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Evans Syndrome As Rare Presentation in Systemic Lupus Erythematosus
International Journal of Health Sciences and Research www.ijhsr.org ISSN: 2249-9571 Case Report Evans Syndrome as Rare Presentation in Systemic Lupus Erythematosus Dr Sabarish Mahalingam1, Dr P. Z. Wadia2, Dr Priyanka Lad1 1Resident Doctor, Department of Internal Medicine, Government Medical College, Surat 2Additional Professor, Department of Internal Medicine, Government Medical College, Surat Corresponding Author: Dr Sabarish Mahalingam ABSTRACT Evans syndrome is a rare disorder in which the body’s immune system produces antibodies that mistakenly destroy red blood cells, platelets and sometimes certain white blood cell known as neutrophils. It is one of the rare presenting features of autoimmune disorders, especially systemic lupus erythematosus (SLE), and sometimes may even precede the onset of disease. Primary Evans syndrome with no cause is very rare and is seen in children. Here, we describe a case of secondary Evans syndrome with severe autoimmune hemolytic anemia leading to acute kidney injury. This is one of the rare presentations of SLE and there are only few case reports. Key word: Evans syndrome, systemic lupus erythematosus, autoimmune haemolytic anaemia. INTRODUCTION literature; [9-11] therefore, the characteristics Evans syndrome (ES), which was and outcome of adult's ES are poorly first described in 1951, is an autoimmune known. disorder characterized by the simultaneous or sequential development of autoimmune CASE REPORT hemolytic anemia (AIHA) and immune A 28 aged female came to (ITP) and/or immune neutropenia in the emergency department with the complain of absence of any underlying cause. [1,2] ES has breathlessness for past 5 days. On been since its first description considered or examination, patient was pale and defined as an “idiopathic” condition and tachypneic, systemic examination was thus mainly as a diagnosis of exclusion, ES normal. -
Case Report Treatment of Severe Evans Syndrome with an Allogeneic Cord Blood Transplant
Bone Marrow Transplantation, (1997) 20, 427–429 1997 Stockton Press All rights reserved 0268–3369/97 $12.00 Case report Treatment of severe Evans syndrome with an allogeneic cord blood transplant E Raetz1, PG Beatty2 and RH Adams1 Departments of 1Pediatrics and 2Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA Summary: began experiencing increased difficulty with mucosal bleeding, which prompted frequent platelet transfusions. At Immunosuppressive therapy is commonly used in the 4. years, he had a major gastrointestinal bleed, followed management of autoimmune disorders. As marrow- 1 month later by an intracranial hemorrhage. He required derived lymphocytes appear to play a key role in these transient ventilator support, but eventually regained full diseases, lymphoid ablation followed by replacement neurologic function. Direct (DAT) and indirect (IAT) with autologous or allogeneic stem cells may be a thera- Coombs evaluations were always 3+ positive. Due to the peutic option. We report a 5-year-old boy with severe severe and refractory nature of his disease, the option of Evans syndrome which consists of immune thrombocy- novel therapy with bone marrow transplantation was topenia and Coombs-positive hemolytic anemia. He was pursued. rendered into complete remission with marrow ablation HLA typing of the family, and a search of the unrelated followed by rescue with an HLA-identical sibling cord marrow donor registries, did not identify an appropriate blood transplant. He unexpectedly died 9 months donor, but DNA-based typing for HLA-A, -B, -DRB1 of following transplant from acute hepatic failure of the amniotic fluid of a sibling fetus, of 6 months gestational unknown etiology. -
Case Report Evans Syndrome
