Fine needle sclerotherapy as a new effective therapeutic approach for nonparasitic splenic cysts: A case series

BackgroundNonparasitic splenic cysts are rare. Until now, surgical intervention has been the standard therapy of symptomatic splenic cysts.AimsWe herein present a retrospective analysis of an approach using percutaneous ultrasound-guided fine needle aspiration and sclerotherapy.MethodsOut of 88,151 ultrasound reports, we identified 138 patients who presented with splenic cysts. A single splenic cyst was found in 88% (mean size 28.9 mm). Twelve patients underwent percutaneous therapy of symptomatic splenic cysts. They were younger, had larger splenic cysts and more often cyst internal echoes than the 126 untreated patients (all p < 0.0001).ResultsInitial sclerotherapy was performed with polidocanol 1% in 9 patients and with NaCl 10% in 2 patients. One hemorrhagic cyst was only purged. Serious adverse events were not noted. Eight patients had to undergo 1–11 further percutaneous cyst therapies. 15 of these 30 reinterventions were cyst aspiration therapies, only, and 11 of them were sclerotherapies with NaCl 10%. Four patients were readmitted to hospital for cyst retreatment. After 57 ± 43 months of follow-up, cyst size significantly decreased (p < 0.0001). Only two patients had a complicated course of cyst therapy.ConclusionsPercutaneous ultrasound-guided sclerotherapy is a new approach for symptomatic splenic cysts. In most patients, cyst size and symptoms can be significantly reduced during one hospital stay.     

Evaluation of brain changes in systemic sclerosis (SSc) patients using two different techniques of MRI: Is it really worthy?

BackgroundSystemic sclerosis (SSc) is a rare chronic multi-system autoimmune disease of unknown cause and a complex pathogenesis. The hallmark of the disease is microvascular vasculopathy which results in tissue ischemia with recurrent episodes of reperfusion. Diffusion-weighted (DW) Magnetic Resonance imaging (MRI) is an excellent tool for the detection of activity of any vascular or inflammatory lesions.ObjectivesDetect brain changes in systemic sclerosis patients with asymptomatic CNS manifestations using fluid attenuation inversion recovery (FLAIR) weighted sequence and diffusion-weighted (DW) sequence MRI.MethodsFifteen systemic sclerosis female patients aged 27–60 years old with disease duration of 1–20 years with no CNS clinical manifestations were included. A controlled group of 14 clinically normal persons, age and sex matched. Both groups were subjected to brain MR examination at 1.5 T; a FLAIR weighted sequence and a DW sequence. SPSS (version 20) was used for statistical analysis.Results37 white matter hyperintense lesions (≤2 to ≥ 5 mm in diameter) were detected in patient group using FLAIR weighted MRI while diffusion-weighted MRI failed to detect the same lesions. A non-significant relation (P = .259) between the presence of white matter hyperintense lesions and the severity of peripheral vascular affection of the disease was observed.ConclusionsAsymptomatic central nervous system vasculopathy is detected in systemic sclerosis using FLAIR MRI, while diffusion MRI failed to detect such lesions. These findings suggest a non-inflammatory form of central nervous system microvasculopathy in SSc patients.     

Les kystes hydatiques cardiaques à propos de 17 cas opérés

Cardiac hydatid cyst is a rare parasitic disease. The purpose of this study was to describe the clinical, pathological features and the outcome of the surgical treatment of cardiac hydatid disease in our unit over a twenty-year period.MethodsBetween May 1994 and May 2014, seventeen cases of cardiac hydatid cysts were operated at our unit. Overall, twelve patients were male (mean age 25 ± 13 years). All patients were complaining of dyspnea and 71% presented with chest pain. The diagnosis, based on histological examination, was suspected on echocardiography and computed tomography of chest.ResultsOur study revealed five possible locations, which were in decreasing order of frequency: left ventricle, interventricular septum, right ventricle, left atrium and pulmonary artery. The surgical procedure was a controlled puncture and aspiration of the cyst content, with cystectomy (69%), or pericystectomy (31%). The resulting cavity left open in 6 cases (37.5%) or carefully closed in 10 (62.5%). Hospital mortality was 11.8% (n = 2). Morbidity was marked by conduction abnormalities (n = 2), bleeding and hematoma of the residual cavity that required surgical treatment (n = 3). Eleven patients were followed with a mean period of 40.5 ± 19.4 months. At follow-up, neither late deaths nor recurrence have occurred.ConclusionCardiac hydatid cyst is a serious disease whose treatment is surgical. Cystectomy and pericystectomy remain the two surgical techniques able to offer good chance of cure with acceptable morbidity and mortality.     

