Myositis Specific Antibodies (MSAs)
Dermatomyositis: MDA5, TIF1y, NXP2, Mi-2, SAE
Anti-Synthetase Syndrome: Jo-1, PL7, PL12, EJ, OJ
Immune Mediated Necrotizing Myopathy (IMNM): HMGCR, SRP
Inclusion Body Myositis (IBM) + others: NT5c1A/cN1A
By Mithu Maheswaranathan, MD @MithuRheum
#Myositis #Specific #Antibodies #MSAs #clinical #diagnosis #rheumatology #table
Hypokalemia - Differential Diagnosis Algorithm
Extra-renal Losses:
• Normal Acid-Base: Low intake
• Metabolic acidosis: Gl tract loss (Diarrhea)
Renal Losses:
• Metabolic acidosis: Proximal and distal RTA, Ureterosigmoidoscopy
• HTN, Low Aldosterone: Liddle's Syndrome, Licorice, Carbenoxolone, SAME, Cushing Syndrome
• HTN, High Aldosterone: Malignant HTN, Renovascular HTN, Renin secreting tumor, Primary hyperaldosteronism
• HTN Absent: Loop and thiazide diuretics, Bartter syndrome, Gitelman syndrom, Vomiting, Non-reabsorbable anions
Dr Priti Meena @priti899
#Hypokalemia #Differential #Diagnosis #Algorithm #causes #potassium #low #nephrology
Cytomegalovirus (CMV) in HIV-AIDS Patients
Cytomegalovirus (CMV): double-stranded DNA virus, herpesvirus family.
CMV infection: virus isolation or detection in any body fluid or tissue specimen regardless of symptoms or signs.
Diagnosis: Quantitative PCR and CMV pp65 antigenemia test. For tissue-invasive CMV CMV, inclusions or positive specific immunohistochemistry on histopathology.
Suspect these CMV-related conditions in any patient with HIV and CD4 50 or less:
• Neurologic: Encephalitis, Myelitis, Polyradiculopathy, Peripheral Neuropathy
• Eye: Retinitis (Most common cause of blindness in AIDS)
• Liver: Hepatitis, Portal vein thrombosis
• Endocrine: Infectious Adrenalitis, Pancreatitis
• Pulmonary: Pneumonitis (In association with PJP/TB)
• Cardiovascular: Myocarditis, ↑Cardiovascular risk, DVT
• Gastrointestinal: Esophagitis, Enteritis, Colitis
By @TheIDtrivia
#Cytomegalovirus #CMV #HIV #AIDS #diagnosis #differential #signs #symptoms
Bell's Palsy - Diagnosis and Management Summary - GrepMed Handbook
Acute Idiopathic Unilateral Facial Nerve (CN7) Palsy
Presentation:
• Unilateral upper AND lower facial weakness ± hyperacusis, ↓lacrimation, ↓taste, ↓salivation.
• Typical progression: over 1-3d → max severity within 3w, some recovery within 4m
• Atypical Features 🚩:
- Atypical Clinical: Isolated lower, bilateral, non-CN7 neuropathies (ataxia, hearing loss, spasm, ophthalmoplegia), systemic signs (rash, swelling, adenopathy)
- Atypical Temporal: Rapid onset to max severity, prolonged onset (weeks-months), progression >3w, No improvement <4m
• Etiology: Idiopathic, HSV most common. Other: viral, Lyme, facial nerve ischemia
• DDx: HZV (Ramsay-Hunt), HIV, Lyme, GBS, tumor, parotid/middle ear/skull base pathology, sarcoidosis, Sjogrens
Diagnosis and Workup:
• No additional workup needed if typical presentation
• Lyme Serology (if endemic area) ± HIV screening
• Imaging (if atypical symptoms): MRI+gad (stroke, CN7, parotid), CT (middle ear/temporal bone pathology)
• LP (if suspect GBS, sarcoid or other CNS inflammatory cause)
• EMG/NCS (rare): assist prognosis with delayed recovery
Management:
• Glucocorticoids: prednisone 60-80mg/d x 1w OR prednisone 60mg x 5d + 10mg taper x 5d
• Antiviral (unproven benefit, rec for severe Sx): Valacyclovir 1g tid x 1w or Acyclovir 400 mg 5x/d x 10d
• Eyecare (prevent corneal injury):
- Awake: Artificial tears gtt qid+prn
- Sleep: Artificial tears oint + TAPE eye shut (patch alone may be insufficient!)
• Monitoring: New/worsening S/Sx after 3w, no improvement within 4m
#Bells #Palsy #Diagnosis #Management #Treatment #Neurology