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Proietti J, Fiorini E, Cantalupo G, Fontana E, Lo Barco T, Bonin C, Bernardina BD, Darra F. Refractory tonic-myoclonic status epilepticus with catamenial recurrence in epilepsy with myoclonic atonic seizures: A case report. Heliyon 2024; 10:e24747. [PMID: 38304836 PMCID: PMC10831770 DOI: 10.1016/j.heliyon.2024.e24747] [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] [Received: 09/19/2023] [Revised: 12/08/2023] [Accepted: 01/12/2024] [Indexed: 02/03/2024] Open
Abstract
In epilepsy with myoclonic-atonic seizures (EMA), status epilepticus (SE) may occur during the onset phase, uncommonly in post-puberal patients. We report a post-puberal patient with EMA who presented SE with insidious onset and catamenial recurrence. She had a stormy epilepsy onset at 4 years, with tonic seizures, atypical absences, and myoclonic-atonic seizures, in the absence of SE. After the onset phase, sporadic nocturnal tonic seizures persisted and a mild intellectual disability appeared. At the age of 7, after gonadotropin-releasing hormone analog administration due to central precocious puberty, she presented with SE characterized by recurrent atypical absences, tonic seizures, and awareness impairment, which was successfully treated in 4 days. At 11 years, one week before menstruation, the patient presented with analogous SE that lasted 8 days. One week before the subsequent menstruation, she presented again with SE, initially characterized by atypical absences alternating with phases of awareness and motor impairment related to fast low-voltage EEG activity in the central regions; later, tonic and myoclonic seizures occurring even in the awake state increased, and the "atonic-akinetic status" related to fast EEG activity worsened. After conventional antiepileptic drugs had failed to control the seizures, a progestin was added, with subsequent gradual complete recovery.
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Affiliation(s)
- Jacopo Proietti
- UOC Neuropsichiatria Infantile, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Integrata, Verona, Italy - Full member of ERN EpiCARE
- Innovation biomedicine Section, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
| | - Elena Fiorini
- UOC Neuropsichiatria Infantile, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Integrata, Verona, Italy - Full member of ERN EpiCARE
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
| | - Gaetano Cantalupo
- UOC Neuropsichiatria Infantile, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Integrata, Verona, Italy - Full member of ERN EpiCARE
- Innovation biomedicine Section, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
| | - Elena Fontana
- UOC Neuropsichiatria Infantile, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Integrata, Verona, Italy - Full member of ERN EpiCARE
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
| | - Tommaso Lo Barco
- UOC Neuropsichiatria Infantile, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Integrata, Verona, Italy - Full member of ERN EpiCARE
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
| | - Cecilia Bonin
- U.O.C. Ostetricia e Ginecologia B, Dipartimento di Ostetricia e Ginecologia, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Francesca Darra
- UOC Neuropsichiatria Infantile, Dipartimento Materno-Infantile, Azienda Ospedaliero-Universitaria Integrata, Verona, Italy - Full member of ERN EpiCARE
- Innovation biomedicine Section, Department of Engineering for Innovation Medicine, University of Verona, Verona, Italy
- Center for Research on Epilepsies in Pediatric age (CREP), Verona, Italy
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Chetambath R, Kumar P, Nandini V, Chandran S, Chacko A. Catamenial haemothorax-A rare cause of pleural effusion. Lung India 2023; 40:541-544. [PMID: 37961963 PMCID: PMC10723198 DOI: 10.4103/lungindia.lungindia_144_23] [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] [Received: 03/27/2023] [Revised: 04/10/2023] [Accepted: 04/26/2023] [Indexed: 11/15/2023] Open
Abstract
Common causes of haemorrhagic pleural effusions include malignancy (primary or metastatic), tuberculosis, pulmonary embolism, collagen vascular diseases, trauma and iatrogenic causes. Clinical history along with pathologic, microbiologic and biochemical evaluation of pleural fluid confirms the diagnosis in most cases. However, if there is recurrent haemorrhagic effusion without corroborative history or mass lesion in lung, or evidence of microorganisms, then we should think of uncommon causes. Catamenial haemothorax (CHt) is a rare cause of haemorrhagic pleural effusion, which recurs during each menstrual cycle. This is a manifestation of thoracic endometriosis syndrome (TES) caused by ectopic endometrial tissue in the thoracic cavity in women of child-bearing age. This extremely rare condition is difficult to diagnose, unless direct correlation with the menstrual cycle is established. TES consists of pleural forms such as catamenial pneumothorax, non-catamenial endometriosis-related pneumothorax and haemothorax; and parenchymal forms such as catamenial haemoptysis and lung nodules. Here we report a case of CHt in a 43-year-old female whose diagnosis was established by thoracoscopic pleural biopsy.
