BACKGROUND Autoimmune pancreatitis(AIP)is a particular type of chronic pancreatitis,and steroid treatment of AIP is effective.Spontaneous remission(SR)of AIP without steroids is relatively rare.The international conse...BACKGROUND Autoimmune pancreatitis(AIP)is a particular type of chronic pancreatitis,and steroid treatment of AIP is effective.Spontaneous remission(SR)of AIP without steroids is relatively rare.The international consensus for the treatment of autoimmune pancreatitis suggests that patients with AIP with obstructive jaundice,abdominal pain,and back pain related to the pancreas or the bile duct should be treated with steroids;most asymptomatic patients with AIP may improve without steroids.However,in our clinical work,we found that the clinical characteristics of AIP patients with SR vary.Four of these cases are described here.In addition,to our knowledge,there is no previously published report of dynamic imaging before and after SR of AIP at present.CASE SUMMARY We present the cases of four patients with AIP(two females and two males)in which the AIP improved spontaneously without steroid treatment.Two patients were asymptomatic,one patient had abdominal pain with obstructive jaundice,and one patient had intermittent right upper abdominal pain.Three patients presented with localized pancreatic enlargement and one with diffuse pancreatic enlargement.In addition to the pancreatic lesions,bile duct involvement was seen in two patients,and no extra-pancreatic organ involvement was found in the other two patients.The serum IgG4 level of all patients was more than twice the normal level.After SR in the four patients,the affected pancreases exhibited three types of image features:Return to normal,progressive fibrosis,and atrophy and calcification.CONCLUSION The clinical features of SR in our four patients with AIP differ,but the imaging findings share some characteristics.After SR,in some cases the affected pancreas could return to normal,although some patients suffer from progressive fibrosis and atrophy as well as calcification.展开更多
Objective To summarize the clinical features of spontaneous remission in classic fever of unknown origin(FUO).Methods Medical records of 121 patients diagnosed with FUO at admission in Peking Union Medical College Hos...Objective To summarize the clinical features of spontaneous remission in classic fever of unknown origin(FUO).Methods Medical records of 121 patients diagnosed with FUO at admission in Peking Union Medical College Hospital between January 2018 and June 2018 were reviewed retrospectively.Patients who were discharged without etiological diagnoses were followed for 2 years.The clinical features and outcomes of these patients were summarized.Multivariate logistic regression was used to analyze related factors of spontaneous remission of FUO.Results After excluding 2 patients who lost to follow-up,the etiology of 119 FUO patients were as follows:infectious diseases in 30(25.2%)cases,connective tissue diseases in 28(23.5%)cases,tumor diseases in 8(6.7%)cases,other diseases in 6(5.0%)cases,and unknown diagnoses in 47(39.5%)cases.Totally,41 patients experienced spontaneous remission of fever(the median time from onset to remission was 9 weeks,ranging from 4 to 39 weeks).In patients with spontaneous remission in FUO,lymphadenopathy was less common clinical manifestation,the levels of inflammatory markers including leukocyte count,neutrophil count,neutrophil ratio,C-reactive protein,and ferritin were lower,and the proportion of CD8 positive T lymphocytes expressing CD38 was lower.Multivariate logistic regression analysis of factors with a P-value<0.05 in univariate analysis shown that white blood cell count(OR:0.S45,95%CI:0.306-0.971,P=0.039),neutrophil count(OR:2.074,95%CI:1.004-4.284,P=0.049),and proportion of neutrophils(OR:0.928,95%Cl:0.871-0.990,P=0.022)were independent significant factors associated with spontaneous remission in FUO.Conclusions This study suggested that most patients discharged with undiagnosed classic FUO would remit spontaneously.Thus,for patients with stable clinical conditions,follow-up and observation could be the best choice.Patients with lower level of some inflammatory factors may have a high likelihood of spontaneous remission in classic FUO.展开更多
APLASTIC anemia （AA） is a bone marrow failure disease caused by abnormal activation of T lymphocytes, resulting in the apoptosis of he- matopoietic cells and bone marrow failure.
