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https://www.readbyqxmd.com/read/28333858/immune-reconstitution-inflammatory-syndrome-causing-progressive-optic-nerve-edema-in-cryptococcal-meningitis
#1
Astrid C Werner, Laurel N Vuong, Thomas R Hedges, Caroline R Baumal
PURPOSE: To report an human immunodeficiency virus-positive patient undergoing therapy for cryptococcal meningitis who developed progressive optic disc edema that was steroid responsive. METHODS: Observational case report. RESULTS: One month after commencing antifungal treatment for cryptococcal meningitis, the patient developed bilateral, progressive, recurrent optic disc edema with subretinal fluid that coincided with initiation of highly active antiretroviral therapy and recovery of CD4 cell counts...
March 22, 2017: Retinal Cases & Brief Reports
https://www.readbyqxmd.com/read/28321515/isolated-optic-neuritis-associated-with-mycoplasma-pneumoniae-infection-report-of-two-cases-and-literature-review
#2
Seo-Young Choi, You-Jin Choi, Jae-Hwan Choi, Kwang-Dong Choi
Mycoplasma pneumonia is a major pathogen of primary atypical pneumonia and has been known to cause various kinds of extrapulmonary manifestations involving almost all organs of the human body. Optic neuritis associated with M. pneumoniae infection has rarely been described and mostly, it combined other neurological complications including meningitis, meningoencephalitis, myelitis, and peripheral neuropathy. We report two patients who presented with isolated optic neuritis due to M. pneumoniae infection, and reviewed the literatures on five additional patients...
March 20, 2017: Neurological Sciences
https://www.readbyqxmd.com/read/28286682/rheumatoid-meningitis-occurring-during-etanercept-treatment
#3
Koji Tsuzaki, Takashi Nakamura, Hiroyuki Okumura, Naoko Tachibana, Toshiaki Hamano
We report a 65-year-old man who had repetitive seizures 6 months after receiving etanercept, methotrexate, and prednisolone for rheumatoid arthritis. Mononuclear cells were mildly increased in the cerebrospinal fluid (CSF). Brain magnetic resonance imaging (MRI) showed high intensity along sulci of the frontal and parietal lobes. Brain biopsy revealed lymphocyte and plasma cell infiltration in the meninges, confirming the diagnosis of rheumatoid meningitis. After steroid pulse therapy, seizures resolved and clinical findings improved...
2017: Case Reports in Neurological Medicine
https://www.readbyqxmd.com/read/28284351/is-musk-myasthenia-gravis-linked-to-igg4-related-disease
#4
Pooja Raibagkar, Judith A Ferry, John H Stone
Immunoglobulin (Ig) G4-related disease (IgG4-RD) is an immune-mediated inflammatory condition that affects a wide variety of sites, including the nervous system, where it can involve the meninges or the pituitary gland, and cause perineural mass lesions. A large subset of acetylcholine receptor antibody (Ab)-negative myasthenia gravis (MG) patients has muscle-specific tyrosine kinase (MuSK) Abs, generally of the IgG4 subclass. There has not been any association found between IgG4-RD and MuSK MG yet. We report the first case of MuSK MG associated with lymphadenopathy with histopathology consistent with IgG4-RD...
April 15, 2017: Journal of Neuroimmunology
https://www.readbyqxmd.com/read/28260120/long-term-outcomes-of-refractory-neurosarcoidosis-treated-with-infliximab
#5
Fleur Cohen Aubart, Diane Bouvry, Damien Galanaud, Caroline Dehais, Guillaume Mathey, Dimitri Psimaras, Julien Haroche, Corinne Pottier, Miguel Hie, Alexis Mathian, Hervé Devilliers, Hilario Nunes, Dominique Valeyre, Zahir Amoura
Central nervous system localizations of sarcoidosis may be refractory to conventional treatment such as steroids and immunosuppressive drugs. Infliximab, a TNF-α antagonist chimeric antibody, has been shown to be effective for treatment of these localizations. The aim of this study was to evaluate the efficacy and safety, in particular the long-term outcomes, of the use of infliximab for the treatment of neurosarcoidosis. We retrospectively reviewed medical records of patients with neurosarcoidosis who had been treated with infliximab between 2009 and 2015...
