- Email: [email protected]
Relapsing polychondritis in an adolescent: A case report and review of the literature
w.
JOURNALOF
9, No. 3
u. cbo iupllcotioeo of thio dicacocio the adolokoat fmsnlo. harm not-boon rbio report doccrlbss a 20 pear-old
cs tha ovolviae ooeualilv of lddtoeced LO thi litoreturo. fonulu wbc Presentad to cur sdoloocoot olisic with nultiplo physics1 Canplsfata mad CI actikiU& doprorscd ufieot. Donocraol bistcrp was eisaificost for ssnaroka .t ago 15. followed by onooatio~of normal soothly
at am IS.\ patiant “IIDLariat
cyeloo
At tbo
tima Of
prooentotiom
to our
clitic.
the
l-2 ncactrucl patiodo Pet Po.r, had had a cotcl of 3 coTloo-pooitiva uoiea p*e*mm*y toetu oalt the paat 3 ywrs,
She bed aad comploiaod of oxtIm&? irritability and mood 0rin8.. redo 5 ouicido tho poet 9 yeoro. oud bad dropped out of ochool attar the Poloa-pooitiro prefm.ocy Workup o( potiaat'o oocondary aman,orrhoe lad to a dia8'Lo.i. ef ~~wn.tu~e ororioa failure, and hormone roplecomoat wsolnitiato& A si@nifiCaak patiaht'o mood "Be tapo?ted by both tRc, patinnt ond bar family. .ad oha ra-earullsd in school 011 Zsaoltlliy followup vioita aero em iOpO?tODt port h.6 OS% Paici.tivu* of the plee, (I. time we. moodad to addreoo the pscieot'o Q.(LC.ID. related to body iurnc, naxuality, and complioace with tbo thompeutic ra@sm ham b=mm iacerti1ity. oxcolloat, cad the patiamt ban oxperiancad aone of the deproooive .ymptom. that wow b&ore k~rrnome eoroful e0eetru.1 biotory opproprlsto laboratory ocudiee lhould bo iacludod ia ovoluaLioeofoey adolsoeest prooeoti.S oo that thio tore bot traotobl. with doproocioa. ALSO. tho heoltb cars proridsr twot coeditloe 10 cot oserlookod. be awelo of the poYohOXO6icol imP1icoti.e. for the adoleocaat vhelr diegeooio of feiluro io medo.
so.turo. la tl+at tbc Is>-rV‘CMatin tba
teat.
patient’m tmat.arat
A
mymF_to.. of
the
RPLA%SlHC POLYC”OWDRITISIN AN ADDLESCEMT:A CASE REPORTAND RNIW OF IIIELITWA1IIRE. Richard 1. trepel. N.D.. Lawrence J. b’A~lo. H.O., N.P.H. Children% Howi~al Natlonl Nedlcal Centor. Yonhiagtoo, D.C. Relapsing Polychondritia VIP) it an u,,c-on SYIIILO~Cdimordsr characterized by ia!lan~rion and destruction of cartiloxe. Vo have recoorly cotod for o I7 Y.O. woman who ~romented with P l-month history of deproo.Ion. wiSht loss. chaet ~011 toederaoos~ bowssnooo, oad dyophayio. She Y~B odaittod For ovsl,,nt1.e of. Poae4blo P8~cbo8outLc illness. Objoetivo findlags inck,rJod cochexla, . low Srodo frvcr. mild .“.zsio (bet 34). and .n o1wat.d uodimantarion rat. ($0). A Z-ooRth @voluatloo raulted lo apirif thoropy with hiah-dose 014 foll~ed by roodmisaion For rerpirotory distcooo: ot calcified tracheal rarrilo~o. subglottic atrlcturo, and P saddlemae dsfonlty were preseoc, Despite therapy with oraroido, dopsone md ~ulro eyclophowhamido. distroon reoccurrod. ovontuolly oocoooitoting tochmotoay. Traeh.a.4corti1a.q~ bloPoY confiroed the prebumwive dlstne nia Of RP. Althuu$h soon 10 all ato XrouPs. leas than 1QX of c.8.~ ct RP are see,, in children and adolooc@nro, &I inllaonatory aoyaaorric orthritie (61% cases), Wool fhondritio (729 CP~PB>, and roepirorory tract choedriris (5bX cow,.) V.C. prsront in WI patiNn. OtherwIse prominset findin~o including auricul~~ chon(89% c.%w). ~nfl~xnetory ‘[email protected] (65% crrseo). ood wdiovoatibular abmmolitioa (46% caon) uoro obaent in our pPtio.t. RP ocenaiowa1y rsiats swntaneous1y. Houwor, 26% of c.ses davelop fotol CUqlliCotiOno, Infections. crp.ciUly of the roapiratory tract, and cardiovascuIII problem are the -in cau.~e. Apppropr~ree dioXnosia and a~,jressive rherrpy Ioaaco chance of this outcone.
etemldrr.hiLlal inprovamtLII. theI respkitory
drltis
the
.pp.rmt the
With
ropLm.aammt ~a&bagan.
avarimn
INFLAN?%mRY PWNMY MASS LEK:OMS IULICNANCY IN AN MKlLcSCSNT FEW.5.
and John W. Creena.H.D.
