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Case Reports in Medicine

Yiming Luo, Yumeng Wen, Ana Belen Arevalo Molina, Punya Dahal, Lorenz Leuprecht, Makda Bsrat
Macrophage activation syndrome (MAS) is a rare manifestation of systemic lupus erythematosus (SLE) with potentially life-threatening consequences. To the best of our knowledge, this is the first case reported in literature for a constellation of MAS, glomerulonephritis, pericarditis, and retinal vasculitis as initial presentation of SLE. Despite extensive multisystem involvement of his disease, the patient responded well to initial steroid treatment, with mycophenolate mofetil successfully added as a steroid-sparing agent...
2018: Case Reports in Medicine
Saira Chaughtai, Bhavika Gandhi, Zeeshan Chaughtai, Dana Tarina, Mohammad A Hossain, Arif Asif
Recently, the incidence of Clostridium difficile- ( C. difficile- ) associated infection has increased significantly in hospital and ambulatory care settings in parallel to the increasing use of inappropriate antibiotics. According to the CDC, approximately 83,000 patients who developed C . difficile experienced at least one recurrence and 29,000 died within 30 days of the initial diagnosis. Patients on dialysis (particularly peritoneal dialysis) are predisposed to this infection due to an inherent immunocompromised state and transmural translocation of the bacteria due to the close association of gastrointestinal tract and peritoneal cavity...
2018: Case Reports in Medicine
Zurab Azmaiparashvili, Kevin Bryan Lo, Nawal Habib, Annie Hsieh
Valacyclovir neurotoxicity is commonly seen in the elderly and those with impaired renal function. Differential diagnosis can be challenging as a myriad of medical conditions, including herpes zoster virus associated encephalitis, may present in a similar fashion. We present a case of a 71-year-old male who presented with altered mental status in the setting of recent herpes zoster eruption. His condition was attributed to valacyclovir neurotoxicity, and initiation of appropriate supportive therapy was met with complete resolution of symptoms and normalization of cognitive function...
2018: Case Reports in Medicine
Pongsakorn Choochuen, Kitiwan Rojneuangnit, Thanitchet Khetkham, Sookkasem Khositseth
Multicentric carpotarsal osteolysis syndrome (MCTO) is a rare skeletal disorder characterized by aggressive osteolysis associated with progressive nephropathy. The early clinical presentation can mimic polyarticular juvenile idiopathic arthritis. Since 2012, MAFB mutations have been discovered in all MCTO patients. Therefore, the early diagnosis can be made based on genetic confirmation. We report the clinical manifestation of mineral bone disease and the molecular genetic study of a Thai female adolescent with MCTO...
2018: Case Reports in Medicine
Olivia Allen, Ahmed Edhi, Adam Hafeez, Alexandra Halalau
Hepatitis A is a common viral infection with a benign course but in rare cases can progress to acute liver failure. It usually presents with abdominal pain, nausea, vomiting, diarrhea, jaundice, anorexia, or asymptomatically, but it can also present atypically with relapsing hepatitis and prolonged cholestasis. In addition, extrahepatic manifestations have been reported, including urticarial and maculopapular rash, acute kidney injury, autoimmune hemolytic anemia, aplastic anemia, acute pancreatitis, mononeuritis, reactive arthritis, glomerulonephritis, cryoglobulinemia, Guillain-Barre syndrome, and pleural or pericardial effusion...
2018: Case Reports in Medicine
Hafiz Muhammad Aslam, Shumaila Muhammad Iqbal, Hira Shaikh, Faizan A Faizee, Ambreen A Merchant, Marwan Shaheen, Shahrukh K Hashmi
Haploidentical stem cell transplantation provides a plausible alternative for the patients when a fully matched donor is unavailable. Historically, the decision of considering haploidentical transplant has remained elusive; however, with the recent advances, the consideration of haploidentical grafts as a treatment option has become more apparent for both allografting for diseases and engraftment failure. We are reporting here an anecdotal case of a successful haploidentical engraftment in a patient with the prior graft failure of an HLA-matched related donor...
2018: Case Reports in Medicine
Anchalia Chandrakumaran, Henry R Bateman, Rehan Qayyum
A 35-year-old African American male, previously healthy, presented with lower back and bilateral lower extremity pain associated with intermitted night sweats and weight loss. Imaging was concerning diffuse vertebral metastatic lesions. He underwent extensive workup to evaluate for metastatic disease. However, right iliac crest, mediastinal, and left inguinal lymph node biopsies were consistent with sarcoidosis. He was started on methotrexate, folic acid, and prednisone.
