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Internal Medicine (Tokyo, Japan) Jan 2024Antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) predominantly affects small vessels. Almost all AAV patients are positive for myeloperoxidase-...
Antineutrophil Cytoplasmic Autoantibody-negative Pauci-immune Necrotizing Glomerulonephritis with Plasma Cell-rich Tubulointerstitial Nephritis Complicated with Pleuritis and Digital Ischemia.
Antineutrophil cytoplasmic autoantibody (ANCA)-associated vasculitis (AAV) predominantly affects small vessels. Almost all AAV patients are positive for myeloperoxidase- or proteinase 3-ANCA, and ANCA plays a crucial role in the pathogenesis of AAV. We herein report an ANCA-negative AAV patient with pauci-immune necrotizing glomerulonephritis and plasma cell-rich tubulointerstitial nephritis who was complicated with pleuritis and digital ischemia. ANCA-negative AAV is a rare clinical entity that is difficult to diagnose, and pleuritis and digital ischemia are rare manifestations of AAV. An early diagnosis and appropriate treatment are important, as any delay in the diagnosis may worsen the prognosis.
Topics: Humans; Autoantibodies; Antibodies, Antineutrophil Cytoplasmic; Plasma Cells; Glomerulonephritis; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Nephritis, Interstitial; Pleurisy; Ischemia; Peroxidase
PubMed: 37164659
DOI: 10.2169/internalmedicine.1040-22 -
Cureus Apr 2024Immunoglobulin A vasculitis (IgAV), also known as Henoch-Schönlein purpura (HSP), is a disease that causes inflammation and bleeding in small blood vessels in the skin,...
Immunoglobulin A vasculitis (IgAV), also known as Henoch-Schönlein purpura (HSP), is a disease that causes inflammation and bleeding in small blood vessels in the skin, joints, intestines, and kidneys. Although various infections and chemicals are known to be triggers, the underlying cause of IgAV remains unknown. Here, we describe a case of an 86-year-old male patient with IgAV that developed after anti-tuberculosis treatment for tuberculous pleurisy. There have been several case reports implicating and other acid-fast bacterium in the development of IgAV, but only a few case reports implicating anti-tuberculous drugs. This case highlights the importance of recognizing that IgAV can be caused by anti-tuberculous drugs.
PubMed: 38779276
DOI: 10.7759/cureus.58707 -
BMC Infectious Diseases Jun 2024Lower Respiratory Tract Infections (LRTI) pose a serious threat to older adults but may be underdiagnosed due to atypical presentations. Here we assess LRTI symptom...
BACKGROUND
Lower Respiratory Tract Infections (LRTI) pose a serious threat to older adults but may be underdiagnosed due to atypical presentations. Here we assess LRTI symptom profiles and syndromic (symptom-based) case ascertainment in older (≥ 65y) as compared to younger adults (< 65y).
METHODS
We included adults (≥ 18y) with confirmed LRTI admitted to two acute care Trusts in Bristol, UK from 1st August 2020- 31st July 2022. Logistic regression was used to assess whether age ≥ 65y reduced the probability of meeting syndromic LRTI case definitions, using patients' symptoms at admission. We also calculated relative symptom frequencies (log-odds ratios) and evaluated how symptoms were clustered across different age groups.
RESULTS
Of 17,620 clinically confirmed LRTI cases, 8,487 (48.1%) had symptoms meeting the case definition. Compared to those not meeting the definition these cases were younger, had less severe illness and were less likely to have received a SARS-CoV-2 vaccination or to have active SARS-CoV-2 infection. Prevalence of dementia/cognitive impairment and levels of comorbidity were lower in this group. After controlling for sex, dementia and comorbidities, age ≥ 65y significantly reduced the probability of meeting the case definition (aOR = 0.67, 95% CI:0.63-0.71). Cases aged ≥ 65y were less likely to present with fever and LRTI-specific symptoms (e.g., pleurisy, sputum) than younger cases, and those aged ≥ 85y were characterised by lack of cough but frequent confusion and falls.
CONCLUSIONS
LRTI symptom profiles changed considerably with age in this hospitalised cohort. Standard screening protocols may fail to detect older and frailer cases of LRTI based on their symptoms.
