Exploring an Uncommon Presentation of Kikuchi-Fujimoto Disease: Case Insights.

Kikuchi-Fujimoto disease (KFD) is a self-limiting, benign illness that is typified by cervical lymphadenopathy, typically accompanied by a low fever and night sweats. Loss of weight, nausea, vomiting, and sore throat are fewer common symptoms. KFD can have an acute or subacute start, and it usually develops over two to three weeks. Although viral aetiology is still a concept that needs further research, the clinical, histological, and immunohistochemical aspects seem to support it. Since specific diagnostic laboratory tests are not available, the diagnosis is frequently established by excising a sample of the affected lymph nodes. This case study features a 63-year-old male patient who first complained of fever and dyspnoea. Upon further investigation, the patient's condition was determined to be Kikuchi-Fujimoto disease, which was treated appropriately.

A High-Dose Corticosteroid Treatment Increases Coronavirus Disease of 2019 Mortality in Intensive Care Units.

Objectives: The study is aimed to investigate the association between different corticosteroid treatment regimens and clinical status, complications, mechanical ventilation requirement, and intensive care unit (ICU) mortality in individuals diagnosed with Coronavirus Disease of 2019 (COVID-19). Materials and Methods: This is a descriptive retrospective study. Patients admitted to the ICU for COVID-19 and treated with low- or medium-dose corticosteroid therapy (methylprednisolone at a dose of 0.5-1 mg/kg for 7-10 days) were compared with patients treated with high-dose pulse corticosteroid therapy (methylprednisolone at varying doses of 250 mg, 500 mg or 1000 mg for 3-7 days) in addition to standard therapy because of increased pulmonary infiltrate and elevated inflammatory markers during clinical monitoring. All demographic and clinical data, including age, sex, clinical course, laboratory findings, discharge status, 28-day mortality, intubation status, acute physiological assessment and chronic health evaluation II score, Charlson Comorbidity Index, and sequential organ failure assessment score, were recorded. Results: Corticosteroid treatment was administered to 689 (88.3%) of 780 COVID-19 ICU patients between April 2020 and October 2021. The overall mortality rate was 45.1% (n= 352). When the mortality rates of patients were compared according to the corticosteroid dose, the mortality rate in the low-to-medium-dose group (40%) was significantly lower than that in the high-dose group (76%). In addition, significant deterioration in laboratory and clinical parameters was observed in the high-dose corticosteroid group. Conclusion: High mortality, adverse effects, and complications were significantly increased when high-dose corticosteroids were administered. Corticosteroid therapy should be used cautiously according to the patient's clinical condition, disease stage, comorbidities, and systemic or organ reserves.

A systematic review of steroid use in peripheral nerve pathologies and treatment.

Background: The use of corticosteroids has become a part of the standard of care in various pathologies but their use in peripheral nerve injury treatment is limited. Given corticosteroids' anti-inflammatory properties and their regulatory role in neuronal protein production and myelination, corticosteroids could serve as an adjunct therapy for peripheral nerve injuries. This review aims to systematically investigate the current use of corticosteroid treatment in peripheral nerve pathologies. Methods: The systematic search was performed on PubMed, MEDLINE, EMBASE, Scopus, Cochrane, and Web of Science using keywords such as "corticosteroid treatment," "peripheral nerve damage," "peripheral neuropathy," and "complications." The PRISMA guidelines were used to conduct the systematic review and all articles were reviewed by the corresponding author. After the initial search, individual study titles and abstracts were further screened and categorized using an inclusion and exclusion criteria followed by a final full-text review. Results: Out of the total 27,922 identified records, 203 studies were included based on the selection criteria. These studies focused on the use and efficacy of steroids across a spectrum of compression and non-compression peripheral neuropathies such as cubital tunnel syndrome and chronic inflammatory demyelinating polyradiculoneuropathy. Various studies noted the promising role of steroids in offering pain relief, nerve block, and nerve regeneration effects. Additionally, safety considerations and potential complications regarding steroid use in peripheral nerve injuries were analyzed. Conclusion: While there is currently limited clinical utilization of corticosteroids in peripheral nerve pathologies, the anti-inflammatory and regenerative effects that steroids provide may be a beneficial tool in managing various peripheral neuropathies and their associated pain. Additional clinical trials and investigation into the mechanism of action could improve the reputation of steroid use as peripheral nerve injury treatment.

