Takayasu's arteritis diagnosed in a patient with long-standing arthralgias and arthritis

A 50-year-old woman had seronegative polyarthritis for three years, followed by vascular obstruction with classic Takayasu's arteritis. She responded symptomatically to high-dose steroid therapy and remains in long-term remission (joints and vasculature) after taper of medication. Literature review documents this relationship of arthritis to vasculitis in this and other types of vascular inflammation.     

Postcesarean wound infection by Mycoplasma hominis in a patient with persistent postpartum fever

Mycoplasma hominis was isolated in pure culture from a wound infection following delivery by cesarean section. The importance of recognizing this organism as a potential pathogen of the female genital tract is emphasized. Two commercially available isolation systems that allow the recovery of this organism are also described.     

Desensitization to allopurinol in a patient with previous failed desensitization

OBJECTIVE: To describe an allopurinol desensitization that failed on the first attempt but was successful on the second attempt, resulting in the management of crippling tophaceous gout. CASE SUMMARY: A 64-year-old white man with a history of gouty nephropathy requiring hemodialysis developed a severe cutaneous reaction from exposure to allopurinol. The first desensitization attempt was unsuccessful, and the gouty nephropathy caused chronic cellulitus and urate microcrystal deposition on the patient's hands and feet. Continuous ambulatory peritoneal dialysis and hemodialysis were used to treat the patient's severe symptoms and increase uric acid clearance. This method, however, was ineffective. Severe tissue ischemia, requiring bilateral below-the-knee amputations, prompted the second desensitization attempt four years later. The second attempt, administered differently and with more caution, was successful and did not cause further complications. DISCUSSION: Allopurinol is the only agent available to effectively reduce uric acid concentrations in those who are over-producers. Hypersensitivity-type reactions have been reported with its use, and desensitization is the only viable therapeutic option. Few cases of desensitization to allopurinol have been reported in the literature. This article describes a failure and a subsequent success in desensitization to allopurinol. CONCLUSIONS: Although desensitization to allopurinol poses potential risks, the benefits can outweigh the risks of therapy. Desensitization requires close monitoring; if failure does occur, subsequent attempts can be successful, as this case report demonstrates.     

Mercaptopurine-induced fever in a patient with Crohn's disease.

OBJECTIVE: To report a case of mercaptopurine-induced fever. CASE SUMMARY: A patient with Crohn's disease was treated with mercaptopurine (6-MP) for an exacerbation of his illness. The patient developed fever and chills. After thorough diagnostic examinations and failure to respond to antimicrobial therapy, symptoms were attributed to an allergic-type reaction to 6-MP. The patient defervesced after 6-MP withdrawal. Fever and chills, along with arthralgias, recurred upon rechallenge with a single dose of 6-MP. DISCUSSION: Adverse effects attributable to 6-MP therapy in inflammatory bowel disease were reviewed in the literature. Drug-induced fever has been previously reported; however, it is an uncommon adverse effect and is difficult to diagnose. It is also difficult to predict which patients will have the reaction. It is a diagnosis of exclusion requiring a thorough investigation. CONCLUSIONS: Drug-induced fever should be considered when confronted with fever and chills in patients with inflammatory bowel disease being treated with 6-MP. This case report shows the difficulty in differentiating between an infectious process and an adverse reaction to a medication.     

An experience nursing a patient with dengue hemorrhagic fever

The case report presented a patient with dengue hemorrhagic fever after being bitten by an insect in a suburban area. The author observed and interviewed the patient and utilized Gorden's functional health scale to collect information, from Nov., 08 to Nov., 15 2002. Thrombocytopenia, febrile, and pain accompanied with dengue hemorrhagic fever were recorded during nursing evaluation. Lack of associated medical information contributed to the patient's anxiety status. The major nursing problems were changing of protection/ thrombocytopenia, hyperthermia, pain, and inadequacy of knowledge. The gum bleeding, fevers, and generalized bone pain were relieved by sincere listening and nursing intervention. In addition, medical information was delivered by way of a health information booklet to improve the understanding of the patient and ease the latter's anxiety status. Amid an increase in cases of dengue hemorrhagic fever in Taiwan, this case report might provide some valuable information to the nursing staff in order to enhance their ability to provide comprehensive care.     

