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Kuwelker S, Soni R, Perez-Sanchez A, Coss E, Soni NJ. Fulminant Celiac Disease Presenting in the Postpartum Period. ACG Case Rep J 2024; 11:e01234. [PMID: 38524264 PMCID: PMC10959559 DOI: 10.14309/crj.0000000000001234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/14/2023] [Indexed: 03/26/2024] Open
Abstract
Celiac disease (CD) is an immune-mediated disorder of the small intestine triggered by dietary exposure to gluten in genetically susceptible individuals. Adult CD usually has an insidious onset with gastrointestinal symptoms, most often diarrhea and weight loss. The association between CD and reproductive abnormalities has been well described in the literature, but it is uncommon for CD to initially manifest during pregnancy or the postpartum period. We report a case of adult CD in a previously healthy woman with a life-threatening presentation during the postpartum period.
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Affiliation(s)
- Saatchi Kuwelker
- Joe R. Theresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX
| | - Riya Soni
- Joe R. Theresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX
| | - Ariadna Perez-Sanchez
- Joe R. Theresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX
| | - Elizabeth Coss
- Joe R. Theresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX
| | - Nilam J. Soni
- Joe R. Theresa Lozano Long School of Medicine, University of Texas Health San Antonio, San Antonio, TX
- Medicine Service, South Texas Veterans Health Care System, San Antonio, TX
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2
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Hashmani S, Manla Y, Al Matrooshi N, Bader F. Red Flags in Acute Myocarditis. Card Fail Rev 2024; 10:e02. [PMID: 38464556 PMCID: PMC10918526 DOI: 10.15420/cfr.2023.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 09/02/2023] [Indexed: 03/12/2024] Open
Abstract
Acute myocarditis is an inflammatory disease of the heart that may occur in the setting of infection, immune system activation or exposure to certain drugs. Often, it is caused by viruses, whereby the clinical course is usually benign; however, it may also present with rapidly progressive fulminant myocarditis, which is associated with high morbidity and mortality. This review highlights the critical red flags - from the clinical, biochemical, imaging and histopathological perspectives - that should raise the index of suspicion of acute myocarditis. We also present an illustrative case of a young female patient with rapidly progressive cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation as a bridge to orthotopic heart transplantation. The patient showed no clinical or echocardiographic recovery signs and eventually underwent orthotopic heart transplantation. Furthermore, we elaborate on the classifications of acute myocarditis based on clinical presentation and histopathology classifications, focusing on identifying key red flags that will inform early diagnosis and appropriate management in such challenging cases.
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Affiliation(s)
- Shahrukh Hashmani
- Section of Advance Heart Failure & Transplantation, Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu Dhabi United Arab Emirates
| | - Yosef Manla
- Section of Advance Heart Failure & Transplantation, Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu Dhabi United Arab Emirates
| | - Nadya Al Matrooshi
- Section of Advance Heart Failure & Transplantation, Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu Dhabi United Arab Emirates
| | - Feras Bader
- Section of Advance Heart Failure & Transplantation, Heart, Vascular & Thoracic Institute, Cleveland Clinic Abu Dhabi United Arab Emirates
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3
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Azuma D, Kunisaki R, Yukawa T, Yaguchi K, Watanabe M, Shibui S, Nakamori Y, Toyoda J, Tanabe M, Maeda K, Inayama Y, Kimura H, Maeda S. Fulminant Amebic Enteritis in the Perinatal Period. Intern Med 2023; 62:2341-2348. [PMID: 36575014 PMCID: PMC10484775 DOI: 10.2169/internalmedicine.0839-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/15/2022] [Indexed: 12/28/2022] Open
Abstract
Pregnancy is a known risk factor for amebic enteritis, which develops into potentially fatal fulminant amebic enteritis in some cases. We describe a case of a 27-year-old non-immunosuppressed pregnant woman with fulminant amebic enteritis complicated with cytomegalovirus enteritis. She improved with intensive care and intravenous metronidazole and ganciclovir but eventually required subtotal colectomy for intestinal stenosis. It is difficult to diagnose amebic enteritis, especially in a non-endemic area. Amebic enteritis must be considered as a differential diagnosis for refractory diarrhea with bloody stools in women in the perinatal period, even those without immunosuppression.
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Affiliation(s)
- Daisuke Azuma
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Japan
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Japan
| | - Reiko Kunisaki
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Japan
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Japan
| | - Tatsu Yukawa
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Japan
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Japan
| | - Katsuki Yaguchi
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Japan
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Japan
| | - Mamoru Watanabe
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Japan
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Japan
| | - Shunsuke Shibui
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Japan
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Japan
| | - Yoshinori Nakamori
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Japan
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Japan
| | - Junya Toyoda
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Japan
| | - Mikiko Tanabe
- Department of Diagnostic Pathology, Yokohama City University Medical Center, Japan
| | - Koki Maeda
- Department of Diagnostic Pathology, Yokohama City University Medical Center, Japan
| | - Yoshiaki Inayama
- Department of Diagnostic Pathology, Yokohama City University Medical Center, Japan
| | - Hideaki Kimura
- Inflammatory Bowel Disease Center, Yokohama City University Medical Center, Japan
| | - Shin Maeda
- Department of Gastroenterology, Yokohama City University Graduate School of Medicine, Japan
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Andour H, Rostoum S, Regragui Y, Fikri M, Jiddane M, Touarsa F. Fulminant Susac syndrome-a rare cause of coma: The history of the fatal course in a young man. SAGE Open Med Case Rep 2023; 11:2050313X221149826. [PMID: 36756223 PMCID: PMC9899952 DOI: 10.1177/2050313x221149826] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 11/15/2022] [Accepted: 12/19/2022] [Indexed: 02/05/2023] Open
Abstract
Susac syndrome is a rare microangiopathy of indeterminate etiology, presumably autoimmune, characterized by a triad of encephalopathy, sensorineural hearing loss, and branch retinal artery occlusions occurring predominantly in women. The onset and progression patterns are multiple, mainly of three modes. Fulminant evolution is exceptional, rarely reported across literature. We report through this case a Susac syndrome in a young man in whom evolution was fatal. Magnetic resonance imaging is essential to raise the diagnosis and for follow-up, with almost pathognomonic findings, all the more useful as the clinical triad is usually incomplete and as the encephalopathy is the most limiting of the symptoms.