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Affiliation(s)
| | - Praveen Kumar
- Department of Pulmonology, Baby Memorial Hospital, Kozhikode, Kerala, India
| | - V Nandini
- Department of Pulmonology, Baby Memorial Hospital, Kozhikode, Kerala, India
| | - Shilpa Chandran
- Department of Pulmonology, Baby Memorial Hospital, Kozhikode, Kerala, India
| | - Anju Chacko
- Department of Pulmonology, Baby Memorial Hospital, Kozhikode, Kerala, India
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3
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Elsayed A, Elmarasi M, Hamad A, Habib MB. Recurrent asymptomatic large pleural effusion due to endometriosis. A case report. Respir Med Case Rep 2023; 44:101877. [PMID: 37332848 PMCID: PMC10272489 DOI: 10.1016/j.rmcr.2023.101877] [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] [Received: 05/01/2023] [Accepted: 05/26/2023] [Indexed: 06/20/2023] Open
Abstract
Pleural endometriosis is a rare manifestation of endometriosis that usually presents with catamenial symptoms, with or without complications. Here, we present a case of incidentally discovered pleural involvement of endometriosis in an asymptomatic young female. Pleurocentesis revealed bloody exudative pleural effusion with lymphocytic predominance. Thoracoscopy revealed inflamed parietal pleura, and the biopsy confirmed endometriotic involvement.
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Affiliation(s)
| | | | - Abdulrahman Hamad
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Mhd Baraa Habib
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
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Abstract
Sex and gender differences in epilepsy are important influencing factors in epilepsy care. In epilepsy, the hormonal differences between the sexes are important as they impact specific treatment considerations for patients at various life stages particularly during early adulthood with establishment of the menstrual cycle, pregnancy, perimenopause and menopause. Choice of antiseizure medication may have direct consequences on hormonal cycles, hormonal contraception, pregnancy and fetal risk of major congenital malformation. Conversely hormones whether intrinsic or extrinsically administered may have direct impact on antiseizure medications and seizure control. This chapter explores these important influences on the management of persons with epilepsy.
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Affiliation(s)
- Lauren Hophing
- Krembil Brain Institute, University Health Network, University of Toronto, Toronto, Canada
| | | | - Esther Bui
- Krembil Brain Institute, University Health Network, University of Toronto, Toronto, Canada.
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5
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Kardaman N, Nizami M, Marciniak S, Hogan J, Aresu G. Catamenial pneumothorax. Ann R Coll Surg Engl 2021; 104:e109-e112. [PMID: 34825583 DOI: 10.1308/rcsann.2021.0164] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Thoracic endometriosis syndrome is an under-recognised manifestation of endometriosis and includes catamenial pneumothorax, catamenial haemothorax, catamenial haemoptysis and pulmonary nodules. Catamenial pneumothorax presents as recurrent spontaneous pneumothorax with a temporal relationship to the onset of menses, affecting mostly the right lung. A 48-year-old woman presented with an eight-year history of right-sided catamenial pneumothorax, during which time she had three episodes of pneumothorax. Serial chest imaging revealed an enlarging mass overlying the right hemi-diaphragm. She was referred to our trust where she underwent video-assisted thoracoscopic surgery for right pleurectomy. Intraoperatively, defects were found in the right hemidiaphragm, through which parts of the liver had herniated. We describe the presenting features and management of catamenial pneumothorax.
