Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0085593 (chills)
 4,268 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

PRESENTING FEATURES: An 85-year-old black woman presented to the Osler Medical Service complaining of a pruritic, erythematous scaly rash that was on her right thigh and abdomen and that had been worsening over the prior 3 months. She also complained of increasing fatigue, decreased exercise tolerance, and a 5-lbs weight loss. There was no orthopnea, paroxysmal nocturnal dyspnea, fevers, chills, or night sweats. She denied recent travel and exposures to or contact with ill people. Her past medical history was unremarkable. There was no history of eczema, atopy, or dermatologic conditions. Her only medication was a baby aspirin taken daily. On physical examination, she was afebrile, her blood pressure was 110/72 mm Hg, and her pulse was 82 beats per minute with a room air oxygen saturation 98%. She was mildly obese but in no apparent distress. She had 1-cm anterior cervical lymphadenopathy bilaterally and a 1-cm left axillary lymph node. Cardiovascular and chest examination was unremarkable. Her abdomen was soft and nontender, with a faint, erythematous rash that was mildly scaly but nontender in her abdominal skin fold. Her right thigh showed a large erythematous area, approximately 15 x 20 cm, which was scaly with multiple areas of discoloration (Figure 1). There was no palpable mass. She had slight edema in her right leg. Her left thigh was normal. Neurologic examination was nonfocal. Laboratory studies were notable for a white blood cell count of 17,000 cells/microL, with a differential of 46% lymphocytes. The absolute lymphocyte count was 8000 cells/microL. Hematocrit was 28%. Platelet count was normal. A comprehensive metabolic panel was normal. A peripheral blood smear (Figure 2) showed numerous atypical lymphocytes with cerebriform nuclei. Peripheral blood flow cytometry showed the presence of a clonal population of T cells that expressed CD4 and CD5 but showed a loss of CD7. What is the diagnosis?
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PMID:Cases from the Osler Medical Service at Johns Hopkins University. 1550 Dec 9

A 33-year-old man with a known bicuspid aortic valve presented with fever, chills, progressive fatigue, anorexia, and night sweats. Echocardiography confirmed aortic-valve endocarditis, but blood cultures remained negative. Bartonella henselae endocarditis was ultimately confirmed by serology as well as by immunohistochemistry and PCR testing of the excised valve. The patient recovered with appropriate antibiotic therapy. B henselae is a common cause of culture-negative endocarditis. It predominantly affects men with underlying valvular disease, and has a predilection for aortic valves. Diagnosis is usually made serologically and with either tissue culture, immunohistochemistry, or PCR. Treatment of this destructive endocarditis consists of a combination of long-term antibiotic therapy and surgical valve repair. This case is used to discuss the approach towards the treatment of patients with endocarditis that is blood-culture negative.
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PMID:A mechanic with a bad valve: blood-culture-negative endocarditis. 1556 27

Tuberculosis (TB) is one of the oldest known diseases and has claimed more lives than any other Today, about one-third of the world's population is infected with TB. In 2003, 1,379 cases of new, active and relapsed TB were reported in Canada. TB is caused by Mycobacterium tuberculosis. Only 10 per cent of infected individuals will develop active TB. Pulmonary TB can be spread by an infectious person through the aerosolization of droplets when coughing, talking, spitting, sneezing or singing. Symptoms of pulmonary TB are a cough with or without sputum production lasting at least three weeks, chest pain, hemoptysis, fever, night sweats, weight loss, lack of appetite, chills and weakness. Extrapulmonary TB is generally not associated with person-to-person spread. Common sites include the throat, lymph nodes, abdomen, intestines, long bones of the legs, spine, kidneys, bladder, skin, eyes and meninges. The risk factors for TB infection and disease include close contact with an active pulmonary TB case, HIV infection or AIDS, inactive disease not adequately treated, low income, underlying medical condition, homelessness, alcoholism, injection drug use, aboriginal background or occupation in health care. Risk settings include travel or residence in an endemic area or work or residence in a correctional facility, shelter, rooming house, residential facility, hospital or long-term care facility. Nurses need to advocate for the prompt diagnosis and isolation of suspected and confirmed TB cases. Knowing when to institute such measures as isolation in a negative pressure room, using respirator masks and limiting interpersonal contacts is vital to the nursing care of TB patients. In addition, the role of the public health department needs to be understood; for example, all jurisdictions have legislated requirements for reporting new positive TB skin tests to public health.
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PMID:Tuberculosis prevention and treatment. 1562 10

