Reviews in Clinical Medicine

76-94

Authors: Behnoush Bakhshoudeh; Maryam Salehi; Ramin Sadeghi; Alireza Omranzadeh; Toktam Sahranavard; Soheil Arekhi; Ali Jafarzadeh Esfehani; Naghmeh Zabolinejad

Introduction: Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are skin diseases that affect the quality of life. Although a systematic review on LPP and FFA treatment was published in 2013, further updates are needed. The aim of this study is to review systematically the studies published after the last systematic review. Methods: We searched Scopus, PubMed, Embase, and ISI Web of Science. All the studies published during March 2012-June 2017 were included in this review. Two reviewers separately selected the studies and extracted the data. The results of studies were categorized as unimproved, stabilized, and improved based on the articles reports. Result: Among the 38 studies, 20, 17, and one studies assessed LPP, FFA, and both treatments, respectively. The papers were case reports, case series, cohorts, and randomized controlled trials. Antimalarial agents and pioglitazone resulted in enhancement in 73 and 71% of the LPP patients, respectively. Improvement and stabilization were observed in almost one third of the topical steroid users and 6/12 of Tacrolimus/Pimecrolimus users in LPP. Improvement and stabilization in FFA was found in 68% of the individuals using antimalarial agents, 83% of intralesional steroid users, all cases of finasteride users, and 95% of the people utilizing dutasteride. Conclusion: Contrary to the previous systematic review, we found antimalarial agents more effective than steroids in LPP. Finasteride/dutasteride may have favorable impacts on FFA. Intralesional steroids showed to be more effective than antimalarial agents in FFA. Still further studies are needed in order to define a treatment protocol. Low quality and heterogeneity of the articles were among the limitations for making a conclusion.

101-104

Authors: Ideh Ghafour; Forouzan Elyasi

Thyroiditis is the most common inflammatory disorder that affects thyroid gland.The diagnosis is mainly based on clinical findings, in particular the degree of pain and tenderness of thyroid. Confirmatory laboratory test includes presence of thyroid specific autoantibodies. Treatment is based on the severity of symptoms (pain and redness) and aims to restore the normal function of thyroid. Drug-induced thyroiditis has been described previously in the literature. Venlafaxine is an antidepressant agent with an efficacy similar to that of selective serotonin reuptake inhibitors. The dose of this medicine can be adjusted up to 150 mg/day one year after initiation. However, usage of venlafaxine may be limited due to the dose-dependent side effects. Here we describe a patient diagnosed with generalized anxiety disorder and migraine headache who developed venlafaxine-induced thyroiditis following dose adjustment to the maximum of 150 mg/day. The diagnosis was made based on the clinical symptoms and confirmatory laboratory tests according to the Naranjo Adverse Drug Reaction Probability Scale. Thyroiditis symptoms subsided after reducing venlafaxine dose and initiating prednisolone therapy. It should be noted that thyroid function was fully restored to normal only after cessation of venlafaxine administration.

108-110

Authors: Zahra Baghestani; Reza Boostani

A 43-year-old male presented with diplopia and right sixth-nerve palsy. Brain magnetic resonance imaging (MRI) demonstrated a lesion in the right periventricular area. High-dose corticosteroid pulse therapy did not resolve the symptom. After one month, his diplopia progressed and he developed weakness of the left lower limb. Detailed examination revealed left sixth-nerve palsy, dropped foot, waddling gait, atrophy of the gluteal muscles and mild atrophy and weakness of the right upper limb. Neurological examination supported evidence of multiple cranial nerve palsies along with asymmetrical peripheral neuropathy. Electrodiagnostic studies were compatible with a mononeuritis multiplex. Rheumatologic evaluations were normal. Malignancy work-up were normal, except for some insignificant lymph nodes. Bone marrow aspiration and biopsy were normal. The second brain MRI detected multiple homogenous enhancing lesions in the right periventricular area.The result of stereotactic biopsy and immunohistochemistry staining demonstrated primary B-cell CNS lymphoma (PCNSL). Mononeuritis multiplex has not been reported as a paraneoplastic manifestation of PCNSL yet. In other words, it is not clear whether involvement of the peripheral nervous system in our patient is a paraneoplastic manifestation of PCNSL or a coincidence of PCNSL and hematologic lymphoma presenting with peripheral vasculitic neuropathy. It is recommendedthat future studies focus more on symptoms associated with PCNSL to recognize the exact relationship between PCNSL and peripheral neuropathy.

115-117

Authors: Maryam Khalesi; Farhad Heydarian; Seyed Javad Sayedi; Shima Badzai; Elahe Heidari

Convulsion with mild gastroenteritis is an afebrile seizure associated with viral gastroenteritis in a healthy child without fever, dehydration, electrolyte imbalance, meningitis, or encephalitis. Convulsion with mild gastroenteritis is more common in children aged 1 to 2 years. Usually, Convulsions are brief generalized tonic colonic type. Most convulsions occur within first 24 hours of illness onset. Rotaviral gastroenteritis is known as the most common type of gastroenteritis associated with Convulsion. Laboratory investigations are normal. Also EEG and neuroimaging are usually normal. Long term antiepileptic treatment is not necessary. It is usually a benign condition with good prognosis and no risk for developing epilepsy in future. Considering this etiology of seizure could prevent supernumerary evaluations and long-term antiepileptic treatment.