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Affiliation(s)
- Hajar Andour
- Department of Neuroradiology, Specialty
Hospital, Rabat, Morocco,Hajar Andour, Department of Neuroradiology,
Specialty Hospital, Hay Riad, Rabat 10100, Morocco.
| | - Soufiane Rostoum
- Department of Neuroradiology, Specialty
Hospital, Rabat, Morocco
| | - Yassine Regragui
- Department of Anesthesiology and
Reanimation, Ibn Sina Hospital, Rabat, Morocco
| | - Meriem Fikri
- Department of Neuroradiology, Specialty
Hospital, Rabat, Morocco
| | - Mohamed Jiddane
- Head of Department of Neuroradiology,
Specialty Hospital, Rabat, Morocco
| | - Firdaous Touarsa
- Department of Neuroradiology, Specialty
Hospital, Rabat, Morocco
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Qiu J, Luo S, Yin W, Li X, Zhou Z. Clinical and immunological characteristics of PD-1 associated fulminant type 1 diabetes mellitus. Zhong Nan Da Xue Xue Bao Yi Xue Ban 2023; 48:49-58. [PMID: 36935177 PMCID: PMC10930557 DOI: 10.11817/j.issn.1672-7347.2023.220290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Indexed: 03/21/2023]
Abstract
OBJECTIVES Programmed death 1 (PD-1) associated fulminant type 1 diabetes (PFD) is a rare acute and critical in internal medicine, and its clinical characteristics are still unclear. This study aims to analyze the clinical characteristics of PFD patients to improve clinical diagnosis and treatment. METHODS We retrospectively analyzed the clinical data of 10 patients with PFD admitted to the Second Xiangya Hospital of Central South University, combined with the data of 66 patients reported in the relevant literature, analyzed and summarized their clinical and immunological characteristics, and compared the patients with PFD with different islet autoantibody status. RESULTS Combined with our hospital and literature data, a total of 76 patients with PFD were reported, with the age of (60.9±12.1) years old, 60.0% male and body mass index of (22.1±5.2) kg/m2. In 76 patients, the most common tumors were lung cancer (43.4%) and melanoma (22.4%). Among PD-1 inhibitors, the most common drugs are nivolumab (37.5%) and pembrolizumab (38.9%). 82.2% of PFD patients developed diabetes ketoacidosis. The median onset time from PD-1 related inhibitor treatment to hyperglycemia was 95 (36.0, 164.5) d, and the median treatment cycle before the onset of diabetes was 6 (2.3, 8.0) cycles. 26% (19/73) of PFD patients had positive islet autoantibodies, and the proportion of ketoacidosis in the positive group was significantly higher than that in the negative group (100.0% vs 75.0%, P<0.05). The onset time and infusion times of diabetes after PD-1 inhibitor treatment in the autoantibody positive group were significantly lower than those in the autoantibody negative group (28.5 d vs 120.0 d; 2 cycles vs 7 cycles, both P<0.001). CONCLUSIONS After initiation of tumor immunotherapy, it is necessary to be alert to the occurrence of adverse reactions of PFD, and the onset of PFD with islet autoantibody positive is faster and more serious than that of patients with autoantibodies negative. Detection of islet autoantibodies and blood glucose before and after treatment with PD-1 inhibitors is of great value for early warning and prediction of PFD.
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Affiliation(s)
- Junlin Qiu
- Department of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University; Ministry of Education, Key Laboratory of Diabetes Immunology (Central South University); National Clinical Research Center for Metabolic Diseases, Changsha 410011, China.
| | - Shuoming Luo
- Department of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University; Ministry of Education, Key Laboratory of Diabetes Immunology (Central South University); National Clinical Research Center for Metabolic Diseases, Changsha 410011, China.
| | - Wenfeng Yin
- Department of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University; Ministry of Education, Key Laboratory of Diabetes Immunology (Central South University); National Clinical Research Center for Metabolic Diseases, Changsha 410011, China
| | - Xia Li
- Department of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University; Ministry of Education, Key Laboratory of Diabetes Immunology (Central South University); National Clinical Research Center for Metabolic Diseases, Changsha 410011, China
| | - Zhiguang Zhou
- Department of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University; Ministry of Education, Key Laboratory of Diabetes Immunology (Central South University); National Clinical Research Center for Metabolic Diseases, Changsha 410011, China
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Ramayya T, Mitchell JD, Hartupee JC, Lavine K, Ridley CH, Kotkar KD, Jimenez J, Lin CY, Alvarez-Cardona JA, Krone RK, Campbell CM. Delayed Diagnosis and Recovery of Fulminant Immune Checkpoint Inhibitor-Associated Myocarditis on VA-ECMO Support. JACC CardioOncol 2022; 4:722-726. [PMID: 36636445 PMCID: PMC9830207 DOI: 10.1016/j.jaccao.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/02/2022] [Indexed: 12/24/2022] Open
Key Words
- CMR, cardiac magnetic resonance
- ICI, immune checkpoint inhibitor
- IRAE, immune-related adverse event
- IV, intravenous
- IVIG, intravenous immunoglobulin
- LGE, late gadolinium enhancement
- LVEF, left ventricular ejection fraction
- NT-proBNP, N-terminal pro–B-type natriuretic peptide
- TTE, transthoracic echocardiogram
- T cell
- VA-ECMO, venoarterial extracorporeal membrane oxygenation
- abatacept
- cardiac arrest
- cardiogenic shock
- cervical cancer
- extracorporeal membrane oxygenation
- fulminant
- heart failure
- hsTnI, high-sensitivity troponin I
- immune
- immune checkpoint inhibitor
- immunosuppressive
- inflammation
- inflammatory
- myocarditis
- troponin
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Affiliation(s)
- Tarun Ramayya
- Cardiovascular Division, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Joshua D. Mitchell
- Cardiovascular Division, Washington University in St. Louis, St. Louis, Missouri, USA
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Justin C. Hartupee
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kory Lavine
- Cardiovascular Division, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Clare H. Ridley
- Department of Anesthesiology, Washington University in St. Louis. St. Louis, Missouri, USA
| | - Kunal D. Kotkar
