Leukocytoclastic vasculitis is a disease mostly limited to the skin. Extracutaneous manifestations that include visceral involvement are normally self-limiting and not life-threatening. We describe a 44-year-old man with palpable purpura, polyarthritis and microhematuria who developed severe vasculitis of the small and large bowel. Initial laboratory tests confirmed leukocytosis, slightly elevated C-reactive protein and mildly increased erythrocyte sedimentation rate. Skin biopsy revealed histological features typical of leukocytoclastic vasculitis. The search for trigger factors revealed urogenital infection with Ureaplasma urealyticum. Severe abdominal pain followed cutaneous symptoms eight days after admission. Abdominal x-ray showed several air-fluid levels in the lower right abdomen and an abdominal CT scan revealed thickening of the intestinal wall in several segments of jejunum, ileum and colon. C-reactive protein rose from 32 mg/l to 107 mg/l. Methylprednisolone pulse therapy rapidly improved gastrointestinal, cutaneous and articular symptoms. The aim of this report is to show the unpredictability of vasculitic disease and the difficulties in its classification. The report emphasizes the importance of adapting diagnosis and treatment according to disease severity rather than to the type of vasculitis. The specific etiological trigger remains unknown in this case, although a causal relationship with U. urealyticum infection is speculated.
Wegener's vasculitis is an autoimmune disease affecting small and medium-sized blood vessels with a high mortality rate. It is a disease of usually subsidious course and nonspecific initial symptoms that are diagnostically misleading. Cardiac involvement is described most frequently in the form of supraventricular tachyarrhytmias, and rarely as a clinically significant myocardial infarction. This case demonstrates another facet of this disease presenting as full blown shock and respiratory insufficiency progressing to ARDS (acute respiratory distress syndrome) and multiorgan failure over the course of two weeks, with an unfortunately fatal outcome.
Uvod: Stečena QT prolongacija može biti prouzročena lijekovima i precipitirana elektrolitskim poremećajem, no pojavljuje se i uz povišeni intrakranijski tlak. QT prolongacija je povezana s torsades de pointes (TdP), po život opasnom polimorfnom ventrikulskom tahikardijom.
Heart failure represents a significant medical and economic burden and is also an important cause of mortality and morbidity. The advances in treating coronary artery disease mainly pertaining to modern invasive cardiology significantly reduced the mortality from coronary atherosclerosis, but on the other side caused an increase in incidence and prevalence of congestive heart failure. Heart failure is a disease of the elderly. In that population the incidence is 10 in 1000 patients older than 65 years and has a high five-year mortality despite all modern treatment modalities. (1)
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