Bangladesh Med J. 2018 Sept; 47(3) Case Report Evans Syndrome: A Case Report *Biswas SK1, BiswasT2, Khondoker N3, Alam MR4, Rahim MA5, Paul HK6, Shahin MA7, Hasan MN 8, Bhuiyan AKMM9 Abstract: INTRODUCTION Evans syndrome, a combined clinical condition of autoimmune Evans syndrome is an uncommon clinical condition de!ned haemolytic anaemia (AHA) and idiopathic thrombocytopaenic by the combination of autoimmune hemolytic anemia 1 purpura (ITP) and has non-speci!c pathogenesis. "e clinical (AHA) and idiopathic thrombocytopenic purpura (ITP). It cases are extremely rare, since only 4% of AHA or ITP are is a chronic immune- associated disease which has unknown incorporated with Evans. It is distinguished from di#erentials, pathophysiology. "e true Evans syndrome is diagnosed such as lupus, IgA de!ciency, and acquired immunode!ciency, when possibility of other confounding disorders is excluded. by peripheral blood !lm, bone marrow, Coombs test, and In 1951, Dr. Robert Evan discovered the spectrum like coagulation pro!le. A case of adult female from Pabna, relationship between these two combined diseases after 1 Bangladesh is documented in this report. She complained of studying twenty-four cases. Epidemiologically, the high grade intermittent fever, exertional dyspnea, icteric skin condition is extremely rare that only less than 4% of ITP or 2-5 and sclera. Other features included mild splenomegaly, dark AHA are diagnosed as Evans syndrome. "ere is evidence urine, and profuse sweating after fever. Investigation reports of both cellular and humoral immune-abnormalities in 6 were consistent with AHA and ITP, with normal coagulation Evans syndrome. Di#erent scientists provided di#erent and viral pro!le. -
(MRA) and Magnetic Resonance Venography (MRV) Medical Policy
Magnetic Resonance Angiography (MRA) and Magnetic Resonance Venography (MRV) Medical Policy The content of this document is used by plans that do not utilize NIA review. Service: Magnetic Resonance Angiography (MRA) and Magnetic Resonance Venography (MRV) PUM 250-0027-1712 Medical Policy Committee Approval 12/11/2020 Effective Date 01/01/2021 Prior Authorization Needed Yes Description: Magnetic Resonance Angiography (MRA) and Magnetic Resonance Venography (MRV) use Magnetic resonance imaging (MRI) technology to produce detailed 2-dimensional or 3- dimensional images of the vascular system and may be tailored to assess arteries or veins. It is often used for vascular conditions where other types of imaging are considered inferior or contraindicated, and to decrease risk of cumulative radiation exposure and often instead of invasive procedures. Indications of Coverage: A. MRA/MRV is considered medically necessary for the anatomical regions listed below when the specific indications or symptoms described are documented: 1. Head/Brain: a. Suspected intracranial aneurysm (ICA) or arteriovenous malformation (AVM). Any of the following: 1. Acute severe headache, severe exertional headache, or sudden onset of explosive headache, in individuals with signs / symptoms highly suggestive of a leaking/ruptured internal carotid artery or arteriovenous malformation. 2. Known subarachnoid hemorrhage or diagnosis of spontaneous intracerebral hemorrhage with concern for underlying vascular abnormality. 3. Suspected arteriovenous malformation (AVM) or dural AV fistula in an individual with prior indeterminate imaging study 4. Thunderclap headache with question of underlying vascular abnormality AND prior negative workup to include EITHER i. negative brain MRI, OR ii. Negative brain CT and negative lumbar puncture Page 1 of 15 5. -
Pelvic Venous Reflux Diseases
Open Access Journal of Family Medicine Review Article Pelvic Venous Reflux Diseases Arbid EJ* and Antezana JN Anatomic Considerations South Charlotte General and Vascular Surgery, 10512 Park Road Suite111, Charlotte, USA Each ovary is drained by a plexus forming one major vein *Corresponding author: Elias J. Arbid, South measuring normally 5mm in size. The left ovarian plexus drains into Charlotte General and Vascular Surgery, 10512 Park Road left ovarian vein, which empties into left renal vein; the right ovarian Suite111, Charlotte, NC 28120, USA plexus drains into the right ovarian vein, which drains into the Received: November 19, 2019; Accepted: January 07, anterolateral wall of the inferior vena cava (IVC) just below the right 2020; Published: January 14, 2020 renal vein. An interconnecting plexus of veins drains the ovaries, uterus, vagina, bladder, and rectum (Figure 1). Introduction The lower uterus and vagina drain into the uterine veins and Varicose veins and chronic venous insufficiency are common then into branches of the internal iliac veins; the fundus of the uterus disorders of the venous system in the lower extremities that have drains to either the uterine or the ovarian plexus (utero-ovarian and long been regarded as not worthy of treatment, because procedures salpingo ovarian veins) within the broad ligament. Vulvoperineal to remove them were once perceived as worse than the condition veins drain into the internal pudendal vein, then into the inferior itself. All too frequently, patients are forced to learn to live with them, gluteal vein, then the external pudendal vein, then into the saphenous or find "creative" ways to hide their legs. -
