Prevalence and prognosis of cerebrovascular accidents and its subtypes among patients with systemic lupus erythematosus in Isfahan, Iran: a hospital clinic-based study

The aim of the present study was to determine the prevalence and prognosis of cerebrovascular accident [CVA] and its subtypes among Iranian patients with systemic lupus erythematosus [SLE]. In a cross-sectional study, medical records of 575 SLE patients were reviewed. The patients developing CVA in their course of disease were extracted. In these patients, data about demographic features, lupus anti bodies, duration of the disease until CVA, CVA manifestation[s] and follow-up duration were gathered. In the next step, patients with any kinds of CVA were summoned to Neurology clinic to identify the grade of disability in each patient with CVA. We identified 38 patients with CVA of which 6 [15.8%] were men and 32 [84.2%] were women. The most common subtype of CVA was small vessels thrombosis [21.05%] among the study patients and hemi paresis was the most prevalent initial presentation [39.47%]. In 11 [28.9%] patients, SLE was initiated with CVA and in 3 [7.9%] patients CVA had happened in the 1st year of SLE. Anti-phospholipid antibodies [APLA] were positive in 29 [76.3%] patients. Mean modified Rankin Scale in patient with positive and negative serology for APLA was 0.93 +/- 1.11 and 0.22 +/- 0.66 respectively [P = 0.006]. Our study shows that 6.6% of Iranian SLE patients have CVA during their course of the disease. Small vessels thrombosis is the most common CVA subtype and hemi paresis is the most prevalent initial presentation. Moreover, we showed that the prognosis of CVA in Iranian SLE patients is not unfavorable

Recurrent acute pancreatitis and cholangitis in a patient with autosomal dominant polycystic kidney disease

Autosomal dominant polycystic kidney disease [ADPKD] is an inherited disorder associated with multiple cyst formation in the different organs. Development of pancreatic cyst in ADPKD is often asymptomatic and is associated with no complication. A 38-year-old man with ADPKD was presented with six episodes of acute pancreatitis and two episodes of cholangitis in a period of 12 months. Various imaging studies revealed multiple renal, hepatic and pancreatic cysts, mild ectasia of pancreatic duct, dilation of biliary system and absence of biliary stone. He was managed with conservative treatment for each attack. ADPKD should be considered as a potential risk factor for recurrent acute and/ or chronic pancreatitis and cholangitis

Fatal disseminated mucormycosis in an immunocompotent patient: a case report and literature review

Disseminated mucormycosis is a rare entity most frequently seen in neutropenic patients with hematologic malignancies, post transplants or in patients on deferoxamine therapy. We report a 64-year-old immunocompetent male with an acute pneumonia and a generalized jaundice who died within 24 h. In the autopsy, extensive perforations of spleen and multiple hemorrhage foci on the pancreas were two significant findings. Histopathological study of tissue sections revealed typical zygomycetes hyphae in the left lung, pancreas, spleen and brain. Involvement of pancreas in this patient was one of the rare features of mucormycosis reported occasionally in the literature. Our case implies an unusual clinical presentation of disseminated mucormycosis and highlights that disseminated mucormycosis should be regarded even in the immunocompetent patients

Precise recognition of liver inflammatory pseudotumor may prevent an unnecessary surgery

Liver inflammatory pseudotumor [IPT] is considered a benign inflammatory lesion mostly presented as a solitary solid mass in the right hepatic lobe. It may clinically and radiologically mimic a malignant liver tumor or an abscess. Accordingly, diagnoses of most of the reported cases have been established after surgical resection. In this report, we describe a 52-year-old woman with a 1-year history of fever of unknown origin. In the following investigation, abdominal computed tomography [CT] scan showed infiltrative lesion in the right hepatic lobe. The patient underwent a CT-guided needle biopsy of the hepatic lesion. Histopathologic study of biopsy specimen revealed the features of IPT. The patient was discharged and followedup for 6 months. After 6 months she had no complaint of fever and control liver ultrasonography disclosed no lesion. As liver IPT has favorable response to conservative therapy and may also resolve spontaneously, precise recognition of this condition with the help of fine-needle biopsy may help to avoid unnecessary surgery