Metabolic syndrome (MetS) predicts cardio and cerebrovascular events in a twenty years follow-up. A prospective study

ObjectivesTo investigate the extent of subclinical atherosclerosis in asymptomatic familial hypercholesterolemia (FH) patients using non-invasive images techniques.Patients, methods and resultsThe atherosclerotic burden of 36 molecularly defined FH patients (18 males, 45.7 ± 10.9 years) without evidence of cardiovascular disease receiving lipid-lowering treatment and 19 (47.8 ± 11.3 years) controls was investigated. Descending thoracic aorta magnetic resonance imaging (MRI) was performed in a 1.5 T equipment with T1 and T2 sequences to characterize atherosclerotic plaques and to measure aortic wall volumen. Carotid intima-media thickness (cIMT) and presence of plaques were measured using B-mode carotid ultrasound.Mean aortic wall volumen, cIMT and atherosclerotic plaques in aorta were significantly higher in FH cases (P < 0.001). A significant correlation between aortic wall volume and cIMT was observed (P < 0.01). Aortic MRI detected plaques in 94% and carotid ultrasound in 14% of cases. Lipid-rich plaques were observed only in FH cases (33%) and were associated with family history of premature coronary artery disease (P < 0.05).ConclusionsAsymptomatic middle-aged FH patients have significantly higher atherosclerotic burden than controls. cIMT has shown a significant correlation with aortic wall volume and MRI allowed the detection of lipid-rich plaques in FH subjects that were associated with family history of premature coronary artery disease.     

The efficacy of percutaneous AHI (arginine hydrochloride injection) for the treatment of recurrent thyroid cysts

ObjectivesThyroid cysts remain a common clinical problem. Although simple aspiration, ethanol ablation, and radiofrequency ablation are effective, they have some limitations. There is therefore a need to identify a new and effective sclerosant for resolving these problems. The aim of this study was to test the efficacy as an active compound for sclerotherapy of thyroid cysts.Patients and methodsEight subjects whose thyroid cysts were recurrent despite repeated simple aspiration treatments were included in this study. The cysts were aspirated and then subjected to AHI. Lack of a significant reduction in cyst size (i.e. < 50%) at follow-up resulted in further AHIs. Treatment success was defined as complete disappearance or a marked (i.e. > 50%) reduction in the size of the cystic portion of the thyroid nodule on follow-up ultrasonography at least 6 months after the final AHI.ResultsA marked size reduction of > 50% was ultimately found in all of the patients (100%), with a reduction varying from 73.68% to 99.07% (P < 0.029). Six of the patients received a single AHI treatment, one received two AHIs, and one received three AHIs. None of the patients suffered from a recurrence during the follow-up period. Three patients experienced tolerable pain and local tenderness. No serious side effects were reported.ConclusionsIntracystic AHI may be a safe and effective treatment for benign thyroid cysts.     

