Histiocytic necrotizing lymphadenitis, called Kikuchi-Fujimoto's disease (KFD), is an idiopathic, self-limited condition rarely associated with systemic lupus erythematosus (SLE). The cause of concomitant KFD and SLE is still unknown. We describe a 19-year-old man simultaneously diagnosed with both KFD and SLE complicated with deep vein thrombosis (DVT). To the best of our knowledge, this is the first case report of KFD associated with SLE complicated with antiphospholipid antibody syndrome (APS). Our patient was successfully treated with intravenous pulse methylprednisolone, anticoagulation with heparin, oral hydroxychloroquine, azathioprine, and low-dose aspirin.
Background
Ankylosing spondylitis (AS) is characterized by excessive production of inflammatory cytokines. Recent evidence suggests that inflammation underlies the neurodegenerative process of Parkinson’s disease (PD). Whether AS has an influence on the development of PD is unclear. We aimed to examine a relationship, if any exists between AS and PD.
Methods
A population-based matched cohort study was performed using data from the 2000–2010 Taiwan National Health Insurance database. 6440 patients with AS and 25,760 randomly selected, age- and sex-matched controls were included in this study. The risk of PD in the AS cohort was evaluated by using a Cox model.
Results
This study revealed a positive association between AS and the risk of PD regardless of sex and age (aHR 1.75, p < .001). Particularly, AS cohort to non-AS cohort relative risk of PD significantly increased for the patients aged below 49 and above 65 years (aHR 4.70, p < .001; aHR 1.69, p < .001, respectively) and the patients with and without comorbidities (aHR 1.61, p < .001; aHR 2.71, p < .001, respectively). Furthermore, NSAID use was associated with lower risk of PD (aHR 0.69, p < .05). However, the risk of PD was higher (aHR 2.40, p < .01) in patients with AS receiving immunosuppressants than in those not receiving (aHR 1.70, p < .001).
Conclusions
Patients with AS had an increased risk of PD which might be related to underlying chronic inflammation. Further research is required to elucidate the underlying mechanism.
fourth metacarpophalangeal joint. Gout was suspected initially, but the response to treatment was poor. Besides, left thumb was reported being pierced by a raw fish bone 2 months ago. A US examination showed extensive extensor and flexor tendon tenosynovitis of the wrist and fingers without signs of crystal deposition. Minimal fluid was found around the flexor digitorum tendons, and was aspirated with US guidance. The culture yielded Mycobacterium gordonae. Conclusions: Infectious tenosynovitis is a serious condition that can result in severe morbidity if untreated, and surgery is often required to make the diagnosis. The utilization of easily accessible US can facilitate early diagnosis with less-invasive procedures.
BackgroundGadobutrol-induced life-threatening allergies, such as acute respiratory distress syndrome (ARDS), is rarely reported. The severe allergies publishing in previous literature report involves IgE and tryptase-mediated immune responses. Gadobutrol-related non-IgE-mediated allergy has not been reported.Case presentationA 39-year-old woman underwent Gadobutrol-contrast magnetic resonance imaging of both lower limbs for clinically suspected vasculitis. One hour after injection of 8 ml Gadobutrol, the patient developed dizziness without respiratory symptoms. Eight hours after the contrast injection, she exhibited vomiting, dyspnea, and rapid progression of edema. She visited the emergency room, where chest imaging showed increased infiltration in both lungs. Arterial blood gas analysis revealed hypoxemia when she was given 100% inspired oxygen. The patient was admitted to intensive care unit and received inotropic agents. Extracorporeal membrane oxygenation was applied due to the diagnosis of ARDS and persistent hypoxia after using mechanical ventilation. Systemic intravenous glucocorticoid and antihistamine were prescribed for allergic reaction. Contrast-relevant non-IgE-mediated allergy was confirmed by detailed medical record and laboratory data. An additional 2 days of intravenous immunoglobulin was prescribed. By 3 days after admission, the patient’s shock and acute respiratory distress syndrome had responded great. She was discharged 13 days after admission.ConclusionsHere, we present the first case of gadobutrol-induced non-IgE-mediated allergy complicated by ARDS. This condition was successfully rescued by dual therapy of venovenous extracorporeal membrane oxygenation and intravenous immunoglobulin without any complications.
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