rss

Recent eLetters

Displaying 1-10 letters out of 230 published

  1. A field level reality

    I am impressed by the straight forward write up with giving emphasis on practical aspects in field.

    Conflict of Interest:

    None declared

    Read all letters published for this article

    Submit response
  2. Re:isolated gastric sarcoidosis

    Dear Reader,

    Thank you for your comments and review of our case. You raise an interesting point regarding the connection between coniosis and sarcoidosis. Mineral particles were not originally commented on in our pathology samples, although the patient did not have characteristic occupational exposures.

    Best, Ronak V. Patel, MD

    Conflict of Interest:

    None declared

    Read all letters published for this article

    Submit response
  3. isolated gastric sarcoidosis

    A very intriguing and well described case !

    I just think useful some further diagnostic qualification starting from the following description of the histological characterization of the disease.

    "Gastric biopsies revealed severe chronic active granulomatous gastritis (figure 3). Additional studies from her gastric biopsies,including gram stain, fungal stain and acid-fast stain, were negative."

    Possible to research and, if present, characterize mineral particles inside the biopsed granulomas, following recent hypotheses interpreting sarcoidosis like a peculiar form of coniosis ?

    Conflict of Interest:

    None declared

    Read all letters published for this article

    Submit response
  4. Case verification

    Hello, how recent is the case that's just been published about Anisakiasas? Is it recent?

    Do you have more details on the case I can read?

    Conflict of Interest:

    None declared

    Read all letters published for this article

    Submit response
  5. cutis aplasia congenita and amniotic band syndrome

    I have read the phenotype description of a child with aplasia cutis congenita as well as transverse limb defects; although this association is not common it is the presentation of Adams Oliver syndrome [OMIM 100300]; in this condition both manifestations are present and often the limb defects resemble the damage caused by the amniotic band sequence. The identification is important as patients with Adams Oliver have an identifiable genetic etiology as well as are at risk of further medical issues ivcluding congenital heart defects; neuronal migration disorders; ocular manifestations etc

    Conflict of Interest:

    None declared

    Read all letters published for this article

    Submit response
  6. Query about site of metastasis

    Hello Mam, I would gladly like to know that the site of metastasis was in the upper extremity or in the lower extremity? and if it was upper extremity then at what site?

    Conflict of Interest:

    None declared

    Read all letters published for this article

    Submit response
  7. Choice of antibiotic

    This is a well written Case Report and helpfully describes some pathology (as well as the phenomenon of S. aureus disease relapse). It should be noted, however, that whilst the supporting evidence for i.v. Linezolid is that it is non-inferior to Vancomycin, it is abundantly clear in the literature that i.v. Vancomycin is wholly inferior to i.v. Flucloxacillin. Regarding data on disc penetration, Gibson et al tested this for fluclox in an animal model, but only after a single i.v. bolus. It is likely that after repeated high doses that fluclox does penetrate, otherwise there would be thousands of cases in the literature of relapse with zero cures. Furthermore, the source referenced for penetration of tissue by Linezolid is actually of skin blisters, not bone, whereas it is widely accepted that beta-lactams penetrate skin and soft tissue beautifully.

    My conclusion is that whilst this is a helpful addition to the literature, there are currently no grounds for withholding i.v. flucloxacillin in invasive MSSA disease and that Linezolid (a bacteriostatic agent) is a long way from having been validated for this setting.

    Conflict of Interest:

    Nil

    Read all letters published for this article

    Submit response
  8. Pulmonary sarcoidosis: calcification within the galaxy sign

    A relevant and very well described case, useful for ongoing comprehension of sarcoidosis'pathogenesis. The "galaxy sign" summons for a spreading of causal agents (mineral dusts ? bacteria ? others ?)from a "mother" lesion to surrounding areas, in coherence with recent interpretations of sarcoidosis as a peculiar, common reaction to different xenobiotics, particularly in contexts of "heavy" exposomes. Calcification is a common feature with silicosis. It could be really interesting which exposures' profile characterized the patient. Please, see a recent paper of mine about a case of lung fibrosis in a woman occupationally exposed to amorphous silica and expoy rosins vapours.

    Conflict of Interest:

    None declared

    Read all letters published for this article

    Submit response
  9. Diagnosis unconfirmed

    This could possibly be anti-GBM disease, though bloody diarrhoea isn't a feature of that condition. But there wasn't a renal biopsy to confirm, or specificity tests on the antibody (e.g. Western blotting with it) so evidence is only the ELISA result. Most such assays encounter occasional false positives.

