mycophenolic-acid and Hematoma

Dermatomyositis (DM) is a rare inflammatory disorder affecting the muscle and skin. DM patients can present with spontaneous muscle hemorrhage, a potentially fatal complication. The best practice for management of hemorrhagic myositis in these patients remains unclear. Here we discuss the case of a patient who presented with progressive muscle weakness and intermittent rash that was diagnosed with dermatomyositis. During admission, she developed spontaneous hemorrhagic myositis of the right pectoralis major treated with surgical evacuation. She also developed a spontaneous left anterior thigh hematoma which was treated conservatively. She recovered and showed no evidence of recurrent bleeding at either location. We performed a literature review and identified ten cases of spontaneous hemorrhage in DM patients, with a 60% mortality rate among reported cases. Given the high mortality rate associated with spontaneous hemorrhage in DM patients, it is important for physicians to be aware of the diagnosis, workup, and management strategies.

Topics: Compression Bandages; Conservative Treatment; Dermatomyositis; Drainage; Enzyme Inhibitors; Female; Glucocorticoids; Hematoma; Hemorrhage; Hemostasis, Surgical; Humans; Hypotension; Immunoglobulins, Intravenous; Immunologic Factors; Methylprednisolone; Middle Aged; Mortality; Muscular Diseases; Mycophenolic Acid; Pectoralis Muscles; Prednisone; Quadriceps Muscle

Topics: Adolescent; Antibodies, Neutralizing; Factor IX; Factor VIIa; Factor VIII; Hemarthrosis; Hematoma; Hemophilia B; Humans; Immune Tolerance; Immunoglobulins, Intravenous; Isoantibodies; Male; Mycophenolic Acid; Risk

Despite advances in immunosuppression and surgical technique, pancreas transplantation is encumbered with a high rate of complication and graft losses. Particularly, venous graft thrombi occur relatively frequently and are rarely detected before the transplant is irreversibly damaged.. To detect complications early, when the grafts are potentially salvageable, we placed microdialysis catheters anteriorly and posteriorly to the graft in a cohort of 34 consecutive patients. Glucose, lactate, pyruvate, and glycerol were measured at the bedside every 1-2 hours.. Nine patients with graft venous thrombosis had significant lactate and lactate-to-pyruvate-ratio increases without concomitant rise in blood glucose or clinical symptoms. The median lactate in these patients was significantly higher in both catheters compared to non-events (n = 15). Out of the nine thrombi, four grafts underwent successful angiographic extraction, one did not require intervention and four grafts were irreversibly damaged and explanted. Four patients with enteric anastomosis leakages had significantly higher glycerol measurements compared to non-events. As with the venous thrombi, lactate and lactate-to-pyruvate ratio were also increased in six patients with graft surrounding hematomas.. Bedside monitoring with microdialysis catheters is a promising surveillance modality of pancreatic grafts, but differentiating between the various pathologies proves challenging.

Topics: Adult; Antilymphocyte Serum; Catheters, Indwelling; Early Diagnosis; Feasibility Studies; Female; Glucose; Glycerol; Graft Rejection; Hematoma; Humans; Immunosuppressive Agents; Lactic Acid; Male; Microdialysis; Middle Aged; Monitoring, Physiologic; Mycophenolic Acid; Pancreas Transplantation; Pyruvic Acid; Tacrolimus; Venous Thrombosis