Structural factors associated with malalignment in knee osteoarthritis: the Boston osteoarthritis knee study

OBJECTIVE: Osteoarthritis (OA) is a multifactorial condition. The progression of knee OA is determined in part by mechanical effects on local structures. One of the mechanical influences on cartilage loss is limb alignment. We explored the structural factors associated with malalignment in subjects with symptomatic OA. METHODS: We conducted a cross-sectional assessment using The Boston Osteoarthritis of the Knee Study, a natural history study of symptomatic knee OA. Baseline assessments included knee magnetic resonance imaging (MRI) and information on weight and height. Long-limb radiographs to assess mechanical alignment were obtained at 15 months. Subarticular bone attrition, meniscal degeneration, anterior and posterior cruciate ligament integrity, medial and lateral collateral ligament integrity, marginal osteophytes, and cartilage morphology were assessed on MRI using a semiquantitative, multi-feature scoring method (Whole-Organ MRI Score) for whole-organ evaluation of the knee that is applicable to conventional MRI techniques. We also quantified the following meniscal position measures on coronal MRI images in both medial and lateral compartments: subluxation, meniscal height, and meniscal covering of the tibial plateau. Using the long-limb radiographs, mechanical alignment was measured in degrees on a continuous scale. The purpose of this cross-sectional analysis was to determine the individual and relative contribution of various structural factors to alignment of the lower extremity. We assessed the cross-sectional association between various structural factors and alignment of the lower extremity using a linear regression model. RESULTS: The 162 subjects with all measures acquired had a mean age of 67.0 years (SD 9.2), body mass index 31.4 (SD 5.6); 30% were female and 77% of knees had a Kellgren-Lawrence grade > or = 2. The main univariate determinants of varus alignment in decreasing order of influence were medial bone attrition, medial meniscal degeneration, medial meniscal subluxation, and medial tibiofemoral cartilage loss. Multivariable analysis revealed that medial bone attrition and medial tibiofemoral cartilage loss explained more of the variance in varus malalignment than other variables. The main univariate determinants of valgus malalignment in decreasing order of influence were lateral tibiofemoral cartilage loss, lateral osteophyte score, and lateral meniscal degeneration. CONCLUSION: Cartilage loss has been thought to be the major determinant of alignment. We found that other factors including meniscal degeneration and position, bone attrition, osteophytes, and ligament damage contribute to the variance of malalignment. Further longitudinal analysis is required to determine cause and effect relationships. This should assist researchers in determining strategies to ameliorate the potent effects of this mechanical disturbance.     

Predictors of self-reported knee osteoarthritis in community-dwelling older women in Japan: A cross-sectional and longitudinal cohort study

PurposeThis study aimed to determine the predictors of knee osteoarthritis in community-dwelling elderly Japanese women.MethodsIn this prospective cohort study, The Tokyo Metropolitan Institute of Gerontology collected baseline data in 2008 and follow-up data in 2012 for participants from the Itabashi Ward of Tokyo, Japan. Participants were asked at each time point if they had been diagnosed with knee osteoarthritis. The baseline evaluation was conducted with 1289 community-dwelling women aged 75–85 years, of which 992 reported no history of knee osteoarthritis. The follow-up survey targeted these 992 participants; we obtained history of knee osteoarthritis from 867 of these participants. The baseline evaluation also included collection of anthropometric, fitness, hematologic, and lifestyle data.ResultsWe performed logistic regression analysis of the cross-sectional data at baseline. Participants who reported fewer light exercise sessions (≤2–4 days/week) had lower odds ratios for history of self-reported knee osteoarthritis than those who reported more frequent exercise (≥5–6 days/week). Logistic regression analysis of the longitudinal data revealed that slow walking speed ( < 65.22 m/min), low serum albumin levels ( < 4.10 g/dL), and low frequency of soy product consumption (≤1 time per 2 days) at baseline resulted in higher odds ratios for incidence of self-reported knee osteoarthritis during the 4-year follow-up period.ConclusionsThe results suggest that slow walking speed, low serum albumin, and insufficient consumption of soy products are predictors for knee osteoarthritis in elderly Japanese women. These results could help in the design of knee osteoarthritis prevention programs for elderly women.     

