1/15. Horizontal conjugate gaze palsy in eosinophilic meningitis.Two cases of eosinophilic meningitis who presented with headache and strabismus are reported. Pertinent physical examination revealed unilateral horizontal conjugate gaze palsy with absence of doll's eye maneuver and hemiparesis. The etiologic agent of eosinophilic meningitis is presumed to be angiostrongylus cantonensis and the infected location that produce horizontal conjugate gaze palsy was a pontine lesion.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/15. Recurrent cholestasis and hypereosinophilia in a young female.A 22-year-old female presented, in December 1998, with asthenia, itching and hypereosinophilia. In January 1997, due to the same clinical picture, the patient had inappropriately been diagnosed elsewhere to have an "idiopathic eosinophilic syndrome" and complete remission was obtained after short-term steroid treatment. Upon admission, physical examination was negative and blood tests revealed absolute eosinophilia [42%, i.e., 3,800 of 9,600 white blood cells], aspartate aminotransferase 4 x upper limits of normal, alanine aminotransferase 5 x upper limits of normal and alkaline phosphatase 2 x upper limits of normal. Both liver biopsy and endoscopic retrograde cholangiopancreatography findings were totally consistent with primary sclerosing cholangitis, while all known causes of hypereosinophilia and alteration in liver function tests were carefully excluded. The clinical course was characterized by complete clinical and biochemical normalization in absence of any treatment and further follow-up was completely negative.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/15. 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 = 0.064674296937185keywords = physical (Clic here for more details about this article) |
4/15. Eosinophilic peritonitis in a patient with continuous ambulatory peritoneal dialysis (CAPD).Eosinophilic peritonitis is defined as when there are more than 100 eosinophils present per milliliter of peritoneal effluent, of which eosinophils constitute more than 10% of its total WBC count. Most cases occur within the first 4 weeks of peritoneal catheter insertion and they usually have a benign and self-limited course. We report a patient of eosinophilic peritonitis that was successfully resolved without special treatment. An 84-year-old man with end stage renal disease secondary to diabetic nephropathy was admitted for dyspnea and poor oral intake. Allergic history was negative. and physical examination was unremarkable. Complete blood count showed a hemoglobin level of 11.1 g/dL, WBC count was 24,500/mm3 (neutrophil, 93%; lymphocyte, 5%; monocyte, 2%), platelet count was 216,000/mm3, serum BUN was 143 mg/dL, Cr was 5.7 mg/dL and albumin was 3.5 g/dL. creatinine clearance was 5.4 mL/min. Three weeks after peritoneal catheter insertion, he was started on peritoneal dialysis with a 6-hour exchange of 2L 1.5% peritoneal dialysate. After nine days, he developed turbid peritoneal effluents with fever (38.4 degrees C), abdominal pain and tenderness. Dialysate WBC count was 180/mm3 (neutrophil, 20%; lymphocyte, 4%; eosinophil, 76% [eosinophil count: 136/mm3]). Cultures of peritoneal fluid showed no growth of aerobic or anaerobic bacteria, or of fungus. Continuous ambulatory peritoneal dialysis (CAPD) was commenced, and he was started on intraperitoneal ceftazidime (1.0 g/day) and cefazolin (1.0 g/day). After two weeksr, the dialysate had cleared up and clinical symptoms were improved. Dialysate WBC count decreased to 8/mm3 and eosinophils were not detected in peritoneal fluid. There was no recurrence of eosinophilic peritonitis on follow-up evaluation, but he died of sepsis and pneumonia fifteen weeks after admission.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
5/15. Eosinophilic fasciitis after allogeneic stem cell transplantation: a case report and review of the literature.We present a 35-year-old male with acute myeloblastic leukemia who underwent allogeneic stem cell transplantation (AlloSCT) from his sibling. He developed acute swelling and tenderness in his extremities with eosinophilia 1 year after AlloSCT following 4 weeks of strenuous physical activity. At that time the leukemia was in complete remission and he had no evidence of chronic graft vs. host disease (cGVHD). His clinical picture and histological appearance of a full thickness skin biopsy were compatible with eosinophilic fasciitis (EF). He received prednisone and responded. Since signs and symptoms of EF can overlap with cGVHD and cause confusion, the careful examination of a skin/muscle/fascia biopsy can distinguish EF from cGVHD. For EF, corticosteroids appear to be the treatment of choice.- - - - - - - - - - ranking = 0.064674296937185keywords = physical (Clic here for more details about this article) |
