Primary bone lymphoma is a very uncommon malignancy, which is responsible for 3% of all bone tumors. We report a case of an 80-year-old patient with chronic back pain associated with a pathological T9 fracture. During admission, spinal cord compression with paraparesis was detected and managed with radiotherapy. After investigation, it was discovered to be caused by a primary bone lymphoma. Staging showed multiple bone lesions compatible with polyostotic lymphoma. Histopathology revealed a diffuse large B-cell lymphoma, which was treated with chemotherapy (age-adjusted R-CHOP [rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone] regimen). In this case report, imaging modalities used to diagnose and stage the disease are discussed. Traditional and new prognostic tools and treatment are also reviewed.
The cat lungworm Aelurostrongylus abstrusus is the most common respiratory parasite of cats. This nematode has a worldwide distribution and is considered an emerging pathogen. Respiratory signs overlap with those of other pathologies, and some agents which co-exist in the same animal may concur in the clinical scenario. Nonetheless, feline verminous bronchopneumonia is underestimated by practitioners and is not commonly included in differential diagnosis in routine practice. The present report describes the clinical presentation of a 6-month old stray cat from central Portugal, which developed respiratory distress. A clinical improvement of lower respiratory signs was achieved after a course of doxycycline and prednisolone course. However, a relapse with a progressive decline in the respiratory functions occurred two weeks later. A further investigation led to the identification of an A. abstrusus infection that was treated with fenbendazole. Ten days after the treatment the cat became negative for A. abstrusus and further analyses performed in the followings 2 months showed improvement of the animal's pulmonary condition and negative results at the faecal examinations. These findings indicate that veterinarians should include aelurostrongylosis in the differential diagnosis of feline respiratory distress even in non-endemic regions and should perform appropriate diagnostics procedures in the presence of compatible signs.
Latent autoimmune diabetes of adults (LADA) is a type of autoimmune diabetes that begins in adulthood (usually after the age of 35 years); its main feature is the presence of diabetes-associated autoantibodies (most often autoantibody against glutamic acid decarboxylase), which leads to progressive destruction of the islets of Langerhans. This is a heterogeneous condition that presents with clinical and laboratory manifestations common to type 1 diabetes and type 2 diabetes.We report a case of a 71-year-old man diagnosed with type 2 diabetes two years ago, poorly controlled with oral antidiabetic therapy, and worsening in the third year. He had a positive family history of type 2 diabetes in two second-degree relatives (nephews). No pathologic findings at the physical examination were found.His body mass index was 23 kg/m 2 and glycated hemoglobin was 10.6%. Laboratory workup revealed low basal C-peptide (<0.1 ng/mL) and positive glutamic acid decarboxylase antibodies, and the LADA diagnosis was confirmed. This case highlights the importance of being aware of this disease, especially in patients previously diagnosed with type 2 diabetes who remain uncontrolled with diet and oral hypoglycemic agents. LADA is often confused with type 2 diabetes, and therefore, the management is frequently inadequate. An early diagnosis and treatment are crucial to delaying disease progression.
Idiopathic chronic eosinophilic pneumonia (CEP) is a rare disease of unknown cause characterized by eosinophilic alveolar and interstitial infiltration. The authors describe the case of a 46-year-old black man, presenting with insidious onset and progressive course of dyspnea on minimum exertion, cough, fever, night sweats, and weight loss for one year and worsening in the last three months. The main findings were serum eosinophilia. Chest radiographs showed multifocal infiltrations of irregular distribution in both lungs and a restrictive functional impairment. The patient underwent open lung biopsy, and the anatomopathological examination revealed consolidation by exudate constituted predominantly by macrophages (25%) and eosinophils (51%), which filled small air spaces, including respiratory and membranous bronchioles. The anatomopathological diagnosis was eosinophilic pneumonia (eosinophils > 25% is widely accepted for diagnosing eosinophilic pneumonia). The patient had a good clinical response after starting corticosteroid therapy.
SUMMARY The authors report a case of a 69-year-old man with idiopathic leukocytoclastic cutaneous vasculitis. For three years, the lesions recurred with progressive worsening and were associated with systemic manifestations of low-grade fever, weight loss and raised inflammatory markers. The patient latter presented a 6th cranial nerve involvement, raising the concern of a possible systemic vasculitis, which was latter evidenced by the development of deep vein thrombosis and angina pectoris. The treatment of the patient witch based on the decreasing of inflammatory activity, by using effective immunosuppressive therapy, with lower toxicity is more important than identifying the type of the vasculitis. This case illustrates the importance of awareness for the systemic involvement that can occur in up to 50% of patients with leukocytoclastic cutaneous vasculitis.
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