Centtr, Wsrhvilt,
-274.
Vandarbilt
klASQUERNIIWC
AS
J.D.Sharpt,H.D. Univardtv_ Medical
An 12 year old fermle with rettune and bulimia rtsented with malairs and bittmittent fever, soon followed by s ronchitis and bronchospeam for which she was treattd. At lnLtZsl follow up she complained of &eat pain and m CXR showed ltft sided infiltrates. Pntmtnit vts dioDnorod. In eplte of therapy with oral liaflan SOCnDQID her opptems were unremitting. %?~aar CXR rhowad matwaa in the left uppar chest. A CT scan en ~dmleelon ravealad two roft timm mttttt in the ltft up ar chest, arillary adenopathy, and a su Dasticn of caliac a s cnoRadioloDy consultants etrong By favored a diagnosis of Iharsfore, 8 thin needle aspiration biopsy vaa obtain a cytologic specimen. Nondiagnostic flui r- or888 obtained. She than want to bronchoocop which revealed thick secretiona in the left upptr lobs bronc 1:us with a thick plug in tha lin ular esgment.Bronchoacoplc cultures Dran Streptoccncua Pneumonf a and AsperDillus Rupi@ua. Becum XgEYW elevated at 4992 &cl, and e inter CDC showsd eosinophilia of 12%. Tkesc flndinge and clenrinp of the pulmonary lesions made clear an imfeceiaua etiology. The diagnosis of asthma complicated by Pntumococcal pnannonia and probable Allergic Bronchopulaonary Asptr2~llosis~ABPA~~.sarolo le confirmaticn pwlingl was made. Prior to thoracotomy, e i! in needle aspixvrcion biopsy and/or bronchoscopy should be considered in selected patients with pu1aonery ncss 1tstons. Increasad avarentsr of A9PA may barten the diagnosis and initiation of therapy in anthmtie adolescents. Does alteration of absorption of oral medications occur in hulimie patients to adversely affect the outcome of therapy?
JOURNALOF
9, No. 3
u. cbo iupllcotioeo of thio dicacocio the adolokoat fmsnlo. harm not-boon rbio report doccrlbss a 20 pear-old
cs tha ovolviae ooeualilv of lddtoeced LO thi litoreturo. fonulu wbc Presentad to cur sdoloocoot olisic with nultiplo physics1 Canplsfata mad CI actikiU& doprorscd ufieot. Donocraol bistcrp was eisaificost for ssnaroka .t ago 15. followed by onooatio~of normal soothly
at am IS.\ patiant “IIDLariat
cyeloo
At tbo
tima Of
prooentotiom
to our
clitic.
the
l-2 ncactrucl patiodo Pet Po.r, had had a cotcl of 3 coTloo-pooitiva uoiea p*e*mm*y toetu oalt the paat 3 ywrs,
She bed aad comploiaod of oxtIm&? irritability and mood 0rin8.. redo 5 ouicido tho poet 9 yeoro. oud bad dropped out of ochool attar the Poloa-pooitiro prefm.ocy Workup o( potiaat'o oocondary aman,orrhoe lad to a dia8'Lo.i. ef ~~wn.tu~e ororioa failure, and hormone roplecomoat wsolnitiato& A si@nifiCaak patiaht'o mood "Be tapo?ted by both tRc, patinnt ond bar family. .ad oha ra-earullsd in school 011 Zsaoltlliy followup vioita aero em iOpO?tODt port h.6 OS% Paici.tivu* of the plee, (I. time we. moodad to addreoo the pscieot'o Q.(LC.ID. related to body iurnc, naxuality, and complioace with tbo thompeutic ra@sm ham b=mm iacerti1ity. oxcolloat, cad the patiamt ban oxperiancad aone of the deproooive .ymptom. that wow b&ore k~rrnome eoroful e0eetru.1 biotory opproprlsto laboratory ocudiee lhould bo iacludod ia ovoluaLioeofoey adolsoeest prooeoti.S oo that thio tore bot traotobl. with doproocioa. ALSO. tho heoltb cars proridsr twot coeditloe 10 cot oserlookod. be awelo of the poYohOXO6icol imP1icoti.e. for the adoleocaat vhelr diegeooio of feiluro io medo.
so.turo. la tl+at tbc Is>-rV‘CMatin tba
teat.