Spontaneous regression of pituitary macroadenomas is rare. It is generally thought that absorption of the necrotic tissue after pituitary apoplexy may cause the spontaneous healing of the tumor. However, such cases ar...Spontaneous regression of pituitary macroadenomas is rare. It is generally thought that absorption of the necrotic tissue after pituitary apoplexy may cause the spontaneous healing of the tumor. However, such cases are often accompanied by hypopituitarism, which sould be treated with hormone replacement therapy. Here we report two cases of spontaneous remission of pituitary macroadenomas in women, who had complete tumor disappearance with preserved pituitary function.展开更多
Pneumocystis jiroveci （P. jiroveci） pneumonia （PCP） in non-AIDS immunocompromised patients ismuch more critical than that in AIDS patients,1 Without treatment, mortality of PCP in immunocompromised patients approa...Pneumocystis jiroveci （P. jiroveci） pneumonia （PCP） in non-AIDS immunocompromised patients ismuch more critical than that in AIDS patients,1 Without treatment, mortality of PCP in immunocompromised patients approaches 100 percent, and there were no reports of spontaneous remissions of PCP without anti-PCP therapy.2 Here we report 2 non-AIDS immunocompromised patients in whom PCP developed and remitted without treatment.展开更多
Polyarteritis nodosa (PAN) affects mostly medium-sized arteries and sometimes small ones as well. The primary methods used to make the diagnosis are through physical examinations, biopsies of organs that are affected,...Polyarteritis nodosa (PAN) affects mostly medium-sized arteries and sometimes small ones as well. The primary methods used to make the diagnosis are through physical examinations, biopsies of organs that are affected, and/or angiographic studies. Immunosuppressants like glucocorticoids and cyclophosphamide are usually started as soon as possible after a diagnosis. So, it’s not clear if sudden remission of PAN happens or not. Here we present a 42-year-old male who presented with right upper quadrant, right flank pain and fever. CT angiogram Aorta revealed soft tissue rind around the small to medium sized vessel in the abdomen and bilateral cortical renal infarcts of variable age in the right more than the left. A diagnosis of polyarteritis nodosa was made and the patient achieved spontaneous remission with no need for corticosteroids or immunosuppressive therapy.展开更多
BACKGROUND Leukemic hematopoietic cells acquire enhanced self-renewal capacity and impaired differentiation.The emergence of symptomatic leukemia also requires the acquisition of a clonal proliferative advantage.Untre...BACKGROUND Leukemic hematopoietic cells acquire enhanced self-renewal capacity and impaired differentiation.The emergence of symptomatic leukemia also requires the acquisition of a clonal proliferative advantage.Untreated leukemia patients usually experience an aggressive process.However,spontaneous remission occasionally occurs in patients with acute myeloid leukemia(AML),most frequently after recovery from a febrile episode,and this is generally attributed to the triggering of antineoplastic immunity.There may be another explanation for the spontaneous remission as implicated in this paper.CASE SUMMARY A 63-year-old Chinese man presented with high fever,abdominal pain and urticaria-like skin lesions.He was diagnosed with AML-M4 with t(8;21)(q22;q22)/RUNX1-RUNX1T1 based on morphological,immunological,cytogenetic and molecular analyses.He had a complex chromosome rearrangement of 48,XY,t(8;21)(q22;q22),+13,+13[9]/49,idem,+mar[9]/49,idem,+8[2].He also had a mutated tyrosine kinase domain in fms-like tyrosine kinase 3 gene.He was treated with antibiotics and glucocorticoids for gastrointestinal infection and urticaria-like skin lesions.The infection and skin lesions were quickly resolved.Unexpectedly,he achieved hematological remission along with resolution of the febrile episode,gastrointestinal symptoms and skin lesions.Notably,after relapse,repeating these treatments resulted in a return to hematological remission.Unfortunately,he demonstrated strong resistance to antibiotic and glucocorticoid treatment after the second relapse and died of sepsis from bacterial infection with multidrug resistance.The main clinical feature of this patient was that symptomatic AML emerged with flaring of the gut inflammatory disorder and it subsided after resolution of the inflammation.Learning from the present case raises the possibility that in a subgroup of AML patients,the proliferative advantage of leukemia cells may critically require the presence of inflammatory stresses.CONCLUSION Inflammatory stresses,most likely arising from gastrointestinal infection,may sustain the growth and survival advantage of leukemic cells.展开更多
