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Persistent Mild Anemia and Hypercalcemia were Ignored as Normal Reaction Secondary to Oral Calcium Supplementation in a Steroid-Dependent Asthma Patient Ultimately Diagnosed as Multiple Myeloma: a Case Report and Literature Review.
Ge, YL, Liu, CH, Zhang, Q, Wang, YM, Wang, N, Zhang, HF, Chen, QC, Chen, Y, Li, WQ, Zhu, XY, et al
Clinical laboratory. 2019;(5)
Abstract
BACKGROUND Anemia can be secondary to many diseases and hypercalcemia can be secondary to oral calcium supplementation. For non-hematologists, anemia and hypercalcemia are usually ignored. Here we report a case of persistent mild anemia and hypercalcemia which were ignored as a normal reaction secondary to oral calcium supplementation in a steroid-dependent asthma patient; it was ultimately diagnosed as multiple myeloma. METHODS Bone marrow puncture, combined serum, and urine laboratory indexes were performed for diagnosis. RESULTS A bone marrow puncture specimen comprised 31.5% plasma cells. The serum and urine immunoelectrophoresis showed monoclonal kappa light chains. CONCLUSIONS When anemia and hypercalcemia occur in an elderly patient, physicians should pay attention to multiple myeloma, especially when accompanied with vertebral and flat bone fractures.
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Autoimmune Hepatitis A Case Report and Literature Review.
Hong, AS, Desta, M, Hong, JM, Ohning, GV, Pillinger, MH, Saxena, A, Modjinou, DV
Bulletin of the Hospital for Joint Disease (2013). 2019;(2):146-152
Abstract
INTRODUCTION Autoimmune hepatitis (AIH) is a cause of chronic liver disease. It is usually suspected based on clinical presentation and laboratory findings, but the diagnosis relies on the presence of specific autoantibodies and characteristic histology. Other unexplained findings should always prompt investigation for coexisting syndromes. CASE PRESENTATION The patient is a 60-year-old Hispanic female with a history of mild asthma presented with exertional and pleuritic chest pain with weight loss, arthralgia, subjective fever, and night sweats for the last 3 months. Given the nonspecific nature of the presentation, further workup was pursued. Laboratory results indicated pancytopenia, elevated INR, and positive autoimmune panel including ANA, anti-chromatin, anti-histone, and rheumatoid factor as well as abnormal C3 and C4. Subsequent liver biopsy with interface hepatitis lead to a diagnosis of AIH with concurrent systemic lupus erythematosus suspected. CONCLUSION The diagnostic work up for AIH is multimodal and aims to differentiate other etiologies such as congestive hepatopathy, iron overload, viral hepatitis, and other autoimmune liver diseases. In this particular case, unusual clinical and laboratory findings led to diagnosis of the overlap syndrome. Treatment for both was necessary to prevent further progression of disease.
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Five years experience on 3,4-diaminopyridine phosphate in Lambert-Eaton syndrome: Case reports.
Portaro, S, Brizzi, T, Sinicropi, S, Cacciola, A, De Cola, MC, Bramanti, A, Milardi, D, Lupica, A, Bramanti, P, Toscano, A, et al
Medicine. 2017;(38):e7839
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Abstract
RATIONALE To report our experience on 7 patients (4 males and 3 females), affected by nonparaneoplastic Lambert-Eaton myasthenic syndrome, treated with 3,4-diaminopyridine phosphate (3,4-DAPP) either alone or in combination with other immunosuppressants or steroids. PATIENT CONCERNS Patients have been evaluated at specific timepoints (ie, baseline and last 5 year follow-up), with neurological examination, autoantibodies against presynaptic voltage-gated Cav2.1 (P/Q type) calcium ion channel (VGCC) dosage, neurophysiological evaluation focusing on the increased amplitude of the compound muscle action potential (cMAP) after maximum voluntary effort, quantitative myasthenia gravis (QMG) and activities of daily living scales, and autonomic nervous system involvement evaluation. OUTCOMES Five out of 7 patients presented a clinical improvement persisting at last 5-year follow-up; 2 out of them improved taking only 3,4-DAPP at the maximal dosage, whereas the remaining received concomitant medications, such as prednisone and azathioprine. However, the clinical amelioration was not statistically significant. No one of the patients reported severe adverse events, except one, complaining of transient chin and perioral paresthesias. A significant association between QMG and the type of pharmacological drugs therapy (P = .028) emerged. Indeed, we observed an improvement of the clinical condition in all 3 subjects treated with 3,4-DAPP and prednisone. CONCLUSIONS In this study, we confirm 3,4-DAPP treatment efficacy on muscle strength, but minor evidence of drug effectiveness have been demonstrated on the autonomic nervous system involvement and on the deep tendon reflexes reappearance, a part from patients who received 3,4-DAPP associated to prednisone.
