Patient: Female, 52-year-old Final Diagnosis: Kikuchi-Fujimoto disease Symptoms: Cervical lymphad... more Patient: Female, 52-year-old Final Diagnosis: Kikuchi-Fujimoto disease Symptoms: Cervical lymphadenopathy • fever Medication: — Clinical Procedure: — Specialty: Infectious Diseases • Rheumatology Objective: Unusual clinical course Background: Kikuchi-Fujimoto (KFD) disease is a rare benign syndrome of necrotizing lymphadenopathy with distinctive histologic characteristics and was first reported in 1972. It is usually manifested by painful cervical lymphadenopathy and fever in young people, predominantly in females. KFD is a self-limiting disease and recurrence is rare. Case Report: We present the case of a middle-aged woman who presented with recurrent cervical lymphadenopathy 3 times in 13 years. Diagnosis of KFD was made by excisional lymph node biopsy, showing typical histopathologic features. She was treated with oral prednisone, with a favorable response. Conclusions: In patients with recurrent lymphadenopathy, excisional biopsy can lead to definitive diagnosis and directed tre...
Sarcoidosis is a rare condition among native Saudis. It typically presents with asymptomatic ches... more Sarcoidosis is a rare condition among native Saudis. It typically presents with asymptomatic chest radiographs, exertional breathlessness and cough. The coexistence of sarcoidosis and HIV is also rare, and the overlap of the symptoms makes their differential diagnosis challenging. Nevertheless, the outcome of sarcoidosis is favourable with or without the presence of HIV. We present a case of a 55-year-old native Saudi man with extremely atypical sarcoidosis presentation coexisting with HIV. This case highlights the association between the two pathologies, and the difficulties encountered in establishing a proper diagnosis in the presence of two overlapping diseases.
Patient: Female, 46-year-old Final Diagnosis: Autoimmune haemolytic anaemia • brucella induced au... more Patient: Female, 46-year-old Final Diagnosis: Autoimmune haemolytic anaemia • brucella induced autoimmune haemolytic anaemia and immune thrombocytopeni • brucellosis • immune thrombocytopenia Symptoms: Fatigue • fever • weight loss Medication: — Clinical Procedure: — Specialty: Hematology • Infectious Diseases • General and Internal Medicine Objective: Rare coexistence of disease or pathology Background: Autoimmune hemolytic anemia and immune thrombocytopenia are rare complications of brucellosis; only a few cases have been reported in the literature. While pancytopenia is common and was reported in Saudi Arabia, the description of autoimmune hemolytic anemia or immune thrombocytopenia has not yet been reported in the kingdom. Hematological complication usually requires supportive treatment, and it is expected to improve with the initiation of antimicrobial therapy for brucellosis. There are few reports on the treatment of patients that fail to improve with conventional therapy. Case Report: A 46-year-old previously healthy Saudi woman was admitted to our hospital after multiple visits to the emergency department with chief concerns of fever and fatigability for 30 days. The examination was remarkable only for fever of 38.4°C and tender hepatomegaly. Laboratory tests upon admission were significant of pancytopenia, with a white blood count of 3×109/L, hemoglobin of 8.1 g/dL, platelet of 13×109/L, moderate hyponatremia, hypokalemia, and metabolic acidosis. Tuberculosis was ruled out and pan-sensitive brucellosis was diagnosed. She was started on standard antimicrobial therapy without significant improvement. Further testing revealed Coomb’s-positive hemolytic anemia and possible immune-mediated severe thrombocytopenia. She was treated with glucocorticoids and intravenous immunoglobulin, with dramatic response. Conclusions: Autoimmune-mediated destruction of blood lines in brucellosis is rare. It should be sought as a potential diagnosis in case of persistent anemia and/or thrombocytopenia that is severe or fails to improve with proper antimicrobial coverage. Early involvement of hematologists and initiation of glucocorticoid with or without intravenous immunoglobulin is crucial.