We report an 80-year-old man who presented with sponta- neous regression of hepatocellular carcinoma(HCC).He complained of sudden right flank pain and low-grade fever. The level of protein induced by vitamin K antagon...We report an 80-year-old man who presented with sponta- neous regression of hepatocellular carcinoma(HCC).He complained of sudden right flank pain and low-grade fever. The level of protein induced by vitamin K antagonist(PIVKA)- II was 1 137 mAU/mL.A computed tomography scan in November 2000 demonstrated a low-density mass located in liver S4 with marginal enhancement and a cystic mass of 68 mm×55 mm in liver S6,with slightly high density content and without marginal enhancement.Angiography revealed that the tumor in S4 with a size of 25 mm×20 mm was a typical hypervascular HCC,and transarterial chemoembolization was performed.However,the tumor in S6 was hypovascular and atypical of HCC,and thus no therapy was given.In December 2000,the cystic mass regressed spontaneously to 57 min×44 mm,and aspiration cytology revealed bloody fluid,and the mass was diagnosed cytologically as class I. The tumor in S4 was treated successfully with a 5 mm margin of safety around it.The PIVKA-II level normalized in February 2001.In July 2001,the tumor regressed further but presented with an enhanced area at the posterior margin.In November 2001,the enhanced area extended,and a biopsy revealed well-differentiated HCC,although the previous tumor in S4 disappeared.Angiography demonstrated two tumor stains,one was in S6,which was previously hypovascular, and the other was in S8.Subsequently,the PIVKA-II level started to rise with the doubling time of 2-3 wk,and the tumor grew rapidly despite repeated transarterial embolization with gel foam.In February 2003,the patient died of bleeding into the peritoneal cavity from the tumor that occupied almost the entire right lobe.Considering the acute onset of the symptoms,we speculate that local ischemia possibly due to rapid tumor growth,resulted in intratumoral bleeding and/or hemorrhagic necrosis,and finally spontaneous regression of the initial tumor in S6.展开更多
The fibrosis of liver cirrhosis was considered to be irreversible before the anti-viral drugs showed that it is reversible when they lead to continuous suppression of viral replication and inflammation. However, sever...The fibrosis of liver cirrhosis was considered to be irreversible before the anti-viral drugs showed that it is reversible when they lead to continuous suppression of viral replication and inflammation. However, several reports previously showed that fibrosis of type B liver cirrhosis was almost completely absorbed after the natural remission of chronic inflammation. This phenomenon might not be limited to exceptional patients, but rather occur commonly, considering the dynamic clinical features of chronic hepatitis B(CHB), where inactive carrier stage normally follows aggravation of hepatitis and progression of fibrosis at the time of HBe Ag seroconversion. Thus, fibrosis levels of CHB as a hepatocellular carcinoma(HCC)-surveillance marker, particularly those of the inactive stage, could be underestimated, because some of them might have been(pre)cirrhotic in the past and recovered with the natural regression of fibrosis. We argue that cirrhosisinduced HCC mechanisms, rather than direct action of viral genome, may be more common than generally considered in CHB patients. This may have some impact on reconsidering the surveillance rationale for HCC in CHB, from where advanced HCCs tended to be missed. In addition, a molecular marker to assess the cancer-prone characteristics of the liver will definitely be needed to resolve the issue.展开更多
文摘BACKGROUND Autoimmune pancreatitis(AIP)is a particular type of chronic pancreatitis,and steroid treatment of AIP is effective.Spontaneous remission(SR)of AIP without steroids is relatively rare.The international consensus for the treatment of autoimmune pancreatitis suggests that patients with AIP with obstructive jaundice,abdominal pain,and back pain related to the pancreas or the bile duct should be treated with steroids;most asymptomatic patients with AIP may improve without steroids.However,in our clinical work,we found that the clinical characteristics of AIP patients with SR vary.Four of these cases are described here.In addition,to our knowledge,there is no previously published report of dynamic imaging before and after SR of AIP at present.CASE SUMMARY We present the cases of four patients with AIP(two females and two males)in which the AIP improved spontaneously without steroid treatment.Two patients were asymptomatic,one patient had abdominal pain with obstructive jaundice,and one patient had intermittent right upper abdominal pain.Three patients presented with localized pancreatic enlargement and one with diffuse pancreatic enlargement.In addition to the pancreatic lesions,bile duct involvement was seen in two patients,and no extra-pancreatic organ involvement was found in the other two patients.The serum IgG4 level of all patients was more than twice the normal level.After SR in the four patients,the affected pancreases exhibited three types of image features:Return to normal,progressive fibrosis,and atrophy and calcification.CONCLUSION The clinical features of SR in our four patients with AIP differ,but the imaging findings share some characteristics.After SR,in some cases the affected pancreas could return to normal,although some patients suffer from progressive fibrosis and atrophy as well as calcification.
基金funded by the Major National Science and Technology Projects for the Control and Prevention of Major Infectious Diseases of China(2017ZX10201302-003)Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences(2016-I2M-1-013).
