Sapountzi Evdoxia*, Staberna Alexandra, Davidhi Andjoli, Rafailidis Vasileios, Pras-sopoulos Panos, Stamou Maria and Galli-Tsinopoulou Assimina
DOI: 10.37421/2684-4915.2023.7.285
Introduction: Systemic Lupus Erythematosus (SLE) is a complex autoimmune disorder with a wide spectrum of clinical manifestations. Though Antiphospholipid Antibodies (APAs) in SLE increase thrombotic risks, renal artery thrombosis is uncommon, especially in younger patients.
Case report: A 15-year-old presented with fever, chest pain, arthritis, and discoloured skin scars. During his hospitalization, he suddenly developed severe acute abdominal pain. Imaging findings revealed renal artery thrombosis at the site of an anatomical variation involving the bifurcating right renal artery. Clinical manifestations and laboratory tests ultimately led to the diagnosis of APA-positive Systemic Lupus Erythematosus (SLE). Treatment with Low-Molecular-Weight Heparin (LMWH), intravenous methylprednisolone at a dosage of 30 mg/Kg/d for three consecutive days, followed by oral prednisolone at a dosage of 1mg/Kg/d, hydroxychloroquine, and methotrexate, resulting in significant improvement. However, arterial hypertension emerged in the seventh week, requiring lisinopril. Six months later, the patient remains in remission with stable blood pressure.
Conclusion: To our knowledge, this is the first documented case of renal artery thrombosis initiating paediatric-onset APA-positive SLE. Thrombotic events should prompt consideration of systemic vasculitis.
DOI: 10.37421/2684-4915.2024.8.287
Background and objectives: The Neodymium-Doped Yttrium-Aluminum-Garnet (ND: YAG) laser has proven effective in the treatment of leg telangiectasias, yet the literature lacks consensus on the optimal settings. This study aims to assess the efficacy of the 1064nm Nd:YAG laser for the treatment of leg telangiectasias in a safety focused setting.
Materials and methods: Records of 42 patients with lower leg telangiectasia who underwent laser treatment between December 2019 and March 2023 were assessed. Laser parameters have been adjusted to prioritize overall safety. Two months after the treatment Global Aesthetic Improvement Score (GAIS) and the extent of vessel clearance were evaluated on a scale ranging between 0% and 100%. Patients rated their satisfaction on an 11-point Likert scale and their perception of pain during the treatment on a 6-point scale. Narratives of all adverse events were examined.
Results: The mean patient satisfaction was 8.4 ± 0.7 (mean ± SD). The mean GAIS score was 81.4% ± 0.8% (mean ± SD). Vessel clearance of 60% and greater was achieved in 52% of patients. Mean patient satisfaction was 8.4 ± 0.7 (mean ± SD). Both GAIS score and vessel clearance were positively correlated with patient satisfaction (correlation coefficient 0.8 and 0.6, respectively). All patients experienced mild crusting at the site of the treatment which resolved spontaneously within up to two weeks. Two instances of hyperpigmentation self-resolved within six and seventeen weeks.
Conclusion: The treatment of leg telangiectasias with the 1064 nm Nd:YAG laser has proven to be safe and effective. The results achieved through a cautious approach in laser settings appear to be comparable to or better than, previous research in a variety of settings.
Hitokazu Tsukao*, Riki Matsukawa, Tsubasa Ueda, Yuya Fujii, Wataru Yamaguchi, Junya Nakaya and Toru Kojima
Certain skin conditions, like atopic dermatitis, pose a risk for the development of skin infections and, in more advanced stages of bacteremia. Consequently, it is hypothesized that skin diseases could play a role in the onset of Infectious Endocarditis (IE). We present a 21-years-old Japanese female with a history of acne vulgaris. Shingles appeared on the patient’s right trunk, thus she consulted a local dermatologist after 9 days, and her condition improved after receiving an antiviral drug. However, 32 days after she developed shingles, she experienced fever and vomiting that did not improve, and presented to a nearby clinic on day 36. She was referred to the hospital on the same day. A medical work-up revealed Staphylococcus aureus in two sets of blood cultures taken upon admission. Transesophageal echocardiography unveiled a 1.7 cm vegetation near the septum of the right ventricular outflow tract, leading to her diagnosis of Infectious Endocarditis (IE), attributed to S. aureus. Chest imaging displayed multiple nodular opacities within her lung fields, interpreted as a complication associated with a septic pulmonary embolism resulting from IE. Empirical treatment with Ceftriaxone (CTRX) + Sulbactam/Ampicillin (SBT/ABPC) was initiated. CTRX+SBT/ABPC was changed to cefazolin monotherapy after identifying the causative organism, and the patient’s condition gradually improved. Our case is a rare as skin disease is not previously regarded as a risk factor that triggers the onset of IE.
Xin Yu, Yahui Huang, Yin Zhang, Xianglong Cai, Liangliang Liu, Na Zhang, Jingzhi Zhu, Xiaotong Xi, Ran Ding and Guoqiang Li*
Introduction: To investigate the clinical and chest imaging features of acute military tuberculosis with diffuse ground-glass opacities. Methods: A case of acute military tuberculosis with diffuse ground-glass opacities was reported. Results: The patient, a 52-year-old male, was hospitalized for 10 days with fever, and his body temperature fluctuated between 37.8 ? and 40 ?. The patient had a medical history of nephrotic syndrome for 20 years, lymph node tuberculosis for 10 years and viral hepatitis C for 3 years. There were no findings with Chest CT, and all 5 times of blood culture were negative during the first 12 days of the disease course. Metagenomic Next-Generation Sequencing (mNGS) was employed, revealing the detection of 13 specific reads belonging to M. tuberculosis complex, indicating the drug treatment on day 13. After receiving treatment with isoniazid, rifampicin, pyrazinamide and ethambutol, the highest body temperature of the patient decreased to 38.5 ? on day 17. A follow-up chest CT scan showed diffuse ground-glass opacities, and mNGS data analysis revealed 27 specific reads of M. tuberculosis complex in Bronchoalveolar Lavage Fluid (BALF) on day 17. The highest body temperature of the patient decreased to 38 ? on day 20. On day 33 of the disease course, a follow-up chest CT scan demonstrated typical imaging changes of miliary tuberculosis, and the body temperature of the patient returned to normal. Conclusion: The imaging features of immunocompromised patients with acute miliary tuberculosis may manifest as diffuse ground glass opacities. mNGS with high sensitivity is valuable for early and accurate diagnosis, particularly in immunocompromised patients presenting with diffuse ground-glass opacities indicative of acute miliary tuberculosis.
Clinical and Medical Case Reports received 40 citations as per Google Scholar report
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