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Journal of Investigative Medicine High Impact Case Reports

Anna Sarcon, Dipayon Roy, David Laughrun, Mary Huntsinger, Jacqueline Schwartz, Jina Sohn, Rahul N Doshi
The Watchman device is a transcatheter left atrial appendage (LAA) occluding device used in patients with nonvalvular atrial fibrillation (NVAF) and a high CHADS2-VA2SC score who are poor long-term anticoagulation candidates. Pericardial effusion related to device deployment and perforation can be a life-threatening complication. While not common in hands of experienced operators, management may require surgical intervention. Here we present a rare case of LAA perforation, which was corrected by successful repositioning of the device foregoing the need for surgical management...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Sherif Elmahdy, Christian C Shults, Muhamad Alhaj Moustafa
Stent migration is an uncommon complication of endovascular stenting procedures. It could cause serious cardiovascular complications. In this article, we describe an interesting case of acute heart failure as a result of stent embolization from the left common iliac vein into the right ventricle and how it was identified and managed.
January 2018: Journal of Investigative Medicine High Impact Case Reports
Frederick Venter, Arash Heidari, Kristine Galang, Macsen Viehweg
Tuberculomas are an intracranial form of tuberculosis that account for a third of intracranial lesions in endemic areas. If symptomatic, they usually present as meningitis in an immunocompromised host; however, in patients without signs of meningitis, clinical features are essentially indistinguishable from any other space-occupying lesion. We present a case of central nervous system tuberculosis in an immunocompetent host who presented with new-onset seizures.
January 2018: Journal of Investigative Medicine High Impact Case Reports
Vijay Gayam, Amrendra Kumar Mandal, Arshpal Gill, Mazin Khalid, Ruby Sangha, Mowyad Khalid, Pavani Garlapati, Bikash Bhattarai
A 48-year-old male presented to the psychiatric emergency room for dysmorphic mood. He was admitted to medical service for the management of hyponatremia, which was discovered in his initial laboratory workup. After the first day of admission, he developed abdominal pain and fever, and subsequent laboratory work revealed a triglyceride level of 10 612 mg/dL (reference range = 0-194 mg/dL). Computed tomography scan of the abdomen and pelvis revealed a hypodense lesion in the pancreas surrounded by a moderate amount of peripancreatic fluid suggestive of hemorrhagic pancreatitis...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Neelam Phalke, Zubin Mehta, Samrat Das
One of the most concerning causes of abdominal pain affecting children is acute appendicitis. However, there are benign conditions that can closely mimic appendicitis in children. In this article, we present a case of a child admitted for possible acute appendicitis and determined to have a condition known as omental infarction. The patient was managed medically and made a full recovery without surgical intervention. The aim of this case report is to review omental infarction and present a way of differentiating this disease from appendicitis, utilizing imaging, with the goal of avoiding surgical intervention...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Hisham Abukamleh, Arash Heidari, Greti Petersen, Piruthiviraj Natarajan, Gian Yakoub, Everardo Cobos, Royce Johnson
Reactive cutaneous coccidioidal skin manifestations are commonly noticed during the early stage of coccidioidomycosis. These skin lesions are devoid of any active coccidioidal organism, and the immune trigger mechanisms are not elucidated. We describe 6 cases of unusual reactive cutaneous coccidioidal manifestation, characterized by painful vesiculobullous lesions known as erythema sweetobullosum. The biopsy of the lesions revealed neutrophilic dermatosis with inflammatory cells resulting in a cleft and elevation of the most superficial layer of the skin forming a bulla...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Medha Joshi, Salah Aldergash, Ali Hussain, Rakesh Gulati, Varun Malhotra
Renal hypoperfusion noted on abdominal computed tomography (CT) scan without any underlying comorbid condition is a rare finding. Most reported cases of renal hypoperfusion have an association with an underlying cardioembolic problem, such as atrial fibrillation, endocarditis, cardiomyopathies, or artificial valve thrombi. We present a case of transient renal hypoperfusion evident on abdominal CT scan following blunt trauma. An 18-year-old male without any significant past medical history presented to the emergency department with the complaint of abdominal pain...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Waqas Ullah, Mohsin Hamid, Hafez Mohammad Ammar Abdullah, Mamoon Ur Rashid, Faisal Inayat
Ketogenic diet or very-low-carbohydrate diet gained widespread popularity in the 1990s due to their favorable effects on weight loss and diabetes among others with good short-term safety data. People on ketogenic diets exist in a state of "dietary ketosis" in which the body production of ketone is equal to consumption and no harmful effects of ketonemia occur. However, in face of stress, the harmless "dietary ketosis" can lead to profound acid-base disturbances due to massive overproduction of ketone bodies that overwhelms the acid buffer system of the body...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Edward C Mader, Daniella Miller, Jeremy M Toler, Piotr W Olejniczak
