1/10. Primary sclerosing cholangitis in a child.Primary sclerosing cholangitis (PSC) is a rare disease in taiwan and has not been described in Taiwanese children previously. We report a 4-year-old girl who presented with prolonged fever, eosinophilia (11%), hepatomegaly, and markedly elevated serum levels of alkaline phosphatase (3,318 IU/L) and gamma-glutamyl transpeptidase (475 IU/L). Subsequent investigations including endoscopic retrograde cholangiopancreatography and liver histology confirmed the diagnosis fo PSC. Treatment with a low dose of prednisolone for 2 months and ursodeoxycholic acid during 32 months of follow-up resulted in clinical remission and halted disease progression. A high index of suspicion is necessary for physicians to diagnose this disorder in children with chronic liver disease. Our experience in this case indicates that therapy with prednisolone and ursodeoxycholic acid may be helpful for the treatment of PSC in children, and suggests the need for more trials of combined therapy.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/10. Is it Crohn's disease? A severe systemic granulomatous reaction to sulfasalazine in patient with rheumatoid arthritis.BACKGROUND: sulfasalazine is a widely used anti-inflammatory agent in the treatment of inflammatory bowel disease and several rheumatological disorders. Although as many as 20% of treated patients may experience reversible, dose-dependent side effects, less frequent but potentially severe, systemic reactions have also been reported. CASE PRESENTATION: A severe systemic reaction to sulfasalazine developed in a 21-year old female with rheumatoid arthritis characterized by eosinophilia, granulomatous enteritis and myelotoxicity, cholestatic hepatitis, and seizures. The clinical course and management of this patient are presented as well as a review of the incidence and outcome of severe systemic reactions to sulfasalazine. CONCLUSIONS: Granulomatous myelotoxicity and enteritis developed in a 21 year old female within 3 weeks of initiating sulfasalazine for rheumatoid arthritis. Following a short course of corticosteroids, the patient had resolution of her cholestatic hepatitis, rash, eosinophilia, and gastrointestinal symptoms with no residual manifestations at 7 months follow-up. Although severe reactions to sulfasalazine are rare and unpredictable, practicing physicians should be aware of unusual clinical presentations of toxicity when prescribing sulfasalazine.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/10. A case of left ventricular endomyocardial fibrosis.The patient was a 29-year-old woman. When she consulted a local physician with chief complaints of fever and fatigue of the extremities, cerebral infarction was detected on MRI, in addition to abnormalities found on ECG. Ultrasonic cardiography revealed the presence of a tumor in the left ventricle. Therefore, tumorectomy and endocardectomy were performed under extracorporeal circulation based on a diagnosis of cardiac tumor. Inflammatory cell infiltration into the ventricular wall was pathologically confirmed, and eosinophilia was observed preoperatively. Therefore, the patient was diagnosed as having endomyocardial fibrosis, which is rarely observed in japan. The postoperative course of this patient was satisfactory, and the eosinophil count was normalized postoperatively. At present, this patient is being followed at the outpatient clinic.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/10. Evaluation of the returned traveler.Recognition of clinical syndromes in returned travelers is an important part of providing care to international travelers. The first step is to take a history with attention to pre-travel preventive measures, the patient's itinerary, and potential exposure to infectious agents. The patient should then be examined to document physical signs, such as fever, rash, or hepatosplenomegaly, and to have basic laboratory data obtained. This evaluation will provide most physicians with the necessary information to generate a differential diagnosis. Each diagnosis should be matched against the incubation period of the disease, the geographic location of illness, the frequency of illness in returned travelers, and the pre-travel preventive measures. Careful attention to these aspects of patient care should result in the appropriate diagnosis and therapeutic intervention for the ill returned traveler.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/10. Eosinophilic meningitis: a case series report and review of the literature.Prompted by a case of eosinophilic meningitis (EM), a review of the literature was performed to evaluate the strength of the diagnoses associated with EM and compares these results with our hospital's experience. Articles were critically reviewed for supporting evidence, method of diagnosis, and established standards for specific diagnosis. EM has been defined as > or = 10 eosinophils per mm3 or > or = 10% eosinophils of total cell count. Sixty-two cases of EM were found at our institution and reviewed. The results of this case series review concur with those found in the literature. It also suggests the importance of considering infectious and noninfectious etiologies when faced with eosinophils in the cerebrospinal fluid. This review and case study analysis provides the clinician with a critically established set of differential diagnoses and a concise definition of EM that may assist the physician in the evaluation of patients presenting with eosinophils in the cerebrospinal fluid.