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Biomedical subjects

H M Adelman

Publications and source records attributed to H M Adelman.

69 records · Page 4Linked to original sources
PubMed1994

Scurvy resembling cutaneous vasculitis.

Various conditions can imitate cutaneous vasculitis. Scurvy is a less appreciated cause of rash that can resemble vasculitis. Three patients were referred to our rheumatology service for "vasculitis," who subsequently were found to have scurvy. Findings included a purpuric skin rash, myalgias, and malaise. The patients had low vitamin C levels and findings on skin biopsy specimens indicative of scurvy. The three patients were on idiosyncratic diets deficient in vitamin C, and the two patients who allowed us to administer vitamin C therapy improved clinically. We emphasize the importance of a careful dietary history. Early recognition of scurvy is important because it can be treated specifically, and toxic treatment of vasculitis can be avoided.

Adult↗
PubMed1992

Fluconazole in the treatment of hepatosplenic candidiasis.

Hepatosplenic candidiasis has increased in frequency among immunocompromised hosts. Risk factors include hematologic malignancy, intensive chemotherapy, prolonged neutropenia, and treatment with broad-spectrum antibiotics. Patients most commonly present with abdominal pain, persistent fevers despite antibiotic therapy, and an elevated alkaline phosphatase level that is out of proportion to other hepatic enzyme levels. Gastrointestinal mucosal damage secondary to intensive chemotherapy may allow colonization with Candida species and subsequent seeding of the portal vein. Treatment has consisted of prolonged courses of amphotericin B, with mortality rates approaching 50%. We report a case of hepatosplenic candidiasis in a patient with acute myelogenous leukemia who had clinical and radiographic improvement during fluconazole therapy. Fluconazole may be an efficacious and less toxic alternative to amphotericin B.

Candidiasis↗
PubMed1991

Retroperitoneal fibrosis accompanying immune thrombocytopenia.

Retroperitoneal fibrosis represents an idiopathic systemic fibrosing syndrome which leads to the development of progressive hydronephrosis and azotemia (Stewart and Friberg: Southern Medical Journal 77:1185-1187, 1984; Morad et al.: American Journal of Medicine 82:363-366, 1987). Evidence in the literature supports a hypothesis that retroperitoneal fibrosis represents a systemic autoimmune process (Lichon et al.: Journal of Rheumatology 11:373, 374, 1984; Lipman et al.: JAMA 196:204-206, 1966; Littlejohn and Keystone: Journal of Rheumatology 8:665-669, 1981; Katz et al.: American Journal of Clinical Pathology 67:436-439, 1977). We report a case of a patient with retroperitoneal fibrosis, immune thrombocytopenia, presence of antinuclear antibody, and direct Coombs positivity which provides further evidence that retroperitoneal fibrosis is an autoimmune process. Progressive obstructive uropathy related to his fibrosis led to bilateral hydronephrosis and significant renal function impairment. Also, he developed marked immune thrombocytopenia. Treatment with prednisone produced a dramatic response in both platelet count and renal function.

Aged↗
PubMed1991

Symptomatic adult polycystic liver disease in a young woman.

Adult polycystic liver disease is an entity that is striking for the presence of extraordinary hepatomegaly. Very rarely do patients under 40 years of age experience problems and only a minority of middle-aged patients manifest symptoms due to organ compression or biliary tree obstruction. The clinical course is usually benign, and no specific therapy is required. The onset of right upper quadrant pain, back pain, and shortness of breath prompted evaluation of a 32-year-old woman with progressive hepatomegaly. CT scan revealed a massive cyst-riddled liver with posterior displacement of the spleen, compression of the pancreas, and renal cysts. Prothrombin time, albumin, and liver enzyme values were normal except for a mildly elevated gamma-glutamyl transpeptidase.

Adult↗
PubMed1991

Ewing's sarcoma of the ilium presenting as unilateral sacroiliitis.

We describe a 24-year-old man who presented with unilateral sacroiliac pain associated with constitutional symptoms. Subsequent biopsy and pathohistologic evaluation demonstrated Ewing's sarcoma. We emphasize a consideration of Ewing's sarcoma in the differential diagnosis of unilateral sacroiliac pain.

Adult↗
PubMed1991

Inability to interpret toxic salicylate levels in patients taking aspirin and diflunisal.

Diflunisal, a nonsteroidal antiinflammatory drug, is not metabolized to the free salicylate moiety, but yields serum salicylate levels. We describe 2 patients who unexpectedly had toxic range serum salicylate levels while taking diflunisal and aspirin for rheumatoid arthritis. Diflunisal is measured by standard salicylate assays, a fact not widely appreciated. Serum salicylate levels by these assays cannot be used to determine salicylate toxicity when a patient is taking both aspirin and diflunisal. High pressure liquid chromatography can be used to distinguish true salicylate toxicity from interference with diflunisal.

Arthritis, Rheumatoid↗
PubMed1990

Eosinophilia-myalgia syndrome in association with L-tryptophan ingestion.

The association between the recently described eosinophilia-myalgia syndrome and L-tryptophan is now well established. We describe a patient with eosinophilia-myalgia syndrome who developed incapacitating myalgias and peripheral eosinophilia responsive only to high dose corticosteroids. When massive upper gastrointestinal hemorrhage developed while receiving corticosteroid therapy, surgery was complicated by striking abdominal wall rigidness. A discussion of this case and of eosinophilia-myalgia syndrome is presented.

Abdomen↗