2.1 = | 1.730 Cit. to date |
842 Docs. to date |
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Pathan Mohamad Rafe Iqbal, Ossama Sajeh Maadarani, Zouheir Ibrahim Bitar
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Background: Tirzepatide is a novel glucagon-like peptide 1/glucose-dependent insulinotropic peptide (GLP-1/GIP) receptor agonist. It was recently approved for diabetes control and weight reduction in non-diabetic patients.
Case description: We report the first case of ketoacidosis after the use of tirzepatide in an obese non-diabetic patient, secondary to the possibility of starvation ketoacidosis and insulin resistance.
Conclusion: The dual-acting GLP-1 and GIP receptor agonists, tirzepatide, can induce ketoacidosis in obese non-diabetic patients.
Magdalini Manti, Nikolaos Kamperidis, Alexandros Toskas, Harry Martin, Ravi Misra
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Ulcerative colitis (UC) is an autoimmune disease associated with both intestinal and extraintestinal manifestations. The latter may include heart complications, such as myopericarditis leading to life-threatening arrythmias. Nowadays, UC is commonly treated with biologic medications and infliximab is the first line therapy in an outpatient setting, while it is also used as rescue therapy in acute severe UC. However, it has been associated with severe immunosuppression, cytomegalovirus (CMV) reactivation and drug-induced hepatitis. We report a case of UC flare in a biologic naïve patient admitted with myopericarditis, which was further complicated by positive CMV biopsies and infliximab-induced transaminitis.
Francisco Josué Cordero Pérez, Eva P. Martín Garrido, Marta Antona-Herranz, Carmen Bailador-Andrés, Pilar Conde-Gacho, Clara de Diego-Cobos, Santiago J. Rodriguez-Gomez
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Background: This report presents the influence of immunosuppression by new rheumatological therapies on hepatitis E virus infection in a 54-year-old male patient with an anti-synthetase syndrome and treatment with methotrexate and rituximab.
Case description: The patient arrived at the Emergency Department with epigastric pain, vomiting and dark urine. Initial examination revealed signs of inflammation and hepatic dysfunction. Subsequent laboratory tests and imaging confirmed acute hepatitis E infection in the context of recent initiation of rituximab therapy. Despite initial suspicion of pancreatitis, subsequent investigations ruled out pancreatic involvement. Treatment with ribavirin, along with supportive measures, led to significant clinical improvement with resolution of jaundice, ascites, and oedema.
Conclusions: This case underscores the importance of considering hepatitis E in patients with autoimmune conditions, especially when initiating immunosuppressive therapies, a situation that is not well described in scientific literature and is increasingly common, necessitating proper recognition.
Sakditad Saowapa, Watsachon Pangkanon , Yaw Adu, Nattanicha Chaisrimaneepan , Diego Olavarria Bernal, Natchaya Polpichai, Pharit Siladech, Jasmine Sekhon
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Chronic lymphocytic leukaemia (CLL) is a lymphoproliferative disorder characterised by an accumulation of monoclonal B lymphocytes, with an increased risk of secondary cancers. The coexistence of CLL and chronic myeloid leukaemia (CML) is a rare phenomenon, with three main types being classified: CML preceding CLL, CLL preceding CML and simultaneous occurrence. The coexistence of these chronic leukaemias poses a complex clinical challenge, with the underlying mechanisms of their association remaining enigmatic. Here, we present a report of an elderly male with a long history of CLL, who was subsequently diagnosed with secondary CML.
Mohammad Kloub, Muhammad Hussain, Fnu Marium, Atheer Anwar, Ahmad Haddad, Jihad Slim, Yatinder Bains
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Peritonitis, the inflammation of the protective membrane surrounding parts of the abdominal organs, is a common clinical pathology with multifactorial aetiologies. While bacterial infections are well-recognised as a cause of peritonitis, fungal infections remain relatively uncommon especially Saccharomyces cerevisiae, which is commonly used for breadmaking and as a nutritional supplement. This fungus has been reported to induce peritonitis in patients on peritoneal dialysis. However, it has never been reported as secondary to percutaneous endoscopic gastrostomy (PEG) tube insertion in immunocompromised patients. We present a 64-year-old female with a history of human immunodeficiency virus (HIV) who developed S. cerevisiae peritonitis following PEG tube insertion. The case highlights the importance of considering rare organisms when treating immunocompromised patients with peritonitis, especially after gastrointestinal tract penetration or peritoneal membrane disruption.
Marine Maenhout, Maxime Gudelj, Allison Gilbert
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Introduction: Pott’s puffy tumour is a rare entity defined by the presence of a subperiosteal abscess of the frontal bone associated with frontal osteomyelitis. Several predisposing conditions can lead to this entity, such as frontal sinusitis.