Patient: Female, 52-year-old Final Diagnosis: Kikuchi-Fujimoto disease Symptoms: Cervical lymphad... more Patient: Female, 52-year-old Final Diagnosis: Kikuchi-Fujimoto disease Symptoms: Cervical lymphadenopathy • fever Medication: — Clinical Procedure: — Specialty: Infectious Diseases • Rheumatology Objective: Unusual clinical course Background: Kikuchi-Fujimoto (KFD) disease is a rare benign syndrome of necrotizing lymphadenopathy with distinctive histologic characteristics and was first reported in 1972. It is usually manifested by painful cervical lymphadenopathy and fever in young people, predominantly in females. KFD is a self-limiting disease and recurrence is rare. Case Report: We present the case of a middle-aged woman who presented with recurrent cervical lymphadenopathy 3 times in 13 years. Diagnosis of KFD was made by excisional lymph node biopsy, showing typical histopathologic features. She was treated with oral prednisone, with a favorable response. Conclusions: In patients with recurrent lymphadenopathy, excisional biopsy can lead to definitive diagnosis and directed tre...
Sarcoidosis is a rare condition among native Saudis. It typically presents with asymptomatic ches... more Sarcoidosis is a rare condition among native Saudis. It typically presents with asymptomatic chest radiographs, exertional breathlessness and cough. The coexistence of sarcoidosis and HIV is also rare, and the overlap of the symptoms makes their differential diagnosis challenging. Nevertheless, the outcome of sarcoidosis is favourable with or without the presence of HIV. We present a case of a 55-year-old native Saudi man with extremely atypical sarcoidosis presentation coexisting with HIV. This case highlights the association between the two pathologies, and the difficulties encountered in establishing a proper diagnosis in the presence of two overlapping diseases.
Patient: Female, 46-year-old Final Diagnosis: Autoimmune haemolytic anaemia • brucella induced au... more Patient: Female, 46-year-old Final Diagnosis: Autoimmune haemolytic anaemia • brucella induced autoimmune haemolytic anaemia and immune thrombocytopeni • brucellosis • immune thrombocytopenia Symptoms: Fatigue • fever • weight loss Medication: — Clinical Procedure: — Specialty: Hematology • Infectious Diseases • General and Internal Medicine Objective: Rare coexistence of disease or pathology Background: Autoimmune hemolytic anemia and immune thrombocytopenia are rare complications of brucellosis; only a few cases have been reported in the literature. While pancytopenia is common and was reported in Saudi Arabia, the description of autoimmune hemolytic anemia or immune thrombocytopenia has not yet been reported in the kingdom. Hematological complication usually requires supportive treatment, and it is expected to improve with the initiation of antimicrobial therapy for brucellosis. There are few reports on the treatment of patients that fail to improve with conventional therapy. Case Report: A 46-year-old previously healthy Saudi woman was admitted to our hospital after multiple visits to the emergency department with chief concerns of fever and fatigability for 30 days. The examination was remarkable only for fever of 38.4°C and tender hepatomegaly. Laboratory tests upon admission were significant of pancytopenia, with a white blood count of 3×109/L, hemoglobin of 8.1 g/dL, platelet of 13×109/L, moderate hyponatremia, hypokalemia, and metabolic acidosis. Tuberculosis was ruled out and pan-sensitive brucellosis was diagnosed. She was started on standard antimicrobial therapy without significant improvement. Further testing revealed Coomb’s-positive hemolytic anemia and possible immune-mediated severe thrombocytopenia. She was treated with glucocorticoids and intravenous immunoglobulin, with dramatic response. Conclusions: Autoimmune-mediated destruction of blood lines in brucellosis is rare. It should be sought as a potential diagnosis in case of persistent anemia and/or thrombocytopenia that is severe or fails to improve with proper antimicrobial coverage. Early involvement of hematologists and initiation of glucocorticoid with or without intravenous immunoglobulin is crucial.
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Papers by Osama Estaitieh