A report of thigh muscle infarction in a diabetic patient

BACKGROUND AND OBJECTIVE: Diabetic muscle infarction, which is a rare microangiopathic complication of uncontrolled diabetes, should be considered as a differential diagnosis for diabetic patients with lower extremity swelling and local pain, and without any other systemic symptoms. In this study, we presented the case of a diabetic patient with thigh muscle infarction. CASE REPORT: The case was a 63-year-old diabetic male with pain and dysfunction in the right lower limb, who was referred to cardiology clinic for vascular assessment. During hospital stay, after rheumatology consultation, a mass was detected in the anterior thigh, which was confirmed with magnetic resonance imaging. Samples were taken from the mass, and the pathology reports showed diabetic muscle infarction. The patient was treated with analgesics and insulin. After partial improvement, the patient was discharged, and two months after hospital discharge the mass size and pain had reduced considerably. CONCLUSION: Diabetic muscle infarction is a rare complication of uncontrolled and prolonged diabetes, which has a simple treatment. In this study, we call attention to this condition to prevent unnecessary actions and help with its early diagnosis. © 2016, Babol University of Medical Sciences. All rights reserved

Posterior reversible encephalopathy syndrome in a patient with mixed connective tissue disease: A case report

Background: Posterior reversible encephalopathy is a syndrome highly associated with hypertension and cytotoxic therapy. The syndrome typically presents with headache, visual abnormality, seizures and characteristic vasogenic edema on magnetic resonance imaging. The entity warrants a prompt diagnosis to avoid deteriorating consequences. Case presentation: In this report, we describe a 15-year-old Iranian boy who was diagnosed with mixed connective tissue disease, and cyclophosphamide pulse therapy was administered. Three days after the second pulse of cyclophosphamide, when he was receiving prednisolone and hydroxycholoroquine, our patient developed generalized tonic-clonic seizures. Magnetic resonance imaging findings showed high signal intensities in the posterior areas of his brain. After 8 days, the brain magnetic resonance imaging abnormalities were resolved following the control of his blood pressure and antiepileptic treatment. These observations have been indicative of posterior reversible encephalopathy syndrome. Nevertheless, our patient developed uncontrollable respiratory distress and eventually died. Conclusions: To the best of our knowledge, this case is the first report of posterior reversible encephalopathy syndrome in a patient with mixed connective tissue disease. As the patient developed posterior reversible encephalopathy syndrome 3 days after cyclophosphamide pulse therapy to reduce the disease activity, it is hard to accurately determine whether posterior reversible encephalopathy syndrome in this case is a complication of cyclophosphamide or a condition that resulted from the mixed connective tissue disease flare-up. © 2016 The Author(s)

Differentiation of cocaine-induced midline destructive lesions from ANCA-associated vasculitis

Introduction: Cocaine-induced midline destructive lesions (CIMDL) are complications of regular nasal cocaine inhalation. CIMDL can mimic systemic diseases with positive anti-neutrophil cytoplasmic antibodies (ANCA), such as granulomatosis with polyangiitis (GPA). Case Report: In this article, we describe the case of a young woman who presented with nasal perforation induced by cocaine, along with positive perinuclear ANCA test (proteinase 3 antigen), misdiagnosed as limited GPA. The patient was treated with immunosuppressive therapy, which partially improved her symptoms. Admittance of cocaine use aided in the diagnosis of CIMDL. This patient was advised to stop cocaine use. Three-month follow-up revealed no further complications. Conclusion: Considering the seropositivity of ANCA in both CIMDL and GPA, early diagnosis of CIMDL and its differentiation from GPA is crucial, and clinicians play an important role in this regard. Lack of distinct histologic characteristics of vasculitis or unresponsiveness to standard therapeutic regimens may favor the diagnosis of CIMDL syndrome. It is crucial to recognize that these conditions may have similar presentations, so that undesired and potentially toxic treatments can be prevented. © 2018, Mashhad University of Medical Sciences

Undesired effect of excessive betamethasone administration during pregnancy: A rare case

Background: Postpartum bilateral femoral neck fracture (BFNF) is a rare condition. We here report a case of BFNF due to excessive corticosteroid consumption, twin pregnancy, immobility, and vitamin D deficiency. Case: This is a report of a 32-yr-old woman with bilateral femoral insufficiency fracture five days after emergency cesarean section due to preterm labor, twin pregnancy, and the history of a previous cesarean section at 33 wk. Antenatal repeated courses of betamethasone injections for fetal lung maturity, daily oral use of prednisolone for the history of miscarriage, immobilization, and vitamin D deficiency were the important contributing factors in her past medical history and lab investigations. The bone mineral density examination showed low bone density for the expected age. Conclusion: Clinicians, who deal with pregnant women, should consider the diagnosis of bilateral femoral insufficiency fracture in any pregnant women with pelvic pain. Awareness of risk factors of BFNF might help to reduce the rate of this complication. © 2018, Research and Clinical Center for Infertitlity. All rights reserved

