Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: EC:3.4.15.1 (ACE)
 18,300 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 25-year-old patient presented with fever over a period of more than three months, night sweats, fatigue and a weight loss of more than 10 kg. A splenomegaly and an enlargement of cervical, thoracic and abdominal lymph nodes were found. The suspected malignant hematologic disorder could not be confirmed. Instead, epithelioid noncaseating granulomas in the bone marrow and a cervical lymph node as well as an elevated serum ACE and a lymphocytic alveolitis were found. These findings led us to the conclusion that the patient was suffering from sarcoidosis. Treatment with corticosteroids resulted in complete regression of all symptoms, including the splenomegaly and the enlargement of the lymph nodes. Sarcoidosis is an important consideration in differential diagnosis of fever of unknown origin, even in the absence of pathological changes on X-ray films of the chest.
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PMID:[Fever of unknown origin]. 763 Nov

A 73-year-old African American female presented to our clinic with painful lower extremity lesions of 2 weeks duration. She was in her usual state of health until 3 months prior to presentation when she reported symptoms of fatigue and weakness. She also noticed an enlarging mass on the left side of her neck. She denied fevers, chills, night sweats or cough. Her symptoms were unresponsive to a course of oral dicloxacillin. The neck mass enlarged over 8 weeks and she was referred to our institution for evaluation. CT scan of the neck showed an enlarged lymph node. Ten days prior to her presentation in dermatology, a fine needle aspirate of the enlarging lymph node revealed necrotizing granulomas. Tissue was sent for routine mycobacterial and fungal cultures. Routine blood work, chest radiograph, and a tuberculin skin test were also performed. At the time of her dermatology visit she described the development of multiple new painful, non-pruritic lesions, bilaterally on the lower extremities. She also reported a red crusted area that appeared at the site of her tuberculin test that was placed subsequent to the development of her lower extremity lesions. Her past medical history was significant for Parkinson's disease, hypothyroidism and hypertension. Her current medications included l-thyroxine, estrogen and diltiazem. Her travel history was only remarkable for a trip to Jamaica the previous spring. She was born and raised in Haiti. She reported a history of a positive tuberculin skin test 20 years ago, but received no therapy. Physical examination revealed a 2 x 3 centimeter firm, nontender left lateral neck mass (Fig. 1). Her right forearm revealed an erythematous, ulcerated, indurated plaque 1.5 cm in diameter (Fig. 2.). Her lower extremities revealed tender 0.5 to 1 cm erythematous nodules below the knees bilaterally (Fig. 3). A punch biopsy of a lower extremity nodule revealed a mild pervisacular dermal infiltrate. Within the subcutaneous tissue there was septal widening. There was also a lymphohistiocytic infiltrate with a slight admixture of neutrophils within the septa of the fat lobules. There was no evidence of necrotizing vasculitis or collagen necrosis. An acid-fast stain was not performed. The histologic findings were consistent with a diagnosis of erythema nodosum. Her laboratory evaluation including CBC, electrolytes, thyroid studies, angiotensin converting enzyme level and chest radiograph were normal. Approximately 1 week after her dermatological evaluation, the fine-needle aspirate culture grew Mycobacterium tuberculosis. A diagnosis of tuberculous lymphadenitis associated with erythema nodosum was confirmed. The patient was started on quadruple therapy of isoniazid, rifampin, ethambutol and pyrazinamide. Her lower limb skins lesions rapidly resolved over the subsequent month and her neck mass also diminished in size. She completed 6 months of antituberculous therapy with complete resolution of her lymphadenopathy.
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PMID:Erythema nodosum associated with reactivation tuberculous lymphadenitis (scrofula). 1201 Mar 45

We report on an otherwise healthy 47-year-old male who developed subacute tenosynovitis of the hand associated with night sweats and inguinal lymphadenopathy. He had a past history of granulomatous mediastinal lymphadenitis with positive histoplasmosis serology 11 years previously. Carpal tunnel exploration with biopsy demonstrated granulomatous inflammation. Granulomatous inflammation, hypercalcemia, and an elevated serum angiotensin converting enzyme (ACE) level suggested the diagnosis of sarcoidosis, however histoplasmosis infection could eventually be diagnosed. This unusual presentation of histoplasmosis underscores the fact that the diagnosis of sarcoidosis requires careful exclusion of other causes of granulomatous inflammation, particularly infectious agents. Even in the setting of an elevated ACE level and hypercalcemia, the possibility of an infectious etiology must be considered before establishing a diagnosis of sarcoidosis.
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PMID:Histoplasmosis with tenosynovitis of the hand and hypercalcemia mimicking sarcoidosis. 1704 88