- Cardiothoracic Surgery Division, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jesus Jimenez
- Cardiovascular Division, Washington University in St. Louis, St. Louis, Missouri, USA
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Chieh-Yu Lin
- Cardiovascular Division, Washington University in St. Louis, St. Louis, Missouri, USA
- Department of Pathology, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jose A. Alvarez-Cardona
- Cardiovascular Division, Washington University in St. Louis, St. Louis, Missouri, USA
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Ronald K. Krone
- Cardiovascular Division, Washington University in St. Louis, St. Louis, Missouri, USA
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Courtney M. Campbell
- Cardiovascular Division, Washington University in St. Louis, St. Louis, Missouri, USA
- Cardio-Oncology Center of Excellence, Washington University in St. Louis, St. Louis, Missouri, USA
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7
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Lin R, Lin YW, Chen MH. Fulminant Type 1 Diabetes Mellitus after SARS-CoV-2 Vaccination: A Case Report. Vaccines (Basel) 2022; 10:1905. [PMID: 36423001 PMCID: PMC9692754 DOI: 10.3390/vaccines10111905] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 07/30/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines have been used worldwide to control the coronavirus disease pandemic. However, several adverse effects have been reported following vaccination. Therefore, further research on the adverse effects in individuals predisposed to life-threatening conditions is needed. Herein, we present a 39-year-old woman without any systemic disease who developed fulminant type 1 diabetes mellitus (T1DM) (low glycohemoglobin levels, despite hyperglycemia and diabetic ketoacidosis (DKA)) following SARS-CoV-2 vaccination. The patient was initially misdiagnosed as having fresh type 2 diabetes mellitus after the first episode of DKA, which was resolved by short-term insulin therapy and treated with oral anti-diabetic agents after the DKA was resolved. This made her develop a second episode of DKA shortly after treatment. The course and presentation of our case are noteworthy for alerting clinicians to vaccine-related fulminant T1DM.
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Affiliation(s)
- Rong Lin
- Department of Internal Medicine, Division of General Internal Medicine, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - Yu-Wei Lin
- Department of Medical Education, Division of General Practice, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
| | - Mei-Hsiu Chen
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Far Eastern Memorial Hospital, New Taipei City 220, Taiwan
- Department of Biomedical Engineering, Ming Chuang University, Taoyuan City 333, Taiwan
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8
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Seay MD, Digre KB. Idiopathic Intracranial Hypertension from Benign to Fulminant: Diagnostic and Management Issues. Ann Indian Acad Neurol 2022; 25:S59-S64. [PMID: 36589036 PMCID: PMC9795713 DOI: 10.4103/aian.aian_203_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/26/2022] [Revised: 03/01/2022] [Accepted: 03/05/2022] [Indexed: 01/04/2023] Open
Abstract
Idiopathic intracranial hypertension (IIH) primarrily affects obese women of childbearing years and is commonly associated with headaches, pulsatile tinnitus, and vision changes. Though most patients have a "benign" course, it can lead to significant morbidity, including blindness. The treatment approach is based on severity of visual impact and includes weight loss, intracranial pressure lowering medications, and sometimes surgery, such as spinal fluid diversion, optic nerve sheath fenestration, or venous sinus stenting. More studies are needed to determine when surgery is most appropriate and which surgical procedure provides maximal benefit with the least risk.
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Affiliation(s)
- Meagan D. Seay
- Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, UT, United States,Department of Neurology, University of Utah, Salt Lake City, UT, United States,Address for correspondence: Dr. Meagan D. Seay, 65 Mario Capecchi Dr. Salt Lake City, UT, 84132, United States. E-mail:
| | - Kathleen B. Digre
- Department of Ophthalmology, Moran Eye Center, University of Utah, Salt Lake City, UT, United States,Department of Neurology, University of Utah, Salt Lake City, UT, United States
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Qiu J, Li X, Chen W, Ma X, Xie Z, Huang G, Luo S, Zhou Z. The fulminant index: A method of rapidly differentiating fulminant type 1 diabetes from diabetic ketoacidosis. Diabetes Metab Res Rev 2022; 38:e3501. [PMID: 34614535 DOI: 10.1002/dmrr.3501] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 07/16/2021] [Accepted: 09/16/2021] [Indexed: 11/09/2022]
Abstract
AIMS AND OBJECTIVES Fulminant type 1 diabetes (FT1D) could present diabetes ketoacidosis (DKA) at early onset. It is crucial to identify FT1D from DKA manifestations in time at clinical practice. This study was aimed at investigating whether the fulminant index (FI), encompassing plasma glucose (PG) to glycated haemoglobin (HbA1c) ratio (PG/HbA1c), serum potassium ion (K+ ) to HbA1c ratio (K+ /HbA1c) and serum sodium ion (Na+ ) multiplied by HbA1c (Na+ *HbA1c), is a feasible indicator for early FT1D diagnosis. MATERIALS AND METHODS A total of 78 subjects were enroled, including 40 FT1D patients and 38 non-FT1D patients with DKA. We utilised receiver operating characteristic (ROC) curve analysis to determine the FI cut-off values between FT1D and non-FT1D groups and examined efficacies of FI based on statistics. RESULTS ROC curve analyses showed that the maximum Youden's index for PG/HbA1c bonding to a cut-off value of 4.389, with the sensitivity of 75.0% and specificity of 81.6% in identifying FT1D from DKA. And optimal K+ /HbA1c cut-off value was 0.728 with a sensitivity of 90.0% and specificity of 84.2%. For Na+ *HbA1c, the best cut-off value was 923.65, and its sensitivity and specificity were 85% and 73.7%, respectively. CONCLUSIONS These results suggested FI could work as a valid and convenient indicator for differentiating FT1D from initial DKA patients. FI (K+ /HbA1c) presented the best efficacy as an independent index.
