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Zeynalyan AA, Kolasani B, Naik C, Sigakis CJG, Silhan L, Mathai SK. Rapidly progressive respiratory failure after helminth larvae ingestion. BMC Pulm Med 2021; 21:422. [PMID: 34930198 PMCID: PMC8686539 DOI: 10.1186/s12890-021-01788-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 12/07/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Self-administration of helminths has gained attention among patients as a potential but unproven therapy for autoimmune disease. We present a case of rapidly progressive respiratory failure in a patient with systemic sclerosis (SSc) and pulmonary arterial hypertension (PAH) as a result of self-administration of parasitic organisms. CASE A 45-year-old woman with a history of interstitial lung disease and PAH due to limited cutaneous SSc presented to pulmonary clinic with worsening dyspnea, cough, and new onset hypoxemia. Three months prior to presentation she started oral helminth therapy with Necator americanus as an alternative treatment for SSc. Laboratory evaluation revelaed eosinophilia and elevated IgE levels. IgG antibodies to Strongyloides were detected. High resolution computed tomography of the chest revealed progressive ILD and new diffuse ground glass opacities. Transthoracic echocardiogram and right heart catheterization illustrated worsening PAH and right heart failure. The patient was admitted to the hospital and emergently evaluated for lung transplantation but was not a candidate for transplantation due to comorbidities. Despite aggressive treatment for PAH and right heart failure, her respiratory status deteriorated, and the patient transitioned to comfort-focused care. CONCLUSION Although ingestion of helminths poses a risk of infection, helminth therapy has been investigated as a potential treatment for autoimmune diseases. In this case, self-prescribed helminth ingestion precipitated fatal acute worsening of lung inflammation, hypoxemia, and right heart dysfunction, highlighting the risk of experimental helminth therapy in patients, especially those with underlying respiratory disease.
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Affiliation(s)
- Anahit A Zeynalyan
- Department of Internal Medicine, Baylor University Medical Center, 3500 Gaston Ave, Dallas, Texas, 75246, USA.
| | - Balaji Kolasani
- Department of Internal Medicine - Pulmonary Research, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Chetan Naik
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA
| | | | | | - Susan K Mathai
- Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, Texas, USA
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Sigakis CJG, Mathai SK, Suby-Long TD, Restauri NL, Ocazionez D, Bang TJ, Restrepo CS, Sachs PB, Vargas D. Radiographic Review of Current Therapeutic and Monitoring Devices in the Chest. Radiographics 2018; 38:1027-1045. [PMID: 29906203 DOI: 10.1148/rg.2018170096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Chest radiographs are obtained as a standard part of clinical care. Rapid advancements in medical technology have resulted in a myriad of new medical devices, and familiarity with their imaging appearance is a critical yet increasingly difficult endeavor. Many modern thoracic medical devices are new renditions of old designs and are often smaller than older versions. In addition, multiple device designs serving the same purpose may have varying morphologies and positions within the chest. The radiologist must be able to recognize and correctly identify the proper positioning of state-of-the-art medical devices and identify any potential complications that could impact patient care and management. To familiarize radiologists with the arsenal of newer thoracic medical devices, this review describes the indications, radiologic appearance, complications, and magnetic resonance imaging safety of each device. ©RSNA, 2018.
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Affiliation(s)
- Christopher J G Sigakis
- From the Departments of Radiology (C.J.G.S., T.D.S.L., N.L.R., T.J.B., P.B.S., D.V.) and Medicine (S.K.M.), University of Colorado, Anschutz Medical Campus, 12401 E 17th Ave, Room L517, Aurora, CO 80045; Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (D.O.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (C.S.R.)
| | - Susan K Mathai
- From the Departments of Radiology (C.J.G.S., T.D.S.L., N.L.R., T.J.B., P.B.S., D.V.) and Medicine (S.K.M.), University of Colorado, Anschutz Medical Campus, 12401 E 17th Ave, Room L517, Aurora, CO 80045; Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (D.O.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (C.S.R.)
| | - Thomas D Suby-Long
- From the Departments of Radiology (C.J.G.S., T.D.S.L., N.L.R., T.J.B., P.B.S., D.V.) and Medicine (S.K.M.), University of Colorado, Anschutz Medical Campus, 12401 E 17th Ave, Room L517, Aurora, CO 80045; Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (D.O.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (C.S.R.)
