ABSTRACT
Adult-onset Still's disease is a systemic autoinflammatory disease the presentation of which can often mimic infection. As a consequence, there is often a delay in diagnosis. Serositis is a recognised but less common clinical feature that can result in complications including cardiac tamponade and constrictive pericarditis. We describe a case of adult-onset Still's disease without the hallmark rash or significant arthritis, presenting with polyserositis that showed a good response to initial steroid treatment and sustained remission with anakinra. An elevated procalcitonin level was due to active adult-onset Still's disease, not bacterial infection.
Subject(s)
Antirheumatic Agents/therapeutic use , Interleukin 1 Receptor Antagonist Protein/therapeutic use , Pericardial Effusion/diagnostic imaging , Still's Disease, Adult-Onset/diagnosis , Anti-Inflammatory Agents/therapeutic use , Female , Humans , Middle Aged , Still's Disease, Adult-Onset/drug therapy , Still's Disease, Adult-Onset/physiopathology , Treatment OutcomeABSTRACT
This review focuses on the current literature directed towards the brain metabolite findings in Cerebral Autosomal-Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) disease using magnetic resonance spectroscopy (MRS) and magnetic resonance spectroscopic imaging (MRSI). Using search terms "metabolites", "spectroscopy", and "CADASIL", six articles were found on PubMed database, Scopus and Google Scholar. Changes in metabolites concentrations and relative ratios (RR) were found not only in abnormal but also in normal-appearing brain regions.
Subject(s)
Brain/diagnostic imaging , CADASIL/diagnostic imaging , Aspartic Acid/analogs & derivatives , Aspartic Acid/metabolism , Brain/metabolism , CADASIL/metabolism , Creatine/metabolism , Glutamic Acid/metabolism , Glutamine/metabolism , Humans , Inositol/metabolism , Lactic Acid/metabolism , Magnetic Resonance Spectroscopy , Proton Magnetic Resonance SpectroscopyABSTRACT
Isolated hepatic tuberculosis without pulmonary or bowel involvement is a diagnostic challenge and can cause considerable morbidity. A young lady from Lahore presented with fever, pain in right hypochondria, nausea and weight loss. CT scan of abdomen showed multiple small hypodense non-enhancing lesions and a heterogeneous texture of liver. Biopsy confirmed the diagnosis of hepatic tuberculosis. It was concluded a case of isolated hepatic tuberculosis without evidence of other primary sites involvement. It is important to consider tuberculosis in the differential diagnosis when suspecting lymphoproliferative or metastatic diseases in a patient with vague symptoms and abnormal hepatic texture on CT.