Reflex sympathetic dystrophy involving the hip in pregnancy: A case report and a review of the literature

IntroductionReflex sympathetic dystrophy (RSD) during pregnancy is a rare condition and may be misdiagnosed. We report a case of RSD involving the hip in a 22-year-old woman with onset during the third trimester of pregnancy.Case presentationA 22-year-old Moroccan woman presented in the third trimester (34 weeks of gestation) of her second pregnancy with permanent pain in the left hip that made standing and walking difficult. Physical examination of the hip showed mild painful range-of-motion restriction. Erythrocyte sedimentation rate was 40 mm (1st hour) and C-reactive protein was 10 mg/l. Ultrasound of the left hip was normal. Magnetic resonance imaging (MRI) revealed a characteristic image of RSD involving the left hip. Treatment was symptomatic, combining non-weight-bearing exercises with rest and analgesics (Paracetamol). Physical therapy was gradually undertaken and was carried out only to the point of pain. Clinical recovery was rapidly obtained (within 2 weeks).ConclusionPregnancy is a potential cause of hip RSD. This diagnosis must be always kept in mind when attending a pregnant patient or a patient with hip pain and functional impairment.     

Liposynovitis prepatellaris in a child (Hoffa’s syndrome): Lessons from MRI

BackgroundLiposynovitis prepatellaris (Hoffa’s syndrome) is a rare condition in children and rarely discussed in the literature. Hoffa’s syndrome can lead to an obscure anterior knee pain resulting from impingement and inflammation of the infrapatellar fat pad.Aim of the workThe aim of this case report is to increase awareness among rheumatologists about this condition among children to avoid erroneous diagnosis of juvenile idiopathic arthritis (JIA) and unnecessary treatment with disease-modifying antirheumatic drugs (DMARDs).Case reportIn this report we presented a 12 year-old child with this condition who presented with chronic pain and intermittent swelling involving his right knee. The patient was wrongly diagnosed as a case of JIA and wrongly treated with DMARDs for three years duration. The report will shed light on the characteristic MRI features of this condition and the value to order MRI in such atypical presentation.ConclusionHoffa’s syndrome can present with chronic arthropathy in children that can mimic mono-articular JIA presentation and eventually unnecessary treatment with DMARDs. MRI is generally very helpful from the diagnostic point of view, it clearly depicts Hoffa’s infrapatellar fat pad entrapment and its findings may suggest Hoffa’s syndrome.     

Clinico-radiological profile of arrhythmogenic right ventricular dysplasia at a tertiary care center: Two year experience

BackgroundArrythmogenic right ventricular dysplasia (ARVD/C) refers to fibro fatty infiltration replacement of ventricular myocardium especially that of right ventricle. The clinical presentation varies from asymptomatic state to ventricular tachycardia, heart failure and even sudden death. Diagnosis is established using modified ARVD/C taskforce criteria. Among all the various modalities of diagnosis, magnetic resonance imaging (MRI) gives most comprehensive evaluation of both morphological and functional abnormalities in this disease. MRI may not only obviate need for myocardial biopsy but also give insights into the nature of disease like presence of left ventricular myocardial involvement. We present our 2 years experience of ARVD/C patents who were admitted in our center and in whom diagnosis of ARVD/C was supported by excellent MR imaging.Materials and methodsThis study was conducted by Department of Radiology and Cardiology SKIMS, a tertiary care center for a period of 2 years. Patients with suspected ARVD/C based on clinical, electrophysiological and echocardiographic findings were subjected to MR imaging. Patients were excluded if they had history metallic implants, claustrophobia or were uncooperative. In this study stress was laid on diagnostic role of MRI in ARVD/C.ResultsThe median age at presentation was 31 years (range 21–43 years). 80% of patients were males. Most common clinical presentation was palpatations (40%). Syncope was present in 27% and heart failure in 13%. EKG suggestive of ARVD was seen in 87%. Echocardiographic features suggestive of ARVD/C was seen in all 15 patients. Family history of premature sudden death less than 35 years old was present in one patient only. MRI evidence classical for ARVD/C was seen in 80%.ConclusionDemographic features and mode of presentation of our patients is consistent with what has been rest of the world. We performed MRI in all patients to increase the specificity of our diagnosis. MR imaging allows a three-dimensional evaluation of the right ventricle and provides the most important anatomic, functional, and morphologic criteria for diagnosis of ARVD/C within one single study. MR imaging appears to be the optimal imaging technique for detection and follow-up of clinically suspected ARVD/C.     