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Affiliation(s)
- N Kardaman
- Royal Papworth Hospital Addenbrookes Biomedical Campus, UK
| | - M Nizami
- Papworth Hospital NHS Foundation Trust, UK
| | - S Marciniak
- Royal Papworth Hospital Addenbrookes Biomedical Campus, UK
| | - J Hogan
- Royal Papworth Hospital Addenbrookes Biomedical Campus, UK
| | - G Aresu
- Royal Papworth Hospital Addenbrookes Biomedical Campus, UK
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Bozkanat KM, West NE, Ladores S, Montemayor K, Tupayachi Ortiz MG, Christianson M, Jain R. Catamenial haemoptysis in females with cystic fibrosis: a case series with review of management strategies. Respirol Case Rep 2021; 9:e00755. [PMID: 33976884 PMCID: PMC8103099 DOI: 10.1002/rcr2.755] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 01/03/2023] Open
Abstract
Catamenial haemoptysis, the expectoration of blood during menses, has not been extensively reported in the cystic fibrosis (CF) literature. We describe four cases (age range: 25-34 years) of catamenial haemoptysis across four CF centres in the United States. These cases may represent thoracic endometriosis versus hormonal fluctuations in airway inflammation or infection resulting in bronchial artery bleeding. We identify common and nuanced management strategies including use of pro-coagulants, hormone contraceptives, anti-inflammatories, bronchial artery embolization, and use of the newer cystic fibrosis transmembrane conductance regulator (CFTR) modulators.
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Affiliation(s)
- Kubra M. Bozkanat
- Department of PediatricsUniversity of Texas Southwestern Medical CenterDallasTXUSA
| | - Natalie E. West
- Department of Internal MedicineJohns Hopkins UniversityBaltimoreMDUSA
| | - Sigrid Ladores
- School of NursingUniversity of Alabama at BirminghamBirminghamALUSA
| | | | | | - Mindy Christianson
- Department of Obstetrics and Gynecology, Internal MedicineJohns Hopkins UniversityBaltimoreMDUSA
| | - Raksha Jain
- Department of Internal MedicineUniversity of Texas Southwestern Medical CenterDallasTXUSA
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Verhulst E, Bafort C, Tomassetti C, Wolthuis A, Bielen D, Coolen J, Weynand B, Platteeuw L, Meuleman C, Van Raemdonck D. Endometriotic lung cyst causing catamenial hemoptysis; a case report and review of literature. Acta Chir Belg 2021; 122:432-437. [PMID: 33657969 DOI: 10.1080/00015458.2021.1887556] [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] [Indexed: 10/22/2022]
Abstract
We report a rare case of an endometriotic lung cyst in a 47-year woman with recurrent catamenial hemoptysis. Chest computed tomography (CT) obtained outside the menstruation in October 2019 revealed a cystic lesion (2.5 cm) located in the right inferior lobe near the distal esophagus and the inferior pulmonary vein. Compared to CT abdomen in May 2019, this lesion had increased with a larger volume and a thicker wall. An endometrial lung cyst was suspected as episodes of hemoptysis no longer occurred after initiating hormonal treatment with nomegestrol acetate. Exploratory video-assisted thoracoscopic surgery with wedge resection of the cyst was performed. Histopathologic examination confirmed the diagnosis of an endometriotic cystic lesion. Postoperative course was uneventful with no further symptoms since then.
