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Shingu M, Fujishima C, Hara S, Nishioka H. Japanese spotted fever complicated by acute sensorineural hearing loss. J Infect Chemother 2024:S1341-321X(24)00104-1. [PMID: 38599283 DOI: 10.1016/j.jiac.2024.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/18/2024] [Accepted: 03/29/2024] [Indexed: 04/12/2024]
Abstract
Japanese spotted fever is an emerging rickettsiosis caused by Rickettsia japonica and is characterized by high fever, rash, and eschar formation. Other symptoms are often vague and nonspecific and include headaches, nausea, vomiting, and myalgia. We present a case of a 46-year-old woman with Japanese spotted fever, complicated by transient bilateral sensorineural hearing loss and presenting cutaneous IgM/IgG immune complex vasculitis. The patient was admitted with a history of several days of high fever, generalized skin erythema, and hearing impairment. Laboratory findings revealed thrombocytopenia and elevated liver enzyme and C-reactive protein levels. Pure-tone audiometry revealed bilateral sensorineural hearing loss, and a skin biopsy revealed leukocytoclastic vasculitis with deposition of C3 and IgM on the vessel walls. Under the tentative diagnosis of rickettsiosis, scrub typhus, or Japanese spotted fever, the patient was treated with minocycline, and her symptoms improved within approximately 10 days. A definitive diagnosis was made on the basis of a serological test showing increased antibody levels against Rickettsia japonica. Japanese spotted fever can cause transient sensorineural hearing loss, a rare complication that presents with cutaneous IgM/IgG immune complex vasculitis.
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Affiliation(s)
- Motohiro Shingu
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe City, Hyogo, 650-0047, Japan
| | - Chieko Fujishima
- Department of Dermatology, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe City, Hyogo, 650-0047, Japan
| | - Shigeo Hara
- Department of Pathology, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe City, Hyogo, 650-0047, Japan
| | - Hiroaki Nishioka
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, 2-1-1 Minami-machi, Minatojima, Chuo-ku, Kobe City, Hyogo, 650-0047, Japan.
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2
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Abdelnabi M, Cavazos A, Mittal N, Tarbox M. Leucocytoclastic vasculitis secondary to urinary tract infection caused by extended-spectrum β-lactamase producing Klebsiella pneumoniae. BMJ Case Rep 2023; 16:e255395. [PMID: 37011993 PMCID: PMC10083772 DOI: 10.1136/bcr-2023-255395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
Affiliation(s)
- Mahmoud Abdelnabi
- Internal Medicine Department, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Annia Cavazos
- Internal Medicine Department, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Neha Mittal
- Internal Medicine Department, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
| | - Michelle Tarbox
- Dermatology Department, Texas Tech University Health Sciences Center, Lubbock, Texas, USA
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3
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Stone JR. Diseases of small and medium-sized blood vessels. Cardiovasc Pathol 2022. [DOI: 10.1016/b978-0-12-822224-9.00020-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
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4
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Fursova NK, Astashkin EI, Ershova ON, Aleksandrova IA, Savin IA, Novikova TS, Fedyukina GN, Kislichkina AA, Fursov MV, Kuzina ES, Biketov SF, Dyatlov IA. Multidrug-Resistant Klebsiella pneumoniae Causing Severe Infections in the Neuro-ICU. Antibiotics (Basel) 2021; 10:antibiotics10080979. [PMID: 34439029 PMCID: PMC8389041 DOI: 10.3390/antibiotics10080979] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/09/2021] [Accepted: 08/13/2021] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study was the identification of genetic lineages and antimicrobial resistance (AMR) and virulence genes in Klebsiella pneumoniae isolates associated with severe infections in the neuro-ICU. Susceptibility to antimicrobials was determined using the Vitek-2 instrument. AMR and virulence genes, sequence types (STs), and capsular types were identified by PCR. Whole-genome sequencing was conducted on the Illumina MiSeq platform. It was shown that K. pneumoniae isolates of ST14K2, ST23K57, ST39K23, ST76K23, ST86K2, ST218K57, ST219KL125/114, ST268K20, and ST2674K47 caused severe systemic infections, including ST14K2, ST39K23, and ST268K20 that were associated with fatal incomes. Moreover, eight isolates of ST395K2 and ST307KL102/149/155 were associated with manifestations of vasculitis and microcirculation disorders. Another 12 K. pneumoniae isolates of ST395K2,KL39, ST307KL102/149/155, and ST147K14/64 were collected from patients without severe systemic infections. Major isolates (n = 38) were XDR and MDR. Beta-lactamase genes were identified: blaSHV (n = 41), blaCTX-M (n = 28), blaTEM (n = 21), blaOXA-48 (n = 21), blaNDM (n = 1), and blaKPC (n = 1). The prevalent virulence genes were wabG (n = 41), fimH (n = 41), allS (n = 41), and uge (n = 34), and rarer, detected only in the genomes of the isolates causing severe systemic infections-rmpA (n = 8), kfu (n = 6), iroN (n = 5), and iroD (n = 5) indicating high potential of the isolates for hypervirulence.
