TOC & Search | Palm Index | Rx  | Pt. Ed UC | PubMed | Refs | Disclaimer | Home

Idiopathic, Syndromes, Symptoms

Links

• local: Hemolytic-Uremic Syndrome, Withdrawl

Erythema Nodosum

• most common type of panniculitis, reddish lumps on pre-tibial area, usually very tender and usually preceded by fever and malaise. Lumps may be very large and numerous and are initially acutely inflamed, typical course 3-6 weeks, new lesions may appear. Autoimmune disorder?
• female age 20-30 mostly, seen in Sarcoid (Lofgren's syndrome), some infections (tb, yersinia, other more common), pregnancy, OCP, drugs (sulfa, gold)
• may be preceded by viral syndrome features, joint pains in half, usually knee and may persist
• possible tests: throat swab, tb, CBC, ESR, ASO, CXR (sarcoid, consider ACE level), Yersinia?
• Rx: potassium iodide? (does that really work?)
• don't confuse (sound alike) with unrelated vasculitis polyarteritis nodosa

Fatigue/fibromyalgia

1. lab evaluation: CBC with diff, ESR, chem 21, TSH, ANA + RF (if arthritis/myalgia), U/A
2. therapy
   • if depression: prozac, zoloft
   • if not depression: elavil 10-20 mg hs
   • exercise
   • see also somatization disorder

Heat-Related Illness

• Heat-Related Illnesses - 9/1/98 AAFP
• Heat cramps: replace sodium, oral rehydration with 1 tsp salt/qt
• Heat syncope: replace fluids
• Heat exhaustion: core temp < 104.9, sick, visual disturbance. Oral rehydration 1L/hour for several hours.
• Heat stroke: core temp > 104.9, mental status changes, seizures, hypotension, EKG changes, coagulation abormalities, very high ALT/AST, renal failure with ATN, vomiting. 5-10% mortality with treatment. IV fluids, cooling, transport to ED.

Sarcoid

• Caribbean immigrant
• Erythema Nodosum esp. with pregnancy is very suggestive
• Lupus Pernia, acute peripheral arthritis, uveitis, erythema nodosum
• usual lung findings ...

Serotonin Syndrome

• Prozac (long t_1/2) + other SSRI
• hyperalertness, agitation, confusion, restlessness
• myoclonus, hyperreflexia, diaphoresis, shivering, death

Vasculitides

See also: An Approach to Diagnosis and Initial Management of Systemic Vasculitis - AFP Oct 1999. As of 2001 it's not clear what the relationship (if any) is between the vasculitides and the clinically somewhat similar thrombotic microangiopathies (TMA) such as Hemolytic-Uremic Syndrome (HUS).

Small vessel

• flu-like with palpable rash - leukocytoclastic angiitis causes purpura, sometimes with ulceration, in lower extremities.
• may have urticaria, peripheral neuropathy
• respiratory (danger pulmonary hemorrhage, See ANCA)
• obliterative endarteritis can produce petechiae

ANCA associated

• 2/100,000 persons in US. Better outcome if diagnosis early, may progress quickly.
• ANCA: antineutrophil cytoplasmic antibody - presence may define a subtype of vasculitis with a risk of life-threatening pulmonary hemorrhage. Good test for Wegener's Granulomatosis.
• includes drug-induced (PTU and hydralazine), Wegener's Granulomatosis (sinusitis), Churg-Strauss syndrome (asthma, eosinophilia, vasculitis)

Immune complex

• Henoch-Schonlein purpura (age @ 5), cryoglobulinemia (Hepatis C, low C4 normal C3), lupus, rheumatoid, Sjogren's, Behcet's (Japan), Goodpasture's, serum-sickness, drug-induced (pen, sulfa, allopurinol, thiazide, quinolones, etc), infection-induced

Other: Paraneoplastic, Inflammatory Bowel disease

• Rocky Mountain Spotted Fever (RMSF)

Medium vessel

• Polyarteritis Nodosa, Kawasaki's, primary granulomatous central nervous system vasculitis

Large Vessel

• Giant-cell arteritis, Takayasu's arteritis (pulseless disease)