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Affiliation(s)
- Evelyne Verhulst
- Faculty of Medicine, Catholic University Leuven, Leuven, Belgium
| | - Celine Bafort
- Doctoral School, Biomedical Sciences, Catholic University Leuven, Leuven, Belgium
| | - Carla Tomassetti
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Didier Bielen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Johan Coolen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Birgit Weynand
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | | | - Christel Meuleman
- Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
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Giordano T, MacDonald W. Thoracic endometriosis presenting as recurrent pleural effusions. Radiol Case Rep 2021; 16:250-253. [PMID: 33304436 PMCID: PMC7708763 DOI: 10.1016/j.radcr.2020.11.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 04/28/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 10/25/2022] Open
Abstract
In rare instances, endometrial glandular tissue can implant in the thorax of women suffering from endometriosis. The presentation is variable depending on site of implant and can be a rare cause of hemothorax in women. A 28-year-old woman presented with shortness of breath and was found to have a significant right sided hemothorax. The hemothorax was drained but subsequently recurred, with shortness of breath increasing around the time of her menses. Considerable workup was performed and ultimately surgery was required to diagnose her with thoracic endometriosis. This case describes how thoracic endometriosis is a challenging diagnosis and may be under reported in the literature. However, there are key elements of the disease that can prevent delay in diagnosis to reduce pain and suffering.
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Affiliation(s)
- Taylor Giordano
- Department of Radiology, Aurora St. Luke's, 2900 W Oklahoma Ave, Milwaukee, WI 53215, USA
| | - William MacDonald
- Department of Radiology, Aurora St. Luke's, 2900 W Oklahoma Ave, Milwaukee, WI 53215, USA
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9
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Padgett C. Recurrence of Symptoms Associated with Menstruation in a Patient with a History of Periodic Fevers. J Pediatr Adolesc Gynecol 2020; 33:429-431. [PMID: 32224248 DOI: 10.1016/j.jpag.2020.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/07/2020] [Accepted: 03/18/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA) syndrome is a cyclic autoinflammatory disease generally diagnosed in childhood. There have been studies suggesting a relationship between menstruation and other autoinflammatory syndromes such as familial Mediterranean fever (FMF), but not PFAPA specifically. CASE This case describes a patient with a diagnosis of PFAPA who experienced complete resolution with tonsillectomy only to have recurrence of symptoms with onset of menstruation. She experienced symptom control with initiation of oral contraceptives. SUMMARY AND CONCLUSION Prior to this case report, there had been no evidence in the literature suggesting a relationship between PFAPA and menstruation despite the observed association in other autoinflammatory syndromes. Onset of menses may be a trigger in PFAPA.
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Affiliation(s)
- Christina Padgett
- Department of Adolescent Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, New York.
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10
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Abstract
The functioning of the pleura and the endocrine system are not entirely independent of each other. Some hormones can reach a greater concentration in the pleural exudate than in the blood. However, the clinical significance of this finding remains unknown. In some circumstances, hormonal changes are responsible for pathological manifestations in the pleura. Hypothyroidism is one of the most common diseases that can cause a pleural effusion, likely resulting from alterations in capillary permeability. The presence of ectopic endometrial tissue within the lung parenchyma, pleura, pericardium or diaphragm is known as thoracic endometriosis and is one of the causes of catamenial pneumothorax and /or catamenial hemothorax, which can affect women of childbearing age and arises within 72 h from the onset of menstruation. Treatment and prevention of recurrent catamenial pneumothorax / hemothorax usually requires an approach that combines surgery and hormone therapy. Malignant pleural effusion from breast cancer may contain estrogen receptor-positive cells. In such a case, endocrine treatment may be effective in reducing the amount of pleural fluid and the associated symptoms. Thyroid cancer and lymphangioleiomyomatosis (LAM) are further hormone-sensitive malignancies in which pleura is frequently involved. The solitary fibrous tumor of pleura (SFPT) is an example of a pleural disease that can cause hormonal balance disorders. It can lead to a rise in the releasing factor for growth hormone (GHRH), human beta chorionic gonadotropin (Beta-hCG), and insulin-like growth factor 2 (IGF2). The consequence of such hormonal imbalance include hypertrophic pulmonary osteoarthropathy, gynecomastia, and refractory hypoglycemia, respectively.
