Hyperinsulinism, Insulin Resistance and Impaired Fasting Glucose Revealing an Insulin Autoimmune Syndrome

We report a case of a 55-year-old woman who was evaluated for multiple episodes of late postprandial hypoglycaemia. We diagnosed her condition as insulin autoimmune syndrome (Hirata disease) because of a high insulin autoantibody (IAA) titre in association with high levels of plasmatic insulin and hypoglycaemia in a patient with no history of exogenous insulin administration and the exclusion of other causes of late postprandial hypoglycaemia.

Haemophagocytic Syndrome in a 19-Year-Old Male with Plasmodium falciparum Malaria

Objectives: Infectious agents triggering haemophagocytic lymphohistiocytosis (HLH) primarily involve the herpes virus group. We report a case of HLH precipitated by Plasmodium falciparum. Materials and methods: Clinical and laboratory findings in a patient presenting with fever were collected. After confirmation of acute malaria, anti-malarial treatment was administered. Results: Despite initial favourable evolution, the patient developed fever again together with a worsening of the haematological parameters and increased ferritin levels. A bone marrow biopsy confirmed the diagnosis of HLH. Conclusion: This case illustrates that HLH should be considered in the differential diagnosis of acute malaria in patients with persisting fever and pancytopenia.

Contributo del Gruppo di Lavoro “Gestione e monitoraggio PON 2007/2013” del Dipartimento Ingegneria, ICT e Tecnologie per l'Energia e i Trasporti alla Conferenza di Dipartimento HORIZON 2020@DIITET del 26 e 27 maggio 2014 - Report del primo anno di lavoro

La progettualità legata ai Bandi PON costituisce una parte consistente delle attività del Dipartimento. Attualmente sono 53 i progetti, legati al VII Programma Quadro, gestiti dal Dipartimento.

Is Aphtous Oral Ulceration Biopsy always Useless?

Objective: To report a case of Behçet’s disease whose diagnosis was only confirmed thanks to an oral aphthous lesion biopsy. Materials and methods: Conventional histopathological analysis of a biopsy of an aphthous oral lesion that had appeared two days previously. Results: A small vein vasculitis with eosinophil and neutrophil granulocytes was evidenced. Conclusion: The presence of a small vein vasculitis was here strongly in favour of Behçet's disease, whereas such a diagnosis was not confirmed according to the International Study Group’s criteria.

Severe Statin-induced Rhabdomyolysis following Cholestatic Hepatitis induced by Amoxicillin-clavulanate

We report the case of an 86-year-old man with a past history of coronary disease admitted to our internal medicine department for severe asthenia and weakness due to rhabdomyolysis. Three days earlier, he had been discharged from a gastroenterology unit with a diagnosis of amoxicillin–clavulanate-induced acute cholestatic hepatitis. A review of his drugs revealed that he had taken atorvastatin 10 mg daily in the previous six years, without clinical or laboratory signs of myopathy. Atorvastatin was therefore stopped, with gradual improvement of the rhabdomyolysis. All concomitant drug therapy needs to be reassessed in elderly patients, especially when they become acutely ill.

Imaging in non Traumatic Emergencies: Acute Thrombosis of the Aorta and Pulmonary Embolism

Objectives: To present the possibility of acute arterial and venous thrombosis. Materials and methods: Report of a patient presenting with acute dyspnoea and chest pain. Results: Using a combined medical team and imaging studies, pulmonary embolism and acute arterial thrombosis were diagnosed. The patient was treated medically and surgically. Conclusion: Physicians should be aware of the possibility of combined thrombosis and the diagnosis and management of the condition.

Rapporto sull'efficienza energetica 2013

Rapporto tecnico sulla gestione energetica nelle grandi strutture del CNR e sui possibili interventi per la riduzione dei consumi (258 pagine, con contributi di 25 autori). Pubblicazione del progetto “Efficienza energetica”, promosso dal Direttore Generale del CNR con lettera prot. CNR n. 0075888 del 7/12/2012.

Leishmaniasis Mimicking Lymphoma and/or Liver Cirrhosis

A 76-year-old man was admitted to hospital with fever, weight loss, pancytopenia, hepatosplenomegaly and a double monoclonal component IgM-IgG-k, suggesting a diagnosis of myeloma. Bone marrow and liver biopsies disclosed the presence of Donovan bodies, and the titre of anti-Leishmania antibodies was extremely high. After treatment with liposomal amphotericin B, the titre of antibodies fell considerably, while monoclonal components, pancytopenia and clinical symptoms slowly disappeared. Polyclonal γ-globulins are made of innumerable monoclonal components, one of which can appear as a recognizable band and be misdiagnosed as myeloma when representing the high titre of an antibody directed towards a specific antigen.

