Carrington syndrome is a rare idiopathic disorder characterized by eosinophilic infiltration into the lungs, causing chronic, recurrent respiratory symptoms. It has a female preponderance and is mostly an adult illness.
Carrington syndrome (CS) is a rare interstitial lung ailment that is progressive in nature . The disease process is caused by an accumulation of eosinophils in the lungs, thus it is also called chronic eosinophilic pneumonia. The etiology of CS is unclear, although it may be linked to allergic reactions. It predominantly affects women, usually manifesting in middle-aged patients . Of the known cases of CS, few of them involve children . Furthermore, only about 10% of cases have a history of tobacco use . CS is considered chronic, however clinically, the disease is characterized by recurrent acute and sub-acute exacerbations. It is reported that up to 50% of affected individuals also suffer from asthma .
Symptoms of CS during an episode are often subclinical, consisting of respiratory complaints such as coughing, wheezing, dyspnea and crepitations on auscultation. As a result, diagnosis may only be made weeks after onset. The dyspnea experienced may be minimal and in some cases severe . However, patients are rarely ill enough to require assisted ventilation . The overall clinical impression may be similar to that of community-acquired pneumonia. Non-pulmonary signs, when present, are non-specific and frequently include fever, weight loss, night sweats and generalized body weakness. Conversely, the presence of systemic pathology is not typical of CS and may prompt the consideration of an alternative diagnosis, namely, idiopathic hypereosinophilic syndrome (IHS) .
Entire Body System
Wegener's granulomatosis, or arteritis-pulmonary-nephropathy syndrome, under Friedrich Wegener, German pathologist, 1907-1990. Bibliography C. B. Carrington, A. A. Liebow: Limited forms of angiitis and granulomatosis of Wegener’s type. [whonamedit.com]
Pediatricians, dental specialists, speech pathologists, orthopedic surgeons, physicians who evaluate and treat skin problems (dermatologists), and other health care professionals may need to systematically and comprehensively plan an affected child's [rarediseases.org]
If an urgent biopsy result is required, ring the pathologist and explain why same day service is required and ensure that the samples are delivered to the laboratory promptly. [renalmed.co.uk]
This could be due an extended labor, a large sized calf, a premature calf, cold weather, wind chill or other factors. Helping the calf nurse or providing colostrum replacement/supplement usually helps the calf eventually show some vigor. [ag.ndsu.edu]
Less frequently, a general feeling of poor health (malaise), chills, and chest pain may occur. Some individuals with CEP have pre-existing asthma or a history of allergies. [rarediseases.org]
"I experience chills after I inject the interferon." B Rationale: Fatigue can be a dose-limiting toxicity for use of biologic therapies. Flulike symptoms, such as muscle aches and chills, are common side effects with interferon use. [quizlet.com]
Issues that arise due to weather events may include: The cow has reduced feed intake due to a weather event that lasts longer than a day Combine that with the growing fetus and the increased energy and nutrient demand during the last few days or weeks [ag.ndsu.edu]
Jaw & Teeth
"Postural orthostatic tachycardia syndrome," said Primary Children's Hospital Pediatric Cardiologist Dr. Susan Etheridge. It's a mouthful and it meant big changes for 13-year-old Emma. "Dance was my life. I did dance competitions. [good4utah.com]
A physical examination may reveal low levels of oxygen in the blood (hypoxemia), a rapid heart rate (tachycardia), wheezes and a rattling sound in the lungs (rales). [rarediseases.org]
Nonetheless, signs and management of a major bleed are as follows: Tachycardia may be the first sign of bleeding – take it seriously Classic signs of shock and back pain may happen much later If shock develops call your blood bank and X-match 2 (or more [renalmed.co.uk]
Limitations: While quite safe, toxicity will frequently include nervousness, tremors, and occasionally seizures, tachycardia, dysrrhythmias. Does increase SVR probably through catecholamine release. Nausea and vomiting can occur. [quizlet.com]
Diagnosis of CS is made on the basis of clinical, laboratory and radiological evidence. Clinical features may be ambiguous, thus the latter studies are useful in delineating the etiology.
Laboratory studies include:
- Full blood count: This has diagnostic value as it may reveal thrombocytosis, high eosinophil count (over 1000/mm3), and iron deficiency anemia, which are associated with CS.
- Inflammatory markers: Usually the erythrocyte sedimentation rate (ESR) and C-reactive protein are high (CRP).
- Iron studies.
- Arterial blood gas analysis may show reduced oxygen levels .
- Blood culture: This rules out possible infectious causes.
- Bronchoalveolar lavage (BAL): BAL may show over 40% eosinophils on a differential count, although only 20% is needed for alveolar inflammation to occur. Nevertheless, a value in excess of 1% is abnormal . BAL is useful when there is no convincing evidence of CS from blood eosinophil counts and chest radiographs. Furthermore, certain histological findings on the analysis of lung samples, are indicative of CS, that is, lung exudates, bronchiolitis, granuloma formation, and organizing pneumonia .
Pulmonary function tests (PFT): Either obstructive or restrictive lung disease patterns may be demonstrated, the latter especially seen in those with pre-existing asthma. One in three patients has normal PFT results.
- Chest X-rays in about 50% of patients show bilateral infiltrative lung disease that is more prominent in the upper lobe and around the outer edges of the lung fields, giving the appearance of a photographic negative of acute pulmonary edema . Pleural effusion is not usually noticed, and pulmonary lesions may be migratory .
- Computerized tomography (CT) scan: At high resolution, areas of consolidation, ground glass lesions, and other opacities are typically seen. These lesions are also found in sarcoidosis and various pneumonia .
Laboratory studies include: Full blood count: This has diagnostic value as it may reveal thrombocytosis, high eosinophil count (over 1000/mm3), and iron deficiency anemia, which are associated with CS. [symptoma.com]
Markers increased serum IgE levels can be seen in two-thirds of patients the erythrocyte sedimentation rate (ESR) is usually elevated peripheral blood thrombocytosis has also been reported the percentage of eosinophils in the BAL fluid is very high Plain [radiopaedia.org]
[…] classical radiographic pattern of chronic eosinophilic pneumonia. ( 26155798 ) Cherian S.V....Thampy E. 2015 22 Efficacy of short-term prednisolone treatment in patients with chronic eosinophilic pneumonia. ( 25614171 ) Oyama Y....Suda T. 2015 23 Marked Thrombocytosis [malacards.org]
"— Presentation transcript: 1 p57: Beckwith-Wiedemann Syndrome Presented By: Jameeka Carrington 2 Symptoms of BWS Large body size (macrosomia) Large tongue (macroglossia) Large organs (visceromegaly) Abdominal wall defects (i.e. umbilical hernia [slideplayer.com]
In the chest, there was neither visceromegaly nor mass. Figure 3. [oatext.com]
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