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Affiliation(s)
- Claudio Sorino
- Division of Pulmonology, Sant'Anna Hospital, Como, Italy; University of Insubria, Varese, Italy.
| | | | - Antonio Spanevello
- University of Insubria, Varese, Italy; Division of Pulmonary Rehabilitation, Maugeri Care and Research Institute, IRCCS, Tradate, Italy
| | - David Feller-Kopman
- Division of Pulmonary, Critical Care, and Sleep Medicine, Johns Hopkins Hospital, USA
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Okyere I, Glover PSK, Forson PK, Okyere P, Blood-Dzraku D. Catamenial pneumothorax in Ghana: case report and literature review. Pan Afr Med J 2019; 33:287. [PMID: 31692942 PMCID: PMC6815506 DOI: 10.11604/pamj.2019.33.287.14187] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 06/23/2019] [Indexed: 11/11/2022] Open
Abstract
Catamenial pneumothorax is a rare condition that is often misdiagnosed. It is defined as spontaneous pneumothorax occurring within 72 hours before or after onset of menstruation. Etiology is unknown but could be linked to endometriosis. Pleural ablation via thoracoscopy and hormonal therapy are mainstay treatment options to avoid recurrence. We present a case of a young adult female who experienced gradual painless abdominal distention that resolved spontaneously after each menses twelve years post menarche. She was first seen at a peripheral facility where laparotomy undertaken was negative for suspected ectopic pregnancy. However, a bleeding omental mass was noticed and a biopsy taken. Histopathology reported it as an endometriotic tissue. The patient subsequently had recurrent cyclical chest pains and breathlessness leading to the diagnosis of catamenial pneumothorax. She had chemical pleurodesis done with sterile talc after chest tube drainage and has been well over two years now.
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Affiliation(s)
- Isaac Okyere
- Department of Surgery, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | | | - Paa Kobina Forson
- Department of Emergency Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Perditer Okyere
- Department of Internal Medicine, School of Medicine and Dentistry, College of Health Sciences, Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital, Kumasi, Ghana
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Zachary C, Fackler N, Juhasz M, Pham C, Mesinkovska NA. Catamenial dermatoses associated with autoimmune, inflammatory, and systemic diseases: A systematic review ,. Int J Womens Dermatol 2019; 5:361-367. [PMID: 31909158 PMCID: PMC6938828 DOI: 10.1016/j.ijwd.2019.09.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 04/17/2019] [Revised: 09/08/2019] [Accepted: 09/26/2019] [Indexed: 11/29/2022] Open
Abstract
Background Sex hormones are important in female sexual physiology, growth, and homeostasis. Through skin receptors, sex hormones contribute to the dermatologic pathology known as catamenial dermatoses. Objective This study aims to summarize the literature on catamenial dermatoses and menses-induced exacerbations of chronic dermatoses. Methods This systematic review used the PRISMA method. PubMed was searched using the terms “menses” and “skin” in July 2018, and an assessment was conducted of the relevant literature on skin diseases related to non-pathologic menstruation, such as polycystic ovarian syndrome. Pathology associated with androgenetic acne was excluded from the study. Results A total of 102 studies with 1269 female patients were included. The most commonly reported primary catamenial dermatoses were autoimmune progesterone dermatitis and autoimmune estrogen dermatitis. The most commonly reported chronic skin disorders exacerbated by menses were psoriasis, Behcet’s disease, and eczematous dermatoses. Conclusion Physicians should be aware of the nature of catamenial dermatoses and their presentation with normal sexual physiology. Patients with chronic dermatoses should be appropriately counseled on menstruation-related exacerbations. Further research needs to be conducted to determine the interplay between immune regulation and sex hormones in catamenial dermatoses and to elucidate effective therapies.
