Pylephlebitis complicating silent diverticulitis.
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Biomedical subjects
Spiros P Dourakis
Publications and source records attributed to Spiros P Dourakis.
Q fever endocarditis masquerading as Mixed cryoglobulinemia type II. A case report and review of the literature.
BACKGROUND: The clinical manifestations of Q fever endocarditis are protean in nature. Mixed cryoglobulinemia type II is rarely a facet of the presenting clinical manifestations of Q fever endocarditis. CASE PRESENTATION: We report a case of a 65-year-old pensioner with such an association and review the literature. As transesophageal echocardiograms are usually normal and blood cultures are usually negative in Q fever endocarditis, many of the manifestations (fever, rash, glomerulonephritis/evidence of renal disease, low serum C4 complement component, presence of mixed type II cryoglobulin, constitutional symptoms as arthralgias and fatigue) can be attributed to Mixed cryoglobulinemia type II per se. The use of Classic Duke Endocarditis Service criteria does not always suffice for the diagnosis of Q fever. CONCLUSION: The application of the modified criteria proposed by Fournier et al for the improvement of the diagnosis of Q fever endocarditis will help to reach the diagnosis earlier and thus reduce the high mortality of the disease. We would like to stress the importance of ruling out the diagnosis of Q fever endocarditis in cases of mixed type II cryoglobulinemia.
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Immune-mediated thrombocytopenic purpura associated with Toxoplasma gondii infection in an immunocompetent patient.
Infection with Toxoplasma gondii (T. gondii) in immunocompetent adults is usually asymptomatic and needs no specific therapy. We report the case of a 16-year-old previous healthy adolescent who presented with bleeding due to immune-mediated thrombocytopenic purpura during an acute acquired T. gondii infection. Treatment with prednisolone and immunoglobulin resulted in a relative increase in the platelet count. Taking into account the fact that the patient became immunocompromised under corticosteroids, specific antitoxoplasmal treatment has been added. The difficulties in treatment decision in this rare case are discussed.
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