Ehlers–Danlos Syndrome in an Adult Woman: A Hidden Syndrome

Ehlers–Danlos syndrome is a rare disease and a diagnostic challenge. This case report serves to remind the clinician that it is important to identify all affected patients in order to prevent complications.

An Unusual Complication of Transthoracic Lung Biopsy

Objectives: We report a case of a frail older adult affected by Chilaiditi syndrome complicating transthoracic lung biopsy, which has never been presented before in the literature. Materials and methods: After illustration of our case, we review the available literature about Chilaiditi syndrome. Results: Chilaiditi syndrome is a rare disease characterised by the interposition of colonic segments between the liver and diaphragm associated with mild to severe clinical symptoms. Conclusion: Although it is uncommon, Chilaiditi syndrome is a clinical condition that should be recognized early and differentiated from other diseases since it may significantly impair a patient’s prognosis.

A Case of Infectious Purpura Fulminans: An Unusual Organism and Method of Diagnosis

Infectious purpura fulminans is a rapidly progressive skin necrosis that carries a mortality rate of 30%. Here, we described a case of infectious purpura fulminans caused by Capnocytophaga diagnosed by a blood film.

Can this be considered a Fondaparinux-induced Thrombocytopenia?

We present a case of an old woman with previously documented heparin-induced thrombocytopenia (HIT), treated with fondaparinux, who presented with thrombocytopenia and venous thrombosis after exposure to a preventive dose of fondaparinux during orthopaedic surgery. Any accidental exposure to heparin was avoided. Other causes of thrombocytopenia were excluded and antigenic tests combined with clinical probability made a diagnosis of HIT likely. Can this be considered a possible case of fondaparinux-related HIT, despite the intense and early decrease in platelets, as usually happens in rapid-onset HIT, and the fact that previous exposure to fondaparinux had occurred 5 months previously?

Chronic Active Hepatitis B with HBV-Associated Nephropathy: Close Resemblance to Lupus Nephritis

We present a rare case of a 23-year-old male incidentally detected with hepatitis B virus (HBV) infection presenting with features suggestive of HBV-associated nephropathy. A renal biopsy specimen suggested a mesangioproliferative glomerulonephritis with a full-house pattern on immunoflourescence consistent with a diagnosis of diffuse lupus nephritis. Glomerular HbeAg and HbsAg antigens were not detectable by immunofluorescence. Antiviral therapy was instituted to suppress viral replication, thereby leading to clinical and virological remission, including that of the glomerulonephritis, without the need for additional immunosuppressant therapy. This case depicts the uniqueness of the presentation of the two conditions mimicking each other, the strategy adopted to prevent the activation of viral replication and the achievement of clinical remission.

Iatrogenic Cushing’s syndrome and Secondary Adrenal Insufficiency in an HIV Patientreceiving Fluticasone and Ritonavir

Objectives: To illustrate that the protease inhibitor (PI) ritonavir, widely used as part of the treatment for HIV, might cause drug–drug interactions with inhaled corticosteroids. Material and methods: A case report is presented. Results: An HIV-positive patient presented with gradually changing body composition that was ascribed to lipodystrophy. Finally, iatrogenic Cushing's syndrome with secondary adrenal insufficiency was diagnosed due to a drug–drug interaction of ritonavir and fluticasone. Conclusion: Lipodystrophy might mimic Cushing's syndrome. The combination of ritonavir and inhaled fluticasone may lead to systemic steroid excess causing Cushing's syndrome and secondary adrenal insufficiency.

Hemophagocytic Lymphohistiocytosis Complicating Myelodysplasia

We describe a 62-year-old patient with a 4-year history of myelodysplasia who later developed striking features that included massive splenomegaly, rapidly evolving visual loss and a sensorimotor polyneuropathy. This led us to consider the diagnosis of haemophagocytic lymphohistiocytosis (HLH). Upon further investigation, we found that he fulfilled the necessary diagnostic criteria for HLH, including the presence of haemophagocytosis of erythroid precursors on bone marrow smear.