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Affiliation(s)
- Cameron Zachary
- Georgetown University, School of Medicine, Washington, D.C., United States.,University of California, Irvine, Department of Dermatology, Irvine, CA, United States
| | - Nathan Fackler
- Georgetown University, School of Medicine, Washington, D.C., United States.,University of California, Irvine, Department of Dermatology, Irvine, CA, United States
| | - Margit Juhasz
- University of California, Irvine, Department of Dermatology, Irvine, CA, United States
| | - Christine Pham
- University of California, Irvine, Department of Dermatology, Irvine, CA, United States.,University of California, Irvine, School of Medicine, Irvine, CA, United States
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AlAqeel S, AlJehani Y, AlMuhaish M. Bilateral catamenial hemopneumothorax: Diagnostic & management challenges. Int J Surg Case Rep 2019; 61:271-274. [PMID: 31398668 PMCID: PMC6699417 DOI: 10.1016/j.ijscr.2019.07.067] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 05/26/2019] [Revised: 07/19/2019] [Accepted: 07/24/2019] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Catamenial pneumothorax (CP) is a rare and usually miss diagnosed condition that is often characterized by non- specific respiratory or gynecological symptoms. A high index of suspicion is warranted for early diagnosis and management. PRESENTATION OF CASE We present a case of 34 year old female who presented with shortness of breath and dyspnea. DISCUSSION The radiological diagnosis was pneumothorax with further history, it was apparent that is was a case of primary infertility secondary to possible pelvic endometriosis. She was treated as a case of bilateral catamenial hemopneumothorax after confirming the diagnosis through surgical exploration & repair of right hemidiaphragm. CONCLUSIONS This case demonstrate the extensive bilateral catamenial hemopnemothorax which is limitedly described in the literature index of suspicion & early diagnosis and management would ensure multiple admission & recurrence.
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Affiliation(s)
- S AlAqeel
- National Guard Hospital, Al-Ahsa, P.O. BOX: 3165, Dammam, Saudi Arabia.
| | - Y AlJehani
- King Fahad University Hospital, P.O. BOX 31774, Khobar, 31952, Saudi Arabia.
| | - M AlMuhaish
- King Fahad University Hospital, P.O. BOX 31774, Khobar, 31952, Saudi Arabia.
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Abstract
Epilepsy and antiepileptic drugs affect the menstrual cycle, aspects of contraception, reproductive health, pregnancy, and menopause through alteration of sex steroid hormone pathways. Sex steroid hormones often have an effect on seizure frequency and may alter the level of some antiepileptic drugs. Approximately one-third of women experience an increase in perimenstrual and/or periovulatory seizure frequency. Some women experience an increase in seizure frequency during pregnancy. Balancing maternal seizure control and the risk of congenital malformations associated with fetal antiepileptic drug exposure may be challenging. Some antiepileptic drugs are associated with cognitive and behavioral teratogenesis and should be avoided if possible during pregnancy.
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Affiliation(s)
- Naymeé J Vélez-Ruiz
- Division of Epilepsy, Department of Neurology, University of Miami, 1120 Northwest, 14th Street, Suite 1329, Miami, FL 33136, USA.
| | - Page B Pennell
- Division of Epilepsy, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Harvard University, 75 Francis Street, Boston, MA 02115, USA; Division of Women's Health, Brigham and Women's Hospital, Harvard Medical School, Harvard University, 75 Francis Street, Boston, MA 02115, USA
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15
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Capek S, Amrami KK, Howe BM, Collins MS, Sandroni P, Cheville JC, Spinner RJ. Sequential imaging of intraneural sciatic nerve endometriosis provides insight into symptoms of cyclical sciatica. Acta Neurochir (Wien) 2016; 158:507-12; discussion 512. [PMID: 26743918 DOI: 10.1007/s00701-015-2683-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/14/2015] [Indexed: 12/30/2022]
Abstract
Endometriosis of the nerve often remains an elusive diagnosis. We report the first case of intraneural lumbosacral plexus endometriosis with sequential imaging at different phases of the menstrual cycle: during the luteal phase and menstruation. Compared to the first examination, the examination performed during the patient's period revealed the lumbosacral plexus larger and hyperintense on T2-weighted imaging. The intraneural endometriosis cyst was also larger and showed recent hemorrhage. Additionally, this case represents another example of perineural spread of endometriosis from the uterus to the lumbosacral plexus along the autonomic nerves and then distally to the sciatic nerve and proximally to the spinal nerves.