Breach rhythm, the hallmark of skull defect, is a familiar finding in the electroencephalogram (EEG). A hole in the skull can also give rise to unfamiliar EEG findings. We present 3 patients with a skull defect whose scalp EEG showed focal epileptiform discharges that resembled F4 electrode artifacts-a 23-year-old man with a right-sided craniectomy for traumatic brain injury, a 63-year-old woman with a history of bifrontal craniectomy and meningioma resection, and a 77-year-old woman who had a right hemicraniectomy for a life-threatening subdural hematoma...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Carlos D'Assumpcao, Ahana Sandhu, Arash Heidari, Arman G Froush, Shahab Hillyer, Joseph Chen, Alan Ragland
Ventriculoperitoneal shunts are the current treatment of choice for congenital hydrocephalus. It is rare for physicians to see patients with alternative types of shunting devices. Lumboureteral shunts, once popular from the 1940s to 1960s, decompress via the genitourinary system. Immediate complications were dehydration, electrolyte imbalances, infection, and the sacrifice of a functional kidney. Long-term complications include retrograde meningitis due to urinary tract infections. Three shunt types have been documented: polyethylene, silicone rubber, and ureterodural anastomosis...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Carlos D'Assumpcao, Benson Lee, Arash Heidari
Magnusiomyces capitatus is a rare cause of fungal infection in immunocompromised patients, mainly seen in hematological malignancies. M capitatus infections are extremely rare in immunocompetent patients, as it is part of normal human microbial flora. We are presenting an extremely rare case of M capitatus peritonitis in an otherwise immunocompetent patient who suffered from gastrointestinal leakage due to pancreatitis. Fungal identification was performed at reference laboratory by phenotypic characteristics and DNA sequencing of target internal transcribed spacer region of the rRNA gene and the D1-D2 domain of the large-subunit rRNA gene and susceptibility testing by Clinical and Laboratory Standards Institute guidelines (document M27-S4) broth dilution method...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Samson Ferm, Constantine Fisher, Akil Hassam, Moshe Rubin, Sang-Hoon Kim, Syed Ahsan Hussain
Duodenal perforation due to biliary stent migration is rare, and it often requires surgical repair; however, endoscopic closure has recently become a viable option in the appropriate patients. We present the case of a 79-year-old female who underwent biliary stent placement for a common bile duct stricture, who subsequently was found to have a duodenal wall perforation secondary to stent migration. The stent was extracted endoscopically with successful defect closure using a ConMed® repositional DuraClip™...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Vasileios Karamouzos, Christos Prokakis, Fotini Kosmopoulou, Evangelos Karanikolas, Christina Kalogeropoulou, Diamanto Aretha, Nikolaos Panagiotopoulos, Efstratios Koletsis, Dimitrios Velissaris
We report a case of a young female with known history of pulmonary Langerhans cell histiocytosis who was initially presented in the emergency department of a university hospital with respiratory distress. Clinical assessment and diagnostic workup revealed left hemithorax subcutaneous emphysema, bilateral pneumothorax, and atelectasis in both lower lung lobes. The patient was treated with bilateral staged thoracoscopic bullectomy and mechanical abrasion of the parietal pleura combined with chemical pleurodesis with talc...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Faisal Inayat, Ali Raza Ghani, Iqra Riaz, Nouman Safdar Ali, Usman Sarwar, Raphael Bonita, Hafeez Ul Hassan Virk
Left ventricular pseudoaneurysm is a rare but life-threatening disorder that is frequently reported secondary to myocardial infarction or cardiac surgery. In this article, we chronicle the case of a patient with no prior risk factors who presented with a 2-week history of nonexertional atypical left chest pain. Apical 2-chamber transthoracic echocardiography revealed an unexpected outpouching of basal inferoseptal wall of the left ventricle, which had a narrow neck and relatively wide apex. The patient was diagnosed with left ventricular pseudoaneurysm and medical therapy was initiated...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Anusha Vakiti, Ravi Pilla, Muhamad Alhaj Moustafa, Jacinth J Joseph, Aarthi G Shenoy
Ifosfamide, an alkylating agent used in cancer treatments, can cause neurotoxicity. The clinical presentation can range from mild symptoms such as acute confusion to non-convulsive seizures, severe irreversible coma, and death. The benefit of methylene blue use in treating ifosfamide-induced metabolic encephalopathy is not well established. In this article, we present 2 cases of ifosfamide-induced metabolic encephalopathy responsive to methylene blue treatment.
