RESUMO
Secondary amyloidosis is one of the most serious complications in chronic inflammatory diseases such as rheumatoid arthritis. The extracellular deposit of aggregates of amyloid leads to target organ dysfunction. The mainstay treatment of secondary amyloidosis is the control of underlying disease activity. Many reports have reported that TNF-alpha inhibitors improve clinical outcomes. Here, we encountered a 34-year-old patient with juvenile rheumatoid arthritis who developed secondary amyloidosis despite treatment with TNF-alpha inhibitors. We present this case and include a review of the literature.
Assuntos
Adulto , Humanos , Amiloide , Amiloidose , Artrite Juvenil , Artrite Reumatoide , Fator de Necrose Tumoral alfaRESUMO
The calcineurin inhibitor-immunosuppressant tacrolimus is widely used in patients undergoing kidney transplantation. Although tacrolimus is absorbed from the entire gastrointestinal tract, the duodenum is the primary site of its absorption and metabolism. Therefore, duodenal bypass surgery in a renal transplant recipient can significantly disrupt tacrolimus absorption and metabolism. Here, we report a case of allograft failure that developed after duodenal bypass surgery. The patient was a 41-year-old woman who received a deceased donor kidney transplantation. She underwent a gastrojejunostomy due to a duodenal perforation and pancreatitis after endoscopic retrograde cholangiopancreatography. After the surgery, her blood tacrolimus level decreased gradually, and remained lower than therapeutic target levels, even after the tacrolimus dose was increased from 5 to 12 mg/day. Repetitive rejection developed and the patient suffered allograft failure 3 months after bypass surgery. This case raises the importance of drug absorption in renal transplant recipients undergoing duodenal bypass surgery.
Assuntos
Adulto , Feminino , Humanos , Absorção , Calcineurina , Colangiopancreatografia Retrógrada Endoscópica , Duodeno , Derivação Gástrica , Trato Gastrointestinal , Rim , Transplante de Rim , Pancreatite , Rejeição em Psicologia , Tacrolimo , Doadores de Tecidos , Transplante Homólogo , TransplantesRESUMO
Herein we report the case of a 71-year-old woman who complained of fatigue and enlarged right axillary lymph nodes for 18 months. At her first visit, her chest X-ray showed diffuse nodular opacities in both lung fields. Initial excisional biopsy of the axillary lymph nodes showed granulomatous lesions and acid fast bacilli were seen on Ziehl-Neelsen staining. However, even after 15 months of anti-tuberculosis (TB) medication, her right axillary lymph nodes were enlarged. We re-performed an excisional biopsy of the nodes, which showed Hodgkin's lymphoma (HL). A retrograde review of the biopsy before anti-tuberculous medication, revealed HL coexisting with TB. HL and TB cause difficulties in differential diagnosis due to similarities in clinical course, imaging procedures and histopathological analysis of the involved tissue. Therefore, it is important to consider the possibility of concurrent HL and TB when patients who undergo treatment for TB or chemotherapy for lymphoma complain of persistent systemic symptoms or enlarged lymph nodes.
Assuntos
Idoso , Feminino , Humanos , Biópsia , Diagnóstico Diferencial , Fadiga , Doença de Hodgkin , Pulmão , Linfonodos , Linfadenite , Linfoma , Tórax , TuberculoseRESUMO
Stent fracture is likely to be caused due to mechanical stress at the hinge point or kinking movement at the point of aneurysm formation with stent malapposition. To our knowledge, this is the first published report of stent fracture at the proximal shaft of the left main stem in a patient with acute myocardial infarction.
Assuntos
Humanos , Aneurisma , Infarto do Miocárdio , Stents , Estresse MecânicoRESUMO
Glioblastoma multiforme (GM) is one of the most aggressive primary brain tumors, and has a poor prognosis despite intensive treatment. GM is also the most malignant astrocytoma, with histopathological features that include cellular polymorphism, rapid mitotic activity, microvascular proliferation, and necrosis. The causes of GM remain obscure, but several reports have shown associations between GM and genetic alterations and radiation exposure. Furthermore, high-dose chemotherapy/radiotherapy with autologous stem cell transplantation is increasingly being used to treat patients with leukemia, and patients who undergo stem cell transplantation have a higher risk of solid tumor cancer development later in life. Based on these associations, we discuss GM development in a patient who underwent chemoradiotherapy conditioning prior to stem cell transplantation.
Assuntos
Humanos , Astrocitoma , Neoplasias Encefálicas , Quimiorradioterapia , Glioblastoma , Transplante de Células-Tronco Hematopoéticas , Células-Tronco Hematopoéticas , Leucemia , Leucemia Mieloide Aguda , Necrose , Prognóstico , Transplante de Células-TroncoRESUMO
Glioblastoma multiforme (GM) is one of the most aggressive primary brain tumors, and has a poor prognosis despite intensive treatment. GM is also the most malignant astrocytoma, with histopathological features that include cellular polymorphism, rapid mitotic activity, microvascular proliferation, and necrosis. The causes of GM remain obscure, but several reports have shown associations between GM and genetic alterations and radiation exposure. Furthermore, high-dose chemotherapy/radiotherapy with autologous stem cell transplantation is increasingly being used to treat patients with leukemia, and patients who undergo stem cell transplantation have a higher risk of solid tumor cancer development later in life. Based on these associations, we discuss GM development in a patient who underwent chemoradiotherapy conditioning prior to stem cell transplantation.