11/63. polyarteritis nodosa.polyarteritis nodosa (PAN) is regarded rightly as the grandfather of the vasculitides. In this Grand Rounds, the case of a 30-year-old man with a 12-year illness is described. The patient presented with daily fevers, tachycardia, and cutaneous ulcers on his distal extremities. He eventually developed mononeuritis multiplex. Because of the striking pattern of his fevers, he was diagnosed for many years as having adult-onset Still disease. Following the addition of daily cyclophosphamide to his long-standing regimen of prednisone, the patient's disease entered remission for the first time in more than a decade. He was ultimately able to discontinue all of his immunosuppressive medications. The case is discussed in the context of the first patient ever described with PAN, the classic report of Kussmaul and Maier.- - - - - - - - - - ranking = 1keywords = ulcer (Clic here for more details about this article) |
12/63. Centrofacial malignant T-cell lymphoma exhibiting recurrent fever and skin ulcer in a 3-year-old girl.A rare case of undetermined fever and skin ulcers is reported. The patient had an 8-month history of recurrent fever, destructive ulceration of the midline facial tissue, and symmetrical skin ulcer in the cheeks and the back of the hand. Pathological examination revealed that the patient had lethal midline granuloma (centrofacial malignant T-cell lymphoma), which is very rare in childhood. Centrofacial malignant T-cell lymphoma should be considered as a differential diagnosis of unexplained fever and skin ulcer in children.- - - - - - - - - - ranking = 8keywords = ulcer (Clic here for more details about this article) |
13/63. Sweet's syndrome: recurrent oral ulceration, pyrexia, thrombophlebitis, and cutaneous lesions.We report a case of Sweet's syndrome with recurrent oral ulceration, pyrexia, skin lesions, and migratory thrombophlebitis, with no detectable systemic cause, during a 2-year follow-up. biopsy examination both of oral lesions and the skin eruption showed a characteristic dense, perivascular, neutrophilic infiltrate in the lamina propria. Laboratory investigations confirmed an inflammatory syndrome with an increased erythrocyte sedimentation rate, but no underlying cause was found. Sweet's syndrome is a rare immunologically mediated condition that belongs to the group of neutrophilic dermatoses that must be differentiated particularly from Behcet's disease. It is characterized by red-brown plaques and nodules that are frequently painful and occur primarily on the head, neck, and upper extremities. Often the patients also have neutrophilia and fever and may have oral ulceration. In approximately 10% of patients with Sweet's syndrome, there is an associated malignancy--most commonly acute myelogenous leukemia--but some cases, as here, are unassociated with detectable malignant or other disease, although the syndrome may precede the onset of definable systemic disease.- - - - - - - - - - ranking = 6keywords = ulcer (Clic here for more details about this article) |
14/63. Colonic perforation due to necrotizing amoebic colitis.A seriously ill woman with the history of fever for 14 days and severe pain in abdomen with frequent passage of blood and mucous mixed loose stool for 11 days was admitted in the Surgery Unit-3 of Mymensingh Medical Collage Hospital. On examination the patient was toxic, moderately anaemic and dehydrated and there was diffuse abdominal tenderness with a palpable tender cystic intra abdominal lump in right lower abdomen. Fluidthril was present with absent bowel sound. digital rectal examination revealed bulged anterior rectal wall. X-ray abdomen revealed multiple gas and fluid leveled loops of intestine with increased haziness of the film. On emergency laparotomy it revealed huge amount of faecal matter with fluid in peritoneal cavity. The greater omentum was adherent to caecum with multiple friable necrotic areas in the caecum, transverse and splenic flexure of the colon with multiple small perforations, Subtotal colectomy and end to end anastomosis was done. Histopathological examination of the resected gut revealed features compatible with amoebic ulcer perforations. On 13th post operative day the patient was discharged without any post operative complication and in the 1st follow up after one month the patient was found without any complication.- - - - - - - - - - ranking = 1keywords = ulcer (Clic here for more details about this article) |
15/63. Utility of tonsillectomy in 2 patients with the syndrome of periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis.OBJECTIVES: To review the various causes of period fever in childhood, including the syndrome of periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA), and to examine the value of tonsillectomy in the treatment of PFAPA syndrome. DESIGN: Retrospective case series. SETTING: Urban and tertiary care referral children's hospital. patients: Two patients who underwent tonsillectomy for presumed recurrent adenotonsillitis were later diagnosed as having PFAPA syndrome.Intervention tonsillectomy. MAIN OUTCOME MEASURE: Frequency of PFAPA symptoms before and after tonsillectomy. RESULTS: No difference was found in the frequency of PFAPA symptoms after tonsillectomy. CONCLUSION: Although a larger series of patients is required, our initial experience suggests that tonsillectomy is not always beneficial for patients with PFAPA syndrome.- - - - - - - - - - ranking = 38610.312080472keywords = aphthous, stomatitis (Clic here for more details about this article) |
16/63. PFAPA syndrome: with regard to a case.BACKGROUND: PFAPA syndrome (Periodic fever, Aphtas, pharyngitis and cervical Adenopathies) is one of the causes of periodic fever in pediatrics and it is characterised by high fever, pharyngitis, cervical adenitis and aphtous stomatitis. Its etiopathogeny is unknown. The diagnosis is clinical and the findings of laboratory are unspecified. One or two doses (1 mg/kg) of oral prednisone are enough for a fast resolution of the clinic. It is a benign syndrome and no sequels have been noticed after its disappearance, usually in four years from its beginning. CLINICAL CASE: We present the case of a 10-year-old patient who has been diagnosed of PFAPA syndrome after 3 years and a half of characteristic clinical bouts, with the fulfilment of diagnostic criteria and after having excluded other entities of similar presentation. CONCLUSIONS: Periodic episodes of high fever, pharyngitis and cervical adenitis with a bad response to the conventional treatment should alert us to the PFAPA syndrome. The recognition of this entity will help us to improve the diagnostic and therapeutical focusing, lowering also the anxiety that these cases produce.- - - - - - - - - - ranking = 378.83285761479keywords = stomatitis (Clic here for more details about this article) |
