Journal of Case Reports in Practice
Volume:3 Issue: 4, Oct 2015

Immune therapy and graft-versus-tumor effect seen after allogeneic hematopoietic stem cell transplantation provide proof-of-principle of the ability of human immune system to control cancer. Spontaneous regression of cancer is another dramatic evidence of the existence of powerful immune surveillance in human body. We report a 54-year-old man with 13q14 deleted chronic lymphocytic leukemia and diffuse lymphadenopathy, who had spontaneous normalization of leukocytosis and resolution of lymphadenopathy thirteen years after the diagnosis of chronic lymphocytic leukemia. Better understanding of spontaneous regression may help elucidate body’s immune response against tumor cell. This may further enhance the development of immune therapies and provide insight towards tumorigenesis.

Fahr’s Disease is characterized by neurologic, psychiatric, and cognitive disorders of unknown etiology, and is also characterized by symmetric calcifications in the basal ganglia and cerebellar dentate nucleus.The most common symptom of the disease is considered to be movement disorders, both Parkinsonism and hyperkinetic movement disorders (chorea, tremor, dystonia, athetosis, oro-facial dyskinesia). The second most common ma- ni-festation of BSPDC is cognitive impairment followed by cerebellar impairment and speech disorder. Psychiat- ric features (dementia, psychosis, affective disturbances), gait disorders, and sensory changes are also reported. A32-year-old male patient presented to Emergency department due to syncope. Coincidentally, hypocalcemia and widespread calcifications in brain computerized tomography indicating Fahr’s Disease were determined. Patients with Fahr’s disease generally presents to Emergency departments with epileptic seizures. Syncope as a presen- tation of the disease is extremely rare. In patients with hypocalcemia and calcifications in brain computerized tomography, Fahr’s Disease must be suspected.

Scleroderma (SSC) is a systemic inflammatory disease characterized by vascular dysfunction and excessive fibrosis which may involve many organs particularly the heart, lungs and kidney. In scleroderma cardiac disease and pulmonary arterial hypertension (PAH) are common findings where as coronary diseases have been reported with a similar frequency or as rare in several studies. Atypical presentation, wide range of differential diagnosis and co morbidities can result in certain difficulties in diagnosing coronary disease in these patients. Hereby, we report two cases with scleroderma and PAH and a mild increased filling pressure in which significant coronary disease was discovered incidentally. Therefore, it seems crucial to perform further studies on the preferred time for evaluating CAD in such patients.

Gastrointestinal stromal tumours (GISTs) are the most common mesenchymal tumours of the gastrointestinal tract, arising from the interstitial cells of Cajal. They have variable malignant potential, ranging from small lesions with a benign behaviour to fatal sarcomas. In this paper, the authors report three cases of GISTs involving respec- tively the stomach, the duodenum and the jejunum. Our series included two women and one man aged between 42 and 74 years. The presenting symptoms included abdominal pain (n=2), gastrointestinal bleeding (n=1), abdomi- nal mass (n=1), weight loss (n=1) and anemia (n=1). The three patients underwent surgical treatment. Histological examination of the surgical specimen coupled with immunohistochemical study confirmed the diagnosis of GIST in all cases. Detailed immunohistochemical studies are useful in successfully identifying any case of GIST, which is crucial to clinical treatment. New insights into the origin and progression of GISTs are setting the stage for further therapeutic innovations, with the goal not just to control disease growth, but to eliminate all tumour cells at the time of initial therapy.

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that predominantly affects young women. Old age lupus occurs after the age 50 years and the disease occurs in 10-20% of patients over 50 years. This case was a 78-year-old woman who admitted to our hospital with polyarthritis, dyspnea, chest pain, typic malar rash, thrombocytopenia, lymphopenia:, positive antinuclear antibody (ANA):,and high titer anti-dsDNA from 3 weeks before admission. However older patients are more likely to have an insidious presentation and anti-ds DNA was very high and the other hand malar rash, polyarthritis and thrombocytopenia was reported very rare in old age in literatures bur our patients had acute presentation and her disease pattern similar pattern of disease in young patients.

The association between TTP and systemic lupus erythematosus (SLE) has been infrequently reported, however an association with discoid lupus was not reported in the literature. Usually, patients with TTP have increased SLE activity and frequent renal involvement. Here we present a case of a 65 year old man who presented to the emergency department with malaise, fever and purpura of several days duration. His past medical history was sig- nificant for discoid lupus diagnosed by biopsy 34 years ago as well as hypertension. On laboratory investigation, he had low complement levels and ADAMTS13 level of < 5 %. A peripheral blood smear showed the presence of schistocytes. On the basis of clinical and biochemical findings, he was diagnosed with TTP.