Macleodrobb2484

We present a case whereby standard immunohistochemistry and flow cytometry studies for a conjunctival biopsy were unable to reliably differentiate between the two distinct pathological processes of benign reactive lymphoid hyperplasia from conjunctival lymphoma. A tissue diagnosis was only able to be conclusively attained after the application of immunoglobulin heavy chain rearrangement studies to the specimen. This is unusual and to our knowledge has not been previously expressed in the literature. Hence, the use of these further molecular studies may have great potential clinical implications in helping resolve such diagnostic dilemmas. Copyright © 2019 by S. Karger AG, Basel.A case of Miller Fisher and acute motor sensory axonal neuropathy (AMSAN) variant Guillain-Barré (MFS/AMSAN-GBS) overlap syndrome is presented. The neurological presentation of the overlap syndrome was preceded by an upper respiratory tract infection. Eventually, severe weakness of bulbar and limb muscles, areflexia, ophthalmoplegia, ataxia, and respiratory insufficiency developed. The electroneuromyography revealed symmetrical axonal polyneuropathy which was dominant in both upper limbs. Although a panel of anti-ganglioside antibodies including anti-GQ1b was negative, immediate treatment with intravenous immunoglobulin resulted in dramatic response. Copyright © 2020 by S. Karger AG, Basel.Giant cell arteritis (GCA) is a common type of vasculitis and may present various forms. Ischemic stroke is one of the complications and sometimes the first symptom of this disease. We want to present the case of a 58-year-old female patient with suspected GCA who suffered from recurrent ischemic strokes due to progressive stenosis of the internal carotid arteries. This site of manifestation is rare but indicative of GCA. The patient was first treated with corticosteroids and methotrexate later with tocilizumab. Facing progressive hemodynamic impairment, an extra-intracranial-bypass-surgery was performed. Although inflammatory activity was reduced, new strokes occurred. Copyright © 2019 by S. Karger AG, Basel.Susac syndrome (SS) is a central nervous system vasculitis characterized by the clinical triad of encephalopathy, sensorineural hearing loss, and visual disturbance caused by branch retinal artery occlusion. It is considered as an inflammatory disorder, and an autoimmune etiology is suggested. A 29-year-old man with a history of recent cocaine abuse developed the clinical features of SS. Toxicological analysis including hair testing revealed that cocaine had been adulterated with levamisole. After an initial clinical improvement following corticosteroid therapy, the introduction of mycophenolate mofetil was justified a few weeks later by the progression (or relapse) of the retinal injury, followed by complete recovery. The presence of levamisole has been documented in patients with multifocal inflammatory leukoencephalopathy (MIL). read more Further investigations are needed to determine if levamisole as an adulterant of cocaine could also play a role in the development of rapidly progressive leukoencephalopathy in young men, with Susac or Susac-like syndromes as possible variants of MIL. Copyright © 2020 by S. Karger AG, Basel.Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an immune-mediated neuropathy that is characterized by a slowly progressive sensory and motor involvement lasting at least 2 months. We present a CIDP patient on subcutaneous Ig (SCIg). Upon fine-tuning his dose from 24 to 28 g/week, this showed a dramatic improvement in both hand grip (13-25%) and dorsiflexion (73-278%). Follow-up nerve conduction studies also demonstrated significant improvements in latencies, motor amplitudes, and conduction velocities. Ongoing surveillance of CIDP patients receiving SCIg therapy is therefore necessary to ensure therapeutic optimization. Copyright © 2020 by S. Karger AG, Basel.The clinical presentation of repetitive choreiform involuntary movements of the anterior abdominal wall was first introduced as "belly dancer's dyskinesia." Etiologies of this rare condition include idiopathic causes, medication inducement, or post-abdominal surgery. We report a case of orobuccal stereotypic movements and abdominal wall dyskinesia secondary to prochlorperazine intake. The movements began 2 weeks after cessation of prochlorperazine. The patient took this dopamine receptor-blocking medication for 6 months to treat nausea due to chemotherapy. To our knowledge, abdominal wall dyskinesia as a tardive syndrome of prochlorperazine has not been previously reported. Copyright © 2020 by S. Karger AG, Basel.Posterior reversible encephalopathy syndrome (PRES) is a neurological syndrome characterized by an altered level of consciousness, headaches, seizure, and visual changes. PRES has several different etiologies, including malignant hypertension, eclampsia, and certain medications. Here, we describe a 41-year-old woman who presented with altered mental status. She had a preliminary diagnosis of serotonin syndrome as she was on many different serotonin-sparing agents, but her imaging findings were consistent with PRES. After her medications were reviewed and the causative agent was removed, the patient's neurological exam and imaging findings improved, and she returned to her baseline. To our knowledge, this is a unique case of PRES caused by serotonin syndrome secondary to venlafaxine usage. Copyright © 2020 by S. Karger AG, Basel.Patients with cancer of unknown primary (CUP) are generally treated with chemotherapy. Bone marrow involvement suggests an advanced stage, and CUP with disseminated carcinomatosis of the bone marrow (DCBM) appears to have a dismal prognosis. However, our case of CUP with DCBM was successfully treated with a sequence of endocrine therapy over a long period. A woman presenting with low back pain was found to have multiple bone metastasis without an identifiable primary tumor on imaging studies. Blood tests revealed anemia and thrombocytopenia. A bone marrow biopsy was performed and showed relatively uniform small cells, strongly positive for estrogen receptor and progesterone receptor expression. We considered chemotherapy to be risky due to bicytopenia and an aromatase inhibitor, letrozole, was initiated. The patient's symptoms and laboratory findings gradually improved and bone lesions almost disappeared on FDG-PET/CT after 1 year of treatment. After 2 years on letrozole, hemoglobin levels and platelet counts had been gradually decreasing.