17/63. Acne fulminans: investigation of acute febrile ulcerative acne.Eight cases of acne fulminans (acute febrile ulcerative acne) are compared with 13 previously reported cases. This rare disorder of male teenage patients is characterized by the sudden appearance of highly inflammatory, tender, ulcerative and crusted lesions on the back, chest, and face: it is one of the most scarring acute dermatologic disorders of young patients. At the onset of the disease, all patients showed febrile temperatures and marked leukocytosis; other systemic symptoms occurred with varying frequency. Polyarthralgia was noted in half of our series. Investigations of potential trigger mechanisms (eg, septisemia due to corynebacterium acnes, immunologic defects, altered polymorphonuclear leukocyte function, shwartzman phenomenon) did not yield any clues regarding the pathogenesis of this disease. Clinical and laboratory findings suggest that acne fulminans is not directly related to acne conglobata.- - - - - - - - - - ranking = 6keywords = ulcer (Clic here for more details about this article) |
18/63. Concomitant oculoglandular and ulceroglandular fever due to herpes simplex virus type I.herpes simplex virus is a commonly encountered infectious agent in clinical practice. The syndromes with which it is usually associated are well described and generally easily recognized. This report documents that two uncommon clinical syndromes, ulceroglandular fever and oculoglandular fever, may be caused by this virus. Our patient's case was even more unusual in that both conditions occurred simultaneously.- - - - - - - - - - ranking = 5keywords = ulcer (Clic here for more details about this article) |
19/63. Febrile ulceronecrotic Mucha-Habermann disease: a case report and a review of the literature.This report describes the case of a 76 year old man who suffered from febrile ulceronecrotic Mucha-Habermann disease (FUMHD). Despite this patient's typical clinical and histological findings, the fulminating course led to death. polymerase chain reaction (PCR) analysis of the skin lesions showed that the infiltrating cells were monoclonal in origin and were from an aberrant clone. FUMHD is a very rare, febrile variant type of pityriasis lichenoides et varioliformis acuta, and is characterised by necrotic cutaneous ulcerations associated with high fever and systemic manifestations. Including this present case, only 18 cases of FUMHD have been reported. FUMHD can occur in both adults and children, although there are several differences between the manifestations of the disease in the two groups. One major difference is prognosis: all cases resulting in fatality are of the adult type, whereas no fatal cases have been reported among children. The aberrant clone detected by PCR may be responsible for host responses, resulting in the severe symptoms observed in this disorder.- - - - - - - - - - ranking = 6keywords = ulcer (Clic here for more details about this article) |
20/63. Acute human immunodeficiency virus syndrome in an adolescent.Acute human immunodeficiency virus (hiv) seroconversion illness is a difficult diagnosis to make because of its nonspecific and protean manifestations. We present such a case in an adolescent. A 15-year-old boy presented with a 5-day history of fever, sore throat, vomiting, and diarrhea. The patient also reported a nonproductive cough, coryza, and fatigue. The patient's only risk factor for hiv infection was a history of unprotected intercourse with 5 girls. physical examination was significant for fever, exudative tonsillopharyngitis, shotty cervical lymphadenopathy, and palpable purpura on both feet. Laboratory studies demonstrated lymphopenia and mild thrombocytopenia. Hemoglobin, serum creatinine, and urinalysis were normal. The following day, the patient remained febrile. physical examination revealed oral ulcerations, conjunctivitis, and erythematous papules on the thorax; the purpura was unchanged. Serologies for hepatitis b, syphilis, hiv, and Epstein-Barr virus were negative. Bacterial cultures of blood and stool and viral cultures of throat and conjunctiva showed no pathogens. Coagulation profile and liver enzymes were normal. Within 1 week, all symptoms had resolved. The platelet count normalized. Repeat hiv serology was positive, as was hiv dna polymerase chain reaction. Subsequent hiv viral load was 350 000, and the cd4 lymphocyte count was 351/mm3. hiv is the seventh leading cause of death among people aged 15 to 24 in the united states, and up to half of all new infections occur in adolescents. Our patient presented with many of the typical signs and symptoms of acute hiv infection: fever, fatigue, rash, pharyngitis, lymphadenopathy, oral ulcers, emesis, and diarrhea. Other symptoms commonly reported include headache, myalgias, arthralgias, aseptic meningitis, peripheral neuropathy, thrush, weight loss, night sweats, and genital ulcers. Common seroconversion laboratory findings include leukopenia, thrombocytopenia, and elevated transaminases. The suspicion of acute hiv illness should prompt virologic and serologic analysis. Initial serology is usually negative. Diagnosis therefore depends on direct detection of the virus, by assay of viral load (hiv rna), dna polymerase chain reaction, or p24 antigen. Both false-positive and false-negative results for these tests have been reported, further complicating early diagnosis. Pediatricians should play an active role in identifying hiv-infected patients. Our case, the first report of acute hiv illness in an adolescent, emphasizes that clinicians should consider acute hiv seroconversion in the appropriate setting. Recognition of acute hiv syndrome is especially important for improving prognosis and limiting transmission. It is imperative that we maintain a high index of suspicion as primary care physicians for adolescents who present with a viral syndrome and appropriate risk factors.- - - - - - - - - - ranking = 3keywords = ulcer (Clic here for more details about this article) |
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