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Affiliation(s)
- Stepan Capek
- Department of Neurosurgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- 2nd Faculty of Medicine, Charles University in Prague, V Uvalu 84, 150 06, Prague 5, Czech Republic.
| | - Kimberly K Amrami
- Department of Radiology, Mayo Clinic, 200 First Street, Rochester, MN, 55905, USA.
| | - Benjamin M Howe
- Department of Radiology, Mayo Clinic, 200 First Street, Rochester, MN, 55905, USA.
| | - Mark S Collins
- Department of Radiology, Mayo Clinic, 200 First Street, Rochester, MN, 55905, USA.
| | - Paola Sandroni
- Department of Neurology, Mayo Clinic, 200 First Street, Rochester, MN, 55905, USA.
| | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, 200 First Street, Rochester, MN, 55905, USA.
| | - Robert J Spinner
- Department of Neurosurgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
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Elia S, De Felice L, Varvaras D, Sorrenti G, Mauriello A, Petrella G. Catamenial pneumothorax due to solitary localization of diaphragmatic endometriosis. Int J Surg Case Rep 2015; 12:19-22. [PMID: 25981153 PMCID: PMC4486100 DOI: 10.1016/j.ijscr.2015.05.012] [Citation(s) in RCA: 4] [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: 04/01/2015] [Revised: 04/27/2015] [Accepted: 05/04/2015] [Indexed: 11/19/2022] Open
Abstract
Catamenial pneumothorax is related to thoracic endometriosis syndrome. Diagnosis of catamenial pneumothorax is a difficult challenge and its treatment is controversial. We report a case of catamenial pneumothorax caused by a single diaphragmatic localization of thoracic endometriosis. Successful treatment consisted of combined video-assisted pleurodesis and postoperative hormonal therapy.
Introduction Catamenial pneumothorax (CP) is a spontaneous recurrent pneumothorax occurring in women in reproductive age. The etiology of CP has been associated with thoracic endometriosis and is its most common presentation. Presentation of case A case of right catamenial pneumothorax in a 38 year old woman is presented in which three episodes of CP occurred within 72 h of menses in a 6 month period. The patient underwent videothoracoscopy that revealed a solitary localization of diaphragmatic endometriosis. After surgical pleurodesis and based on final pathology of resected lesion, hormonal treatment was started. The outcome was uneventful and the patients is symptom-free at 6 months. Discussion Catamenial pneumothorax (CP) is a rare clinical entity characterized by lung collapse during menstruation, believed to be secondary to pleural endometriosis. Nearly all catamenial pneumothorax occur on the right side as pleural lesions are almost exclusively right-sided. Diagnostic imaging is based on high resolution computed tomography (HRCT) and, preferably, magnetic resonance imaging (MRI) since it is able to detect the blood products in the endometrial deposits. However the lack of macroscopic findings at surgery makes this condition still under-diagnosed. Based on the solitary diaphragmatic localization of endometriosis in our case we preferred to limit surgery to videothoracoscopic pleurodesis and start hormonal treatment with successful outcome. Conclusion Catamenial pneumothorax is the most common presentation of thoracic endometriosis syndrome and should always be suspected in women in childbearing age. Treatment option are still debated but best results are achieved by videothoracoscopic pleurodesis combined with hormonal therapy.
