The American journal of the medical sciences
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Review Case Reports
Case report: purpura in disseminated strongyloidiasis.
Purpuric lesions have been described previously in 10 patients with disseminated strongyloidiasis. We identified three additional patients in whom purpura developed as a manifestation of disseminated strongyloidiasis. Nine (69%) of the 13 patients were men, and the median age of patients was 61 years (range, 32-75 years). ⋯ Skin biopsies of purpuric lesions were obtained in 12 patients, in 10 (83%) of which larvae were found. Despite recommended treatment with thiabendazole in 12 of 13 patients, 11 (85%) of the patients died, and at least 6 died within 16 days of onset of purpura. Physicians, particularly those in the southeastern United States, should strongly consider the diagnosis of disseminated strongyloidiasis in patients receiving corticosteroids and in whom purpura and systemic toxicity develops.
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Review Case Reports
Case report: the lupus anticoagulant-hypoprothrombinemia syndrome.
The lupus anticoagulant is a well-described in vitro phenomenon that may be associated with arterial and venous thrombotic episodes. The lupus anticoagulant is never accompanied by a hemorrhagic diathesis unless it is associated with a second coagulation abnormality such as thrombocytopenia or hypoprothrombinemia. The lupus anticoagulant-hypoprothrombinemia syndrome is now a well-defined entity that may cause a severe, life-threatening hemorrhagic diathesis. ⋯ They were able to demonstrate hypoprothrombinemia and the presence of prothrombin-antiprothrombin antibody immune complexes. The patient was treated with prednisone, with correction of the bleeding disorder; however, the patient had resultant death from thrombosis. A literature review of the past 30 years as it relates to the discovery and treatment of this phenomenon is included.
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Transesophageal echocardiography has emerged recently as a powerful cardiac imaging tool. The strengths and limitations of transesophageal echocardiography are reviewed. The clinical use of transesophageal echocardiography in aortic dissection, endocarditis, mitral valve disease, prosthetic heart valves, stroke, and miscellaneous other conditions is discussed.
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Review Case Reports
Southwestern Internal Medicine Conference: Shiga-like toxins in hemolytic-uremic syndrome and thrombotic thrombocytopenic purpura.
The majority of cases of hemolytic-uremic syndrome and a smaller proportion of cases of thrombotic thrombocytopenic purpura have recently been shown to result from a toxin produced by enteric bacteria, referred to as verotoxin, or Shiga-like toxin. The predominant toxin-producing bacterial strain in North America is E. coli O157:H7, which causes hemorrhagic colitis in humans after ingestion of contaminated meat. ⋯ The toxin inactivates ribosomes inside the cells, thereby killing them and producing the clinical manifestations of hemolytic-uremic syndrome. Recognition of the etiology of hemolytic-uremic syndrome may lead to better prospects for prevention and treatment.