Abstract:
:Common variable immunodeficiency (CVID) is readily considered in patients presenting with recurrent sino-pulmonary infections, however this disease has a broad range of clinical manifestations and diagnosis can be delayed by several years. We present the case of a 44-year-old postpartum female who presented with nausea, vomiting and abdominal distension. Four years prior, she was hospitalized for treatment of immune thrombocytopenia (ITP) with splenectomy and rituximab followed by two episodes of bacterial meningitis despite immunizations. The recurrent meningitis had been attributed to splenectomy and immunotherapy. During this hospitalization, extensive workup for gastrointestinal pathology was negative and she was diagnosed with intestinal pseudo-obstruction. Her hospital course was complicated by development of severe pseudomonas pneumonia, and subsequent immunoglobulin testing and impaired antibody response to vaccines were consistent with CVID. We review the clinical presentation of CVID, its association with autoimmune disease, and treatment implications, specifically the impact of rituximab therapy and splenectomy on immunoglobulin function and risk of serious infection. Intestinal pseudo-obstruction has been reported in children with CVID, but literature search failed to reveal similar presentation in adults. Physicians must consider the heterogeneous clinical manifestations of CVID to avoid delay in diagnosis and treatment. Institution of appropriate therapy with immunoglobulin replacement is important to decrease risk of serious infection.
journal_name
Postgrad Medjournal_title
Postgraduate medicineauthors
Arays R,Goyal S,Jordan KMdoi
10.1080/00325481.2016.1199250subject
Has Abstractpub_date
2016-08-01 00:00:00pages
567-72issue
6eissn
0032-5481issn
1941-9260journal_volume
128pub_type
杂志文章abstract::Drug-induced illness is common in any clinical practice. The consequences of failure or delay in diagnosis--persistent or recurring illness, unnecessary diagnostic evaluation, inappropriate treatment, and future jeopardy from the drug--can be avoided by early recognition. Using descriptions of cases from his practice,...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1980.11715344
更新日期:1980-01-01 00:00:00
abstract::Technical advances over the past few years have rapidly increased the possibilities for filmless radiology services provided by PACS. Such systems are also financially feasible for many healthcare practices, primarily because of the goals achieved through increased efficiency and improved patient care. In coming years...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2001.06.960
更新日期:2001-06-01 00:00:00
abstract::Readers are invited to submit questions relating to problem cases. Inquiries will be answered by qualified consultants and replies forwarded by mail promptly. Selected problems and solutions are published every month in this section. ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1985.11698867
更新日期:1985-02-01 00:00:00
abstract::Although low-dose oral corticosteroid therapy cannot be considered remittive, it has earned a place in the therapeutic armamentarium for rheumatoid arthritis. Major clinical trials of a group using corticosteroid compared with a control group have not been done since the 1950s. One of these three large trials showed s...