Should we use CT or MRI for detection and characterization of benign adrenal lesions?

ObjectivesComputed tomography (CT) and magnetic resonance imaging (MRI) are the main imaging modalities used for analysis of adrenal lesions. We compared the ability of CT and MRI to detect and characterize benign adrenal lesions.Patients and methodsUnenhanced abdominal CT and MRI were performed in 16 patients (age range 39–77), and reviewed by a radiologist with 6 years of experience in abdominal imaging. The presence, number, size and structure of each mass were analyzed and compared between the two modalities.ResultsThere were 18 adrenal masses in 11 patients, four patients had adrenal hyperplasia (AH), whereas one patient had left-sided AH and right-sided adenoma. Ten masses were ≥ 2 cm in diameter, and were perfectly depicted using CT and all MRI techniques. There were nine masses with diameter < 2 cm detected by CT, three of them were missed using MRI. AH was detected in five patients using CT, but its mild form was missed in one patient using MRI. Four masses with attenuation values of > 10 Hounsfield units could not be characterized using unenhanced CT, but three of them were characterized using MRI.ConclusionCT has higher sensitivity for detection of small adrenal tumours and adrenal hyperplasia than MRI. MRI is an important tool in characterization of adrenal masses that could not be characterized using unenhanced CT.     

Dysglycemia,brain volume and vascular lesions on MRI in a memory clinic population

ObjectiveIt is unclear, if the association between abnormalities in glucose metabolism (dysglycemia) and impaired cognitive functioning is primarily driven by degenerative or vascular brain damage. We therefore examined the relation between dysglycemia and brain volume and vascular lesions on MRI in a memory clinic population.MethodsThe relations between markers of glycemia (HbA1c and fasting glucose levels) and normalized brain volume, medial temporal lobe atrophy and vascular lesions (white matter hyperintensities, lacunes) were assessed in 274 consecutive patients attending a memory clinic, using linear regression analyses.ResultsClinical diagnoses were subjective complaints (n = 117), mild cognitive impairment (n = 62), Alzheimer's disease (n = 61) and other type of dementia (n = 34). Twenty patients had a history of diabetes. Across the whole study population there was no relation between HbA1c or fasting glucose and the brain MRI measurements, after adjustments for age, sex and diagnostic group. Secondary analyses after stratification by diabetes status, diagnosis and median age (67 years) did not change the results.ConclusionIn this memory clinic population, dysglycemia was not associated with either brain volume or vascular lesions. Apparently, dysglycemia is not associated with a specific class of brain pathology in patients with cognitive complaints.     

Bursal osteochondromatosis of the shoulder: An exceptional location

IntroductionThe osteochondromatosis is a rare synovial tissue metaplasia. The location at the shoulder is very rare. Bursal affection is exceptional.Case presentationWe report a case of a male, 41 years old living in north Morocco and presenting to the rheumatology outpatient clinic at Fes Hassan II University Hospital with a swelling of the right shoulder that had been evolving for two years, without any history of trauma, gradually increasing in size, without fever or alteration of the general state. Clinical examination revealed a 5 cm soft, non-tender oval mass on the anterior surface of the right shoulder with no signs of inflammation but limited range of motion. Plain X-ray was normal and diagnostic ultrasonography revealed an avascular multilocular cystic mass. A differential diagnosis was considered and other conditions with comparable pictures were ruled out. The diagnosis was confirmed by a magnetic resonance imaging showing synovitis and distension of the sub acromiodeltoid bursa with many rounded bodies, few millimeters in size of intermediate signal in T1 and T2 without enhancement after intravenous gadolinium. A diagnosis of osteochondromatosis of the subacromiodeltoid bursa (third stage) was made. The patient underwent an open bursectomy and histological examination further verified the diagnosis.ConclusionPresenting such rare cases could help in raising the awareness of rheumatologists regarding such conditions when considering a differential diagnosis for patients presenting with monoarticluar shoulder swelling. Excision of the tumor has a remarkably better prognosis.     

