Paliperidone is an atypical antipsychotic drug used to treat schizophrenia. Paliperidone can cause some rare side effects during treatment. Despite many publications of mania and hypomania induced by antipsychotics, ma- nia cases induced by paliperidone are few in the literature. In this case a schizophrenia patient showing symptoms of mania during usage of paliperidonewith a dose of 9 mg/ day in which the symptoms rapidly disappeared after dis- continuation of paliperidone and initiation of aripiprazole was reported. Clinicians should be aware of that Paliperi- done treatment may trigger mania symptoms. J Clin Exp Invest 2015; 6 (3): 321-323
39 mg/dL, creatinine 0.8 mg/dL, fast glucose 122 mg/ dL, sodium 138 mEq/L, potassium 4.0 mEq/L, calcium 8.6 mg/dL, albumin 4.2 g/dL, VHS 34 mm, PCR 0.7. Urinalysis: Ph 5.0, protein traces, hemoglobin +++, leukocytes +++ (30/high power field), erythrocytes 25/ high power field, moderate bacteriuria. Urine culture was positive for Escherichia coli, resistant to ciprofloxacin, amikacin and ceftriaxone. Antibiotic therapy was initiated with piperacillin-tazobactam and opioids. Despite antibiotic use, the patient persisted with dysuria, lumbar pain and purulent collection in the kidney. She had no signs of systemic inflammatory response syndrome, but the persistent pain and absence of regression of the collection with gas suggestive of emphysematous pyelonephritis (EP) refractory to clinical treatment. On
According Rebhun and Thamm (2010), animals with malignant melanoma, mast cell tumor and thyroid carcinoma are more susceptible to developing more than one type of neoplasm simultaneously. Moreover, the effects of previous treatment such as radiotherapy and chemotherapy might also predispose to a secondary neoplasm. (Rebhun and Thamm, 2010). Riou et al. (1995), state that previous treatment would be responsible for immunosuppression, especially of T-cells, preventing the recognition of a new primary neoplasia. Nevertheless, our patient had not been treated with chemotherapy, radiotherapy, or any immunosuppressive drug previous to the emergence of the lesions.
Fracture of the acromion and arterial injury are a rare association. he clinical picture is characterized by shoulder pain, functional disability and swelling of the afected limb with decreased distal pulse and temperature. Radiography of the shoulder and arteriography deine the diagnosis and assist in postoperative follow-up. he authors report a rare case of fracture of the acromion associatedwith injury of the ipsilateral ulnar artery and describe its treatment, as well as pre- and postoperative evaluations.
The present casereport described the rare development of affective symptoms in a patient previously diagnosed withschizophrenia who developed Graves’ disease at an advanced age. It is widely known that thyroid diseases can trigger psychiatric symptoms (e.g., anxiety, depression, mania, and psychosis) in previously healthy patients. In psychotic patients, thyrotoxicosis can trigger other psychiatric symptoms or worsen the primary disease; this inding justiies thyroid blood testing in psychotic patients. Further studies are necessary to elucidate the pathological process involved in these cases.
