Letters to the Editor
- To the Editor: I read with interest the article by Mohammad et al.1 The authors report the case of a man in his 60s, in whom a petechial rash appeared on his arm after measuring his blood pressure early in his hospitalization. In the context of normal laboratory results, this finding was interpreted as an example of the Rumple-Leede phenomenon (intracutaneous hemorrhage produced by prolonged proximal pressure, signifying increased capillary fragility). Given the specifics of this case (the patient had a history of intravenous drug use, retained needles in the forearm give a picture of self-neglect), consideration should be given to underlying vitamin C deficiency (scurvy), which can also be manifested in this manner.
- We thank Dr Martin Windpessl for his interest in our case of Rumpel-Leede sign. As was pointed out, the cutaneous manifestation of a petechial rash should also suggest vitamin C deficiency. On discovery of the rash, our team did include vitamin C deficiency as part of the differential, consulted with the dermatology service, and sent a vitamin C level that returned within normal limits. We regret not being able to elaborate on this work-up in our initial manuscript because of the word limit associated with submissions of this nature.
- To the Editor: Erdheim-Chester disease (ECD) is a rare non–Langerhans cell histiocytosis belonging to the L-group of the 2016 revised histiocytosis classification.1 Although frequent and associated with clinical complications, cardiac involvement is underdiagnosed in ECD.2 Cardiac magnetic resonance (CMR) imaging is the most robust way to detect cardiac involvement.3 However, access to this technique is limited. We evaluated the utility of B-type natriuretic peptides and troponin for the diagnosis of cardiac involvement in ECD.
- α-Gal syndrome is a recently recognized entity in which allergy to mammalian meat may be acquired by exposure to the disaccharide galactose-α-1,3-galactose (α-gal) antigen through the saliva of the Lone Star tick. Subsequent exposure to the antigen in meat may result in the delayed presentation (3 to 6 hours after ingestion) of systemic hypersensitivity reactions (eg, urticaria, angioedema), gastrointestinal symptoms, or life-threatening anaphylaxis.1,2 Anaphylaxis is potentially fatal, and identifying the cause is critical.
- Arteriovenous fistulas are a common form of autogenous access in patients requiring renal replacement therapy.1-3 Aneurysmal degeneration of segments of the outflow vein and outflow stenosis are frequently identified.4 Albeit rare, arteriovenous fistulas bleeding can be a devastating and fatal dialysis access complication. Skin thinning and ulceration are signs of increased risk for bleeding or impending rupture.5 Immediate investigation of the fistula for any concerning signs of bleeding is imperative and any issues should prompt swift referral.
- The artificial intelligence–enhanced electrocardiogram (AI-ECG) has been validated for the identification of multiple cardiac pathologies.1-3 We developed an AI-ECG algorithm that closely predicts chronologic age and demonstrated that the difference between AI-ECG age and chronologic age, or delta age (the first minus the latter), predicts long-term survival. Furthermore, AI-ECG age has been associated with cardiovascular diseases and risk factors such as hypertension and dyslipidemia.4,5 As this AI tool reflects potentially valuable information about overall fitness and cardiovascular health, we discuss an exemplary case where the AI-ECG showed a change towards youth following risk factor modification.
- Determining the clinical diagnosis underlying thrombotic microangiopathy (TMA), a pathologic entity, may be challenging, as is its effective management. This is especially true when TMA occurs in pregnancy. We report a case of a woman presenting in mid-pregnancy with severe pre-eclampsia and acute TMA who was successfully managed with eculizumab.
- The vaccine mRNA is sensed by multiple pattern recognition receptors of dendritic cells, leading to type I interferon secretion. This interferon response promotes the adaptive immune reaction to provoke antiviral response and probably interferonopathy including type 1 diabetes mellitus (T1DM), lupus, and thyroiditis.1 Indeed, not merely severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection but also vaccination induces disease flare-up in patients with rheumatoid arthritis (RA).2-4 We here report an elderly woman with autoimmune background who received the Pfizer BioNTech vaccine BNT162b2, resulting in new-onset autoimmune polyarthritis-like RA.
- To the Editor: Aortic stenosis (AS) is one of the most common valvular heart diseases with insidious progression and significant morbidity. Because of the deleterious effect of the valve disease on the myocardium, early valve intervention is now recommended before the onset of symptoms,1,2 emphasizing the importance for detecting these individuals with AS early. Although current diagnostic approaches are technology-intensive with advanced imaging techniques, there remains a demand for an effective, inexpensive screening strategy for this clinical entity.