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Affiliation(s)
- Nadezhda K. Fursova
- Department of Molecular Microbiology, State Research Center for Applied Microbiology and Biotechnology, Territory “Kvartal A”, 142279 Obolensk, Russia; (E.I.A.); (T.S.N.)
- Correspondence:
| | - Evgenii I. Astashkin
- Department of Molecular Microbiology, State Research Center for Applied Microbiology and Biotechnology, Territory “Kvartal A”, 142279 Obolensk, Russia; (E.I.A.); (T.S.N.)
| | - Olga N. Ershova
- Department of Clinical Epidemiology, National Medical Research Center of Neurosurgery Named after Academician N.N. Burdenko, 125047 Moscow, Russia; (O.N.E.); (I.A.A.); (I.A.S.)
| | - Irina A. Aleksandrova
- Department of Clinical Epidemiology, National Medical Research Center of Neurosurgery Named after Academician N.N. Burdenko, 125047 Moscow, Russia; (O.N.E.); (I.A.A.); (I.A.S.)
| | - Ivan A. Savin
- Department of Clinical Epidemiology, National Medical Research Center of Neurosurgery Named after Academician N.N. Burdenko, 125047 Moscow, Russia; (O.N.E.); (I.A.A.); (I.A.S.)
| | - Tatiana S. Novikova
- Department of Molecular Microbiology, State Research Center for Applied Microbiology and Biotechnology, Territory “Kvartal A”, 142279 Obolensk, Russia; (E.I.A.); (T.S.N.)
| | - Galina N. Fedyukina
- Department of Immunobiochemistry of Pathogenic Microorganisms, State Research Center for Applied Microbiology and Biotechnology, Territory “Kvartal A”, 142279 Obolensk, Russia; (G.N.F.); (S.F.B.)
| | - Angelina A. Kislichkina
- Department of Culture Collection, State Research Center for Applied Microbiology and Biotechnology, Territory “Kvartal A”, 142279 Obolensk, Russia;
| | - Mikhail V. Fursov
- Department of Training and Improvement of Specialists, State Research Center for Applied Microbiology and Biotechnology, Territory “Kvartal A”, 142279 Obolensk, Russia; (M.V.F.); (E.S.K.)
| | - Ekaterina S. Kuzina
- Department of Training and Improvement of Specialists, State Research Center for Applied Microbiology and Biotechnology, Territory “Kvartal A”, 142279 Obolensk, Russia; (M.V.F.); (E.S.K.)
| | - Sergei F. Biketov
- Department of Immunobiochemistry of Pathogenic Microorganisms, State Research Center for Applied Microbiology and Biotechnology, Territory “Kvartal A”, 142279 Obolensk, Russia; (G.N.F.); (S.F.B.)
| | - Ivan A. Dyatlov
- Department of Administration, State Research Center for Applied Microbiology and Biotechnology, Territory “Kvartal A”, 142279 Obolensk, Russia;
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Arsanios DM, Cabezas DF, Barragán AF, Estupiñán MF, Calderón CM, Quintero-Muñoz E. Tercer caso de vasculitis leucocitoclástica cutánea secundaria al uso de oxacilina: reporte de caso. INFECTIO 2020. [DOI: 10.22354/in.v25i1.908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
La vasculitis leucocitoclastica es una patologìa que compromete los vasos pequeños y cuya causa predominantemente se ha descrito como idiopatica. Se presenta el caso de una mujer de 78 años hipertensa, diabética y con enfermedad renal crónica en estadio 5, que presentó lesiones limitadas a la piel posterior a la administración de oxacilina para manejo de bacteremia por SAMS. La presentación clínica se basó en purpuras palpables predominantemente en miembros inferiores y lesiones dolorosas coalescentes que formaban ampollas de contenido hemorrágico. Estas lesiones resolvieron gradualmente después del cambio de la terapia mencionada anteriormente. La biopsia fue compatible con vasculitis leucocitoclástica, con paraclínicos que descartaron causas infecciosas y autoinmunes.
