1/63. colitis may be part of the antiepileptic drug hypersensitivity syndrome.PURPOSE: To show that colitis may be part of the antiepileptic hypersensitivity syndrome. methods: Description of two case histories. RESULTS: The first patient was a 47-year-old man who developed fever, lymphadenopathy, influenza-like symptoms, facial edema, skin rash and diarrhea after 3 weeks of carbamazepine (CBZ) treatment. laparotomy because of severe abdominal pain 2 weeks later showed severe colitis with perforations. The second patient was a 41-year-old woman who developed fever, diarrhea, and skin rash 4 weeks after start of CBZ treatment. A colon biopsy confirmed colitis. Stool examinations did not show pathogenic microorganisms, and there was no evidence of Crohn's disease or ulcerative colitis. Both patients had elevated liver enzymes, peripheral eosinophilia, and eosinophils in the infiltrate of the colon. CONCLUSIONS: In view of the close temporal relation between start of CBZ intake and development of colitis, the presence of fever, lymphadenopathy, and rash, and improvement after discontinuation of CBZ, we conclude that the two patients developed an AED hypersensitivity syndrome. Our case histories demonstrate that severe colitis may be part of this syndrome.- - - - - - - - - - ranking = 1keywords = ulcer (Clic here for more details about this article) |
2/63. Perinatal vasoconstrictive renal insufficiency associated with maternal nimesulide use.A full-term newborn developed oliguric renal failure at 24 hr of life, which persisted for several days. Her mother ingested therapeutic doses of nimesulide, a non-steroidal anti-inflammatory (cyclo-oxygenase-2 inhibitor) drug, during the last 2 weeks of pregnancy. She was found at delivery to have developed oligohydramnion, esophagitis, and a bleeding peptic ulcer. The infant's fractional excretion of sodium was very low (0.5%) pointing for a severe vasoconstrictive mechanism involved. Renal sonogram showed hyperechogenic medullary papillae, which resolved during convalescence. This case emphasizes the importance of renal prostagandins in the control of vascular tone and sodium homeostasis. This is the first report of an adverse effect of fetal renal circulation by maternal ingestion of nimesulide.- - - - - - - - - - ranking = 1keywords = ulcer (Clic here for more details about this article) |
3/63. Pseudomembranous enteritis after proctocolectomy: report of a case.Intestinal pseudomembrane formation, sometimes a manifestation of antibiotic-associated diarrheal illnesses, is typically limited to the colon but rarely may affect the small bowel. A 56-year-old female taking antibiotics, who had undergone proctocolectomy for idiopathic inflammatory bowel disease, presented with septic shock and hypotension. A partial small-bowel resection revealed extensive mucosal pseudomembranes, which were cultured positive for clostridium difficile. Intestinal drainage contents from an ileostomy were enzyme immunoassay positive for C. difficile toxin A. Gross and histopathologic features of the small-bowel resection specimen were similar to those characteristic of pseudomembranous colitis. The patient was treated successfully with metronidazole. These findings suggest a reservoir for C. difficile also exists in the small intestine and that conditions for enhanced mucosal susceptibility to C. difficile overgrowth may occur in the small-bowel environment of antibiotic-treated patients after colectomy. Pseudomembranous enteritis should be a consideration in those patients who present with purulent ostomy drainage, abdominal pain, fever, leukocytosis, or symptoms of septic shock.- - - - - - - - - - ranking = 0.16700596357446keywords = mucosa (Clic here for more details about this article) |
4/63. Periodic fever and pharyngitis in young children: a new disease for the otolaryngologist?OBJECTIVE: A clinical entity consisting of periodic fever associated with aphthous stomatitis, pharyngitis and cervical adenitis termed "PFAPA syndrome" in young children (<5 years old) may be unfamiliar to otolaryngologists. We present our 5-year experience of PFAPA syndrome. DESIGN: Case series. SETTING: Tertiary academic. patients: A 5-year retrospective chart review for children (<5 years old) who have undergone tonsillectomies with and without adenoidectomies was conducted. medical records from subjects who underwent the procedures for recurrent pharyngitis were reviewed with reference to a history of periodic fever and stomatitis associated with pharyngitis. INTERVENTIONS: tonsillectomy with and without adenoidectomy. MAIN OUTCOME MEASURE: The objective measure was a comparison of the number of visits to the primary care physician for pharyngitis associated with fever in a 3-month period before and after the surgical intervention. The subjective measure was a telephone interview evaluating preoperative and postoperative symptoms. RESULTS: Of the 117 patients identified, 22 (19%) underwent surgery for recurrent pharyngitis. Five subjects (average age, 2.5 years) were identified as having PFAPA syndrome. The average number of preoperative PFAPA-related complaints was 11.6 compared with 0.2 for the number of postoperative PFAPA-related complaints (P=.03). CONCLUSIONS: Our experience suggests that PFAPA syndrome is an uncommon disease. Most of these children have undergone workup(s) for sepsis performed by their pediatricians because of the associated high fever. The clinical history of this cohort was quite distinctive. This small sample suggests a significant decrease if not cessation of pharyngitis following surgical intervention.- - - - - - - - - - ranking = 8100.8952737091keywords = aphthous, stomatitis (Clic here for more details about this article) |