Case description: We report the case of a 15-year-old patient who presented to the emergency department for headache, fever and forehead swelling. Computed tomography revealed severe pansinusitis complicated by a subperiosteal abscess associated with frontal osteomyelitis, leading to the diagnosis of Pott’s puffy tumour. The management combined intravenous antibiotics and surgical drainage of both the sinusitis and subperiosteal abscess.
Discussion: Pott’s puffy tumour represents a rare but serious complication of frontal sinusitis. Clinicians should be aware of this potential complication as the diagnosis can be challenging at an early stage but may influence the subsequent prognosis.
Mustafa Kayabaşı, Işıl Kefeli, Pınar Çakar Özdal, Ali Osman Saatci
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Introduction: A case of ocular bartonellosis under anti-tumour necrosis factor treatment is described.
Case description: A 29-year-old woman with psoriasis who had been on certolizumab treatment was examined with a left visual deterioration following a fever bout, malaise, and placoid erythematous rashes on her neck. As there was acute anterior uveitis in her left eye, it was recommended to stop certolizumab treatment for a possible infectious aetiology. However, her physician elected to continue the certolizumab treatment. Ten days later, the patient noticed further visual decline despite the topical steroid treatment. This time, there were scattered yellow-white small retinitis foci at the left posterior pole. Infectious agents were searched and while Bartonella henselae antibodies were negative for immunoglobulin M, the immunoglobulin G titre was 1/80. Clinical findings were improved with the systemic treatment of oral trimethoprim-sulfamethoxazole (160/800 mg twice daily for six weeks) and azithromycin (500 mg once daily for two weeks).
Discussion: Though extremely rare, ocular bartonellosis should be kept in mind in patients on anti-tumour necrosis factor treatment as rapid and accurate diagnosis may end up with an excellent visual outcome and full recovery.
Raffaele Natale, Clelia Nasti, Annadora Morena, Fabrizio Pasanisi, Lidia Santarpia
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Kocuria kristinae is a Gram-positive commensal bacterium, rarely responsible for infection in immunocompromised patients.
A 29-year-old woman affected by intestinal pseudo-obstruction and requiring home parenteral nutrition, was hospitalised for fever and shivering during the infusion through a long-term central venous catheter (CVC).
Blood cultures were positive for K. kristinae infection. At a chest CT scan, two partially cavitated nodular lesions were evidenced. Meropenem antibiotic therapy was used locally and systemically, resulting in catheter use restoration.
A chest CT scan two months later at follow-up showed two centimetric, fibrotic and disventilatory areas replacing the previous nodular thickenings.
Kokuria kristinae was responsible for haematogenous pulmonary involvement with excavated nodules, requiring a differential diagnosis. Moreover, in the case of a CVC infection, in addition to the risk of right endocarditis, haematogenous pneumonia must also be considered.
Lamis Khedr, Mohamed Ekram
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Introduction: Most pregnancies in women after a kidney transplant result in a live birth, but kidney functions should be stable for one year before conception. For immunosuppression modification occurring before pregnancy, azathioprine is used because it is considered safe for major congenital malformations during pregnancy. However, there may be an association between exposure to azathioprine during pregnancy and the onset of an unusual, early and severe form of intrahepatic cholestasis.
Case description: A young patient with a twin pregnancy after a second kidney transplant experienced intrahepatic cholestasis. There was a wide range of differential diagnosis. A battery of tests was requested including autoimmune markers, virology, and imaging. The conclusion that azathioprine was contributing to intrahepatic cholestasis with pregnancy was reached after exclusion of all other differentials.
Conclusions: Complications of pregnancy after a kidney transplant include hypertension, pre-eclampsia, deterioration of graft function up to rejection, but also unusual side effects of immunosuppression medication.
Vimonsri Rangsrisaeneepitak, Arnant Tekarnjnavanit, Pattarapol Kanjanapipatkul, Sukrisd Koowattanatianchai
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Osmotic demyelination syndrome (ODS) is a disorder characterised by the widespread development of demyelination in both pontine and extrapontine regions. It has been recognised as a complication arising from the rapid correction of hyponatraemia. This study presents the case of a 20-year-old Thai female patient at 10 weeks gestation, exhibiting an initial presentation of catatonia – an uncommon manifestation of ODS. The patient developed symptoms following the rapid correction of hyponatraemia in the context of hyperemesis gravidarum. Magnetic resonance imaging (MRI) of the brain revealed a trident or bat-wing-shaped pattern in T2-weighted and fluid-attenuated inversion recovery (FLAIR) sequences at the central pons. The patient underwent five cycles of plasmapheresis and received rehabilitation, leading to clinical improvement.
2.1 = | 1.730 Cit. to date |
842 Docs. to date |
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