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Digestive tract symptoms in congenital langerhans cell histiocytosis: a fatal condition in an illness usually considered benign.
Vetter-Laracy, S, Salinas, JA, Martin-Santiago, A, Guibelalde, M, Balliu, PR
Journal of pediatric hematology/oncology. 2014;(6):426-9
Abstract
INTRODUCTION Congenital Langerhans cell histiocytosis is usually limited to cutaneous lesions and has a good prognosis. In rare cases of gut involvement, mortality is high and early and aggressive treatment essential. MATERIALS AND METHODS We report a case of histiocytosis in a newborn with bowel involvement, and performed a literature review of 13 similar cases worldwide documented between 1973 and 2008. RESULTS Skin eruptions are usually the initial symptoms at birth. Bloody stools or protein-losing enteropathy are the first signs of bowel involvement that appear mostly in the first 4 weeks of life. Risk organs (hematopoietic system, liver, spleen) are often affected in the newborns with intestinal Langerhans cell histiocytosis. Prognosis is usually poor, with 78.5% mortality. CONCLUSIONS Even if histiocytosis in a neonate appears limited to autoinvoluting skin lesions, it is important to exclude all other organ involvement, including the bowel and stomach, as early treatment is vital.
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[Reversal of acute liver failure with N-acetylcysteine and prednisone in a patient with DRESS syndrome: a case report and literature review].
Pérez-Reyes, E, Casanova-Lara, A, Pérez-Torres, E, Córdova, J
Revista de gastroenterologia de Mexico. 2014;(3):208-10
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Adult idiopathic isolated ACTH deficiency: a short series and literature review.
Guo, Q, Lu, J, Mu, Y, Chen, K, Pan, C
Neuro endocrinology letters. 2013;(7):693-700
Abstract
OBJECTIVES Adult idiopathic isolated ACTH deficiency (AIIAD) is an underestimated disorder which is frequently misdiagnosed. We presented 3 new Chinese AIIAD cases, summarized their clinical characteristics and analyzed the available literature. METHODS Three cases of AIIAD managed in Chinese PLA General Hospital during the period 1998-2003 were retrospectively identified. We have collected information on clinical presentation, laboratory findings and treatment response. The clinical characteristics were summarized and pertinent literatures were analyzed. RESULTS Our 3 cases with AIIAD aged 52-68 years old were misdiagnosed for a long period of time. Clinical features of AIIAD were summarized by reviewing the limited literature: 1. Most patients were over 40 years; 2. Clinical presentations were insidious; 3. Usually no pigmentation; 4. Hypogonadism and amenorrhea could present; 5. mild hypoglycemia, hyponatremia, normal-high potassium, mild anemia, lymphocytosis and eosinophilia could present; 6. With low or absent cortisol, normal secretion of pituitary hormones other than ACTH; 7. High prevalence of thyroid disorder; 8. Usually present concomitantly with other autoimmune disease, which usually disappeared on steroid replacement; 9. Absence of structural pituitary defects except for empty sella; 10. No evidence in any infiltration, trauma, surgery, infectious or radiotherapy, or glucocorticoid medication; 11. No growth abnormalities. CONCLUSION AIIAD is an unspecified and underestimated condition with much misdiagnosis. We summarized the clinical features to improve the recognition. Indeed, every patient with unexplained hyponatremia and malaise, particularly in patients with autoimmune diseases, needs to be evaluated for the possibility of AIIAD.
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Central serous retinopathy.
Tarabishy, AB, Ahn, E, Mandell, BF, Lowder, CY
Arthritis care & research. 2011;(8):1075-82
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Polymyositis associated with hypothyroidism or hyperthyroidism: two cases and review of the literature.