During the child’s psychiatric evaluation, it was observed that his level of psychomotor activity was more than normally ac- cording to his age and developmental level, he had diiculty in focusing his attention, and his level of impulsivity was very pro- nounced. No further psychiatric signs were identiied. Based on the child’s psychiatric assessment, a diagnosis of ADHD-Com- bined Type was considered to patient according to the DSM-IV- TR criteria. As methylphenidate use was associatedwith com- plaints of palpitation, the child was referred to a Pediatrician for cardiac evaluation. The physical examination and ECG ind- ings of the patient were within normal limits. And atomoxetine treatment was started. Based on the case’s weight (55 kg), it was planned to give atomoxetine at a dose of 25 mg/day, and
At seven months of age, the dog showed an improvement in her aggressive behavior and the number of seizures she suffered; however, facial pain could still be detected. When the dog was clinically stable, a second tomographic examination was performed in order to assess the progress of the lesion and determine the best clinical and/or surgical treatment, taking into account potential prosencephalic compression and close contact with the nervous tissue. This second CT examination of the nasal cavity and brain revealed the presence of an intranasal mass starting near the upper right canine tooth,
Introduction: Purpura fulminans (PF) is a rapid progressive thrombotic disease in which hemorrhagic infarction of the skin and disseminated intravascular coagula- tion (DIC) occurs. It can potentially cause acute kidney injury (AKI). However, there is no description in the medical litera- ture of renal histological findings of PF. Casereport: A 20-year-old female patient, previously healthy, was admitted to the emergency department (ED) with odyno- phagia, fever, generalized myalgia and an- uria, which evolved with the appearance of purpuric plaques on the face and limbs. She required dialysis on admission. Labo- ratorial tests showed anemia, leukocyto- sis, thrombocytopenia, and elevation of lactic dehydrogenase (LDH). The purpu- ric lesions became bullous with ruptures and then necrotic and erosive, reaching the dermis, subcutaneous tissue and mus- culature, until bone exposure. There was no improvement with initial antibiotic therapy aimed at the treatment of menin- gococcemia. Thrombotic microangiopa- thy (TMA) and PF were then suspected. The patient remained in daily dialysis, requiring plasmapheresis. After sustained improvement of the thrombocytopenia, she underwent renal biopsy, which was not compatible with TMA, characteriz- ing possible PF. A complete recovery of the renal function was achieved and cu- taneous sequels were treated with grafts. Conclusion: When thrombotic and hem- orrhagic phenomena overlap, obtaining a renal biopsy can be difficult. However, in the presented case, the biopsy allowed the exclusion of AKI caused by TMA, pre- senting for the first time, histological find- ings compatible with PF.
Virus-Associated Hemophagocytic Syndrome (VAHS) is a severe hematological disorder related to some viral infections. It is an illness characterized by persistent fever, pancytopenia, splenomegaly, hyperferritinemia and, the most important, hemophagocytosis observed in the bone marrow, liver and/or lymph nodes. VAHS associatedwith hepatitis A virus infection is rarely described, despite the high incidence of this viral infection in the population in general. There is no consensus in the literature regarding the optimal treatment of VAHS. In this article the clinical features, presumed pathogenesis, diagnostic criteria and treatment of VAHS are discussed, including description of cases of VAHS related to hepatitis A virus infection found in the medical literature.
boceprevir was a probable drug associatedwith pancreatitis in the present case. Another finding supporting the causal relationship between boceprevir and acute pancreatitis is the fact that the patient did not develop pancreatitis prior to the use of boceprevir or during the 6-month observa- tion period after the end of treatment. Other less common causes of acute pancreatitis, such as biliary microlithia- sis and autoimmune pancreatitis, could therefore be ruled out.
The first follow-up visit was 3 weeks after initiation of therapy and every 6 to 8 weeks thereafter. The patient was monitored with a complete blood count, Cyclospori- ne A blood level and liver function test (aspartate amino- transferase and alanine aminotransferase levels) every 2 months. Cyclosporine blood levels were obtained to mo- nitor patient compliance and potential toxicity. The pati- ent was also specifically queried at each visit about the presence of potential adverse reactions associatedwith Cyclosporine A. Drug dosage was adjusted according to the therapeutic response and side effects. Once the choro- iditis appeared not active, oral prednisone was tapered to a lower dosage and finally discontinued. The goal of cyclosporine treatment was inactivity of the lesions for approximately 12 to 24 months, after which the drug was tapered and discontinued.
Radioactive iodine (RAI) therapy has been used as a treatment option for Graves’ disease, and it has been widely accepted to be safe. On the other hand, some evidence suggests that RAI therapy is possibly associatedwith a small increased risk of thyroid cancer. Herein, we report a rare case of anaplastic thyroid carcinoma (ATC) associatedwith Graves’ disease, following RAI treat- ment. A 42-year-old woman had been diagnosed with Graves’ disease and although she was treated with an antithyroid drug, she remained in a hyperthyroid state, which led to two RAI treatments. More than 10 years later, the patient revisited our clinic due to hoarseness, dysphagia, and dyspnea, which had lasted for 2 months. Neck computed tomography suggested thyroid carcinoma and a lymph node biopsy showed metastatic papillary carcinoma. The patient underwent total thyroidectomy and was finally di- agnosed as having an ATC. It is not clear if the occurrence of ATC reported here was influenced by the RAI therapy or alterna- tively, it may only represent the delayed recognition of a rare change in the natural history of Graves’ disease. Nevertheless, this report is worthwhile since it presents a very rare case of ATC that occurred eleven years after the RAI therapy for Graves’ disease.
