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Journal of Medical Case Reports Jan 2023Kawasaki disease is an acute febrile condition in children. It affects mainly children under 5 years old, and is known to cause coronary artery abnormalities if...
BACKGROUND
Kawasaki disease is an acute febrile condition in children. It affects mainly children under 5 years old, and is known to cause coronary artery abnormalities if treatment is delayed. The diagnosis rests mainly on clinical criteria. However, it is also known that some infants do not have diagnostic criteria sufficient enough for the diagnosis of Kawasaki disease. Further, children may rarely present with unusual features, and this entity is recognized as "Atypical Kawasaki disease."
CASE PRESENTATION
We present the case of a 9-month-old Tamil boy who presented with sterile gross hematuria in association with prolonged fever, lymphadenopathy, and generalized maculopapular rash. He had high inflammatory markers and echocardiogram disclosed left coronary artery dilatation. The diagnosis of incomplete Kawasaki disease was confirmed based on clinical grounds supported by investigations and exclusion of differential diagnosis. The child showed a good response to intravenous immunoglobulin and aspirin.
CONCLUSION
Kawasaki disease is one of the important differential diagnoses of protracted fever of unknown origin in very young children. Since delayed treatment is associated with a high risk of complications, atypical Kawasaki disease needs to be suspected in children presenting with unusual features such as macroscopic hematuria that occurs in association with unexplained prolonged fever.
Topics: Male; Child; Humans; Infant; Child, Preschool; Mucocutaneous Lymph Node Syndrome; India; Hematuria; Fever; Aspirin; Immunoglobulins, Intravenous
PubMed: 36627702
DOI: 10.1186/s13256-022-03739-3 -
Urology Case Reports Jan 2023Primary Ewing sarcoma of the kidney is an extremely rare yet aggressive tumour. We present a 31-year-old pregnant female who presented to the emergency department with...
Primary Ewing sarcoma of the kidney presenting as haematuria in a pregnant woman - A case report highlighting the diagnostic and therapeutic dilemmas of the condition in pregnancy.
Primary Ewing sarcoma of the kidney is an extremely rare yet aggressive tumour. We present a 31-year-old pregnant female who presented to the emergency department with macroscopic haematuria and an ultrasound scan demonstrating a right renal mass. On magnetic resonance imaging, the lesion had features concerning for malignancy. She underwent a radical nephrectomy and was commenced on a personally tailored chemotherapy regime designed to permit healthy delivery of her baby while adequately treating her disease. This highlights an extremely rare differential for a renal mass which should be considered in rapidly growing renal tumours of a young patient.
PubMed: 36606096
DOI: 10.1016/j.eucr.2022.102308 -
Journal of Medical Case Reports Dec 2022Bladder paraganglioma is a neuroendocrine tumor that accounts for less than 0.1% of all bladder tumors. Symptoms caused by catecholamine release such as hypertension,...
BACKGROUND
Bladder paraganglioma is a neuroendocrine tumor that accounts for less than 0.1% of all bladder tumors. Symptoms caused by catecholamine release such as hypertension, palpitation, syncope, and macroscopic hematuria are the most common findings. Treatment modalities include transurethral resection, and partial or total cystectomy.
CASE PRESENTATION
A 38-year-old Turkish female patient was examined for hematuria that had been persisting for 6 months. Among the clinical findings, only hematuria was present. Absence of adrenergic symptoms such as hypertension, palpitations, and syncope at the first presentation made it difficult to consider bladder paraganglioma in the differential diagnosis. Therefore, cystoscopy and transurethral resection were performed with the thought of urothelial cancer. Findings such as hypertension and bradycardia that developed during diagnostic transurethral resection suggested that it might be bladder paraganglioma. After the radiological evaluation and endocrinological preparation, the patient underwent partial cystectomy.
CONCLUSION
The rarity of cases having been reported in the literature leads to uncertainties in the management of bladder paraganglioma. Adrenergic symptoms developing during transurethral resection should suggest paraganglioma in the differential diagnosis. A multidisciplinary approach and medical treatment are mandatory to prevent life-threatening complications such as hypertensive crisis, vascular collapse, and multiple-organ system failure. We aimed to report the clinical presentation that includes only macroscopic hematuria mimicking urothelial cancer and to emphasize the multidisciplinary approach in the treatment.
