Cardiac Echinococcosis Associated with Other Organ Involvement: Report of Two Challenging Cases.
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ABSTRACT:
SUBMITTER: Meimand SE
PROVIDER: S-EPMC7887518 | biostudies-literature | 2021 Feb
REPOSITORIES: biostudies-literature
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Cardiac Echinococcosis Associated with Other Organ Involvement: Report of Two Challenging Cases.
Meimand Saeed Ebrahimi SE Sadeghpour Anita A Pakbaz Marziyeh M Ghavidel Alireza A AA Pouraliakbar Hamidreza H Kamali Monireh M Safaei Ali A
CASE (Philadelphia, Pa.) 20201109 1
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Project description:Background Granulomatosis with polyangiitis (GPA), a systemic antineutrophil cytoplasmic antibody (ANCA) associated vasculitis, is characterized by inflammation of the small arteries, arterioles, and capillaries classically manifesting with glomerulonephritis and necrotizing granulomatous lesions of the upper and lower respiratory tract. With an incidence of approximately 12 cases per one million individuals per year it is an uncommon diagnosis that typically presents as frequent pulmonary and sinus infections; however, if left without definitive treatment progresses to more severe manifestations specifically hemoptysis and hematuria. Case Description This case report highlights a 15-year-old woman who had both classic and non-classic findings making the diagnosis challenging. Specifically, her age of presentation, improvement with anti-microbials, and coronary dilation were not classic. Additionally, her lab work was negative for the cytoplasmic subset antineutrophil cytoplasmic autoantibody (c-ANCA), but positive for serum anti-proteinase 3 antineutrophil cytoplasmic antibody (PR3-ANCA) which further delayed the ultimate diagnosis as this is typically c-ANCA positive. Conclusions Other systemic vasculitides, such as mucocutaneous lymph node disease, are associated with cardiac pathology necessitating further medical management and follow-up to prevent increased morbidity and mortality. Knowing this, we conclude that further evaluation for cardiac pathology would be prudent as part of the initial workup of patients with a diagnosis of GPA. Included is a brief review of available literature on GPA to emphasize the typical presentation, lab findings, and importance of early diagnosis.
| S-EPMC9929659 | biostudies-literature
Project description:In 2013, two cases of infection by Echinococcus that caused cystic echinococcosis in the lungs were reported. In the first case, there was a cyst of 6 × 7 cm in diameter, and in the second case, there were four cysts of 5 × 6 cm, 4 × 4 cm, 3.5 × 3 cm and 2.5 × 2 cm in diameter, respectively. In both cases, Echinococcus larvae were collected from the cysts. The larvae were identified as Echinococcus ortleppi by morphology and a molecular method (using reduced nicotinamide adenine dinucleotide hydrogenase [NADH] with 99%-100% homology compared with E. ortleppi in GenBank). This is the first time that this species has been found in humans in Vietnam.
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Project description:Introduction and importanceDue to advances in diagnostic methods and human immunodeficiency virus, there has been a recent increase in cardiac involvement by lymphoma.Case presentation case 115-year-old HIV infected male patient presented with features of heart failure and cardiac tamponade. The transthoracic echocardiogram showed pericardial effusion and a right atrioventricular mass. The resected tumour was confirmed to be diffuse large b-cell lymphoma on histopathology. Unfortunately, the patient died few hours after surgery. Case 2: 30-year-old HIV infected pregnant female presented with features of cardiac tamponade. The transthoracic echocardiogram showed pericardial effusion with right atrial mass. The resected tumour was confirmed to be Burkitt's lymphoma on histopathology. She was successfully treated with chemotherapy.Clinical discussionCardiac lymphomas are rare with most cases diagnosed on autopsy. However, advances in diagnostic methods has increased antemortem diagnosis with subsequent optimal management. Majority of the cases are of B-cell lineage, although T-cell origin has been reported.ConclusionA high index of suspicion of cardiac lymphoma should be maintained in the right clinical setting in order to receive adequate attention and management.
