Patient with clinical and laboratory picture compatible with acute infectious mononucleosis with Epstein-Barr Virus (EBV). Although he still feels weak, his condition is slowly improving. There is a gradual disappearance of the fever episodes and rash, in parallel with gradual normalization of the liver enzymes results, and disappearance of atypical lymphocytes. The reactivation of Herpes labialis can be explained by the stress involved in the EBV infection or the Cortisone treatment.
60-year-old patient was diagnosed with Still's disease. He was treated with high doses of corticosteroids (methylprednisolone, 110 mg daily). The dose was gradually lowered to 4 mg daily. In the last 2 years he had two exacerbations of the disease which were successfully treated by the increased dose of methylprednisolone. The expert recommends different complementary treatments that can be helpful to reduce pain , other symptoms and inflammation, reduce the dose of the drugs needed to control the disease, and improve quality of life.
50-year-old male was diagnosed with Juvenile arthritis with systemic onset (Stills disease) after having symptoms of high fever, rashes and pain. He was treated with high doses of corticosteroids, but had two exacerbations in the last 2 years. In the current time he suffers of swelling of knee joints and hand joints, and occasionally a feeling of burning feet or cold feet. In the expert's opinion, the clinical description fit well with the diagnosis of adult onset systemic arthritis which manifestations are similar to the juvenile systemic arthritis.
21-year-old female with an acute onset of a unilateral sixth cranial nerve deficit. Brain MRI showed at least a dozen white matter lesions, one of them contrast-enhancing. Sensory evoked potentials showed a bilateral increase in latency. Multiple sclerosis was diagnosed, and the patient was treated by corticosteroids, followed by improvement of symptoms. The first follow-up revealed no focal neurological signs with a history of a transitory unilateral lower limb hyposthenia. On the second visit, a horizonto-rotatory nystagmus and irregular paraesthesia in the right toes are documented.
16-year-old boy started to cough without any preceding febrile illness. With the persistent of the cough and the diagnostic procedure he was diagnosed as suffering from BOOP and corticosteroid was initiated. In the expert's opinion the diagnosis is post infectious hyperactive airway disease.
86-year-old female presented to the clinic due to rapid growing T-formation on the mandible body in the frontal section, covering the body supra- and sub-mandibular, and was referred to a surgical biopsy procedure. Soft tissue was removed surgically by cutting out, and this Tumor over growth of gingiva and mandible bone was diagnosed as Giant Cell Tumor of Soft tissues.
74-year-old male suffers from pancytopenia and symptomatic anemia. Bone marrow aspiration revealed some myelodysplasia, and the patient started immune therapy. He continues to require repeated blood transfusions. The expert recommends to complete the diagnostic workup. If no other disease is diagnosed than it can be assumed that the patient carries the diagnosis of MDS hypoplastic type.
15 years old patient presented with clinical syndrome of fever, fatigue, and diarrhea. Laboratory findings showed severe anemia with findings of microangiopathic hemolysis (schistocytes, hyperbilirubinemia, elevated LDH) and severe thrombocytopenia. He was later documented to have fluctuating ADAMTS13 activity that appeared to correlate with the hematologic abnormalities. He also had urinary findings of hematuria, moderate proteinuria, and creatinine as high as 1.4 mg/dL.
21 years old female who provided us medical report of her endocrinological examination with diagnosis of “Basedow’s Hyperthyroidism in autoimmune non-nodular thyroid (Hashimoto’s thyroiditis). Under therapy with Tapazole at the dosage of 2 tablets daily with FT3 and FT4 values within normal limits and TSH=0.00” . In the light of such values and of the clinical picture, the specialist confirmed the current therapy with Tapazole (2 tablets daily) suggesting therapeutic dosage of 131 Iodine after examination at nuclear medicine department.
A 58 year-old woman who first presented for evaluation of a bleeding pigmented lesion on the back. An excisional biopsy was performed and revealed a nodular melanoma. A wide excision was performed and no residual melanoma was identified. After a sentinel lymph node biopsy found to be positive, a completion of node dissection was performed and on pathological evaluation, total 6 of 17 lymph nodes contained melanoma.
Staging studies included whole body PET/CT scan and a head CT. FDG uptake by PET was noted in the left axilla only, with no evidence of more distant metastatic disease.
A 58 years old male. 4 years ago the patient was hospitalized due to acute thrombosis of the right femoral-iliac axis. The patient was treated succesfully with locoregional intra-arterial fibrinolytic therapy. A follow-up arteriography, revealed sub-occlusion of the common iliac, occlusion of the right superficial femoral artery in Hunter’s canal. PTA + stent of the iliac was carried out with excellent final angiographic result.
