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Rijal R, Kandel K, Aryal BB, Asija A, Shrestha DB, Sedhai YR. Waterhouse-Friderichsen syndrome, septic adrenal apoplexy. VITAMINS AND HORMONES 2023; 124:449-461. [PMID: 38408808 DOI: 10.1016/bs.vh.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
Waterhouse-Friderichsen syndrome is a rare but potentially fatal disorder of the adrenal gland characterized by bilateral adrenal hemorrhage. It is classically a result of meningococcal sepsis and presents acutely with features of shock, petechial rashes, abdominal pain, and non-specific symptoms such as headache, fatigue, and vomiting. Treatment consists of fluid resuscitation, corticosteroid replacement, and possibly surgery. The prognosis is poor despite treatment. This chapter will review the etiology, pathogenesis, clinical features, and management of the disease.
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Affiliation(s)
- Rishikesh Rijal
- University of Louisville School of Medicine, Louisville, KY, United States.
| | - Kamal Kandel
- Matri Shishu Miteri Hospital, Gandaki Province, Nepal
| | - Barun Babu Aryal
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, IL, United States.
| | - Ankush Asija
- Division of Nephrology, Indiana University, Indianapolis, IN, United States.
| | | | - Yub Raj Sedhai
- Division of Pulmonary Disease and Critical Care Medicine, University of Kentucky College of Medicine, Bowling Green, KY, United States.
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Cousin E, Belicard F, Michel L, Pronier C, Lassalle N, Lamy T, Houot R, Lhomme F. Severe cytomegalovirus disease with encephalitis after CAR-T cell therapy: A rare but potentially fatal complication. J Med Virol 2021; 93:6398-6403. [PMID: 34370316 DOI: 10.1002/jmv.27257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/02/2021] [Indexed: 11/09/2022]
Abstract
Cytomegalovirus (CMV) is a ubiquitous herpes virus that develops lifelong latency following primary infection and can be reactivated following immune suppression. CMV encephalopathy has been described in few reports after hematopoietic stem cell transplantation and in patients with acquired immunodeficiency syndrome. To the best of our knowledge, CMV encephalopathy following CAR-T cells infusion had not been previously reported. Initial CMV viral load and monitoring are crucial in patients with CAR-T cells to allow early intervention with aggressive antiviral treatment without delay if needed.
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Affiliation(s)
- Elie Cousin
- Department of Hematology, Rennes University Hospital, Rennes, France
| | - Félicie Belicard
- Department of Hematology, Rennes University Hospital, Rennes, France
| | - Laure Michel
- Department of Neurology, Rennes University Hospital, Rennes, France.,Clinical Neuroscience Centre, Rennes University Hospital, Rennes University, Rennes, France
| | | | - Nicolas Lassalle
- Department of Radiology, Rennes University Hospital, Rennes, France
| | - Thierry Lamy
- Department of Hematology, Rennes University Hospital, Rennes, France
| | - Roch Houot
- Department of Hematology, Rennes University Hospital, Rennes, France
| | - Faustine Lhomme
- Department of Hematology, Rennes University Hospital, Rennes, France
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Case control study: magnetic resonance spectroscopy of brain in HIV infected patients. BMC Neurol 2016; 16:99. [PMID: 27405321 PMCID: PMC4942893 DOI: 10.1186/s12883-016-0628-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 06/22/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND In vivo proton magnetic resonance spectroscopy ((1)H-MRS) studies on brain in HIV infected patients have shown significant alteration in neuro-biochemicals. METHODS In this study, we measured the neuro-biochemical metabolites from the left frontal white matter (FWM) and left basal ganglia (BG) caudate head nucleus in 71 subjects that include 30 healthy controls, 20 asymptomatic HIV and 21 HIV patients with CNS lesion. Proton MR spectra were acquired at 3 T MRI system and the concentration (institutional units) of tNAA (N-acetylaspartate, NAA + N-acetylaspartylglutamate, NAAG), tCr (Creatine, Cr + phosphocreatine, PCr), choline containing compounds (tCho), glutamate + glutamine (Glx) and lipid and macromolecules at 0.9 ppm were determined using LC Model. RESULTS In BG, the concentration of tNAA (6.71 ± 0.64) was decreased and in FWM, the concentration of Glx (20.4 ± 7.8), tCr (9.14 ± 3.04) and lipid and macromolecules at 0.9 ppm (8.69 ± 2.96) were increased in HIV patients with CNS lesion. In healthy controls, the concentration of tNAA in BG was 7.31 ± 0.47 and concentration of Glx, tCr and lipid and macromolecules in FWM were 15.0 ± 6.06, 6.95 ± 2.56, 5.59 ± 1.56, respectively. CONCLUSION Reduced tNAA in BG suggests neuronal loss in HIV patients with CNS lesion while increased Glx in FWM may suggest excito-toxicity. In addition, increased levels of tCr in FWM of HIV patients were observed. The study indicates region specific metabolic changes in tNAA, tCr and Glx in brain of HIV infected patients.