January 2018: Journal of Investigative Medicine High Impact Case Reports
Bryan Oronsky, Chris Larson, Tony R Reid, Corey A Carter
For all of the optimism that immunotherapy has engendered, the flip side is that 7/10 patients with susceptible tumor types do not respond, while in nonsusceptible tumor types the response rates are significantly lower. In contradiction of the current orthodoxy against surgery in the setting of unresectable disease, we present 3 examples of immunotherapy-treated patients with widespread recurrence who experienced dramatic clinical improvement following debulking/metastasectomy. Taken together with examples from the literature that correlate longer survival with surgical intervention during treatment with immunotherapy, these 3 cases suggest that a new paradigm involving a wider role for surgery in the management of these patients should be explored...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Masooma Aqeel, Nevin Uysal-Biggs, Timothy S Fenske, Nagarjun Rao
Introduction . Mantle cell lymphoma (MCL) comprises approximately 3% to 10% of all non-Hodgkin lymphomas. Although there is an increased risk for secondary malignancies after treatment among non-Hodgkin lymphomas survivors, a synchronous diagnosis of primary lung cancer arising in conjunction with lymphoma at the same site has rarely been reported. We report an unusual case of primary lung adenocarcinoma with coexistent MCL within the same lung lesion. Case Presentation . A 55-year-old female with newly diagnosed stage IV-B MCL was referred for workup of a right upper lobe cavitary lesion detected during lymphoma staging...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Binav Shrestha, Paritosh Kafle, Shivani Thapa, Suyash Dahal, Vijay Gayam, Alix Dufresne
Introduction. Myocardial infarction in the setting of anaphylaxis may result from the anaphylaxis itself or from the epinephrine used to treat the anaphylaxis. While cases of myocardial infarction due to large doses of intravenous epinephrine have previously been reported, myocardial infarction after therapeutic doses of intramuscular epinephrine is rarely reported. Case Report. A 23-year-old male presented with sudden onset of difficulty in swallowing and speech after eating takeout food. He was treated with intramuscular epinephrine for presumed angioedema following which he immediately developed chest tightness associated with ST elevation on electrocardiogram and elevated serum troponin...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Jordana Cheta, Michael Binder, Jolanta Kowalewska, Sandeep Magoon
Systemic sclerosis (SSc) is a rare autoimmune disorder that is typically divided into limited cutaneous systemic sclerosis and diffuse cutaneous systemic sclerosis. Scleroderma renal crisis (SRC) is a severe complication of SSc and typically presents with new-onset hypertension and a reduction in renal functioning. In patients presenting with typical features of SRC, treatment with an angiotensin-converting enzyme inhibitor along with dialysis as needed is typically initiated empirically. Renal biopsy is not recommended in patients with SSc presenting with typical features of SRC...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Moshe Bachar, Eduard Fatakhov, Christopher Banerjee, Nathan Todnem
Objectives. We describe a rare case of nonalcoholic Marchiafava-Bignami disease (MBD) in the setting of malnourishment after gastric bypass. Methods. A 44-year-old nonalcoholic Caucasian woman with malnutrition after gastric bypass presented with 2 weeks of weakness. The patient acutely became stuporous. Brain magnetic resonance imaging showed lesions in the corpus callosum and internal capsules consistent with MBD. After 10 days of treatment, the patient had resolution of her encephalopathy with return to baseline mental function, with radiological improvement...
January 2018: Journal of Investigative Medicine High Impact Case Reports
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