Klavsenpontoppidan8629

Antiphospholipid syndrome (APS) is an autoimmune systemic disorder characterized by arterial, venous, or small vessel thrombosis, and/or recurrent early pregnancy loss, fetal loss, or pregnancy morbidity. APS is induced by persistent positive antiphospholipid antibodies (aPL), the main being lupus anticoagulant (LA), and/or anticardiolipin (aCL) antibodies, and/or anti-beta 2 glycoprotein 1 (β2-GP1) antibodies. Some studies have shown that the incidence of APS is about 5 new cases per 100,000 persons per year, and the prevalence is around 40-50 cases per 100,000 persons. APS can be primary or secondary. Secondary APS often coexists with another autoimmune disorder, most commonly systemic lupus erythematosus (SLE). Behcet's disease (BD) is usually characterized by recurrent oral and genital aphthous ulcers and ocular involvement. It can occasionally affect the venous system. BD usually affects small vessels, but can sometimes affect large veins or even a variety of veins. Because most of APS is secondary to SLE, APS secondary to incomplete BD is quite rare. This report describes a case in which a 15-year-old male experienced bilateral leg swelling and pain. The patient had a long history of self-healing recurrent mouth ulcers. selleck chemicals Laboratory tests revealed positive β2-GP1 immunoglobulin A (IgA). His symptoms improved by using steroids, prednisolone, uro-kinase, and hirudin. In this rare case of secondary APS, the patient was diagnosed with anti-β2-GP-1 IgA positive to incomplete BD. It is a rare case of secondary APS with positive anti-β2-GP1 IgA to incomplete BD. It is suggested that patients with recurrent mouth ulcers should be closely examined to prevent thrombosis, and more laboratory markers should be used to avoid a risk of misdiagnosing patients with APS.Lung cancer can be divided into small cell lung cancer and non-small cell lung cancer (NSCLC). NSCLC can be further divided into squamous cell carcinoma, adenocarcinoma, and large-cell neuroendocrine carcinoma (LCNEC). At present, our understanding of LCNEC is limited. LCNEC is a rare condition but is highly malignant with a poor prognosis. The mean age of onset was about 65 years old, and was highly correlated with smoking. Although many treatment methods, including surgery, radiotherapy, and chemotherapy, are available, the therapeutic effect was limited and there is still a lack of clear guidelines and recommendations for its therapy. At present, immunotherapy is rapidly developing, and its application in lung cancer is increasing. However, there is limited literature about immunotherapy in LCNEC. Here, we present a case of LCNEC at stage IIIA, which involved a 64-year-old man with a 30-year history of smoking. Enhanced chest radiography indicated a malignant tumor in the upper lobe of the left lung. We treated this patient with neoadjuvant chemo-immunotherapy with albumin paclitaxel, carboplatin, and sintilimab. We also performed postoperative chemo-immunotherapy the same as before surgery. The patient has well tolerated this treatment and remains under postoperative observation for 6 months at the time of writing.Steroid myopathy (SM) is a side effect of glucocorticoid administration. Previous reports of SM after glucocorticoid therapy for respiratory diseases have focused on asthma and chronic obstructive pulmonary disease in adults or adolescents. To our knowledge, there have been no reports of SM after treatment with glucocorticoid for diffuse alveolar hemorrhage (DAH) in preschoolers. We present a 4-year-old girl with DAH requiring the treatment with methylprednisolone, who was transferred to the pediatric intensive care unit (PICU) due to respiratory failure caused by severe pneumonia requiring mechanical ventilation. When transferred to respiratory department, the strength of the limbs of the patient decreased, and her lower limbs were paralyzed. We performed relevant examination to rule out juvenile dermatomyositis and other diseases such as deep venous thrombosis of lower limbs, Guillain-Barre syndrome that may cause the decline of muscle strength. SM was considered based on the clinical characteristics and risk factors of the child, so glucocorticoid treatment was tapered following the treatment regimen for DAH and SM. The muscle strength of the child completely recovered, which further confirmed our diagnosis of SM. In pediatrics, SM should also be a concern when patients with respiratory disease experience decreased muscle strength following glucocorticoid therapy.Leptomeningeal metastasis (LM) is associated with poor prognosis and represents a terminal event of non-small cell lung cancers (NSCLC). In previous studies, most of LM-patients have detected epidermal growth factor receptor (EGFR) mutation and responded to the third generation of EGFR-tyrosine kinase inhibitor (TKI). This study aimed to report a case of ERBB2 (HER2) exon 20 insertion mutations in the cerebrospinal fluid (CSF) of LM-patient which response to poziotinib. At the beginning, postoperative pathology showed a primary invasive adenocarcinoma with no mutations in EGFR and ROS-1. Pemetrexed plus carboplatin combined with bevacizumab was administered as the first-line followed by bevacizumab alone for continuation maintenance therapy. Targeted therapy and immunotherapy were given after the disease progressed in two months. Subsequently, the patient developed mental symptoms and adenocarcinoma cells were found in the CSF. Next-generation sequencing (NGS) results showed HER2 exon 20 insertion mutations in the primary tissue, CSF and plasma samples. Then, poziotinib was administered and the symptoms improved significantly after 3 days and the progress free survival was nearly 2 months. Therefore, we speculate that the CSF concentration and penetration rate of poziotinib may significantly higher than of other TKIs so that it achieves a higher CSF concentration than standard dosing, and successfully controlled LM. It may provide a new therapeutic option for LM-patient and may be especially who are lung adenocarcinoma with HER2 exon 20 insertion.We report a case of retroperitoneal emphysema caused by a renal abscess. A 45-year-old man with underlying type 2 diabetes mellitus visited the emergency department with right flank pain and a fever. On physical examination, right costovertebral tenderness in the ipsilateral flank was noted. Leukocytosis and high inflammatory marker levels were observed. Urinalysis showed pyuria and glucosuria. Urine culture was positive for Streptococcus agalactiae. A computed tomography scan of the abdomen showed a focal, lowattenuation lesion in the right kidney with a 3 cm, exophytic, high-attenuation lesion in the right kidney upper pole and gas-containing fluid collection within the retroperitoneal space. The diagnosis was retroperitoneal emphysema caused by a renal abscess. As the vital signs were stable and the patient refused puncture, we decided on a course of antibiotics alone with follow-up without percutaneous drainage or surgery. The patient improved without any complications. This is a rare case of a renal abscess penetrating the renal fascia and progressing to a posterior paranephric emphysema.