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Musso CG, Belloso WH, Glassock RJ. Water, electrolytes, and acid-base alterations in human immunodeficiency virus infected patients. World J Nephrol 2016; 5:33-42. [PMID: 26788462 PMCID: PMC4707166 DOI: 10.5527/wjn.v5.i1.33] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 09/05/2015] [Accepted: 11/17/2015] [Indexed: 02/06/2023] Open
Abstract
The clinical spectrum of human immunodeficiency virus (HIV) infection associated disease has changed significantly over the past decade, mainly due to the wide availability and improvement of combination antiretroviral therapy regiments. Serious complications associated with profound immunodeficiency are nowadays fortunately rare in patients with adequate access to care and treatment. However, HIV infected patients, and particularly those with acquired immune deficiency syndrome, are predisposed to a host of different water, electrolyte, and acid-base disorders (sometimes with opposite characteristics), since they have a modified renal physiology (reduced free water clearance, and relatively increased fractional excretion of calcium and magnesium) and they are also exposed to infectious, inflammatory, endocrinological, oncological variables which promote clinical conditions (such as fever, tachypnea, vomiting, diarrhea, polyuria, and delirium), and may require a variety of medical interventions (antiviral medication, antibiotics, antineoplastic agents), whose combination predispose them to undermine their homeostatic capability. As many of these disturbances may remain clinically silent until reaching an advanced condition, high awareness is advisable, particularly in patients with late diagnosis, concomitant inflammatory conditions and opportunistic diseases. These disorders contribute to both morbidity and mortality in HIV infected patients.
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Xu L, Ye H, Huang F, Yang Z, Zhu B, Xu Y, Qiu Y, Li L. Moderate/Severe hyponatremia increases the risk of death among hospitalized Chinese human immunodeficiency virus/acquired immunodeficiency syndrome patients. PLoS One 2014; 9:e111077. [PMID: 25360785 PMCID: PMC4215865 DOI: 10.1371/journal.pone.0111077] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 09/21/2014] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES To evaluate whether the serum sodium concentration is associated with the progression and long-term prognosis of Chinese HIV/AIDS patients. METHODS Three hundred and eighty seven hospitalized patients were recruited into this retrospective cohort study. The strata of serum sodium concentration were moderate/severe hyponatremia, mild hyponatremia and normonatremia. Disease progression was estimated using CD4 counts and the WHO clinical stage. Correlation analysis was used to evaluate the serum sodium concentration with disease progression. The Kaplan-Meier method and the Cox proportional hazards model were used to analyze the effect of different serum sodium levels on survival. RESULTS In this study 206 patients (53.2%) had hyponatremia, including 10.6% patients with moderate/severe hyponatremia and 42.6% with mild hyponatremia. The serum sodium concentration was significantly correlated with the HIV/AIDS progression (P<0.001). During the follow-up, 100 patients (25.6%) died. The cumulative survival rates of HIV/AIDS patients were 47.8% ± 8.5% in patients with moderate/severe hyponatremia, 59.8% ± 5.0% with mild hyponatremia and 79.9% ± 3.4% with normonatremia (log-rank P<0.001). After adjusting for sex, age, WHO stage, CD4 count, hemoglobin and albumin, the relative hazard was 3.5 (95% CI: 1.9-6.5) for patients with moderate/severe hyponatremia (P<0.001), and 1.5 (95% CI: 0.9-2.4) for those with mild hyponatremia (P = 0.161), compared with normonatremic patients. CONCLUSIONS The serum sodium level is closely correlated with the severity of patients. Only moderate/severe hyponatremia affects the prognosis of Chinese HIV/AIDS patients. Earlier intensive medical managements(including HAART)are necessary to increase the survival rates of Chinese HIV/AIDS patients with moderate/severe hyponatremia.
