Systemic necrotizing vasculitis induced by isoniazid

A rare fatal case of antineutrophil cytoplasmic antibody-positive vasculitis induced by isoniazid is described.     

Disseminated intravascular coagulation induced by generalized cytomegalic inclusion disease during steroid therapy for polymyositis

A 56-year-old woman came to the hospital with fever and skin eruptions. A rise in myogenic enzyme and the presence of antileucocyte antibody were noticed, along with the gradual appearance of myalgia in both lower extremities, and muscle weakness. Steroid therapy was started under the diagnosis of polymyositis. The steroid was reduced because of mental disturbance but immediately the patient developed high fever. Various forms of treatment were carried out but there was no improvement, and the patient died. At autopsy there were scattered purpura on the skin, and the muscles were atrophic and yellowish-grey in color. Histopathologically, there was inflammatory cell infiltration and muscle fiber degeneration visible in many of the muscles, and the findings showed evidence of polymyositis. There were intranuclear inclusions in the lungs, ovaries, and adrenal glands, and this was diagnosed as generalized cytomegalic inclusion disease. Fibrin thrombi were found in the kidneys, lungs, and adrenal glands and this was pathologically diagnosed as disseminated intravascular coagulation. Endothelial cell damage caused by cytomegalovirus was assumed to be involved to a large extent in triggering the disseminated intravascular coagulation.     

Disseminated cryptococcosis presenting as cellulitis with necrotizing vasculitis.

Patients with disseminated cryptococcosis infrequently present with cutaneous involvement. Skin lesions, when present, are usually multiple and polymorphous in appearance. Cellulitis caused by Cryptococcus neoformans is rare, and necrotizing vasculitis associated with cryptococcal vascular invasion has not to our knowledge been reported. We report here a case of disseminated cryptococcosis in a renal transplant recipient who had cellulitis and necrotizing vasculitis and in whom a diagnostic skin biopsy allowed for early therapy with cure and salvage of the renal allograft.     

Intestinal lesions induced experimentally by methotrexate.

Mice were given up to 9 doses of methotrexate intermittently over a 3-week period. Inhibition of mitosis occurred in the duodenum, jejunum and ileum after the first injection, and after 2 doses the crypt epithelium showed megalocytosis and occasional abnormal mitotic figures. Further treatment produced degeneration of the epithelium of the villi, which became irregular and atrophic, and the amount of crypt tissue was greatly reduced. Focal ulceration and haemorrhage occurred in some animals. Changes in the caecum and colon developed later and were much milder. After withdrawal of methotrexate the intestinal mucosa rapidly recovered and was normal 1 week later.     

Mitochondrial myopathies with necrotizing encephalopathy of the Leigh type

Two patients with mitochondrial encephalomyopathy (MEP) serve to emphasize the variability of this group of diseases. Cerebral insults, mitochondrial cardiopathy, relapsing ileus, cerebral angioma, ataxia, and myoclonic seizures characterized the first case of an adult man with similar diseases in his family, interpreted as transitional form between mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes (MELAS) and myoclonus epilepsy associated with ragged red fibers (MERRF). The second patient, a floppy infant with cardiomyopathy and myoclonism, statomotoric and mental retardation showed combined defects in mitochondrial respiratory chain at NADH-CoQ reductase and cytochrome c oxidase and a deficiency of carnitine. In both patients neuropathologically criteria of Leigh's syndrome could be demonstrated in the cerebral cortex, in case 2 also clinically. The classificatory problems of the relationships between KSS, MELAS, MERRF, Leigh's as well as Alpers' syndromes are discussed.     

Disseminated neonatal herpes simplex virus infection with necrotizing encephalitis--an autopsy case

An autopsy case of disseminated HSV type 2 infection occurring in a neonate at 32 weeks' gestation, delivered by cesarean section after premature rupture of membrane of 7 days duration, is presented. Herpes simplex virus type 2 was isolated from the vesicular skin lesion. The mother and patient had specific antibody to type 2 herpes simplex virus. Patient's parents had denied any herpetic orolabial or genital lesion during or before this pregnancy. Cultures from the cervical and vaginal swabs of the mother were negative for HSV. Postmortem examination showed hepatic necrosis, skin vesicle, devastating necrotizing inflammation of the brain, chorioretinitis and interstitial pneumonitis.     

内毒素诱发肝硬化大鼠发生肝性脑病的实验研究

目的：观察外源性内毒素诱发肝硬化大鼠发生肝性脑病的可能性及可能机制。方法：采用腹腔内小剂量内毒素一次性注射（３００μｇ／１００ｇＢＷ）诱发肝硬化大鼠发生肝性脑病。结果：小剂量内毒素腹腔内注射可以诱发肝硬化大鼠发生肝性脑病。内毒素注射后,动物一般行为状态及脑电图皆有明显变化,与其他肝性脑病模型或肝性脑病病人类似。同时,血氨和胰高血糖素水平显著升高。血浆内毒素含量与血氨、血胰高血糖素含量之间及血氨与务     

Ferrokinetics after high-dose methotrexate therapy

Summary After high-dose methotrexate with doses ranging from 2–10 g/m², ferrokinetics were performed in 11 patients with different tumors. Iron-III-citrate-⁵⁹Fe was injected at methotrexate serum concentrations ranging between 2.7×10^–7–1.3×10^–8 M. With MTX levels 4.2×10^–8 M the plasma iron clearance was always retarded, and the plasma iron turnover was diminished in 5 of 6 patients with levels of 3.1–8.9×10^–8 M at the time of the injection. In all cases with MTX concentrations 5×10^–8 M the⁵⁹Fe-utilization as the measure of effective erythropoiesis was reduced pathologically below normal range. These results show that the erythropoiesis resumes its normal extent even in case of normal methotrexate clearance only when the methotrexate serum concentrations have fallen down below 5×10^–8 and that erythropoiesis is more sensitive against methotrexate toxicity than the granulocytopoiesis.     