Topics: Humans; Aged; Male; Female; Middle Aged; Respiratory Tract Infections; Hospitalization; Adult; Aged, 80 and over; Age Factors; COVID-19; United Kingdom; SARS-CoV-2; Young Adult; Comorbidity; Adolescent
PubMed: 38849730
DOI: 10.1186/s12879-024-09425-7 -
Cureus Mar 2024Group B Streptococcus (GBS or ) is a common component of the human flora. However, infections in adults are infrequent, and occurrences of infectious pleurisy or septic...
Group B Streptococcus (GBS or ) is a common component of the human flora. However, infections in adults are infrequent, and occurrences of infectious pleurisy or septic arthritis are exceedingly uncommon. To our knowledge, the concurrent manifestation of both conditions has not been previously documented. We present the case of a 61-year-old man who exhibited an unusual association of infectious pleurisy and septic arthritis in the knee, both attributed to GBS. The patient was admitted to the hospital due to thoracic pain and discomfort in the left knee. Clinical examination revealed a pleural effusion in the left lung and arthritis in the left knee. Synovial and pleural fluid samples were sent to the bacteriology laboratory for cytobacteriological examination, confirming the presence of GBS in both fluids. The patient is diabetic and has a history of undergoing total cystoprostatectomy for a urothelial tumor, with the placement of a mono J catheter. The prevailing hypothesis suggests that the colonization of the mono J catheter, followed by hematogenous dissemination, is the probable source of the infection. This unusual clinical case underscores GBS's ability to induce severe invasive infections in adults, particularly in those with underlying medical conditions.
PubMed: 38681291
DOI: 10.7759/cureus.57160 -
Vaccine Mar 2024Vaccination is the most cost-effective tool to control contagious bovine pleuropneumonia. The vaccines currently used in Africa are derived from a live strain called T1,...
Vaccination is the most cost-effective tool to control contagious bovine pleuropneumonia. The vaccines currently used in Africa are derived from a live strain called T1, which was attenuated by passage in embryonated eggs and broth culture. The number of passages is directly correlated to the degree of attenuation of the vaccinal strains and inversely correlated to their immunogenicity in cattle. Current quality control protocols applied to vaccine batches allow the assessment of identity, purity, and titers, but cannot assess the level of genetic drift form the parental vaccine strains. Deep sequencing was used to assess the genetic drift generated over controlled in vitro passages of the parental strain, as well as on commercial vaccine batches. Signatures of cloning procedures were detected in some batches, which imply a deviation from the standard production protocol. Deep sequencing is proposed as a new tool for the identity and stability control of T1 vaccines.
Topics: Animals; Cattle; Bacterial Vaccines; Pleuropneumonia; Africa; Vaccines, Attenuated; Quality Control; High-Throughput Nucleotide Sequencing; Pleuropneumonia, Contagious; Cattle Diseases; Mycoplasma mycoides
PubMed: 38365481
DOI: 10.1016/j.vaccine.2024.02.031 -
Cureus Feb 2024Familial Mediterranean fever (FMF) is an inherited autoinflammatory disease characterized by recurrent bouts of fever and serositis. Mediterranean Fever () gene...
Familial Mediterranean fever (FMF) is an inherited autoinflammatory disease characterized by recurrent bouts of fever and serositis. Mediterranean Fever () gene mutations may cause not just FMF but various serositis including arthritis, enterocolitis, aseptic meningitis, pulmonary disease, and pericarditis. In this report, we present a 44-year-old female carrying gene variant. She was admitted to our hospital with a high fever, right back pain during inspiration, and lower-left abdominal pain. Laboratory findings showed high inflammatory response. Computed tomography (CT) indicated pleurisy of the right lobe and inflammation of the left uterine appendage. Transvaginal sonography and magnetic resonance imaging (MRI) indicated hydrosalpinx of the left oviduct. The symptoms of recurrent fever and transient serositis suggested FMF, and abdominal pain was resolved after taking colchicine. Later, it turned out that she had gene mutation (exon2 G304R heterozygous). Although she did not meet the criteria of FMF, this is the first reported variant carrier with transient hydrosalpinx. Attacks in female patients with FMF are triggered by menstruation. Moreover, FMF and associated amyloidosis may cause both male and female infertility. Although male patients with FMF may present with acute scrotum, diagnostic criteria of FMF do not include inflammation of uterine appendages. Internal medicine physicians need to cooperate with gynecologists to diagnose female patients carrying gene variants.
