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Clinical Medicine Insights. Case Reports

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https://www.readbyqxmd.com/read/27840582/therapeutic-dilemmas-regarding-anticoagulation-an-experience-in-a-patient-with-nephrotic-syndrome-pulmonary-embolism-and-traumatic-brain-injury
#1
Tetsu Akimoto, Tomoyuki Yamazaki, Eiji Kusano, Daisuke Nagata
Patients with active bleeding complications who concomitantly develop overt pulmonary embolism (PE) present distinct therapeutic dilemmas, since they are perceived to be at substantial risk for the progression of the embolism in the absence of treatment and for aggravation of the hemorrhagic lesions if treated with anticoagulants. A 76-year-old patient with nephrotic syndrome, which is associated with an increased risk of thromboembolism, concurrently developed acute PE and intracranial bleeding because of traumatic brain injury...
2016: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/27812294/influenza-virus-associated-fatal-acute-necrotizing-encephalopathy-role-of-nonpermissive-viral-infection
#2
Anek Mungaomklang, Jiraruj Chomcheoy, Supaporn Wacharapluesadee, Yutthana Joyjinda, Akanitt Jittmittraphap, Apaporn Rodpan, Siriporn Ghai, Abhinbhen Saraya, Thiravat Hemachudha
In 2014, two unusual peaks of H1N1 influenza outbreak occurred in Nakhon Ratchasima Province, in Thailand. Among 2,406 cases, one of the 22 deaths in the province included a 6-year-old boy, who initially presented with acute necrotizing encephalopathy. On the other hand, his sibling was mildly affected by the same influenza virus strain, confirmed by whole-genome sequencing, with one silent mutation. Absence of acute necrotizing encephalopathy and other neurological illnesses in the family and the whole province, with near identical whole viral genomic sequences from the two siblings, and an absence of concomitant severe lung infection (cytokine storm) at onset suggest nonpermissive infection as an alternative pathogenetic mechanism of influenza virus...
2016: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/27790051/astym-therapy-improves-bilateral-hamstring-flexibility-and-achilles-tendinopathy-in-a-child-with-cerebral-palsy-a-retrospective-case-report
#3
Nicole A Scheer, Lucas R Alstat, Robert S Van Zant
PURPOSE: The purpose of this case report was to describe the use of Astym therapy to improve hamstring flexibility and Achilles tendinopathy in a child with cerebral palsy. CASE DESCRIPTION: An eight-year-old female with cerebral palsy was referred to physical therapy for the treatment of bilateral hamstring inflexibility and Achilles tendinopathy. Treatment focused on an Astym therapy protocol of eccentric exercise, stretching, active and passive range of motion, gait training, and a home exercise program...
2016: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/27773995/amiodarone-induced-pulmonary-toxicity-a-frequently-missed-complication
#4
Alexander J Sweidan, Navneet K Singh, Natasha Dang, Vinh Lam, Jyoti Datta
INTRODUCTION: Amiodarone is often used in the suppression of tachyarrhythmias. One of the more serious adverse effects includes amiodarone pulmonary toxicity (APT). Several pulmonary diseases can manifest including interstitial pneumonitis, organizing pneumonia, acute respiratory distress syndrome, diffuse alveolar hemorrhage, pulmonary nodules or masses, and pleural effusion. Incidence of APT varies from 5-15% and is correlated to dosage, age of the patient, and preexisting lung disease...
2016: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/27746678/citrobacter-koseri-pneumonia-as-initial-presentation-of-underlying-pulmonary-adenocarcinoma
#5
Kelly Pennington, Martin Van Zyl, Patricio Escalante
Citrobacter koseri is a motile, gram-negative rod traditionally known to cause infection in individuals with significant comorbidities and immunocompromised status. While most cases represent nosocomial infections, rarely community-acquired infections have been reported. We present a previously healthy man in his 60s with C. koseri pneumonia who was subsequently found to have underlying pulmonary adenocarcinoma, illustrating the need for further investigation for immunodeficiency and/or intrapulmonary pathology...
