1/27. Relapsing polychondritis diagnosed by Tc-99m MDP bone scintigraphy. PURPOSE: Relapsing polychondritis is a generalized recurring disease of cartilage that involves joints, trachea, bronchi, laryngeal cartilages, costal cartilages, and cartilages of the ear and nose. It is associated with autoimmune diseases, including hashimoto disease in some cases. methods: The authors evaluated a 29-year-old man with relapsing polychondritis who had symptoms and signs of a common cold for 2 months and anterior chest pain near the sternum for 1 month. RESULTS: After the diagnosis, the authors found that the patient had a history of thyroid therapy for hyperthyroidism 15 years before. Tc-99m MDP bone scintigraphy performed to evaluate anterior chest pain showed diffusely increased accumulation of radioactivity in all costocartilages and sternoclavicular joints. Based on that information, relapsing polychondritis was diagnosed. Ga-67 citrate scintigraphy was preformed to determine the optimum biopsy site of the cartilage. The diagnosis was histologically supported by the results of the open biopsy. CONCLUSIONS: In this case, Tc-99m MDP bone scintigraphy was useful for diagnosing relapsing polychondritis, and Ga-67 citrate scintigraphy was helpful in determining the biopsy site. ( info) |
2/27. rib fractures induced by coughing: an unusual cause of acute chest pain. We report three patients with stress fractures of the ribs induced by coughing. Standard radiographs of the chest and ribs did not reveal evidence of rib fractures in any of the patients. Bone scintigraphy, performed 1 to 2 weeks after initial onset of symptoms, showed a focal area of increased uptake along the chest wall in all cases. Thin section angulated helical CT directly visualized the subtle rib fractures. Initial diagnosis of a cough-induced fracture of the rib may be difficult because of the associated underlying disorder, and unnecessary examinations are commonly performed. Identification of a cough-induced fracture of the rib using helical CT may be clinically important to avoid unnecessary concern and additional examinations. ( info) |
3/27. Isolated superior division oculomotor palsy in a child with spontaneous recovery. A 10 year old boy with a superior division palsy of the left oculomotor nerve is reported. He had a flu-like illness 1 week before the onset. The computed tomography and magnetic resonance imaging scans were normal. Laboratory data for evaluation of infection, diabetes mellitus and myasthenia gravis were normal. The symptoms spontaneously disappeared after 2 months. The course of the illness in conjunction with the negative laboratory findings made this case an example of partial paralysis of the third nerve related to viral infection. In the literature, only several cases with isolated divisional palsy of the oculomotor nerve were found after a viral infection. Inferior division palsy has been reported in five children. Superior division palsy has been published in only two cases. Divisional palsy is more common among children and resolves spontaneously. This rare but important clinical entity is one of the differential diagnoses in oculomotor nerve palsies, particularly in children, which are neuroradiologically undiagnosed. It occurs after a viral infection and may affect a superior or inferior division alone. ( info) |
4/27. A case of toxic epidermal necrolysis-type drug eruption induced by oral lysozyme chloride. We report a case of toxic epidermal necrolysis-type drug eruption. A 23-year-old man took an oral over-the-counter preparation for the common cold. A few days later, generalized erythema developed with systemic malaise and pain. A multiple blister formation followed, and Nikolsky's sign was noted on each blister. A lymphocyte stimulation test (LST) with the patient's peripheral lymphocytes strongly suggested that the eruption was attributable to lysozyme chloride which was included in the preparation taken. Following an intravenous drip of betamethasone for two weeks, the eruptions improved favorably. ( info) |
5/27. ileus after administration of cold remedy in an elderly diabetic patient treated with acarbose. A 69-year-old type 2 diabetic man was admitted due to diabetic gangrane. He had a history of subtotal gastrectomy. During hospitalization, he was treated with regular insulin and 300 mg/day of acarbose. He developed a low grade fever, cough and nasal discharge, and was given a compound "cold" remedy with anticholenergic properties. The next day, he suffered from a paralytic ileus. Oral intake and acarbose were withheld and the ileus spontaneously resolved after 2 days. These finding indicate the possibility that the ileus was triggered by drugs with anticholinergic properties in this elderly diabetic patient treated with alpha-glucosidase inhibitors. ( info) |