    Conflict of Interest:

    None declared

    Read all letters published for this article

    Submit response
  10. Neurosarcoidosis: Diagnosis towards Clinical Insight

    Dear Sir, We have read your impressive article "Neurosarcoidosis presenting as a large dural mass lesion" published in BMJ Case report on 8 November 2016. I have read about neurosarcoidosis thoroughly because of my previous exposure with few patients who were recovered as per diagnosis and prognosis.

    First, your esteem has mentioned that the biopsy confirmed the diagnosis while the diagnosis of sarcoidosis depends on multiple factors. Infact, histopayhology is only one of the diagnostic steps that we totally agreed to be included in the investigative process but histopathological changes are non-specific because of unidentified molecular and cellular events. Indeed, Sarcoidosis has neither distinctive clinical features [1] exclusive changes in pulmonary function studies, diagnostic labarotary investigations,[2] definite disease activity marker,[3] special imaging findings nor specific histological picture.[4-6]

    Consequently, the diagnosis of sarcoidosis is based on clinico- radiographic ?ndings which are supported by histologic evidence of the presence of noncaseating granulomatous in?ammation with the exclusion of similar presenting diseases such as tuberculosis, brucellosis, lymphoma, and lung cancer,[7] autoimmunity disorders (primary biliary cirrhosis and Wegener's granulomatosis), drug reactions, occupational and environmental exposures (e.g. beryllium, talc), farmer's lung disease (hypersensitivity pneumonitis) and infections.[4-6]

    So, when the diagnosis of sarcoidosis is considered, stains and culture for fungi and mycobacteria should always be obtained.[6] Approching patient with sarcoidosis is based on the following criteria:[8] 1) a compatible clinical and/or radiological picture; 2) histological evidence of non-caseating granulomas; and 3) exclusion of other diseases capable of producing a similar histological or clinical picture.

    Second, your esteem has mentioned that your case has been treated with steroids and as you now there is no global / international consensus about the dose and duration. Most recommend prednisolone 20 - 40 mg for not less than 12 months. [9] While we have treated ourpatient with prednisolone tablet orally started with 40 mg daily in divided doses and tapered for as short as two months. We are egger to know what type of steroids you have prescribed and more importantly what was the dose and for how long was the treatment spectrum of this neurosarcoidosis case?

    References 1. Baughman RP, Drent M, Kavuru M, Judson MA, Costabel U, Du BR, Albera C, Brutsche M, Davis G, Donohue JF, et al. In?iximab therapy in patients with chronic sarcoidosis and pulmonary involvement. Am J Respir Crit Care Med 2006;174:795-802. 2. Keir G, Wells AU. Assessing pulmonary disease and response to therapy: which test? Semin Respir Crit Care Med 2010;31:409-418. 3. Chesnutt AN. Enigmas in sarcoidosis. West j Med 1995; 162:519-526. 4. Nunes H, Bouvry D, Soler P, Valeyre D. Sarcoidosis. Orphanet J Rare Dis 2007; 2: 46. 5. Warshauer DM, Lee JKT. Imaging manifestations of abdominal sarcoidosis. AJR 2004; 182: 15-28. 6. Jundson MA. Sarcoidosis: clinical presentation, diagnosis and approach to treatment. Am J Med Sci 2008; 335: 26-33. 7. Iannuzzi MC, Rybicki BA, Teirstein AS. Sarcoidosis. N Engl J Med. 2007;357(21):2153-2165. 8. U. Costabel. Sarcoidosis: clinical update. Eur Respir J 2001; 18: Suppl. 32, 56s-68s. 9. Eishi Y, Suga M, Ishige I, Kobayashi D, Yamada T, Takemura T, Takizawa T, Koike M, Kudoh S, Costabel U, et al. Quantitative analysis of mycobacterial and propionibacterial DNA in lymph nodes of Japanese and European patients with sarcoidosis. J Clin Microbiol 2002;40(1):198-204.

    Conflict of Interest:

    None declared

    Read all letters published for this article

    Submit response

Register for free content

The full text of all Editor's Choice articles and summaries of every article are free without registration

The full text of Images in ... articles are free to registered users

Only fellows can access the full text of case reports (apart from Editor's Choice) - become a fellow today, or encourage your institution to, so that together we can grow and develop this resource

Don't forget to sign up for content alerts so you keep up to date with all the case reports as they are published, and let us know what you think by commenting on the Editor's blog