A 23-year-old man was admitted to hospital with an extremely painful sacroiliitis on the left side. He had been back in The Netherlands for 5 weeks after a one-year stay on a farm in India where he consumed unpasteurised cow's milk almost daily. Three months before admission he had been ill for several weeks with high fever, a painful right hip joint and night sweats. He was diagnosed in India as having coxitis, thought to be due to a Giardia infection. After hospitalisation in The Netherlands, he developed daily high fever with chills and Brucella sacroiliitis was diagnosed via a positive serology, later confirmed by a positive blood culture for Brucella melitensis. The patient was treated with doxycycline and rifampicin but due to persistent fever, gentamicin was later added for 7 days. As a result of nausea related to rifampicin, this was changed to ciprofloxacin. During treatment he also developed a severely painful right coxitis, possibly due to local release of bacterial endotoxins from a previous Brucella infection in India. After three months of antibiotic treatment, he recovered fully. Although brucellosis is a rare imported disease in The Netherlands, the possibility must be kept in mind in cases of arthritis following a stay in the (sub)tropics.
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PMID:[Brucellosis as an imported disease in a young man with arthritis]. 1638 35

A 40-year-old man visited Haiti in the winter. His visit was uneventful, and he went swimming in the ocean. A week after his return he developed a small "pimple" on his right fifth finger. This condition progressed for several weeks, with new lesions developing over the extensor surface of his forearm and in the antecubital fossa. He had tender axillary adenopathy. The patient started a new job when he returned from Haiti, working 4 days per week in a greenhouse. He denied any fever, chills, or night sweats. He was in good health without any underlying chronic health problems. Physical examination revealed a small eschar over the distal phalanx of the patient's right fifth finger (Figure 1). There were 2 erythematous nodules over the extensor surface of his right forearm (Figure 2) as well as over the antecubital fossa (Figure 3). A punch biopsy was performed and results showed suppurative granulomatous dermatitis. Sporothrix schenckii was grown from the specimen.
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PMID:A rose by any other name. 1748 58

Requena et al, in their article titled "Histiocytoid Sweet syndrome," in 2005, established that the dermal infiltrate in some patients with Sweet's syndrome is composed of histiocyte-like immature myeloid cells, not polymorphonuclear leukocytes as is the norm. With this premise in mind, we report on 6 cases of inflammatory skin disease in which the common denominator was a dermal and/or subcutaneous infiltrate of histiocytoid myeloid cells in patients with new-onset cutaneous eruptions and systemic symptoms. The cases were diverse clinically and microscopically, fell short of the criteria necessary for a diagnosis of classical Sweet's syndrome, and were difficult to categorize at the outset. The systemic manifestations ranged from malaise alone to a combination of fever, chills, night sweats, and polyarthralgia. The clinical morphology of the cutaneous eruptions varied from being papulovesicular in 1 patient to mainly consisting of erythematous plaques and nodules in the remainder. The dermatologists' differential diagnoses included Sweet's syndrome in 3 cases, a drug eruption in 2, and other entities such as erythema nodosum and Well's syndrome. Biopsies in all cases revealed a dermal and/or subcutaneous infiltrate composed predominantly of mononuclear histiocytoid cells of myeloid origin. With the benefit of detailed clinicopathologic correlation, the cases were classified for the purpose of this report as follows: Sweet's-like neutrophilic dermatosis, histiocytoid (3 cases); subcutaneous Sweet's syndrome, histiocytoid (2 cases); histiocytoid neutrophilic dermatosis, unspecified (1 case). In addition, we describe a further instructive case that exhibited overlap with those in the series but proved ultimately to represent leukemia cutis. The spectrum of observations in this report supports and expands the original concept of histiocytoid Sweet's syndrome.
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PMID:Histiocytoid neutrophilic dermatoses and panniculitides: variations on a theme. 1803 66

