465","DOIUrl":"https://doi.org/10.15761/ccrr.1000465","url":null,"abstract":"IgA vasculitis is commonly presenting as small vessel vasculitis in pediatric age group, while the occurrence in adults has been rarely reported. The diagnosis can be easily missed in adult patients. A high degree of suspicion and performing a biopsy of involved tissue along with immuno-fluorescence studies in suspected cases are mandatory to establish the diagnosis. Presence of Leukocytoclastic vasculitis with IgA deposition in biopsied tissue is pathognomonic finding for IgA vasculitis. Clinical manifestations can be seen in the skin, joints, gastrointestinal tract, and kidneys. Very unusual presentations it may involve pulmonary system [3].","PeriodicalId":72607,"journal":{"name":"Clinical case reports and reviews","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67447956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Systemic lupus erythematosus (SLE) is rarely reported in association with HIV infection. The coincidence of autoimmune diseases in the setting of immunocompetence loss during HIV infection may seem paradoxical. Case Report: A 35-year-old woman presented with a 9-month history of diffuse progressive colicky abdominal pain, weight loss, and watery diarrhoea. Colonoscopic biopsy revealed nonspecific proctocolitis. Steroids plus mesalazine were initiated with no improvement. Few months later, she suffered from alopecia, arthritis of the small joints, photosensitivity associated with fever and abnormal behaviour in the form of aggression, depressed mood, diminished interest in daily activities as well as a decline in her self-care, memory impairment and deficits in attention. On physical examination patient was pale, emaciated, malar rash and oral candidiasis were noted higher cerebral functions examination revealed impaired sustained attention recent memory and restricted affect. Neurological examination revealed with bilateral upper limb tremors, paraparesis symmetrical rigidity, and exaggerated deep tendon reflexes. Plantar reflexes were bilaterally extensor. Blood tests revealed pancytopenia, with reticulocytosis, positive coomb’s test and ESR 100mm/h. ANA test was positive homogenous with titre 1/320. Anti-ds DNA was negative and Hepatic and renal parameters were normal. HIV by ELISA and Western Blot was positive. Her CD4 count was 44/mm 3 . Viral load by PCR was HIV RNA 68,962, other virology screen was negative copies/ml). Magnetic resonance imaging of the brain revealed diffuse cortical atrophy, thick sheets of abnormal MR signals were seen within the paraventricular white matter and subcortical level, with capacious ventricular system. Conclusion: HIV could be a great mimicker and we suggest screening for HIV more often than is generally done now in the context of evaluation of suspected autoimmune disease.
{"title":"Systemic lupus or HIV: The wolf also shall dwell with the lamb","authors":"H. I. E. Gendy, G. Maghraby","doi":"10.15761/ccrr.1000445","DOIUrl":"https://doi.org/10.15761/ccrr.1000445","url":null,"abstract":"Background: Systemic lupus erythematosus (SLE) is rarely reported in association with HIV infection. The coincidence of autoimmune diseases in the setting of immunocompetence loss during HIV infection may seem paradoxical. Case Report: A 35-year-old woman presented with a 9-month history of diffuse progressive colicky abdominal pain, weight loss, and watery diarrhoea. Colonoscopic biopsy revealed nonspecific proctocolitis. Steroids plus mesalazine were initiated with no improvement. Few months later, she suffered from alopecia, arthritis of the small joints, photosensitivity associated with fever and abnormal behaviour in the form of aggression, depressed mood, diminished interest in daily activities as well as a decline in her self-care, memory impairment and deficits in attention. On physical examination patient was pale, emaciated, malar rash and oral candidiasis were noted higher cerebral functions examination revealed impaired sustained attention recent memory and restricted affect. Neurological examination revealed with bilateral upper limb tremors, paraparesis symmetrical rigidity, and exaggerated deep tendon reflexes. Plantar reflexes were bilaterally extensor. Blood tests revealed pancytopenia, with reticulocytosis, positive coomb’s test and ESR 100mm/h. ANA test was positive homogenous with titre 1/320. Anti-ds DNA was negative and Hepatic and renal parameters were normal. HIV by ELISA and Western Blot was positive. Her CD4 count was 44/mm 3 . Viral load by PCR was HIV RNA 68,962, other virology screen was negative copies/ml). Magnetic resonance imaging of the brain revealed diffuse cortical atrophy, thick sheets of abnormal MR signals were seen within the paraventricular white matter and subcortical level, with capacious ventricular system. Conclusion: HIV could be a great mimicker and we suggest screening for HIV more often than is generally done now in the context of evaluation of suspected autoimmune disease.","PeriodicalId":72607,"journal":{"name":"Clinical case reports and reviews","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67447758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pain is a distressing symptom that affects about 66% of patients with advanced cancer. Among these, 51.9% have moderate to severe pain [1]. Approximately 75-90% of patients with cancer related pain syndromes achieve symptom control with treatment guided by the World Health Organisation (WHO) Pain Relief [2]. However this means that 10-20% of patients do not achieve satisfactory pain control [3]. Patients with complex pain require more time to achieve stable pain control and may require different interventions [4] including intrathecal analgesia.
