The Details You Havent Heard About Mannose-binding protein-associated serine protease

Testicular examination may give a clue to the diagnosis in such patients. Germ cell tumours present with multiple large, well-defined cannonball lesions in the lungs. It is important to diagnose germ cell tumours because of their good response to treatment and potential curability. Germ cell tumours are associated with pulmonary embolism. Patients with malignancy who develop pulmonary embolism need long-term anticoagulation. Footnotes Competing interests: None. Patient consent: Obtained. Provenance and peer review: Not commissioned; externally peer reviewed.""Echocardiogram postarrest (figure 1) revealed a large circumferential pericardial Mannose-binding protein-associated serine protease effusion and 700?ml of straw coloured fluid was aspirated on pericardiocentesis. Coronary angiogram was negative for significant obstructive disease. Erythrocyte sedimentation rate (ESR) and C reactive protein (CRP) were 41?mm/h (Westergren) and 26?mg/dL, respectively. Troponin T high-sensitivity (TNT Hs) levels peaked at 60?ng/L. Antineutrophil cytoplasmic antibodies (ANCAs), antinuclear antibodies, extractable nuclear antigens, serum ACE and antiglomerular basement membrane (anti-GBM) antibodies were negative. Urinalysis and urine microscopy were normal. Chest X-ray (CXR) and pulmonary function tests (PFTs) were normal. The pericardial fluid analysis revealed an exudate with mesothelial cells and numerous eosinophils. A differential white cell count revealed an eosinophil count of 2.34��109/L which had been persistent since his initial presentation. Histological examination of the nasal biopsy specimens revealed vascular and perivascular inflammation with granulomatous matter, consistent with a vasculitis. He was diagnosed with EGPA. Figure?1 An echocardiogram showing a large circumferential pericardial effusion. Treatment Disease remission was attained with pulsed intravenous methylprednisolone and intravenous cyclophosphamide with concomitant oral prednisolone following the CYCLOPS regime.3 Outcome and follow-up Subsequent cardiac MRI showed no significant areas of myocardial involvement and normal ventricular function. He remains well on maintenance mycophenolate mofetil and a tapering course of oral prednisolone. Case presentation Patient B, a 55-year-old man was admitted to the general medical take with a 4-week history of dyspnoea, nasal congestion, arthralgia and a well-circumscribed erythematous and blistering rash on his back and buttocks. Routine investigations by his general practitioner revealed an eosinophil count of 15.75��109/L and elevated creatine kinase of 370 U/L and TNT Hs of 165?ng/L. He had a medical history of asthma, nasal polyps and over the previous year a non-specific skin rash for which he had previously attended a dermatologist. Investigations Admission bloods revealed a peripheral eosinophilia of 16.67��109/L. ESR and CRP were 26?mm/h (Westergren) and 49?mg/dL, respectively.