Urinalysis was positive for blood and protein urinary sediment displayed granular casts, calcium oxalate crystals, and a few erythrocytes, some of which were dysmorphic. Initial laboratory analysis was notable for deteriorating renal function, severe normocytic anemia, and elevated inflammatory markers (see Table 1). Minor purulent discharge was present in the right leg ulcer.
Physical examination revealed severe bilateral leg pitting edema and a markedly swollen scrotum. In the emergency department, the patient was tachycardic (106 beats/min), with elevated blood pressure (165/85 mmHg) and low-grade fever (38☌) oxygen saturation in room air was normal. His medical record was remarkable for uncontrolled insulin-dependent diabetes mellitus, with secondary target organ insults, including severe retinopathy, chronic renal failure, sensorimotor peripheral neuropathy, and a diabetic ulcer in his right foot.
Case PresentationĪ 29-year-old male patient was admitted to our tertiary care center for a two-week history of fever, watery diarrhea, oliguria, and lower limb and scrotal edema. Based on sporadic evidence from the pediatric literature, he received intravenous immunoglobulin (IVIG), as an add-on therapy, leading to rapid control of the massive bleeding event. Herein, we report the case of a 29-year-old male patient with a new diagnosis of IgA vasculitis, who suffered from hemorrhagic shock, secondary to severe GI bleeding, complicating the disease course. Evidence-based therapeutic approaches for such manifestations are still lacking. Life-threatening gastrointestinal (GI) bleeding is a rare occurrence in adults with IgA vasculitis (formerly known as Henoch–Schönlein purpura). We herein discuss the patient’s presentation, the gastrointestinal manifestations of IgA vasculitis, the recommended treatments, and the existent evidence about IVIG therapy. It was not until therapy with intravenous immunoglobulin (IVIG) was introduced that the massive bleeding was controlled. The late appearance of severe gastrointestinal bleeding dominated the clinical picture, necessitating the administration of tens of units of packed cells and the augmentation of the immunosuppressive protocol. those not cited during the following year.We report the case of a 29-year-old adult presenting with severe IgA vasculitis, with cutaneous, urologic, and renal manifestations. Ratio of a journal's items, grouped in three years windows, that have been cited at least once vs. those documents other than research articles, reviews and conference papers.
#Modern pathology windows
Not every article in a journal is considered primary research and therefore "citable", this chart shows the ratio of a journal's articles including substantial research (research articles, conference papers and reviews) in three year windows vs. journal self-citations removed) received by a journal's published documents during the three previous years.Įxternal citations are calculated by subtracting the number of self-citations from the total number of citations received by the journal’s documents. Journal Self-citation is defined as the number of citation from a journal citing article to articles published by the same journal.Įvolution of the number of total citation per document and external citation per document (i.e. The two years line is equivalent to journal impact factor ™ (Thomson Reuters) metric.Įvolution of the total number of citations and journal's self-citations received by a journal's published documents during the three previous years. The chart shows the evolution of the average number of times documents published in a journal in the past two, three and four years have been cited in the current year. This indicator counts the number of citations received by documents from a journal and divides them by the total number of documents published in that journal. Q1 (green) comprises the quarter of the journals with the highest values, Q2 (yellow) the second highest values, Q3 (orange) the third highest values and Q4 (red) the lowest values. The set of journals have been ranked according to their SJR and divided into four equal groups, four quartiles.
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