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Cureus May 2024The diagnosis of autoimmune diseases in elderly, immunocompromised patients undergoing dialysis poses significant challenges due to the diverse etiology of symptoms such...
The diagnosis of autoimmune diseases in elderly, immunocompromised patients undergoing dialysis poses significant challenges due to the diverse etiology of symptoms such as fever and systemic pain. This case study reports on a 79-year-old man undergoing hemodialysis with a history of multiple comorbidities, including diabetes, heart failure, and pure red cell aplasia. He presented with subacute polyarthritis and fever and was ultimately diagnosed with seronegative rheumatoid arthritis. The case illustrates the complexities of differential diagnosis in this population, emphasizing the need for a systematic approach to distinguish between possible infectious and autoimmune causes. Despite the absence of rheumatoid factor and anti-citrullinated protein antibody, the patient's clinical presentation and response to steroids supported the diagnosis of seronegative rheumatoid arthritis. Treatment with prednisolone resulted in significant improvement in symptoms and quality of life, demonstrating the effectiveness of steroids in managing autoimmune conditions in elderly, high-risk patients. However, such treatment necessitates careful monitoring due to potential adverse effects. This case underlines the importance of considering autoimmune diseases in differential diagnoses and customizing treatment strategies to accommodate the unique needs of elderly, immunocompromised patients on dialysis. Insights from this case contribute to better understanding and management of complex clinical scenarios in similar patient populations.
PubMed: 38860062
DOI: 10.7759/cureus.60066 -
Oxford Medical Case Reports Jun 2024Pyomyositis is a purulent infection of skeletal muscle that is mostly observed in tropical countries. Aseptic pyomyositis is a rare, potentially life-threatening...
Pyomyositis is a purulent infection of skeletal muscle that is mostly observed in tropical countries. Aseptic pyomyositis is a rare, potentially life-threatening disorder characterized by the formation of sterile pus in muscle. We present a case of 53-years old female, diagnosed case of seropositive rheumatoid arthritis, presented with pain and swelling of the right calf muscle for 2 weeks. There was no history of fever, cough, skin erythema, no history of prolonged standing or immobility, or fetal loss. The diagnosis was made as rheumatoid arthritis with autoimmune pyomyositis, and the patient was treated with oral prednisolone 1mg/kg body weight in tapering dose, cs DMARDS, (methotrexate 25 mg once a week, and leflunomide 20mg daily hydroxychloroquine 200 mg daily orally) and another supportive treatment along with surgical drainage of pus was done. There was complete resolution of the initial lesion and remission of the primary disease in 3 months.
PubMed: 38860021
DOI: 10.1093/omcr/omae059 -
F1000Research 2024Managing recalcitrant oral lichen planus (OLP) can be challenging. Laser therapy has been suggested as an alternative to corticosteroids for treatment. Photodynamic...
BACKGROUND
Managing recalcitrant oral lichen planus (OLP) can be challenging. Laser therapy has been suggested as an alternative to corticosteroids for treatment. Photodynamic therapy (PDT) is a non-invasive technique that enables the removal of lesions without surgery. Photobiomodulation therapy (PBMT) can promote healing and recovery of the lesions.
CASE PRESENTATION
The objective was to treat unresponsive bilateral OLP of the whole buccal mucosae with a combination of PDT and PBMT.
RESULTS
A 43-year-old Thai male presented with the severe painful reticular type of OLP of bilateral buccal mucosae involving upper and lower vestibular areas. The lesions were not remitted with either prednisolone systemic steroids or fluocinolone topical corticosteroids. After undergoing ten sessions of PDT with 10% 5-Aminolevulinic acid (5-ALA) in the form of thermoplastic gel and a 635 nm diode laser at 100 to 400 mW with an energy density of 20 to 30 J/cm in continuous wave mode, combined with five interim-sessions of PBMT using a 635 nm diode laser at 200 to 300 mW with an energy density of 6 to 10 J/cm in continuous wave, the patient reported relief of burning sensation beside remission of lesions without any complications.
CONCLUSION
The wide-spreading recalcitrant OLP with burning sensation can be managed by combining PDT and PBMT.
Topics: Humans; Male; Adult; Photochemotherapy; Lichen Planus, Oral; Mouth Mucosa; Low-Level Light Therapy; Combined Modality Therapy; Aminolevulinic Acid
PubMed: 38854440
DOI: 10.12688/f1000research.146733.1 -
Rheumatology Advances in Practice 2024To unravel the mechanisms underlying cell death in the vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome using peripheral blood samples and to...
OBJECTIVES
To unravel the mechanisms underlying cell death in the vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic (VEXAS) syndrome using peripheral blood samples and to assess the clinical value of this knowledge.
METHODS
Nine patients undergoing treatment for VEXAS syndrome at Yokohama City University Hospital were included in this study. Monocytes and neutrophils were isolated from peripheral blood and then monocytes were differentiated into polarized macrophages. Viable cell counts, cell death assays and measurements of various indicators such as high mobility group box 1 (HMGB1) concentration, extracellular adenosine triphosphate (ATP) concentration, annexin V level and caspase 1, 3 and 7 activities were performed.
