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Hofstrand R, Casey B, Onyeaso E. Hemophagocytic Lymphohistiocytosis Secondary to Obstructive Uropathy and Escherichia coli Bacteremia. Cureus 2023; 15:e41779. [PMID: 37575709 PMCID: PMC10418134 DOI: 10.7759/cureus.41779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 08/15/2023] Open
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare syndrome in which widespread activation of the immune system causes multi-organ tissue damage. HLH is a serious and potentially fatal disorder characterized by excessive immune system activation. It is characterized by a dysregulation in natural killer (NK) T-cell function, causing activation of lymphocytes and histiocytes. These cells secrete a large number of inflammatory cytokines and infiltrate various tissues causing multi-organ system failure. The spectrum consists of hereditary or "primary" HLH that comprises genetically heterogeneous conditions, occurring during childhood. The secondary form presents later in life and is associated with several conditions mainly malignancy, autoimmune diseases, viral or bacterial infections, and hematological diseases. Here we present an interesting case in which a 39-year-old patient presented with a complaint of shortness of breath. He was diagnosed with obstructive uropathy in the emergency department and subsequently developed acute liver injury, acute kidney injury, Escherichia coli bacteremia, and was diagnosed with HLH with comorbid bacteremia.
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Affiliation(s)
- Reese Hofstrand
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA
| | - Bradley Casey
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA
| | - Elizabeth Onyeaso
- Internal Medicine/Infectious Disease, Cape Fear Valley Medical Center, Fayetteville, USA
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Hofstrand R, Portela R, Juneau R, Okafor C, Watts R. Hemorrhagic Stroke Due to Varicella Zoster Virus Vasculopathy. Cureus 2023; 15:e36604. [PMID: 37102032 PMCID: PMC10123232 DOI: 10.7759/cureus.36604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 04/28/2023] Open
Abstract
Varicella-zoster virus (VZV) vasculopathy is a granulomatous vasculitis that has a wide variety of clinical presentations. It is most common in patients with HIV not on anti-retroviral therapy (ART) with low cluster of differentiation (CD)4 cell counts. This disease affects the central nervous system and can cause small intracranial bleeds. Our patient presented with stroke-like symptoms in the setting of recent VZV reactivation in the ophthalmic distribution with HIV on ART. Her MRI scan showed a small punctate bleed and the CSF workup was consistent with VZV vasculitis. She was treated with 14 days of acyclovir and five days of high-dose steroids with clinical improvement to baseline.
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Affiliation(s)
- Reese Hofstrand
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA
| | - Rafael Portela
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA
| | - Ryan Juneau
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA
| | - Chika Okafor
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA
| | - Ryan Watts
- Cardiothoracic Surgery, Campbell University School of Osteopathic Medicine, Lillington, USA
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Casey B, Hofstrand R, Bahekar A, Patel D, Chhetri B. Unusual Presentation of an Inguinal Bladder Hernia. Cureus 2023; 15:e35594. [PMID: 37007429 PMCID: PMC10063245 DOI: 10.7759/cureus.35594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2023] [Indexed: 03/06/2023] Open
Abstract
Cases of an inguinal bladder hernia (IBH) are rare as the diagnosis may be challenging because patients are often asymptomatic or have nonspecific symptoms. When patients are symptomatic, normally they complain of urinary symptoms. Our patient initially presented to the hospital because he had a ground-level fall after having chest pain while transitioning from a bed to a wheelchair. Incidentally in the emergency department, he was found to have scrotal edema, which was later diagnosed as inguinal bladder herniation. The patient did not have any further episodes of chest pain or abdominal pain once he was given medicinal therapy for his IBH. Surgery is usually the definitive treatment for inguinal bladder herniation, but our patient wished to try medicinal therapy and follow-up outpatient.