Disseminated Bacillus Calmette-Guerin infections after intravesical therapy

Intravesical instillation of Bacillus Calmette-Guerin (BCG) is the treatment of choice for superficial bladder carcinoma. Disseminated BCG infection presenting as granulomatous hepatitis or pneumonitis is a very rare complication of this treatment. Here we report a case series of seven patients previously treated with BCG presenting with pneumonitis. In two of the cases, identification of Mycobacterium bovis was achieved with molecular methods.     

Disseminated intravascular coagulation induced by progesterone in the pregnant rat. Prevention by estogens.

Fatal disseminated intravascular coagulation (DIC) was induced in female rats by administration of progesterone in late pregnacy. This prevented parturition, with intrauterine fetal death 2 to 4 days past term and subsequent retention of dead fetuses. Concomitantly with or closely following the intrauterine death of their litters, a large proportion of pregnant rats died with histologically evident DIC. Administration of cortisone, heparin, or disoumarin did not prevent DIC, and xi-aminocaproic acid, acetylsalicylic acid, or an onion-rich diet tended to increase its incidence. Antibiotic regimens gave variable results, with significant decrease in DIC only with a combination of two wide-spectrum penicillins. Neomycin and polymyxin had little effect on susceptible Sprague-dawley derived rats, but polymxin caused a significant increase in DIC in a resistant strain of hooded rats. Fatal maternal DIC was completely prevented only by use of natural or synthetic estrogens concurrently with progesterone, although this did not alter the sequence of abnormally prolonged pregnacy with intrauterine fetal death and retention of dead fetuses. Potencies of estrogens varied greatly, but all compounds tested prevented DIC at adequate dosage levels. Diethylstilbestrol, the most potent drug tested, was completely protective at 1 mug daily given subcutaneously. beta-Estradiol was the most effective natural estrogen, giving complete protection with a 10-mug daily subcutaneous injection. Estrogens were much more potent by subcutaneous injection than by oral ingestion, and toxic side effects were sometimes noted with higher levels of the latter. For estrogen therapy to be effective, it was necessary to begin its use before the expected onset of DIC, and in no instance was there evidence of reversal of this process after signs of illness were observed.     

Electrolytic raphe magnus lesions block analgesia induced by a stress-morphine interaction but not analgesia induced by morphine alone

Morphine analgesia in the tail withdrawal test was examined in rats which had had lesions of the nucleus raphe magnus (NRM) or sham operations. Half of the rats were tested while restrained, whereas the other half were not restrained. In the sham-operated rats, restraint potentiated the analgesic response to morphine. Lesions of the NRM had no effect on unrestrained rats but reduced the morphine analgesia exhibited by restrained rats so that it was indistinguishable from that of unrestrained rats. The NRM seems to be involved in analgesia induced by an interaction of morphine and restraint but not in analgesia induced by morphine alone.     

Acupuncture induced necrotizing aortitis with infected pseudoaneurysm formation

Necrotizing aortitis is a rare and life-threatening complication of local or generalized bacterial infections and most commonly affects the abdominal aorta. We described a case of a 79-year-old man with an acupuncture-induced bacterial aortitis associated with pseudoaneurysm formation causing near rupture. The patient underwent emergent explolapartomy, resection of the infected aorta, wide debridement of surrounding infected tissues, and extra-anatomic axillary to bifemoral graft bypass. The microbiologic examination revealed Escherichia coli and methicillin resistant Staphylococcus aureus (MRSA). Necrotizing aortitis is very serious and fatal disease, careful history taking as well as rapid diagnosis and urgent treatment are of critical importance.     

Disseminated cryptococcosis with necrotizing fasciitis in an apparently immunocompetent host: a case report.

We present an unusual case of disseminated cryptococcosis with necrotizing fascitis in an immunocompetent host. The multi-system cryptococcal infection was proved using standard microbiological, histopathological and radiological investigations. After a combination of antifungal, antimicrobial and surgical therapy clinical cure was achieved.     

Hepatic encephalopathy. Pathogenesis and therapy

Hepatic encephalopathy is a frequent complication of cirrhosis. Portal-systemic shunts and depression of hepatic function are the primary underlying abnormalities. Arterial blood ammonia levels are frequently elevated during hepatic encephalopathy and are lower when a clinical improvement is established. Glutamine synthesis is part of the metabolic pathway for ammonia cerebral detoxification that induces ATP and glutamate (excitatory neurotransmitter) depletion. Plasma levels of branched chain amino acids are reduced in patients with cirrhosis, this event allows aromatic amino acids to cross the hemato-liquoral barrier through exchange with glutamine. Cerebral excess of aromatic amino acids promotes the synthesis of octopamine and feniletiletanolamine, weak neurotransmitters. Benzodiazepine-like substances may affect GABA-ergic transmission by interacting with their receptors on the GABA-benzodiazepine complex. Therapy is aimed at controlling the events that may precipitate the acute encephalopathy, at reducing the ammonia levels, and correcting the neurotransmission abnormalities.