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Skin disorders in AIDS, immunodeficiency, and venereal disease
Published in Rashmi Sarkar, Anupam Das, Sumit Sethi, Concise Dermatology, 2021
Indrashis Podder, Rashmi Sarkar
This venereal infection is caused by the Gram-negative bacillus Haemophilus ducreyi. One to 5 days post-infection, a soft sloughy ulcer appears on the areas of contact on the penis or vulva. Other sites may be affected, and inguinal adenitis occurs in 50% of patients, usually unilateral in distribution. Both the genital ulcer and lymphadenopathy are painful, a characteristic feature of this condition.
General Physical
Published in Keith Hopcroft, Vincent Forte, Symptom Sorter, 2020
Many clinical markers (see Ready reckoner) are non-specific and are present in many different infections. It is often a matter of degree as to how likely they are a pointer to a specific pathology. For example, many infections cause mesenteric adenitis with abdominal pain, but the tenderness of appendicitis, for example, is usually far greater on examination. Respiratory rate is raised in all fevers, but a chest problem will increase it further along with the presence of chest signs. A good policy is to be as thorough as possible in an examination so as to be able to cross-reference the maximum clinical information.
Unexplained Fever Associated with Diseases of the Gastrointestinal Tract
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
Mesenteric adenitis is usually a self-limited illness and is characterized by fever, right lower quadrant pain and tenderness, vomiting, and diarrhea. Leukocytosis is usual and polymorphonuclear leukocytes may be found in the stool. Culture of lymph nodes and blood serologic tests may confirm the diagnosis. The differential diagnosis includes acute appendicitis and conditions which simulate it.
Sarcoidosis presenting as acute pericarditis. A case report and review of pericardial sarcoidosis
Published in Acta Cardiologica, 2022
Alexandre Unger, Philippe Unger, Raphaël Mottale, Mihaela Amzulescu, Abraham J. Beun
Lymph node biopsy showed epithelioid granulomatous adenitis without necrosis (Figure 5). Ten days after discharge, a repeat echocardiography showed mildly increased pericardial effusion, without inferior vena cava plethora (Figure 4(B)). An 18 F-fluorodeoxyglucose-positron emission tomography with CT (PET/CT) showed multiple hypermetabolic lymphadenopathies with symmetrical distribution (sub-clavicular, retroclavicular, mediastinal and hilar), consistent with the diagnosis of sarcoidosis. It also showed diffuse myocardial standardised uptake values (SUV), however of indeterminate significance (Figure 6). Cardiac Magnetic Resonance Imaging (MRI) showed thickened pericardium with pericardial (but not myocardial) late gadolinium enhancement (LGE) and oedema indicating acute pericarditis (Figure 7). Two weeks after initial presentation, the patient reported shortness of breath and recurrent chest pain, and methylprednisolone 32 mg od was started, while clarithromycin was discontinued. Methotrexate was subsequently added. The clinical evolution thereafter was uneventful.
Remarkable effectiveness of tocilizumab in familial Mediterranean fever exon 3 variant with severe abdominal pain and PFAPA-like symptoms: a child case report and review of the literature
Published in Modern Rheumatology Case Reports, 2019
Makiko Tajika, Yusuke Takeuchi, Mai Arai, Koichiro Fujimaki, Takashi Soga, Kazunaga Agematsu, Atsushi Kawakami, Yoh Umeda
PFAPA represents the most common autoinflammatory fever disorder occurring during childhood [6]. The clinical entity is characterised by regular episodes of high fever (>39 °C) that are associated with at least 1 of 3 cardinal clinical signs of aphthous stomatitis, pharyngitis and cervical adenitis. Additional manifestations, including headache, gastrointestinal symptoms and sore throat, may be present [4] but are not consistently noted. Disease onset is generally before the age of 5 years, with attacks lasting 2–8 days and recurring every 3–8 weeks. Patients are asymptomatic between episodes and show normal growth and development [7]. Although the genetic defects in PFAPA have not yet been identified, monogenic, oligogenic or complex inheritance of variants in multiple disease genes in combination with epigenetic and environmental factors have been suggested [8,9]. Yabuuchi et al. recently described a 54-year-old Japanese man with FMF exon 3 variants who presented with recurrent abdominal pain, fever lasting >5 d and renal failure from amyloidosis. He did not respond to infliximab, but tocilizumab therapy was successful [10].
A Novel CD40L Mutation Associated with X-Linked Hyper IgM Syndrome in a Chinese Family
Published in Immunological Investigations, 2020
Liangshan Li, Jing Ji, Mengmeng Han, Yinglei Xu, Xiao Zhang, Wenmiao Liu, Shiguo Liu
As his condition progressed, other clinical manifestations also presented as gastrointestinal disease (symptomatic diarrhea), BCG adenitis, serious recurrent infections even after anti-infection treatment, such as fungal infection, pneumocystis carinii pneumonia and cytomegalovirus (CMV) infection, mild anemia which may be caused by recurrent infections. Physical examinations: pulse 124/min, respiration 43/min, pharyngeal hyperaemia, thick sound of breath in both lungs, the abdomen is supple without organomegaly. Laboratory tests: Routine blood test HGB 94 g/L (Reference value: 110–145 g/L). Stool occult blood test (+). CMV DNA>1.0 × 10^7copies/mL, Th1 8.88%, Th2 0.05%. Pneumocystis carinii DNA (+). Detection of fungi (1-3)-β-D-glucan 222.2 pg/mL.