Wang, H, Li, H, Kai, C, Deng, J
Clinical rheumatology. 2011;(4):449-58
Abstract
Studies confirming a possible relationship of polymyositis within thyroid dysfunction, either hypothyroidism or hyperthyroidism, are hardly available. To define the association, identify clinical, laboratory, electromyographic, and pathologic features in polymyositis (PM) patients with hypothyroidism or hyperthyroidism, we conducted a MEDLINE and Chinese biomedicine database search to identify relevant literature published in the past 25 years. Seventeen cases were included. All patients were female (10 hypothyroidism patients, seven hyperthyroidism patients). The mean (SD) age of PM, hypothyroidism, and hyperthyroidism at diagnosis was 54.8 (16.7), 55.5 (16.5), and 32.7 years (10.2), respectively. PM diagnosis can precede or parallel hypothyroidism while PM may occur following the diagnosis of hyperthyroidism. The most common comorbidities were malignant tumors in these disorders, including thymoma, colon cancer, and thyroid cancer. Muscle weakness was described in 100% of patients. Other common manifestations included muscles' atrophy and pain, deep tendon reflexes, polyarthralgia, and dysphagia. Most patients had markedly elevated creatine kinase and the presence of anti-Sjogren's syndrome A (SSA) antibodies was also found in two cases. Malignancy associated with PM may more frequently occur in hypothyroidism than in hyperthyroidism. The abnormalities on electromyography and biopsy did not differ from those findings of PM. Therapy consisting of corticosteroids, thyroid hormone, or anti-thyroid drugs was administrated; however, poor prognosis seemed to be associated with malignant tumors as well as older age and the presence of anti-SSA antibodies. It is reasonable to suggest that those patients should be routinely evaluated for thyroid function, especially in older female and patients suffering from cancers.
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A case of Cronkhite-Canada syndrome presenting with adenomatous and inflammatory colon polyps.
Sweetser, S, Alexander, GL, Boardman, LA
Nature reviews. Gastroenterology & hepatology. 2010;(8):460-4
Abstract
BACKGROUND A 72-year-old man was referred for evaluation of dysgeusia, diarrhea and anorexia. 3 months prior he began to experience taste changes, a decline in appetite and 3-7 loose, non-bloody stools per day. Nausea and lower abdominal cramping subsequently developed and he lost 22.68 kg in weight. His past medical history included atrial fibrillation treated with anticoagulation and digoxin. In the past, he had experienced markedly increased levels of triglycerides and was being treated for this condition with a lipid-lowering agent. There was no family history of colorectal neoplasia or IBD. He was a non-smoker and did not drink alcoholic beverages. INVESTIGATIONS Medical history, physical examination, laboratory evaluation (including 72 h stool collection), upper endoscopy, colonoscopy and histologic analysis of biopsy samples. DIAGNOSIS Cronkhite-Canada syndrome. MANAGEMENT Prednisone (40 mg orally once daily, eventually tapered to 10 mg orally once daily), a histamine-2-receptor blocker and oral micronutrient supplementation (iron, vitamins A, E and D and a multivitamin). Removal of all visible polyps from the anal verge to 25 cm endoscopically by snare polypectomy or with hot biopsy forceps, followed by subtotal colectomy with end-to-side ileorectostomy.
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Dermatomyositis complicated with Kaposi sarcoma: a case report.
Simeoni, S, Puccetti, A, Moruzzi, S, Tinazzi, E, Peterlana, D, Lunardi, C
Clinical rheumatology. 2007;(3):440-2
Abstract
We describe the case of a 75-year-old Italian woman affected by dermatomyositis (DM) treated with steroid, high-dose intravenous immunoglobulins (IVIgs) and cyclophosphamide (CPX), taken orally. After a few months, the patient presented multiple red vascular skin lesions diagnosed as Kaposi sarcoma (KS). Steroid was furtherly reduced, and CPX was stopped. We put the patient on chemotherapy with intravenous infusion of vinblastine and vincristine on alternate weeks obtaining the remission of KS. DM is well controlled by a low-dosage steroid and high-dose IVIgs.