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Clinical Medicine. Case Reports

Rakesh Biswas, Saroj Gupta, Sumit Dahiya, Shashi Kiran, B V Girish, A S Kasthuri
This case report discusses issues related to a 56-year-old man from Bangalore who presented with complaints of a gradual protrusion of his eyeballs along with diminishing vision for the previous month. The approach to diagnosis and management issues around this unusual presentation is dicussed.
2010: Clinical Medicine. Case Reports
Branka Filipović, Zorica Sporčić, Tomislav Randjelović, Goran Nikolić
Common variable immunodeficiency (CVID) is a heterogeneous group of primary immunodeficiency disorders characterized by defective antibody production, low levels of serum immunoglobulins and increased susceptibility to infection. The patient was a 39-year-old male who was admitted to the gastroenterology department with a two week history of diarrhea, blunt abdominal pain below the umbilicus, prolonged febrile state, loss of appetite and loss of body weight of 18 kg during the previous six months. Screening tests of serum immunoglobulins showed decreased concentrations of three types of immunoglobulins: IgA < 0...
2009: Clinical Medicine. Case Reports
Syoichiro Kono, Yasuhiro Manabe, Tomotaka Tanaka, Daiki Fujii, Yasuko Sakai, Hisashi Narai, Nobuhiko Omori, Koji Abe
We report a case of 30-year-old man presenting chorea in his legs. A brain computed tomography (CT) scan showed bilateral symmetric calcifications in the basal ganglia, thalamus, cerebellum and subcortical white matter. Laboratory studies showed no abnormalities of serum calcium, phosphate, PTH, lactic acid, pyruvic acid and cerebrospinal fluid. Under the diagnosis of Fahr's disease (FD), we treated with quetiapine (75 mg/day), which completely abolished his symptoms and he showed no other side effect. Our experience suggests that quetiapine is well tolerated in FD patients and effectively treats chorea without extrapyramidal movement...
2009: Clinical Medicine. Case Reports
Steve Vucic
Guillain-Barré syndrome (GBS) is characterized by acute and symmetric flaccid paraparesis and areflexia. Involvement of the central nervous system has been infrequently reported. In the current issue of Clinical Medicine: Case reports, an unusual case of GBS with asymmetric muscle weakness was reported. Corticomotoneuronal dysfunction was invoked as a possible cause for this neurological finding. Reversible blockade of voltage gated Na(+) channels resulting in conduction failure may be a possible pathophysiological mechanism...
2009: Clinical Medicine. Case Reports
S Richard-Devantoy, J B Garré, B Gohier
Postoperative complications resulting from bariatric surgery can lead to severe vitamin-deficiency states. A patient who underwent bariatric bypass surgery and later developed Wernicke's encephalopathy prompted us to present her interesting case history for discussion. Although bariatric surgery is known to be a risk factor for Wernicke's encephalopathy, this diagnosis is only rarely evoked in the postoperative course. We recommend that the occurrence of digestive, psychiatric or neurological symptoms after bariatric surgery should suggest a thiamine deficiency that must be promptly assessed...
2009: Clinical Medicine. Case Reports
Takao Kiriyama, Makito Hirano, Susumu Kusunoki, Daiji Morita, Minako Hirakawa, Yasuyo Tonomura, Takanori Kitauchi, Satoshi Ueno
Guillain-Barrè syndrome (GBS) is usually associated with symmetrical weakness, and therefore asymmetrical weakness may confuse diagnosis. We report on a patient with GBS subsequent to Campylobacter jejuni enteritis who had asymmetrical weakness with CNS involvement. The patient tested positive for anti-ganglioside antibodies, including anti-GM1 IgM, anti-GD1b IgG, and anti-GT1a IgG. Patients with GBS can manifest asymmetrical signs and symptoms attributable to CNS involvement. Prompt, accurate diagnosis and treatment of post-C...
2009: Clinical Medicine. Case Reports
Khalid A Al-Anazi, Khalid I Eltayeb, Mohammed Bakr, Fahad I Al-Mohareb
For many years, methotrexate has been used in the treatment of certain chronic medical disorders e.g. rheumatoid arthritis and psoriasis as well as a number of malignant disorders e.g. acute lymphoblastic leukemia, certain types of lymphoma and breast carcinoma. Its use has been associated with various systemic toxicities and complications. The association between methotrexate therapy and the development of lymphoma and pseudolymphoma is well established. In patients treated with methotrexate, the development of leukemia has been attributed to either the primary disorder e...