Topics: Humans; Female; Adult; Urinary Bladder; Cystectomy; Hematuria; Urinary Bladder Neoplasms; Pheochromocytoma; Paraganglioma; Hypertension; Carcinoma, Transitional Cell; Adrenal Gland Neoplasms; Adrenergic Agents
PubMed: 36566235
DOI: 10.1186/s13256-022-03715-x -
Radiology Case Reports Feb 2023Priapism is an unintentional prolonged penile erection, lasting equal to or greater than 4 hours, in the absence of sexual stimulation or after having finished it. It is...
Priapism is an unintentional prolonged penile erection, lasting equal to or greater than 4 hours, in the absence of sexual stimulation or after having finished it. It is a rare pathology that can represent a urological emergency. The present report describes the case of a 25-year-old patient who presented priapism after suffering a one-meter fall on the genital area. Patient is a 25-year-old male with macroscopic hematuria without clots, testicular pain 4/10 on the numerical pain scale, stabbing type, without irradiation, secondary to a fall that occurred 3 months earlier, which resulted in a blow to the genital area. He presented an evolution of 20 days with detumescence and erectile dysfunction. Penile Doppler was performed and inverted priapism, arteriolacunar fistula at the base of the left corpus cavernosum, plus severe erectile dysfunction, were diagnosed. After a cavernography and an arteriography, a thrombolysis was performed. The patient continued with anticoagulant treatment with clopidogrel and enoxaparin and did not present complications after thrombolysis. A detailed clinical history, physical examination and a Doppler ultrasound study can provide a clear and timely diagnosis for the patient. Cavernography and arteriography have shown satisfactory results. In the present case, thrombolysis treatment with alteplase provided favorable results.
PubMed: 36439923
DOI: 10.1016/j.radcr.2022.10.066 -
International Journal of Surgery Case... Dec 2022The most common causes of hematuria are lower urinary tract infections, especially of the bladder, urolithiasis, urogenital tumors or benign prostatic hyperplasia;...
INTRODUCTION
The most common causes of hematuria are lower urinary tract infections, especially of the bladder, urolithiasis, urogenital tumors or benign prostatic hyperplasia; consequently, this condition presents the greatest clinical challenge due to its broad clinical spectrum, hematuria is an atypical form of presentation of testicular tumors, with very few cases reported in the literature, reaffirming the importance of a complete examination when approaching hematuria in the emergency department.
CASE PRESENTATION
We present a case of a 31-year-old patient who presented to the emergency department with macroscopic hematuria of 5 weeks of evolution, showing on examination a mass in the left testicle. Imaging studies showed bilateral pulmonary metastatic lesions and retroperitoneal lymph node activity with a retrocaval conglomerate infiltrating the left ureter, for which a radical left orchiectomy and multiple procedures were performed to resolve the hematuria.
DISCUSSION
Macroscopic hematuria in adolescents or young adults is an infrequent cause of admission to the Emergency Department with a large list of differential diagnoses both benign and malignant so it is necessary to perform exhaustive studies in its approach, when young patients present with a painless testicular mass, it is important to keep testicular cancer within the differential diagnoses, metastatic disease is a rare form of presentation in this type of tumors. The relevance of this clinical case lies in the fact that hematuria was the main symptom that brought the patient to the emergency department, so we must not forget that macroscopic hematuria should be extensively studied.
CONCLUSION
When approaching a patient with macroscopic hematuria, the clinical history and physical examination is extremely important to provide the best possible care and focus the treatment properly.
PubMed: 36434876
DOI: 10.1016/j.ijscr.2022.107799 -
Time-Averaged Hematuria as a Prognostic Indicator of Renal Outcome in Patients with IgA Nephropathy.Journal of Clinical Medicine Nov 2022We aim to investigate the association of time-averaged hematuria (TA-hematuria) with the progression of IgA nephropathy (IgAN). Based on TA-hematuria during follow-up,...