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Colon RP, Hofstrand R, Clar D, Bonilla AL, Trinnel D. Young female with extensive deep vein thrombosis due to may-thurner syndrome with additional compression by large uterine fibroid. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00124-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Colon RP, Hofstrand R, Clar D, Trinnel D. Direct bilirubinemia 15 years after cholecystectomy, a case of post-cholecystectomy syndrome. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00168-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Casey B, Hofstrand R, Patel D, Bahekar A, Chapa-Rodriguez A. Hypokalemia-Induced Cardiac Arrest. Cureus 2023; 15:e35034. [PMID: 36942187 PMCID: PMC10023261 DOI: 10.7759/cureus.35034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 02/17/2023] Open
Abstract
Renal tubular acidosis (RTA) refers to a group of disorders in which the elimination of hydrogen ions from the kidney or the reabsorption of filtered bicarbonate is impaired, resulting in metabolic acidosis. Hypokalemia is also prominent in different types of RTA. We are presenting an interesting case about a chronic alcoholic patient who presented to the emergency department and was found to be severely hypokalemic. During her hospital stay, she had multiple cardiac arrests likely secondary to her hypokalemia despite adequate treatment with potassium supplementation. We came to the conclusion of distal RTA in our patient based on hyperchloremic metabolic acidosis, sodium bicarbonate of 10 mmol/L, low potassium, blood urea nitrogen, and creatinine within normal limits, alkaline urine, and a positive urinary anion gap. It is likely that the cause of our patient's underlying type 1 RTA was secondary to her chronic alcohol abuse. Her potassium eventually returned to baseline, and she was discharged.
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Affiliation(s)
- Bradley Casey
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA
| | - Reese Hofstrand
- Internal Medicine, Cape Fear Valley Medical Center, Fayetteville, USA
| | - Divyang Patel
- Cardiology, Cape Fear Valley Medical Center, Fayetteville, USA
| | - Amol Bahekar
- Cardiology, Cape Fear Valley Medical Center, Fayetteville, USA
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Villamizar O, Chambers CB, Mo YY, Torry DS, Hofstrand R, Riberdy JM, Persons DA, Wilber A. Data in support of transcriptional regulation and function of Fas-antisense long noncoding RNA during human erythropoiesis. Data Brief 2016; 7:1288-95. [PMID: 27141526 PMCID: PMC4838931 DOI: 10.1016/j.dib.2016.03.106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 03/28/2016] [Accepted: 03/31/2016] [Indexed: 11/24/2022] Open
Abstract
This paper describes data related to a research article titled, “Fas-antisense long noncoding RNA is differentially expressed during maturation of human erythrocytes and confers resistance to Fas-mediated cell death” [1]. Long noncoding RNAs (lncRNAs) are increasingly appreciated for their capacity to regulate many steps of gene expression. While recent studies suggest that many lncRNAs are functional, the scope of their actions throughout human biology is largely undefined including human red blood cell development (erythropoiesis). Here we include expression data for 82 lncRNAs during early, intermediate and late stages of human erythropoiesis using a commercial qPCR Array. From these data, we identified lncRNA Fas-antisense 1 (Fas-AS1 or Saf) described in the research article. Also included are 5′ untranslated sequences (UTR) for lncRNA Saf with transcription factor target sequences identified. Quantitative RT-PCR data demonstrate relative levels of critical erythroid transcription factors, GATA-1 and KLF1, in K562 human erythroleukemia cells and maturing erythroblasts derived from human CD34+ cells. End point and quantitative RT-PCR data for cDNA prepared using random hexamers versus oligo(dT)18 revealed that lncRNA Saf is not effectively polyadenylated. Finally, we include flow cytometry histograms demonstrating Fas levels on maturing erythroblasts derived from human CD34+ cells transduced using mock conditions or with lentivirus particles encoding for Saf.
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Affiliation(s)
- Olga Villamizar
- Department of Medical Microbiology, Immunology and Cell Biology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Christopher B Chambers
- Department of Medical Microbiology, Immunology and Cell Biology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Yin-Yuan Mo
- Department of Medical Microbiology, Immunology and Cell Biology, Southern Illinois University School of Medicine, Springfield, IL, USA; Department of Pharmacology and Toxicology and Cancer Institute, University of Mississippi Medical Center, Jackson, MS, USA
| | - Donald S Torry
- Department of Medical Microbiology, Immunology and Cell Biology, Southern Illinois University School of Medicine, Springfield, IL, USA; Simmons Cancer Institute, Springfield, IL, USA
| | - Reese Hofstrand
- Department of Medical Microbiology, Immunology and Cell Biology, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Janice M Riberdy
- Department of Hematology, St. Jude Children׳s Research Hospital, Memphis, TN, USA
| | - Derek A Persons
- Department of Hematology, St. Jude Children׳s Research Hospital, Memphis, TN, USA
| | - Andrew Wilber
- Department of Medical Microbiology, Immunology and Cell Biology, Southern Illinois University School of Medicine, Springfield, IL, USA; Simmons Cancer Institute, Springfield, IL, USA
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