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Degenerative Diseases of the Nervous System
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
James A. Mastrianni, Elizabeth A. Harris
As described in the section on AD. With suspicion for VaD, consider addition of the following: Lipid panel.Hemoglobin A1c.Antinuclear antibodies.Serum protein electrophoresis.Coagulation studies (younger patients).Antiphospholipid antibodies.Proteins C and S.Antithrombin III.Factor V Leiden mutation.
Multiple Myeloma
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
Myeloma is increasingly detected incidentally by the finding of a monoclonal protein following serum protein electrophoresis/serum free light chains on routine screening or when being investigated for an unrelated problem. In November 2014 the International Myeloma Working Group (IMWG) published a revised definition of multiple myeloma that incorporated three new criteria for initiating therapy in addition to the established CRAB criteria.15 These three criteria are based on the level of plasma cell infiltration, the serum free light chain (sFLC) level/ratio, and the presence of two or more focal lesions on advanced imaging (CT [low dose whole body], MRI, 18F FDG PET). They define a group of otherwise asymptomatic patients who have an extremely high risk of progression to symptomatic disease within 2 years and for whom delayed intervention could be detrimental. In terms of treatment the revised definitions impact on a relatively small group of patients who are now upstaged and have an indication for immediate treatment when previously they would have been monitored. The effects of the new definition are however wide-ranging in terms of the use of imaging and in using new biomarkers. The term asymptomatic myeloma is somewhat misleading (as a patient may be well but have a very high FLC ratio for example) and smoldering myeloma is a better term for patients with myeloma that do not have an indication for immediate treatment.15
Osteoporosis
Published in Peter V. Giannoudis, Thomas A. Einhorn, Surgical and Medical Treatment of Osteoporosis, 2020
Ippokratis Pountos, Peter V. Giannoudis
Parathyroid hormone (PTH) analysis is recommended in cases of abnormal serum calcium to investigate the cause of the abnormality. Several centers have introduced PTH measurement in their routine investigation in patients with high clinical suspicion for osteoporosis. A number of laboratory tests can be performed to rule out other causes of osteoporosis. Erythrocyte sedimentation rate can be a useful investigation to rule out inflammatory disease, which can be associated to bone loss. Hypogonadism in men can be screened with serum testosterone. Cortisol and dexamethasone levels should be performed to exclude Cushing syndrome. Serum protein electrophoresis and free light chains could aid in the diagnosis of multiple myeloma. Finally, the measurement of urea and creatinine together with the estimation of the glomerular filtration rates can identify the presence of renal failure, which can inversely affect the skeleton.
A case report of recurrent Well’s syndrome masquerading as cellulitis
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Anum Qureshi, Jasmine Manley, Tristan Flack, Mark H. Lowitt
Two weeks after completing glucocorticoid therapy, she returned to the emergency department with complaints of severe back pain as well as recurrent cellulitis (lower extremities, groin, and perianal) with lower extremity edema. Significant laboratory findings included eosinophilia (11%). ANA, immunoglobulin panels, inflammatory markers, chemistries, and flow cytometry were normal. Serum protein electrophoresis revealed an elevated alpha-2 globulin fraction, but no monoclonality. She was again treated with parenteral then oral corticosteroids. Back pain was attributed to a musculoskeletal cause. Hematology and rheumatology consultants found no underlying abnormalities that could be associated with Well’s syndrome. Prednisone was again tapered over weeks, and she declined additional possible steroid sparing agents. She was free of active disease for fivemonths. Five months, later she had trauma to the left arm that led to severe arm redness, bruising and skin tear [Figure 4(a)] that initially healed, but later, she developed severe pain, redness at the site of injury (Figure 4(b)) and her symptoms were similar to the previous WS flare; she was treated with steroid and symptoms improved significantly and successfully tapered off steroids in fourweeks.
AL amyloidosis presenting as inflammatory polyarthritis: a case report
Published in Modern Rheumatology Case Reports, 2021
Muhammad Shoaib Momen Majumder, Shamim Ahmed, Md. Nahiduzzamane Shazzad, Mohammad Mamun Khan, Syed Atiqul Haq, Mohammed Kamal, Md. Sohrab Alam, Johannes J. Rasker
Our patient presented with typical inflammatory polyarthritis with subcutaneous nodules over the wrists mimicking rheumatoid arthritis that preceded the features of amyloidosis. Presence of macroglossia with lateral indentation of the tongue, shoulder pad sign, perioral and periocular papules, bilateral carpal tunnel syndrome, renal impairment, biopsy evidence of amyloid deposition distinguished it from rheumatoid arthritis. Most of the case reports reported polyarthritis in AL amyloidosis are associated with multiple myeloma [8,9]. The prevalence of a dominant soft tissue and bone involvement is 3.9–4.3 times higher in patients with AL amyloidosis with multiple myeloma than in patients with AL amyloidosis without multiple myeloma [10]. We had excluded multiple myeloma in our case with the help of radiological skeletal survey, the study of bone marrow, and serum protein electrophoresis.
Idiopathic Central Nervous System Inflammatory Disease in the Setting of HLA-B27 Uveitis
Published in Ocular Immunology and Inflammation, 2019
Eric L. Crowell, Margaret L. Pfeiffer, Ankur A. Kamdar, Mary K. Koenig, Susan E. Wittenberg, Emilio P. Supsupin, Ore-ofe O. Adesina
Brain MRI showed enhancing and T2 hyperintense lesions in the right midbrain, superior colliculus, cerebellar peduncles and cerebellar vermis, and leptomeningeal enhancement along the vermian foliae (Figure 1). Lumbar puncture showed an opening pressure of 26 cm H2O. Glucose was 61 mg/dL and protein 80 mg/dL. There was a lymphohistiocytic pleocytosis of 25 white blood cells with 6% neutrophils, negative cytology, and normal angiotensin-converting enzyme (ACE) in the cerebrospinal fluid (CSF). Serum ACE, ferritin, thyroid-stimulating hormone, free thyroxine fraction, thyroperoxidase antibody, thyroid-stimulating immunoglobulin, lysozyme, erythrocyte sedimentation rate, C-reactive protein, C3 and C4, aquaporin-4, purified protein derivative, antinuclear antibody and lupus autoantibody subsets, cysticercus, Lyme, and HIV labs were within normal limits or negative. His chest X-ray and computed tomography of his chest to evaluate for lymphadenopathy were both negative. Serum protein electrophoresis was negative for signs of monoclonal gammopathy. He received 5 days of 1 g intravenous methylprednisolone without symptomatic improvement; however, repeat MRI showed reduced enhancement of his CNS lesions (Figure 2).