We aim to investigate the association of time-averaged hematuria (TA-hematuria) with the progression of IgA nephropathy (IgAN). Based on TA-hematuria during follow-up, 152 patients with IgAN were divided into a hematuria remission group (≤28 red blood cells [RBCs]/μL) and a persistent hematuria group (>28 RBCs/μL). The persistent hematuria group had a higher percentage of patients with macroscopic hematuria, lower levels of hemoglobin and TA-serum albumin, and more severe renal pathologic lesions. The composite endpoint is defined as a doubling of the baseline SCr level (D-SCr), or the presence of ESRD. During the mean follow-up of 58.08 ± 23.51 months, 15 patients (9.9%) reached the primary outcome of ESRD and 19 patients (12.5%) reached the combined renal endpoint. Kaplan-Meier analysis showed that the persistent hematuria group had a lower renal survival rate. The persistent hematuria patients who were incorporated with proteinuria (≥1.0 g/day) and low TA-serum albumin (<40 g/L) had the worst renal outcomes. Multivariate Cox regression indicated that TA-hematuria (hazard ratio [HR] = 0.004, 95% CI: 0.001, 0.008; p = 0.010) was independently associated with the progression of IgAN. Receiver operating characteristic analysis indicated the optimal TA-hematuria cutoff value for predicting the progression of IgAN was 201.21 RBCs/μL in females and 37.25 RBCs/μL in males.
PubMed: 36431262
DOI: 10.3390/jcm11226785 -
Journal of Cancer Research and... 2022Primary urinary bladder marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) is an extremely rare disease. Here, we have reported a case of MALT...
Primary urinary bladder marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT) is an extremely rare disease. Here, we have reported a case of MALT lymphoma that was successfully treated with transurethral resection of the bladder tumor (TUR-BT) and radiotherapy. A 65-year-old woman presented with macroscopic hematuria. She had a history of chronic cystitis. Cystoscopy of the bladder revealed a submucosal tumor measuring 4 cm in the trigone of the bladder floor. Magnetic resonance imaging showed that the lesion had intermediate intensity on T2-weighted images. TUR-BT was performed, and the lesion was diagnosed with marginal zone B-cell lymphoma of MALT histopathologically. Positron emission tomography (PET) showed a slightly higher fluorine-18-deoxyglucose (FDG) accumulation, with a maximum standardized uptake value of 17.3, than the physiological accumulation in the tumor resection area of the bladder, with no obvious abnormal accumulation outside the bladder. The patient underwent field radiotherapy at a dose of 30 Gy in 15 fractions, administered in 5 fractions per week. She developed grade 2 cystitis as an acute radiation-related adverse event, without any hematological adverse events. On PET at 5 months after radiotherapy, FDG accumulation in the posterior wall of the bladder was obscured and remained regressed after 2 years.
Topics: Female; Humans; Aged; Lymphoma, B-Cell, Marginal Zone; Urinary Bladder; Fluorodeoxyglucose F18; Positron-Emission Tomography; Cystitis
PubMed: 36412452
DOI: 10.4103/jcrt.jcrt_238_21 -
European Review For Medical and... Nov 2022In this pilot study, we aimed at investigating the predictive power of pan-immune inflammation value (PIV) on response rates at 6 months in idiopathic IgA nephropathy...
OBJECTIVE
In this pilot study, we aimed at investigating the predictive power of pan-immune inflammation value (PIV) on response rates at 6 months in idiopathic IgA nephropathy (IgAN) patients who started steroids.
PATIENTS AND METHODS
The study was conducted with patients diagnosed with idiopathic IgAN and treated with 3-6 months of conservative treatment and steroid therapy started because proteinuria was above 1 g/day. Patients with proteinuria lower than 0.3 g/day, no macroscopic hematuria, and no hematuria detected in 3 consecutive urinalyses for 6 months were considered to be patients in remission. PIV was calculated by [neutrophil count (103 µL)*platelet count (103 µL)*monocyte count (103 µL)]/lymphocyte count (103 µL)]. Patients were compared according to their remission status in terms of PIV.
RESULTS
The mean PIV was significantly higher in patients in the non-remission group than in patients in the remission group (1,869.2±1,781.9 to 574.1±364.5, respectively). The best cut-off for PIV was 752.6 to predict non-remission with a 75% sensitivity and 71.4% specificity.
CONCLUSIONS
Our study showed that PIV is a reliable marker for predicting steroid response at the 6th month in patients with idiopathic IgAN.