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Affiliation(s)
- Junlin Qiu
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
- Department of Endocrinology, Beihai People's Hospital, The Ninth Affiliated Hospital of Guangxi Medical University, Beihai, Guangxi, China
| | - Xia Li
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Wen Chen
- Department of Endocrinology, Beihai People's Hospital, The Ninth Affiliated Hospital of Guangxi Medical University, Beihai, Guangxi, China
| | - Xiaoxi Ma
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhiguo Xie
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Gan Huang
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Shuoming Luo
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Zhiguang Zhou
- Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China
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10
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Grossman SM, Pravda NS, Orvin K, Hamdan A, Vaturi M, Bengal T, Kornowski R, Weissler-Snir A. Characterization and long-term outcomes of patients with myocarditis: a retrospective observational study. Postepy Kardiol Interwencyjnej 2021; 17:60-7. [PMID: 33868419 DOI: 10.5114/aic.2021.104770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 11/30/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction There is limited data on the long-term follow-up of patients with myocarditis. Aim To investigate the long-term follow-up of patients with myocarditis. Material and methods We performed a retrospective observational analysis on the clinical long-term outcomes of patients with myocarditis over a 10-year period. The primary outcome was mortality. We identified risk factors for mortality and adverse clinical outcomes. We also compared the characteristics and outcomes of patients presenting with fulminant myocarditis to those presenting with non-fulminant myocarditis. Results Between May 2004 and December 2014, 203 patients with myocarditis or perimyocarditis were admitted to our center. Most patients were male (87.7%) with a median age at presentation of 33 years (interquartile range: 25.4–38.9). The median follow-up period was 56.9 months (interquartile range 25.3–87.3 months), during which the overall mortality was 4.4% (9 patients). Fifteen patients presented with fulminant myocarditis. After multivariable analysis, older age (HR = 1.11, 95% CI: 1.05–1.16, p < 0.001) and a poorer New York Heart Association (NYHA) function class (HR = 4.6, 95% CI: 1.18–18, p = 0.028) were found to be independently associated with a higher risk of mortality, whereas higher albumin levels at presentation (HR = 0.2, 95% CI: 0.07–0.56, p = 0.002) were associated with decreased mortality. The group presenting with fulminant myocarditis had a more severe course of disease and a higher in-hospital mortality (13.3% vs. 0%, p = 0.005). Conclusions The overall prognosis of patients with myocarditis is good – in terms of both survival and recovery without residual left ventricular dysfunction.
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Abstract
Idiopathic intracranial hypertension (IIH) causes visual involvement secondary to papilledema but rarely presents with acute gross diminution of vision. Anemia is associated with IIH. Acute hemorrhage-related anemia causing severe sudden onset bilateral visual loss due to IIH has not been previously reported. A 28-year-old female attempted the first-trimester abortion by self-administration of oral drugs. She presented with bleeding per vaginum, followed by bilateral visual loss. Symptoms pertaining to intracranial hypertension were mild. Examination revealed pallor, normal hemodynamic parameters, bilaterally dilated pupils, bilateral lateral rectus palsy, and only perception of light in both eyes. Lumbar puncture demonstrated high pressures; neuroimaging was noncontributory. Blood transfusion and supportive therapy in the form of acetazolamide and pulse methylprednisolone improved her vision in the right eye to six of 24; optic nerve sheath fenestration was performed in the left eye. During follow-up, her vision improved to six of 24 (right) and two of 60 (left), respectively. The IIH can present with severe acute onset bilateral visual loss even if features of raised intracranial pressure are minimal or absent. Immediate correction of anemia and supportive measures may significantly improve visual outcomes in fulminant IIH without the necessity of surgery.
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Affiliation(s)
- Jayachandran Selvaraj
- General Internal Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
| | - Vamsidhar Veeranki
- General Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
| | - Sai Yasaswini Kommaraju
- General Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
| | - Pradeep Ravi
- General Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
| | - Subashini Kaliaperumal
- Ophthalmology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
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Heindl SE, Tsouklidis N. Appendectomy as a Potential Predisposing Factor for the Development of Recurrent and Fulminant Clostridium Difficile. Cureus 2020; 12:e10091. [PMID: 32874818 PMCID: PMC7455376 DOI: 10.7759/cureus.10091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 12/01/2022] Open
Abstract
This literature review assesses how the vermiform appendix has been considered a vestigial organ by many, but over the years, new research has allowed us to reconsider its potential purpose. Studies have indicated that the appendix plays an evident role in immune response and harbors a biofilm that may remain unaffected by gastrointestinal infections, such as infection with Clostridium difficile. Our research analyzes the prominent gut-associated lymphoid tissue (GALT) as a mechanism of defence in infection, as well as the robust biofilm that could aid in the reinoculation of beneficial bacteria within the colon. Furthermore, we wanted to determine if patients who have undergone a prior appendectomy, leading to decreased GALT and a lack of a bacterial reservoir, were predisposed to the development of Clostridium difficile, with particular emphasis in the recurrence and development of fulminant Clostridium difficile infections. Although research continues to be conflicting, there appears to be some connection between these variables, but prospective studies are needed in order to say for certain that there is a link.
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Affiliation(s)
- Stacey E Heindl
- Medicine, Avalon University School of Medicine, Willemstad, CUW.,Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Nicholas Tsouklidis
- Health Care Administration, University of Cincinnati Health, Cincinnati, USA.,Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Medicine, Atlantic University School of Medicine, Gros Islet, LCA
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13
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Chen J, Chen S, Li Z, Zhou P, Huang W, Wang H, Shi J, Ni Y, Lin L, Lei Y. Role of electrocardiograms in assessment of severity and analysis of the characteristics of ST elevation in acute myocarditis: A two-centre study. Exp Ther Med 2020; 20:20. [PMID: 32934685 PMCID: PMC7471845 DOI: 10.3892/etm.2020.9148] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 01/04/2020] [Accepted: 07/22/2020] [Indexed: 12/25/2022] Open
Abstract
Acute myocarditis is a severe disease with a high mortality rate and various dynamic changes visible on electrocardiograms (ECGs). The purpose of the present study was to investigate ECG findings of patients with acute myocarditis, ECG findings associated with fulminant myocarditis (FM) and the characteristics of ST elevation on admission. A retrospective analysis of 1,814 ECGs of 274 consecutive patients with acute myocarditis aged ≥13 years, who were hospitalized in two centres between August 2007 and November 2019, was performed. A total of 251 patients with myocarditis (91.6%) presented with ECG abnormalities. The most common ECG findings were T-wave inversion and ST elevation. Univariate logistic regression analysis demonstrated that 12 ECG findings were associated with FM. Multivariate regression analysis revealed that the independent predictive factors for FM included ventricular tachycardia, high-degree atrioventricular block, sinus tachycardia, low voltage and QRS duration of ≥120 msec (all P<0.05). A total of 112 cases displayed ST elevation at admission. Of these, ST elevation without T-wave inversion (n=87) was associated with a shorter duration of cardiac symptoms (1.5 vs. 3.1 days; P<0.001) compared with ST elevation with T-wave inversion (n=25). Of the aforementioned 87 patients, 71 (81.6%) presented with T-wave inversion at the hospital. The median time from the onset of cardiac symptoms to T-wave inversion was 4.0 days. In conclusion, patients with acute myocarditis exhibited various dynamic changes on ECG. Thus, ECGs should be widely used for the assessment of severity and the characteristics of ST elevation on admission.