RESULTS
Elevated cell death of monocytes and neutrophils was observed in VEXAS syndrome patients, as indicated by cultured cell counts and cell death assays. Annexin V assays and measurements of caspase 1, 3 and 7 activities suggested increased apoptosis and pyroptosis in these cells. Serum HMGB1 levels were significantly elevated in VEXAS syndrome patients and decreased after prednisolone (PSL) dose escalation. Monocytes and neutrophils from the VEXAS group exhibited heightened extracellular ATP secretion, which was significantly reduced by soluble PSL co-culture.
CONCLUSION
This study confirms increased cell death of monocytes and neutrophils and damage-associated molecular patterns in VEXAS syndrome, and these findings may be valuable for drug screening, therapeutic strategies and as biomarkers.
PubMed: 38854419
DOI: 10.1093/rap/rkae065 -
Cureus May 2024Autoimmune hepatitis (AIH) is a hepatocellular disorder thought to be caused by an immune system that cannot tolerate autoantigens specific to hepatocytes. This study... (Review)
Review
Autoimmune hepatitis (AIH) is a hepatocellular disorder thought to be caused by an immune system that cannot tolerate autoantigens specific to hepatocytes. This study aims to evaluate the efficacy of using corticosteroids (prednisolone and azathioprine) as a combination therapy in treating AIH. This study aims to synthesize and analyze existing evidence to inform clinical practices concerning the overall clinical efficacy of this treatment approach in managing AIH. A comprehensive search was conducted across multiple online databases and search engines, including PubMed, Google Scholar, ScienceDirect, Medline, and Embase. RevMan 5.4 software was used for meta-analysis, with forest plots created for each outcome. Thirteen studies were included in this systematic review and meta-analysis. The results indicate that the combination of prednisolone and azathioprine for treating AIH leads to less recurrence and better disease control.
PubMed: 38854256
DOI: 10.7759/cureus.60049 -
Cureus May 2024Longitudinally extensive myelitis with 15 or more vertebrae in length is extremely rare, with limited evidence regarding clinical features and therapeutic response. We...
Longitudinally extensive myelitis with 15 or more vertebrae in length is extremely rare, with limited evidence regarding clinical features and therapeutic response. We report a case of a 29-year-old male patient with extremely longitudinally extensive myelitis ultimately diagnosed as myelin oligodendrocyte glycoprotein-associated disease (MOGAD). The patient presented with an acute onset of meningismus, limb weakness, sensory disturbance below the C5 level, ataxia, and urinary retention. T2-weighted imaging on MRI showed an extremely longitudinally extensive spinal cord lesion ranging from C2 to the medullary conus, together with a left pontine lesion. Positive anti-myelin oligodendrocyte glycoprotein antibodies were serologically detected, which led to the diagnosis of MOGAD. Intravenous methylprednisolone followed by 1 mg/kg oral prednisolone with taper resulted in complete symptomatic and radiological resolution. The striking complete resolution despite the symptomatic and radiological severity observed in this case has been described in a few previously reported MOGAD cases. Extremely longitudinally extensive myelitis with excellent therapeutic response may be a characteristic presentation of MOGAD.
PubMed: 38854217
DOI: 10.7759/cureus.59938 -
Indian Journal of Public Health Jan 2024Acute lymphoblastic leukemia (ALL) is the most common childhood cancer. Immunophenotype (IPT) and cytogenetics are essential for diagnosis, risk stratification, and...
BACKGROUND
Acute lymphoblastic leukemia (ALL) is the most common childhood cancer. Immunophenotype (IPT) and cytogenetics are essential for diagnosis, risk stratification, and management for ALL.
OBJECTIVES
Evaluating the burden of immunophenotypic and cytogenetic profile of pediatric ALL patients.
MATERIALS AND METHODS
A descriptive cross-sectional study was conducted on 100 patients of ALL (1-18 completed years) attending a tertiary-care center in Kolkata, Eastern India.
RESULTS
Ninety-six percent of patients had B-cell ALL (94.00% pre-B ALL and 2.00% Pro-B ALL) and 4.0% had T-ALL. 60% B-cell ALL were CD19/CD10 positive, 10% were CD79a positive, 9% were only CD19 positive, and 7% were only CD10 positive. Thirty-three percent of T-ALL were CD3+, whereas 22% were positive each for CD4 and CD7. 51.0% of patients had diploid, 46.0% hyperdiploid, and 3.0% hypodiploid karyotype. Among hyperdiploids, 98% had good prednisolone response and 89% had measurable residual disease (MRD) <0.01.
CONCLUSION
The most commonly diagnosed ALL by IPT was pre-B ALL. Among the detectable cytogenetic abnormalities, t(12; 21) ETV6-RUNX1 was the most common. ZNF-384 gene arrangement was also detected in our study. t(12;21) ETV6-RUNX1 had a good treatment response, while t(9;22) BCR-ABL, t(1;19) TCF3-PBX1, iAMP-21, MLL gene rearrangement, and ZNF-384 gene arrangement had poor treatment response in terms of MRD.
