Obesity in patients hospitalised for COPD substantially reduces in-hospital mortality risk and the possibility of early re-admittance. Malnutrition is associated with an important increase in in-hospital mortality and risk of re-admittance in the 30 days following discharge.
External jugular vein thrombosis is a rare complication that, when it occurs, is usually secondary to cervical trauma, infection, venous cannulation or malignancy. By contrast, spontaneous external jugular thrombosis is extremely uncommon. We report the case of a 69-year-old woman presenting to the Emergency Department with a 3 centimetre neck lump, which had suddenly appeared on the same day. She did not have any other relevant symptoms. The patient had not suffered any recent cervical trauma or infection. There was no personal or familial history of thromboembolic disease. Physical examination was normal, apart from the neck mass. A neck ultrasound revealed a non-occlusive thrombus inside the right external jugular vein. Usual workup, including a coagulation laboratory profile, autoimmunity and malignancy research, was unremarkable, identifying the thrombosis as idiopathic. Anticoagulation treatment was started, leading to a complete resolution of the thrombus, without recurrence. The sudden appearance of a painless cervical mass, without any identified triggering factor, is not common. The possibility of a jugular thrombosis should be kept in mind in the differential diagnosis of an isolated neck lump. In this case, point-of-care ultrasound, which is becoming increasingly available in Emergency Departments, contributed to the rapid and accurate diagnosis of the patient. LEARNING POINTS Vascular diseases such as aneurysms and thrombosis, although infrequent in jugular veins, should be considered in the differential diagnosis of a painless promptly growing neck lump. Since idiopathic external jugular vein thrombosis is uncommon, a complete diagnostic workout and follow-up is recommended, to exclude a triggering factor, such as an underlying malignancy, coagulation disorder or hidden infection. Ultrasound is the most accurate non-invasive method to diagnose venous thrombosis. Point-of-care ultrasound has proved to be a useful tool for the rapid diagnosis of vascular diseases.
BackgroundProtozoan parasites of the genus Leishmania can cause opportunistic infections in patients using anti-tumour necrosis factor (anti-TNF) agents, and some authors recommend serological tests for leishmaniasis before using them. An outbreak of cutaneous and visceral leishmaniasis (CL,VL) occurred in the Fuenlabrada area (Spain) in 2010–2012. Some patients were on anti-TNF treatment.ObjectivesWe aimed to explore leishmaniasis related to bilogical therapies in the literature, and to obtain data on leishmaniasis cases in patients using antiTNFs referred to our Department of Infectious DiseasesMethodsLiterature search of leishmaniasis cases in patients using biological therapies, and to realise descriptive analysis of the clinical features of patients treated with anti-TNFs in our outbreak.ResultsCases detected in the literature, included our cases, are listed in table 1. In our outbreak of Leishmaniasis, 127 VL and 194 CL cases were detected. Six patients were using anti-TNFs: 2 presented with VL and were using etanercept (33.3%) and 4 using other anti-TNFs had CL (66,6%). (table 2) These results do not coincide with the total data (table 1): CL 55.2%, VL 44.8%, 17 ADA (44,7%), 16 IFM (42,1%), 4 ETN (10.5%), 1 CTZ (2.7%). There are not more cases described with another biologic therapies at the present time.Abstract SAT0387 – Table 1ConclusionsThis preliminary detection of leishmaniasis in patients using anti-TNFs is aimed at examining the safety of TNFα inhibitors in areas where Leishmania is endemic. This is a small series, but the largest described to date. Our preliminary results suggest that the use of either TNFα receptor or other anti-TNFs has the same probability of triggering the disease but etanercept seems to be associated with fewer, although more severe, cases of VL. Nevertheless, adding all the cases, Table number 1, ADA e IFM are the 86.8% of the Leishmaniasis, but perhaps will be due to this therapies are combinated and of the most prevalent use. On the other hand, no leishmaniasis cases related to IBD treatment have been described in the literature, suggesting possible involvement of therapies concomitant with the use of anti-TNF with MTX. We detected 3 additional cases of VL and 1 CL using MTX without anti-TNFs. Serological tests for leishmaniasis before using anti-TNFs might not be useful.References[1] Smith VM, Goulden V. Cutaneous leishmaniasis while taking adalimumab for psoriasis. Br J Dermatol [Internet]((Smith V.M.; Goulden V.) Dermatology Department, Leeds Teaching Hospitals, Leeds, United Kingdom)2014;171:100.[2] Guedes-Barbosa LS, Pereira da Costa I, Fernandes V, Henrique da Mota LM, de Menezes I, Aaron Scheinberg M. Leishmaniasis during anti-tumor necrosis factor therapy: report of 4 cases and review of the literature (additional 28 cases). Semin Arthritis Rheum. octubre de 2013;43(2):152–7.AcknowledgementsTo our familiesDisclosure of InterestNone declared
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