2018: Case Reports in Medicine
Patrick Groga-Bada, Iris I Mueller, Federico Foschi, Meinrad Gawaz, Christian Eick
Lactobacillus species are Gram-positive, facultative anaerobic, rod-shaped bacteria. They belong to the lactic acid bacteria group and are also known as a usual part of the normal flora of the gastrointestinal tract as well as of the urinary and genital tracts. They are an infrequent human pathogen but can induce several infections such as bacteremia and infectious endocarditis. We report the case of an 81-year-old woman with Lactobacillus bacteremia and mitral valve endocarditis as well as splenic abscesses...
2018: Case Reports in Medicine
Marta Vázquez, Cecilia Maldonado, Natalia Guevara, Andrea Rey, Pietro Fagiolino, Antonella Carozzi, Carlos Azambuja
Lamotrigine (LTG) is currently indicated as adjunctive therapy for focal and generalized tonic-clonic seizures and for treatment of bipolar disorder and neuropathic pain. A common concern with LTG in children is the frequency of appearance of skin rash. The intensity of this adverse effect can vary from transient mild rash to Stevens-Johnson syndrome (SJS), which can be fatal mainly when LTG is coadministered with valproic acid (VPA). Hereby, we present the case of an 8-year-old boy who suffered from SJS and other complications two weeks after LTG was added to his VPA treatment in order to control his seizures...
2018: Case Reports in Medicine
Tina Bregant, Milica Klopcic Spevak
Ehlers-Danlos syndrome is an umbrella term for a group of heritable soft connective tissue disorders which is characterized by joint hypermobility, skin texture and elasticity abnormalities, and visceral and vascular fragility or dysfunctions. As the syndrome is rare, it is often underdiagnosed. Patients usually present late, with chronic moderate to severe pain which is attributed to the joint hypermobility and joint subluxations. If the clinician is aware of the syndrome, he/she can identify affected patients in order to prevent complications...
2018: Case Reports in Medicine
Ruslinda Mustafar, Lydia Kamaruzaman, Beh Hui Chien, Azyani Yahaya, Noor'Ain Mohd Nasir, Rozita Mohd, Rizna Cader, Kong Wei Yen
We reported a case of primary renal lymphoma (PRL) presented with non-oliguric acute kidney injury and bilateral kidney infiltrates in an individual with human immunodeficiency virus (HIV) disease. Acute kidney injury secondary to lymphoma infiltrates is very rare (less than 1% of hematological malignancy). A 37-year-old gentleman with underlying human immunodeficiency virus (HIV) disease was on combined antiretroviral therapy since diagnosis. He presented to our center with uremic symptoms and gross hematuria...
2018: Case Reports in Medicine
Shiko Gen, Akio Ogawa, Koji Kanai, Kanako Nobe, Naofumi Ikeda, Atsuko Mochizuki, Kazuo Tokushige
We treated a patient with neurosarcoidosis, which caused the syndrome of inappropriate secretion of antidiuretic hormone (SIADH), in whom diagnosis was performed using neuroendoscopy. The patient was a 56-year-old female who was hospitalized for hyponatremia and diagnosed with SIADH based on a detailed examination. During the course, she developed impaired consciousness due to acute hydrocephalus, which improved after ventricular drainage. Head magnetic resonance imaging (MRI) confirmed nodular lesions at the floor of the third ventricle and the cerebral aqueduct...
2018: Case Reports in Medicine
Charles T Mupamombe, Jude Noel, Derek B Laskar, Liza Valdivia
Non-Hodgkin's lymphoma (NHL) is a common AIDS-defining malignancy among people living with HIV. Of the different types of NHLs, diffuse large B-cell lymphoma (DLBCL) is the most common. Prognosis of DLBCL has improved over the years in the general population but remains relatively poor in HIV-positive individuals. Almost any organ system can be affected by DLBCL; however, cardiac involvement remains rare and suggests aggressive disease. We present a case of DLBCL in an HIV-positive patient, who had cardiac involvement, with the only clue to cardiac involvement being symptom being tachycardia and dysphagia...