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/10. Eosinophilic gastroenteritis: presentation of two patients with unusual affect of terminal ileum and caecum with manifestations of acute abdomen and literature review.Eosinophilic gastroenteritis is a rare disease; the long-term personal history with digestive symptoms and the course of the disease with relapses and remissions is the key for the disease to be suspected. endoscopy, CT scan and sonographic studies may provide important indirect signs of the disease and in combination with histological examination the diagnosis can be achieved. The administration of corticosteroids is an important factor for the treatment or the remission of the disease. In this study two cases with unusual location of the disease, on the terminal ileum and caecum, are presented and a literature review is attempted. The disease process, clinical and laboratory findings as well as the surgical approach used are described. Eosinophilic gastroenteritis is a very rare disease with its surgical complications. The disease is a non-surgical disease, thus presurgical diagnosis is important because the entity discussed can be under control by conservative treatment. A high disease suspicious index must be kept in the physicians' mind.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/10. Eosinophilic granulomatous lymphadenopathy: association with hyper-IgE and eosinophilia.Cervical lymph node enlargement is probably the most frequently detected childhood lymphadenopathy. We report 2 cases of cervical lymphadenopathy in children associated with hyper-IgE and eosinophilia, displaying the features of necrotizing eosinophilic granulomatosis. Immunohistochemical analysis and a serological work-up failed to elucidate the underlying etiology. We would like to call the attention of physicians and pathologists to this unusual clinical picture, different from the fatal form of necrotizing eosinophilic granulomatosis, and we suggest a role for the eosinophils in the pathologic appearance of the lymph nodes.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/10. A case of eosinophilic meningo-encephalitis accompanied by eosinophilic inflammation of the myenteric plexus in Hodgkin's disease.A case of Hodgkin's disease with eosinophilia in the cerebrospinal fluid without blood eosinophilia is presented. An additional remarkable feature was the finding of eosinophilia in Auerbach's myenteric plexus. cerebrospinal fluid eosinophilia is usually associated with blood eosinophilia and this is often caused by helminthic infections of the CNS. The finding of cerebrospinal fluid eosinophilia without blood eosinophilia in any patient with Hodgkin's disease should point the physician to the possibility of a localization of tumour in the CNS.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/10. porokeratosis of Mibelli: benzylhydrochlorothiazide-induced new lesions accompanied by eosinophilic spongiosis.We observed the course of development of porokeratosis stimulated by benzylhydrochlorothiazide (BHCTh) in normal-appearing skin of a patient with long-standing stable porokeratosis of Mibelli. A 72-year-old Japanese man had had porokeratosis of Mibelli for more than 50 years. During administration of BHCTh for 1 year because of his hypertension, a lichenoid drug eruption developed over the lesions of porokeratosis on the flexor aspects of his legs. Readministration of BHCTh by another physician for 6 months resulted in the occurrence of a similar drug eruption that converted into typical skin lesions of porokeratosis 8 weeks later. Serial microscopic examination suggested that BHCTh administration resulted in eosinophilic spongiosis and cornoid lamella formation, which developed into epidermal changes characteristic of porokeratosis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/10. strongyloidiasis. When to suspect the wily nematode.strongyloidiasis is a tenacious soil-transmitted nematode infestation endemic in the south-eastern united states. Thirty-three cases were diagnosed in a series of 1,290 stool examinations in 971 patients at veterans Administration Medical Center, Mountain Home, tennessee. Most patients had a concurrent major illness, such as chronic lung disease, serious bacterial infection, or cancer. A minority presented with gastrointestinal symptoms alone. skin rash was uncommon. eosinophilia, IgE elevation, and skin anergy were common. Atypical presentations included severe proctitis, colitis, and exacerbation of inflammatory bowel disease. In a patient with the hyperinfection syndrome, the diagnosis was made only at autopsy. Since strongyloidiasis seems to present like an opportunistic illness, all physicians, not just those in endemic areas, should consider its presence in the appropriate setting.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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