6/27. Autoimmune hepatitis associated with the odour of fish food proteins: a causal relationship or just a mere association? We present the case of a 15-year-old boy [HLA phenotype: A 1, 25 (10); B 18, 8; C 7; DR 17 (3), 6] with classic (type 1) autoimmune hepatitis presumably caused by a long-term exposure to the strong odour of food fed to a large number of tropical fish which that the boy kept in tanks in his bedroom. The boy presented with a history of recent symptoms of common cold, and a high cytomegalovirus-IgG titer, both known to activate proinflammatory cytokines. The patient's laboratory results and physical findings improved without specific treatment during his first stay in the hospital for several weeks, as well as when the thanks were removed from his bedroom while disease activity increased after his return home. This suggests that the association with fish food odour (putative volatile protein antigens) was not simply coincidental. Our patien's history is in agreement with the recently postulated pathomechanism of autoimmune hepatitis, according to which viral infections may trigger the disease in a genetically predisposed individuals persistently exposed to a constant antigenic stimulus, which results in ongoing allergic inflammation and finally develops into an immune process. The spontaneous remissions observed in our patient were characteristic of the natural course of autoimmune hepatitis and may reflect periods when he was not exposed to the eventually harmful effects of the odour of fish food proteins. ( info) |
7/27. Sudden death in a 35-year-old man with occult malformation of the brain and aseptic meningitis. A 35-year-old man was found dead by his wife. He was reported to have had symptoms of a common cold the week preceding his death. The medicolegal autopsy yielded signs of central dysregulation (ectasia of the urinary bladder and rectum, dystelectasis of the lungs) together with marked brain edema and fresh bite marks on the tongue. The cause of death was presumed to be lethal epileptic seizure. Neuropathologic examination revealed neuronal nodular heterotopia as well as discrete lymphocytic meningitis (aseptic meningitis). The death was most probably caused by the combination of the meningitis with the occult malformation, leading to a lowered seizure threshold and subsequent lethal seizure. The morphologic findings of this case are presented, and the probable mechanisms of death are discussed. ( info) |
8/27. Nonpigmenting solitary fixed drug eruption caused by a Chinese traditional herbal medicine, ma huang (ephedra Hebra), mainly containing pseudoephedrine and ephedrine. We describe a case of nonpigmenting solitary fixed drug eruption appearing on the right thigh of a 31-year-old woman in japan. The causative drug was determined by closed patch test on postlesional skin as a Chinese traditional herbal medicine, ma huang (ephedra Hebra), mainly containing pseudoephedrine and ephedrine. ( info) |
| Coronaviruses strains 229E and OC43 have been associated with various respiratory illnesses ranging from the self-resolving common cold to severe pneumonia. Although chronic underlying conditions are major determinants of severe respiratory virus infections, few data about coronavirus-related pneumonia in immunocompromised patients are available. Here we report 2 well-documented cases of pneumonia related to coronavirus 229E, each with a different clinical presentation. diagnosis was made on the basis of viral culture and electron microscopy findings that exhibited typical crown-like particles and through amplification of the viral genome by reverse transcriptase-polymerase chain reaction. On the basis of this report, coronaviruses should be considered as potential causative microorganisms of pneumonia in immunocompromised patients. ( info) |
10/27. zinc gluconate and the common cold: a controlled clinical study. A report in 1984 on the success of zinc gluconate against common cold symptoms could not be confirmed in three subsequent studies, which are now known to have used formulations that inactivated zinc. A non-chelating formulation including glycine, which releases 93% of contained zinc into saliva, was tested in a randomized, placebo-controlled, double-blind trial in 73 young adults. Efficacy was recorded in symptom diaries using a symptom severity rating. patients' symptoms first appeared 1.34 days prior to entry to the study in both groups. Disappearance of symptoms occurred after an additional 4.9 days for zinc-treated patients versus 6.1 days for placebo-treated patients. A difference was noted in the efficacy of treatment if it was started 1 day after symptom onset: cold duration was an additional 4.3 days in zinc-treated patients compared with 9.2 days for placebo-treated patients. cough, nasal drainage and congestion were the symptoms most affected, and only mild side-effects were noted. ( info) |