2016: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/27721660/primary-metastatic-squamous-cell-carcinoma-of-the-male-urethra-presenting-with-scrotal-abscess-and-subsequent-development-of-fournier-s-gangrene
#6
Sarah J Moore, Omid Rashidipour, Ronald B Moore
This male patient presented with a scrotal abscess and urinary obstruction. The patient's history included a perineal abscess and the development of urethrocutaneous fistulae (watering-can perineum). He underwent multiple debridement procedures without resolution. During the fifth debridement for Fournier's gangrene, a biopsy revealed invasive squamous cell carcinoma. The patient was bedridden because of the large mass, a wide en bloc resection with lymphadenectomy and reconstruction was performed revealing a large (22 cm) squamous cell carcinoma originating from the urethra...
2016: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/27660505/acquired-hemophilia-a-may-be-associated-with-ticagrelor-therapy-in-a-52-year-old-man-after-a-recent-percutaneous-transluminal-coronary-angioplasty
#7
Paola Pasquino, Roberto Canaparo, Tiziana Capello, Barbara Deorsola, Laura Perazzolo, Claudio Marengo, Loredana Serpe
We present a case report of a 52-year-old man who was hospitalized for right leg pain due to a relevant hemorrhagic effusion. He was on dual antiplatelet therapy (DAPT): acetylsalicylic acid and ticagrelor, a reversible P2Y12 receptor antagonist. Signs, symptoms, and laboratory blood tests led to the diagnosis of acquired hemophilia A (AHA). Ticagrelor therapy-associated AHA was hypothesized due to the fact that, before adding this drug, all laboratory and clinical examinations were repeatedly normal. Prednisone and cyclophosphamide treatment was started without DAPT interruption due to the high risk of stent thrombosis...
2016: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/27579001/streptococcal-toxic-shock-syndrome-life-saving-role-of-peritoneal-lavage-and-drainage
#8
Minako Yokoyama, Fumie Oyama, Asami Ito, Megumi Yokota, Daisuke Matsukura, Shinji Tsutsumi, Tomonori Kasai, Yohshiro Nitobe, Akiko Morikawa, Takashi Ozaki, Yoshihito Yokoyama
PURPOSE: We encountered a case where an infection with group A streptococcus (GAS; ie, Streptococcus pyogenes) initially caused primary peritonitis and then subsequently caused streptococcal toxic shock syndrome. The patient's life was likely saved by an emergency laparotomy followed by extensive peritoneal lavage and drainage. CASE PRESENTATION: A 40-year-old woman was admitted to the Emergency Department for lower abdominal pain and numbness in the extremities...
2016: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/27559301/disseminated-mycobacterium-bovis-infection-complicating-intravesical-bcg-instillation-for-the-treatment-of-superficial-transitional-cell-carcinoma-of-the-bladder
#9
Fatehi Elzein, Nada Albogami, Mustafa Saad, Nazik El Tayeb, Abdullah Alghamdi, Ghaleb Elyamany
BACKGROUND: Intravesical instillation of Bacillus Calmette-Guérin (BCG) remains a first-line treatment for superficial transitional cell carcinoma of the bladder. Although its use is relatively safe, severe complications such as granulomatous hepatitis, osteomyelitis, pneumonitis, and sepsis occur in few patients. Complications of intravesical instillation of BCG can be local or systemic, with early or late presentation. CASE PRESENTATION: Here, we report an 88-year-old man who developed fever, rigors, and episodes of syncope following fourth intravesical BCG instillation for the treatment of superficial transitional cell carcinoma of the bladder...
2016: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/27547044/complete-and-voluntary-starvation-of-50-days
#10
Bradley Elliott, Michelle Mina, Chrystalla Ferrier
A 34-year-old obese male (96.8 kg; BMI, 30.2 kg m(-1)) volitionally undertook a 50-day fast with the stated goal of losing body mass. During this time, only tea, coffee, water, and a daily multivitamin were consumed. Severe and linear loss of body mass is recorded during these 50 days (final 75.4 kg; BMI, 23.5 kg m(-1)). A surprising resilience to effects of fasting on activity levels and physical function is noted. Plasma samples are suggestive of early impairment of liver function, and perturbations to cardiovascular dynamics are also noted...
