Medicine
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Case Reports
Malignant hypertension induces thrombotic microangiopathy and renal failure: A case report.
Thrombotic microangiopathies (TMA) caused by malignant hypertension is an acute and critical disease among rare diseases. Although renal biopsy pathology is a golden indicator for diagnosing kidney disease, it cannot distinguish between primary and secondary TMA and requires a comprehensive diagnosis in conjunction with other laboratory tests and medical history. ⋯ TMA caused by malignant hypertension is rare and similar to the clinical manifestations of TMA caused by Thrombotic Thrombocytopenic Purpura and Hemolytic Uremic Syndrome, but it is often sudden and critical. Early identification and diagnosis and aggressive antihypertensive therapy, must be given to avoid end-stage renal disease, long-term maintenance of dialysis, and the financial burden of unnecessary plasmapheresis and potential side effects of glucocorticoids.
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We report the efficacy of combination prednisolone and intravenous (IV) rituximab as an immunosuppressive regimen for a young male presenting with extensive venous thromboembolism including a submassive pulmonary embolism secondary to life-threatening nephrotic syndrome from very high risk anti-phospholipase-A2 receptor (PLA2R) positive membranous nephropathy. Initial treatment was with mechanical thrombectomy and anticoagulation. Thereafter, oral prednisolone was initiated to induce remission, during a period of uninterrupted anticoagulation. He subsequently underwent a kidney biopsy for histological confirmation and IV rituximab was administered as definitive treatment. ⋯ This case demonstrates that preemptive treatment in patients with anti-PLA2R positive membranous nephropathy can initiated without a histological diagnosis when there are strong contraindications against a kidney biopsy. Treatment with a combination of steroids and IV rituximab could be a viable treatment option for patients with very high-risk membranous nephropathy over conventional therapy with cyclophosphamide.
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Carbapenem-resistant Klebsiella pneumoniae (CRKP) bloodstream infections are a severe complication resulting from granulocyte deficiency following chemotherapy for hematologic malignancies and have a high mortality rate. However, reports of disseminated organ infections secondary to bloodstream infections are rare. ⋯ Ceftazidime-avibactam exhibited satisfactory efficacy and safety in the 2 cases of disseminated organ infection secondary to CRKP bloodstream infection following chemotherapy for acute lymphoblastic leukemia.
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Case Reports
Abdominal pain as a novel manifestation in children with PCDH19-related epilepsy: A case report.
PCDH19-related epilepsy manifested various clinical features, including febrile epilepsy, with or without intellectual disability, and psych-behavioral disorders. However, there are few studies demonstrating abdominal pain as the first symptom. ⋯ Abdominal pain is a rare autonomic symptom in the setting of seizures. This report describes abdominal pain as a novel manifestation of PCDH19-related epilepsy and might expand its phenotypes spectrum. It also alerts us to perceive the abdominal pain characterized by seizures and early conduct EEG examination to clarify the nature of abdominal pain.
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Case Reports
Primary malignant melanoma of the vagina: A case report of a rare disease that is difficult to diagnose.
Malignant melanoma is a rare cancer that accounts for approximately 1% of all cancers. Primary malignant melanoma of the female genital tract accounts for approximately 3% to 7% of all malignant melanomas, and 0.3% to 0.8% of all melanomas in women. It affects postmenopausal women ages 60 to 80 years. Various hormonal factors, including puberty, pregnancy, menopause, oral contraceptive use, and human papillomavirus infection are associated with primary malignant melanoma of the vagina. ⋯ To consider the possibility of primary malignant melanoma of vagina, postmenopausal women, particularly those who with human papillomavirus infection, should be performed thorough examination regardless of symptoms of vaginal bleeding or discharge.