2009: Clinical Medicine. Case Reports
Cem Onal, Berrin Pehlivan, Nebil Bal, Erkan Topkan, Ferhat Kilinc, Savas Topuk
Sarcomatoid carcinoma is a rare tumor of the urinary bladder accounting for less than 0.5% of all primary urinary bladder tumors. Since the patients were presented with large tumor with extended stages, outcome was found to be poor. In order to improve local control, adjuvant local treatment may be practical. We report a rare case with sarcomatoid carcinoma of the urinary bladder diagnosed with immunuhistochemical (IHC) study and treated with 3D-conformal radiotherapy (3DCRT) post-operatively. A 55-year old female patient complained about painless hematuria for 2 months...
2009: Clinical Medicine. Case Reports
Brian Bowers, Deepak Gupta, Hirenkumar Patel, Naureen Mirza
Wegener's granulomatosis is a granulomatous necrotizing vasculitis characterized by its predilection to affect the upper and lower respiratory tracts and kidneys. Ocular manifestations such as keratitis, conjunctivitis, scleritis, episcleritis, nasolacrimal duct obstruction, uveitis, retroorbital pseudotumor with proptosis retinal vessel occlusion, and optic neuritis have all been described. We present a case of limited Wegener's granulomatosis presenting with proptosis. A 57 year old woman with a history of Graves' disease 20 yrs ago, presented to her ophthalmologist with new onset of exophthalmos of right eye...
2009: Clinical Medicine. Case Reports
J A Olaniyi
This is a case report of a 35 year old female with diagnosed Immune Thrombocytopaenic Purpura (ITP) that was strangely followed by acute myeloid leukaemia at 10 months post diagnosis of ITP. She was managed as ITP using prednisolone 45 mg daily for 10 months with good response. She also synchronously carried a pregnancy to term and safe delivery. Shortly after delivery, she represented with gingival bleeding and peripheral film review and subsequent bone marrow cytology was in keeping with AML-M4 subtype. She died shortly after diagnosis without being able to receive chemotherapy...
2009: Clinical Medicine. Case Reports
Yasuyo Kashiwagi, Shunsuke Suzuki, Tao Fujioka, Shingo Oana, Hisashi Kawashima, Kouji Takekuma, Akinori Hoshika
Tubulointerstitial nephritis and uveitis (TINU) syndrome is a rare autoimmune disease and the pathogenesis is still unknown. We report a case of TINU syndrome with high ASLO titer. Uveitis improved and urine β2-MG normalized with low dose systemic predonisolone and cyclosporin A. The high ASLO titer in early phase suggested that streptococcal infection might have triggered TINU syndrome. Lymphocyte phenotypes normalized after treatment with low dose systemic predonisolone and cyclosporin A.
2009: Clinical Medicine. Case Reports
Takeo Nomura, Ryuta Satoh, Kenji Kashima, Mutsushi Yamasaki, Kenichi Hirai, Fuminori Satoh, Hiromitsu Mimata
Solitary fibrous tumor (SFT) is a rare spindle cell neoplasm mainly originated in the pleural cavity. We report here an unusual case of a large SFT in the retroperitoneum. A 27-year-old female complaining of a palpable mass in the right flank with dull pain was admitted to our hospital with the diagnosis of right retroperitoneal tumor. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large retroperitoneal tumor arising from latissimus dorsi muscle. Surgical findings revealed a partly encapsulated tumor and complete resection of tumor concomitantly with right kidney, 11th and 12th ribs, and diaphragm was performed...
2009: Clinical Medicine. Case Reports
Satoko Kinoshita, Kazuma Sugie, Hiroshi Kataoka, Miho Sugie, Makito Hirano, Satoshi Ueno
We report the first case of acute autonomic, motor and sensory neuropathy (AASMN) associated with meningoencephalitis. A 62-year-old man presented with fever, neck stiffness, and coma. Respiratory failure developed. Magnetic resonance images showed an abnormality in the medial temporal lobe. Cerebrospinal fluid analysis revealed pleocytosis with a high protein level. Intensive care gradually improved the consciousness level, but paralysis of the four extremities persisted. Nerve conduction studies revealed demyelinating sensory and motor polyneuropathy...