2016: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/27547043/a-supraglottic-pseudotumor-in-an-immunocompromised-patient-with-nephrotic-syndrome-herpes-zoster-and-a-cytomegalovirus-infection
#11
Tetsu Akimoto, Tomoyuki Yamazaki, Osamu Saito, Shigeaki Muto, Eiji Kusano, Daisuke Nagata
Several viral infections may occasionally induce supraglottic mass lesions, resulting in an obstructive airway emergency. We herein report one such case in a 63-year-old male immunocompromised patient with nephrotic syndrome due to membranous nephropathy who also had ophthalmic herpes zoster with a laryngeal mass, which required urgent intubation and mechanical ventilation. The patient was initially treated with acyclovir; however, because a serological analysis revealed a concurrent cytomegalovirus infection, we discontinued the administration of acyclovir and gave priority to the simultaneous treatment of the cytomegalovirus and varicella-zoster virus infections with ganciclovir...
2016: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/27547042/bowel-obstruction-and-peritoneal-dialysis-a-case-report-of-a-patient-with-complications-from-a-broad-ligament-hernia
#12
Naoko Otani-Takei, Tetsu Akimoto, Ai Sadatomo, Osamu Saito, Shigeaki Muto, Eiji Kusano, Daisuke Nagata
Abdominal hernias are a common cause of bowel obstruction. The major types of abdominal hernias are external or abdominal wall hernias, which occur at areas of congenital or acquired weakness in the abdominal wall. An alternative entity is internal hernias, which are characterized by a protrusion of viscera through the peritoneum or mesentery. We herein present the case of a female peritoneal dialysis patient with bowel obstruction due to an internal hernia. Although an initial work-up did not lead to a correct diagnosis, an exploratory laparotomy revealed that she had intestinal herniation due to a defect in the broad ligament of the uterus, which was promptly corrected by surgery...
2016: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/27441005/anterior-chamber-live-loa-loa-case-report
#13
G Kagmeni, R Cheuteu, Y Bilong, P Wiedemann
We reported a case of unusual intraocular Loa loa in a 27-year-old patient who presented with painful red eye. Biomicroscopy revealed a living and active adult worm in the anterior chamber of the right eye. After surgical extraction under local anesthesia, parasitological identification confirmed L. loa filariasis.
2016: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/27398038/aggressive-lymphoma-sarcoma-mimicker-originating-in-the-gluteus-and-adductor-muscles-a-case-report-and-literature-review
#14
Sarah A Elkourashy, Abdulqadir J Nashwan, Syed I Alam, Adham A Ammar, Ahmed M El Sayed, Halima El Omri, Mohamed A Yassin
Extranodal lymphoma (ENL) occurs in approximately 30%-40% of all patients with non-Hodgkin lymphoma and has been described in almost all organs and tissues. However, diffuse large B-cell lymphoma is the most common histological subtype of non-Hodgkin lymphoma, primarily arising in the retroperitoneal region. In this article, we report a rare case of an adult male diagnosed with primary diffuse large B-cell lymphoma of the gluteal and adductor muscles with aggressive bone involvement. All appropriate radiological and histopathological studies were done for diagnosis and staging...
2016: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/27279756/double-trouble-in-a-patient-with-coronary-ectasia-bradycardia-with-angina-epiphenomenal-or-mechanistic-association
#15
Vanessa Rameh, Antoine Kossaify
Coronary artery ectasia is a rare angiographical finding, and it accounts for less than 5% of all coronary angiograms. We report a case of a 55-year-old male patient who presented with fatigue and exertional chest pain. Paraclinical tests revealed cardiac ischemia and sinus node dysfunction, as well as coronary artery ectasia without significant coronary stenosis. Factors involved in cardiac ischemia in this context comprise slow flow, poor collateral circulation, microcirculatory dysfunction, lack of adequate exertional coronary vasodilatation, and endothelial dysfunction...