文摘Objective To summarize the clinical features of spontaneous remission in classic fever of unknown origin(FUO).Methods Medical records of 121 patients diagnosed with FUO at admission in Peking Union Medical College Hospital between January 2018 and June 2018 were reviewed retrospectively.Patients who were discharged without etiological diagnoses were followed for 2 years.The clinical features and outcomes of these patients were summarized.Multivariate logistic regression was used to analyze related factors of spontaneous remission of FUO.Results After excluding 2 patients who lost to follow-up,the etiology of 119 FUO patients were as follows:infectious diseases in 30(25.2%)cases,connective tissue diseases in 28(23.5%)cases,tumor diseases in 8(6.7%)cases,other diseases in 6(5.0%)cases,and unknown diagnoses in 47(39.5%)cases.Totally,41 patients experienced spontaneous remission of fever(the median time from onset to remission was 9 weeks,ranging from 4 to 39 weeks).In patients with spontaneous remission in FUO,lymphadenopathy was less common clinical manifestation,the levels of inflammatory markers including leukocyte count,neutrophil count,neutrophil ratio,C-reactive protein,and ferritin were lower,and the proportion of CD8 positive T lymphocytes expressing CD38 was lower.Multivariate logistic regression analysis of factors with a P-value<0.05 in univariate analysis shown that white blood cell count(OR:0.S45,95%CI:0.306-0.971,P=0.039),neutrophil count(OR:2.074,95%CI:1.004-4.284,P=0.049),and proportion of neutrophils(OR:0.928,95%Cl:0.871-0.990,P=0.022)were independent significant factors associated with spontaneous remission in FUO.Conclusions This study suggested that most patients discharged with undiagnosed classic FUO would remit spontaneously.Thus,for patients with stable clinical conditions,follow-up and observation could be the best choice.Patients with lower level of some inflammatory factors may have a high likelihood of spontaneous remission in classic FUO.
基金Supported by Key Provincial Talents Program of Jiangsu(H201126)the Natural Science Fund for Colleges and Universities of Jiangsu Province (09KJB320015)+1 种基金Key Projects in the National Science & Technology Pillar Program (2008BAI61B02 and 2008ZX09312-026)the Priority Academic Program Development of Jiangsu Higher Education Institutions (PAPD)
文摘APLASTIC anemia （AA） is a bone marrow failure disease caused by abnormal activation of T lymphocytes, resulting in the apoptosis of he- matopoietic cells and bone marrow failure.
文摘Spontaneous regression of pituitary macroadenomas is rare. It is generally thought that absorption of the necrotic tissue after pituitary apoplexy may cause the spontaneous healing of the tumor. However, such cases are often accompanied by hypopituitarism, which sould be treated with hormone replacement therapy. Here we report two cases of spontaneous remission of pituitary macroadenomas in women, who had complete tumor disappearance with preserved pituitary function.
文摘Pneumocystis jiroveci （P. jiroveci） pneumonia （PCP） in non-AIDS immunocompromised patients ismuch more critical than that in AIDS patients,1 Without treatment, mortality of PCP in immunocompromised patients approaches 100 percent, and there were no reports of spontaneous remissions of PCP without anti-PCP therapy.2 Here we report 2 non-AIDS immunocompromised patients in whom PCP developed and remitted without treatment.
文摘Polyarteritis nodosa (PAN) affects mostly medium-sized arteries and sometimes small ones as well. The primary methods used to make the diagnosis are through physical examinations, biopsies of organs that are affected, and/or angiographic studies. Immunosuppressants like glucocorticoids and cyclophosphamide are usually started as soon as possible after a diagnosis. So, it’s not clear if sudden remission of PAN happens or not. Here we present a 42-year-old male who presented with right upper quadrant, right flank pain and fever. CT angiogram Aorta revealed soft tissue rind around the small to medium sized vessel in the abdomen and bilateral cortical renal infarcts of variable age in the right more than the left. A diagnosis of polyarteritis nodosa was made and the patient achieved spontaneous remission with no need for corticosteroids or immunosuppressive therapy.