Topics: Humans; India; Child; Male; Female; Child, Preschool; Adolescent; Cross-Sectional Studies; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Immunophenotyping; Infant; Cytogenetic Analysis
PubMed: 38847628
DOI: 10.4103/ijph.ijph_889_23 -
Annals of Medicine and Surgery (2012) Jun 2024The SARS-CoV-2 is the source of COVID-19, a respiratory disease. It typically manifests as restricted pulmonary symptoms, but autoimmune dysfunction might occasionally...
INTRODUCTION AND IMPORTANCE
The SARS-CoV-2 is the source of COVID-19, a respiratory disease. It typically manifests as restricted pulmonary symptoms, but autoimmune dysfunction might occasionally show up. A COVID-19 infection may cause a multi-system connective tissue disease known as systemic sclerosis (SSc). In patients who recovered from COVID-19, autoimmunity may have multiple underlying causes.
CASE PRESENTATION
The authors report the case of a 68-year-old female who, 1 month after contracting COVID-19, complained of dyspnoea and muscle exhaustion. The patient was treated for post-COVID syndrome. She developed symptoms of chronic dyspnoea, pale fingers, pursed lips, trouble chewing and swallowing, and muscle weakness after 7 weeks. A chest high-resolution computerised tomography (HRCT) scan suggested interstitial lung disease. Clinical characteristics and an autoantibody profile containing anti-Ro 52 and anti-centromere antibodies pointed towards SSc. She was treated with azathioprine and prednisolone at a reduced dosage, and she is now stable with monthly follow-ups.
CLINICAL DISCUSSION
COVID-19 might induce cytokine storms and immunological dysregulation, ultimately culminating in autoimmune manifestations. Several autoantibodies are observed in autoimmune illnesses in post-COVID-19 infection patients. Our situation is distinct because SSc following a COVID-19 infection is not commonly seen as an autoimmune illness.
CONCLUSION
The number of patients with rare autoimmune diseases, like SSc, following COVID-19 has been rising. Therefore, we should consider the possibility of autoimmune disease when looking into a patient who presents strangely or has developed new symptoms after COVID and should contact the patient's management immediately.
PubMed: 38846898
DOI: 10.1097/MS9.0000000000002032 -
Annals of Medicine and Surgery (2012) Jun 2024Takayasu Arteritis (TA) is a rare chronic inflammatory disease of unknown etiology that primarily affects large vessels, such as the aorta and its major branches. The...
INTRODUCTION AND IMPORTANCE
Takayasu Arteritis (TA) is a rare chronic inflammatory disease of unknown etiology that primarily affects large vessels, such as the aorta and its major branches. The disease typically presents with diverse symptoms, depending on the site and degree of arterial lesions. Delayed diagnosis is common, especially in younger populations.
CASE PRESENTATION
A 39-year-old Syrian female presented with an initial stroke. She had no prior medical history and was otherwise healthy. On examination, she had an absent left radial pulse, a carotid bruit, and muscle weakness. Blood tests showed an elevated ESR and CRP. Computed tomography of the brain revealed a right large cerebral infarction. Multislice computed tomography angiography showed diffuse arterial wall thickening, stenosis, and occlusion of several major vessels, including the left internal carotid artery, right internal carotid artery, and left subclavian artery.
CLINICAL DISCUSSION
The patient was diagnosed with TA based on the American College of Rheumatology criteria. She was treated with prednisolone, methotrexate, and aspirin, and her symptoms improved significantly.
CONCLUSION
This case highlights the importance of considering TA in the differential diagnosis of ischemic stroke, especially in young patients with atypical presentations. Early identification and management are essential to preclude critical sequelae.
PubMed: 38846855
DOI: 10.1097/MS9.0000000000002098 -
Frontiers in Veterinary Science 2024Canine gastrointestinal (GI) and hepatosplenic (HS) high-grade (large cell) lymphomas are uncommon forms of canine lymphomas, with a very poor response to chemotherapy...
Canine gastrointestinal (GI) and hepatosplenic (HS) high-grade (large cell) lymphomas are uncommon forms of canine lymphomas, with a very poor response to chemotherapy and a very poor prognosis. Currently, there are no established effective chemotherapy protocols for canine GI/HS lymphomas. This case series aimed to retrospectively evaluate the efficacy of lomustine-based protocols L-LOP (L-asparaginase, lomustine, vincristine, and prednisolone) and L-LOPP (with the addition of procarbazine) for treatment of canine GI/HS lymphomas. Medical records of dogs with cytologically or histologically diagnosed lymphoma at CityU Veterinary Medical Centre from 2019 to 2022 were retrospectively reviewed. The L-LOP/LOPP treatment protocol was well tolerated with rare severe adverse events. Median progression-free survival for GI and HS lymphoma was 56 days (range, 10-274 days) and 57 days (range 8-135 days) respectively; while median survival time for GI and HS lymphoma was 93 days (range 10-325 days) and 210 days (range 8-240 days) respectively.
PubMed: 38846784
DOI: 10.3389/fvets.2024.1373180