Long-Lasting Follow-Up with Low-Dose Steroid in an 18-Year-Old Male with Rosai–Dorfman Disease

Rosai–Dorfman disease (RDD) is a rare and benign pathology of sinus histiocytosis of unknown etiology. Lymphadenopathy is the predominant clinical manifestation, but diverse organs can also be affected. Histological features involve S-100+ histiocytes with characteristic nuclear features within the enlarged sinusoids of the lymph nodes. The clinical course is unpredictable, but is often benign with spontaneous resolution of disease in most patients. We report a patient with bilateral massive enlargement of cervical, axillary, and inguinal lymph nodes, moderately enlarged spleen, and a weight loss of 15 kg. Excisional biopsy from the cervical lymph node showed that the dilated sinusoids were infiltrated by lymphocytes, plasma cells, and large histiocytes with CD 68 and S-100 protein positive. Due to the slow progression of the disease, oral prednisolone with a body weight of 1 mg/kg was started in March 2016. The steroid dosage has been adjusted many times during the clinical follow-up. After 33 months, steroid treatment resulted in partial shrinkage of lymph nodes, the spleen returned to its normal size, and the patient gained weight. After 38 months of follow-up, no systemic symptoms, sign, or extranodal involvement were detected, and the patient continued with low-dose steroid treatment

Monoballism Associated with Newly Onset Ketotic Hyperglycemia

Movement disorders as the initial symptoms of diabetes mellitus are rare. Here, we describe one of these rare manifestations of primary diabetes: a case of newly diagnosed diabetes mellitus in an old-age female patient with transient monoballismus during an episode of ketotic hyperglycemia

Serum magnesium levels in patients with the necrotizing and edematous types of acute pancreatitis with and Without hypocalcemia

Objective: We aimed to investigate the association of serum magnesium levels with the disease state in patients having necrotizing and edematous types of acute pancreatitis with or without hypocalcemia.Methods: the hospital records of 114 patients, meeting the criteria of the revised Atlanta classification of acute pancreatitis were evaluated retrospectively for their serum magnesium, calcium, albumin and C-reactive protein (CRP) levels and leukocyte and platelet counts. Results: Mean age of the patients was 58.9±15 years. Serum magnesium, calcium and albumin levels were significantly lower in patients with acute necrotizing pancreatitis than those of the cases with the edematous type (1.85±0.6 mg/dL vs. 2.12±0.26 mg/dL; p;lt;0.001, 8.37±0.51 mg/dL vs. 8.86±0.59 mg/dL; p;lt;0.001 and 3.34 g/dL±0.67 g/dL vs. 3.75±0.46 g/dL; p=0.003, respectively). Patients with hypocalcemia had lower levels of serum magnesium, and higher levels of serum CRP and leucocyte counts when compared with the patients without hypocalcemia (p;lt;0.001, p=0.002 and p=0.002, respectively). According to the type of disease, the number of patients with advanced age increased 1.047-fold (CI: 1.006-1.089; p=0.025), normal levels of serum magnesium increased 45.4-fold (CI: 3.548-582.336; p=0.003) in patients with the edematous type, and, high levels of serum CRP increased 1.082-fold (CI: 1.017-1.157; p=0.013) in patients with the acute necrotizing pancreatitis. After the disease severity was taken under control , serum magnesium levels were found to be moderately correlated with the serum albumin levels (r=0.32; p;lt;0.001).Conclusion: Although patients with acute necrotizing pancreatitis and hypocalcemia revealed low levels of serum magnesium, hypomagnesemia was not associated with the disease severity in patients with acute pancreatitis.Amaç: Nekrotizan ve ödematöz tip akut pankreatitli, hipokalsemisi olan ve olmayan hastaların serum magnezyum düzeylerinin hastalık ile ilişkisini incelemeyi amaçladık.Yöntem: Akut pankreatit için revize edilmiş Atlanta kriterlerini karşılayan 114 hastanın hastane kayıtlarından geriye dönük olarak serum magnezyum, kalsiyum, albumin, C-reaktif protein düzeyleri ile lökosit ve trombosit sayıları değerlendirildi.Bulgular: Yaş ortalaması 58,9±15 yıldı. Serum magnezyum, kalsiyum ve albumin düzeyleri nekrotizan tip akut pankreatitli hastalarımızda ödematöz tipteki akut pankreatitli hastalarımıza göre anlamlı derecede düşüktü. Sırasıyla (1,85±0,6 mg/dL vb. 2,12±0,26 mg/dL; p0,001, 8,37±0,51 mg/dL vb. 8,86±0,59 mg/dL; p0,001 ve 3,34 g/dL±0,67 g/dL vb. 3,75±0,46 g/dL; p=0,003). Tüm hasta grubunda hipokalsemi saptananlarda saptanmayanlara göre serum magnezyum düzeyleri düşük, serum CRP düzeyleri ve lökosit sayıları yüksek bulundu. Sırasıyla (p0,001; p=0,002 ve p=0,002). Hastalık tipine göre yapılan değerlendirmede, ödematöz tip akut pankreatitli hastalarda ileri yaşın 1,047-kat (CI: 1,006-1,089; p=0,025), normal düzeylerdeki serum magezyumun 45,4-kat (CI: 3,548-582,336; p=0,003), nekrotizan tip akut pankreatitli hastalarda yüksek serum CRP düzeylerinin 1,082-kat (CI: 1,017-1,157; p=0,013) daha fazla görüldüğü saptandı. Hastalık şiddeti kontrol altına alındıktan sonra serum magnezyum ile albumin düzeylerinin orta düzeyde (r=0,32; p0,001) ilişkili olduğu saptandı.Sonuç: Nekrotizan tip akut pankreatitli ve hipokalsemisi olan hastalarımızda serum magnezyum düzeyleri düşük bulunsa da akut pankreatitte hipomagnezeminin hastalık şiddeti ile ilişkisi bulunamadı