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Granulomatous Conditions of the Nose
Published in R James A England, Eamon Shamil, Rajeev Mathew, Manohar Bance, Pavol Surda, Jemy Jose, Omar Hilmi, Adam J Donne, Scott-Brown's Essential Otorhinolaryngology, 2022
Symptomatology includes the following: Nasal obstruction, crusting, bleeding or facial pain (1–4%).Characteristic ‘strawberry skin’ appearance of nasal mucosa with or without ulceration, crusting, septal perforation and adhesions.Expansion of the nasal dorsum can be associated with thickening and purplish discoloration of the overlying skin known as lupus pernio, which is a cutaneous manifestation of chronic systemic sarcoid.Salivary gland enlargement (5–10%), which is more rarely associated with facial palsy and uveitis (uveoparotid fever, Heerfordt's syndrome).Laryngeal involvement (1–5%), especially supraglottitis (85%), with cough, hoarseness, dysphagia and rarely stridor.
Abnormal Personality in Functional Somatic Syndromes
Published in Peter Manu, The Psychopathology of Functional Somatic Syndromes, 2020
Four of the 15 chronic fatigue syndrome patients (27 percent) had one or more current psychiatric disorders. These diagnoses were major depression; generalized anxiety disorder and social phobia; generalized anxiety disorder and eating disorder; and attention-deficit hyperactivity disorder and oppositional defiant disorder. The incidence of past physical abuse was significantly greater among the 15 patients with major depression. The severity of depressive symptomatology was statistically similar in the chronic fatigue, juvenile rheumatoid arthritis, and depressed groups. Patients with chronic fatigue syndrome had significantly more somatic complaints than did the subjects with depression and arthritis. The personality inventories were generally similar in the three groups. The only significant difference indicated more conversion hysteria in the chronic fatigue syndrome group. The authors concluded that that the main finding was the high rate of somatization in the chronic fatigue syndrome group. Given the low frequency of psychiatric disorders identified in this group of patients, the results suggested “that personality features play a greater role than psychiatric disorders” (Gray et al., 2001, p. 240).
Management of deep infiltrative endometriosis (DIE) causing gynecological morbidity: A urologist's perspective
Published in Seema Chopra, Endometriosis, 2020
Aditya Prakash Sharma, Girdhar Singh Bora
Due to common symptomatology, BE mimics other common urological conditions such as bacterial cystitis, tubercular cystitis, overactive bladder, carcinoma bladder, and interstitial cystitis/bladder pain syndrome. Studies have shown a coexistence (16%–78%) of bladder endometriosis and interstitial cystitis, given the term “evil twin syndrome” by Chung et al. [25,26]. Physical examination including a vaginal examination is the first step in making the diagnosis of DIE and BE [6,7]. Physical findings include a palpable nodule, a thickening along the anterior vaginal wall with tender points [6–8]. In women in the reproductive age group complaining of LUTS, particularly in combination with pain and positive findings on vaginal examination, endometriosis should be strongly suspected and further investigations should be done.
Depressed skull fracture compressing eloquent cortex causing focal neurologic deficits
Published in Brain Injury, 2023
Alexander In, Brittany M. Stopa, Joshua A. Cuoco, Adeolu L. Olasunkanmi, John J. Entwistle
Traumatic causes of focal neurologic deficits may include intraparenchymal hemorrhage, subdural hematoma, epidural hematoma, or internal carotid artery dissection. However, altered mentation would usually be observed in the presence of intra- or extra-axial hemorrhage that is large enough to cause focal deficits. Although an internal carotid artery dissection may lead to contralateral hemiplegia, it typically is associated with headache, neck pain, or Horner’s syndrome and tends not to disturb the frontal eye fields. In the absence of trauma, the differential diagnosis of the observed symptomatology may include ischemic stroke or seizure activity. Ischemic stroke and seizure activity can certainly present in a similar fashion; however, gaze preference should be a differentiating factor between these diagnoses. In the setting of ischemic stroke, inhibition of the frontal eye field would cause gaze deviation toward the lesion. Comparatively, seizure activity would stimulate the frontal eye field and cause gaze deviation away from the lesion.
Pembrolizumab-Induced Giant Cell Arteritis in the Setting of Urothelial Carcinoma
Published in Neuro-Ophthalmology, 2023
Deanna Ingrassia Miano, Ryan Cosgrove, Joshua Sherman, Savitha Balaraman, Michael Sherman
Micaily et al. first reported the connection of pembrolizumab and GCA in 2017 in a patient with stage IV non-small cell lung carcinoma. The patient developed GCA and colitis after the first and second rounds of pembrolizumab, respectively, although ophthalmological findings were not further expanded upon. Narala et al. presented another case where a patient with metastatic uveal melanoma developed GCA in the contralateral eye after six cycles of pembrolizumab treatment. This lengthier time frame, when compared with our findings after one treatment cycle, demonstrates the variability in symptom onset. Narala et al. described symptomatology as nasal and central visual field loss OD, no systemic pain including cephalgia or jaw claudication, and elevated inflammatory markers. Before confirmation with a biopsy, they reported their patient’s GCA manifested as a retinal artery occlusion and paracentral acute middle maculopathy, confirmed by an FA and OCT, respectively.5 Accordingly, our patient demonstrated occlusive findings in the retinal vasculature.
Renal biopsy in systemic infections: expect the unexpected
Published in Ultrastructural Pathology, 2023
Bangchen Wang, Alexandra Grand, Micah Schub, Harpreet Singh, David I. Ortiz Melo, David N. Howell
A 31-year-old female with history of end-stage kidney disease secondary to granulomatosis with polyangiitis (GPA) received a kidney transplant which failed due to rejection. She received a second kidney transplant three years prior to presentation but later developed secondary focal segmental glomerulosclerosis (FSGS) with baseline proteinuria. She had a recent pregnancy complicated by preterm delivery and disseminated herpes simplex virus (HSV) infection with HSV hepatitis, treated with acyclovir. Her urine culture was positive for E. coli, and she had mild, transient pyuria, but symptomatology suggestive of urinary tract infection was absent. She developed AKI, with serum Cr gradually increasing from 1.5 to 4.9 mg/dL over a 4-week period. The clinical differential diagnoses for her AKI included HSV nephritis, drug-induced acute interstitial nephritis, allograft rejection, recurrent GPA, thrombotic microangiopathy (TMA), progression of FSGS, and pyelonephritis.