ULTRASOUND STUDY GUIDE • Technical Knowledge O Physics And
ULTRASOUND STUDY GUIDE Technical knowledge o Physics and Safety, understand the following: 1) Physics of sound interactions in the body. 2) How transducers work, how the image is created, and what physical properties are being displayed. 3) Relative strengths and weaknesses of different transducers including various aspects of resolution. Sound properties and interactions Reflection Attenuation Scattering Refraction Absorption Acoustic impedance Speed of sound Wavelength Other . Transducer fundamentals Transmit frequencies Transducer components Transducer types Transducer pros and cons Other . Beam formation Focusing Steering Other . Imaging modes and display 2D 3D 4D Panoramic imaging Compound imaging Harmonic imaging Elastography Contrast imaging Scanning modes o 2D o 3D o 4D o M-mode o Doppler o Other Image orientation Other . Image resolution Axial Lateral Elevational / Azimuthal Temporal Contrast Penetration vs. resolution Other . System Controls - Know the function of the controls listed below and be able to recognize them in the list of scan parameters shown on the image monitor Gain Time gain compensation Power output Focal zone Transmit frequency Depth Width Zoom / Magnification Dynamic range Frame rate Line density Frame averaging / persistence Other . Doppler / Flow imaging – Be familiar with the terminology used to describe Doppler exams. Be able to interpret and optimize the images. Be able to recognize artifacts, know their significance, and know what produces them. Doppler -
Polyarteritis Nodosa and Renal Vein Thrombosis: a Case Report and Review of the Literature
International Journal of Case Report Clinical Rheumatology Polyarteritis nodosa and renal vein thrombosis: A case report and review of the literature Renal Vein Thrombosis (RVT) is rare and usually complicates nephrotic syndrome and renal malignancies. Francesco Bozzao*1, We report the case of a 48-year-old woman, who was diagnosed with polyarteritis nodosa (PAN) and Silvano Bettio1, RVT, which was incidentally detected during diagnostic workup. Venous thromboembolism (VTE) can Monica Regis2, 3 complicate the active phases of several vasculitides. Our review of the literature suggests that the risk of Marina Drabeni , Diego Rossi4 & VTE in PAN is lower than that in other vasculitides, although it remains higher during the active disease. 1 Our case reminds clinicians that VTE can be a rare manifestation of PAN. Fabio Fischetti 1Department of Medicine, Azienda Sanitaria Universitaria Integrata and University of Trieste (ASUITs), Strada di Keywords: polyarteritis nodosa • renal vein thrombosis • venous thromboembolism • vasculitis Fiume 449, 34149, Trieste, Italy 2Department of Internal Medicine, Azienda per l'Assistenza Sanitaria n. 2 Bassa Friulana-Isontina, Viale Fatebenefratelli 34, List of Abbreviations: RVT: Renal Vein Thrombosis; HBV: Hepatitis B Virus; DNA: deoxyribonucleic 34170, Gorizia, Italy acid; ANCA: AntiNeutrophil Citoplasmic Antibodies; CT: Computed Tomography; PAN: Polyarteritis 3 Nodosa; VTE: Venous Thromboembolism; AKI: Acute Kidney Injury; AAV: ANCA-Associated Vasculitides; Department of Dermatology, Azienda per l'Assistenza Sanitaria n. 2 Bassa Friulana- BD: Behçet's Disease; GPA: Granulomatosis with Polyangiitis; MPA: Microscopic Polyangiitis; EGPA: Isontina, Viale Fatebenefratelli 34, 34170, Eosinophilic Granulomatosis with Polyangiitis; H&E: Hematoxylin and Eosin Gorizia, Italy 4Department of Gestione Anatomia Patologica, Azienda per l'Assistenza Sanitaria n. -
Unilateral Renal Vein Thrombosis Treated by Nephrectomy and Post-Operative Heparin by E
