Concurrent treatment with rituximab and plasma exchange for severe refractory granulomatosis with polyangiitis: A case report

Rationale: Rituximab is recommended to induce remission of severe granulomatosis with polyangiitis (GPA). Plasma exchange (PE) may be considered in the setting of rapidly progressive glomerulonephritis (RPGN) with a serum creatinine increase of more than 5.6 mg/dl or diffuse alveolar hemorrhage (DAH). However, there are no sufficient studies on combination therapy with rituximab and PE in GPA. Patient concerns: A 23-year-old woman was admitted with fever, abdominal pain, and diarrhea on suspicion of infectious colitis. Colonoscopy showed hemorrhagic colitis and antibiotic treatment was ineffective. Physical examination revealed episcleritis and skin lesions similar to Janeway lesions or Osler nodes on her palms and soles. Transesophageal echocardiogram (TEE) revealed mitral valve vegetation mimicking infective endocarditis. However, no pathogen was grown in the blood culture. Ten days after admission, blood-tinged sputum and respiratory distress developed. Imaging studies of lung, bronchoscopy, and bronchoalveolar lavage indicated DAH. Moreover, serum creatinine levels rapidly increased from 0.8 mg/dl to 6.1 mg/dl with proteinuria. Diagnosis: The patient was diagnosed with GPA and non-infectious endocarditis, DAH, and RPGN, based on a biopsy which revealed pauci-immune crescentic glomerulonephritis with granuloma and leukocytoclastic vasculitis and antineutrophil cytoplasmic antibodies against proteinase 3- positivity. Interventions: Initial methylprednisolon...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

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ABSTRACT Objectiv:e to analyze the relationship of anxiety and depression in the preoperative period with the presence of pain in the postoperative period. Method: cohort study conducted at a university hospital in the state of Minas Gerais (Brazil), between february and July 2017, with 65 patients. A collection instrument was elaborated for the demographic and clinical characteristics. The Hospital Anxiety and Depression Scale was used to assess anxiety and depression; pain intensity was measured using the Verbal Numerical Scale. Data were submitted to descriptive and inferential statistical analysis. Results: according t...
Source: Texto e Contexto - Enfermagem - Category: International Medicine & Public Health Source Type: research
OBJECTIVES: Unlike many investigations that focus on suicide ideation rather than suicidal behavior, the present research evaluates the merit and relative efficacy of psychache (i.e., unbearable mental pain) for predicting self-reported suicide attempts am...
Source: SafetyLit - Category: International Medicine & Public Health Tags: Age: Adolescents Source Type: news
Kratom or Mitragna speciosa is a tropical tree that is indigenous to Southeast Asia, where it has been used for various medicinal reasons. In the West, it is used in the self-treatment of opioid withdrawal, pain, and a variety of mood and anxiety states. T...
Source: SafetyLit - Category: International Medicine & Public Health Tags: Alcohol and Other Drugs Source Type: news
PURPOSE: Opioids are commonly prescribed for acute pain after surgery. However, it is unclear whether these prescriptions are usually modified to account for patient age and, in particular, opioid-related risks among older adults. We therefore sought to de...
Source: SafetyLit - Category: International Medicine & Public Health Tags: Alcohol and Other Drugs Source Type: news
Alright guys so I'll be starting fellowship this year - some practices say they pay "training stipend" but don't want someone who can't start in the next 6months - how does that add up? Who would pay a training stipend then - a training stipend means a stipend during training, which means that the person is in training for the year. Someone explain this to me please.
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Pain Medicine Source Type: forums
Condition:   Pain, Acute Interventions:   Drug: cannabidiol;   Drug: placebo;   Drug: acetaminophen 500mg and ibuprofen 200mg combo Sponsor:   University of Tennessee Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Conditions:   Spinal Cord Injury;   Inflammation;   Neuropathic Pain Interventions:   Other: Anti-inflammatory Diet;   Other: Placebo Diet Sponsors:   Lawson Health Research Institute;   Ontario Neurotrauma Foundation Not yet recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Condition:   Plantar Fasciitis, Chronic Intervention:   Sponsor:   Gaziosmanpasa Taksim Research and Education Hospital Recruiting
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
Conditions:   Anxiety;   Fear of Pain;   Child Behavior Intervention:   Other: Video Sponsor:   KK Women's and Children's Hospital Completed
Source: ClinicalTrials.gov - Category: Research Source Type: clinical trials
This report describes a case of hantavirus-associated acute renal failure and proteinuria. How was this case ultimately diagnosed?Emerging Infectious Diseases
Source: Medscape Today Headlines - Category: Consumer Health News Tags: Infectious Diseases Journal Article Source Type: news
More News: Bronchoscopy | Colonoscopy | Endocarditis | Glomerulonephritis | Infective Endocarditis | Internal Medicine | Laboratory Medicine | Lessons | Methylprednisolone | Pain | Prednisolone | Proteinuria | Respiratory Medicine | Rituxan | Skin | Skin Biopsy | Study | Vasculitis