<i>Lautropia mirabilis</i> is a gram-negative coccoid bacterium isolated from oral and upper respiratory sites with unclear pathogenic potential. We present an exceedingly rare case of peritoneal dialysis-associated peritonitis due to <i>L. mirabilis</i> in a patient with a recent history of periodontal infection, successfully treated with intraperitoneal antibiotics. We propose that clinicians consider this organism as a potential cause of illness.
Background: Hemodialysis (HD) patients with atrial fibrillation (AF) have a particularly high risk of stroke and bleeding, but no high-quality evidence-based recommendations exist to properly manage these patients.
Objectives:We aim to evaluate the ischemic versus the hemorrhagic risk in a HD population with AF.
Methods:We selected incident patients that started hemodialysis between 2011 and 2015. All patients that had AF before HD, or developed AF during the follow-up, were included. Both CHA 2 DS 2 -VASC and HAS-BLED scores were calculated at the time of beginning of HD or AF diagnosis and correlated with the outcomes using a logistic regression model. The outcomes were hemorrhagic events, ischemic events and death related to any of these events. A p-value < 0.05 was set as statistically significant.Results: Forty-six patients were included. Most of them had had AF before they started hemodialysis. Twentytwo patients were on oral anticoagulation (OAC). There was no significant difference between the incidence of ischemic and hemorrhagic events, regardless of the use of OAC. Previous stroke, transient ischemic attack, and thromboembolic event significantly increased the risk of an ischemic event (OR 6.78, p=0.028).
Conclusions:In this population, we did not observe any difference between the incidence of ischemic and hemorrhagic events, which was also true in patients with OAC. Therefore, the benefit of OAC in such patients remains questionable. However, patients with previous stroke, transient ischemic attack, or thromboembolic event seem to have a higher risk of new ischemic events and might benefit from anticoagulation.
Paraneoplastic syndromes, such as myasthenia gravis, pure red-cell aplasia and systemic lupus erythematosus are well-documented in thymoma. Association with glomerulopathies is rare and may occur several years after thymectomy. We report a case of a 60-year-old male presenting with nephrotic syndrome after thymectomy due to thymoma. The kidney biopsy showed minimal change disease. The patient went into complete remission after treatment with corticosteroids. The pathogenesis of glomerular lesions associated with thymic disease remains controversial.
Macrophage activation syndrome is a form of secondary hemophagocytic lymphohistiocytosis in the setting of autoimmune diseases. It’s a rare, hyperinflammatory complication requiring prompt institution of therapy to prevent organ dysfunction and death. We report a young female presenting with macrophage activation syndrome with multiorgan failure and diffuse alveolar hemorrhage in the setting of inaugural systemic lupus erythematosus. The patient was successfully treated with steroids, plasma exchange and cyclophosphamide.
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