Behcet’s disease (BD) classically presents with recurrent oral ulcers, genital ulceration, uveitis and skin manifestations. Middle-aged people are usually affected with the male gender being associated with severe variant of the disease. It can involve any organ system of the body. Although central nervous system and vascular involvement tend to occur less frequently, they are the commonest cause of mortality. We present a case of a 30-year-old man referred with suspicion of cerebral venous sinus thrombosis to our hospital and subsequently diagnosed with BD. The patient developed, despite being on immunosuppression and anticoagulation, extensive arteriovenous thrombi of lower limbs requiring catheter-directed thrombolysis with continuous 24-hour infusion of tissue plasminogen activator for refractory right lower limb venous thrombosis and placement of inferior vena cava filter to prevent pulmonary embolism. Later disease remission was achieved with rituximab.
Sarcoidosis is a systemic inflammatory disorder resulting from an inappropriate immune response to ubiquitous environmental stimuli. It has a predilection for African Americans and people of Northern European countries. The classic histology is that of a non-caseating granuloma. Central nervous system involvement is a rare occurrence in sarcoidosis and even in this manifestation, the presence of vasculitis is comparatively uncommon. We present a case of a 35-year-old female, who presented with complaints of persistent headache of moderate intensity and had a violaceous plaque on nose, being treated by a dermatologist. The patient on further workup had mildly raised proteins on cerebrospinal fluid analysis. MRI brain showed multiple foci in bilateral frontoparietal regions and centrum semiovale, while digital subtraction angiography brain depicted vasculitis of small vessels of brain and complete occlusion of right internal carotid artery at its origin. Biopsy of lesion on nose was performed that showed chronic granulomatous inflammation. A diagnosis of brain vasculitis secondary to sarcoidosis was made. The patient was treated with plasmapheresis and pulse steroid therapy initially, and later on with cyclophosphamide and azathioprine. This resulted in resolution of headache and nose lesion.
Central nervous system tuberculosis (CNS TB), though comparatively uncommon as compared to other forms of extrapulmonary tuberculosis (TB), results in high morbidity and mortality. The symptoms are non-specific and of a progressive nature resulting in delayed diagnosis. We present a case of CNS TB that presented two months after the onset of symptoms. The patient’s condition reached the point of being bedbound. On investigation, the widespread involvement of the brain with shower-like pattern of ring enhancing tuberculomas and associated tuberculous meningitis was found. This was a surprising finding considering the patient was immunocompetent. Contrast-enhanced magnetic resonance imaging showed lesions in midbrain, pons, medulla, thalamus, bilateral cerebellar hemispheres and bilateral cerebral hemispheres. Upon treatment initiation the patient responded well with resolution of all lesions.
Objective: To determine frequency of sapheno-femoral junction (SFJ) and sapheno-popliteal junction (SPJ) incompetence on duplex ultrasonography in patients with varicose veins.Study Design: Cross-sectional study.Place and Duration of Study: Shaikh Khalifa Bin Zayed Al-Nahyan/Combined Military Hospital, Rawalakot, Azad Jammu & Kashmir, from Aug 2019 to Feb 2020.Methodology: A total of 70 patients were selected using non-probability, consecutive sampling. After ethical approval, informed consent and relevant history taking, duplex ultrasonography (DUS) was done in standing and supine positions in patients with varicose veins, fulfilling inclusion and exclusion criteria. Presence or absence of SFJ and SPJ incompetence was assessed.Results: Mean age was 41.99 ± 11.08 years with 36 (51.43%) patients between 36-50 years. Mean duration of disease was 6.33 ± 2.29 months while 47 (67.14%) patients had symptoms for more than 6 months at the time of presentation. Occupation wise, 40 (57.14%) patients were field workers while 30 (42.86%) were office and domestic workers. Isolated SFJ, SPJ and combined junction incompetence were found in 27 (38.57%), 20 (28.57%) and 23 (32.86%) patients respectively. Both SFJ and SPJ incompetence were more in obese patients (78.6% and 71.4% respectively) as compared to non-obese patients. Conclusion: Frequency of SFJ incompetence was more than SPJ incompetence on DUS. Obesity, male gender and prolonged motionless standing predispose to the development of varicose veins. Preventive measures and early diagnosis can decrease disease burden.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.