A 22-year-old male patient was refer- red by an orthodontist because of asymptoma- tic radiolucent areas on routine radiographs. The physical examination showed no bulging of the mandibular cortex, displa- cement, mobility, or loss of vitality of teeth adjacent to the pathologic areas. The patient reported no local trauma. Blood work-up (serum calcium, phosphorous, alkaline phos- phatase, and PTH) were within normal limits. Radiographic findings consisted of two unilocular radiolucent areas with a sclerotic halo that did not cause absorption of tooth roots, and that were located in the left parasymphyseal region in the mandible (measuring about 2.5 cm) and the right body of the mandible (diameter of about 2 cm) (Figure 1).
A white, male, 15-year old patient (accompanied by an adult responsible woman) came to the Coloproctology Service out- patient clinic (HC-UFTM) complaining of “getting constipated since childhood.” The woman reported that since the age of 4 the patient suffers from constipation that, on certain occasions, lasts for a full month (sic). She also reported that since about a year ago there is a frequent need for “ene- mas” and denied other diseases, the use of medicines, or previous surgeries, and that socially the patient is “a very withdrawn boy.” During the physical examination of the patient’s abdomen, we could perceive a distended abdomen with a non-pulsatile, depressible, painless palpable mass in his left hemiabdomen. The proctological examination revealed a normotonic sphincter and a large amount of hard stools occupying the rectum, as well as a wide rectal ampulla.
A 56-year-old male patient was referred to the general sur- gery service of a hospital in Ceará to perform skin biopsy. He had diffuse and recurrent erythematous, erosive lesions, mainly in lower trunk, inguinal region (Figure 1) and lo- wer limbs for nine years without remission with medical treatment. Patient had little glycemic control with oral hypoglycemic agents and diet. He denied alcohol consump- tion or smoking habit. On examination, the patient was in good general condition, thin, with reddish-crusted lesions, mainly in lower trunk, inguinal region and lower limbs; erosive and blistering lesions in the perioral area. Abdomen without visceromegaly or palpable masses. Laboratory tests: presence of mild normocytic and normochromic anemia, abnormal glucose tolerance test, reduced albumin and to- tal protein levels, and amino acids quite diminished.
A 56-year-old right-handed woman was referred to our hospital because of action tremors in both hands for 10 years. One year back, she had been diagnosed with essential tremor in a local hospital. She was prescribed 80 mg propranolol and 1 mg clonazepam for the tremor, but her neurologic state did not show any improvement after treatment. She had no family his- tory of neurological disorders and had no medical problems. The neurological examination revealed mild postural tremor and moderate to severe action tremor in both hands with spon- taneous rhythmic oscillatory movements of the distal agonist and antagonist muscles. The pa- tient exhibited a 5 to 7 Hz postural tremor when her hands were outstretched. No motor weakness or sensory changes were observed, and the patient’s bowel and bladder functions were normal. She had spasticity in all limbs with exaggerated tendon reflexes. Babinski sign and ankle clonus were present in the left lower limb.
In this casereport, because the associated congenital heart defect was not present, as reported by Serrano et al. , the reconstruction in the neonatal period was chosen due to the greater flexibility of the thorax . It was used a resected rib segment, after the thoracic cavity had been INTRODUCTION
Frequency, dysuria, or abdominal/lank pain have also been described. The age of patients diagnosed with urinary myopericytoma was variable, with the youngest patient being a 33-year-old male. None of these patients developed any evidence of recurrent or metastatic disease after surgical removal of the lesion (mean follow-up: 30 months). Our case concerned a malignant myopericytoma. In contrast to the typical myopericytoma, this tumour has atypical features such as a high mitotic index, nuclear pleomorphism, necrosis, and high cellularity. In 2002, McMenamin and Fletcher 12
Abstract: Lichen nitidus is a disease of unknown etiology, characterized by flesh-colored, shiny papules of 1-2 mm and generally asymptomatic or with mild pruritus. The most common sites of occurrence are genitalia, upper limbs, trunk and abdomen. The generalized form is rare. This is the fourth reported case of lichen nitidus associatedwith Down Syndrome.