Integrated Assessment of OCT, Multimodal Imaging, and Cytokine Markers for Predicting Treatment Responses in Retinal Vein Occlusion Associated Macular Edema: A Comparative Review of Anti-VEGF and Steroid Therapies.

Retinal vein occlusion (RVO) is a significant cause of vision loss, characterized by the occlusion of retinal veins, leading to conditions such as central retinal vein occlusion (CRVO) and branch retinal vein occlusion (BRVO). Macular edema (ME), a prevalent consequence of RVO, is the primary cause of vision impairment in affected patients. Anti-VEGF agents have become the standard treatment, showing efficacy in improving visual acuity (VA) and reducing ME. However, a subset of patients exhibit a suboptimal response to anti-VEGF therapy, necessitating alternative treatments. Corticosteroids, which address inflammatory pathways implicated in ME, have shown promise, particularly in cases resistant to anti-VEGF. This review aims to identify biomarkers that predict treatment response to corticosteroids in RVO-associated ME, utilizing multimodal imaging and cytokine assessments. Baseline imaging, including SD-OCT and OCT-A, is essential for evaluating biomarkers like hyperreflective foci (HRF), serous retinal detachment (SRF), and central retinal thickness (CRT). Elevated cytokine levels, such as IL-6 and MCP-1, correlate with ME severity and poor anti-VEGF response. Early identification of these biomarkers can guide timely transitions to corticosteroid therapy, potentially enhancing treatment outcomes. The practical conclusion of this review is that integrating biomarker assessment into clinical practice enables personalized treatment decisions, allowing for earlier and more effective management of RVO-associated ME by transitioning patients to corticosteroid therapy when anti-VEGF agents are insufficient. Advanced diagnostics and machine learning may further refine personalized treatment strategies, improving the management of RVO-associated ME.

The Diagnostic Challenge of a Dyshidrosiform Bullous Pemphigoid: A Palmar Puzzle.

We present a unique case of an 89-year-old male with Alzheimer's disease who developed hemorrhagic blisters on his palms, which ruptured with time and were followed by pruritic erythematous lesions across his chest, upper back, lower abdomen, and thighs. The patient was diagnosed with dyshidrosiform bullous pemphigoid (DBP), an uncommon variant of the autoimmune condition bullous pemphigoid characterized by cutaneous and mucosal blistering, which commonly appears as vesiculobullous eruptions in the palmoplantar areas and may spread to other parts of the body. Less than 100 cases of DBP have been documented in the medical literature. Since DBP is difficult to identify and treat due to its clinical appearance similar to pompholyx, we reviewed the treatment of DBP and included clinical images and direct immunofluorescence (DIF) staining technique images to better establish the diagnosis.

Unmasking the Veiled Intruder: A Complicated Case of Eosinophilic Fasciitis.

Eosinophilic fasciitis (EF) is a rare inflammatory disease characterized by skin and fascial thickening. Unlike systemic sclerosis, EF lacks internal organ involvement and specific autoantibodies, with peripheral eosinophilia as a hallmark feature. Patients may exhibit joint pain and contractures due to fibrosis. We present a case of a patient who presented with skin thickening involving her upper and lower extremities and was ultimately diagnosed with EF based on a skin biopsy. This case underscores the importance of recognizing the unique clinical and histological features of EF.

Addressing Binocular Diplopia in a Diabetic Patient: Efficacy of Corticosteroids.

