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A 25-year-old woman complained of anasarca and was admitted to Sakura National hospital on the presumptive diagnosis of nephrotic syndrome with 10.7 g of 24-hour urinary protein. At first, lupus nephritis with antiphospholipid antibody syndrome was suspected because of prolongation of APTT, existence of lupus anticoagulant and elevation of serum anticardiolipin antibody titer (IgM) in addition to positive ANA, lymphocytopenia and the biologically false positive test for syphilis (BFPTS). On day 28 of hospitalization, renal biopsy findings revealed severe endocapillary cell damage, such as swelling and proliferation of endothelial cells, fragmentation and double contour of the basement membrane walls, which were located only in the capillary lumens with a few thrombi. Immunofluorescent micrography revealed the absence of specific immunoglobulin or complement deposit. Therefore, the diagnosis of lupus nephritis was negated as these findings were suggestive of characteristic glomerulopathy due to primary antiphospholipid antibody syndrome. She was treated initially with oral prednisolone 60 mg and intravenous infusion of heparin 20,000 units daily. Moreover, cyclophosphamide 750 mg was administered intravenously as pulse therapy on day 13 as her serum level of CH50 had fallen suddenly, and hemodialysis was necessary because her renal function had deteriorated and she was suffering from cough and orthopnea with overhydratin. After the combined therapy, BFPTS disappeared and APTT returned to the normal range: dialysis treatment was not required further after the 4th hemodialysis. Thereafter, renal function improved and complete remission of nephrotic syndrome was obtained. This patient was a case of primary antiphospholipid antibody syndrome in which endothelial cell damage was located exclusively in the capillary lumens and pulse cyclophosphamide therapy in addition to prednisolone and anticoagulant was effective. We present this instructive case to promote understanding of the pathogenesis of primary antiphospholipid antibody syndrome.
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PMID:[A case of primary antiphospholipid antibody syndrome with severe nephrotic syndrome showing remarkable endothelial cell damage in the capillary lumen]. 919 67

A 26-year-old woman presented with a high-grade fever and chills of 2 days' duration. She complained of associated joint pain, especially in the wrists and knees. One day before admission, tender skin lesions began to develop on the fingers, and subsequently spread to the more proximal extremities. The patient recalled having a sore throat and a nonproductive cough before the onset of the fever and eruption. The past medical history was significant for Gardnerella vaginitis and several urinary tract infections. The patient was taking oral contraceptive pills; her most recent menstruation was 3 weeks before admission. She reported having sexual intercourse with her boyfriend 2 weeks before admission. The patient's temperature was 40 degrees C. Dermatologic examination revealed a 6-mm, hemorrhagic pustule on an ill-defined pink base, overlying the volar aspect of the left second proximal interphalangeal joint (Fig. 1a). Scattered on the upper and lower extremities were occasional round, ill-defined pink macules with central pinpoint vesiculation (Fig. 1b). A skin biopsy of the digit revealed a dense neutrophilic infiltrate with leukocytoclasis and marked fibrin deposition in the superficial and deep dermal vessels (Fig. 2a). Gram stains demonstrated the presence of Gram-negative diplococci (Fig. 2b). Laboratory findings included leukocytosis (leukocyte count of 20 x 109/L, with 81% neutrophils). Analysis of an endocervical specimen by polymerase chain reaction was positive for Neisseria gonorrhoeae and negative for Chlamydia trachomatis. Throat and blood cultures grew N. gonorrhoeae. Specimen cultures obtained by skin biopsy yielded no growth. Results of serologic analysis for human immunodeficiency virus, hepatitis, syphilis, and pregnancy were negative. Beginning on admission, intravenous ceftriaxone, 2 g, was administered every 24 h for 6 days, followed by oral cefixime, 400 mg twice daily for 4 days. Oral azithromycin, 1 g, was administered to treat possible coinfection with C. trachomatis. By treatment day 4, the patient was afebrile, with the resolution of leukocytosis and symptomatic improvement of arthralgias.
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PMID:Disseminated gonococcemia. 1265 17