Arch Dis Child: first published as 10.1136/adc.26.128.358 on 1 August 1951. Downloaded from UNILATERAL RENAL VEIN THROMBOSIS TREATED BY NEPHRECTOMY AND POST-OPERATIVE HEPARIN BY E. W. PARRY From the Paediatric Unit, County Hospital, Bangor (RECEIVED FOR PUBLICATION JANUARY 19, 1951) In the majority of cases renal vein thrombosis is The child's general condition showed him to be pale and secondary to dehydration, sepsis, or both, and has quiet with evidence of dehydration. His chest and heart occurred in enterocolitis, diphtheria, umbilical were normal; his abdomen was normal in appearance and skin infections. It has been and movements. The umbilicus was clean and dry. sepsis, measles, Palpation revealed a large firm mass extending from the recorded as a sequel to pyelo-nephritis due to a level of the costal margin to the iliac crest on the left side. spread from the glomerular to the renal vein. The The mass was perfectly smooth in outline and no notch renal vein may become secondarily involved as a could be felt. It conformed in outline to a renal swelling result of thrombophlebitis in the vena cava, the and could be displaced from the loin. The mass was Protected by copyright. spermatic, or the ovarian veins. This type, however, obviously painful, and any palpation caused marked seems to be confined to adults, and is very rare in distress. No other abnormality could be found on infancy. examination. The right kidney was not palpable. Both sexes are equally involved. The age On rectal examination the mass could be felt in front is in that of cases occur of the rectum at the pelvic brim. -
Arterial Thrombosis in the Nephrotic Syndrome Ibrahim H
Postgrad Med J: first published as 10.1136/pgmj.70.830.905 on 1 December 1994. Downloaded from Postgrad Med J (1994) 70, 905 - 909 i) The Fellowship of Postgraduate Medicine, 1994 Clinical Review Arterial thrombosis in the nephrotic syndrome Ibrahim H. Fahal, Peter McClelland, Charles R.M. Hay' and Gordon M. Bell The Regional Renal Unit and 'Department ofHaematology, Royal Liverpool University Hospital, Prescot Street, Liverpool L7 8XP, UK Summary: Thrombosis is a frequent cause of morbidity and mortality in patients with the nephrotic syndrome. Venous thrombotic complications are well recognized but arterial complications are rare. Thrombosis is multifactorial, and has been attributed to a hypercoaguable state due to alterations in blood levels of the various factors involved in the coagulation and fibrinolytic systems, alterations in platelet function, venous stasis, haemoconcentration, increased blood viscosity and possibly the administration of steroids. Thrombosis in general and arterial thrombosis in particular is a significant and potentially serious problem in nephrotic patients. Awareness of the condition and its pathogenesis is needed. Assessment for the risk factors is required to allow appropriate prophylactic measures to be taken. Introduction Thrombotic complications are common in the 135% (75-125), fibrinogen 13.1 g/l (1.5-4 g/l) and nephrotic syndrome. These have been attributed to antithrombin III antigen activity of55% (80-155). by copyright. a hypercoagulable state."2 Venous thrombosis is Haemoglobin was 16.5 g/dl, haematocrit 48.6%, well recognized, but arterial thrombosis occurs less leucocyte count 21.2 x 109/1, neutrophils frequently and is seen primarily in children.3 14.8 x 109/1 and platelet count 318 x 109/l. -
Evans' Syndrome
Journal of Clinical Medicine Review Evans’ Syndrome: From Diagnosis to Treatment Sylvain Audia 1,* , Natacha Grienay 1, Morgane Mounier 2, Marc Michel 3 and Bernard Bonnotte 1 1 Service de Médecine Interne et Immunologie Clinique, Centre de Référence Constitutif des Cytopénies Auto-Immunes de l’Adulte, Centre Hospitalo-Universitaire Dijon Bourgogne, Université de Bourgogne Franche Comté, 21000 Dijon, France; [email protected] (N.G.); [email protected] (B.B.) 2 Registre des Hémopathies Malignes de Côte d’Or, Centre Hospitalo-Universitaire Dijon Bourgogne, Université de Bourgogne Franche Comté, UMR 1231 Dijon, 21000 Dijon, France; [email protected] 3 Service de Médecine Interne 1, Centre de Référence des Cytopénies Auto-Immunes de l’Adulte, Centre Hospitalo-Universitaire Henri Mondor, 94000 Créteil, France; [email protected] * Correspondence: [email protected]; Tel.: +333-80-29-34-32 Received: 11 October 2020; Accepted: 25 November 2020; Published: 27 November 2020 Abstract: Evans’ syndrome (ES) is defined as the concomitant or sequential association of warm auto-immune