This report outlines an unusual instance involving a 65-year-old man who has a medical history of beta thalassemia minor, diabetes mellitus complicated by retinopathy, and iron deficiency anemia. He presented with binocular diplopia, a condition that frequently presents treatment difficulties. Despite inconclusive magnetic resonance imaging (MRI) findings, the patient's symptoms improved significantly with prednisone treatment. The etiology likely includes underlying retinopathy and cranial nerve palsy associated with diabetic complications. This case highlights utilizing corticosteroids, a largely unexplored treatment option, to optimize outcomes in managing binocular diplopia potentially linked to diabetic etiologies. It is notable that this patient was treated in a clinic for uninsured patients, emphasizing his low socioeconomic background, which adds further layers of complexity to his medical care. The complexities of managing diplopia in diabetes, compounded by limited treatment efficacy and financial constraints hindering complete diagnostic evaluation, underscore the intricate challenges of addressing diverse binocular diplopia presentations.

Exploring Non-invasive Therapies for Bell's Palsy: A Case Report.

Unknown in origin, Bell's palsy is a common acute facial nerve paralysis that is usually characterized by unilateral facial weakening or paralysis. People of all ages are affected by this illness, which peaks in the fourth decade of life. Although the precise etiology is yet unknown, viral infections - particularly type 1 herpes simplex virus - are frequently linked to the problem. Based on the evidence of abrupt onset facial weakness and the elimination of other neurological diseases, the diagnosis is essentially clinical. The goals of management techniques are to lessen related symptoms, encourage nerve regeneration, and lessen inflammation. Corticosteroids, antiviral drugs, physical therapy, and supportive measures are available as treatment alternatives. The majority of patients experience spontaneous recovery within weeks to months, and the prognosis is generally excellent. Nonetheless, a portion may experience long-term consequences, highlighting the significance of individualized follow-up care. Bell's palsy is succinctly summarized in this abstract to aid in better comprehension and well-informed clinical practice decision-making.

Tietze Syndrome in a 41-Year-Old Patient Without Significant Comorbidities.

Tietze syndrome is a relatively uncommon condition characterized by painful swelling localized in the costo-sternal, sternoclavicular, or costochondral joints. Despite its benign nature, Tietze syndrome can mimic more serious conditions, necessitating thorough evaluation and exclusion of differential diagnoses. Management typically involves non-steroidal anti-inflammatory drugs and corticosteroid therapy, with surgical intervention reserved for refractory cases. This case of a 41-year-old athlete underscores the importance of considering Tietze syndrome in the differential diagnosis of acute chest pain, especially in younger individuals without significant comorbidities. By raising awareness and sharing our experience, we aim to contribute to improved recognition and management of this condition, ultimately enhancing patient care outcomes.

Post-COVID-19 Pulmonary Inflammatory Pseudotumors Treated With Steroid Taper.

The aftermath of COVID-19 continues to unveil an array of pulmonary complications, extending beyond the acute phase of the viral infection. Among these emerging sequelae, we present the case of a 58-year-old individual who developed pulmonary inflammatory pseudotumors (PIPs) following recovery from COVID-19. PIPs are exceedingly rare benign lesions that can pose a diagnostic challenge due to their clinical and radiological resemblance to malignant neoplasms. Histologically, PIPs are characterized by a proliferation of myofibroblastic spindle cells accompanied by inflammatory infiltrates, including lymphocytes, plasma cells, and histiocytes. As our understanding of post-COVID-19 complications evolves, this case serves as the first exploration into the complex interplay between COVID-19 infections and the subsequent development of inflammatory pseudotumors. In this report, an investigation is performed into the clinical presentation, diagnostic challenges, and successful management of post-COVID-19 PIPs with a focus on the pivotal role of corticosteroid therapy in mitigating the inflammatory response associated with this unique post-viral entity and resolution of the masses.

Right ventricular myocardial edema leading to severe heart failure after open heart surgery - possible effect of high-dose corticosteroid therapy.

