RESUMO
Empyema necessitatis is a rare complication of an empyema. Although the incidence is thought to be decreased in the post-antibiotic era, immunocompromised patients such as patients with chronic kidney disease on dialysis are still at a higher risk. A 56-year-old woman on peritoneal dialysis presented with an enlarging mass on the right anterior chest wall. The chest computed tomography scan revealed an empyema necessitatis and the histopathologic findings revealed a granulomatous inflammation with caseation necrosis. The patient was treated with anti-tuberculous medication.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Diálise , Empiema , Hospedeiro Imunocomprometido , Incidência , Inflamação , Mycobacterium tuberculosis , Necrose , Diálise Peritoneal , Insuficiência Renal Crônica , Parede Torácica , TóraxRESUMO
We report the case of a patient who experienced extreme recurrent gestational hyperlipidemia. She was diagnosed with partial lipoprotein lipase (LPL) deficiency but without an associated LPL gene mutation in the presence of the apolipoprotein E3/2 genotype. This is the first reported case of extreme gestational hyperlipidemia with a partial LPL deficiency in the absence of an LPL gene mutation and the apolipoprotein E 3/2 genotype. She was managed with strict dietary control and medicated with omega-3 acid ethyl esters. A patient with extreme hyperlipidemia that is limited to the gestational period should be considered partially LPL-deficient. Extreme instances of hyperlipidemia increase the risk of acute pancreatitis, and the effect of parturition on declining plasma lipid levels can be immediate and dramatic. Therefore, decisions regarding the timing and route of delivery with extreme gestational hyperlipidemia are critical and should be made carefully.
Assuntos
Adulto , Feminino , Humanos , Gravidez , Doença Aguda , Apolipoproteína E2/genética , Apolipoproteína E3/genética , Biomarcadores/sangue , Terapia Combinada , Dieta com Restrição de Gorduras , Ácidos Graxos Ômega-3/uso terapêutico , Hidratação , Predisposição Genética para Doença , Hiperlipoproteinemia Tipo I/sangue , Lipídeos/sangue , Lipase Lipoproteica/genética , Pancreatite/diagnóstico , Nutrição Parenteral Total , Fenótipo , Complicações na Gravidez/sangue , Recidiva , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
The term inflammatory pseudotumor (IPT) has been used to describe inflammatory and fibrosing tumoral processes of an undetermined cause that may involve a variety of organ system. IgG4-related disease is a newly recognized fibroinflammatory condition characterized by IgG4-producing plasma cell expansion in affected organs and, often but not always, elevated serum IgG4 concentrations. IgG4-related IPTs, a subtype of IPT, are characterized by dense infiltration of IgG4-positive plasma cells and stromal fibrosis. The association between inflammatory pseudotumor and IgG4 was first reported with a regard to sclerosing pancreatitis. Despite there are many reports on intraperitoneal IPTs including both cellular and lymphoplasmacytic type, only a few cases have been confirmed to be IgG4-related. We experienced a case of intraperitoneal IgG4-related inflammatory pseudotumor in an 83-year-old woman presenting with epigastric pain and malaise. Surgical specimens revealed an IgG4-related inflammatory pseudotumor.
Assuntos
Idoso de 80 Anos ou mais , Feminino , Humanos , Proteína C-Reativa/análise , Granuloma de Células Plasmáticas/diagnóstico , Imunoglobulina G/sangue , Plasmócitos/metabolismo , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios XRESUMO
The term inflammatory pseudotumor (IPT) has been used to describe inflammatory and fibrosing tumoral processes of an undetermined cause that may involve a variety of organ system. IgG4-related disease is a newly recognized fibroinflammatory condition characterized by IgG4-producing plasma cell expansion in affected organs and, often but not always, elevated serum IgG4 concentrations. IgG4-related IPTs, a subtype of IPT, are characterized by dense infiltration of IgG4-positive plasma cells and stromal fibrosis. The association between inflammatory pseudotumor and IgG4 was first reported with a regard to sclerosing pancreatitis. Despite there are many reports on intraperitoneal IPTs including both cellular and lymphoplasmacytic type, only a few cases have been confirmed to be IgG4-related. We experienced a case of intraperitoneal IgG4-related inflammatory pseudotumor in an 83-year-old woman presenting with epigastric pain and malaise. Surgical specimens revealed an IgG4-related inflammatory pseudotumor.
Assuntos
Idoso de 80 Anos ou mais , Feminino , Humanos , Proteína C-Reativa/análise , Granuloma de Células Plasmáticas/diagnóstico , Imunoglobulina G/sangue , Plasmócitos/metabolismo , Tomografia por Emissão de Pósitrons , Tomografia Computadorizada por Raios XRESUMO
Recently, the incidence of candida infection has increased. Candida species often show hematogenous spread to the kidney, brain, heart, and eyes. And delayed onset of hematogenous spread is relatively rare. A 53-year-old female patient was admitted with left anterior chest pain with swelling and mild fever. She had been treated successfully with fluconazole for candidemia caused by C. albicans eight month ago. On admission chest CT scan revealed multiple subcutaneous abscesses involving the anterior chest. Percutaneous drainage of the abscess was performed. C. albicans was isolated from drained pus. Treatment with fluconazole did not to improve the abscess; therefore, micafungin and voriconazole were administered as a replacement. The patient recovered after 10-week administration.