{"title":"Complex Cancer Pain - When Intrathecal Analgesia Is Not Enough","authors":"Woong Liling Natalie","doi":"10.15761/ccrr.1000462","DOIUrl":"https://doi.org/10.15761/ccrr.1000462","url":null,"abstract":"Pain is a distressing symptom that affects about 66% of patients with advanced cancer. Among these, 51.9% have moderate to severe pain [1]. Approximately 75-90% of patients with cancer related pain syndromes achieve symptom control with treatment guided by the World Health Organisation (WHO) Pain Relief [2]. However this means that 10-20% of patients do not achieve satisfactory pain control [3]. Patients with complex pain require more time to achieve stable pain control and may require different interventions [4] including intrathecal analgesia.","PeriodicalId":72607,"journal":{"name":"Clinical case reports and reviews","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67447899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniel A. Rubin, Jocelyn R. Gravlee, Robert L Hatch
Muscle Cramps are a common chief complaint encountered in sports medicine and primary care clinics. Cramping can be debilitating and significantly impact a person’s quality of life and athletic performance. Current theories generally categorize cramps as those caused by overexertion of a specific muscle group or due to sodium deficiencies. In patients that have associated fasciculations, the diagnosis of Cramp Fasciculation Syndrome (CFS) should be considered as the pathophysiology and treatment is different. Cramp Fasciculation syndrome (CFS) is a chronic, benign condition characterized by fasciculations and significant muscle cramps. The cramps are typically triggered by exertion and are due to peripheral nerve hyper-excitability rather than muscle fatigue or electrolyte deficiency. Examination is typically normal with no evidence of motor weakness or atrophy. Anticonvulsants such as Gabepentin has been shown to reduce cramping.
{"title":"Cramp Fasciculation Syndrome in Athletes: A Report of Two Cases","authors":"Daniel A. Rubin, Jocelyn R. Gravlee, Robert L Hatch","doi":"10.15761/ccrr.1000466","DOIUrl":"https://doi.org/10.15761/ccrr.1000466","url":null,"abstract":"Muscle Cramps are a common chief complaint encountered in sports medicine and primary care clinics. Cramping can be debilitating and significantly impact a person’s quality of life and athletic performance. Current theories generally categorize cramps as those caused by overexertion of a specific muscle group or due to sodium deficiencies. In patients that have associated fasciculations, the diagnosis of Cramp Fasciculation Syndrome (CFS) should be considered as the pathophysiology and treatment is different. Cramp Fasciculation syndrome (CFS) is a chronic, benign condition characterized by fasciculations and significant muscle cramps. The cramps are typically triggered by exertion and are due to peripheral nerve hyper-excitability rather than muscle fatigue or electrolyte deficiency. Examination is typically normal with no evidence of motor weakness or atrophy. Anticonvulsants such as Gabepentin has been shown to reduce cramping.","PeriodicalId":72607,"journal":{"name":"Clinical case reports and reviews","volume":"2 2 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67448050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Giant Inguino-scrotal swelling","authors":"Meghna Kinjalk","doi":"10.15761/ccrr.1000464","DOIUrl":"https://doi.org/10.15761/ccrr.1000464","url":null,"abstract":"","PeriodicalId":72607,"journal":{"name":"Clinical case reports and reviews","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67447944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
H. Qaisar, S. Gor, A. Cheema, A. Amirpour, A. Masud, Diana Currasmartin, M. A. Hossain, A. Asif
Sarcoidosis is an idiopathic multisystem granulomatous disease that has been postulated to be autoimmune etiology [1]. Incidence and prevalence of sarcoidosis is variable depending on geographic region and has been reported as 10 per 100,000 per year [2-4]. Highest incidence has been noted in the African American population [5]. Diagnosis is mostly dependent on a biopsy of an involved organ showing non-caseating granulomas as there is no reliable test to rule in or rule out this disease [6]. Lungs are most commonly involved but extra pulmonary manifestations have also been reported. Renal manifestation secondary to sarcoidosis are mostly due to hypercalcemia and hypercalciuria leading to nephrocalcinosis but clinically apparent renal failure is less common [1]. We present 3 cases of renal failure secondary to sarcoidosis and all them had features of interstitial nephritis on renal biopsy. Apart from the cases presented, we reviewed all cases of sarcoidosis induced interstitial nephritis reported from 2013 to 2018. There was a total of 13 case reports found that were reviewed. Sarcoidosis induced interstitial nephritis without granuloma formation has not been reported in the past 5 years which was observed in one of our cases. Once this condition is diagnosed, steroids with and without immunosuppressive agents play important role in the prognosis of renal sarcoidosis to prevent end stage renal disease (ESRD) [1,6].