BACKGROUND: Cardiopulmonary bypass induces a systemic inflammatory response and alterations in fluid homeostasis, resulting in generalized tissue edema. Additionally, ischemia-reperfusion injury following cardioplegic arrest presumably prompts organ-specific myocardial edema. CASE PRESENTATION: The case report presents a 75-year-old Caucasian male diagnosed with aortic dissection, Stanford type A, who underwent complicated open-heart surgery. Postoperatively, the patient developed excessive myocardial edema, particularly affecting the right ventricle myocardium to an extent where the right ventricle surpassed the sternal rim, making it impossible to close the sternum. Ischemia was ruled out by performing coronary angiography, demonstrating well-calibrated coronary arteries. Transoesophageal echocardiography showed a restrictive right ventricle with free-wall thickness of 30 mm, severely reduced right ventricle systolic function and a volume-depleted left ventricle consistent with right ventricular heart failure due to right ventricular edema. The patient presented with unstable haemodynamics despite use of inotropes and continuation of open sternotomy. In an attempt to reduce myocardial edema, the patient was started on corticosteroid treatment despite of ongoing mediastinitis. Corticosteroid treatment reduced myocardial edema and enabled the closure of sternum on the 44th postoperative day. CONCLUSIONS: The case report addresses the clinical relevance of corticosteroid treatment in selective cases of intractable haemodynamically significant postoperative myocardial edema.

Clinical evaluation and treatment outcomes of caustic ingestion injuries in Syrian pediatric patients: A retrospective study: Short title: High-dose steroids for pediatric caustic ingestions in Syria.

Introduction: Accidental ingestion of caustic agents poses a significant concern in pediatric emergency departments globally. It is a growing public health concern in low-to-middle income countries, which often lack comprehensive data reporting. This study examines high doses of corticosteroid treatment outcomes of caustic ingestion injuries in Syrian pediatric patients, addressing clinical features, and associated variables. Methods and materials: A retrospective observational study was conducted at University Pediatric Hospital from January 2016 to January 2019. Medical records were reviewed for patients aged <10 years with esophagoscopy-confirmed grade IIa, IIb, or III burns. Data collected included sociodemographics, esophagoscopy results, treatment details, and outcomes. Results: Among 114 pediatric patients, 76 (67%) were males and 38 (33%) were females. Age groups included <1 year (11%), 1-3 years (39%), 3-5 years (29%), 5-7 years (11%), and >7 years (11%). Alkaline burns accounted for 54% of injuries, acidic for 32%, and other substances for 13%. Complications included bleeding (19%) and psychomotor disability (7%). The most common burn site was the entire esophagus (62%), with 81% having grade II burns. Healing was achieved in 71% of patients with high doses of corticosteroids treatment, and 29% required dilation, with final 92% healing rate. Conclusion: The use of corticosteroids for esophageal strictures remains inconclusive, demanding further robust research with larger sample sizes and control groups. While our study revealed that high doses of corticosteroids treatment followed by esophageal dilation had a 92% success rate. However, our study demonstrates promising results, methodological limitations and absence of a control group underscore the need for more definitive evidence. Both alkali and acidic ingestion contribute to stricture development.

Clinical Features, Outcomes, and Response to Corticosteroid Treatment of Acute Tubulointerstitial Nephritis: A Single-Centre Retrospective Cohort Study in the Czech Republic.

INTRODUCTION: Acute tubulointerstitial nephritis (ATIN) is a well-recognized cause of acute kidney injury (AKI) due to the tubulointerstitial inflammation. The aim of this study was to explore the clinical features, outcomes, and responses to corticosteroid treatment in patients with ATIN. METHODS: Patients with biopsy-proven ATIN, who were diagnosed between 1994 and 2016 at the Department of Nephrology, Charles University, First Faculty of Medicine, and General University Hospital in Prague, were included in the study. Patient demographics, the aetiological and clinical features, the treatment given, and the outcome at 1 year of follow-up were extracted from patient records. RESULTS: A total of 103 ATIN patients were analysed, of which 68 had been treated with corticosteroids. There was no significant difference in the median serum creatinine 280 (169-569) µmol/L in the conservatively managed group versus 374 (249-558) µmol/L in the corticosteroid-treated group, p = 0.18, and dependence on dialysis treatment at baseline at the time of biopsy (10.3 vs. 8.6%). During the 1 year of follow-up, those ATIN patients who had been treated with corticosteroids did better and showed greater improvement in kidney function, determined as serum creatinine difference from baseline and from 1 month over 1-year period (p = 0.001). CONCLUSIONS: This single-centre retrospective cohort study supports the beneficial role of the administration of corticosteroid therapy in the management of ATIN.