Acute human immunodeficiency virus (HIV) seroconversion illness is a difficult diagnosis to make because of its nonspecific and protean manifestations. We present such a case in an adolescent. A 15-year-old boy presented with a 5-day history of fever, sore throat, vomiting, and diarrhea. The patient also reported a nonproductive cough, coryza, and fatigue. The patient's only risk factor for HIV infection was a history of unprotected intercourse with 5 girls. Physical examination was significant for fever, exudative tonsillopharyngitis, shotty cervical lymphadenopathy, and palpable purpura on both feet. Laboratory studies demonstrated lymphopenia and mild thrombocytopenia. Hemoglobin, serum creatinine, and urinalysis were normal. The following day, the patient remained febrile. Physical examination revealed oral ulcerations, conjunctivitis, and erythematous papules on the thorax; the purpura was unchanged. Serologies for hepatitis B, syphilis, HIV, and Epstein-Barr virus were negative. Bacterial cultures of blood and stool and viral cultures of throat and conjunctiva showed no pathogens. Coagulation profile and liver enzymes were normal. Within 1 week, all symptoms had resolved. The platelet count normalized. Repeat HIV serology was positive, as was HIV DNA polymerase chain reaction. Subsequent HIV viral load was 350 000, and the CD4 lymphocyte count was 351/mm3. HIV is the seventh leading cause of death among people aged 15 to 24 in the United States, and up to half of all new infections occur in adolescents. Our patient presented with many of the typical signs and symptoms of acute HIV infection: fever, fatigue, rash, pharyngitis, lymphadenopathy, oral ulcers, emesis, and diarrhea. Other symptoms commonly reported include headache, myalgias, arthralgias, aseptic meningitis, peripheral neuropathy, thrush, weight loss, night sweats, and genital ulcers. Common seroconversion laboratory findings include leukopenia, thrombocytopenia, and elevated transaminases. The suspicion of acute HIV illness should prompt virologic and serologic analysis. Initial serology is usually negative. Diagnosis therefore depends on direct detection of the virus, by assay of viral load (HIV RNA), DNA polymerase chain reaction, or p24 antigen. Both false-positive and false-negative results for these tests have been reported, further complicating early diagnosis. Pediatricians should play an active role in identifying HIV-infected patients. Our case, the first report of acute HIV illness in an adolescent, emphasizes that clinicians should consider acute HIV seroconversion in the appropriate setting. Recognition of acute HIV syndrome is especially important for improving prognosis and limiting transmission. It is imperative that we maintain a high index of suspicion as primary care physicians for adolescents who present with a viral syndrome and appropriate risk factors.
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PMID:Acute human immunodeficiency virus syndrome in an adolescent. 1452 19

The analysis of clinical neurological symptoms on the basis of available letters and other documents confirms beyond a doubt the long standing diagnosis of neurosyphilis in the form of chronic meningitis with cranial polyneuritis and wide spread polyradiculitis, formerly called Lues cerebro-spinalis. The symptoms which recurred over 25 years include multiple severe paralysis of cranial nerves, dramatic radicular neuralgias and radicular paralysis in addition to a partial transverse lesion of the spinal cord and terminal coughing and regurgation fits in the absence of symptoms in the cerebrum and brain stem, these symptoms hardly permit different diagnosis. Tuberculosis, lead poisoning, multiple sclerosis or even a myatrophic lateral sclerosis do not explain his neurological symptoms or the cause of his death.
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PMID:[The suffering of Heinrich Heine]. 1566 22

