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Journal of Investigative Medicine High Impact Case Reports

Sanjay K Yadava, Ambika Eranki
In this article, we report the case of a 75-year-old man who was presented with new low back pain for 2 weeks. His past history was significant for severe aortic stenosis necessitating bioprosthetic aortic valve placement 4 years ago, hypertension, and coronary artery disease. His physical examination was positive for point tenderness over the lower lumbar spine. He was found to be bacteremic with Cardiobacterium hominis . Magnetic resonance imaging of the spine showed lumbar (L4-L5) epidural abscess and vertebral osteomyelitis, discitis...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Abdisamad M Ibrahim, Mohammad Al-Akchar, Zainab Obaidi, Hamid Al-Johany
Malignant peritoneal mesothelioma (MPM) is a rare diagnosis that presents with difficulties in diagnosis and management. This article reports a case of an 88-year-old male who presented with a 2-week history of abdominal distention and bloating. He worked at an insulation production factory between the ages of 23 and 25 years with presumed asbestos exposure. On the computed tomography scan of the abdomen/pelvis, the patient was found to have diffuse omental, peritoneal, and mesenteric nodularity with moderate to large ascites...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Mithu Maheswaranathan, Tue Ngo, Don C Rockey
In this article, we describe the case of a 61-year-old woman who presented with altered mental status and was found to have Klebsiella pneumoniae meningitis, bacteremia, and hepatic abscess. Despite intravenous antibiotic therapy and percutaneous drainage of the hepatic abscess, the patient developed worsening meningitis with ventriculitis, which led to her death. This invasive Klebsiella syndrome is characterized by metastatic infections with a hypervirulent strain and a poor clinical prognosis. Important elements of this patient's case-including the widespread and highly aggressive course-and of those reported in the literature are reviewed...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Noah Frydenlund, Yousef Zakharia, Rohan Garje, Laila Dahmoush, Michael A O'Donnell
Urothelial carcinoma, the most common histologic subtype of bladder cancer in the United States, most frequently presents as non-muscle invasive disease. Initially, therapy involves transurethral endoscopic resection and subsequent intravesical therapies with extended surveillance for high-risk disease. Even with the best treatments, recurrence and progression can occur. However, metastasis of non-muscle invasive bladder cancer to distant sites without evidence of progression or regional metastasis is rare...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Mina Shenouda, Garrett Enten, Thanh Nguyen, Devanand Mangar, Enrico Camporesi
Dermatobia hominis , commonly known as the human botfly, is native to Tropical America. As such, cutaneous infestation by its developing larvae, or myiasis, is quite common in this region. The distinct dermatological presentation of D hominis myiasis allows for its early recognition and noninvasive treatment by locals. However, it can prove quite perplexing for those unfamiliar with the lesion's unique appearance. Common erroneous diagnoses include the following: folliculitis, benign dermatocyst, and embedded foreign body with localized infection...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Mohsin Hamid, Waqas Ullah, Mamoon Ur Rashid, Waseem Amjad, Maryam Mukhtar, Abu Hurairah
The barium swallow is an important radiological investigation used for the diagnosis of upper gastrointestinal anatomical disorders like esophageal cancer, diverticulum, achalasia, foreign body, among others. Generally, it is believed to be a safe technique with rare complications, but few cases of barium sulfate aspiration have been reported in the literature with multiple complications. We are reporting a case of an elderly male who underwent esophagogram for the workup of chronic dysphagia, aspirated barium sulfate, and went into respiratory failure and circulatory shock several hours later...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Tagore Sunkara, Prashanth Rawla, Krishna Sowjanya Yarlagadda, Gerald A Baltazar, Vinaya Gaduputi
Chilaiditi syndrome is a very rare disorder characterized by abdominal pain due to the entrapment of the colon between the liver and the diaphragm. However, it is rare to have bowel perforation as a complication of this syndrome with only 2 cases reported to date. In this article, we present the case of a 56-year-old woman with medical history of scleroderma who presents with abdominal pain and was found to have colonic perforation from Chilaiditi syndrome. She was also incidentally found to have cecal adenocarcinoma...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Piruthiviraj Natarajan, Fowrooz Joolhar, Sudhagar Thangarasu, Ayham Aboeed, Theingi Tiffany Win, Everardo Cobos
The risk of thromboembolism is increased when associated with the human immunodeficiency viral (HIV) infection. Various factors are involved in promoting thrombosis, and the presence of a patent foramen ovale augments the potential for a paradoxical embolism. We describe the case of a 56-year-old man receiving antiretroviral therapy with features of right heart failure and pulmonary embolism. Due to the high incidence of life-threatening thromboembolism in the HIV-infected group, the need for long-term anticoagulation has to be evaluated...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Andrew Silverman, Sonia Taneja, Liliya Benchetrit, Peter Makusha, Robert L McNamara, Alexander B Pine
A 24-year-old man with history of unspecified arrhythmia presented with palpitations and chest pain. Initial electrocardiogram (ECG) revealed irregular tachycardia with varying QRS width: 150 to 200 beats per minute for narrow complexes and 300 beats per minute for wide complexes. Following cardioversion, ECG revealed sinus tachycardia with a preexcitation pattern of positive delta waves in the anterolateral leads and negative delta waves in inferior leads. The patient remained in sinus rhythm and underwent successful ablation of a right posteroseptal accessory pathway...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Ankit Bhargava, Rachel Eisenstadt, Jennifer A Shih, Viranuj Sueblinvong
Bordetella bronchiseptica infection is a common cause of pneumonia in animals but rarely causes disease in humans. Additionally, coinfection with Pneumocystis jirovecii is very uncommon and is occasionally seen in patients with acquired immunodeficiency syndrome (AIDS). We report a case of a 61-year-old HIV-negative man, who presented with hypoxic respiratory failure 2 days after completion of systemic intravenous antibiotic treatment for B bronchiseptica. His past medical history was significant for a benign thymoma...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Uththara Perera, Brooke A Kennedy, Robert A Hegele
Background. Multiple symmetric lipomatosis (MSL), also known as Madelung disease, is a rare adult-onset disorder characterized by benign lipomatosis usually localized to the nuchal and upper thoracic region. A subset of these patients has germline variants in mitochondrial DNA. Methods. Three siblings of Northern European descent with MSL were assessed initially and provided whole blood for DNA analysis. Family history revealed several additional affected siblings who were dispersed across Canada. Targeted histories were obtained from 6 additional affected family members by telephone interviews using a standardized questionnaire, and genomic DNA was obtained from saliva...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Alvaro Moreira, Hrishikesh Das
Hemorrhagic shock is a rare, emergent condition that is often fatal in newborns. In this article, we report cases of 3 neonates presenting with acute, life-threatening hemorrhage who were subsequently diagnosed with severe hemophilia (<1% factor VIII). The first infant was tachycardic, pale, and had a precipitous drop in his hemoglobin secondary to a subgaleal hemorrhage. The second patient sustained a splenic rupture, a sequela that has been reported in only 4 other neonatal cases. The last infant presented with tonic-clonic seizures and respiratory distress...
January 2018: 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
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