Asunto(s)
Antineoplásicos/uso terapéutico , Trasplante de Células Madre Hematopoyéticas/efectos adversos , Leucemia Mieloide Aguda/tratamiento farmacológico , Mutación Puntual , Inhibidores de Proteínas Quinasas/uso terapéutico , Tirosina Quinasa 3 Similar a fms/genética , Adulto , Bencenosulfonatos , Femenino , Enfermedad Injerto contra Huésped , Humanos , Leucemia Mieloide Aguda/genética , Leucemia Mieloide Aguda/metabolismo , Niacinamida/análogos & derivados , Compuestos de Fenilurea , Piridinas , Recurrencia , Sorafenib , Trasplante Homólogo , Tirosina Quinasa 3 Similar a fms/antagonistas & inhibidoresRESUMEN
Henoch-Schönlein purpura (HSP) frequently occurs in children below the age of 15 years and is rare with increasing age. Prognosis and therapy largely depend on the clinical presentation. The disease may be preceded by an upper respiratory tract infection, and drugs have also been implicated in the pathogenesis of the disease. Most children recover from the illness, whereas 40% of adults have persistent hematuria and 10% develop chronic renal failure. Recent studies strongly suggest that adults with HSP should be monitored for prolonged periods and treated aggressively. Here, we present a case of a patient with HSP who developed multiorgan failure requiring assistance in breathing and dialysis, and also sustained gastrointestinal bleeding despite aggressive immunosuppressive therapy. In analogy to published data in children with severe HSP, the patient was treated by plasma exchange in combination with low dose oral cyclophosphamide, while high dose steroids were reduced over time. The patient could be discharged 70 days after admission. One year after discharge, the patient is doing well without any signs of activity of HSP and completely unremarkable renal function. The maintenance daily dose of steroids is 7.5 mg.
Asunto(s)
Vasculitis por IgA/terapia , Insuficiencia Multiorgánica/terapia , Plasmaféresis , Ciclofosfamida/uso terapéutico , Hemorragia Gastrointestinal/complicaciones , Hemorragia Gastrointestinal/terapia , Humanos , Vasculitis por IgA/complicaciones , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana Edad , Intercambio Plasmático , Pronóstico , Resultado del TratamientoRESUMEN
Many different diseases have overlapping clinical symptoms. A major challenge in daily clinical practice is to differentiate between diseases associated with systemic inflammation, such as neoplasia, infection and autoimmune disease. We report on a 46-year-old Caucasian male with a 3-month history of rheumatoid arthritis presenting with dramatic weight loss and dysphagia. Computer tomography revealed multiple lesions in the liver and the spleen, strongly suggesting malignant disease of unknown origin. Surprisingly, on biopsy, the liver lesions drained pus. Workup revealed that the abscesses resulted from gastric perforation, which was the consequence of NSAR therapy for rheumatoid arthritis. Antibiotic therapy was initiated, abscesses diminished and dysfunctional deglutition improved. This unique case demonstrates in a dramatic way the difficulties in daily clinical practice to differentiate between paraneoplasia, infection and autoimmune disease and the potentially life-threatening consequences of their therapy.
Asunto(s)
Artritis Reumatoide/diagnóstico , Hepatopatías/diagnóstico , Síndromes Paraneoplásicos/diagnóstico , Enfermedades del Bazo/diagnóstico , Infecciones Estreptocócicas/diagnóstico , Antirreumáticos/efectos adversos , Artritis Reumatoide/tratamiento farmacológico , Trastornos de Deglución/microbiología , Diagnóstico Diferencial , Humanos , Hepatopatías/microbiología , Masculino , Persona de Mediana Edad , Enfermedades del Bazo/microbiología , Rotura Gástrica/inducido químicamente , Streptococcus intermedius/aislamiento & purificación , Tomografía Computarizada por Rayos X , Pérdida de PesoAsunto(s)
Anticuerpos Monoclonales/uso terapéutico , Antígenos CD20/inmunología , Enfermedad Mixta del Tejido Conjuntivo/terapia , Administración Oral , Ciclofosfamida/administración & dosificación , Femenino , Humanos , Técnicas de Inmunoadsorción , Inmunosupresores/administración & dosificación , Persona de Mediana Edad , Resultado del TratamientoRESUMEN
Assessment of gustatory sensitivity in a clinical setting is the prerequisite for correct diagnosis and adequate treatment of taste dysfunction. Despite of this, no taste test has been established for the routine clinical testing. The aim of the present study was to create a protocol which is easy to administer. The presently used technique is based on strips made from filter paper which were impregnated with different taste solutions (four concentrations each for sweet, sour, salty and bitter). These strips are placed on the tongue and subjects are asked to identify the taste quality. After establishing the concentration range of the taste solutions, the test was tried in 69 subjects. Each subject received eighteen taste strips (four concentrations of each taste quality plus two blanks) in a pseudo-randomized sequence. Results from this new procedure correlated significantly with the results of the well established extensive three-drop-technique (r69 = 0.67). Repeated measures indicated good reproducibility of the results for the taste strips (r69 = 0.68). These data suggest the usefulness of this new technique in routine clinical practice. Major advantages are long shelf-life, convenience of administration, short time needed for testing (approximately 8 min), and the possibility to test each side of the tongue separately.