Systemic lupus erythematosus and damage: What has changed over the past 20 years?

The young age of onset and chronic/relapsing nature of systemic lupus erythematosus (SLE) make SLE patients prone to develop and accrue organ damage as a result of long-standing disease activity and side effects of treatment. There is a growing interest in objectifying damage and identifying its risk factors. Still, the lack of therapeutic alternatives has led to difficulties in avoiding immunosuppressives particularly corticosteroids, which have been implicated in a large spectrum of organ damage in SLE patients. Moreover, it continues to be very challenging to determine what actually causes damage in different organ-systems. Cardiovascular disease continues to be one of the leading types of damage in patients with SLE, reported as early as 1976. Since then, many researchers have focused on identifying SLE or treatment-related and traditional risk factors. The same considerations are valid for other conditions, such as the occurrence of metabolic syndrome, osteoporosis, avascular necrosis, susceptibility to infections, etc. On the other hand, diverse risk factors contribute to the development of chronic kidney disease (CKD) in SLE. Most evidence suggests that high initial levels of serum creatinine, hypocomplementemia, nephrotic range proteinuria, concomitant uncontrolled hypertension, Black and Hispanic ancestry, non-adherence to treatment, and biopsy findings such as diffuse proliferative lupus nephritis (LN), a high chronicity index, tubular atrophy, and tubulointerstitial inflammation are risk factors for progression to end stage renal disease (ESRD) in LN. While cardiovascular disease, CKD and infections are leading causes of mortality in patients with SLE, hospitalizations are caused mostly by SLE disease flares and infections. Cognitive impairment and mood disorders are common in SLE but continue to impose a challenge on how to measure, manage and decipher the underlying pathogenesis. Nevertheless, they have a great impact on SLE patients' health-related quality of life (HRQoL) and social functioning. Also, skin manifestations, such as alopecia and scaring, cataracts, and sicca symptoms result in a significant decrease in HRQoL. In light of recent developments in SLE treatment, we can expect to enter a period of new-age targeted therapies that will enable us to reduce disease activity and glucocorticoid usage further and positively alter the trajectory of damage development and accrual in SLE.

Changes in the Oral-Health-Related Quality of Life of Thai patients with oral lichen planus after topical corticosteroid treatment: a 1-month longitudinal study.

BACKGROUND: Oral lichen planus (OLP) is a chronic inflammatory disease of the oral cavity that affects many patients' daily living activities. Topical corticosteroids are the first-line drug for treating OLP. The Oral Impact on Daily Performances index (OIDP) is an Oral-Health-Related Quality of Life (OHRQoL) measure developed to assess the ultimate impacts. The aims of this study were to evaluate the clinical, pain and OHRQoL responses after treating OLP patients with topical corticosteroids for 1 month, and secondly to assess the relationships of changes in the clinical sign score, pain score, and OHRQoL. METHODS: Seventy-two OLP patients were treated by topical corticosteroids based on their dentists' clinical judgments. Clinical and patient-based outcomes were assessed at baseline and follow-up visit. The clinical outcomes were evaluated by the highest and total Thongprasom sign score. Patient-based outcomes were evaluated by numeric rating scale (NRS) and OIDP. The self-rated overall changes in quality of life during the 1-month treatment period using the Patient Global Impression of Change (PGIC) were also recorded at the follow-up visit. RESULTS: This study comprised 59 women and 13 men. All clinical and patient-based outcomes were significantly reduced after 1-month treatment with topical corticosteroids (P < 0.01). The most commonly affected activities were Emotional stability, followed by Eating and Cleaning the oral cavity. Forty-six percent reported the same or up to moderately improved, while 54% had a greatly improved quality of life as assessed by PGIC. There were no significant differences in the improvement of clinical and patient-based outcomes between these groups. There were significant relationships between the differences in the highest Thongprasom sign score and the differences in total Thongprasom sign score (r = 0.293; P < 0.05), and the differences in total OIDP percentage score and the difference in pain score (r = 0.427; P < 0.001). The differences in the total Thongprasom sign score also significantly related to the difference in the total OIDP percentage score (r = 0.335; P < 0.01). CONCLUSIONS: Topical corticosteroids were significantly effective after 1-month treatment of OLP based on the clinical and patient-based outcomes. The OHRQoL improvement was significantly related to the reductions in pain and clinical severity. TRIAL REGISTRATION: The trial was registered at the Thai Clinical Trials Registry (TCTR identifier: TCTR 20221110001).

