Reactivation histoplasmosis after treatment with anti-tumor necrosis factor alpha in a patient from a nonendemic area

Histoplasma capsulatum (HC) is a thermally dimorphic ascomycete that is a significant cause of respiratory infections (>80%) in endemic areas (Midwest and southeast USA), but infections are rare in non-endemic areas. Most primary HC infections are subclinical or self-limited. While reactivation Histoplasmosis has been reported in the setting of immunosuppression, it remains unclear whether remote primary latent infection represents risk of endogenous reactivation after anti-tumor necrosis factor (TNF)-alpha therapy. We report a case of a patient who developed reactivation Histoplasmosis after receiving anti-TNF-alpha. To our knowledge, this is the first clear report of reactivation of "latent" Histoplasmosis after anti-TNF-alpha therapy.     

Mammary involvement in a patient with sarcoidosis

Sarcoidosis is a systemic granulomatous disease of unknown etiology. Sarcoidosis affects multiple organs; the lungs, lymphoid system, eyes and skin are usually involved. Commonly, any organ system may be affected. Sarcoid involvement in the nervous system, locomotor system, lacrimal and salivary glands, heart, kidney and liver has been recognized in patients with sarcoidosis. However, sarcoid involvement of the breast parenchyma has been extremely rare in patients with sarcoidosis. Herein, we report a patient with a sarcoid breast mass who had bilateral hilar lymphadenopathy and lymphocytosis in bronchoalveolar lavage analysis.     

Gastric involvement in a patient with secondary syphilis

A 30-year-old man was referred because of a short lasting history of severe epigastric pain and early satiety, with remarkable weight loss. Physical examination was fully consistent with secondary syphilis and upper GI tract endoscopy revealed multiple gastric mucopurulent erosions and several nodular lesions ranging from 2 to 3 cm in diameter, with central crater, abruptly ending at the pyloric level. Appropriate antibiotic treatment obtained a dramatic improvement and complete reversal of cutaneous and gastric lesions.     

Cardiac involvement in a patient with limb-girdle muscular dystrophy

A case of limb-girdle muscular dystrophy with cardiomegaly, electrocardiographic abnormalities, and paroxysmal ventricular tachycardia was described. Some of the interesting electrocardiographic features were discussed, and the importance of serial electrocardiograms for the detection of cardiac involvement is emphasized, since acute disturbances in cardiac rhythm may indicate that the patient is in immediate danger of sudden death.     

Reiter's syndrome in a patient with polyarthritis and nail involvement

An 8-year old boy with polyarthritis and nail involvement is presented in this report. Nail involvement in Reiter's syndrome is a rare condition that may include painless erythematous nduration of the base of the nail fold; subungual parakeratotic scaling and thickening opacification, ridging of the nail plate.     

Motor neuron involvement in a patient with long-term corticosteroid administration

An asthmatic patient with corticosteroid treatment for 45 years presented with slowly progressive limb muscle atrophy. His muscle symptoms were involved in four limbs and tongue, and deep tendon reflexes were exaggerated. Biopsied muscle pathology indicated the presence of neurogenic muscular atrophy in combination with corticosteroid myopathy. Furthermore, 8-hydroxy-deoxyguanosine (8-OH-dG) was prominently increased in mitochondrial and nuclear DNA. An aerobic exercise test demonstrated remarkable serum lactate elevation, which was attenuated by the administration of coenzyme Q10. These findings are consistent with the assumption that long-term corticosteroid administration potentially induces not only myopathy but also motor neuron involvement as in mitochondrial diseases.     

Hypereosinophilic syndrome with cardiac involvement in a pregnant patient with multiple sclerosis

In hypereosinophilic syndrome, the sustained overproduction of eosinophils leads to the dysfunction of one or more organs. Symptoms vary in accordance with which organ is affected. Cardiac involvement leads to substantial morbidity and to most of the deaths that are associated with hypereosinophilic syndrome.Herein, we present the case of a 31-year-old woman, pregnant for 12 weeks and with a history of multiple sclerosis, who presented with transient vision loss and splinter hemorrhages in her fingernail beds. The diagnosis was hypereosinophilic syndrome with cardiac involvement. Echocardiography revealed 2 echodense structures: one that obliterated the left ventricular apex, and another in the basal lateral wall. The patient underwent therapy with prednisone and heparin but developed heparin-induced thrombocytopenia. This condition resolved when argatroban was substituted for heparin. Two weeks after the patient's release from the hospital, echocardiography revealed improvement in the echodense ventricular structures. The transient vision loss and the splinter hemorrhages were attributed to the hypereosinophilic syndrome.We believe that this is the 1st report of a pregnant patient with hypereosinophilic syndrome and cardiac involvement.     

Natural history of infection with Bartonella bacilliformis in a nonendemic population

An investigation was performed after an outbreak of bartonellosis in a region of Peru nonendemic for this disorder. Symptoms of acute and chronic bartonellosis were recorded. Serological analysis was performed on 55% of the affected population (554 individuals), 77.5% of whom demonstrated previous infection with Bartonella bacilliformis. The attack rate of Oroya fever was 13.8% (123 cases); the case-fatality rate was 0.7%. The attack rate of verruga peruana was 17.6%. A new specific immunostain was developed and used to confirm the presence of B. bacilliformis in the biopsied skin lesions. Most seropositive individuals (56%) were asymptomatic. The symptoms that were associated with prior infection, as determined by Western blot, included fever (37.2% of the seropositive vs. 17.2% of the seronegative population; P<.001), bone and joint pain (27% vs. 9%; P<.001), headache (27% vs. 12.3%; P <.001), and skin lesions described as verruga peruana (26.8% vs. 4.9%; P<.001). Our findings suggest that infection with B. bacilliformis causes a broad spectrum of disease that is significantly milder in severity than that frequently reported.     