PubMed: 38558641
DOI: 10.7759/cureus.55188 -
Cureus May 2024Cryptococcosis, primarily an opportunistic infection, often occurs in immunocompromised patients but can also affect immunocompetent individuals. Cryptococcosis...
Cryptococcosis, primarily an opportunistic infection, often occurs in immunocompromised patients but can also affect immunocompetent individuals. Cryptococcosis typically manifests in the lungs, but pleurisy is rare, particularly in immunocompetent patients. This report details a case of cryptococcal pleuritis in a 74-year-old immunocompetent male with a history of heart failure, presenting initially with pleural effusion. Diagnostic challenges arose due to the initial absence of intrapulmonary lesions. The diagnosis was eventually established through a surgical biopsy and tissue culture, revealing . This case underscores the complexity of diagnosing cryptococcal infections, particularly in immunocompetent patients, and highlights the need for considering cryptococcosis in differential diagnoses of lymphocyte-predominant exudative pleural effusions.
PubMed: 38872700
DOI: 10.7759/cureus.60260 -
BMJ Case Reports Feb 2024Sarcomatoid mesothelioma is difficult to differentiate from other mesotheliomas. Here, we describe the case of a man in his early 80s with sarcomatoid mesothelioma and a...
Detailed clinical course of a patient with rapidly progressing sarcomatoid pleural mesothelioma without p16 deletion with systemic haematogenous metastasis to soft tissues.
Sarcomatoid mesothelioma is difficult to differentiate from other mesotheliomas. Here, we describe the case of a man in his early 80s with sarcomatoid mesothelioma and a history of asbestos exposure. He initially presented with right-sided chest pain and was examined. Right-sided pleural effusion was detected; therefore, he was hospitalised. Based on the observed pleural effusion and biopsy result, the presence of a malignant tumour was excluded; hence, he was diagnosed with benign asbestos pleurisy. He subsequently developed left-sided pleural effusion, masses and lung nodules, and died 9.5 months after the initial examination. A definitive diagnosis of sarcomatoid mesothelioma with rapid systemic progression was established after detailed investigations using autopsy specimens. This rare case of mesothelioma-without deletion (detected using fluorescence in situ hybridisation)-presented differently from the usual sarcomatoid mesothelioma.
Topics: Humans; Male; Asbestos; Disease Progression; Lung Neoplasms; Mesothelioma; Mesothelioma, Malignant; Pleural Effusion; Pleural Neoplasms; Aged, 80 and over
PubMed: 38341199
DOI: 10.1136/bcr-2023-257618 -
World Journal of Surgical Oncology Jun 2024Thymic mucosa-associated lymphoid tissue (MALT) lymphoma is rare and is known to be associated with Sjögren's syndrome (SjS). SjS is rarely accompanied by serositis....
BACKGROUND
Thymic mucosa-associated lymphoid tissue (MALT) lymphoma is rare and is known to be associated with Sjögren's syndrome (SjS). SjS is rarely accompanied by serositis. Here, we describe the first case of postoperative cardiac tamponade and acute pleuritis in a patient with thymic MALT lymphoma associated with SjS.
CASE PRESENTATION
A 33-year-old woman with SjS presented with an anterior mediastinal mass on chest computed tomography, which was performed for further examination of the condition. Suspecting a thymic MALT lymphoma or thymic epithelial tumor, total thymectomy was performed. The mediastinal mass was histopathologically diagnosed as a thymic MALT lymphoma. The patient was discharged with a good postoperative course but visited the hospital 30 days after surgery for dyspnea. Cardiac tamponade was observed and drainage was performed. Four days after pericardial drainage, chest radiography revealed massive left pleural effusion, and thoracic drainage was performed. The patient was diagnosed with serositis associated with SjS and treated with methylprednisolone, which relieved cardiac tamponade and pleuritis.
CONCLUSIONS
Surgical invasion of thymic MALT lymphomas associated with SjS may cause serositis. Postoperative follow-up should be conducted, considering the possibility of cardiac tamponade or acute pleuritis due to serositis as postoperative complications.
Topics: Humans; Lymphoma, B-Cell, Marginal Zone; Female; Adult; Cardiac Tamponade; Sjogren's Syndrome; Pleurisy; Thymus Neoplasms; Postoperative Complications; Thymectomy; Prognosis; Tomography, X-Ray Computed; Acute Disease
PubMed: 38902721
DOI: 10.1186/s12957-024-03442-1