11/85. Familial occurrence of the May-Hegglin anomaly: is the accompanying renal failure part of a new subentity?We present two cases of the May-Hegglin anomaly discovered in a patient and one of her two sons. The female patient was known to have proteinuria from the age of 14 and was hospitalized in 1980, at the age of 25 years, because of hypertension and proteinuria (1.5 g/day). thrombocytopenia was found with an abundance of megakaryocytes in the bone marrow. Both steroid treatment and splenectomy failed to ameliorate the thrombocytopenia, thought to be due to idiopathic thrombocytopenic purpura. Progressive renal failure, secondary hyperparathyroidism and uremic osteodystrophy were diagnosed in 1995. In January 1996, when she was hospitalized because of high-grade fever, we saw giant platelets and prominent blue inclusion bodies in almost all granulocytes in the peripheral blood smear. Electron microscopy confirmed the diagnosis of May-Hegglin anomaly in this patient and one of her sons, who at that time showed thrombocytopenia but no renal disease. Three years later, however, at the age of 15, the affected son was found to develop proteinuria. Coexpression of the May-Hegglin anomaly and renal disease, reported previously in a few other patients, may in fact represent a new subentity.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
12/85. Shigella septicaemia in adults: report of two cases and mini-review.INTRODUCTION: We report 2 cases of Shigella septicaemia in adult patients. CLINICAL PICTURE: Two 57-year-old women presented with non-bloody diarrhoea and fever. The first patient was an inmate of a long-term care facility who was schizophrenic and the second patient was a diabetic who recently travelled to Medan, indonesia. Both patients were febrile, hypotensive and dehydrated. The first patient was neutropenic, thrombocytopenic and had acute renal failure. blood cultures yielded shigella flexneri and stool cultures gave negative results for both patients. TREATMENT: Rehydration and intravenous ceftriaxone were instituted. OUTCOME: The patients' symptoms and hypotension resolved. CONCLUSION: Appropriate antibiotics can decrease the severity and duration of Shigella septicaemia.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
13/85. Management of a patient with hiv infection-induced anemia and thrombocytopenia who presented with thrombotic thrombocytopenic purpura.A 32-year-old male presented with fever, mental status changes, renal dysfunction, cytopenias and hemolysis. His platelet count was 14,000/microL, hemoglobin 5.7 g/dL and LDH 2,636 U/L. He was diagnosed with thrombotic thrombocytopenic purpura (TTP) and also found to be hiv positive on admission. TTP was confirmed by a low von willebrand factor-cleaving protease level, the gold standard test for TTP, which was 10-15%. No protease-specific antibody was detected. Treatment of this patient consisted of 23 plasmapheresis procedures and trials of vincristine and dextran-70. Despite therapy, the patient remained anemic and thrombocytopenic, though his mental status and renal abnormalities improved. Highly active anti-retroviral therapy (HAART) consisting of efavirenz, 3TC, and d4T was started. Only after plasma exchanges were discontinued and HAART was instituted did the cytopenias resolve. He continued to improve following discharge, and platelet count was 206,000/microL and hemoglobin, 12.5 g/dL one month after the initiation of HAART.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
14/85. Hepatosplenic gammadelta T-cell lymphoma presenting with immune-mediated thrombocytopenia and hemolytic anemia (Evans' syndrome).We describe an unusual case of hepatosplenic T-cell lymphoma in a 61-year-old man who presented with fever, hepatosplenomegaly, anemia, and thrombocytopenia. A spleen biopsy was consistent with T-cell lymphoma. Cytogenetic studies did not reveal chromosome abnormalities. Using the polymerase chain reaction approach, clonality of the T-cell receptor gamma-chain gene rearrangement could be demonstrated, while Southern blot analysis disclosed only a germline configuration of the T-cell receptor beta chain genes. Of interest, an immune-mediated mechanism was demonstrated and was most likely responsible for erythrocyte and platelet destruction; this is, therefore, the first report of gamma T-cell lymphoma in association with Evans' syndrome. Initial steroid treatment was efficacious in limiting autoimmunity but constitutional symptoms did not subside. Chemotherapy (MACOP-B) was successful in obtaining complete clinical remission. Finally, thrombocytopenia in gammadelta T-cell lymphoma patients should be routinely evaluated for platelet autoantibodies.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
15/85. Isolated thrombocytopenia: the presenting finding of typhoid fever.thrombocytopenia is generally seen as a complication in typhoid fever. However, it can also be encountered as a presenting sign on admission. A 29-year-old man with complaints of fever and diarrhoea was hospitalized because of isolated thrombocytopenia encountered on routine complete blood count examination. The diagnosis of typhoid fever was established when salmonella typhi was isolated from the blood cultures. The platelet count returned to normal level within the first week of ceftriaxone therapy. Possible mechanisms of thrombocytopenia were discussed.- - - - - - - - - - ranking = 7keywords = fever (Clic here for more details about this article) |
