Plastic bronchitis and a novel management approach with streptokinase inhalation therapy: a case study

Plastic bronchitis (PB) is a rare condition of obstructive bronchial casts. The most common demographic that is affected by PB is children but adults with acute onset have also been reported. At present, there are no established guidelines for the management of PB which has led to the proposition of a variety of treatment regimens. Inhaled streptokinase (SK) can be one such treatment modality for this rare condition. An adult female patient presented to the Grodno university clinic with complaints of dyspnea, shortness of breath, and expectoration of firm, long, and branching bronchial casts. We used inhaled SK to treat this patient based on the cast composition on microscopic evaluation. Written consent was taken from the patient mentioned in the study. The study was approved by the hospital and institutional ethics committee. SK, a potent fibrinolytic agent, can be useful in lysing fibrin-rich bronchial casts. With Inhaled SK therapy, there was a gradual improvement in the overall condition of the patient. In the subsequent clinical follow-up, the patient was asymptomatic and without recurrent casts.  The course of treatment and positive recovery of the patient signifies the fact that inhaled SK can be a suitable therapeutic approach in PB. Therefore, based on our novel therapeutic approach, SK inhalation may be a possible treatment for bronchial casts in PB

Undifferentiated necrotizing ulcerative vasculitis in a patient with pneumonia and stage 5 chronic kidney disease-a case report

Skin is a frequently involved and damaged organ in cutaneous necrotizing vasculitis (CNV), mainly characterized histologically by a segmental angiocentric inflammatory condition with fibrinoid necrosis of the vessel wall. Various etiological factors have been described as probable causes that trigger CNV, ranging from infectious causes to autoimmune conditions. We have described a case of a middle-aged man with chronic kidney disease (CKD) that presented to the Grodno university clinic with Staphylococcal pneumonia and high level of the IgE antibodies that probably triggered CNV. Written consent was taken from the patient mentioned in the study. The study was approved by the hospital and institutional ethics committee. Based on the provisional diagnosis of hemorrhagic necrotizing vasculitis (cutaneous form), the patient was started on a low dose of glucocorticosteroid therapy. After carrying out a skin flap biopsy, a confirmed diagnosis of ANCA-negative CNV-leukocytoclastic vasculitis (LcV) form was made. The patient was started on steroid pulse therapy followed by plasmapheresis for elevated IgE count, leading to rapid resolution of symptoms. Literature has stated that CNV-LcV form commonly involves immune complexes composed of IgG or IgM. Based on our observation, we have proposed a novel hypothesis that elevated IgE and IgE immune complexes can be an additional triggering factor for CNV-LcV form as well

Renal artery stenosis complicated by an intraoperative rupture of renal artery: a case study

Renal artery stenosis (RAS) is a major contributor to the prevalence of secondary hypertension. Fibromuscular dysplasia and atherosclerosis are commonly responsible for the occurrence of the disease. Medical therapy is the primary means of treatment for RAS. However, surgical interventions for revascularization are also considered, in selected group of patients, which can effectively cure hypertension and chronic kidney disease. An older man presented at Venus hospital, Surat, Gujarat with the complaints of severe dyspnea, edema, uncontrolled hypertension and renal insufficiency. He was diagnosed RAS and was operatively managed with percutaneous transluminal renal angioplasty. Written consent was taken from the patient mentioned in the study. During the procedure, the renal artery got ruptured, which was managed by placing a covered stent. The patient was successfully treated for RAS, in spite of comorbidities and intraoperative complication. In the subsequent clinical follow-up, the patient was asymptomatic. There was marked reduction in serum creatinine levels and even the blood pressure improved significantly. Absence of post-operative complications and positive recovery of the patient signifies the fact that management of renal artery rupture with a covered stent is a convenient approach in acquiring effective haemostasis. This approach can be useful in managing any sort of vessel rupture, related to revascularization procedures