Hydralazine-induced ANCA-associated vasculitis is a rare clinical entity, with complications including rapidly progressive glomerulonephritis, pulmonary hemorrhage, and pulmonary-renal syndrome. We present this case to highlight the clinical features that support this challenging diagnosis and to emphasize the importance of prompt recognition and aggressive intervention given its significant morbidity and mortality.
Introduction
Acquired hemophilia A (AHA) also known as acquired factor VIII (FVIII) deficiency is an acquired inhibition of coagulation by antibodies that either inhibit the activity or increase the clearance of a clotting factor (FVIII). Mortality in patients presenting with AHA is related to bleeding and hemorrhage, therefore rapid diagnosis and effective treatment are needed.
Case presentation
We present a case of a 59-year-old male with acquired VIII deficiency presenting with diffuse ecchymosis and bleeding diathesis. The patient was treated successfully with steroids and rituximab.
Clinical discussion
It is a rare autoimmune disorder caused by neutralization of Factor VIII by IgG antibodies. This can lead to severe, life threatening bleeding. Treatment involves replacement of FVIII and immunosuppression.
Conclusion
A key point to successfully treating AHA is to remove inhibitors and stop bleeding. Mortality in patients presenting with AHA is related to the bleeding and hemorrhage, therefore rapid diagnosis and effective treatment are needed.
Purpose: To assess the effects passive smoking and heavy metal concentrations in the blood and follicular fluid on assisted reproductive technology outcome.Methods: A prospective study was conducted between March 2017 and January 2018 in population consisted of 75 female patients undergoing an In vitro fertilization (IVF) cycle at Dr. Faris Medical center for Infertility and Human Reproduction located on Heliopolis, Cairo, Egypt; with unexplained infertility who underwent intracytoplasmic sperm injection (ICSI) using GnRH-antagonist protocol. Concentrations of three toxic metals Cadmium (Cd), Lead (Pb) and Arsenic (As) were measured both in blood sera and follicular fluid specimens. Patients were evaluated in two groups both undergoing ICSI; the first group consisted of patients who does not smoke or exposed to smoking (n=28) and the group passive smoker females (n=47). Results: These three heavy metals were significantly higher in serum and follicular fluid of passive smoking females (P<0.05). Also, higher concentrations of Cd, Pb and As were found in follicular fluid of passive smoking patients in comparison with non-smoker females. However, concentrations of Cd and Pb were not significantly different between both serum and follicular fluid. Conclusion: Passive smoking could affect levels of Cd, Pb and As in serum and follicular fluid of females undergoing Intra Cytoplasmic Sperm Injection (ICSI).
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