We present the case of a young woman that was diagnosed with Churg-Strauss syndrome. The classical as well as the atypical symptoms, signs and findings are discussed in the context of clinically relevant differential diagnoses. The diagnostic criteria and the relevant aspects of pathogenesis, clinical course and treatment are reviewed. In addition, the similarities and differences with respect to the other idiopathic interstitial eosinophilic pneumopathies are described.

Adult↗

PubMed2005

[Rare cause of right heart failure: two cases].

HISTORY AND ADMISSION FINDINGS: Two asylum seekers (patient A, 30 year old man from Mongolia; patient B, 18 year old woman from the Sudan) were referred to our outpatient clinic because of acute and chronic deterioration of their general condition and shortness of breath. Both patients presented with a clear clinical picture of systemic venous hypertension and moderate pulmonary congestion. Patient B had a paradoxical pulse compatible to cardiac tamponade. INVESTIGATIONS: In patient A, the chest radiogram revealed a markedly enlarged cardiac silhouette and an infiltrate in the upper left lobe of the lung. The echocardiogram confirmed a pericardial effusion causing a cardiac tamponade. A therapeutic and diagnostic pericardiocentesis was performed immediately. In patient B, the chest radiogram revealed a thickened and calcified pericardium and a left-sided pleural effusion. The pleural fluid revealed a lymphocyte-predominant exudate. In both patients the tuberculin skin test was positive. DIAGNOSIS, TREATMENT AND COURSE: In both patients we initiated an antituberculous therapy (four-drug therapy with isoniazid, rifampin, pyrazinamide and ethambutol; in patient A in addition corticosteroids). In patient A the PCR for Mycobacterium tuberculosis complex from pericardial fluid was positive. In patient B we started the antibiotic treatment despite negative microbiological studies because of the high degree of suspicion in a person at high risk. Due to the impaired ventricular filling, patient B required additional pericardectomy. After completion of treatment, both patients have been doing well. CONCLUSION: Despite a clear reduction in the incidence of tuberculous pericarditis in Europe this multifaceted condition should still be of concern in patients at high risk as e. g. immigrants from areas with a high tuberculosis prevalence. Early diagnosis and adequate treatment are required for prevention of severe complications and disabling constrictive pericarditis.

Adolescent↗

PubMed2004

[Dyspnea and hemoptysis in a young woman with unclear renal alterations].

We describe the clinical course and treatment of a young woman diagnosed with tuberous sclerosis. Classical as well as atypical clinical findings are discussed with regards to the differential diagnosis. The most important components of the pathogenesis and the criteria necessary for diagnosis are highlighted. In addition the similarities and differences to lymphangioleiomyomatosis are discussed.

Adult↗

PubMed2004

Ceftriaxone acts synergistically with levofloxacin in experimental meningitis and reduces levofloxacin-induced resistance in penicillin-resistant pneumococci.

Ceftriaxone acted synergistically with levofloxacin in time-killing assays in vitro over 8 h against two penicillin-resistant pneumococcal strains (WB4 and KR4; MIC of penicillin: 4 mg/L). Synergy was confirmed with the chequerboard method, showing FIC indices of 0.25. In the experimental rabbit meningitis model, ceftriaxone (1x 125 mg/kg) was slightly less bactericidal (-0.30 Deltalog(10) cfu/mL(.)h) compared with levofloxacin (-0.45 Deltalog(10) cfu/mL(.)h) against the penicillin-resistant strain WB4. The combination therapy (levofloxacin and ceftriaxone) was significantly superior (-0.64 Deltalog(10) cfu/mL(.)h) to either monotherapy. In cycling experiments in vitro, the addition of ceftriaxone at a sub-MIC concentration (1/16 MIC) reduced levofloxacin-induced resistance in the two strains KR4 and WB4. After 12 cycles with levofloxacin monotherapy, the MIC increased 64-fold in both strains versus a 16-fold increase with the combination (levofloxacin + ceftriaxone 1/16 MIC). In both strains, levofloxacin-induced resistance was confirmed by mutations detected in the genes parC and gyrA, encoding for subunits of topoisomerase IV and gyrase, respectively. The addition of ceftriaxone suppressed mutations in parC but led to a new mutation in parE in both strains.

Animals↗

PubMed2003

Meropenem prevents levofloxacin-induced resistance in penicillin-resistant pneumococci and acts synergistically with levofloxacin in experimental meningitis.

The aim of the present study was to investigate the potential synergy between meropenem and levofloxacin in vitro and in experimental meningitis and to determine the effect of meropenem on levofloxacin-induced resistance in vitro. Meropenem increased the efficacy of levofloxacin against the penicillin-resistant pneumococcal strain KR4 in time-killing assays in vitro and acted synergistically against a second penicillin-resistant strain WB4. In the checkerboard, only an additive effect (FIC indices: 1.0) was observed for both strains. In cycling experiments in vitro, levofloxacin alone led to a 64-fold increase in the MIC for both strains after 12 cycles. Addition of meropenem in sub-MIC concentrations (0.25 x MIC) completely inhibited the selection of levofloxacin-resistant mutants in WB4 after 12 cycles. In KR4, the addition of meropenem led to just a twofold increase in the MIC for levofloxacin after 12 cycles. Mutations detected in the genes encoding for topoisomerase IV (parC) and gyrase (gyrA) confirmed the levofloxacin-induced resistance in both strains. Addition of meropenem was able to completely suppress levofloxacin-induced mutations in WB4 and led to only one mutation in parE in KR4. In experimental meningitis, meropenem, given in two doses (2 x 125 mg/kg), produced a good bactericidal activity (-0.45 Deltalog10 cfu/ml.h) comparable to one dose (1 x 10 mg/kg) of levofloxacin (-0.44 Deltalog10 cfu/ml.h) against the penicillin-resistant strain WB4. Meropenem combined with levofloxacin acted synergistically (-0.93 Deltalog10 cfu/ml.h), sterilizing the CSF of all rabbits.

Animals↗