5/63. Deaths of children during an outbreak of hand, foot, and mouth disease in sarawak, malaysia: clinical and pathological characteristics of the disease. For the Outbreak Study Group.From April through June 1997, 29 previously healthy children aged <6 years (median, 1.5 years) in Sarawak, malaysia, died of rapidly progressive cardiorespiratory failure during an outbreak of hand, foot, and mouth disease caused primarily by enterovirus 71 (EV71). The case children were hospitalized after a short illness (median duration, 2 days) that usually included fever (in 100% of case children), oral ulcers (66%), and extremity rashes (62%). The illness rapidly progressed to include seizures (28%), flaccid limb weakness (17%), or cardiopulmonary symptoms (of 24 children, 17 had chest radiographs showing pulmonary edema, and 24 had echocardiograms showing left ventricular dysfunction), resulting in cardiopulmonary arrest soon after hospitalization (median time, 9 h). Cardiac tissue from 10 patients showed normal myocardium, but central nervous system tissue from 5 patients showed inflammatory changes. brain-stem specimens from 2 patients were available, and both specimens showed extensive neuronal degeneration, inflammation, and necrosis, suggesting that a central nervous system infection was responsible for the disease, with the cardiopulmonary dysfunction being neurogenic in origin. EV71 and possibly an adenovirus, other enteroviruses, or unknown cofactors are likely responsible for this rapidly fatal disease.- - - - - - - - - - ranking = 1keywords = ulcer (Clic here for more details about this article) |
6/63. PFAPA syndrome (Periodic Fever, Aphthous stomatitis, pharyngitis, Adenitis).This paper aims to remind paediatric clinicians to suspect and confirm 'PFAPA' syndrome (Periodic Fever, Aphthous stomatitis, pharyngitis and cervical Adenitis syndrome). We report two cases of PFAPA syndrome: a 3-year-old healthy boy with atopic rhinitis and a boy aged 8 years 5 months who simultaneously had lymphocytic vasculitis syndrome treated with immunosuppressive drugs. Both met Marshall's criteria. The literature regarding PFAPA syndrome was complied using a medline search for articles published between 1963 and 1998 and we then reviewed the reference lists of the articles. The medline search revealed 28 cases with available clinical manifestations, management and prognosis. Our study describes two additional cases. We divided the cases into typical (28 cases) and atypical (two cases) PFAPA syndrome. In typical PFAPA, the age of onset was less than 5 years in most cases and the patients presented 4.9 /- 1.4 days of fever (100%), pharyngitis (89.3%), cervical adenitis (72.1%), stomatitis (71.4%), malaise (64.3%), headache (60.7%), abdominal pain (53.6%) and nausea/vomiting (17.9%). Afebrile intervals were 3.2 /- 2.4 months and increased with age. The time from initial onset to final episode was 3 years 7 months /- 3 years 6 months. The total number of episodes was 8.3 /- 2.5 (range 6-14). Effective treatment included steroids, tonsillectomy/adenoidectomy and cimetidine. The general outcome was good. In atypical PFAPF, the clinical manifestations were similar to those of typical PFAPA except that the age of onset was more than 5 years, and life-threatening intestinal perforation happened once in a patient with underlying Fanconi's anaemia. It was concluded that typical PFAPA syndrome is benign and can be diagnosed by detailed history-taking and from physical findings during repeated febrile episodes with tests to rule out other periodic fever syndromes. A review of the literatures since the first report in 1987 has shown that typical PFAPA syndrome is not associated with significant long-term sequelae and has a good response to steroids. One patient with atypical PFAPA, who received low-dose steroids for over 1 year, developed intestinal perforation after an increment of the 7-day steroid dose. If an underlying problem requires long-term immunosuppressive medication, it is wiser to choose cimetidine rather than increasing the steroid dosage to resolve atypical PFAPA.- - - - - - - - - - ranking = 2272.9971456887keywords = stomatitis (Clic here for more details about this article) |