2016: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/27257401/posterior-epidural-migration-of-a-sequestrated-lumbar-disk-fragment-causing-cauda-equina-syndrome-in-an-old-patient-a-case-report
#16
Kaveh Haddadi, Hamid Reza Ganjeh Qazvini
Disk fragment relocation is commonly limited to the anterior epidural space, although posterior epidural movement of a sequestrated disk piece to the posterior epidural space is infrequent. We present an uncommon case of dorsal extradural sequestration of lumbar disk herniation. A 77-year-old man presented with severe leg pain, low back pain, and urinary incontinence. Deep tendon reflexes were inattentive at the knee and ankle, and the motor power in terms of ankle dorsiflexion and great toe dorsiflexion was 2/5 in both lower limbs...
2016: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/27158226/intra-abdominal-hematoma-following-enoxaparin-injection
#17
Kin Tong Chung
An elderly patient, who was being treated for therapeutic enoxaparin for a couple of days due to suspected deep vein thrombosis, was admitted to hospital following a collapse and severe abdominal pain. She was in hypovolemic shock and was fluid resuscitated. Ultrasound scan and computed tomography (CT) scan showed a large pelvic hematoma. Radiologists also suspected a possibility of bleeding from inferior epigastric artery following a CT angiogram. The patient was stabilized and transferred to intensive care unit (ICU) for further hemodynamic supports and close monitoring...
2016: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/27081321/primary-hepatic-osteosarcoma-a-rare-cause-of-primary-liver-tumor
#18
Tsering Gyalpo Lama Tamang, Marina Shuster, Abhinav B Chandra
INTRODUCTION: Extraosseous osteosarcomas are rare, accounting for approximately 4% of all osteosarcomas. A literature review yields very few cases of osteosarcoma primarily arising from the hepatic parenchyma. CASE REPORT: This report describes a case of a man in his 50s with a history of hepatitis C and cirrhosis who presented with 5 days of progressive right upper quadrant pain. Magnetic resonance imaging of the abdomen and pelvis demonstrated a 4.4 cm × 4.8 cm × 4...
2016: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/27013901/dental-perspective-of-rare-disease-of-fanconi-anemia-case-report-with-review
#19
Mridula Goswami, Urvashi Bhushan, Manoj Goswami
Fanconi anemia is an extremely rare genetic disease characterized by chromosomal instability that induces congenital alterations in individuals. It causes defective hemopoiesis ultimately leading to bone marrow failure. Patients are susceptible to recurrent infections and increased risk of hemorrhage, as well as delayed and poor wound healing. Herein, we report a case of Fanconi anemia in which various classical signs of the disease were present. The patient has been on regular follow-up since three and a half years for management of dental problems...
2016: Clinical Medicine Insights. Case Reports
https://www.readbyqxmd.com/read/26997878/tubulointerstitial-nephritis-and-uveitis-syndrome-are-drugs-offenders-or-bystanders
#20
Mutsumi Kawamata, Tetsu Akimoto, Taro Sugase, Naoko Otani-Takei, Takuya Miki, Takahiro Masuda, Takahisa Kobayashi, Shin-Ichi Takeda, Shigeaki Muto, Daisuke Nagata
A 16-year-old female patient was admitted to our hospital due to progressive renal dysfunction with an increased serum creatinine (sCr) level of 1.7 mg/dL. Her clinical course without any ocular manifestations and results of drug-induced, lymphocyte-stimulating tests, in addition to a renal histological assessment, initially encouraged us to ascribe the patient's renal abnormalities to drug-induced acute interstitial nephritis (AIN). Four months later, she started to complain about reduced visual acuity when she was found to have anterior bilateral uveitis despite the recovered renal function with almost constant sCr levels around 0...
2016: Clinical Medicine Insights. Case Reports
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