The roots of Calotropis gigantea have been used in leprosy, eczema, syphilis, elephantiasis, ulceration and cough in the Indian system of traditional medicine. The present communication evaluated its antipyretic activity by using yeast-induced and TAB (Typhoid) vaccine-induced pyrexia in rats and rabbits. In both yeast-induced and TAB vaccine-induced fever, the fever was significantly reduced and the body temperature was normalized by administration of 200 and 400 mg/kg dose intraperitoneally. Based on the results of the present study it can be concluded that the extract of C. gigantea has potential antipyretic activity against both yeast-induced and TAB vaccine-induced fever, indicating the possibility of developing C. gigantea as a cheaper and potent antipyretic agent.
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PMID:Evaluation of antipyretic activity of Calotropis gigantea (Asclepiadaceae) in experimental animals. 1610 90

A 29-year-old HIV seropositive male patient from Manipur presented with fever, cough, weight loss and asymptomatic papules and nodules all over the body. Differential diagnoses of secondary syphilis, histoplasmosis, cryptococcosis and penicilliosis were considered. Histopathological and mycological study of the skin biopsy tissue, and blood culture confirmed the diagnosis of penicilliosis. Although penicilliosis, an AIDS-defining illness, is restricted to Southeast Asia, more and more cases are being recognized in non-endemic countries.
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PMID:Penicillium marneffei infection: an AIDS-defining illness. 1639 15

The incidence of tertiary syphilis has declined in recent years owing to the early recognition of the disease and use of antibiotics. As a result, syphilitic aortic aneurysms are rarely encountered nowadays. We report the case of a 65 years old man, who was admitted to our hospital in June 2004 for dyspnea, cough and chest discomfort. On physical examination, blood pressure was 130/80 mmHg with no significant laterality, pulse rate was 70 per minute and there was a decrease of breath sounds over the right lung. Laboratory findings revealed a slight elevation of the erythrocyte sedimentation rate. Serological studies for syphilis showed a positive venereal disease laboratory test (VDRL) at 1/32 and a positive Treponema pallidum hemagglutination test (TPHA) at 1/2560. The chest radiography showed a right para cardiac opacity measuring 16 x 12 cm. Fiber optic bronchoscopy showed an extrinsic compression of the right upper lobar bronchus. Gadolinium-enhanced magnetic resonance angiography and 16 multidetector-row spiral computed aortography showed a huge partially thrombosed saccular aneurysm of the ascending aorta measuring 132 mm in diameter. The circulating lumen measured 53 mm in its largest diameter. This aneurysm involved the innominate artery. There was no other arterial involvement. The patient was given a three week course of intravenous penicillin followed by a successful surgical procedure in September 2004 with ascending aortic replacement and innominate artery reimplantation. This case illustrates well a formerly common, but now extremely rare disease.
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PMID:[Syphilitic aortic aneurysm. A case report]. 1673 42

A 29-year-old black male had multiple hospital admissions for fever (101 degrees F-104 degrees F) of unknown origin. Over six months, the patient had a constellation of symptoms, including pleuritic chest pain, dry cough, arthralgias of hand joints and marked constitutional symptoms including weigh loss. Patient had erythema nodosum, generalized lymphadenopathy, multiple subcutaneous nodules over the epigastric region and a nodule in his left eye. The patient had bilateral hilar lymphadenopathy, mildly enlarged mediastinal lymph nodes, right upper and lower lobes infiltrate and right side pleural effusion. Patient also had cardiomyopathy with EF 35 percent. Workup for HIV, TB, atypical mycobacterium, infectious mononucleosis, CMV, toxoplasmosis, syphilis and fungal etiologies were negative. Initial rheumatological workup was also negative. Despite a broad spectrum of empiric antibiotics, the patient was having a daily spike of temperature. A left supraclavicular lymph node biopsy showed small non-caseating granuloma typical for sarcoidosis. This patient had fever of unknown origin secondary to a sub acute form of sarcoidosis, with marked constitutional symptoms, bilateral hilar and mediastinal lymphadenopathy, erythema nodosum, and arthralgias--a setof findings sometimes referred to as Lofgren's syndrome.
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PMID:Lofgren's syndrome presenting as a case of fever of unknown origin. 1768 99