{"title":"Sarcoidosis induced interstitial nephritis. A case series with literature review","authors":"H. Qaisar, S. Gor, A. Cheema, A. Amirpour, A. Masud, Diana Currasmartin, M. A. Hossain, A. Asif","doi":"10.15761/ccrr.1000443","DOIUrl":"https://doi.org/10.15761/ccrr.1000443","url":null,"abstract":"Sarcoidosis is an idiopathic multisystem granulomatous disease that has been postulated to be autoimmune etiology [1]. Incidence and prevalence of sarcoidosis is variable depending on geographic region and has been reported as 10 per 100,000 per year [2-4]. Highest incidence has been noted in the African American population [5]. Diagnosis is mostly dependent on a biopsy of an involved organ showing non-caseating granulomas as there is no reliable test to rule in or rule out this disease [6]. Lungs are most commonly involved but extra pulmonary manifestations have also been reported. Renal manifestation secondary to sarcoidosis are mostly due to hypercalcemia and hypercalciuria leading to nephrocalcinosis but clinically apparent renal failure is less common [1]. We present 3 cases of renal failure secondary to sarcoidosis and all them had features of interstitial nephritis on renal biopsy. Apart from the cases presented, we reviewed all cases of sarcoidosis induced interstitial nephritis reported from 2013 to 2018. There was a total of 13 case reports found that were reviewed. Sarcoidosis induced interstitial nephritis without granuloma formation has not been reported in the past 5 years which was observed in one of our cases. Once this condition is diagnosed, steroids with and without immunosuppressive agents play important role in the prognosis of renal sarcoidosis to prevent end stage renal disease (ESRD) [1,6].","PeriodicalId":72607,"journal":{"name":"Clinical case reports and reviews","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67447559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hyponatremia is a common medical disorder with high mortality and morbidity. Extensive guidelines are developed by internal medicine and critical care specialists. However, every physician should be familiar with initial assessment and treatment of hyponatremia. A case of a severe hyponatremia presenting to an emergency room is described where care was suboptimal. This case illustrates that diagnosis and treatment are not always straight forward. Three questions are proposed to guide physicians in the immediate care of hyponatremic patients.
{"title":"Suboptimal care in a case of severe hyponatremia in an elderly male patient in the emergency department. A three-question guide for basic assessment and treatment of hyponatremia","authors":"J. Liesveld","doi":"10.15761/ccrr.1000461","DOIUrl":"https://doi.org/10.15761/ccrr.1000461","url":null,"abstract":"Hyponatremia is a common medical disorder with high mortality and morbidity. Extensive guidelines are developed by internal medicine and critical care specialists. However, every physician should be familiar with initial assessment and treatment of hyponatremia. A case of a severe hyponatremia presenting to an emergency room is described where care was suboptimal. This case illustrates that diagnosis and treatment are not always straight forward. Three questions are proposed to guide physicians in the immediate care of hyponatremic patients.","PeriodicalId":72607,"journal":{"name":"Clinical case reports and reviews","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67448113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Belousov, E. Malygon, V. Yavorskiy, E. Belousova
{"title":"Use of nanotechnology to increase the lifetime of blood's donor by stabilizing the molecular structure of the proteins and lipids bonds of membranes of preserved erythrocytes","authors":"A. Belousov, E. Malygon, V. Yavorskiy, E. Belousova","doi":"10.15761/ccrr.1000444","DOIUrl":"https://doi.org/10.15761/ccrr.1000444","url":null,"abstract":"","PeriodicalId":72607,"journal":{"name":"Clinical case reports and reviews","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67447711","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Muhammad Ali MD, Angelos G. Rigopoulos, M. Mammadov, Marios Matiakis, Michel Noutsias MD
Her significant prior medical history included a Non-Hodgkin Lymphoma type B, stage III (Ann Arbor staging) diagnosed and treated since 2015. In the ICU, she received Cotrimoxazole 960 mg/250ml intravenously twice a day for 4 weeks treatment for the primary disease as well as rehabilitation to prevent muscle atrophy. After clinical improvement, the patient was transferred to the normal ward. In the clinical examination follow up we noticed flat brown itchy spots on the skin in her legs. The spots developed a slightly raised border that expanded outward, forming a circular ring. The interior of the spot was clear and smooth (Figure 1).
{"title":"Ringworm on the Legs of a Patient after Long-term Intensive care Unit Residency","authors":"Muhammad Ali MD, Angelos G. Rigopoulos, M. Mammadov, Marios Matiakis, Michel Noutsias MD","doi":"10.15761/ccrr.1000453","DOIUrl":"https://doi.org/10.15761/ccrr.1000453","url":null,"abstract":"Her significant prior medical history included a Non-Hodgkin Lymphoma type B, stage III (Ann Arbor staging) diagnosed and treated since 2015. In the ICU, she received Cotrimoxazole 960 mg/250ml intravenously twice a day for 4 weeks treatment for the primary disease as well as rehabilitation to prevent muscle atrophy. After clinical improvement, the patient was transferred to the normal ward. In the clinical examination follow up we noticed flat brown itchy spots on the skin in her legs. The spots developed a slightly raised border that expanded outward, forming a circular ring. The interior of the spot was clear and smooth (Figure 1).","PeriodicalId":72607,"journal":{"name":"Clinical case reports and reviews","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67448052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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