patient’m tmat.arat
A
mymF_to.. of
the
RPLA%SlHC POLYC”OWDRITISIN AN ADDLESCEMT:A CASE REPORTAND RNIW OF IIIELITWA1IIRE. Richard 1. trepel. N.D.. Lawrence J. b’A~lo. H.O., N.P.H. Children% Howi~al Natlonl Nedlcal Centor. Yonhiagtoo, D.C. Relapsing Polychondritia VIP) it an u,,c-on SYIIILO~Cdimordsr characterized by ia!lan~rion and destruction of cartiloxe. Vo have recoorly cotod for o I7 Y.O. woman who ~romented with P l-month history of deproo.Ion. wiSht loss. chaet ~011 toederaoos~ bowssnooo, oad dyophayio. She Y~B odaittod For ovsl,,nt1.e of. Poae4blo P8~cbo8outLc illness. Objoetivo findlags inck,rJod cochexla, . low Srodo frvcr. mild .“.zsio (bet 34). and .n o1wat.d uodimantarion rat. ($0). A Z-ooRth @voluatloo raulted lo apirif thoropy with hiah-dose 014 foll~ed by roodmisaion For rerpirotory distcooo: ot calcified tracheal rarrilo~o. subglottic atrlcturo, and P saddlemae dsfonlty were preseoc, Despite therapy with oraroido, dopsone md ~ulro eyclophowhamido. distroon reoccurrod. ovontuolly oocoooitoting tochmotoay. Traeh.a.4corti1a.q~ bloPoY confiroed the prebumwive dlstne nia Of RP. Althuu$h soon 10 all ato XrouPs. leas than 1QX of c.8.~ ct RP are see,, in children and adolooc@nro, &I inllaonatory aoyaaorric orthritie (61% cases), Wool fhondritio (729 CP~PB>, and roepirorory tract choedriris (5bX cow,.) V.C. prsront in WI patiNn. OtherwIse prominset findin~o including auricul~~ chon(89% c.%w). ~nfl~xnetory ‘[email protected] (65% crrseo). ood wdiovoatibular abmmolitioa (46% caon) uoro obaent in our pPtio.t. RP ocenaiowa1y rsiats swntaneous1y. Houwor, 26% of c.ses davelop fotol CUqlliCotiOno, Infections. crp.ciUly of the roapiratory tract, and cardiovascuIII problem are the -in cau.~e. Apppropr~ree dioXnosia and a~,jressive rherrpy Ioaaco chance of this outcone.
etemldrr.hiLlal inprovamtLII. theI respkitory
drltis
the
.pp.rmt the
With
ropLm.aammt ~a&bagan.
avarimn
INFLAN?%mRY PWNMY MASS LEK:OMS IULICNANCY IN AN MKlLcSCSNT FEW.5.
and John W. Creena.H.D.
Centtr, Wsrhvilt,
-274.
Vandarbilt
klASQUERNIIWC
AS
J.D.Sharpt,H.D. Univardtv_ Medical
An 12 year old fermle with rettune and bulimia rtsented with malairs and bittmittent fever, soon followed by s ronchitis and bronchospeam for which she was treattd. At lnLtZsl follow up she complained of &eat pain and m CXR showed ltft sided infiltrates. Pntmtnit vts dioDnorod. In eplte of therapy with oral liaflan SOCnDQID her opptems were unremitting. %?~aar CXR rhowad matwaa in the left uppar chest. A CT scan en ~dmleelon ravealad two roft timm mttttt in the ltft up ar chest, arillary adenopathy, and a su Dasticn of caliac a s cnoRadioloDy consultants etrong By favored a diagnosis of Iharsfore, 8 thin needle aspiration biopsy vaa obtain a cytologic specimen. Nondiagnostic flui r- or888 obtained. She than want to bronchoocop which revealed thick secretiona in the left upptr lobs bronc 1:us with a thick plug in tha lin ular esgment.Bronchoacoplc cultures Dran Streptoccncua Pneumonf a and AsperDillus Rupi@ua. Becum XgEYW elevated at 4992 &cl, and e inter CDC showsd eosinophilia of 12%. Tkesc flndinge and clenrinp of the pulmonary lesions made clear an imfeceiaua etiology. The diagnosis of asthma complicated by Pntumococcal pnannonia and probable Allergic Bronchopulaonary Asptr2~llosis~ABPA~~.sarolo le confirmaticn pwlingl was made. Prior to thoracotomy, e i! in needle aspixvrcion biopsy and/or bronchoscopy should be considered in selected patients with pu1aonery ncss 1tstons. Increasad avarentsr of A9PA may barten the diagnosis and initiation of therapy in anthmtie adolescents. Does alteration of absorption of oral medications occur in hulimie patients to adversely affect the outcome of therapy?