Ethnobotanical knowledge is one of the precious cultural heritage parts of an area that involves the interaction between plants and people and foremost among these are the management of plant diversity by indigenous communities and the traditional use of medicinal plants. An ethnobotanical analysis was conducted in order to document the traditional medicinal uses of plants, particularly medicinally important folklore food phytonims of flora of Samahni valley, Azad Kashmir (Pakistan). In the valley, inhabitants use different taxa of flora in two different ways; herbal medicines and food (vegetable and fruits) medicines. The distinctive geographic position and historic demological background of the area keep folk phytotherapy potential of medicinal herbs hitherto alive, which are used in various forms; as regular herbal medicines prescribed by Hakeems (herbal practitioners) and as food (medicines) recepies suggested by elder people. Among these, some herbs are used as single remedy while others depict better curative effects in synergistic mode against various ailments. Some interesting and uncommon findings are as; Sisymbrium irio is used for treatment of measles, asthma; Solanum miniatum to cure urinary calculi, heart pain, rheumatism, Momordica balsamina leaves as wound healer; Allium sativum bulb juice as anti cancer, contraceptive, blood pressure; Boerhavia diffusa roots as anti jaundice, anemia, edema; Capsicum annuum fruit as omen against evil eye and giant, yellow fever; Corriandrum sativum seeds as diuretic, anti spermatogenesis; Raphanus sativus seeds against syphilis; Solanum miniatum fruit for treatment of enlarged spleen and liver; seed's oil of Pisum sativum as anti spermatogenesis; Bauhinia variegata for skin diseases, ulcers; Malva sylvestris for cough, bladder ulcer; Phoenix sylvestris kernel as anti-aging tonic; Phyllanthus emblica for diuretic, anemia, biliousness; Terminalia chebula to cure chronic ulcers, carious teeth pain, heart problems; Veronica anthelmintica for bandage of broken bones and Withania coagulans is used to treat small pox. Many wild plants are eaten green and raw as salad, or in boiled form of soup as blood and intestine cleansing tonics. Moreover, some plants are spiritually recorded as sacred and used as ritual plant for good omens or against the evil eye and removal of giant. About 95 species of 38 families were recorded to be important part of phyto heritage of folk pharmacopoeia of Samahni valley. Among most frequent used families are Papilionaceae 9.47%, Solanaceae and Poaceae 8.42% each, Cucurbitaceae 7.36% and Brassicaceae and Rosaceae 6.31% each. Among the surveyed families used to treat various diseases, Solanaceae is at first rank with 9.74%, Brassicaceae 8.23% and Cucurbitaceae 7.39% subsequently. Most commonly used families with highest percentage of plants used as food medicines are Solanaceae (11.37%), Brassicaceae (8.38%) and Papilionaceae (7.18%) respectively. Most frequent plant parts used are; roots, leaves, seeds and flowers while popular forms of plants uses are decoction, poultice, infusions, soups and raw form as salad. Importance of ethnobotanical inventory constructed from ethnomedicinal uses and folklore phytonims of flora in perspectives of initiative for future phytochemical and pharmacological research on these taxa to develop and discover of new drugs is present and discussed.
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PMID:An ethnomedicinal survey and documentation of important medicinal folklore food phytonims of flora of Samahni valley, (Azad Kashmir) Pakistan. 1907 Jan 89

Atypical features of secondary syphilis are more common in patients with human immunodeficiency virus infection. We report this case in which the clinical features, serology and response to therapy were clearly suggestive of secondary syphilis but histopathology raised concerns about cutaneous lymphoma. A 30-year-old male presented with history of fever and cough of one month duration. He was seropositive for human immunodeficiency virus infection one year back. He had discrete multiple papular and papulonodular patches all over the body. VDRL and TPHA tests were positive. HIV infection was confirmed by two ELISA tests. Skin biopsy report raised the possibility of lymphomatous infiltration. He was treated with penicillin and responded favourably. He was also instituted antiretroviral therapy later.
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PMID:Secondary syphilis mimicking cutaneous lymphoma. 2201 May 94


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