ABSTRACT
We report three patients with anti-signal recognition particle antibodies who had different presenting clinical pictures, mimicking acute polymyositis, limb-girdle muscular dystrophy, and acute rhabdomyolysis. Muscle biopsies typically showed necrotizing myopathy with little or no inflammation and deposits of membrane attack complex (C5b-9) in endomysial capillaries. The clinical course was severe in two patients and mild in one. The combination of corticosteroid with either an immunosuppressive agent or intravenous immunoglobulins was required to improve the condition of these patients.
Subject(s)
Autoantibodies/blood , Muscle, Skeletal/immunology , Muscle, Skeletal/pathology , Muscular Diseases/diagnosis , Muscular Diseases/immunology , Signal Recognition Particle/immunology , Adrenal Cortex Hormones/therapeutic use , Adult , Biomarkers/analysis , Biomarkers/metabolism , Biopsy , Complement Membrane Attack Complex/immunology , Complement Membrane Attack Complex/metabolism , Diagnosis, Differential , Disease Progression , Female , Humans , Immunosuppressive Agents/therapeutic use , Male , Middle Aged , Muscle Fibers, Skeletal/immunology , Muscle Fibers, Skeletal/metabolism , Muscle Fibers, Skeletal/pathology , Muscle, Skeletal/physiopathology , Muscular Diseases/physiopathology , Muscular Dystrophies, Limb-Girdle/diagnosis , Muscular Dystrophies, Limb-Girdle/immunology , Muscular Dystrophies, Limb-Girdle/physiopathology , Phenotype , Polymyositis/diagnosis , Polymyositis/immunology , Polymyositis/physiopathology , Predictive Value of Tests , Rhabdomyolysis/diagnosis , Rhabdomyolysis/immunology , Rhabdomyolysis/physiopathologyABSTRACT
The DRESS (Drug Rash with Eosinophilia and Systemic Symptoms) corresponds to a drug reaction generally including cutaneous eruption, fever, hematologic abnormalities such as eosinophilia and atypical lymphocytosis and one or more specific visceral lesions specially in the liver. We report a case of drug hypersensitivity syndrome or DRESS associated with intra and extra-hepatic biliary lesions. This syndrome was associated with sulfasalazine and naproxene therapy. A reactivation of HHV6 was documented in the continuations of the DRESS and could play a role in the symptomms.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Cholangitis/chemically induced , Drug Hypersensitivity/complications , Naproxen/adverse effects , Sulfasalazine/adverse effects , Adult , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Eosinophilia/chemically induced , Exanthema/chemically induced , Humans , Male , Naproxen/therapeutic use , Sulfasalazine/therapeutic useABSTRACT
OBJECTIVE: To prospectively evaluate the relationship between the early computerized tomography (CT) features of disk herniation and the clinical outcome in patients with recent-onset sciatic or femoral neuralgia treated conservatively. Early CT is often used, despite the absence of data on usefulness for predicting outcomes. METHODS: Of 78 patients with sciatica or femoral neuralgia of less than 1 month's duration, presumably due to a disk herniation, 75 were found by CT to have a disk herniation at the expected level. All patients were treated conservatively. The 60 patients who were reassessed clinically after 3 months were included in the study. Based on the results of the clinical assessment, the patients were classified as having a good outcome (complete or partial recovery) or a poor outcome. CT findings were compared in these two groups. RESULTS: None of the features of disk herniation studied on the CT scans were significantly correlated with the clinical outcome. A larger herniation or presence of a free fragment was more common in the good outcome group, but the differences were not statistically significant (P= 0.07). CONCLUSION: In this study, early CT scan did not predict the clinical outcome of patients with nerve root pain from lumbar disk herniation. None of the CT criteria was associated with a poor clinical outcome. Early CT scan has no prognostic value in this setting.