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Affiliation(s)
- Stefano Elia
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Italy.
| | - Laura De Felice
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Italy
| | - Dimitrios Varvaras
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Italy
| | - Giuseppe Sorrenti
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Italy
| | | | - Giuseppe Petrella
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Italy
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Herzog AG, Fowler KM, Sperling MR, Massaro JM. Distribution of seizures across the menstrual cycle in women with epilepsy. Epilepsia 2015; 56:e58-62. [PMID: 25823700 DOI: 10.1111/epi.12969] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [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: 02/12/2015] [Indexed: 01/11/2023]
Abstract
The purpose of this study was to determine whether seizure frequency and cycle days with seizure occurrence vary across the menstrual cycle. The subjects were the first 100 women with intractable focal onset seizures, 13-45 years old, who completed the baseline phase of the National Institutes of Health (NIH) Progesterone Trial. Each subject recorded seizures and menses during a 3-month baseline phase. Data consisted of (1) seizure numbers for each cycle day and (2) cycle days with seizure occurrence. Statistical comparisons of seizure frequency and days with seizures were performed using generalized estimating equation one-way analysis of variance (ANOVA) and logistic regression followed by pairwise multiple comparisons of days based on the least square means. Seizure numbers and cycle days with seizure occurrence varied across the menstrual cycle. There was an approximately twofold difference between the highest (day 1) and lowest (day -8) values for both seizure frequency and days with occurrence. The demonstration of variation in seizure frequency and cycle days with seizure occurrence across the menstrual cycle, as well as identification of specific days that have substantially higher or lower frequencies than other days, supports the existence of catamenial epilepsy.
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Affiliation(s)
- Andrew G Herzog
- Harvard Neuroendocrine Unit, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A
| | - Kristen M Fowler
- Harvard Neuroendocrine Unit, Beth Israel Deaconess Medical Center, Boston, Massachusetts, U.S.A
| | | | - Joseph M Massaro
- Harvard Clinical Research Institute, Boston, Massachusetts, U.S.A
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Herzog AG. Catamenial epilepsy: Update on prevalence, pathophysiology and treatment from the findings of the NIH Progesterone Treatment Trial. Seizure 2015; 28:18-25. [PMID: 25770028 DOI: 10.1016/j.seizure.2015.02.024] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 02/08/2015] [Accepted: 02/12/2015] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To extend our knowledge and practical application of the concept of catamenial epilepsy. METHODS The review focuses on the impact of the NIH Progesterone Trial on our understanding of the pathophysiology and treatment of catamenial epilepsy. RESULTS Catamenial epilepsy refers to the cyclic exacerbation of seizures in relation to the menstrual cycle. An interaction between seizures and the menstrual cycle is suggested by variations in seizure frequency according to the day, phase and ovulatory status of the menstrual cycle. There are three commonly recognized patterns: perimenstrual (C1: Day -3 to +3), peri-ovulatory (C2: Day 10 to 3) and entire luteal phase in anovulatory cycles (C3: Day 10 to 3). Pathophysiological determinants include 1) the neuroactive properties of reproductive steroids, 2) the variation of neuroactive steroid levels across the menstrual cycle and 3) the differential susceptibility of epileptic substrates to neuroactive steroid effects. Perimenstrual seizure exacerbation may result from the premenstrual withdrawal of progesterone which is accompanied by withdrawal of allopregnanolone, a potent positive allosteric modulator of the GABAA receptor, and changes in the subunit composition of the GABAA receptor to the α4 subtype which is insensitive to benzodiazepine and GABA. Bioidentical progesterone supplement is no better than placebo in the treatment of women with focal onset epilepsy overall but shows superior efficacy in women whose seizures show robust perimenstrual exacerbation. CONCLUSION There is sound evidence for the existence of catamenial epilepsy and class 3 evidence for adjunctive progesterone treatment of the perimenstrually exacerbated subtype.
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Affiliation(s)
- Andrew G Herzog
- Harvard Medical School, Harvard Neuroendocrine Unit, Beth Israel Deaconess Medical Center, Boston, MA 02481, USA.
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