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Project description:Key clinical messageBefore valvular interventions, echocardiography, especially the TEE or the ventilation/perfusion scan, should be performed to detect silent PTE and set a more accurate treatment and surgical plan.AbstractPulmonary hypertension (PH) is a progressive and critical disease that can be caused by mitral stenosis (MS). Some of these patients present with disproportionate PH, which is an uncommon phenomenon and is considered a challenging diagnostic and treatment process. In these patients, other causes may also play a role in developing PH. This report presented two cases with disproportionate PH and severe MS who were scheduled for percutaneous mitral valvuloplasty (PMV). The pre-procedural echocardiography revealed systolic pulmonary artery pressure (sPAP) of 90 and 120 mmHg, mitral valve area of 0.80 and 0.55 cm2 by three-dimensional (3D) planimetry, and diastolic pressure gradient (DPG) of 13 and 18.8 mmHg, respectively. Furthermore, in the first patient, 3D transesophageal echocardiography (TEE) revealed multiple saddle-type organized thrombi in the proximal parts of the right and left pulmonary arteries, extending to the distal branches. In the second patient, 3D TEE revealed a large, relatively fresh, flow-limiting thrombosis in the proximal part of the right pulmonary artery. The diagnosis of pulmonary thromboembolism (PTE) in both patients was confirmed by CT angiography. In both patients, the valves were surgically repaired, while all thrombi were removed from the cardiac chambers and pulmonary vessels during surgery. In addition, patients underwent warfarin therapy orally. They were followed up 6 months after the intervention, and their clinical symptoms had improved significantly.
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Project description:Most schistosomiasis japonica cerebral granulomas reported in the literature have been single and located in the cerebellum, and multiple lesions located in the cerebral hemisphere are uncommon and often misdiagnosed as metastases or gliomas. We describe two rare cases of multiple schistosomiasis japonica cerebral granulomas. Laboratory examinations and cerebrospinal fluid were normal. Parasite eggs were not detected in the stool. No positive findings were detected in the abdominal ultrasonography or chest radiography. Magnetic resonance revealed two intensive patchy lesions in the cerebral hemisphere and surrounded by a large area of edema in both of our patients. Both were misdiagnosed as glioma or metastatic carcinoma before operation. Pathological examination confirmed that the diagnosis was schistosomiasis japonica cerebral granuloma. Praziquantel and dexamethasone were administered. Both patients are alive, symptom-free, and without evidence of recurrence. Combining our date with other literature reports, we summarize the possible mechanism, reasons for misdiagnosis, radiological characteristics, surgical treatment, and postoperative management of schistosomiasis japonica cerebral granuloma, which can be used for clinical reference and to improve our knowledge of schistosomiasis japonica cerebral granuloma.
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Project description:BackgroundViral or bacterial infections can trigger auto-immune inflammatory reactions and conditions in children. Self-reactivity arises due to similarities in molecular structures between pathogenic microorganisms and regular body structures with consequent immune-cross reactions. Reactivation of latent Varicella Zoster Virus (VZV) infections can cause neurological sequalae, including cerebellitis, post-herpetic neuralgias, meningo/encephalitis, vasculopathy and myelopathy. We propose a syndrome caused by auto-immune reactivity triggered by molecular mimicry between VZV and the brain, culminating in a post-infectious psychiatric syndrome with childhood VZV infections.Case presentationTwo individuals, a 6-year-old male and 10-year-old female developed a neuro-psychiatric syndrome 3-6 weeks following a confirmed VZV infection with intrathecal oligoclonal bands. The 6-year-old male presented with a myasthenic syndrome, behavior deterioration and regression in school, he was poorly responsive to IVIG and risperidone, however had a pronounced response to steroid treatment. The 10-year-old female presented with marked insomnia, agitation, and behavioral regression as well as mild bradykinesia. A trial of neuroleptics and sedatives resulted in a mild unsustained reduction in psychomotor agitation and IVIG was also unsuccessful, however the patient was very responsive to steroid therapy.ConclusionPsychiatric syndromes with evidence of intrathecal inflammation temporally related to VZV infections that are responsive to immune modulation have not been described before. Here we report two cases demonstrating neuro-psychiatric symptoms following VZV infection, with evidence of persistent CNS inflammation following the resolution of infection, and response to immune modulation.
| S-EPMC9969201 | biostudies-literature
Project description:The current standard for graft rejection surveillance is endomyocardial biopsy (EMB), an invasive procedure with rare but potentially serious complications. Detection of circulating donor-derived cell-free DNA (ddcfDNA) is an option for noninvasive monitoring of graft injury and rejection. A 63-year-old man and a 65-year-old woman were monitored by EMB for allograft rejection. A total of 48 single-nucleotide polymorphisms with a minor allele frequency range of 0.4-0.5 were screened to distinguish donor and recipient DNA based on homozygosity, and digital droplet PCR was used to analyze ddcfDNA concentrations. Both subjects suffered rejection within the first 6 months after transplantation. The maximal ddcfDNA level of 270 copies (cp)/ml during EMB-confirmed acute cellular rejection (ACR; mild grade 1R/2, patient 1), and the maximal concentration of 1,846 cp/ml in the case of EMB-confirmed antibody-mediated rejection (AMR; grade 1+; patient 2), was detected. Individual monitoring of ddcfDNA dynamics from the 1st to the 6th month posttransplant reflected cardiac graft injury in patients suffering ACR or AMR, meaning that ddcfDNA may serve as a noninvasive biomarker.