Recurrent nonvariceal upper gastrointestinal bleeding in a patient with gastroduodenal schistosomiasis

In this case report, we describe the rare situation of a patient with nonvariceal upper gastrointestinal bleeding induced by gastric and duodenal involvement of Schistosoma mansoni infection. In this unique case severe, recurrent upper gastrointestinal bleeding was induced by central ulcerations of gastric pseudopolypoid and duodenal polypoid lesions. However, very atypically, there were no signs of portal hypertension, coagulopathy, or variceal bleeding, and no macroscopic evidence of lower gastrointestinal tract involvement. Neither anti-ulcer therapy nor endoscopic hemostasis methods were effective in preventing recurrent bleeding episodes. Finally, typical histological and serological tests (positive for S. mansoni hemagglutination) led to the correct diagnosis, and the patient was completely cured by specific antischistosomal therapy.     

Recurrent urinary tract infection with antibiotic‐resistant Klebsiella pneumoniae in a patient with Crohn's disease: A case report

Recurrent urinary tract infections with resistant strains of Klebsiella pneumoniae are a potential complication of the long‐term use of immunosuppressive therapy in patients with Crohn''s disease.     

Uneventful plasma exchange with albumin replacement in a patient with a previous anaphylactoid reaction to albumin

A patient who had a previous anaphylactoid reaction to albumin required plasma exchange for myasthenia gravis. She was rechallenged with albumin from a different manufacturer after premedication with diphenhydramine. No adverse reaction occurred during five exchanges over a 10-day period. Possible pathogenic mechanisms and prevention of such reactions are discussed.     

Recurrent cervical osteomyelitis after radiation therapy in a patient with oropharyngeal cancer

It is crucial to consider cervical osteomyelitis as a differential diagnosis for neck pain in patients who underwent radiotherapy for early diagnosis and management, thereby preventing the development of potentially debilitating neurologic symptoms.     

Brucella canis infection in a woman with fever of unknown origin

A 58-year-old woman with prolonged febrile illness was found to have brucellosis caused by Brucella canis, presumably acquired through contact with infected dogs. After initial laboratory tests failed to yield a diagnosis, the disease was confirmed by the Brucella agglutination test. A combination of tetracycline and streptomycin therapy was begun, and the illness resolved. B canis, a recently recognized cause of human brucellosis, must now be considered in patients with fever of unknown origin. With adequate medical therapy, rapid and complete recovery can be expected.     

Successful rehabilitation after hip fracture to a patient with previous above-elbow amputation

We experienced successful rehabilitation of an elderly man after hip fracture (HF) who had had ipsilateral above-elbow amputation. He was a wounded soldier whose right arm had been amputated more than 60 yrs ago, and he had never used a prosthesis. He had been admitted to our hospital because of exacerbation of chronic obstructive pulmonary disease. During his admission, he had a fall-related hip fracture. We devised a special upper-limb prosthesis so that he could hold an ipsilateral crutch to enable appropriate acute-phase rehabilitation for HF. As a result, effects of disuse were prevented and he gained improvement of lower-limb function. The specialized upper-limb prosthesis also reduced his anxiety regarding walking. It can be considered that the prosthesis contributed to his quality of life with regard to activities of daily living after discharge.     

Recurrent sepsis and seronegative arthritis in a patient with a selective IgG3 deficiency

In a sixty-one-year-old patient with chronic polyarthritis, two life-threatening septic events were observed over a period of 6 months. The patient also had a selective IgG3 deficiency. The susceptibility to infection and chronic polyarthritis observed in this patient were very likely a consequence of the selective IgG3 deficiency.