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Affiliation(s)
- Lijun Xu
- The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, China
| | - Hanhui Ye
- Clinical Center of HIV/AIDS, Fuzhou Infectious Disease Hospital, Fujian Medical University, Fuzhou City, China
| | - Fan Huang
- Department of Infectious Diseases, Jianxin Hospital of Fujian Province, Fuzhou City, China
| | - Zongxing Yang
- The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, China
| | - Biao Zhu
- The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, China
| | - Yan Xu
- The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, China
| | - Yunqing Qiu
- The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, China
| | - Lanjuan Li
- The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou City, China
- * E-mail:
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Bal A, Dhooria S, Agarwal R, Garg M, Das A. Multiple and atypical opportunistic infections in a HIV patient with Toxoplasma myocarditis. Cardiovasc Pathol 2014; 23:358-62. [PMID: 25060385 DOI: 10.1016/j.carpath.2014.06.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Revised: 06/12/2014] [Accepted: 06/12/2014] [Indexed: 10/25/2022] Open
Abstract
Opportunistic infections cause significant morbidity and mortality in patients infected with the human immunodeficiency virus (HIV). Multiple opportunistic infections can occur in a patient in the setting of severe immunodeficiency and can have atypical clinicoradiological presentation. Cardiac involvement has also been observed on autopsy in HIV-infected patients in the form of myocarditis, dilated cardiomyopathy, endocarditis, neoplasms, and drug-related cardiotoxicity. Mostly, the cardiac opportunistic infections are clinically asymptomatic, and sudden death due to these is extremely rare. We report a case of 44-year-old gentleman who presented with cough, pleuritic chest pain, and breathlessness and died of refractory shock due to myocarditis. At autopsy, he was found to have Toxoplasma myocarditis, Pneumocystis jirovecii pneumonia, and cytomegalovirus adrenalitis.
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Affiliation(s)
- Amanjit Bal
- Department of Histopathology, Post Graduate Institute of Medical Education & Research, (PGIMER), Sector-12, Chandigarh 160012, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education & Research, (PGIMER), Sector-12, Chandigarh 160012, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education & Research, (PGIMER), Sector-12, Chandigarh 160012, India
| | - Mandeep Garg
- Department of Radiodiagnosis, Post Graduate Institute of Medical Education & Research, (PGIMER), Sector-12, Chandigarh 160012, India
| | - Ashim Das
- Department of Histopathology, Post Graduate Institute of Medical Education & Research, (PGIMER), Sector-12, Chandigarh 160012, India.
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Upadhyay J, Sudhindra P, Abraham G, Trivedi N. Tuberculosis of the adrenal gland: a case report and review of the literature of infections of the adrenal gland. Int J Endocrinol 2014; 2014:876037. [PMID: 25165474 PMCID: PMC4138934 DOI: 10.1155/2014/876037] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 07/15/2014] [Accepted: 07/16/2014] [Indexed: 12/14/2022] Open
Abstract
Infections of the adrenal glands remain an important cause of adrenal insufficiency, especially in the developing world. Indeed, when Thomas Addison first described the condition that now bears his name over 150 years ago, the vast majority of cases were attributable to tuberculosis. Here we describe a classic, but relatively uncommon, presentation in the United States of adrenal insufficiency followed by a review of the current literature pertaining to adrenal infections.