Undesired effect of excessive betamethasone administration during pregnancy: A rare case

Background: Postpartum bilateral femoral neck fracture (BFNF) is a rare condition. We here report a case of BFNF due to excessive corticosteroid consumption, twin pregnancy, immobility, and vitamin D deficiency. Case: This is a report of a 32-yr-old woman with bilateral femoral insufficiency fracture five days after emergency cesarean section due to preterm labor, twin pregnancy, and the history of a previous cesarean section at 33 wk. Antenatal repeated courses of betamethasone injections for fetal lung maturity, daily oral use of prednisolone for the history of miscarriage, immobilization, and vitamin D deficiency were the important contributing factors in her past medical history and lab investigations. The bone mineral density examination showed low bone density for the expected age. Conclusion: Clinicians, who deal with pregnant women, should consider the diagnosis of bilateral femoral insufficiency fracture in any pregnant women with pelvic pain. Awareness of risk factors of BFNF might help to reduce the rate of this complication. © 2018, Research and Clinical Center for Infertitlity. All rights reserved

A study of the value of trabecular bone score in fracture risk assessment of postmenopausal women

Objective: Trabecular Bone Score (TBS) is an index of bone microarchitecture that provides additional skeletal information to areal Bone Mineral Density (aBMD). Recently TBS data has been used to optimize the Fracture Risk Assessment Tool (FRAX) predictive value. The aim of this study was to evaluate the clinical value of TBS on FRAX algorithm. Materials and Methods: Among total of 358 postmenopausal Iranian women (mean age 61.3 ± 9.5 years) tested for aBMD and TBS, 184 osteopenic women were identified. Thoracolumbar spine X-ray done in all participants revealed twenty-one vertebral fractures. For the osteopenic group, FRAX and TBS adjusted FRAX (FRAX-TBS) were calculated and compared. Results: Mean TBS of the patients was 1.31 (±0.11). A significant correlation was found between TBS and spine aBMD (r = 0.50, p < 0.001) and TBS and femoral neck aBMD (r = 0.37, p < 0.0001). A strong positive correlation was observed between aBMD adjusted FRAX and FRAX-TBS in predicting the risk of major osteoporotic fracture (r = 0.90, p < 0.0001), and hip fracture (r = 0.97, p < 0.0001). According to the area under the receiver operating characteristics curve, the predictive value of the three different models using aBMD, TBS, and combination of aBMD and TBS were similar (0.765, 0.776, and 0.781, respectively; p = 0.19). The proportion of the women needed treatment remained unchanged using FRAX or FRAX-TBS. Conclusion: This study showed no clinical benefit for TBS in postmenopausal women. Adding TBS data to aBMD or FRAX neither improved aBMD predictive value for vertebral fracture nor changed the decision on treatment based on FRAX. © 201

Melatonin in the treatment of fibromyalgia symptoms: A systematic review

The available pharmacological modalities for the treatment of fibromyalgia (FM) are associated with a variety of adverse effects and limited benefits. In this study, we systematically reviewed the impact of melatonin in the treatment of FM. Interventional studies, either controlled or uncontrolled and randomized or non-randomized, were included. PubMed, EMBASE, Scopus, Web of Science, and the Cochrane Library were searched without time limitation. Primary outcome measures were the effect of melatonin on the disease impact, pain, sleep quality, tender point count, fatigue, anxiety, stiffness, and depression in FM patients. Four studies, reporting the effect of melatonin on 98 patients, were eligible to include. All the studies reported the positive effect of melatonin on the FM symptoms. No major adverse event was reported. A significant level of heterogeneity was observed between the studies. Therefore, further high-quality controlled clinical trials are needed to understand the role of melatonin in FM treatment fully. © 2019 Elsevier Lt

A Report of Thigh Muscle Infarction in a Diabetic Patient

BACKGROUND AND OBJECTIVE: Diabetic muscle infarction, which is a rare microangiopathic complication of uncontrolled diabetes, should be considered as a differential diagnosis for diabetic patients with lower extremity swelling and local pain, and without any other systemic symptoms. In this study, we presented the case of a diabetic patient with thigh muscle infarction. CASE REPORT: The case was a 63-year-old diabetic male with pain and dysfunction in the right lower limb, who was referred to cardiology clinic for vascular assessment. During hospital stay, after rheumatology consultation, a mass was detected in the anterior thigh, which was confirmed with magnetic resonance imaging. Samples were taken from the mass, and the pathology reports showed diabetic muscle infarction. The patient was treated with analgesics and insulin. After partial improvement, the patient was discharged, and two months after hospital discharge the mass size and pain had reduced considerably. CONCLUSION: Diabetic muscle infarction is a rare complication of uncontrolled and prolonged diabetes, which has a simple treatment. In this study, we call attention to this condition to prevent unnecessary actions and help with its early diagnosis