Safe endoscopic treatment of large colonic lipomas using endoscopic looping technique

PurposeColonic lipomas are benign, submucosal tumours that are usually asymptomatic. Typically, they are incidentally diagnosed during colonoscopy. Due to a low prevalence, the natural history of lipomas remains largely unknown. While large (>2 cm) lesions can cause symptoms and complications, their endoscopic treatment is not routinely recommended because of prior reports of a high rate of perforation.MethodsWe used a standardized technique of polypectomy, using endoscopic looping to resect large colonic lipomas in 8 patients and followed their clinical outcomes.ResultsThe mean lipoma size was 3.8 ± 1.2 cm (range 2.5–6 cm). No patient developed bleeding or perforation. On follow-up (mean = 13.5 months, range 2–29), there was one small residual lesion.ConclusionColonic lipomas larger than 2 cm can be safely and efficaciously removed using endoloop assisted polypectomy technique.     

Impact of pancreatic comorbidities in patients with end-stage liver disease on outcome after liver transplantation

BackgroundDiseases leading to end-stage liver disease (ESLD), especially alcoholic liver cirrhosis cause comorbidities of the pancreas, too. The aim of this retrospective study was to determine the impact of pancreatic alterations diagnosed pretransplant on the outcome after liver transplantation (LT).MethodsIn total, data from 372 LT patients were analyzed. Patients were followed up for a mean of 4.2 years. Incidence of chronic pancreatitis (CP), pancreatic cysts (PC) and intraductal papillary mucinous neoplasm (IPMN) was acquired retrospectively from patient's charts.ResultsCP, IPMN and PC were rarely diagnosed in LT-recipients [CP (3.8%), PC (1.6%) and IPMN (1.6%)]. There was no significant correlation of IPMN, CP, PC and other patient characteristics. The prevalence of CP (log rank: p = 0.315), PC (log rank: p = 0.242) and IPMN (log rank: p = 0.491) did not influence patient survival.ConclusionFrequency of radiological alterations of the pancreas in LT recipients (such as CP, PC, IPMN) diagnosed by sonography, CT scan or MRI is comparable to the non-transplant population. Short term survival of LT-recipients after transplantation is not reduced for patients with CP, PC and patients with branch-duct IPMN (with a low-risk for malignancy according to international consensus guidelines).     

A new case of solitary true pancreatic cyst

A true cyst of the pancreas is extremely rare, and few cases have been reported in adult patients. The authors report a new case of this rare pathological entity. A 35-year-old male patient was admitted to our unit with a cystic mass, about 6 cm in diameter, located in the pancreatic head, in proximity to the duodenum, vena cava, biliary tree and right kidney. Clinical features and imagery were suggestive for a benign neoplasm, as did surgical findings. Cystoduodenostomy was done. Histological finding revealed a cyst lined by cuboidal epithelium without morphologic alterations. Analysis of the cyst fluid showed a high level of CA 19-9 (10,000 U ml^?1). After 1-year follow-up, the patient was found to be doing well without any abdominal symptoms. Ultrasound images revealed no cyst recurrence.     

Entéropathie exsudative sévère compliquant une primo-infection à cytomégalovirus chez un adulte immunocompétent