基金Supported by the Specialized Scientific Research Fund Projects of The Medical Group of Qingdao University,No. YLJT20201002
文摘BACKGROUND Leukemic hematopoietic cells acquire enhanced self-renewal capacity and impaired differentiation.The emergence of symptomatic leukemia also requires the acquisition of a clonal proliferative advantage.Untreated leukemia patients usually experience an aggressive process.However,spontaneous remission occasionally occurs in patients with acute myeloid leukemia(AML),most frequently after recovery from a febrile episode,and this is generally attributed to the triggering of antineoplastic immunity.There may be another explanation for the spontaneous remission as implicated in this paper.CASE SUMMARY A 63-year-old Chinese man presented with high fever,abdominal pain and urticaria-like skin lesions.He was diagnosed with AML-M4 with t(8;21)(q22;q22)/RUNX1-RUNX1T1 based on morphological,immunological,cytogenetic and molecular analyses.He had a complex chromosome rearrangement of 48,XY,t(8;21)(q22;q22),+13,+13[9]/49,idem,+mar[9]/49,idem,+8[2].He also had a mutated tyrosine kinase domain in fms-like tyrosine kinase 3 gene.He was treated with antibiotics and glucocorticoids for gastrointestinal infection and urticaria-like skin lesions.The infection and skin lesions were quickly resolved.Unexpectedly,he achieved hematological remission along with resolution of the febrile episode,gastrointestinal symptoms and skin lesions.Notably,after relapse,repeating these treatments resulted in a return to hematological remission.Unfortunately,he demonstrated strong resistance to antibiotic and glucocorticoid treatment after the second relapse and died of sepsis from bacterial infection with multidrug resistance.The main clinical feature of this patient was that symptomatic AML emerged with flaring of the gut inflammatory disorder and it subsided after resolution of the inflammation.Learning from the present case raises the possibility that in a subgroup of AML patients,the proliferative advantage of leukemia cells may critically require the presence of inflammatory stresses.CONCLUSION Inflammatory stresses,most likely arising from gastrointestinal infection,may sustain the growth and survival advantage of leukemic cells.
文摘We report an 80-year-old man who presented with sponta- neous regression of hepatocellular carcinoma(HCC).He complained of sudden right flank pain and low-grade fever. The level of protein induced by vitamin K antagonist(PIVKA)- II was 1 137 mAU/mL.A computed tomography scan in November 2000 demonstrated a low-density mass located in liver S4 with marginal enhancement and a cystic mass of 68 mm×55 mm in liver S6,with slightly high density content and without marginal enhancement.Angiography revealed that the tumor in S4 with a size of 25 mm×20 mm was a typical hypervascular HCC,and transarterial chemoembolization was performed.However,the tumor in S6 was hypovascular and atypical of HCC,and thus no therapy was given.In December 2000,the cystic mass regressed spontaneously to 57 min×44 mm,and aspiration cytology revealed bloody fluid,and the mass was diagnosed cytologically as class I. The tumor in S4 was treated successfully with a 5 mm margin of safety around it.The PIVKA-II level normalized in February 2001.In July 2001,the tumor regressed further but presented with an enhanced area at the posterior margin.In November 2001,the enhanced area extended,and a biopsy revealed well-differentiated HCC,although the previous tumor in S4 disappeared.Angiography demonstrated two tumor stains,one was in S6,which was previously hypovascular, and the other was in S8.Subsequently,the PIVKA-II level started to rise with the doubling time of 2-3 wk,and the tumor grew rapidly despite repeated transarterial embolization with gel foam.In February 2003,the patient died of bleeding into the peritoneal cavity from the tumor that occupied almost the entire right lobe.Considering the acute onset of the symptoms,we speculate that local ischemia possibly due to rapid tumor growth,resulted in intratumoral bleeding and/or hemorrhagic necrosis,and finally spontaneous regression of the initial tumor in S6.
基金Supported by A Grant-in-Aid for Scientific Research(C)(25461012 to Ohkoshi S) from the Japan Society for the Promotion of Science
文摘The fibrosis of liver cirrhosis was considered to be irreversible before the anti-viral drugs showed that it is reversible when they lead to continuous suppression of viral replication and inflammation. However, several reports previously showed that fibrosis of type B liver cirrhosis was almost completely absorbed after the natural remission of chronic inflammation. This phenomenon might not be limited to exceptional patients, but rather occur commonly, considering the dynamic clinical features of chronic hepatitis B(CHB), where inactive carrier stage normally follows aggravation of hepatitis and progression of fibrosis at the time of HBe Ag seroconversion. Thus, fibrosis levels of CHB as a hepatocellular carcinoma(HCC)-surveillance marker, particularly those of the inactive stage, could be underestimated, because some of them might have been(pre)cirrhotic in the past and recovered with the natural regression of fibrosis. We argue that cirrhosisinduced HCC mechanisms, rather than direct action of viral genome, may be more common than generally considered in CHB patients. This may have some impact on reconsidering the surveillance rationale for HCC in CHB, from where advanced HCCs tended to be missed. In addition, a molecular marker to assess the cancer-prone characteristics of the liver will definitely be needed to resolve the issue.
