A diagnosis you can ’t afford to miss

4 out of 5 stars Antibody-Mediated Encephalitis. Dalmau J, Graus F. N Engl J Med 2018 Mar 1;378:840-851. Reference TPR has posted before about anti-NMDA receptor encephalitis, a must-know, can’t-miss, humbling diagnosis that is distressingly easy to overlook. Although it is not a toxicologic condition, all toxicologists and emergency physicians should be thoroughly familiar with its presentation and clinical course. Let me explain why. NMDAR encephalitis often begins with behavioral changes, mood swings, and memory deficits in relatively young patients. According to this somewhat technical but excellent review, the median age is 21 years, with a 4:1 ratio of females to males. Because of the initial symptoms, patients are often diagnosed as having new-onset psychiatric disease. It is not unusual for these patients to then be treated with antipsychotic medication in an attempt to control abnormal and agitated behavior. This is where a toxicologist may be consulted. As the authors point out in this review, patients with NMDAR encephalitis seem to have increased susceptibility to developing neuroleptic malignant syndrome (NMS) after receiving antipsychotics. When these patients then develop movement disorders, autonomic instability, and altered mental status, the toxicology service is brought in to advise about the treatment of NMS. If the diagnosis of NMDAR encephalitis is not considered, the outcome can be catastrophic. As the authors of this review note “...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical anbitody-mediated encephalitis anti-NMDA receptor encephalitis brain on fire diagnosis Source Type: news

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In this study, we aimed to evaluate the influence of insulin production on immune system after the onset of diabetes, and we showed that the duration of honeymoon period could be related to the onset of other autoimmune conditions. For this retrospective study, 159 children aged between 11 and 18 years with type 1 DM were eligible. They have been diagnosed diabetes at least 10 years ago and use exogenous insulin. Our results showed that younger age at the onset of Type 1 DM in children, predicts Celiac Disease. Female sex and low HCO3 levels at the onset of DM had a high predictive value on patients who did not experience ...
Source: International Journal of Endocrinology - Category: Endocrinology Tags: Int J Endocrinol Source Type: research
CONCLUSION: This case report demonstrates a possible severe adverse effect of the immunomodulatory drug ibrutinib and the importance of a multidisciplinary approach in its diagnosis. Since PML is a rare but highly fatal disease, it is of utmost importance to be aware of the possible connection with the use of this drug to prevent missed or delayed diagnosis, considering that timely therapeutic intervention is crucial for improved prognosis.
. PMID: 32213285 [PubMed - as supplied by publisher]
Source: International Journal of Clinical Pharmacology and Therapeutics - Category: Drugs & Pharmacology Tags: Int J Clin Pharmacol Ther Source Type: research
Publication date: Available online 27 March 2020Source: Hematology/Oncology Clinics of North AmericaAuthor(s): Tongyuan Xue, L. Elizabeth Budde
Source: Hematology Oncology Clinics of North America - Category: Hematology Source Type: research
Publication date: Available online 28 March 2020Source: Autoimmunity ReviewsAuthor(s): Maaike Biewenga, Arantza Farina Sarasqueta, Maarten E. Tushuizen, Eveline S.M. de Jonge-Muller, Bart van Hoek, Leendert A. Trouw
Source: Autoimmunity Reviews - Category: Allergy & Immunology Source Type: research
Such newer treatments may seem miraculous, but they have drawbacks that chemo, even with it’s sometimes terrible side effects, doesn’t.
Source: Washington Post: To Your Health - Category: Consumer Health News Authors: Source Type: news
Downregulated miR-203 attenuates IL-β, IL-6, and TNF-α activation in TRAF6-treated human renal mesangial and tubular epithelial cells. Int J Clin Exp Pathol. 2020;13(2):324-331 Authors: Zhang L, Zhang X Abstract Circulating microRNAs (miRNAs) are attracting major interest as novel non-invasive biomarkers for human autoimmune diseases including lupus nephritis (LN). A previous study showed that altered miR-203 expression may provide highly diagnostic for systemic lupus erythematosus. However, whether miR-203 is a diagnostic biomarker for LN is still unknown. In the present research, serum sa...
Source: International Journal of Clinical and Experimental Pathology - Category: Pathology Authors: Tags: Int J Clin Exp Pathol Source Type: research
Purpose of review Cutaneous lupus erythematosus (CLE) is a highly heterogeneous autoimmune disease. No specific Federal Drug Administration-approved therapies for CLE-alone are available, and resistance to conventional treatments is common. This review will summarize current treatment approaches and pending treatment strategies. Recent findings Research into the pathogenesis of CLE is accelerating. A skewed type I interferon production and response contribute to CLE lesions. The pathophysiology of lesions may be similar among the lesional subtypes, and patients with a more TLR9-driven disease mechanism may have more b...
Source: Current Opinion in Rheumatology - Category: Rheumatology Tags: CLINICAL THERAPEUTICS AND HEMATOLOGIC COMPLICATIONS: Edited by W. Joseph McCune Source Type: research
Purpose of review Antiphospholipid syndrome (APS), more common than once believed, is an autoimmune disease best known for its high risk of incident and recurrent thrombotic events. The approach to treatment potentially differs from treatment of thrombosis in the general population, and this article endeavors to review the latest updates on this topic. Recent findings The epidemiology of APS is being increasingly elucidated by large population-based studies, with APS perhaps affecting as many as 1 in 2000 individuals. Vitamin K antagonists, aspirin, and heparinoids continue to have obvious roles in the management of p...
Source: Current Opinion in Rheumatology - Category: Rheumatology Tags: CLINICAL THERAPEUTICS AND HEMATOLOGIC COMPLICATIONS: Edited by W. Joseph McCune Source Type: research
Purpose of review This review provides a risk-stratified and evidence-based management for subsets of systemic sclerosis (SSc) patients in the first five years from disease onset. Recent findings Cardiopulmonary disease remains the primary cause of mortality in SSc patients. Morbidity and mortality in SSc-associated pulmonary arterial hypertension have improved with combination treatment, in either an upfront or sequential treatment pattern. Traditional therapies for interstitial lung disease (SSc-ILD) have targeted those with clinically significant and progressive ILD with immunosuppression. New data suggest a possib...
Source: Current Opinion in Rheumatology - Category: Rheumatology Tags: CLINICAL THERAPEUTICS AND HEMATOLOGIC COMPLICATIONS: Edited by W. Joseph McCune Source Type: research
Purpose of review This review is to provide an update on the current understanding of rheumatoid arthritis (RA) development related to disease development prior to the onset clinically apparent synovitis (i.e. Pre-RA), and opportunities for disease prevention. Recent findings A growing number of studies have demonstrated that serum elevations of autoantibodies rheumatoid factor, antibodies to citrullinated protein/peptide antigens (ACPAs) and antibodies to other posttranslationally modified proteins (e.g. carbamylated proteins) are highly predictive of future development of inflammatory arthritis/RA during a period th...
Source: Current Opinion in Rheumatology - Category: Rheumatology Tags: RHEUMATOID ARTHRITIS: Edited by Joshua F. Baker Source Type: research
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