March 4, 2017: Journal of Neurology
https://www.readbyqxmd.com/read/28220322/serious-fungal-infections-in-the-philippines
#6
M C R Batac, D Denning
The Philippines is a low middle-income, tropical country in Southeast Asia. Infectious diseases remain the main causes of morbidity, including tuberculosis. AIDS/HIV prevalence is still low at <1%, but is rapidly increasing. Fungal disease surveillance has not been done, and its burden has never been estimated. This becomes more important as the population of immunocompromised patients increases, drawn from patients with AIDS, TB, malignancies, and autoimmune diseases requiring chronic steroid use. Using the methodology of the LIFE program ( www...
February 21, 2017: European Journal of Clinical Microbiology & Infectious Diseases
https://www.readbyqxmd.com/read/28184274/cerebrospinal-fluid-infection-after-lumbar-nerve-root-steroid-injection-a-case-report
#7
Kwan-Sub Kim, Young-Ki Kim, Seong-Su Kim, Sung Min Shim, Hae Jun Cho
A 45-year-old woman was admitted due to severe headache and neck stiffness. She had visited a local clinic for back pain and received a lumbar nerve root steroid injection 10 days before admission. Computed tomography and magnetic resonance imaging showed psoas abscess, pneumocephalus, and subdural hygroma. She was diagnosed with psoas abscess and meningitis. The abscess and external ventricle were drained, and antibiotics were administered. Unfortunately, the patient died on hospital day 19 due to diffuse leptomeningitis...
February 2017: Korean Journal of Anesthesiology
https://www.readbyqxmd.com/read/28120349/glial-fibrillary-acidic-protein-immunoglobulin-g-as-biomarker-of-autoimmune-astrocytopathy-analysis-of-102-patients
#8
Eoin P Flanagan, Shannon R Hinson, Vanda A Lennon, Boyan Fang, Allen J Aksamit, P Pearse Morris, Eati Basal, Josephe A Honorat, Nora B Alfugham, Jenny J Linnoila, Brian G Weinshenker, Sean J Pittock, Andrew McKeon
OBJECTIVE: A novel autoimmune central nervous system (CNS) disorder with glial fibrillary acidic protein (GFAP)-IgG as biomarker was recently characterized. Here, 102 patients with GFAP-IgG positivity are described. METHODS: The 102 included patients had: (1) serum, cerebrospinal fluid (CSF), or both that yielded a characteristic astrocytic pattern of mouse tissue immunostaining; (2) confirmation of IgG reactive with specific GFAP isoforms (α, ɛ, or κ) by cell-based assays; and (3) clinical data available...
February 2017: Annals of Neurology
https://www.readbyqxmd.com/read/28114998/th17-skewed-immune-response-and-cluster-of-differentiation-40-ligand-expression-in-canine-steroid-responsive-meningitis-arteritis-a-large-animal-model-for-neutrophilic-meningitis
#9
Jessica Freundt-Revilla, Arianna Maiolini, Regina Carlson, Martin Beyerbach, Kai Rentmeister, Thomas Flegel, Andrea Fischer, Andrea Tipold
BACKGROUND: Steroid-responsive meningitis-arteritis (SRMA) is an immune-mediated disorder characterized by neutrophilic pleocytosis and an arteritis particularly in the cervical leptomeninges. Previous studies of the disease have shown increased levels of IL-6 and TGF-ß1 in cerebrospinal fluid (CSF). In the presence of these cytokines, naive CD4+ cells differentiate into Th17 lymphocytes which synthesize interleukin 17 (IL-17). It has been shown that IL-17 plays an active role in autoimmune diseases, it induces and mediates inflammatory responses and has an important role in recruitment of neutrophils...
January 23, 2017: Journal of Neuroinflammation
https://www.readbyqxmd.com/read/28108140/steroid-treatment-in-ocular-tuberculosis-a-double-edged-sword
#10
S Souissi, T David, L Beral
INTRODUCTION: We report the case of a Caribbean patient with an atypical presentation of bilateral tuberculous chorioretinopathy. PATIENT AND METHODS: A 57-year-old woman, with hypertension and non-insulin dependent diabetes, was referred to our center for a sudden loss of vision in the right eye to hand motions. Ophthalmic examination revealed only right papilledema. Brain magnetic resonance imaging was normal. Laboratory examination revealed no signs of inflammation...
