121 research outputs found
Opening new vistas for young researchers–a report of the 54th Scientific Meeting of Japan College of Rheumatology and International Workshop
No full textANCA-Associated Vasculitis Presenting as a Pituitary Mass – A Diagnostic and Therapeutic Challenge
No full textBackground: Pituitary involvement in ANCA-associated vasculitis (AAV) is rare, occurring in approximately 1-2%. Here we highlight the diagnostic and therapeutic challenges of AAV presenting with pituitary involvement and other systemic manifestations. Case Summary: A 44-year-old Indian female presented with headache, polydipsia, and polyuria for three months. Imaging revealed a sellar and suprasellar lesion, and laboratory tests confirmed central diabetes insipidus and secondary hypothyroidism. Two months later, she developed bilateral ear pain, hearing loss, and ear discharge. A binostril endoscopic transnasal transsphenoidal biopsy and decompression of the pituitary mass were performed. Histopathology revealed necrotizing granulomatous inflammation, but GeneXpert and MGIT cultures were negative. Initial ANCA levels were mildly elevated (25 RU/ml, normal [Formula: see text]20 U/ml). Given the possibility of tuberculous hypophysitis, empirical anti-tubercular therapy (ATT) was initiated. However, her ear symptoms worsened, and she developed acute lower motor neuron facial palsy. High-resolution CT of the temporal bone showed bilateral otomastoiditis with ossicular erosion, requiring right cortical mastoidectomy and tympanoplasty with left myringotomy. Repeat histopathology from the ear also showed necrotizing granulomatous inflammation, with negative tuberculosis tests. Repeat ANCA testing showed significantly elevated anti-PR3 ([Formula: see text]200 RU/ml), leading to the diagnosis of AAV. Given disease progression on ATT, treatment was switched to immunosuppression with methylprednisolone (500 mg IV for three days), followed by oral prednisolone (1 mg/kg) and monthly cyclophosphamide (15 mg/kg) for six months. Her symptoms improved significantly, except for residual hearing impairment. Six months later, she developed diplopia, and MRI revealed a recurrent pituitary lesion with a retroclival soft tissue mass, likely causing left lateral rectus palsy. Treatment was escalated with another pulse of methylprednisolone (750 mg) and rituximab (1 g, two doses 15 days apart), leading to resolution of diplopia. Conclusion: This case underscores the complexity of diagnosing AAV with pituitary involvement, highlighting the importance of repeat ANCA testing and awareness of its diverse presentations. The initial misdiagnosis as tuberculous hypophysitis emphasizes the need for careful differential diagnosis in granulomatous hypophysitis. Prompt immunosuppressive therapy significantly improved outcomes, but the recurrence of pituitary involvement illustrates the relapsing nature of AAV, necessitating close monitoring and multidisciplinary management
Demyelinating Syndromes — Transverse Myelitis, Optic Neuritis in Systemic Lupus Erythematosus: Clinical Features and Treatment Outcomes — A 24-year Retrospective Analysis from a Tertiary Care Center
No full textBackground: Systemic Lupus Erythematosus (SLE) with acute myelitis or optic neuritis is rare and causes significant morbidity. Data on these conditions remain limited. This study aimed to evaluate the clinical profile and outcomes of patients presenting with demyelinating syndromes (transverse myelitis or optic neuritis) in SLE. Methods: A retrospective chart review was conducted, identifying patients diagnosed with SLE and myelitis or optic neuritis at our centre between 2000 and 2024. SLE was diagnosed using ACR-EULAR 2019 criteria. The Expanded Disability Status Scale (EDSS) was used to assess disability levels. Data were analysed using descriptive statistics. Results: A total of 25 female patients were identified with a mean age of 27.04 ± 9.69 years. The interval between SLE diagnosis and onset of demyelination varied widely, with 24% of patients presenting with demyelination as an initial manifestation. The mean SLEDAI was 17.72 ± 6.88. Sixteen patients (64%) reached the nadir of clinical presentation within 24 hours. Severe impairments included motor deficit (88%), sensory