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Affiliation(s)
- Jagriti Upadhyay
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01760, USA
- *Jagriti Upadhyay:
| | - Praveen Sudhindra
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01760, USA
| | - George Abraham
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01760, USA
| | - Nitin Trivedi
- Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA 01760, USA
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Hiramine S, Murata M, Sakemi R, Ohnishi H, Ogawa E, Taniai H, Nagasaki Y, Furusyo N, Hayashi J. [Case report: An AIDS patient with adrenal crisis after immune reconstitution inflammatory syndrome due to Pneumocystis jiroveci pneumonia]. ACTA ACUST UNITED AC 2012; 101:1389-92. [PMID: 22693860 DOI: 10.2169/naika.101.1389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Satoshi Hiramine
- Department of General Internal Medicine, Kyushu University Hospital, Japan
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Abstract
PURPOSE OF REVIEW Adrenal dysfunction can increase morbidity and mortality among patients with HIV infection. Disorders and medications affecting cortisol, aldosterone or adrenal androgens in patients with HIV infection are reviewed. RECENT FINDINGS Iatrogenic Cushing's syndrome and hypothalamic-pituitary-adrenal suppression from concomitant use of ritonavir with nonsystemic corticosteroids such as intra-articular triamcinolone in addition to the previously reported interactions with inhaled fluticasone are increasingly recognized in HIV patients. Integrated measure of aldosterone throughout the day is higher in patients with HIV-associated visceral adipose tissue accumulation. SUMMARY Abnormalities in adrenal function are more common in HIV patients than in the general population. HIV care providers should pursue workup for adrenal dysfunction in HIV patients when symptoms or signs are present, especially in patients with advanced AIDS or receiving medications that can affect adrenal function. The clinical implications of aldosterone elevation in HIV patients with visceral adiposity will need to be examined in future research studies.
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Affiliation(s)
- Janet Lo
- Program in Nutritional Metabolism and Neuroendocrine Clinic, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA
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Abstract
Cytomegalovirus (CMV) is an important pathogen in organ-transplant recipients. There have been frequent reports of CMV-induced adrenal insufficiency in patients with human immunodeficiency virus infection. Herein, we report CMV-induced renal insufficiency in a renal transplant recipient. A 24-year-old woman had gradual onset of weakness, anorexia, nausea, hypotension, and skin hyperpigmentation at 5 months after renal transplantation. The immunosuppression regimen included cyclosporine, mycophenolate mofetil, and corticosteroid (prednisolone, 5 mg/d). Recent history included acute CMV infection, which was treated with ganciclovir. Basal serum cortisol concentration was 4 microg/dL, and stimulated serum cortisol concentration was less than 10 microg/dL. All clinical signs and symptoms and hypotension gradually improved after the oral prednisolone dose was increased to 10 mg/d. Clinicians must be aware of the possibility of CMV-induced adrenal insufficiency in renal transplant recipients. The condition may be symptomatic despite low-dose prednisolone therapy.
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Affiliation(s)
- M Ardalan
- Nephrology Department, Tabriz University of Medical Sciences, Tabriz, Iran.
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Current world literature. Curr Opin Endocrinol Diabetes Obes 2009; 16:260-77. [PMID: 19390324 DOI: 10.1097/med.0b013e32832c937e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Mercedes Panizo M, Reviákina V, Navas T, Casanova K, Sáez A, Napoleón Guevara R, María Cáceres A, Vera R, Sucre C, Arbona E. Neumocistosis en pacientes venezolanos: diagnóstico y epidemiología (2001-2006). Rev Iberoam Micol 2008; 25:226-31. [DOI: 10.1016/s1130-1406(08)70054-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Hecht L, Saeger W, Püschel K. Plötzlicher Tod bei Erkrankungen der Hypophyse und der Nebennieren. Rechtsmedizin (Berl) 2008. [DOI: 10.1007/s00194-008-0548-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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