Subject(s)
Chemical and Drug Induced Liver Injury/diagnosis , Glucocorticoids/adverse effects , Graves Ophthalmopathy/drug therapy , Methylprednisolone/adverse effects , Administration, Intravenous , Chemical and Drug Induced Liver Injury/etiology , Chemical and Drug Induced Liver Injury/pathology , Glucocorticoids/administration & dosage , Glucocorticoids/therapeutic use , Humans , Male , Methylprednisolone/administration & dosage , Methylprednisolone/therapeutic use , Middle Aged , Pulse Therapy, DrugABSTRACT
An 81-year-old woman with adenocarcinoma of the rectosigmoid presented with progressive muscle weakness and difficulty swallowing, with symptoms worsening following successful resection of the tumor. On examination, she had weakness primarily of lower limb proximal muscles, with no other abnormal findings. Laboratory tests showed significant elevation of creatine kinase, and EMG findings indicated myositis of the proximal muscles. While MRI showed increased signal intensity on T2-weighted images of the leg muscles, indicating inflammation, muscle biopsy found widespread necrosis with only weak and focal lymphocytic infiltration. A diagnosis of paraneoplastic necrotizing myopathy (PNM) was made, and immunomodulatory treatment initiated, with little response. Four months later she returned with exacerbation of symptoms, this time with skin changes pathognomonic of dermatomyositis (DM). A repeat MRI showed progression of inflammation, as well as necrotic foci. It is important to distinguish between paraneoplastic myopathies such as DM and PNM, with implications regarding treatment and prognosis.
Subject(s)
Adenocarcinoma/complications , Dermatomyositis/etiology , Muscular Diseases/etiology , Paraneoplastic Syndromes/etiology , Sigmoid Neoplasms/complications , Aged , Aged, 80 and over , Female , Humans , Magnetic Resonance Imaging , NecrosisABSTRACT
We present a case of eosinophilic pleural effusion due to valproic acid (VPA), a rare adverse event that has been reported previously. A 30-year-old male patient presented with respiratory symptoms and right-sided pleuritic pain, within days of initiation of VPA treatment for a generalized seizure. Chest radiography revealed a moderate-sized right-sided pleural effusion, which was an exudate with a pH of 7.54 and 48% eosinophils. Symptoms resolved soon after discontinuation of the drug, as did the effusion in a repeat radiograph 3 weeks later. The likelihood that VPA was the cause of the effusion is examined.
Subject(s)
Eosinophilia/chemically induced , Exudates and Transudates/cytology , Pleural Effusion/chemically induced , Valproic Acid/adverse effects , Adult , Humans , Male , Seizures/drug therapySubject(s)
Fasciitis, Necrotizing/complications , Pressure Ulcer/etiology , Soft Tissue Infections/complications , Anti-Bacterial Agents/therapeutic use , Debridement/methods , Diagnosis, Differential , Fasciitis, Necrotizing/diagnosis , Fasciitis, Necrotizing/therapy , Fatal Outcome , Female , Humans , Middle Aged , Pressure Ulcer/diagnosis , Pressure Ulcer/therapy , Soft Tissue Infections/diagnosis , Soft Tissue Infections/therapyABSTRACT
OBJECTIVES: To assess the diagnostic value of the chest radiograph for the diagnosis of pneumonia in bedridden patients, using non-contrast-enhanced high-resolution chest computed tomography (CT) as the gold standard. METHODS: We prospectively evaluated bedridden patients hospitalized with moderate to high clinical probability of pneumonia. Chest radiographs were interpreted in a blinded fashion by 3 observers and classified as definite, normal, or uncertain for pneumonia. Chest CT was obtained within 12 hours of chest radiograph. We applied Bayesian analysis to assess the accuracy of chest radiograph in the diagnosis of pneumonia. RESULTS: In a 5-month period, 58 patients were evaluated, 31 (53%) were female. Their chest radiographs were interpreted as negative, uncertain, or positive for pneumonia in 31 (53%), 15 (26%), and 12 (21%) patients, respectively, while CT confirmed pneumonia in 11 (35%), 10 (67%), and in 10 (83%). The sensitivity of the chest radiograph to diagnose pneumonia was 65%, the specificity was 93%, the positive and negative predictive values were, respectively, 83% and 65%, while the overall accuracy was 69% (95% confidence interval, 50%-79%). CONCLUSIONS: In bedridden patients with suspected pneumonia, a normal chest radiograph does not rule out the diagnosis, hence, a chest CT scan might provide valuable diagnostic information.
Subject(s)
Bed Rest/adverse effects , Pneumonia/diagnostic imaging , Radiography, Thoracic/methods , Tomography, X-Ray Computed/methods , Adolescent , Adult , Age Distribution , Aged , Aged, 80 and over , Female , Follow-Up Studies , Hospitals, University , Humans , Incidence , Inpatients , Male , Middle Aged , Pneumonia/epidemiology , Pneumonia/etiology , Probability , Prospective Studies , Risk Assessment , Sex Distribution , Young AdultABSTRACT
BACKGROUND: Spontaneous pneumomediastinum is a rare entity that usually occurs in young males without any apparent precipitating factor. Several case series have been published focusing on clinical features, workup and prognosis. Due to the rarity of this entity, there is no consensus on the most appropriate treatment. OBJECTIVES: To describe the clinical characteristics and course of patients with spontaneous pneumomediastinum in our institution. METHODS: This retrospective descriptive study was based on a review of the charts of all patients discharged from our hospital with a diagnosis of SPM during the period 2000 to 2007. Thirteen patients were identified and information on their clinical presentation, course, hospital stay, investigations and outcome was gathered. RESULTS: In 70% of patients the presenting complaint of SPM was pleuritic chest pain, while 30% of patients developed SPM in the course of another respiratory illness. Subcutaneous emphysema was the most common clinical finding (46%). Chest X-ray was diagnostic in 12 of 13 patients, and additional tests such as esophagogram and echocardiogram were unrevealing. Leukocytosis and electrocardiographic changes in inferior leads were seen in 30% of patients. Mean hospital stay was 48 hours, treatment was supportive, and symptomatic improvement was usually noted within 24 hours. No recurrences occurred. CONCLUSIONS: SPM is a rare entity that should be considered in patients with pleuritic chest pain. Treatment is supportive, and if no clues for esophageal rupture are present, investigations other than chest X-ray are probably not warranted. It is safe to discharge the patient within 24 hours provided that symptomatic improvement is achieved.