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Affiliation(s)
- Jiaozhen Chen
- Department of Electrocardiogram, Wenzhou People's Hospital, Wenzhou, Zhejiang 325000, P.R. China
| | - Shouquan Chen
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Zhangping Li
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Peisen Zhou
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Weijia Huang
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Hete Wang
- Department of Electrocardiogram, Wenzhou People's Hospital, Wenzhou, Zhejiang 325000, P.R. China
| | - Jincun Shi
- Department of Critical Care Medicine, Wenzhou Central Hospital, Wenzhou, Zhejiang 325000, P.R. China
| | - Yunchao Ni
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Lili Lin
- Department of Electrocardiogram, Wenzhou People's Hospital, Wenzhou, Zhejiang 325000, P.R. China
| | - Yuanli Lei
- Department of Emergency Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
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Kucsora N, Becker B. [Ethyl-Toxic Steatohepatitis, the "Quiet Killer" - from Inflamed Fat to Multi-Organ Failure]. Praxis (Bern 1994) 2020; 109:677-686. [PMID: 32635847 DOI: 10.1024/1661-8157/a003486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Ethyl-Toxic Steatohepatitis, the "Quiet Killer" - from Inflamed Fat to Multi-Organ Failure Abstract. The spectrum of the alcohol-associated liver disease (ALD) includes the potentially reversible simple fatty degeneration of the liver (AFLD), ethyl-toxic steatohepatitis (ASH), and the ethyl-toxic liver cirrhosis. Despite an interdisciplinary andn intensive care approach, alcohol-associated steatohepatitis (ASH), clinically characterized by jaundice and SIRS, may, in case of a fulminant course and due to the limited therapeutic options, have a mortality rate of up to 40 % . In highly selected cases, if the basic medical care of corticosteroids combined with N-acetylcysteine fails, a liver transplantation might be discussed, which occasionally shows a satisfactory long-term course. With the presented case we would like to raise awareness about the underlying disease, emphasize prevention, and summarize the most important facts for the clinical practice.
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Affiliation(s)
- Natàlia Kucsora
- Innere Medizin, Departement Medizin, Kantonsspital Winterthur
| | - Björn Becker
- Gastroenterologie und Hepatologie, Kantonsspital Winterthur
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15
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Moribuchi H, Sato R, Matsushima S, Tominaga M, Sasaki J, Nakamura M, Sakazaki Y, Nishiyama M, Hoshino T, Kawayama T. Fulminant Tracheobronchial Aspergillosis in an Apparently Healthy Adult. Intern Med 2020; 59:1295-1298. [PMID: 32418954 PMCID: PMC7303448 DOI: 10.2169/internalmedicine.3857-19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A 56-year-old healthy man who was a current smoker died from fulminant tracheobronchial aspergillosis despite a month of treatment with a combination of intravenous anti-fungal agents that had been started immediately after the diagnosis. This case report is important for understanding and managing fulminant Aspergillus infections in healthy subjects, although the pathogenesis and underlying pathways are still unknown.
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Affiliation(s)
- Hayato Moribuchi
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Rumi Sato
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
- Respiratory Medicine, Asakura Medical Association Hospital, Japan
| | | | - Masaki Tominaga
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Jun Sasaki
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Masayuki Nakamura
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Yuki Sakazaki
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Mamoru Nishiyama
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Tomoaki Hoshino
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
| | - Tomotaka Kawayama
- Division of Respirology, Neurology, and Rheumatology, Department of Medicine, Kurume University School of Medicine, Japan
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16
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Zhu A, Zhang T, Hang X, Zhang X, Xiong Y, Fang T, Chen M. Hypoperfusion With Vomiting, Abdominal Pain, or Dizziness and Convulsions: An Alert to Fulminant Myocarditis in Children. Front Pediatr 2020; 8:186. [PMID: 32432061 PMCID: PMC7214534 DOI: 10.3389/fped.2020.00186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 03/30/2020] [Indexed: 01/12/2023] Open
Abstract
Objective: To investigate the clinical features, treatment methods, and outcomes of fulminant myocarditis (FM) in children. Methods: The clinical data of 23 children with FM hospitalized in the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (Anhui Provincial Hospital) and Anhui Provincial Children's Hospital from January 2011 to September 2019 were retrospectively analyzed. Results: Among the 23 patients analyzed, 10 were male and 13 were female. The patients aged from 6 months to 14 years old (6.5 ± 3.4 years), and 18 patients were over 3 years old. There were 14 cases with respiratory symptoms, 16 cases with gastrointestinal symptoms, 15 cases with neurological symptoms, and 19 cases with hypoperfusion manifestations. Creatine kinase MB (CK-MB) and cardiac troponin I (CTnI) levels were increased in 19 and 21 cases, respectively. Electrocardiography (ECG) showed ST-T changes in 18 cases and atrioventricular blocks (AVB) in 15 cases. Echocardiography (ECHO) showed cardiac chamber enlargement (CCE) in eight cases, left ventricular systolic dysfunction in five cases, decrease in left ventricular ejection fraction (LVEF) in four cases, reduction in wall motion in two cases, and pericardial effusion in seven cases. Intravenous immunoglobulin (IVIG) and glucocorticoids were administered to 19 and 20 patients, respectively. Fourteen patients were treated with temporary pacemakers, one patient received extracorporeal membrane oxygenation (ECMO), one patient received continuous renal replacement therapy (CRRT), and one patient received ECMO combined with CRRT. Twenty patients improved at discharge, and three patients died. Conclusion: Preschool and school-age children showing hypoperfusion symptoms, such as paleness, cold, clammy limbs, and capillary refill time (CRT) extension, accompanied by vomiting, abdominal pain, dizziness, convulsions, and other symptoms, should be carefully examined for FM. CK-MB, CTnI, ECG, and echocardiogram need to be performed at the earliest opportunity. In the early stages of FM, vital signs should be actively monitored, high-dose IVIG and glucocorticoids should be administered, and life support technologies such as temporary pacemakers, ECMO, and CRRT should be used to increase the survival rate of children with FM as needed.
