Research
A Diagnostic Challenge in a Patient with Intractable Nausea and Vomiting: A Case of Systemic Amyloidosis
Amyloidosis is a rare disorder caused by deposition of amyloid fibrils in various tissues causing structural and functional defects. Depending upon organs involved, it may be categorized as localized or systemic. Systemic amyloidosis involves multiple organs where some organs are affected more commonly than others. Diagnosis is often challenging as in a 76-yearsold female described here who presented with intractable nausea and vomiting. Clinical course was complicated because of simultaneous presence of peptic ulcer disease and hypothyroidism. Involvement of multiple systems including gastrointestinal tract, thyroid, liver, heart and kidneys was seen, and diagnosis was achieved after renal biopsy showing Congo red staining and apple green birefringence. Gastric and thyroid infiltration by amyloidosis are extremely rare occurrences described very infrequently in the literature. However, to our knowledge, involvement of both organs in a single patient has not been reported in the literature.
Triple Vessel Coronary Artery Disease in Young Female
Although coronary heart disease (CHD) primarily occurs in patients over the age of 40, younger men and women can be involved. Majority of studies have used an age cut-off of 40 to 45 years to define "young" patients with CHD or acute myocardial infarction (MI). The same age definition will be used in this article. The prevalence of CHD in younger subjects is difficult to establish accurately since it is frequently a silent process. Acute Myocardial infarction in young females is an uncommon occurrence and even if we see cases, very few of them have shown to have greater than one vessel coronary artery disease. When a young female present with acute MI, the presentation is very vague and can be easily missed so, presence or absence of cardiovascular risk factors regardless of age should be the key factor in making a decision to perform coronary angiography and full cardiovascular workup. We report here 31 year old female with multiple cardiovascular risk factors who presented with an atypical chest pain with normal EKG in emergency room and was ultimately diagnosed with triple vessel coronary artery disease. In this paper we will describe a case to describe the importance of early coronary angiography and cardiovascular workup in presence of significant risk factors despite atypical presentation and younger age of patient.
Latest Diagnostic and Treatment Modalities for TTP
TTP is a very uncommon disease which used to have very high mortality and morbidity before the introduction of plasmapharesis and immunosup-pressant therapy. Even after the introduction of these modalities, atypical HUS patients had a very grave prognosis and ultimately led to death in many until the introduction of complement inhibitors like eculizumab which is C5a monoclonal antibody. Additionally differentiating typical HUS versus atypical HUS was very difficult but some work on complement markers can be very fruitful in differentiating them.
