Brucellosis: a case for concern. Case presentation.
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Biomedical subjects
Publications and source records attributed to R K Osterholm.
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Three cases of disseminated cutaneous sporotrichosis are reported, including a rare presentation of the disease as vesicular dermatitis. The diagnosis was confirmed by culture of a skin biopsy specimen, and all patients responded well to amphotericin B therapy. The sporotrichosis slide latex agglutination titer was used to determine the end point of therapy.
The hemolytic-uremic syndrome has varied prodromal symptoms. In a few patients the dominant initial gastrointestinal symptoms have led to a presumptive diagnosis of ulcerative colitis. The colitis tends to be self-limited, to have minimal lesions detected by proctoscopic or roentgenographic studies, and usually to resolve spontaneous without specific therapy. Rarely, more serious colonic involvement can progress to toxic megacolon, rectal prolapse, colonic perforation, intussusception, or colonic stricture. Early hemodialysis will reduce morbidity and mortality in patients with severe renal impairment. The physician should be aware of this entity when young patients present with a picture compatible with ulcerative colitis in order to circumvent delayed or inappropriate management of what would appear to be a primary bowel disorder.
Mixed connective tissue disease (MCTD) has been characterized as a benign rheumatic syndrome with a favorable response to immunosuppressive therapy. Serious renal and pulmonary involvement are reported to be rare in MCTD. We are describing a female adolescent with MCTD in whom fatal cor pulmonale developed due to recurrent thromboembolic primary pulmonary hypertension. Death occurred after two years of therapy with prednisone and azathioprine for an immune-complex glomerulonephritis. Paramesangial and intramembranous electron-dense deposits had been identified in several glomeruli at the start of treatment. Improved renal function and apparent histologic improvement were demonstrated four months after the institution of prednisone and azathioprine therapy, and stable renal function was maintained until death. The pulmonary hypertension was progressive and apparently not altered by either the prednisone or azathioprine. At necropsy, there was no evidence of a pulmonary arteritis or vascular immune-complex deposition to account for the recurrent thromboembolic lesions in the small pulmonary arteries and arterioles. This is a clinical course not previously described in patients with MCTD and may represent an extreme of the clinical spectrum of this syndrome.