Tuberculosis-associated hemophagocytic lymphohistiocytosis misdiagnosed as systemic lupus erythematosus: A case report.

BACKGROUND: Hemophagocytic lymphohistiocytosis (HLH) is a rare disorder with rapid progression and high mortality. HLH occurs mostly due to infection, malignant tumors, and immune disorders. Among infections that cause HLH, viral infections, especially Epstein-Barr virus infections, are common, whereas tuberculosis is rare. Tuberculosis-associated HLH has a wide range of serological and clinical manifestations that are similar to those of systemic lupus erythematosus (SLE). CASE SUMMARY: This study describes a case of tuberculosis-associated HLH misdiagnosed as SLE because of antinuclear antibody (ANA), Smith (Sm) antibody and lupus anticoagulant positivity; leukopenia; thrombocytopenia; pleural effusion; decreased C3, quantitatively increased 24 h urinary protein and fever. The patient was initially treated with glucocorticoids, which resulted in peripheral blood cytopenia and symptom recurrence. Then, caseating granulomas and hemophagocytosis were observed in her bone marrow. She was successfully treated with conventional category 1 antituberculous drugs. In addition, we reviewed the literature on tuberculosis-associated HLH documented in PubMed, including all full-text articles published in English from December 2009 to December 2019, and summarized the key points, including the epidemiology, clinical manifestations, diagnosis, and treatment of tuberculosis-associated HLH and the differences of the present case from previous reports. CONCLUSION: Tuberculosis should be considered in patients with fever or respiratory symptoms. Antituberculous drugs are important for treating tuberculosis-associated HLH.

Response to belimumab in thrombotic thrombocytopenic purpura associated with systemic lupus erythematosus: a case-based review.

Thrombotic thrombocytopenic purpura (TTP), a life-threatening syndrome characterized by acute microangiopathic hemolytic anemia, thrombocytopenia, and visceral ischemia, can be classified as congenital TTP (inherited due to a mutation in ADAMTS13) and acquired TTP. The acquired TTP is further classified as idiopathic and secondary TTP. Systemic lupus erythematosus (SLE) is regarded as one of the most common causes of secondary TTP (SLE-TTP). In contrast to patients with idiopathic TTP, some patients with SLE-TTP, especially those diagnosed with refractory TTP, are resistant to plasma exchange and high-dose corticosteroids and usually require second-line drugs, including newly developed biologicals. Belimumab, a B-lymphocyte stimulator-specific inhibitor, was the first approved new therapy for SLE in the past 50 years. Only two cases of SLE-TTP using belimumab have been reported; however, detailed information has not been made available. Herein, we describe a 28-year-old female patient who presented with palm petechiae, strong tawny urine, and yellow stained skin and sclera, and was diagnosed with SLE-TTP supported by high anti-ANA titers; positive anti-SSA/SM; pleural effusion; decreased platelet count, hemoglobin, and complement C3/C4 counts; increased lactate dehydrogenase level, along with increased schistocytes; and a significant deficiency of ADAMTS13 activity. Belimumab (10 mg/kg) was administered after six plasma exchanges. Good efficiency and outcomes without any adverse events, SLE, or TTP relapse were observed during 12 months of follow-up. Therefore, belimumab is a promising choice for SLE-TTP management. In addition, we provide a focused review of the existing literature on the pathogenesis, diagnosis, and therapeutic strategies for SLE-TTP.

A double-population chaotic self-adaptive evolutionary dynamics model for the prediction of supercritical carbon dioxide solubility in polymers.

Solubility of gas in polymers is an important physico-chemical property of foam materials and widely used in the preparation and modification of new materials. Under the conditions of high temperature and high pressure, the dissolution process is a nonlinear, non-equilibrium and dynamic process, so it is difficult to establish an accurate solubility calculation model. Inspired by particle dynamics and evolutionary algorithm, this paper proposes a hybrid model based on chaotic self-adaptive particle dynamics evolutionary algorithm (CSA-PD-EA), which can use the iterative process of particles in evolutionary algorithms at the dynamic level to simulate the mutual diffusion process of molecules during dissolution. The predicted solubility of supercritical CO2 in poly(d,l-lactide-co-glycolide), poly(l-lactide) and poly(vinyl acetate) indicated that the comprehensive prediction performance of the CSA-PD-EA model was high. The calculation error and correlation coefficient were, respectively, 0.3842 and 0.9187. The CSA-PD-EA model showed prominent advantages in accuracy, efficiency and correlation over other computational models, and its calculation time was 4.144-15.012% of that of other dynamic models. The CSA-PD-EA model has wide application prospects in the computation of physical and chemical properties and can provide the basis for the theoretical calculation of multi-scale complex systems in chemistry, materials, biology and physics.

Intervention for diagnosis of deep vein thrombosis in acute stroke patients: a hospital-based study.

BACKGROUND: Immobile stroke patients are at high risk of deep vein thrombosis (DVT). Demographic studies suggest a low incidence of DVT in Asian patients, but that might be underestimated. OBJECTIVE: Intervention by in-hospital case management for diagnosis of DVT in patients with acute stroke. PATIENTS AND METHODS: Intervention was defined as: recommendation of D-dimer test for patients who are immobile by day 4 after stroke onset and compression ultrasonography if the level of D-dimer is ≥500 ng/ml. Treating physicians were notified by case managers before they failed to do so for qualified patients. Data of patients hospitalized 12 months before and 8 months after the intervention, including basic demographics, Glasgow Coma Scale score, National Institute of Health Stroke Scale (NIHSS) score, laboratory results, and examination reports, was retrieved from electronic medical records for analysis by code searches for acute stroke. RESULTS: A total of 2523 patients were identified. 1528 were before and 995 after intervention. More patients after intervention had D-dimer test and ultrasound examination than that before intervention (22.1% vs 8.6%, P<0.001 and 15.1% vs 1.2%, P<0.001, respectively). Ultrasound diagnosis of DVT was significantly more after than before intervention (2.0% vs 0.3%, P<0.001). DVT was 55.7 per 1000 in patients with a NIHSS score≧18. Male sex (Odds ratio 0.33, 95% confidence intervals: 0.11-0.98), NIHSS score (Odds ratio 1.05, 95% confidence intervals: 1.00-1.09), and intervention (Odds ratio 5.39, 95% confidence intervals: 1.88-15.44) were independent predictors of ultrasound diagnosis of DVT. CONCLUSIONS: Intervention by in-hospital case management may be an effective strategy for improvement of under-diagnosis of DVT in acute stroke patients.