Try your hand at this medical mystery, which is followed by some didactics on a fascinating disease which will hopefully make sense of this inscrutable title.
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- Intro :22
- What to expect in each episode :30
- The case: A 75-year-old man with Sjogren's and MALT lymphoma presents with recurrent cerebral infarcts of multiple territories 1:10
- Rheumatology is consulted 6:11
- Decreased sensation in toes occurs between strokes 7:14
- What's going on with this patient? 8:36
- What additional labs can we perform? 9:36
- We spin the urine 11:10
- What kind of vasculitis are Sjogren's and lymphoma associated with? 12:22
- C3 and C4 had already been performed 13:00
- An overall picture of this patient 13:54
- What about the strokes? 14:19
- Should we do more imaging? 15:57
- At this point we can make a clinical decision 16:33
- Why make a decision so quickly vs. waiting for biopsy? 18:18
- Two things you must check before moving forward with a cryoglobulinemic vasculitis 19:46
- Spoiler alert: The patient is doing really well 20:16
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- What is cryoglobulinemic vasculitis? 21:00
- What are these immunoglobulins? There are three types of cryoglobulins 22:55
- Usually driven by another identifiable disease 25:18
- What is making these immunoglobulins? 26:49
- We don't know why these immunoglobulins behave this way 27:18
- How do you explain the kidneys? 28:28
- What's occurring at the tissue level? 29:35
- How does type 1 present? 30:50
- Type 2 and type 3 31:12
- What other organ systems are involved? 33:11
- I hope you enjoyed this patient presentation 36:00
- What we'll discuss in episodes 2 and 3 36:05
- Thanks for listening 38:03
**Coming soon from Healio, Unmasking COVID-19, a podcast hosted by Gitanjali Pai, MD, infectious disease physician at Memorial Hospital and Physicians' Clinic in Stilwell, Oklahoma. In this timely new show, Dr. Pai will explore COVID-19's impact on vulnerable patient populations by answering questions from experts in various medical fields, including oncology, endocrinology and rheumatology. To submit your question for Dr. Pai, email covid19podcast@healio.com.**
We'd love to hear from you! Send your comments/questions to rheuminationspodcast@healio.com. Follow us on Twitter @HRheuminations @AdamJBrownMD @HealioRheum @LCalabreseDO @CCalabreseDO
Disclosure: Brown reports no relevant financial disclosures.
References:
Fuentes A, et al. Current Rheumatology Reports. 2019;21:60.
Silva F, et al. J Autoimmun. 2019;105:102313.