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Affiliation(s)
- Angang Zhu
- Department of Pediatrics, Anhui Provincial Hospital, Wannan Medical College, Hefei, China
| | - Tian Zhang
- Department of Pediatrics, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Xiaobi Hang
- Department of Pediatrics, Anhui Provincial Children's Hospital, Hefei, China
| | - Xiaoguang Zhang
- Department of Pediatrics, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Yingying Xiong
- Department of Pediatrics, Anhui Provincial Hospital, Wannan Medical College, Hefei, China
| | - Tao Fang
- Division of Life Sciences and Medicine, Department of Pediatrics, The First Affiliated Hospital of USTC, Anhui Provincial Hospital, University of Science and Technology of China, Hefei, China
| | - Mingwu Chen
- Department of Pediatrics, Anhui Provincial Hospital, Wannan Medical College, Hefei, China.,Division of Life Sciences and Medicine, Department of Pediatrics, The First Affiliated Hospital of USTC, Anhui Provincial Hospital, University of Science and Technology of China, Hefei, China
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17
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Dohmen K, Tanaka H, Haruno M, Aishima S. Immunoserological and histological differences between autoimmune hepatitis with acute presentation and chronic autoimmune hepatitis. Hepatol Res 2017; 47:1375-1382. [PMID: 28219122 DOI: 10.1111/hepr.12875] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 02/01/2017] [Accepted: 02/16/2017] [Indexed: 12/12/2022]
Abstract
AIM The histological features of clinically chronic autoimmune hepatitis (AIH) have been well established, with interface hepatitis and plasma cell infiltration as hallmark lesions, however, the immunoserological and histological features of recent-onset and acute AIH remain undefined. The goal of this study was to define the immunoserological and histological differences between AIH with acute presentation and chronic AIH. METHODS Thirty-two consecutive patients with well-characterized AIH who had undergone a liver biopsy were identified at our institution. These patients were divided into two groups. Sixteen patients whose liver dysfunction had persisted for at least 12 months were defined as chronic AIH (C-AIH) patients, and 16 patients whose liver dysfunction had been within normal limits for >12 months previously, and had only recently been found to have abnormal function for the first time, were defined as AIH with acute presentation (AIH-a) patients. Various biological and histological characteristics were compared between these two patient groups. RESULTS No significant differences were found between the groups for age, body mass index, serum levels of total bilirubin, transaminase, alkaline phosphatase, prothrombin activity, immunoglobulin, titers of antinuclear antibody, or diagnostic scores between the groups. Histologically, there was no significant difference in the degree of interface hepatitis, plasma cell infiltration, or centrilobular necrosis between AIH-a and C-AIH patients. However, histological active findings such as activity, lobular inflammation, rosette formation, spotty necrosis, seroid-laden macrophages, and single cell necrosis were significantly more frequent in AIH-a patients, whereas portal fibrosis was significantly more frequent in C-AIH patients. Only one case among the 16 AIH-a patients was confirmed as acute AIH, showing massive centrilobular necrosis with a mild degree of portal inflammation and interface hepatitis. All patients with AIH-a and C-AIH responded well to corticosteroid or ursodeoxycholic acid treatment. CONCLUSIONS Patients with AIH-a could not be distinguished from C-AIH patients clinically or immunoserologically. Based on the histopathological findings of the liver, almost all cases of AIH-a might be exacerbations of non-symptomatic pre-existing C-AIH.
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18
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Ng VL, Li R, Loomes KM, Leonis MA, Rudnick DA, Belle SH, Squires RH; Pediatric Acute Liver Failure Study Group (PALFSG). Outcomes of Children With and Without Hepatic Encephalopathy From the Pediatric Acute Liver Failure Study Group. J Pediatr Gastroenterol Nutr 2016; 63:357-64. [PMID: 27367788 DOI: 10.1097/MPG.0000000000001178] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Hepatic encephalopathy (HE) is challenging to identify in children with acute liver failure and was not a requirement for enrollment into the Pediatric Acute Liver Failure Study Group (PALFSG). The outcomes of PALFSG participants presenting with and without HE are presented. METHODS PALFSG participants were classified based on daily assessment of HE during the first 7 days following study enrollment: group 1-never developed HE; group 2-no HE at enrollment with subsequent HE development; and group 3-HE at study enrollment. Clinical and biochemical parameters and outcomes of death, spontaneous recovery, or liver transplantation were compared between groups. RESULTS Data from 769 PALFSG (54% boys; median age 4.2 years; range 0-17.9 years) participants were analyzed, with 277 in group 1 (36%), 83 in group 2 (11%), and 409 in group 3 (53%). Mortality occurred in 11% of all participants and was highest among group 3 participants who demonstrated persistent grade III-IV HE (55%) or showed progression of HE (26%). Eleven (4%) group 1 participants died within 21 days of enrollment. Spontaneous recovery was highest in group 1 (79%) and lowest in group 2 (25%; P < 0.001). CONCLUSIONS Mortality 21 days after enrollment was highest in participants enrolled with severe HE (grades III or IV) or demonstrating HE progression. Four percent of participants without recorded clinical HE in the 7 days after enrollment, however, died within 21 days. Improved assessment of neurological injury and pediatric acute liver failure prognostication schema are needed.
