The Editor's Choice
In this Letter to the Editor, Agrawal et al. debate the conflicts that can arise regarding the authorship of case reports. Like all other medical journals, EJCRIM has zero tolerance for the willful undisclosed re-submission of papers that have already been published elsewhere. However, this may occasionally happen by accident, especially in large healthcare institutions in which multiple teams of physicians may care for a patient throughout their illness. EJCRIM endorses and recommends to all potential authors the very sensible suggestions made by Agrawal et al. to avoid such an error occurring...
We continue the Hospital Grand Rounds section with complex case from the University General Hospital Attikon, Athens, Greece. Pityriasis rubra pilaris (PRP) is a rare chronic inflammatory papulosquamous dermatosis affecting both adults and children. Ustekinumab is an anti-IL12/23 IgG1 kappa human monoclonal antibody. It has been approved for the treatment of Crohn’s disease, plaque psoriasis, psoriatic arthritis and ulcerative colitis. It has also been reported to be effective as an off-label treatment for PRP. Current data are equivocal regarding infectious disease risk with ustekinumab administration. We describe a case of meningococcal and HSV-2 infection of the central nervous system in a patient being treated with ustekinumab for PRP.
We kick off the Hospital Grand Rounds section with an interesting article from the University Medical Centre (UKC) Maribor, Slovenia. In this case, the authors describe a patient on peritoneal dialysis with a newly discovered pleural effusion with a high glucose level. The patient was treated conservatively with peritoneal dialysis cessation and switched to haemodialysis with complete resolution of the pleural effusion. After 5 weeks, the patient successfully restarted peritoneal dialysis without recurrence of the hydrothorax.
We are glad to present you the second article of the Hospital Grand Rounds, coming from the Public University Hospital Maggiore della Carità, Novara, Italy. Serous effusions complicating the course of lymphomas occur commonly in the pleural space but seldom in the peritoneum, where they most often present as chylous ascites with diagnostic cytology. Almost invariably, in these rare cases, the serum to ascites albumin gradient is low. We describe a 28-year-old woman with anasarca, ascites and a serum to ascites albumin gradient of 1.1 g/dl, consistent with portal hypertension...
Objectives: To describe the case of a patient presenting with weight loss and a pelvic mass.
Materials and methods: We performed an advanced search in MEDLINE using the key words "wasting syndrome", "actinomycosis" and "pelvic mass".
Results: A 63-year-old woman had a well-delimited and tender pelvic mass and was found to be anaemic. Before scans were performed, clinicians considered malignancy and other diagnoses.
Conclusion: Actinomycosis is a chronic infection that usually affects the abdomen. Because of the lack of specificity of clinical and radiological findings, a multidisciplinary approach is the keypoint for making an accurate diagnosis.
A 31-year-old Caucasian woman of South-American descent was diagnosed with a variant of multicentric Castleman disease (MCD) that has been reported in Japan as Castleman-Kojima disease. This is a systemic inflammatory disorder known as TAFRO Syndrome which includes thrombocytopenia, polyserositis (ascites/pleural effusion), microcytic anemia, myelofibrosis, fever, renal dysfunction and organomegaly, with immunologic disorder, polyclonal hypergammaglobulinemia, and elevated levels of interleukin-6 (IL-6) and the vascular endothelial growth factor present in serum and/or effusions. Optimal therapies are not well established. The patient was treated with methylprednisolone and rituximab. Following the start of treatment, the patient has been asymptomatic for over 8 months.
This is one of only a few reports of TAFRO Syndrome in a non-Japanese patient.
Disseminated nocardiosis of the central nervous system (CNS) has been rarely reported, especially in the immunocompetent patient. We report a case of cerebral and cervical intradural extramedullary nocardiosis likely to have been the result of disseminated spread from a pulmonary infective focus. Attempts at tissue biopsy and culture of the initial cerebral and pulmonary lesions both failed to yield the diagnosis. Interval development of a symptomatic intradural extramedullary cervical lesion resulted in open biopsy and an eventual diagnosis of nocardiosis was made.
We highlight the diagnostic dilemma and rarity of spinal nocardial dissemination in an immunocompetent individual.