haemolytic anaemia (AIHA) with immune thrombocytopenia (ITP), and less frequently autoimmune neutropenia. ES is a rare situation that represents up to 7% of AIHA and around 2% of ITP. When AIHA and ITP occurred concomitantly, the diagnosis procedure must rule out differential diagnoses such as thrombotic microangiopathies, anaemia due to bleedings complicating ITP, vitamin deficiencies, myelodysplastic syndromes, paroxysmal nocturnal haemoglobinuria, or specific conditions like HELLP when occurring during pregnancy. As for isolated auto-immune cytopenia (AIC), the determination of the primary or secondary nature of ES is important. Indeed, the association of ES with other diseases such as haematological malignancies, systemic lupus erythematosus, infections, or primary immune deficiencies can interfere with its management or alter its prognosis. -
Hemophilia Update 2015
J. Martin Johnston, MD Pediatric Project ECHO 7 December 2018 Objectives Review history and physical exam as they relate to a potential bleeding disorder Discuss step-wise laboratory evaluation: screening labs and follow-ups Review some common congenital and acquired bleeding disorders, and their management Objectives Review history and physical exam as they relate to a potential bleeding disorder Discuss step-wise laboratory evaluation: screening labs and follow-ups Review some common congenital and acquired bleeding disorders, and their management Objectives Review history and physical exam as they relate to a potential bleeding disorder Discuss step-wise laboratory evaluation: screening labs and follow-ups Review some common congenital and acquired bleeding disorders, and their management The chief complaint “Easy” bruising Nosebleeds Petechiae Menorrhagia Bleeding after Circumcision Tonsillectomy/adenoidectomy, tooth extraction Mild (head) trauma The problem…. • Everyone bleeds. • All bleeding eventually stops. The bleeding history Birth/neonatal Tooth eruption/shedding Bruising Nosebleeds Surgeries? (don’t forget circumcision!) Orthopedic hx (traumas, joints) Menstruation Family history How much bleeding is too much? Neonatal ICH, needle/heel sticks, post-circumcision How much bleeding is too much? Neonatal ICH, needle/heel sticks, post-circumcision Infant Petechiae, chest/back/buttock bruising Consider NAT How much bleeding is too much? Neonatal ICH, needle/heel sticks, post-circumcision Infant -
Evans Syndrome
CASE REPORT Evans Syndrome Ahmed Al Hazmi, MBBS* *University of Maryland Medical Center, Department of Emergency Medicine, Michael E. Winters, MD, MBA† Baltimore, Maryland †University of Maryland School of Medicine, Department of Emergency Medicine, Baltimore, Maryland Section Editor: Steven Walsh, MD Submission history: Submitted September 22, 2018; Revision received December 31, 2019; Accepted January 23, 2019 Electronically published February 26, 2019 Full text available through open access at http://escholarship.org/uc/uciem_cpcem DOI: 10.5811/cpcem.2019.1.41028 A 22-year-old man presented to the emergency department with facial swelling, rash, and fatigue. He had a past medical history of pericarditis and pericardial effusion. His evaluation showed anemia and thrombocytopenia. He was admitted for intravenous administration of steroids, plasmapheresis, and workup of his anemia and thrombocytopenia. He was ultimately diagnosed with Evans syndrome as a presenting feature of systemic lupus erythematosus. Plasmapheresis was stopped but administration of steroids continued. His blood counts improved, and the facial swelling and rash subsided. Evans syndrome is an immunologic conundrum that requires early recognition and treatment. [Clin Pract Cases Emerg Med. 2019;3(2):128-131.] INTRODUCTION the chief complaint of facial swelling, which had been present Evans syndrome (ES) is a very rare autoimmune disease for the prior three weeks. The swelling was predominantly on first described in 1951. It is the combination of Coombs- the right side of his face and upper lip. He had no history of positive idiopathic autoimmune hemolytic anemia (IAHA) angioedema, had not started any new medications, and was not and immune thrombocytopenic purpura (ITP).1-3 In addition, aware of an environmental exposure that immediately preceded ES can be associated with the development of neutropenia the onset of swelling.