February 2017: Journal Français D'ophtalmologie
https://www.readbyqxmd.com/read/28064139/neurological-adverse-events-associated-with-immune-checkpoint-inhibitors-review-of-the-literature
#11
REVIEW
S Cuzzubbo, F Javeri, M Tissier, A Roumi, C Barlog, J Doridam, C Lebbe, C Belin, R Ursu, A F Carpentier
Immune checkpoint inhibitors (ICIs) targeting CTLA4 and PD1 constitute a promising class of cancer treatment but are associated with several immune-related disorders. We here review the literature reporting neurological adverse events (nAEs) associated with ICIs. A systematic search of literature, up to February 2016, mentioning nAEs in patients treated with ICIs was conducted. Eligible studies included case reports and prospective trials. One case seen in our ward was also added. Within the 59 clinical trials (totalling 9208 patients) analysed, the overall incidence of nAEs was 3...
March 2017: European Journal of Cancer
https://www.readbyqxmd.com/read/28053850/disseminated-coccidioidomycosis-presenting-with-intramedullary-spinal-cord-abscesses-management-challenges
#12
Kristina L Bajema, Mark F Dalesandro, David N Fredricks, Meena Ramchandani
Coccidioides species are endemic to the southwestern United States and typically cause a mild or asymptomatic primary infection. In some instances, infection can disseminate and involve the central nervous system with meningitis being the most common manifestation. Non-osseous spinal cord involvement is exceedingly rare. We report a case of disseminated coccidioidomycosis in an otherwise healthy 20 year old man with diffuse leptomeningeal enhancement, cerebrospinal fluid findings suggestive of meningitis, and intramedullary spinal cord abscesses...
March 2017: Medical Mycology Case Reports
https://www.readbyqxmd.com/read/28052943/corticosteroid-induced-cryptococcal-meningitis-in-patient-without-hiv
#13
Anand Nidhi, Alpana Meena, Arjun Sreekumar, Mradul Kumar Daga
Cryptococcus neoformans is the most frequent cause of fungal meningitis in humans. Cryptococcus affects people of all ages and has a worldwide distribution. It is the fourth most common infection in AIDS (CD4 counts <100/mm(3)). Cases also occur in patients with other forms of immunosuppression and in apparently immunocompetent individuals. Chronic high-dose steroid may precipitate such an immunocompromised state and thus create susceptibility to fungal infections. In our case, we describe a 14-year-old boy who was on steroids for tubercular meningitis for a period of 8 weeks after which he developed cryptococcal meningitis...
January 4, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/27913223/hepatitis-e-virus-infection-beyond-the-liver
#14
REVIEW
Sven Pischke, Johannes Hartl, Suzan D Pas, Ansgar W Lohse, Bart C Jacobs, Annemiek A Van der Eijk
Hepatitis E virus (HEV) infections are not limited to the liver but may also affect other organs. Several diseases, including Guillain-Barré syndrome, neuralgic amyotrophy, glomerulonephritis, cryoglobulinemia, pancreatitis, lymphoma, thrombopenia, meningitis, thyroiditis and myocarditis have been observed in the context of hepatitis E. To date, the definite pathophysiological links between HEV and extrahepatic manifestations are not yet established. However, it is suggested that HEV infection might be causative based on serological studies, case series, in vitro data and animal models...
November 29, 2016: Journal of Hepatology
https://www.readbyqxmd.com/read/27878586/-parainfectious-optic-neuritis-with-macular-infiltrate-in-neisseria-meningitidis-b-meningitis
#15
A Chronopoulos, F Hoogewoud, H Steffen, G Thumann
OBJECTIVE: We report on the case of a young immunocompetent female patient with parainfectious optic neuritis and macular inflitrate due to Neisseria meningitidis B meningitis. METHOD: Case report RESULTS: A 22-year-old female patient was admitted to the emergency department for intensive care treatment with a strong suspicion of meningitis. Clinical and serological parameters were indicative of a bacterial genesis of the meningitis. By analysis of the cerebrospinal fluid (CSF) Neisseria meningitidis type B could be detected...