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Project description:BackgroundPrimary cardiac echinococcosis is rare, and cardiac alveolar echinococcosis is even rarer and more unusual. Reported cases of this disease are extremely limited, and multimodal imaging provides an important guide to treatment and decision-making. We report a case of cardiac alveolar echinococcosis. A 31-year-old male patient with no significant history was diagnosed to have a space-occupying lesion in the mediastinum. Transthoracic echocardiography showed a cystic mass anterior to the right lateral aspect of the right atrium, which did not show enhancement on the enhanced scan. Multidetector computed tomography (MDCT) and cardiac magnetic resonance showed a cystic space-occupying lesion in the right lateral aspect of the right atrium, with mild enhancement of the edges of the lesion and multiple small vesicles on the enhancement scan. Clinicians operated on the patient under suspicion of cardiac echinococcosis and successfully removed the lesion. Ultimately, postoperative histopathologic examination revealed cardiac alveolar echinococcosis. The patient recovered well and was discharged with regular postoperative oral albendazole tablets and regular follow-up reviews.ConclusionWe report a case of cardiac alveolar echinococcosis with multimodal imaging features and therapeutic strategies, an extremely rare cardiac occupying disease. Multimodal imaging is of great help in the diagnosis of this disease, and surgical resection and histopathological diagnosis are essential. After surgery, treatment and follow-up will be carried out based on the results of the histological examination. This rare case emphasizes the integrated diagnosis of cardiac alveolar echinococcosis with clinical, multimodal imaging and pathologic data.
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Project description:Alveolar echinococcosis (AE) is a severe parasitic infection caused by the ingestion of Echinococcus multilocularis eggs. While higher incidence and faster evolution have been reported in immunosuppressed patients, no studies have been performed specifically on AE in transplant patients. We searched for all de novo AE cases diagnosed between January 2008 and August 2018 in solid organ transplant (SOT) recipients included in the Swiss Transplant Cohort Study and the FrancEchino Registry. Eight cases were identified (kidney = 5, lung = 2, heart = 1, liver = 0), half of which were asymptomatic at diagnosis. AE diagnosis was difficult due to the low sensitivity (60%) of the standard screening serology (Em2+) and the frequently atypical radiological presentations. Conversely, Echinococcus Western blot retained good diagnostic performances and was positive in all eight cases. Five patients underwent surgery, but complete resection could only be achieved in one case. Moreover, two patients died of peri-operative complications. Albendazole was initiated in seven patients and was well tolerated. Overall, AE regressed in one, stabilized in three, and progressed in one case, and had an overall mortality of 37.5% (3/8 patients). Our data suggest that AE has a higher mortality and a faster clinical course in SOT recipients; they also suggest that the parasitic disease might be due to the reactivation of latent microscopic liver lesions through immune suppression. Western blot serology should be preferred in this population. Finally, surgery should be considered with caution, because of its low success rate and high mortality, and conservative treatment with albendazole is well tolerated.
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Project description:Cystic echinococcosis is considered as an emerging zoonosis that can develop asymptomatically for years, clinically nonpathognomic. The disease is of public health importance due to often late, difficult diagnostics, uncertain results of treatment, the need to remove hydatid cysts surgically in advanced cases, and poor prognosis in untreated patients. Six Polish female patients with diagnosed cystic echinococcosis (CE) were examined. DNA extracted from the liver and lung samples served for amplification of mitochondrial nad1 gene fragment. Sequence alignments of 5 isolates showed identity with the pig strain, Echinococcus canadensis G7. One case was in 100% identical with Echinococcus ortleppi G5, the cattle strain. These data demonstrate first report of E. ortleppi, regarded as extinct species, causing human cystic echinococcosis in Poland, where the most frequent causative agent of human CE is E. canadensis.
| S-EPMC6476137 | biostudies-literature