IntroductionClinical expression of cytomegalovirus (CMV) infection is numerous and depends on the immune status of the host. In immunocompromised patients, CMV disease corresponds to reactivation of the virus with tissue damage responsible for significant morbidity and mortality. In immunocompetent adults, primary CMV infection is usually asymptomatic but may rarely result in severe organ damage.ObservationWe report the case of a 28-year-old man, considered immunocompetent and without medical history, presenting with a primary CMV infection revealed by a severe protein-losing gastroenteropathy (serum albumin level: 18.9 g/L). The CT scan showed a gastro-duodeno-jejuno-ileitis pattern. Upper intestinal endoscopy revealed diffuse ulcerated and congestive gastritis predominantly in the fundus. Histological analysis of the biopsies showed no viral inclusion and no immunohistochemical staining reaction, but a high viral load (5.61 log). Treatment was symptomatic associated with anticoagulation due to the major hypoalbuminemia. The patient slowly recovered, and normal clinical examination and blood tests were observed two months after the onset of symptoms.ConclusionSevere CMV organ involvement in the immunocompetent patient is very rare but potentially serious. Digestive involvement complicated by exudative enteropathy is possible. Evolution is usually favorable without the need for antiviral treatment.     

Obesity and iron deficiency anemia as risk factors for asymptomatic bacteriuria

BackgroundFew studies examined the risk factors of asymptomatic bacteriuria, showing contradictory results. Our study aimed to examine the association between different clinical and laboratory parameters and asymptomatic bacteriuria in internal medicine patients.Materials and methods330 consecutive hospitalized subjects, asymptomatic for urinary tract infections (UTIs), underwent to microscopic examination of urine specimens. 100 subjects were positive for microscopic bacteriuria and were recruited into the study. At the quantitative urine culture 31 subjects of study population were positive while 69 subjects were negative for bacteriuria.ResultsThe analysis of clinical characteristics showed that the two groups of subjects (positive and negative urine culture for bacteriuria) were significant different (p < 0.05) about obesity (76.7% vs 42% respectively), metabolic syndrome (80.6% vs 44,9%), cholelithiasis (35.5% vs 13,2%) and iron deficiency anemia (80.6% vs 53,6%). The univariate analysis showed that only obesity, cholelithiasis and iron deficiency anemia were positively associated with positive urine culture for bacteriuria (Odds Ratios [OR] = 3.79, p = 0.0003; OR = 2,65, p = 0.0091; OR = 2.63, p = 0.0097; respectively). However, the multivariate analysis by logistic regression showed that only obesity and iron deficiency anemia, independently associated with positive urine culture for bacteriuria (OR = 3.9695, p = 0.0075; OR = 3.1569, p = 0.03420 respectively).ConclusionsThis study shows that obesity and iron deficiency anemia are independent risk factors for asymptomatic bacteriuria.     

Life-threatening onset of systemic lupus erythematosus coincides with Kikuchi disease in a Croatian patient

BackgroundKikuchi disease (KD) or histiocytic necrotizing lymphadenitis is a benign self-limited extremely-rare disorder of unkown etiology. It is characterized by regional cervical lymphadenopathy with tenderness, usually accompanied with mild fever and night sweats. The recognition of KD is crucial as it can be mistaken for or be associated with systemic lupus erythematosus (SLE).Case reportWe present a 29-year-old Croatian female admitted to the Hematology and Oncology Department, General Hospital Dr. Josip Benčević, Croatia in a life threatening condition. She was feverish (40 °C) with chills and weight loss. On clinical examination the patient had bilaterally enlarged cervical, axillary and inguinal lymph nodes with sizes up to 3 cm. Our differential diagnosis was SLE, lymphoma, sarcoidosis, Still’s disease, hemophagocytic syndrome and KD. An extensive workup was done to confirm one of these diagnoses. Methylprednisolone 100 mg iv (1.5 mg/kg) was initiated for 5 days and as the patient’s condition was severe, steroids were maintained. Lymph node biopsy histopathology was compatible with KD. Antinuclear antibody and anti-double-stranded-DNA were positive. The patient fulfilled the classification criteria for SLE. A diagnosis of SLE associated with KD was held. On CT scan there was bilateral pleural effusion and ascites. Brain MRI was compatable with lupus cerebritis. On steroids plus hydroxychloroquine the patient remarkably improved and remained in remission after 3 months.ConclusionPrompt diagnosis and treatment with steroids may save the life of SLE patients with KD and leads to a favorable outcome. Raising the awareness towards this possibly serious association is important.