A 51-year-old man presented with painless left testicular swelling for 1 month, with fevers, chills, night sweats, weight loss, and increased difficulty voiding over 6 months. He underwent radical orchiectomy; surgical pathology revealed granulomas containing acid-fast bacilli in the testis and epididymis. Male genital tuberculosis was diagnosed using nucleic acid amplification on urine and confirmed by positive urine and sputum cultures for Mycobacterium tuberculosis. Genital disease is an unusual extrapulmonary manifestation of tuberculosis, often seen in middle-aged men with renal or pulmonary tuberculosis. Clinical findings are variable, but commonly include dysuria with sterile pyuria or a painless testicular mass. Initial diagnosis is often incidentally made on pathological specimens and confirmed with nucleic acid amplification and cultures. Treatment using a standard four-drug regimen is usually sufficient; surgery is rarely required. This case is used to raise awareness of, and formulate a minimally invasive diagnostic approach to, this unusual but important entity.
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PMID:Male genital tuberculosis. 1847 78

An 88-year-old Caucasian man of Italian ancestry came into our clinic with multiple, painful purple-red "growths" on his left foot that he'd had for several years. The patient had no systemic complaints (no fever, chills, weight loss, night sweats). He had a history of hypertension, a cardiac valve replacement, and chronic back pain (secondary to a motor vehicle accident). He was taking warfarin and nadolol. The patient had multiple, 0.1- to 0.5-cm purple-red papules and nodules on the dorsal and plantar surfaces of the left foot, with associated moderate lower extremity edema and mottled dyspigmentation. We did a punch biopsy, which showed a nodular neoplasm composed of moderately plump, spindle-shaped cells in short interweaving fascicles and numerous extravasated erythrocytes in the spaces ("vascular slits") between the spindle-shaped cells. What is your diagnosis, and how would you manage this condition?
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PMID:Purple-red papules on foot. 1854 22

A 40-year-old woman from Ecuador diagnosed with a complex congenital heart disease was admitted complaining of fever chills, night sweats, and productive cough 6 months after surgical correction of the anomalies. An echocardiography showed vegetations located on the interatrial pericardium patch. To the best of our knowledge, this is the first reported case of postoperative infective endocarditis on this location.
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PMID:Infective endocarditis of unusual location following surgical correction of a complex congenital heart disease. 1935 77

Primary skeletal muscle ALCL is very rare. Here the authors report a case of skeletal muscle ALCL that was proven pathologically. A 14-year-old boy presented with a persistent fever, chills, night sweats, headache, and significant weight loss. A CT scan of the abdomen showed a hazy mass about 3.2 x 1.2 cm in his left sacrospinalis. Ultrasonography revealed a low-echo and irregular mass in the left lumbar muscle measuring 8 x 1.4 x 3.6 cm in size and a similar mass 8 x 3.5 x 3.7 cm in size in the femoral muscle of the left thigh. MRI demonstrated an abnormal mass signal 4 x 3 x 9 cm in size infiltrating the left sacrospinalis muscle. The biopsy specimen was taken from the femoral muscle of the left thigh at surgery. Histopathological examination revealed a diffuse infiltration of large and atypical cells with pleomorphic nuclei and abundant cytoplasm. Immunohistological staining showed these atypical cells were positive for CD30 (Ki-l), anaplastic lymphoma kinase (ALK), epithelial membrane antigen (EMA), CD3, CD45RO, and CD68. The morphology and immunophenotype were consistent with CD30-positive, ALK-positive, and ALCL of T-cell lineage. The patient's condition was diagnosed as CD30-positive primary skeletal muscle ALCL.
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PMID:Anaplastic large cell lymphoma with primary involvement of skeletal muscle: a rare case report and review of the literature. 1938 36


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