journal_title:Postgraduate medicine
pub_type: 临床试验,杂志文章,评审
doi:10.1080/00325481.1987.11700016
更新日期:1987-10-01 00:00:00
abstract:OBJECTIVE:Among a random sample of emergency department (ED) patients, we sought to determine the extent to which reported risk for human immunodeficiency virus (HIV) is related to ever having been tested for HIV. METHODS:A random sample of patients (aged 18-64 years) from an adult, urban, northeastern United States, ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.2010.01.2100
更新日期:2010-01-01 00:00:00
abstract::A concerted national effort has reduced cardiovascular mortality rates in the general US population. Unfortunately, not all ethnic groups have benefited equally from these improvements in our national health. The author presents insights into social and clinical factors that affect cardiovascular disease among Hispani...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1992.11701252
更新日期:1992-03-01 00:00:00
abstract::The association of depression and erectile dysfunction (ED) has been firmly established, but it may be difficult to distinguish between cause and effect--whether ED causes the depression or the depression causes ED--in an individual patient. In most patients who have major depression, successful reversal of the depres...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.5.15.2000.suppl5.29
更新日期:2000-05-01 00:00:00
abstract::Deep neck infection has ominous implications if not detected and treated in an early stage. The anatomic relationships of head and neck spaces encourage spread of infection. Immediate hospitalization and constant monitoring of the patient after diagnosis are mandatory. ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1976.11714389
更新日期:1976-06-01 00:00:00
abstract::Treatment of immunologically mediated diseases has been hampered by the lack of therapeutic agents capable of selectively altering distinct areas of the immune network. Unfortunately, most immunomodulating drugs with such capability are not selective in their suppressive effects, often causing untoward reactions such ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1983.11698479
更新日期:1983-10-01 00:00:00
abstract:OBJECTIVE:To identify attitudes and practices of endocrinologists (ENDOs), family practitioners (FPs), internists (IMs), primary care nurse practitioners (NPs), physician assistants (PAs), certified diabetes educators (CDEs), retail pharmacists (R-PHs), and hospital pharmacists (H-PHs) with respect to type 2 diabetes m...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.2014.05.2764
更新日期:2014-05-01 00:00:00
abstract::Maternal peripartum complications continue to be a significant problem in the United States, even among previously healthy women. The problems include peripartum bleeding, infection, hypertension, and thromboembolic disease. Primary care physicians are often called upon to treat these conditions. An awareness of the a...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1994-02-01 00:00:00
abstract::In a case of rheumatic disease, the patient's history and a careful physical examination should yield most of the information needed to identify the specific disorder present. A convenient classification is based on four differentiating features: number of joints affected, acuteness or chronicity of disease, absence o...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1976.11708414
更新日期:1976-12-01 00:00:00
abstract::This case report describes prolongation of a patient's prothrombin time and partial thromboplastin time possibly due to coadministration of warfarin and an overdose of an acetaminophen-propoxyphene combination analgesic. Patients receive warfarin for many indications, and concomitant use of an analgesic agent is commo...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1988.11700233
更新日期:1988-04-01 00:00:00
abstract::Clinicians are often perplexed by patients with bacterial infection who are not responding to oral antibiotic therapy. Since most of the commonly used antibiotics are excreted in the urine, inhibitory activity of urine against susceptible organisms can be used as a measure of patient compliance. To assess the reliabil...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1979.11715090
更新日期:1979-03-01 00:00:00
abstract::The cutaneous manifestations of systemic diseases are diverse. In some cases, they are the first signs of an underlying disorder, such as Cowden's disease, dermatomyositis, and Lyme disease. Sister Mary Joseph's nodule (metastatic involvement of the umbilicus) is an ominous sign of internal malignant disease. Drug-ind...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1994-12-01 00:00:00
abstract::Preview Practical assessment of the functional and support factors affecting quality of life in older patients should be an integral part of medical management. This approach allows physicians to focus on remediable problems that compromise patients' daily functioning and may hinder them from living independently. In ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1996.11946120
更新日期:1996-05-01 00:00:00
abstract::Looking back at the long history of cancer, we can still relate to that POSTGRADUATE MEDICINE editorial written 50 years ago: "None of the basic problems of cancer has been solved. The death rate is constantly mounting. Small wonder that many doctors face cancer with a pessimism bordering on resignation." The temptati...