November 23, 2016: Der Ophthalmologe: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft
https://www.readbyqxmd.com/read/27857783/hyponatremia-in-children-with-tuberculous-meningitis-a-hospital-based-cohort-study
#16
Prithi Inamdar, Sanjeevani Masavkar, Preeti Shanbag
BACKGROUND: Hyponatremia has long been recognized as a potentially serious metabolic consequence of tuberculous meningitis (TBM) occurring in 35-65% of children with the disease. The syndrome of inappropriate antidiuretic hormone (SIADH) secretion has for long been believed to be responsible for the majority of cases of hyponatremia in TBM. Cerebral salt wasting syndrome (CSWS) is being increasingly reported as a cause of hyponatremia in some of these children. AIM: This study was done to determine the frequency and causes of hyponatremia in children with TBM...
July 2016: Journal of Pediatric Neurosciences
https://www.readbyqxmd.com/read/27856137/therapeutic-hypothermia-and-inhalation-anesthesia-in-a-patient-with-severe-pneumococcal-meningitis-and-secondary-cardiac-arrest
#17
Nejc Bukovnik, Andrej Markota, Tomaž Velnar, Janez Rebol, Andreja Sinkovič
Therapeutic hypothermia was associated with increased mortality in patients with severe bacterial meningitis in a large randomized trial. It still remains a treatment strategy for comatose survivors of cardiac arrest. There are several potential advantages of inhalational anesthetics as long-term sedation agents compared to intravenous sedation, however, uncontrollable increases of intracranial pressure were observed in neurocritical patients. Here we present a patient with severe bacterial meningitis and secondary cardiac arrest where therapeutic hypothermia and inhalational anesthesia were successfully used...
November 2, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27819416/neurological-manifestations-of-acute-posterior-multifocal-placoid-pigment-epitheliopathy
#18
Hussein Algahtani, Ashjan Alkhotani, Bader Shirah
BACKGROUND AND PURPOSE: Acute posterior multifocal placoid pigment epitheliopathy (APMPPE) is an immune-mediated chorioretinal disease that causes acute visual symptoms with characteristic ophthalmoscopic findings. Neurological complications are rarely reported in the literature. Here we report two new cases of APMPPE that presented with neurological manifestations, one of which was associated with peripheral neuropathy, which has not been described before. METHODS: A retrospective database review of all patients with a diagnosis of APMPPE was performed...
October 2016: Journal of Clinical Neurology
https://www.readbyqxmd.com/read/27818191/corticosteroids-for-the-management-of-severe-intracranial-hypertension-in-meningoencephalitis-caused-by-cryptococcus-gattii-a-case-report-and-review
#19
R-A Maciel, L-S Ferreira, F Wirth, P-D Rosa, M Aves, E Turra, L-Z Goldani
Immune reconstitution inflammatory syndrome in meningitis caused by Cryptococcus gattii in immunocompetent patients after initiation of antifungal therapy appears to be the result of paradoxical antifungal treatment-induced clinical deterioration due to improved local immune responses to cryptococcal organisms. Recent anecdotal reports have suggested a favorable clinical response to corticosteroids in select patients with C. gattii central nervous system (CNS) infections. In this report, we describe a 65-year-old patient with meningoencephalitis caused by C...
November 3, 2016: Journal de Mycologie Médicale
https://www.readbyqxmd.com/read/27807490/a-case-of-tuberculous-meningitis-with-paradoxical-response-in-a-14-year-old-boy
#20
Murat Özer, Yasemin Özsürekci, Ali Bülent Cengiz, Nagehan Emiralioğlu, Deniz Doğru, Kader Karlı Oğuz, Onur Akça, Özgür Özkayar
A clinical or radiological worsening of already existing lesions or an emergence of new lesions after beginning treatment in patients with tuberculosis (TB) is referred to as the paradoxical response. This has aroused suspicion regarding the accuracy of diagnosis, the possibilities of treatment failure, or the presence of another underlying disease, and thus it is an important topic for clinicians to understand. In this article, the development of a paradox reaction in a 14-year-old male patient diagnosed with and treated for tuberculosis meningitis is reported...
2016: Case Reports in Infectious Diseases
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