Stevens-Johnson Syndrome in a Patient With Recent SARS-CoV-2 Infection and Ciprofloxacin Administration.

Stevens-Johnson syndrome (SJS) is an acute, rare, and potentially life-threatening condition with high morbidity and mortality. It is characterized by a blistering rash and erosions with mucosal involvement, which depending on the extent of the skin area involved may be categorized as epidermal necrolysis, along with systemic symptoms. Symptoms are preceded by the administration of a newly introduced drug in almost 80% of cases and less commonly by infections in genetically predisposed individuals. We report a case of SJS in a female patient secondary to a recent SARS-CoV-2 infection and subsequent ciprofloxacin administration.

Rapidly Progressing Autoimmune Hemolytic Anemia in a Pediatric Patient With COVID-19.

SARS-CoV-2 is a novel virus that is known to have a predilection for complications associated with the respiratory system. Although COVID-19 has a wide spectrum of manifestations, the pathophysiology of severe illness remains poorly understood but is thought to be associated with fulminant cytokine release. While severe complications secondary to COVID-19 in the pediatric population are considered rare, they do happen. Children with and without comorbidities have required intensive care unit admissions for respiratory distress and, more notably, multisystem inflammatory syndrome in children (MIS-C). While MIS-C is associated with hematologic complications, such as thrombocytopenia and coagulopathies, it is not associated with blood hemolysis. In this report, we describe a case of a 23-month-old previously healthy female, who presented with lethargy and positive COVID-19 PCR status. This case illustrates the rapid and fatal sequela caused by autoimmune hemolytic anemia (AIHA) from COVID-19. It stresses the importance of thorough workup and management of AIHA secondary to COVID-19 illness. Currently, there is limited understanding of AIHA from COVID-19 illness in children. Our aim is to describe this rare complication of COVID-19 illness in pediatric patients and discuss the best practices to manage it.

Idiopathic Orbital Pseudotumor: A Rare Case Report.

Orbital pseudotumor is a rare inflammatory condition affecting the orbit of the eye. It has diverse clinical manifestations. Although its exact etiology remains unknown, it is believed to involve an immune-mediated response. A 42-year-old male presented to the ophthalmology clinic with progressively worsening symptoms in his left eye, including pain, swelling, and blurry vision. He had no history of trauma or recent illness. Initial discomfort had escalated over three weeks. The patient had controlled hypertension but no known allergies. Examination showed eyelid edema, erythema, and mild anterior chamber cell, and flare in the left eye. Magnetic resonance imaging revealed orbital soft tissue enhancement, extraocular muscle thickening, and optic nerve involvement. Laboratory results showed elevated inflammatory markers. A diagnosis of orbital pseudotumor was made. The patient was treated with oral corticosteroids, resulting in symptom improvement and regression of inflammatory changes on follow-up. Orbital pseudotumor is a complex condition with diverse clinical manifestations. Its diagnosis requires a comprehensive approach involving clinical evaluation, imaging studies, and laboratory investigations.

A Rare Rheumatologic Case of Catastrophic Antiphospholipid Syndrome.

A very rare and severe disease catastrophic antiphospholipid syndrome is defined by small vessel occlusions resulting in multi-organ involvement in the presence of antiphospholipid antibodies. This case report presents a case of catastrophic antiphospholipid syndrome in a young female without past medical history.