journal_title:Postgraduate medicine
pub_type: 历史文章,杂志文章
doi:10.3810/pgm.1997.09.307
更新日期:1997-09-01 00:00:00
abstract::Many controversies, only a few of which have been discussed here, are now raging in the field of resuscitation. Much is expected to change in the next five to ten years. The American Heart Association is now considering changes for its new advanced cardiac life support course, which should be ready this year. The cour...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1986.11699404
更新日期:1986-05-15 00:00:00
abstract::Cluster headache is a syndrome of severe head and facial pain accompanied by autonomic abnormalities. Men are affected more frequently than women. Headaches occur daily during periods of susceptibility, which may be followed by periods of remission. The etiology of cluster headache is uncertain. Recent work suggests t...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.1992.11701227
更新日期:1992-02-15 00:00:00
abstract::The goal of screening for colorectal cancer is to find early, asymptomatic cancers and adenomatous polyps that are 1 cm or more in diameter or that are villous or tubulovillous histologically. A study using fecal occult blood testing with rehydration and no sigmoidoscopy found that deaths from colorectal cancer can be...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1994-07-01 00:00:00
abstract::To help you save time in identifying those meetings and courses of greatest interest to you, POSTGRADUATE MEDICINE offers this objectively rated listing as a regular reader service. Each event has been rated on the factors that matter most to you: relevance of the subject to primary care, number of credit hours, cost ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1977.11714671
更新日期:1977-11-01 00:00:00
abstract::A 65-year-old woman presented to the hospital with weight loss and diarrhea. A diagnosis of thyroid storm was established by the presence of fever, lethargy, tachycardia, heart failure (HF), and abnormal thyroid function tests. An acute coronary syndrome (ACS) was suspected because of anteroseptal ST-segment elevation...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.3810/pgm.2009.05.2012
更新日期:2009-05-01 00:00:00
abstract::In recent years bone marrow transplantation has become increasingly feasible for treating adult acute leukemia unresponsive to chemotherapy. However, the technique is not without significant intrinsic morbidity. The mouth is a singularly sensitive reflector of the cytotoxic, infectious, and hemorrhagic complications a...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:10.1080/00325481.1979.11715304
更新日期:1979-11-01 00:00:00
abstract::Syncope is a common complaint that is frequently evaluated without identifying a precipitating cause. Gelastic (laughter-induced) syncope is an uncommon and poorly understood condition. We describe 3 patients who experienced loss of consciousness during vigorous laughter. Each patient had an extensive medical evaluati...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2010.11.2231
更新日期:2010-11-01 00:00:00
abstract::Ultraviolet (UV) radiation is a notorious environmental carcinogen. Acute and chronic UV radiation exposure increase the risk for skin cancer. Protecting oneself from both UVA and UVB radiation with broad-based sunscreen can prevent certain skin cancers, their precursors, and photoaging. Although sun protection factor...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2011.07.2315
更新日期:2011-07-01 00:00:00
abstract:BACKGROUND:Irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC) are common functional bowel disorders. Patients with IBS-C or CIC often present with ≥ 1 comorbidity that coincides with either of these conditions. These comorbidities may make underappreciated contributions to the ...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2013.03.2640
更新日期:2013-03-01 00:00:00
abstract::Pulmonary artery hypertension (PAH) refers to several subgroups of disease in which the mean pulmonary artery pressure (mPAP) is elevated to more than 25 mm Hg, pulmonary artery wedge pressure (PAWP) ≤ 15 mmHg, and an elevated pulmonary vascular resistance (PVR) > 3 Wood units as confirmed by right heart catheterizati...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.1080/00325481.2016.1188664
更新日期:2016-06-01 00:00:00
abstract::Politicians may have written a temporary obituary for healthcare reform, but as anyone in medicine knows, reform is alive and (debatably) well. Mergers, acquisitions, and practice changes are happening all across the land, and many a physician is going from being a small-business owner to being an employee. Difficult ...
journal_title:Postgraduate medicine
pub_type: 杂志文章
doi:
更新日期:1994-11-15 00:00:00
abstract::Genetic syndromes that convey a significant risk of breast cancer are responsible for a small but significant percentage of these cancers. However, the vast majority of breast cancers occur in women with no family history of the disease. Nongenetic risk factors include age, previous breast disease, breast tissue densi...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:10.3810/pgm.2004.10.1595
更新日期:2004-10-01 00:00:00
abstract::In an era when air travel is commonplace, middle ear block is not unusual. Educating patients about the simple techniques they can perform at the first signs of a problem may save a business trip or vacation from becoming a trip to the emergency department and a train ride home. The most important preventive measure i...
journal_title:Postgraduate medicine
pub_type: 杂志文章,评审
doi:
更新日期:1994-08-01 00:00:00