2018: Case Reports in Medicine
Sanjay Prakash Neupane, Pratibha Sharma, Mahesh Mani Dangal
Introduction: Hyperkalemia is a commonly encountered clinical problem. Pseudohyperkalemia is believed to be an in vitro phenomenon that does not reflect in vivo serum potassium and therefore should not be treated. Here, we present a case who unfortunately underwent unnecessary treatment because of failure to detect the common lab abnormality of pseudohyperkalemia. Case Presentation: A 91-year-old female with a history of chronic lymphocytic leukemia presented to the emergency with nausea and vomiting 24 hours after her first chemotherapy with chlorambucil...
2018: Case Reports in Medicine
Tuan-Hsing Loh, Samir Patel, Anish Mirchandani, Maxim Eckmann
Chemical neurolytic nerve blocks have been successfully used to treat a variety of cancer-related pain. However, the literature has been sparse regarding neurolysis of the brachial plexus for cancer pain. We present a unique case report of a successful chemical neurolysis of the brachial plexus with dehydrated ethanol for a patient suffering from metastatic mammary carcinoma with tumor invasion of the right brachial plexus.
2018: Case Reports in Medicine
Linn E Hauvik, Mercy Varghese, Erik W Nielsen
Ethylene glycol poisoning is a medical emergency. The metabolites glycolate and glyoxylate give metabolic acidosis. Because of similar structure, these metabolites are misinterpreted as lactate by many point-of-care blood gas analyzers. The falsely high lactate values can lead to misdiagnosis, inappropriate laparotomies, and delayed antidotal therapy. As laboratory analyzers measure plasma lactate only, the difference or the "lactate gap" aids in early diagnosis. We present a patient with severe metabolic acidosis and elevated lactate levels on the point-of-care analyzer...
2018: Case Reports in Medicine
Zulfiqar Qutrio Baloch, Muhammad Ayyaz, Muhammad Hussain, Shabber Agha Abbas, Fnu Samreen
All syncopal patients who present to the emergency department should be considered for pulmonary embolism (PE) as part of their differential diagnosis. PE presenting as a syncopal episode and associated with occult uterine malignancy is uncommon. Review of the literature indicates that up to 10% of patients with unprovoked venous thromboembolism (VTE) are diagnosed with cancer in the year following that first episode of VTE. In patients suspected of having a PE who do not manifest any source of an embolism require eventual workup to screen for an occult malignancy...
2018: Case Reports in Medicine
Akinaru Yamamoto, Wataru Nakata, Gaku Yamamichi, Go Tsujimura, Yuichi Tsujimoto, Mikio Nin, Hideaki Miwa, Masao Tsujihata
Leiomyosarcoma arising from the external iliac vein is uncommon. This is a report of a 51-year-old Japanese man with venous leiomyosarcoma originating from a branch vessel of the left external iliac vein. The tumor was found during a medical examination, and the patient had no symptoms. Computed tomography showed a 72 × 49 mm mass adjacent to the left external iliac vein. The tumor was resected en-block along with ligation of the external iliac vein due to strong adhesion with the tumor. Histological examination showed venous leiomyosarcoma, and its origin was thought to be a branch vessel of the left external iliac vein...
2018: Case Reports in Medicine
Myat Han Soe, Krishna Adit Agarwal, Alueshima Akough-Weir
Catastrophic antiphospholipid syndrome (CAPS) is a rare but highly fatal clinical syndrome that occurs in up to 1% of patients with antiphospholipid syndrome (APS). The diagnosis of CAPS is often delayed because its presentation with multiple organ thromboses can be confused with other thrombotic microangiopathies and severe sepsis. We report a case of CAPS in a patient with APS and systemic lupus erythematosus (SLE) presenting with thrombotic storm precipitated by trauma, cytomegalovirus (CMV) infection, and noncompliance with anticoagulation therapy...
2018: Case Reports in Medicine
Junji Matsuda, Takashi Ikenouchi, Giichi Nitta, Shunichi Kato, Kazuya Murata, Miki Kanoh, Yukihiro Inamura, Nobutaka Kato, Tomomasa Takamiya, Ken Negi, Akira Sato, Tsunehiro Yamato, Yutaka Matsumura, Junichi Nitta
Congenital coronary artery anomalies, including anomalous origin of a coronary artery, can manifest as life-threatening conditions, such as myocardial infarction or arrhythmia, and may even lead to sudden death associated with specific congenital anatomical features. Such arteries can also develop atherosclerotic lesions. This report describes the case of a 75-year-old man who was admitted to our hospital due to exertional dyspnea. The right coronary artery was found to originate from the left coronary sinus and exhibit tight stenosis due to atherosclerosis, causing effort angina pectoris...
2018: Case Reports in Medicine
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