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19
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Sharma S, Tanigasalam V, Parameswaran N, Chandrasekaran V, Gulati R, Joseph NM, Chandrashekar L. Fulminant BCG Disease in a 7 Month Old Healthy Male Infant. J Trop Pediatr 2015; 61:474-7. [PMID: 26423512 DOI: 10.1093/tropej/fmv062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A seven month old healthy male infant was brought with papular skin lesions all over the body, which became ulcerative with increasing fever and redness within 1 week duration. On examination, Bacilli Calmette Guerin (BCG) scar was ulcerated with discharge; infant was irritable with tachycardia and tachypnea. Investigations revealed pancytopenia, and acid fast bacilli was positive in skin lesions and at BCG scar site. There was progressive worsening of infant's condition, culminating in death.
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Affiliation(s)
- Shreya Sharma
- Department of Pediatrics, JIPMER, Puducherry-6, India
| | | | | | | | - Reena Gulati
- Department of Pediatrics, JIPMER, Puducherry-6, India
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20
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Rosen CB, Emond JC. Living donor liver transplantation in emergencies: is it time to say yes? Am J Transplant 2015; 15:1455-6. [PMID: 25800039 DOI: 10.1111/ajt.13205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 12/07/2014] [Accepted: 12/14/2014] [Indexed: 01/25/2023]
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Abstract
BACKGROUND & AIMS Fulminant hepatitis is a rare outcome of infection with hepatitis E virus. Several recent reports suggest that virus variation is an important determinant of disease progression. To critically examine the evidence that virus-specific factors underlie the development of fulminant hepatitis following hepatitis E virus infection. METHODS Published sequence information of hepatitis E virus isolates from patients with and without fulminant hepatitis was collected and analysed using statistical tests to identify associations between virus polymorphisms and disease outcome. RESULTS Fulminant hepatitis has been reported following infection with all four hepatitis E virus genotypes that infect humans comprising multiple phylogenetic lineages within genotypes 1, 3 and 4. Analysis of virus sequences from individuals infected by a common source did not detect any common substitutions associated with progression to fulminant hepatitis. Re-analysis of previously reported associations between virus substitutions and fulminant hepatitis suggests that these were probably the result of sampling biases. CONCLUSIONS Host-specific factors rather than virus genotype, variants or specific substitutions appear to be responsible for the development of fulminant hepatitis.
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Affiliation(s)
- Donald B. Smith
- Centre for Immunity, Infection and Evolution; Ashworth Laboratories; University of Edinburgh; King's Buildings West Mains Road Edinburgh EH9 3JT UK
| | - Peter Simmonds
- Centre for Immunity, Infection and Evolution; Ashworth Laboratories; University of Edinburgh; King's Buildings West Mains Road Edinburgh EH9 3JT UK
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22
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Stewart DB, Hollenbeak CS, Wilson MZ. Is colectomy for fulminant Clostridium difficile colitis life saving? A systematic review. Colorectal Dis 2013; 15:798-804. [PMID: 23350898 DOI: 10.1111/codi.12134] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Accepted: 11/15/2012] [Indexed: 12/31/2022]
Abstract
AIM It is unclear whether colectomy for fulminant Clostridium difficile colitis (FCDC) leads to a improvement in survival compared with continued medical therapy for this moribund population. METHOD Selected studies from 1994-2010 were identified through a comprehensive search theme applied to MEDLINE (OvidSP and PubMed), EMBASE and by hand searching. Data regarding mortality rates between medically and surgically treated patients were extracted. Risk of bias was assessed using a Newcastle-Ottawa Scale score. A meta-analysis of the odds ratios for mortality between surgical and medical treatment for FCDC was conducted using the Mantel-Haenszel method and fixed-effects modelling. RESULTS Five hundred and ten patients with FCDC were identified in six studies. The pooled adjusted odds ratio of mortality comparing surgery with medical therapy was 0.70 (0.49-0.99), suggesting that surgery provided a survival benefit. CONCLUSION Emergent colectomy for patients with FCDC provides a survival advantage compared with continuing antibiotics. Though there is selection bias of patients having surgery, the results of this systematic review suggest that colectomy has a therapeutic role in treating severe forms of C. difficile colitis.
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Affiliation(s)
- D B Stewart
- Department of Surgery, Division of Colon and Rectal Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania 17033, USA.
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23
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Magiorkinis E, Paraskevis D, Pavlopoulou I, Kantzanou M, Haida C, Hatzakis A, Boletis I. Renal transplantation from hepatitis B surface antigen (HBsAg)-positive donors to HBsAg-negative recipients: a case of post-transplant fulminant hepatitis associated with an extensively mutated hepatitis B virus strain and review of the current literature. Transpl Infect Dis 2013; 15:393-9. [DOI: 10.1111/tid.12094] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 11/25/2012] [Accepted: 12/08/2012] [Indexed: 02/06/2023]
Affiliation(s)
- E. Magiorkinis
- Department of Hygiene, Epidemiology and Medical Statistics; Athens University Medical School; Athens; Greece
| | - D. Paraskevis
- Department of Hygiene, Epidemiology and Medical Statistics; Athens University Medical School; Athens; Greece
| | - I.D. Pavlopoulou
- Pediatric Research Laboratory; Faculty of Nursing; University of Athens; Athens; Greece
| | - M. Kantzanou
- Department of Hygiene, Epidemiology and Medical Statistics; Athens University Medical School; Athens; Greece
| | - C. Haida
- Department of Hygiene, Epidemiology and Medical Statistics; Athens University Medical School; Athens; Greece
| | - A. Hatzakis
- Department of Hygiene, Epidemiology and Medical Statistics; Athens University Medical School; Athens; Greece
| | - I.N. Boletis
- Department of Nephrology and Renal Transplantation Unit; “Laikon” Hospital; Athens University Medical School; Athens; Greece
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24
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Füvesi J, Hanrieder J, Bencsik K, Rajda C, Kovács SK, Kaizer L, Beniczky S, Vécsei L, Bergquist J. Proteomic analysis of cerebrospinal fluid in a fulminant case of multiple sclerosis. Int J Mol Sci 2012; 13:7676-93. [PMID: 22837721 DOI: 10.3390/ijms13067676] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 04/19/2012] [Accepted: 06/05/2012] [Indexed: 11/17/2022] Open
Abstract
Multiple Sclerosis (MS) is a chronic disease, but in rare fulminant cases rapid progression may lead to death shortly after diagnosis. Currently there is no diagnostic test to predict disease course. The aim of this study was to identify potential biomarkers/proteins related to rapid progression. We present the case history of a 15-year-old male MS patient. Cerebrospinal fluid (CSF) was taken at diagnosis and at the time of rapid progression leading to the patient’s death. Using isobaric tag labeling and nanoflow liquid chromatography in conjunction with matrix assisted laser desorption/ionization time of flight tandem mass spectrometry we quantitatively analyzed the protein content of two CSF samples from the patient with fulminant MS as well as one relapsing-remitting (RR) MS patient and one control headache patient, whose CSF analysis was normal. Seventy-eight proteins were identified and seven proteins were found to be more abundant in both fulminant MS samples but not in the RR MS sample compared to the control. These proteins are involved in the immune response, blood coagulation, cell proliferation and cell adhesion. In conclusion, in this pilot study we were able to show differences in the CSF proteome of a rapidly progressing MS patient compared to a more typical clinical form of MS and a control subject.