6/15. Bullous "cellulitis" with eosinophilia: case report and review of Wells' syndrome in childhood.A 1-year-old girl presented with acute onset of edematous erythematous plaques associated with bullae on her extremities and accompanied by peripheral eosinophilia. She was afebrile, and the skin lesions were pruritic but not tender. The patient was treated with intravenously administered antibiotics for presumed cellulitis, without improvement. However, the lesions responded rapidly to systemic steroid therapy. On the basis of lesional morphologic features, peripheral eosinophilia, and cutaneous histopathologic features, a diagnosis of Wells' syndrome was made. Wells' syndrome is extremely rare in childhood, with 27 pediatric cases reported in the literature. Because it is seen so infrequently, there are no specific guidelines for evaluation and management of Wells' syndrome among children. The diagnosis should be considered for children with presumed cellulitis and eosinophilia who fail to respond to antibiotics. Evaluation should include a directed history, physical examination, complete blood count, and stool testing for ova and parasites, to identify potential triggers. Treatment is with systemic steroid therapy unless disease is limited, in which case medium/high-potency topical steroids may be indicated. If systemic features are prominent or disease is chronic (lasting >6 months), then a referral to hematology/oncology should be considered.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
7/15. ketotifen--a therapeutic agent of eosinophilic fasciitis?A 30-year-old male with eosinophilic fasciitis (EF) associated with morphoea and vitiligo is described. The patient showed a partial response to prednisone, but did not respond to hydroxychloroquine, D-penicillamine and cimetidine. In the light of reports of increased plasma histamine levels, and a putative role of mast cells in the pathogenesis of EF, ketotifen (a mast cell stabilizer) was prescribed. This non-toxic drug has allowed the patient to continue hard physical labour without further relapses and without corticosteroid therapy.- - - - - - - - - - ranking = 0.064674296937185keywords = physical (Clic here for more details about this article) |
8/15. A 55-year-old woman with muscle pain and eosinophilia.We present the case of a 55-year-old female with three months of severe, diffuse muscle aching and pain. She had recently undergone orthopedic surgery, but had otherwise not noticed any changes to her baseline health. Her physical examination demonstrated only diffuse muscle tenderness and post-surgical changes to her right knee. Her laboratory evaluation was notable for plasma eosinophilia. An extensive rheumatological workup revealed no evidence of an underlying connective tissue disease. After undergoing a diagnostic procedure, the patient enjoyed a dramatic response to therapy for this disease. This disorder often has subtle clinical manifestations and is associated with vague systoms that can confound an accurate diagnosis.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
9/15. eosinophilia associated with perimyositis and pneumonitis.We describe a patient who had severe myalgias, bronchial asthma, pulmonary infiltrates, and eosinophilia. The findings on physical examination and the erythrocyte sedimentation rate were normal; there was no elevation of the serum creatine kinase. Muscle biopsy demonstrated an inflammatory exudate that contained eosinophils, localized primarily to the perimysium. Pulmonary and muscle manifestations responded to corticosteroids. Systemic eosinophilic disease associated with perimyositis or myositis has not been reported previously. In addition, we review the spectrum of eosinophilic muscle diseases--eosinophilic perimyositis, eosinophilic polymyositis, and focal eosinophilic myositis.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
10/15. Eosinophilic heart disease presenting with features suggesting hypertrophic obstructive cardiomyopathy.We report a 25-year-old female with characteristic features of eosinophilic heart disease on clinical presentation, echocardiography, cardiac catheterization, and LV endomyocardial biopsy. Concomitant physical examination and echocardiographic findings suggesting hypertrophic obstructive cardiomyopathy resolved during treatment with anticoagulation and prednisone therapy.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
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