7/63. Clinical onset of the Crohn's disease after eradication therapy of helicobacter pylori infection. Does helicobacter pylori infection interact with natural history of inflammatory bowel diseases?BACKGROUND: There are conflicting reports concerning the prevalence of helicobacter pylori infection in patients with inflammatory bowel diseases: some studies connected Sulphasalazine therapy and lower incidence of helicobacter pylori infection, but others showed lower prevalence of helicobacter pylori infection in inflammatory bowel diseases despite the choice of therapy. CASE REPORT: A 28-year-old male patient presented in January 1996 with the symptoms of ulcer like dyspepsia. There was no significant abnormality on physical examination, laboratory testing and abdominal ultrasound. histology examination of the biopsy specimen taken during the upper endoscopy revealed helicobacter pylori associated active gastritis only in the corporal part of the stomach. After two weeks eradication therapy (omeprazole, amoxicillin) he was well. Three months later, at the control endoscopy, granulomatous gastritis of the corporal localization was detected, without helicobacter pylori present. Antral mucosa appeared normal, both, on endoscopy and histology examination. In July 1996 he started with cramping abdominal pain, mild periodical fever and episodes of watery diarrhea. In laboratory results we found nonspecific signs of inflammation. We repeated upper endoscopy, colonoscopy and enteroclysis--with evidence of segmental stenotic lesions of the upper part of ileum and jejunum. Again, we confirmed granulomatous gastritis and small granuloma in the proximal jejunum. After starting the 5-ASA therapy in combination with Metronidazol, patient was better clinical condition, and laboratory results were normal. We suggested mesalamine maintenance therapy 1 gr. every day, and three years later he is well, in clinical remission of Crohn's disease. CONCLUSION: The clinical course of the Crohn's disease maybe "sui generis" connected with helicobacter pylori infection- but the exact mechanisms remain to be discovered.- - - - - - - - - - ranking = 1.0835029817872keywords = ulcer, mucosa (Clic here for more details about this article) |
8/63. Detection of cytomegalovirus infection in a patient with febrile ulceronecrotic Mucha-Habermann's disease.BACKGROUND: Febrile ulceronecrotic Mucha-Habermann's disease (FUMHD) is a severe and very rare variant of pityriasis lichenoides et varilioformis acuta, which is characterized by large coalescing, and ulceronecrotic maculopapules or plaques. Morphological changes of the skin accompanied by persistent high fever and several constitutional symptoms have suggested virus infection in patients with FUMHD. However, the available information of viral origin is limited. In this study we investigated the relationship of cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpesvirus 8 (HHV8), type I human T-cell lymphotropic virus (HTLV-I), and parvovirus B19 (PVB19) with FUMHD in a Taiwanese patient. methods: The existence of CMV, EBV, HHV8, HTLV-I, and PVB19 was determined by polymerase chain reaction (PCR). The presence of CMV in the endothelial cells was characterized by in situ hybridization (ISH) and immunohistochemistry (IHC). RESULTS: Serologic immunoglobulin to CMV and IHC identification of CMV late gene in the biopsy specimen indicated that the patient was infected with CMV. Detection of CMV was confirmed by PCR and ISH. CONCLUSIONS: These results indicate that FUMHD is associated with dermal CMV manifestation. Nonetheless, the induction mechanism of FUMHD with CMV infection has yet to be determined.- - - - - - - - - - ranking = 6keywords = ulcer (Clic here for more details about this article) |
9/63. Fevers and mouth ulcers.mouth ulcers are commonly caused by infection but may be due to neutropenia. The most common form of hyper-IgM syndrome is of X-linked inheritance and caused by cd40 ligand gene mutations. Consider hyper-IgM syndrome in a male child with recurrent bacterial or opportunistic infections, neutropenia, hypogammaglobulinaemia (IgG and IgA) and normal T- and B-cell counts. In X-linked hyper-IgM syndrome: - the serum IgM concentration is normal in about 50% of cases. - transient or persistent neutropenia occurs in 70% of cases. First-line therapeutic options for hyper-IgM syndrome include regular intravenous immunoglobulin and prophylactic trimethoprimsulphamethoxazole.- - - - - - - - - - ranking = 5keywords = ulcer (Clic here for more details about this article) |
10/63. Occult maxillary sinusitis as a cause of fever in tetraplegia: 2 case reports.Common causes of fever in tetraplegia include urinary tract infection, respiratory complications, bacteremia, impaired autoregulation, deep vein thrombosis, osteomyelitis, drug fever, and intra-abdominal abscess. We report 2 acute tetraplegic patients who presented with fever of unknown origin. After extensive work-up, they were diagnosed with occult maxillary sinusitis. A search of current literature revealed no reports of sinusitis as a potential source of fever in recently spinal cord--injured patients. patients with tetraplegia, especially in the acute phase of spinal cord injury, often undergo nasotracheal intubation or nasogastric tube placement, which may result in mucosal irritation and nasal congestion. All of the previously mentioned factors, in combination with poor sinus drainage related to supine position, predispose them to developing maxillary sinusitis. The 2 consecutive cases show the importance of occult sinusitis in the differential diagnosis of fever in patients with tetraplegia.- - - - - - - - - - ranking = 0.083502981787232keywords = mucosa (Clic here for more details about this article) |
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