Acute vasculitis with multiorgan involvement in a patient with familial Mediterranean fever

We report a rare case of a patient with long-standing familial Mediterranean fever who presented with sudden onset of dyspnea, abdominal pain, and cutaneous manifestations. Chest CT and histologic preparations disclosed pulmonary hemorrhage and signs of systemic vasculitis. Cyclophosphamide and steroid therapy were initiated, with marked improvement. Based on this and 1 other case, we propose that systemic vasculitis should be included as a clinical manifestation of FMF.     

Generalized periodontal involvement in a young patient with systemic lupus erythematosus

Inflammation is considered to be a leading cause of morbidity in systemic lupus erythematosus (SLE), yet inflammatory periodontal involvement is rarely encountered. A young lady suffering from active SLE accompanied by severe periodontal loss, manifested by gingival recession of all her teeth, was referred to our clinic for treatment. The association between periodontal involvement and connective tissue diseases is unclear, and the literature dealing with periodontal involvement in patients suffering from Sjogren's syndrome and rheumatoid arthritis is comprised of studies showing both normal and pathological periodontal status. We discuss the possible underlying mechanisms.     

Hypercapnic coma due to diaphragmatic involvement in a patient with dermatomyositis

We report an acute respiratory distress by diaphragmatic involvement due to dermatomyositis. A fifty year-old patient with typical dermatomyositis presented an acute respiratory insufficiency with hypercapnic coma due to diaphragmatic muscle involvement. Respiratory state required mechanical ventilation initially and improved secondarily gradually upon corticosteroids and intravenous immunoglobulins. Only few cases of acute respiratory distress in dermatomyositis due to respiratory muscle involvement are reported in literature.     

Oculomotor muscles involvement revealing dermatomyositis in a patient with rheumatoid arthritis

INTRODUCTION: Oculomotor muscles (OMM) involvement in dermatomyositis (DM) and in rheumatoid arthritis (RA) is unusual. The DM always leads to OMM inflammation, whereas the RA particularly leads to tenosynovitis of the superior oblique muscle referred to as the Brown syndrome. OBSERVATION: The patient is a 43-year-old woman who gives a 17-year-history of severe seropositive RA with bilateral coxite. She was hospitalized for acute painful proptosis. The clinical examination revealed an orbital erythema and a muscular rhizomelic weakness. The muscular enzymes were increased. The orbital CT revealed in the right side, an enlargement of the superior rectus muscle that was enhanced after intravenous injection, which is compatible with myositis involvement. The muscular biopsy practiced at the level of the calf showed the specific histological signs of the DM. This orbital involvement was resolved with a high dose of corticosteroids. CONCLUSION: Our observation has the specificity of associating RA with DM with an involvement of the superior rectus muscle, which is due to the DM rather than the RA.     

A case of rhinoscleroma cured with ciprofloxacin

Summary The diagnosis of rhinoscleroma was confirmed in a 17-year-old female patient from Tehran, Iran, suffering from a roundish tumour of the nose. Prior treatment with streptomycin and tetracycline had been unsuccessful. A three-month course of high-dose oral ciprofloxacin (750 mg b. i. d.) led to prompt cessation of the growth of the granuloma which was removed later by plastic surgery. Although serology alone appeared to have little value for the specific diagnosis of rhinoscleroma, a significant increase of IgG antibodies during treatment with ciprofloxacin confirmed infection byKlebsiella rhinoscleromatis in this case.

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Heilung eines Falles von Rhinosklerom mit Ciprofloxacin

Zusammenfassung Bei einer 17jährigen Patientin aus Teheran/Iran, die sich wegen einer tumorösen Raumforderung der Nase vorstellte, wurde histologisch die Diagnose eines Rhinoskleroms gesichert. Da vorangegangene Behandlungen mit Streptomycin und Tetrazyklinen erfolglos geblieben waren, wurde ein Therapieversuch mit hochdosiertem Ciprofloxacin (2 × 750 mg/d p. o.) unternommen. Unter der Therapie kam es zu einem raschen Wachstumsstillstand des Granuloms, das später chirurgisch entfernt wurde. Serologische Untersuchungen zeigten einen signifikanten Anstieg von IgG-Antikörpern gegenKlebsiella rhinoscleromatis unter der Therapie. Die Patientin ist seit mehr als drei Jahren symptomlos.

     

High level of IgG4 in a patient with Extensive pulmonary involvement

Immunoglobulin G4-Related Disease (IgG4-RD) is a systemic fibro-inflammatory disease that has been proposed as a separate entity since thebeginning of this century. The disease is often manifested by increasedserum IgG4 levels and certain histopathological manifestations. The patientmentioned in this article is a 29-year-old man from Tajikistan, who has had achronic cough since the beginning of 2018 without a previous history of thedisease. At first, he was diagnosed with pneumonia for a long time and thenunderwent a lung biopsy due to exacerbation of symptoms and the spreadof lung lesions in radiology but no abnormalities were found in theseevaluations. The patient traveled to Iran to continue his treatment. He wasre-evaluated and then the previous samples taken from the patient's lungtissue were re-examined. There were key findings in favor of diagnosingIgG4 RD. Evaluations did not confirm the involvement of other organs. Hewas first treated with steroids and due to recurrence of symptoms, he wastreated with rituximab once which was significantly effective in improving thepatient's clinical symptoms. In general, it can be concluded that thediagnosis of IgG4-RD is very challenging and if it has not been diagnosedand treated in time, it can lead to irreversible fibrosis and permanent loss offunction of the involved organ.