Inflammatory processes, such as an infection or drug reaction, can cause antineutrophil cytoplasmic autoantibody (ANCA)‐associated vasculitis (AAV). Although quite rare, AAV may occur with SARS‐coronavirus disease 2019 (COVID‐19) antigenic exposure, either from infection or immunization. We present two cases of AAV: one that developed after COVID‐19 infection presenting as diffuse alveolar haemorrhage and another that developed shortly after vaccination, presenting as granulomatous pulmonary nodules. Both patients improved with supportive care and immunosuppressive therapies. This adverse event appears to be a very rare complication of COVID‐19 infection or vaccination. Early diagnosis of AAV is important because immunosuppressive therapy may improve patient outcomes.
The detection of antibodies against
Histoplasma capsulatum
remains a frequently relied-on approach to diagnose histoplasmosis. We retrospectively assessed the performances of complement fixation (CF) and immunodiffusion (ID) assays for anti-
Histoplasma
antibody detection in patients with culture-confirmed histoplasmosis at Mayo Clinic (Rochester, MN) over a 10-year period (2011 to 2020).
Introduction. Primary amyloidosis is a disorder resulting from the deposition of fibrillary protein in extracellular tissue. Diagnosis of primary amyloidosis in the celiac/para-pancreatic lymph nodes via endoscopic ultrasound-guided fine needle aspiration has not been reported in the literature. In this article, we report our first observation. Our patient is a 64-year-old Caucasian man who was referred to our institution from an outlying hospital for recurrent abdominal pain. Radiological imaging revealed an enlarged abdominal lymph node that was already biopsied under computed tomography needle guidance but diagnosis was not achieved on pathological examination. At our institution, endoscopic ultrasound-guided fine needle aspiration showed enlarged para-celiac/pancreatic lymph nodes. Endosonography-guided fine needle aspiration revealed the diagnosis of primary amyloidosis. The patient tolerated the procedure well with follow-up as an outpatient. Conclusions. Lymph node involvement in amyloidosis is not uncommon. However, the involvement of the pancreatic/celiac lymph nodes by amyloidosis is obscure in this case. This case shows a rare presentation of amyloidosis diagnosed for the first time by the technique of endosonography-guided fine needle aspiration. In the future, this might serve as an establishment to standardize diagnosing abdominal lymph node amyloidosis, once suspected, by endosonography-guided fine needle aspiration.
Current medical therapy in the treatment of fibrotic interstitial lung disease (f-ILD) is focused on objective improvement or stabilisation of lung function decline as represented by raw or per cent predicted forced vital capacity (FVC % pred). Patient-reported quality of life (PR-QoL) outcomes, as measured from the viewpoint of how patients assess their own health-related well-being, have not been the primary targets of recent clinical trials. However, it has been reported that lung function (i.e. measured FVC % pred) in f-ILD correlates poorly with patient-reported well-being [1]. This study explored the degree to which two previously unassessed PR-QoL outcomes in f-ILD correlate with clinical and functional parameters, and a respiratory-related QoL instrument applied in a novel manner. Institutional research review board approval was obtained prior to study initiation (Mayo Clinic IRB 17-005475). Patients with f-ILD of all aetiologies (>10% fibrosis as visually assessed on computed tomography (CT) imaging) seen at Mayo Clinic Rochester from January 2019 to February 2020 were prospectively recruited and enrolled after study consent. Demographics, fibrosis type, FVC % pred, per cent predicted diffusion capacity for carbon monoxide (D LCO % pred), symptom duration, and radiological pattern were collected at presentation. Enrolled participants completed four specific questionnaires. 1) Dyspnoea was assessed with the modified Medical Research Council score (mMRC) [2]. 2) Emotional affect or mood was measured by the positive and negative affect scale (PANAS), a 20-item scale measuring both positive and negative affect with a total positive to negative score ratio of >2.9 suggesting more positive affect (1-week recall period) [3]. 3) Self-management ability was assessed by the Self-Management Ability Score (SMAS-30), with a total score on a 100-point scale calculated as the average of the scores of the six subscales (higher numbers suggest better self-management, no reported recall period) [4]. 4) Respiratory-related QoL was defined by four original domains of the Chronic Respiratory Questionnaire (CRQ) (Dyspnoea, Emotional, Fatigue, and Self-mastery domains), a Physical summary domain (combined dyspnoea and fatigue domains), and Emotional Function domain (combined emotional and mastery domains) [5]. For each CRQ domain, a lower score suggested a greater degree of dysfunction on a 7-point scale with a 2-week recall period. Baseline demographic, functional, and survey measurements were compared between idiopathic pulmonary fibrosis (IPF) and non-IPF patients. Regression analysis with LASSO was performed to delineate predictors of the CRQ subdomains and two summary CRQ scores. Statistical analysis was completed with SAS 9.0 (SAS Institute Inc., Cary, NC, USA) and two-sided p-values<0.05 were considered statistically significant. 167 patients were enrolled (median age 70 years, (interquartile range (IQR) 65-75 years); 41% female) with older age and greater frequency of usual interstitial pneumonia CT fibrosis pattern fo...
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