Drug-induced sarcoidosis has been rarely described but it constitutes a potential side effect of immunomodulatory medications. We report a case of rituximab-induced scar sarcoidosis and review similar published cases. Although there is evidence of B-cell dysregulation in the pathogenesis of sarcoidosis, the use of rituximab for this disease needs to be carefully evaluated based on reports of worsening and de novo development of sarcoidosis after rituximab therapy.
BackgroundUnintentional injury is the leading cause of death and disability for America’s children. The economic consequences of injury are staggering; with injury being the leading cause of medical spending for children ages 5–14 in Wisconsin. As a health care system, we see the consequences of preventable injuries. As a children’s hospital we have an obligation to lead the way in modelling best practice, evidence-based injury prevention strategies for children in collaboration with our community partners.Methods/approachReview of Wisconsin paediatric injury and death data formed the basis of prioritising program development or system-level strategies for injury prevention. Using a policy, systems, environmental approach, we identified best practice injury prevention strategies with our community partners. By implementing a collective impact model and community engagement, we formulated plans for improving the injury prevention strategies for children and families in our community.ResultsExamples related to child passenger safety, home visitor program, a safe sleep campaign, Safety Town, and a “safety store” will be provided. Program barriers and challenges, as well as successful outcomes in strengthening the culture of injury prevention through community engagement will be shared.ConclusionsHealth care providers and community partners are looking to embrace population health strategies to achieve a greater good for improving the health of children. Using a collective impact model enables communities to accelerate the progress they can have in reducing childhood injury related morbidity and mortality. Safety devices, when correctly used, are highly effective in preventing injuries and saving lives. Recognition of the need to reduce health disparities by removing potential social, economic and language barriers for families around injury prevention strategies is critical.
Granulomatosis with polyangiitis (GPA) is an ANCA-associated, systemic vasculitis of small and medium-sized blood vessels. GPA causes inflammation and destruction to the vessel wall and eventual tissue and organ damage. It classically affects the tissues and vasculature of the sinuses, lungs, and kidneys. The organ damage results in epistaxis, cough, hemoptysis, shortness of breath and/or even kidney failure. Cutaneous manifestations are rare, but have been reported. We discuss the case of a 27-year-old African American female who presented with skin lesions on her bilateral forearms and hands, several years after diagnosis and treatment for GPA. The lesions were isolated papules, located on bilateral elbows, palms, and the lateral edge of the 3rd digit on her left hand. The lesions were intensely pruritic and non-painful. A skin biopsy of the lesions showed neutrophilic and granulomatous inflammation with nuclear debris, a largely non-specific histopathologic finding. An extensive autoimmune work up revealed elevated c-ANCA/PR3-ANCA levels supporting a diagnosis of cutaneous GPA. GPA is diagnosed by a combination of clinical signs and symptoms, serologic testing, and histology from biopsy of affected organs. Patient’s who meet the criteria should be tested for anti-neutrophil cytoplasmic antibody (ANCA), specifically c-ANCA/PR3-ANCA. A positive ANCA is supportive for GPA diagnosis. However, a negative ANCA does not rule out disease. Patients with cutaneous findings suggestive of GPA and positive c-ANCA/PR3-ANCA serologic testing should be closely followed up, which will lead to overall better prognosis, improved health outcomes and reduced patient and health care expenses.
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