A 23-year-old woman presented with a 1-month history of headache, vomiting, recurrent episodes of syncope, weight gain, and leg pain. A physical examination revealed several subcutaneous nodules on the patient’s face and trunk. Exophthalmos, fundal hemorrhage, neck rigidity, and a hypertrophic appearance of the thigh and calf muscles were also noted.
Case Studies 2017
A 48-year-old man presented with a 2-month history of abdominal discomfort and lethargy. Physical examination revealed pallor, and results from laboratory studies showed mild anemia (hemoglobin level, 9.2 g per deciliter [normal, 12 to 15 g per deciliter]). Colonoscopy revealed a proglottid from a tapeworm in the rectosigmoid colon, and gastroduodenoscopy identified its location in the proximal duodenum, extending distally (Video 1).
March 9, 2017 Plasmodium falciparum has developed resistance to artemisinin in many countries in Southeast Asia.1,2 Artemisinin combination therapy is the first-line treatment for malaria in the majority of countries in which the disease is endemic, and its efficacy is particularly important in Africa, where malaria is the most widespread.3 We report here an
Background Babesiosis is a tickborne zoonotic disease that is caused by intraerythrocytic protozoa of the genus babesia. In the northeastern and upper midwestern regions of the United States, where Babesia microti is endemic, the incidence of babesiosis has increased dramatically in the past 10 years, particularly in New England.1,2 The severity of babesiosis varies from
A 46-year-old woman presented to the emergency department with a 10-day history of pain and swelling in her right arm. She had recently returned to the United Kingdom from the Ivory Coast. Examination revealed distinct areas of ulceration with surrounding erythema distal to her right elbow.
B cells are increasingly recognized as a therapeutic target in autoimmune diseases. B-cell–depleting therapy with the use of rituximab, a monoclonal antibody to CD20, is approved for the treatment of rheumatoid arthritis and antineutrophil cytoplasmic antibody–associated vasculitis and is frequently used off-label to treat lupus nephritis.1 The rationale for targeting B cells in multiple sclerosis has remained controversial, particularly because major animal models of the disease do not involve B cells.2
New Hope with Moxidectin? Moxidectin is well established in veterinary practice to treat a range of parasites, including sarcoptic mange. This provides a solid foundation for considering its potential translation to human scabies. Some studies show excellent efficacy as a single 0.2 mg/kg dose, with 100% cure at day 14 in cattle , whereas sheep required two 0.2 mg/kg doses to achieve cure [39,40], with a single dose reducing mites by 75%–92%. When higher concentrations (1 mg/kg) of a long-acting formulation were used, 100% efficacy was achieved in a single dose . Importantly, both 0.2 mg/kg and 1 mg/kg single-doses prevented reinfection from untreated animals for 25 and 54 days, respectively [41,42]. Differences in observed clinical efficacy may relate to the severity of infestation or pharmacokinetic differences between different species. Differences are also evident between injectable, oral tablet, and liquid formulations, so determining this in human pharmacokinetic profiling, including skin levels, would be ideal, in addition to controlled dose-finding efficacy studies.