Topics: Humans; Glomerulonephritis, IGA; Pilot Projects; Proteinuria; Steroids; Inflammation
PubMed: 36394738
DOI: 10.26355/eurrev_202211_30141 -
The Turkish Journal of Pediatrics 2022Kidney involvement related to infective endocarditis (IE) may present with different clinical findings. The most common histopathological finding of renal involvement is...
BACKGROUND
Kidney involvement related to infective endocarditis (IE) may present with different clinical findings. The most common histopathological finding of renal involvement is a combination of proliferative and exudative glomerulonephritis. However, severe acute kidney injury (AKI) induced by crescentic glomerulonephritis (CGN) is extremely rare in children with IE. To date, only 4 pediatric cases with IE-induced CGN had been reported. We present a 14-year old girl with IE-induced CGN.
CASE
A 14-year old girl with fever, macroscopic hematuria, oliguria, and acute kidney injury (AKI) was admitted to our clinic. The medical history revealed that the patient had undergone several cardiac interventions due to truncus arteriosus type 1, and she recovered from IE-induced glomerulonephritis following antibiotherapy six months ago. During admission, the patient was diagnosed with IE according to one major (positive imaging finding) and three minor (fever, predisposing cardiac disease, and immunological criterion) criteria. Immediate antibiotic treatment was initiated. A kidney biopsy was performed, which showed crescentic glomerulonephritis (CGN with crescents, > 50%). Daily pulse steroid (3 days), monthly pulse cyclophosphamide (6 doses), and oral steroid (2 mg/kg/day) therapy were initiated with gradual dose tapering. The patient underwent 12 hemodialysis sessions until the 38 < sup > th < /sup > day of the treatment. She was discharged on the 45th day of treatment with normal kidney function tests and negative acute phase reactants. Treatment was maintained with mycophenolate mofetil (MMF) after a 6-month course of cyclophosphamide. MMF was discontinued in the 12th month. At the 18thmonth follow-up visit the patient had mild proteinuria, and was on ramipril therapy.
CONCLUSIONS
The occurrence of CGN should be considered in children with predisposing cardiac disease, who develop hematuria, proteinuria, and severe AKI. Although antibiotic therapy alone is often sufficient in this immune complex GN induced by infection, early initiation of additional immunosuppressive therapy in the presence of CGN may be beneficial for long term preservation of kidney functions.
Topics: Female; Child; Humans; Adolescent; Hematuria; Glomerulonephritis; Endocarditis; Acute Kidney Injury; Glomerulonephritis, Membranoproliferative; Proteinuria; Cyclophosphamide; Anti-Bacterial Agents; Kidney
PubMed: 36305443
DOI: 10.24953/turkjped.2021.4397 -
International Journal of Surgery Case... Nov 2022Cystitis Glandularis (CG) is an unusual proliferative disease of the bladder. This condition was associated with chronic inflammation or chronic obstruction. This...
Cystitis Glandularis (CG) is an unusual proliferative disease of the bladder. This condition was associated with chronic inflammation or chronic obstruction. This condition usually presents as microscopic finding and the presence of large macroscopic lesion is a rare feature. Until now, the course of disease from transitional to cystitis glandularis is still unclear and the uncertainty of CG to potentially develop into adenocarcinoma has once been documented. Herewith, we report our experience with 2 years old boy with cystitis glandularis presenting with LUTS obstructive symptoms, hematuria and bladder mass. Ultrasound examination revealed bilateral hydronephrosis with hydroureter and bladder wall thickness suggesting the sign of obstruction and chronic inflammation. Cystoscopy examination was performed to ensure the diagnosis with the result revealing protruding mass partially obstructing the bladder trigone, both ureteral orifice and posterior urethra. Transurethral resection was performed and the administration of COX-2 inhibitor and oral steroid therapy were given. Post-operative course was uneventful with the improvement in symptom and uroflowmetry revealed promising result. This case represented an entity of rare and interesting case of cystitis glandularis causing severe obstructive symptoms and urinary bladder mass which appropriate therapy of endoscopic intervention, COX-2 inhibitor and oral steroid resulted in promising outcome. Follow up of 1 year resulted in reduced LUTS symptoms such as straining and difficulty of urination.
PubMed: 36244150
DOI: 10.1016/j.ijscr.2022.107709