2009: Clinical Medicine. Case Reports
S Feuillet, V Meignin, J Brière, P Brice, V Rocha, G Socié, A Tazi, A Bergeron
The Epstein-Barr virus (EBV) associated Post-Transplant Lymphoproliferative Disorders (PTLD) are increasingly recognized as a fatal complication of hematological stem cell transplantation (HSCT). Thoracic involvement, that may be isolated or part of a disseminated disease, usually encompasses pulmonary nodules or masses and mediastinal lymph node enlargement. The current case study presents 2 patients who underwent HSCT, one allogenic and the other autologous, who developed an exceptional endobronchial EBV related PTLD...
2009: Clinical Medicine. Case Reports
Cherag Daruwala, Giancarlo Mercogliano, Gary Newman, Mark J Ingerman
OBJECTIVE: The purpose of this study is to report a case of C. difficile bacteremia in a Crohn's disease patient and to review the literature on previously reported cases. METHODS: Searches of MEDLINE and PubMed databases were made. RESULTS: We report the first case of C. difficile bacteremia in a Crohn's disease patient. There are 15 other reported cases of C. difficile bacteremia reported in the literature. We found that the majority of patients (10 of 15 patients) had polymicrobial bacteremia and that the overall mortality rate is significant, with 6 of 15 reported patients dying...
2009: Clinical Medicine. Case Reports
George Shih, Wei-Jen Shih, Bonnie Mitchell, Primo P Milan
F-18 Fluorodeoxyglucose Positron Emission Tomography imaging (F-18 FDG PET) detects malignancies depending on the uptake profile of glycolysis of tumors; however, the role of FDG PET is limited in the evaluation of primary renal malignancy because of low FDG uptake by renal cell carcinoma and also because normal urinary excretion of FDG seen in the images. A patient with renal cell carcinoma whose FDG PET imaging study incidentally shows a photon-deficient mass in the upper pole of the right kidney is present here...
2008: Clinical Medicine. Case Reports
P Paskaran, A U Murugananthan, V Manglam, J Arnold, A Pal
No abstract text is available yet for this article.
2008: Clinical Medicine. Case Reports
Andrew Crean, Narinder Paul, Naeem Merchant, Lianne Singer, Yves Provost
Summary Castleman disease is an uncommon disorder affecting the lymphatic system and is characterised by atypical lymphocyte proliferation. The usual clinical presentation is of a solitary mass lesion, frequently within the thorax. A number of different imaging findings have been reported on CT and MRI. We present a case of paracardiac Castleman disease where the diagnosis was suggested by dramatic enhancement of the tumour mass during a dynamic MR perfusion sequence. To our knowledge this is the first report of the use of a first pass bolus tracking technique in the diagnosis of Castleman disease...
2008: Clinical Medicine. Case Reports
Alaattin Yurt, Kubilay Uçar, Füsun Ozer, Ismail Oran, Nuri Arda
Aneurysms of the complex of the anterior cerebral artery are frequently associated with anatomic variations of the circle of Willis. We describe a case of aneurysmal rupture of the anterior communicating artery, a variant of the anterior cerebral artery. The aneurysm appeared to be situated on this vessel proximal to the infered site of the AcoA. Surgery was performed at the 6th day after hemorrhage. The anterior communicating artery aneurysm was clipped. The post operative course was unventful, with complete recovery...
2008: Clinical Medicine. Case Reports
Terje Forslund, Anna-Mari Koski, Arvo Koistinen, Anu Sikiö
A breakthrough in understanding of mechanisms of bone structure regulation has brought about the introduction of the new synthetic recombinant human parathyroid hormone 1-34 (PTH1-34; Teriparatide) in the treatment of osteoporosis. These mechanisms, involving the RANKL, RANK, and osteoprotegerin system, are also known to be involved in malignant myeloma (MM) and tumor and bone metastasis development. We report a case in which MM was found after treatment of osteoporosis with teriparatide. We were unable to demonstrate any direct association between the MM and teriparatide treatment...
2008: Clinical Medicine. Case Reports
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