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6
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Mericliler M, Shnawa A, Al-Qaysi D, Fleisher J, Moraco A. Oxacillin-induced leukocytoclastic vasculitis. IDCases 2019; 17:e00539. [PMID: 31384556 PMCID: PMC6667486 DOI: 10.1016/j.idcr.2019.e00539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 04/15/2019] [Accepted: 04/15/2019] [Indexed: 12/03/2022] Open
Abstract
Leukocytoclastic vasculitis (LCV) refers to a histopathological pattern of neutrophil predominant inflammatory process of small vessels associated with fibrinoid necrosis. Cutaneous LCV usually presents as symmetrically distributed palpable purpuric nodules of the lower extremities with or without systemic involvement. Although 50% of LCV cases are idiopathic, it can be secondary to identifiable causes such as malignancy, autoimmune conditions, infections, and medications. Medications have been implicated in up to 25% of cases; sulfonamides, NSAIDs, and beta-lactams have the most frequent association. We herein present a 32-year-old female who developed palpable purpura over hands and lower limbs 12 days after exposure to oxacillin administered for infective endocarditis. Punch biopsy from the skin lesions confirmed the diagnosis of LCV. Given the temporal relationship between oxacillin administration and development of skin findings, the diagnosis of oxacillin-associated LCV was suspected. Discontinuation of drug resulted in resolution of the lesions confirming the diagnosis. To our knowledge, this is the second case of oxacillin-induced cutaneous LCV described in literature.
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Affiliation(s)
- Meric Mericliler
- St. Elizabeth's Medical Center, Department of Medicine, Brighton, MA 02135.,Tufts University School of Medicine, Boston, MA 02111
| | - Aya Shnawa
- Tufts University School of Medicine, Boston, MA 02111.,Tufts Medical Center, Department of Medicine, Boston, MA 02111.,Harvard University Medical School, Boston, MA 02115
| | - Dalya Al-Qaysi
- St. Elizabeth's Medical Center, Department of Medicine, Brighton, MA 02135.,Tufts University School of Medicine, Boston, MA 02111
| | - Jorge Fleisher
- Tufts University School of Medicine, Boston, MA 02111.,St. Elizabeth's Medical Center, Department of Infectious Disease, Brighton, MA 02135
| | - Andrew Moraco
- Tufts University School of Medicine, Boston, MA 02111.,St. Elizabeth's Medical Center, Department of Pulmonary and Critical Care, Brighton, MA 02135
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7
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A Case of Leukocytoclastic Vasculitis Caused by Listeria monocytogenes Bacteremia. Case Rep Infect Dis 2016; 2016:1093453. [PMID: 27313916 PMCID: PMC4903135 DOI: 10.1155/2016/1093453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 05/05/2016] [Indexed: 11/28/2022] Open
Abstract
Importance. Infections can cause leukocytoclastic vasculitis. Observations. We report the case of a patient with a left ventricular assist device who presented with acute kidney injury and biopsy proven leukocytoclastic vasculitis. Blood cultures grew Listeria monocytogenes. The patient's rash improved with treatment of the underlying Listeria infection. Conclusion. Clinicians should be aware that there are a number of broad categories of disease associated with the histologic finding of vasculitis, including infection. It is important to keep in mind the risk factors of a particular patient when formulating a differential diagnosis. This is the first reported case of Listeria bacteremia causing leukocytoclastic vasculitis.
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8
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Mosher CA, Owen JL, Barker BR. Staphylococcus aureus Bacteremia Masquerading as Leukocytoclastic Vasculitis. Am J Med 2016; 129:e5-7. [PMID: 26656759 DOI: 10.1016/j.amjmed.2015.10.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 10/01/2015] [Accepted: 10/28/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Christina A Mosher
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.
| | - Joshua L Owen
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Blake R Barker
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
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10
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Yuan WH, Li AFY, Hsu HC, Chou YH. Isolated panniculitis with vasculitis of the male breast suspicious for malignancy on CT and ultrasound: a case report and literature review. SPRINGERPLUS 2014; 3:642. [PMID: 25392810 PMCID: PMC4227985 DOI: 10.1186/2193-1801-3-642] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 09/29/2014] [Indexed: 11/30/2022]
Abstract
Introduction We report a case of a 54-year-old male patient with a hard, painful nodule within his right breast which was misdiagnosed preoperatively as breast cancer. Case description Preoperative work-up included physical examination, non-contrast chest computed tomography (CT), sonography, and sono-guided breast biopsy. Isolated breast panniculitis with vasculitis (BPWV), a rare disease, was diagnosed by histopathologic examination of tissue obtained from excisional biopsy. Discussion and Evaluation Subcutaneous panniculitis with or without vasculitis, a condition of nonsuppurative inflammatory process involving the subcutaneous fat layer of skin, is related to different causes. A palpable benign male breast lesion resembling a malignancy includes gynecomastia, panniculitis with or without vasculitis, fat necrosis, ruptured epidermal cyst, pseudoangiomatous stromal hyperplasia, subareolar abscess, intraductal papilloma, hematoma, and atypical fibroadenoma. To make an accurate preoperative diagnosis of a male breast mass, a physician has to carefully analyze various imaging findings. The cases of BPWV may present as an isolated breast lesion or as a component of a systemic disease. The diagnosis of the reported patient was compatible with an isolated BPWV because panniculitis and/or vasculitis were not present at other sites or organs at the time of diagnosis or during follow-up. Conclusions Excisional biopsy and clinical data can provide the correct diagnosis and determined the appropriate treatment strategy of a male BPWV.