| | - Nicole L Restauri
- From the Departments of Radiology (C.J.G.S., T.D.S.L., N.L.R., T.J.B., P.B.S., D.V.) and Medicine (S.K.M.), University of Colorado, Anschutz Medical Campus, 12401 E 17th Ave, Room L517, Aurora, CO 80045; Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (D.O.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (C.S.R.)
| | - Daniel Ocazionez
- From the Departments of Radiology (C.J.G.S., T.D.S.L., N.L.R., T.J.B., P.B.S., D.V.) and Medicine (S.K.M.), University of Colorado, Anschutz Medical Campus, 12401 E 17th Ave, Room L517, Aurora, CO 80045; Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (D.O.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (C.S.R.)
| | - Tami J Bang
- From the Departments of Radiology (C.J.G.S., T.D.S.L., N.L.R., T.J.B., P.B.S., D.V.) and Medicine (S.K.M.), University of Colorado, Anschutz Medical Campus, 12401 E 17th Ave, Room L517, Aurora, CO 80045; Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (D.O.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (C.S.R.)
| | - Carlos S Restrepo
- From the Departments of Radiology (C.J.G.S., T.D.S.L., N.L.R., T.J.B., P.B.S., D.V.) and Medicine (S.K.M.), University of Colorado, Anschutz Medical Campus, 12401 E 17th Ave, Room L517, Aurora, CO 80045; Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (D.O.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (C.S.R.)
| | - Peter B Sachs
- From the Departments of Radiology (C.J.G.S., T.D.S.L., N.L.R., T.J.B., P.B.S., D.V.) and Medicine (S.K.M.), University of Colorado, Anschutz Medical Campus, 12401 E 17th Ave, Room L517, Aurora, CO 80045; Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (D.O.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (C.S.R.)
| | - Daniel Vargas
- From the Departments of Radiology (C.J.G.S., T.D.S.L., N.L.R., T.J.B., P.B.S., D.V.) and Medicine (S.K.M.), University of Colorado, Anschutz Medical Campus, 12401 E 17th Ave, Room L517, Aurora, CO 80045; Department of Radiology, University of Texas Health Science Center at Houston, Houston, Tex (D.O.); and Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, Tex (C.S.R.)
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Newell MC, Henry CR, Sigakis CJG, Unger BT, Larson DM, Chavez IJ, Burke MN, Traverse JH, Henry TD. Comparison of safety and efficacy of sirolimus-eluting stents versus bare metal stents in patients with ST-segment elevation myocardial infarction. Am J Cardiol 2006; 97:1299-302. [PMID: 16635599 DOI: 10.1016/j.amjcard.2005.11.054] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2005] [Revised: 11/15/2005] [Accepted: 11/15/2005] [Indexed: 10/24/2022]
Abstract
Sirolimus-eluting stents (SESs) are superior to bare metal stents (BMSs) for percutaneous coronary intervention, but data regarding SESs in ST-segment elevation myocardial infarction (STEMI) are limited. We investigated the clinical outcomes of patients with STEMI who were treated with SESs. We measured clinical characteristics and acute and long-term outcomes in 306 consecutive patients with STEMI who received a SES (n = 156) or a BMS (n = 150). Patients were followed for death, nonfatal reinfarction, and target vessel revascularization. Patients with SESs had a 0.6% in-hospital mortality rate versus 5.3% in patients with BMSs (p = 0.015). Six-month mortality rates were 1.9% (SES) and 10.1% (BMS, p = 0.003). At 6 months, patients with SESs were less likely to have target vessel revascularization (1.3% vs 8.1%, p = 0.005) and achieve the composite end point (3.2% vs 16.1%, p = 0.0001). No subacute thrombosis or clinical restenosis occurred in the SES group. Patients who received BMSs were older, received more stents, and had more myocardial damage, worse renal function, and lower ejection fractions than did those in the SES group. By multivariate discriminant analysis, stent type (SES vs BMS) was the most significant determinant of the 6-month composite end point (p = 0.01) and the need for target vessel revascularization (p = 0.02). In conclusion, SESs are safe and effective in STEMI at 6 months.
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Affiliation(s)
- Marc C Newell
- Department of Internal Medicine, Abbott Northwestern Hospital, Minneapolis, USA
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