Subject(s)
Anemia, Iron-Deficiency/etiology , Carcinoma, Squamous Cell/diagnosis , Lung Neoplasms/diagnosis , Paraneoplastic Syndromes/etiology , Vasculitis, Leukocytoclastic, Cutaneous/etiology , Anemia, Iron-Deficiency/blood , Anemia, Iron-Deficiency/drug therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Biopsy , Carcinoma, Squamous Cell/complications , Carcinoma, Squamous Cell/therapy , Chemotherapy, Adjuvant , Humans , Lung Neoplasms/complications , Lung Neoplasms/therapy , Male , Middle Aged , Neoadjuvant Therapy , Paraneoplastic Syndromes/pathology , Paraneoplastic Syndromes/therapy , Pneumonectomy , Predictive Value of Tests , Radiotherapy, Adjuvant , Tomography, X-Ray Computed , Treatment Outcome , Vasculitis, Leukocytoclastic, Cutaneous/pathology , Vasculitis, Leukocytoclastic, Cutaneous/therapySubject(s)
Antibodies, Monoclonal/therapeutic use , Hemoglobinuria, Paroxysmal/drug therapy , Anemia, Aplastic/etiology , Antibodies, Monoclonal, Humanized , Anticoagulants/therapeutic use , Blood Transfusion/statistics & numerical data , Hemoglobins , Hemoglobinuria, Paroxysmal/blood , Humans , Thrombosis/prevention & controlSubject(s)
Antineoplastic Agents/adverse effects , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/drug therapy , Pleural Effusion/chemically induced , Protein Kinase Inhibitors/adverse effects , Pyrimidines/adverse effects , Thiazoles/adverse effects , Dasatinib , Humans , Paracentesis , PleurodesisABSTRACT
This case report describes a patient who presented with severe anemia, monoclonal gammopathy, a high erythrocyte sedimentation rate and significant weight loss. These features were highly suggestive of multiple myeloma. Bone marrow aspiration was negative for myeloma on two occasions. A positron emission tomography (PET) scan showed extensive 2-flourodeoxy-glucose uptake in the vascular tree consistent with arteritis. A temporal artery biopsy established the diagnosis of giant cell arteritis (GCA). There were no typical symptoms of GCA, such as headache, visual disturbance, or polymyalgia rheumatica. The patient was treated with steroids, which resulted in the resolution of anemia, monoclonal gammapathy, and other symptoms.
Subject(s)
Giant Cell Arteritis/diagnosis , Multiple Myeloma/diagnosis , Positron-Emission Tomography , Aged , Female , Glucose-6-Phosphate/analogs & derivatives , Humans , Necrosis , Temporal Arteries/pathologyABSTRACT
Acute thrombotic thrombocytopenic purpura (TTP) is a life-threatening disorder that has previously been described associated with various types of surgery. An association between total abdominal hysterectomy (TAH) and TTP has never been reported. Thrombotic thrombocytopenic purpura is classically characterized by thrombocytopenia, microangiopathic hemolytic anemia, fever, azotemia and neurological manifestations. Atypical manifestations of TTP include hepatitis, pancreatitis, acute respiratory distress syndrome, non-occlusive mesenteric ischemia and peripheral digital ischemia. This case report describes the occurrence of acute TTP following TAH and bilateral salpingo-oopherectomy, which manifested with typical and atypical features (i.e. hepatitis, pancreatitis). Plasma exchange therapy resulted in the complete resolution of the process.
Subject(s)
Hepatitis/complications , Hysterectomy/adverse effects , Pancreatitis/complications , Plasma Exchange/methods , Purpura, Thrombotic Thrombocytopenic/complications , Acute Disease , Adult , Blood Chemical Analysis , Female , Follow-Up Studies , Hepatitis/diagnosis , Humans , Hysterectomy/methods , Ovariectomy/adverse effects , Ovariectomy/methods , Pancreatitis/diagnosis , Purpura, Thrombotic Thrombocytopenic/diagnosis , Risk Assessment , Severity of Illness Index , Treatment OutcomeABSTRACT
Neoplastic fever is relatively common in cancer patients. Naproxen is one of the most commonly used non-steroidal anti-inflammatory drugs for the treatment of neoplastic fever. Naproxen is associated with platelet dysfunction and gastrointestinal side effects. We substituted rofecoxib, a cyclooxygenase-II inhibitor, for naproxen in patients with a previous history of, or a newly diagnosed, neoplastic fever in whom naproxen was relatively contraindicated. In all patients the fever resolved completely without any side effects.
