Cerebral Amyloid Angiopathy-Related Inflammation in the Immunosuppressed: A Case Report

We present a case of CAA-ri in a subject already on immunosuppressive therapy after orthotopic heart transplantation (OHT). A 57-year-old man 8 months post-OHT for sarcoid cardiomyopathy developed headaches and staring spells while hospitalized for disseminated mycobacterial infection. His brain MRI revealed bi-hemispheric T2-weighted fluid-attenuated inversion recovery white matter hyperintensities and widespread microhemorrhages. Two weeks later, he developed gait ataxia and alterations in mental status, and repeat brain MRI showed more extensive confluent white matter hyperintensities. Leptomeningeal and cortex biopsy revealed changes consistent with amyloid angiitis, with perivascular and intramural histiocyte and lymphocyte collections. Mass spectroscopy confirmed Aβ deposition. Notably, the patient was on immunosuppression with daily 5 mg oral prednisone and tacrolimus before biopsy. After high-dose intravenous followed by oral corticosteroids, he demonstrated significant clinical and radiographic improvement. No relapse was noted despite the relatively rapid tapering of the prednisone therapy over 3 months, as mandated by his systemic infection. Despite the lack of a standard treatment protocol for CAA-ri, case series have reinforced the benefit of prolonged courses of glucocorticoids as single agent or in combination with other immunomodulatory agents. Hence, management of CAA-ri in patients with disseminated mycobacterial infections or OHT is challenging. Our ca...
Source: Frontiers in Neurology - Category: Neurology Source Type: research

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The objective of this study was to enhance the quantitative understanding of DMD disease progression through nonlinear mixed effects modeling of the population mean and variability of the 6-min walk test (6MWT) clinical endpoint. An indirect response model with a latent process was fit to digitized literature data using full Bayesian estimation. The modeling data set consisted of 22 healthy controls and 218 DMD patients from one interventional and four observational trials. The model reasonably described the central tendency and population variability of the 6MWT in healthy subjects and DMD patients. An exploratory categor...
Source: Journal of Pharmacokinetics and Pharmacodynamics - Category: Drugs & Pharmacology Source Type: research
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Source: The American Journal of Surgery - Category: Surgery Source Type: research
ConclusionThe acetabular reconstruction with the Cup-Cage system is a valid alternative for the reconstruction of massive acetabular defects (Paprosky type IIIA and IIIB) and pelvic discontinuities offering good results at short and midterm follow-up.ResumenIntroducciónLa reconstrucción acetabular con defectos óseos masivos y discontinuidades pélvicas es un procedimiento quirúrgico complejo que presenta importantes dificultades para el cirujano ortopédico. El objetivo de este estudio es presentar los resultados a corto y medio plazo de la revisión acetabular con el sistema d...
Source: Revista Espanola de Cirugia Ortopedica y Traumatologia - Category: Orthopaedics Source Type: research
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Source: Revista Espanola de Cirugia Ortopedica y Traumatologia - Category: Orthopaedics Source Type: research
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Source: Revista Espanola de Cirugia Ortopedica y Traumatologia - Category: Orthopaedics Source Type: research
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Source: Gynecologic Oncology Reports - Category: OBGYN Source Type: research
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Source: Specified Life - Category: Information Technology Tags: index jules berman jules j berman precision medicine Source Type: blogs
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