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25
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Girotra M, Kumar V, Khan JM, Damisse P, Abraham RR, Aggarwal V, Dutta SK. Clinical predictors of fulminant colitis in patients with Clostridium difficile infection. Saudi J Gastroenterol 2012; 18:133-9. [PMID: 22421720 PMCID: PMC3326975 DOI: 10.4103/1319-3767.93820] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND/AIM Clostridium difficile infection (CDI) can affect up to 8% of hospitalized patients. Twenty-five percent CDI patients may develop C. difficile associated diarrhea (CDAD) and 1-3% may progress to fulminant C. difficile colitis (FCDC). Once developed, FCDC has higher rates of complications and mortality. PATIENTS AND METHODS A 10-year retrospective review of FCDC patients who underwent colectomy was performed and compared with randomly selected age- and sex-matched non-fulminant CDAD patients at our institution. FCDC (n=18) and CDAD (n=49) groups were defined clinically, radiologically, and pathologically. Univariate analysis was performed using Chi-square and Student's t test followed by multivariate logistic regression to compute independent predictors. RESULTS FCDC patients were significantly older (77 ± 13 years), presented with triad of abdominal pain (89%), diarrhea (72%), and distention (39%); 28% had prior CDI and had greater hemodynamic instability. In contrast, CDAD patients were comparatively younger (65 ± 20 years), presented with only 1 or 2 of these 3 symptoms and only 5% had prior CDI. No significant difference was noted between the 2 groups in terms of comorbid conditions, use of antibiotics, or proton pump inhibitor. Leukocytosis was significantly higher in FCDC patients (18.6 ± 15.8/mm³ vs 10.7 ± 5.2/mm³; P=0.04) and further increased until the point of surgery. Use of antiperistaltic medications was higher in FCDC than CDAD group (56% vs 22%; P=0.01). CONCLUSIONS Our data suggest several clinical and laboratory features in CDI patients, which may be indicative of FCDC. These include old age (>70 years), prior CDI, clinical triad of increasing abdominal pain, distention and diarrhea, profound leukocytosis (>18,000/mm³), hemodynamic instability, and use of antiperistaltic medications.
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Affiliation(s)
- Mohit Girotra
- Division of Gastroenterology, Department of Medicine, The Johns Hopkins University/Sinai Hospital, Baltimore
| | - Vivek Kumar
- Division of Gastroenterology, Department of Medicine, Norwalk Hospital Program/Yale University, Norwalk, CT
| | - Javaid M. Khan
- Division of Gastroenterology, Department of Medicine, The Johns Hopkins University/Sinai Hospital, Baltimore
| | - Pamela Damisse
- Department of Medicine, Johns Hopkins University/Sinai Hospital, Baltimore, MD
| | - Rtika R. Abraham
- Department of Medicine, Johns Hopkins University/Sinai Hospital, Baltimore, MD
| | - Vikas Aggarwal
- Department of Biostatistics, The Johns Hopkins Bloomberg School of Public Health, Baltimore
| | - Sudhir K. Dutta
- Department of Medicine, University of Maryland School of Medicine, Baltimore and Division Director of Gastroenterology, Sinai Hospital of Baltimore,Address for correspondence: Dr. Sudhir K. Dutta, Professor of Medicine, University of Maryland School of Medicine and Division Chief, Gastroenterology, Sinai Hospital of Baltimore, 2411 W. Belvedere Ave, Baltimore, MD, 21215. E-mail:
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26
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Abstract
Inhalational agents are used routinely for maintenance of anaesthesia. Post anaesthesia hepatic failure has been documented following exposure to halothane. However, there are very few reports of such complications following isoflurane anaesthesia. A 6-year-old child developed fulminant hepatic failure 2 days following craniotomy under general anaesthesia. There was no evidence of viral, autoimmune, or metabolic causes of hepatitis. No other medications known to cause hepatitis, except low dose paracetamol, were administered. The clinical and histological picture of our case is similar to that of halothane hepatitis, which has a significant mortality rate. We report this as a possible fulminant hepatic failure resulting from exposure to isoflurane anaesthesia.
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Affiliation(s)
- Halemani R Kusuma
- Department of Anaesthesiology & Critical Care, BGS Global Hospitals, Bangalore, Karnataka, India
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27
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Abstract
Amebiasis is an important cause of death from parasitic disease worldwide. The causative organism is Entamoeba histolytica, which has an infective cyst stage and a pathogenic and motile trophozoite stage. The clinical presentation can vary from an asymptomatic carrier state to fulminant colitis and colonic perforation. The majority of patients can be managed medically. However, a small percentage of patients require urgent exploration and resection with an associated high mortality rate. Early recognition and initiation of medical therapy including treatment of asymptomatic carriers are vital to preventing catastrophic outcomes.
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Affiliation(s)
- Karim A Alavi
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, St. Paul, MN 55104, USA.
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