Subject(s)
Cyclooxygenase Inhibitors/therapeutic use , Fever/drug therapy , Fever/etiology , Isoenzymes/antagonists & inhibitors , Neoplasms/complications , Cyclooxygenase 2 , Cyclooxygenase 2 Inhibitors , Dose-Response Relationship, Drug , Drug Administration Schedule , Fever/diagnosis , Humans , Lactones/therapeutic use , Membrane Proteins , Prostaglandin-Endoperoxide Synthases , Sulfones , Treatment OutcomeABSTRACT
Release of unusually large von Willibrand factor (UL vWF) multimers and a deficiency of vWF metalloprotease may result in thrombotic thrombocytopenic purpura (TTP), a life threatening disease. Surgery has been associated with TTP, probably by releasing massive amounts of UL vWF. An association between TTP and orthopedic surgery has never been reported in the literature. We report a case of TTP following a total knee replacement surgery in which prior use of ticlopidine might have played a role.
Subject(s)
Orthopedic Procedures/adverse effects , Female , Humans , Middle Aged , Purpura, Thrombotic Thrombocytopenic/etiology , von Willebrand Factor/immunologyABSTRACT
HELLP syndrome (an acronym for hemolysis, elevated liver enzymes, and low platelets) is a life-threatening complication of pregnancy seen in association with either preeclampsia or eclampsia. HELLP syndrome is rarely diagnosed before 24 weeks of gestation. This atypical form of severe preeclampsia is associated with significant fetal and maternal mortality. The only effective treatment is delivery. We report a case of HELLP syndrome that proved to be a diagnostic clue to an early pregnancy.
Subject(s)
Abortion, Therapeutic , HELLP Syndrome/diagnosis , HELLP Syndrome/therapy , Adult , Female , Humans , Pregnancy , Pregnancy TestsABSTRACT
BACKGROUND: Thrombotic microangiopathy (TM) is characterized by thrombocytopenia and microangiopathic hemolytic anemia in association with diffuse microthrombi in the arteriolar capillaries of various organs. Its clinical manifestation is protean, and a few well-defined clinical syndromes have been recognized. A clear understanding of the consequence of TM is needed to appreciate the unusual clinical syndromes due to atypical presentation of thrombotic thrombocytopenic purpura (TTP). METHODS: The medical records of patients with known diagnoses of TTP, hemolytic uremic syndrome (HUS), and the syndrome in which hemolysis, elevated liver enzymes, and low platelet count are found in association with pregnancy were examined retrospectively from 1981 to 1994 and prospectively from 1995 to 2000. Various thrombotic microangiopathic presentations were identified in these patients. Their response to exchange plasmapheresis was evaluated, and their clinical outcome was determined. RESULTS: A total of 74 patients were diagnosed with TM. Among these patients, several well-defined thrombotic microangiopathic presentations were identified. These presentations included TTP in 57 patients, acute respiratory distress syndrome (ARDS) in 13 patients, HUS in 9 patients, the syndrome in which hemolysis, elevated liver enzymes, and low platelet count are found in association with pregnancy in 9 patients, peripheral digit ischemic syndrome (PDIS) in 6 patients, pancreatitis in 3 patients, hepatitis in 3 patients, and nonocclusive mesenteric ischemia (NOMI) in 2 patients. Exchange plasmapheresis was an effective treatment, with a response rate of 79%. A poor prognosis was evident when ARDS was present, with an overall survival rate of 46%. CONCLUSION: Traditionally, TTP and HUS are considered the main entities of TM. It is evident that other manifestations of TM, if unrecognized in a timely fashion, can lead to fatality. The understanding of the pathophysiologic consequences of TM and the recognition of its atypical presentations are essential to achieve favorable outcomes in patients with this life-threatening disease.