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Affiliation(s)
- Wei-Hsin Yuan
- Division of Radiology, Taipei Municipal Gan-Dau Hospital (Managed by Taipei Veterans General Hospital), Taipei, Taiwan ; Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, ShiPai Road, 11217 Taipei City, Beitou District Taiwan ; School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Anna Fen-Yau Li
- Department of Pathology, Taipei Veterans General Hospital, Taipei, Taiwan ; School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Hui-Chen Hsu
- Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, ShiPai Road, 11217 Taipei City, Beitou District Taiwan ; Division of Medical Imaging for Health Management, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Yi-Hong Chou
- Department of Radiology, Taipei Veterans General Hospital, No. 201, Sec. 2, ShiPai Road, 11217 Taipei City, Beitou District Taiwan ; School of Medicine, National Yang Ming University, Taipei, Taiwan
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11
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Huang HY, Wu YH, Kuo CF. Klebsiella pneumoniae sepsis with unusual cutaneous presentation of generalized pustulosis. Clin Exp Dermatol 2014; 38:626-9. [PMID: 23837936 DOI: 10.1111/ced.12092] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2012] [Indexed: 11/27/2022]
Abstract
Klebsiella pneumoniae is a well-known Gram-negative pyogenic pathogen that can cause various types of infection. Liver abscesses caused by community-acquired K. pneumoniae infection are commonly reported in Taiwan, especially in people with diabetes mellitus. Meningococcal bacteraemia can present as disseminated pustules and leucocytoclastic vasculitis, but it has rarely been seen in patients with K. pneumoniae infection. To date, there are only two reports in the English literature about K. pneumoniae bacteraemia presenting as generalized pustulosis. We report a third case, occurring in a Taiwanese woman with a community-acquired K. pneumoniae liver abscess leading to sepsis and generalized pustules, complicated by cutaneous leucocytoclastic vasculitis.
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Affiliation(s)
- H Y Huang
- Department of Dermatology, Mackay Memorial Hospital, Taipei, Taiwan
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12
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Kutukculer N, Genel F, Aksu G, Karapinar B, Ozturk C, Cavusoglu C, Casanova JL, Fieschi C. Cutaneous leukocytoclastic vasculitis in a child with interleukin-12 receptor beta-1 deficiency. J Pediatr 2006; 148:407-9. [PMID: 16615980 DOI: 10.1016/j.jpeds.2005.10.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Revised: 08/11/2005] [Accepted: 10/03/2005] [Indexed: 11/25/2022]
Abstract
We report a patient with complete interleukin-12 receptor beta-1 deficiency associated with cutaneous leukocytoclastic vasculitis. The patient experienced Bacille Calmette Guérin, Mycobacterium chelonae, and Salmonella enteritidis infection. Vasculitis affecting both small arteries and postcapillary venules due to deposition of immune complexes was probably caused by S. enteritidis and/or M. chelonae infection.
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MESH Headings
- Animals
- Cattle
- Child
- Consanguinity
- Female
- Humans
- Mycobacterium Infections, Nontuberculous/diagnosis
- Mycobacterium Infections, Nontuberculous/drug therapy
- Mycobacterium bovis/isolation & purification
- Mycobacterium chelonae/isolation & purification
- Psoas Abscess/microbiology
- Receptors, Interleukin/deficiency
- Receptors, Interleukin-12
- Salmonella Infections/diagnosis
- Salmonella Infections/drug therapy
- Salmonella enteritidis/isolation & purification
- Splenomegaly/surgery
- Tuberculosis, Bovine/diagnosis
- Tuberculosis, Bovine/drug therapy
- Vasculitis, Leukocytoclastic, Cutaneous/drug therapy
- Vasculitis, Leukocytoclastic, Cutaneous/microbiology
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Affiliation(s)
- Necil Kutukculer
- Department of Pediatrics, Ege University Medical School, Izmir, Turkey.
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Kathiresan S, Kelsey PB, Steere AC, Foster CS, Curvelo MS, Stone JR. Case records of the Massachusetts General Hospital. Case 14-2005. A 38-year-old man with fever and blurred vision. N Engl J Med 2005; 352:2003-12. [PMID: 15888702 DOI: 10.1056/nejmcpc059010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Sekar Kathiresan
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, USA
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