AM REPORT PEARLS: IGG4 DISEASE, SEPTIC EMBOLI REVIEW

AM Report Pearls: IgG4 Disease Questions from Report

  • The hallmark NEJM review on IgG4 disease which is by John Stone, our Grand Rounds speaker for tomorrow 3/12! http://www.nejm.org/doi/full/10.1056/NEJMra1104650
  • A very quick brief read on IgG4 disease is this UPMC Path website http://path.upmc.edu/cases/case651/dx.html
  • To Harry’s question about the relationship of IgG4 disease and malignancy – there was one study showing a relatively increased risk of non-Hodgkin’s lymphoma but the study was very small (111 patientsà 3 developed NHL)
  • Another series of 108 patients with IgG4-related pancreatitis showed an increased risk of cancer including gastric cancers >> lung, prostate, colon, lymphoma, pancreatic cancers
  • There are numerous case reports regarding the association between IgG4 pancreatitis and pancreatic cancer and 1 case series of 84 patients with autoimmune pancreatitis à 2 cases of pancreatic cancer – so far, no bigger trials so no clear conclusions
  • Remember the key point: IgG4 levels can be elevated in pancreatic malignancy, so you must biopsy to rule-out malignancy

AM Report Pearls: Septic Emboli

  • Septic pulmonary emboli are often seen with R-sided endocarditis or other intravascular disease
    • Can also be seen from deep soft tissue infections (osteo, septic arthritis, cellulitis, pyomyositis)
  • For septic thrombophlebitis, there is a risk of septic pulmonary emboli, which is higher with IJ catheters than peripheral catheters
  • Empiric antibiotic therapy for septic thrombophlebitis should cover skin flora as well as beta-lactamase resistant-beta-lactams b/c treatment failure with PCN has been reported – obviously tailor to culture results when you get them back but Amp/Sulbactam or Pip/Tazo + Vanc are good places to start
  • Remember that once septic thrombophlebitis has progressed to bacteremia/endovascular infection, duration of therapy is longer – at least 4 weeks (even if there is no valve involvement)
  • Radiopaedia once again has great examples of Chest CTs of different representations of septic pulmonary emboli http://radiopaedia.org/articles/septic-pulmonary-emboli
  • I also love this article from Chest on septic pulmonary emboli http://journal.publications.chestnet.org/data/Journals/CHEST/22027/162.pdf
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