level involvement (88%), urinary retention (72%), and optic neuritis (16%). MRI was abnormal in all cases, with thoracic cord involvement in 88%, longitudinally extensive myelitis in 53%, and area postrema involvement in 8.3%. ANA was positive in all patients, 76% had low complements, and 12% tested positive for aquaporin-4 antibodies. Pulse methylprednisolone was administered to 92%; cyclophosphamide (68%) was the most used second-line therapy. At baseline, 72% had severe disability (EDSS ¿ 5), which improved after six months, with only 12% retaining severe disability. Three patients relapsed after treatment and one patient succumbed to sepsis. No patients with optic neuritis developed optic atrophy within one year. Conclusion: Demyelinating syndromes in SLE primarily affect young females and correlate with high disease activity. Early immunosuppressive therapy leads to significant improvement, though some patients retain residual disability, underscoring the need for prompt intervention
Rheumatological Manifestations and Outcomes of Amyloidosis. Retrospective Study from a Tertiary Care Rheumatology Clinic
No full textBackground: Amyloidosis is a complex systemic disorder characterized by the extracellular deposition of amyloid fibrils, affecting multiple organ systems and presenting with diverse rheumatological manifestations. This study aimed to analyse the clinical symptoms, organ involvement, and outcomes in patients with amyloidosis presenting with rheumatological complaints. Methods: This retrospective study was conducted by reviewing the medical records of patients diagnosed with amyloidosis who presented to the rheumatology clinic at our centre between January 2010 and January 2024. Data on demographics, clinical presentations, amyloid subtypes, diagnostic investigations, and outcomes were collected. Descriptive statistics were used for analysis. Results: A total of 24 patients (12 males, 12 females) with a mean age of 46.68 ± 11.46 years were included. Symptom duration before diagnosis ranged from 1 to 288 months. The mean hospital stay for diagnostic confirmation and therapy initiation was 11.65 ± 2.90 days. Amyloid subtypes included AA [Formula: see text], AL [Formula: see text], and unspecified [Formula: see text]. Biopsies showed amyloid deposition in vessel walls in all cases (100%). The most common rheumatological complaint was arthralgia. Secondary amyloidosis was associated with conditions such as axial spondyloarthritis, psoriatic arthritis, systemic lupus erythematosus (SLE), Takayasu arteritis, and IgG4-related disease. Renal involvement, defined as proteinuria [Formula: see text]1 g, was observed in 50% [Formula: see text], with chronic kidney disease developing in 41% [Formula: see text] of these cases. Cardiac amyloidosis was diagnosed in 29% of patients based on echocardiographic speckling and characteristic cardiac MRI findings, with diastolic dysfunction being the most common echocardiographic abnormality. Six of the seven patients with cardiac involvement died during the study period. Conclusion: Amyloidosis can present with various rheumatological complaints and poses significant diagnostic and therapeutic challenges, with delayed diagnoses contributing to poor outcomes. Cardiac involvement was associated with a significantly worse prognosis. Early diagnosis through advanced imaging and histopathological confirmation is crucial for improving patient outcomes
Study of Probiotic Lactic Acid Bacteria for Beneficial Properties.
No full textThis Dissertation / Report is the outcome of investigation carried out by the creator(s) / author(s) at the department/division of Central Food Technological Research Institute (CFTRI), Mysore mentioned below in this page
Production, Purification and Characterisation of Pectinase from Soil Metagenomic Library.
No full textThis Dissertation / Report is the outcome of investigation carried out by the creator(s) / author(s) at the department/division of Central Food Technological Research Institute (CFTRI), Mysore mentioned below in this page
P50 Subclinical limited joint mobility (LJM) as a marker for micro-vascular complications in type 2 diabetes mellitus (T2DM)—results of a pilot study
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