16/85. Pseudothrombocytopenia associated with infectious mononucleosis.A 22-year-old man was hospitalized for assessment of thrombocytopenia and fever. Examination showed that he had infectious mononucleosis and moderately severe thrombocytopenia that was asymptomatic. Examination of blood smears revealed that the thrombocytopenia was caused by the clumping of platelets. We made a diagnosis of ethylenediaminetetraacetic acid-dependent pseudothrombocytopenia after excluding other infectious mononucleosis-related mechanisms of thrombocytopenia. When the patient recovered from infectious mononucleosis 2 months later, his thrombocytopenia improved, and no platelet clumping in peripheral blood smears was noted. Ethylenediaminetetraacetic acid-dependent pseudothrombocytopenia should always be considered as a possible cause of reported low platelet counts, even in patients with infectious mononucleosis and splenomegaly.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
17/85. Severe echovirus 30 infection in twin neonates.Although enteroviruses can cause overwhelming and fatal systemic infections in neonates, such severe neonatal infections remain uncommon and rarely involve both of twin neonates at the same time. We report the cases of twin neonates who developed fever initially, and then progressed to disseminated systemic disease with marked thrombocytopenia, coagulopathy, and hepatic failure. One of the neonates died and the other survived. Both neonates were treated with intravenous immunoglobulin and maternal fresh frozen plasma was also given to the neonate who survived. Virus cultures from the nasopharynx, rectum and cerebral spinal fluid of both neonates yielded enterovirus, later typed as echovirus 30. The surviving neonate had normal development without obvious sequelae during a follow-up period of 1 year. The major determinant of the survival from severe neonatal enterovirus infection might have been the pre-existing severity of the disease before treatment, and complete recovery could be expected if the infant survived the acute stage of illness.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
18/85. dengue hemorrhagic fever with fulminant hepatic failure in an immigrant returning to bangladesh.An immigrant from bangladesh living in the United Kingdom presented with a nonspecific febrile illness after visiting his homeland and subsequently developed fulminant hepatic failure accompanied by hypotension, ascites, a generalized coagulopathy, and thrombocytopenia. serology and detection of dengue virus serotype 3 by PCR established a postmortem diagnosis of hepatic failure secondary to dengue hemorrhagic fever.- - - - - - - - - - ranking = 5keywords = fever (Clic here for more details about this article) |
19/85. vancomycin-induced thrombocytopenia: a case proven with rechallenge.In a rare case of vancomycin-induced thrombocytopenia, a 50-year-old man with culture-negative subacute bacterial endocarditis underwent mitral valve replacement surgery and was treated with vancomycin. His platelet count dropped from 346 x 10(3)/mm3 to 13 x 10(3)/mm3 on postoperative day 4, and a differential diagnosis of heparin- versus drug-induced thrombocytopenia was considered. Antiheparin antibodies were detected in the patient's serum on day 5. He showed no signs of bleeding. His platelet count remained below 5 x 10(3)/mm3 despite two platelet transfusions on day 5. A hemorrhagic pericardial effusion with tamponade developed, requiring drainage. A trial with intravenous immunoglobulin led to fever and chills, and the infusion was not completed. vancomycin was changed to clindamycin on day 9, and methylprednisolone therapy was started on day 11. On day 12, the patient's clinical condition improved, and his platelet count increased from 3 x 10(3)/mm3 to 32 x 10(3)/mm3 with no bleeding. On day 18, his platelet count was 424 x 10(3)/mm3, and he was scheduled for discharge with vancomycin therapy for a total of 6 weeks. He received a single dose of intravenous vancomycin 1 g at the hospital; his platelet count dropped to 160 x 10(3)/mm3 1 hour after the infusion and to 58 x 10(3)/mm3 12 hours later. vancomycin was discontinued and clindamycin and prednisone were restarted. On day 20, the patient's platelet count increased to 105 x 10(3)/mm3 and he was discharged with warfarin, prednisone, and clindamycin therapy. We suspect that our patient's thrombocytopenia was due to vancomycin.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
20/85. Interferon alfa-2a therapy for life-threatening hemangiomas of infancy.BACKGROUND AND methods. Most hemangiomas are small, harmless birthmarks that appear soon after birth, proliferate for 8 to 18 months, and then slowly regress over the next 5 to 8 years, leaving normal or slightly blemished skin. In rare cases, hemangiomas can endanger vital structures, with a mortality of up to 60 percent. About a third of these life-threatening hemangiomas respond to treatment with corticosteroids, but for the others there is no safe and effective treatment. We evaluated the effects of daily subcutaneous injections of interferon alfa-2a (up to 3 million units per square meter of body-surface area) in 20 neonates and infants with life-threatening or vision-threatening hemangiomas that failed to respond to corticosteroid therapy. RESULTS. In 18 of the 20 patients the hemangiomas regressed by 50 percent or more after an average of 7.8 months of treatment (range, 2 to 13). One infant died of refractory proliferation of a lesion and consumptive coagulopathy. The condition of three other patients who had large hemangiomas associated with consumptive coagulopathies that were unresponsive to conventional therapies stabilized after seven days of treatment with interferon alfa-2a alone. Transient side effects of treatment with interferon alfa-2a included fever, neutropenia (one patient), and skin necrosis (one patient). No long-term toxicity has been observed after a mean follow-up of 16 months. CONCLUSIONS. Interferon alfa-2a appears to induce the early regression of life-threatening corticosteroid-resistant hemangiomas of infancy.- - - - - - - - - - ranking = 1keywords = fever (Clic here for more details about this article) |
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