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Journal of Investigative Medicine High Impact Case Reports

John T Denny, Sagar S Mungekar, Benjamin R Landgraf, Zoe M Rocke, Valerie A McRae, Christian P McDonough, James T Tse, Scott J Mellender, Geza K Kiss
We report an unusual case of endotracheal tube failure. It was due to a manufacturing defect in the internal white plastic piece that is normally depressed by the luer-lock syringe within the blue pilot balloon. Prior to use, the endotracheal tube was tested and functioned normally. A 64-year-old patient in the intensive care unit with a history of hypertension was being mechanically ventilated after uneventful abdominal surgery. After several hours in the intensive care unit, he was noted to be suddenly no longer receiving adequate tidal volumes from the ventilator...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Laith Al Momani, Shoura Karar, Lindsey C Shipley, Allison Locke, James Swenson
Endoscopic retrograde cholangiopancreatography (ERCP) is an invasive procedure with significant complications. Splenic hematoma is an extremely rare but known complication following ERCP that has been increasingly reported in the past several years. We report the case of a 44-year-old patient with a history of sleeve gastrectomy who underwent an ERCP that was complicated by both acute pancreatitis and splenic hematoma. She was managed conservatively under close monitoring in the intensive care unit. Clinicians should be aware of this potentially life-threatening complication to make a prompt diagnosis and begin early appropriate management...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Niharika Yedla, Daniela Pirela, Alex Manzano, Claudio Tuda, Saberio Lo Presti
Thyroid abscess is an uncommon infectious pathology. The thyroid is highly resistant to infection due to high iodine content, capsular encasement, and rich vascularity. Acute suppurative thyroiditis represents <1% of thyroid diseases that could potentially become a life-threatening endocrine emergency. A 48-year-old woman with AIDS presented with 3 days of fever, tender neck swelling, and methicillin-resistant Staphylococcus aureus bacteremia. Apart from leukocytosis, initial laboratory values including thyroid function tests were normal...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Tagore Sunkara, Santosh R Sharma, Andrew Ofosu, Vinaya Gaduputi, Madhavi Reddy, Ghulamullah Shahzad
Multiple myeloma (MM), a plasma cell tumor, is primarily a disease of the bone marrow. Extramedullary plasmacytoma, also a plasma cell tumor, is very rare in the gastrointestinal tract and the pancreas, and only a handful cases have been documented till now. Gastric and pancreatic plasmacytomas are usually seen in elderly patients; however, cases in patients as young as 32 years of age have been reported. Commonly, patients with gastric plasmacytoma present with nonspecific symptoms like epigastric pain, abdominal fullness, anorexia, and weight loss, or serious conditions like massive upper gastrointestinal bleeding and gastric outlet obstruction...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Dimpi Desai, Sara Zahedpour Anaraki, Neetha Reddy, Eric Epstein, Vafa Tabatabaie
Thyroid storm is a life-threatening endocrine emergency with an incidence rate of 1% to 2%. It is a systemic condition of excessive thyroid hormone production and release leading to thermoregulatory, adrenergic, neuropsychiatric, cardiovascular, and abdominal manifestations. Although it is a rare condition, it carries a significant mortality rate. Hence, knowing the common and uncommon presentations of thyroid storm is important for its prompt diagnosis and treatment. In this article, we present an unusual case of a young woman who presented with psychosis as the manifesting symptom of thyroid storm...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Shahrazad Akbar, Lujayn Akbar, Nuralhuda Akbar, Ali Nawras
One of the most commonly encountered medical problems affecting all age groups in health care is abdominal pain. There are many surgical and medical causes behind this symptom; however, a rare cause of abdominal pain and other unspecific abdominal complaints are gastric bezoars. Gastric bezoars are defined as the accumulation of undigested or partially digested foreign materials in the stomach. They are typically found incidentally during upper endoscopy. Patients may present with abnormal behavior or eating disorders such as pica...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Saad Ullah, Hassan Mehmood, Nawja Pervin, Hassan Zeb, Khushbakht Ramsha Kamal, Sadaquat Liaqat
Gram-negative infections are a rising concern faced by the medical community. Approximately 30% of nosocomial bloodstream infections in intensive care units in the United States are caused by these gram-negative species. Emergence of multidrug-resistant organisms further complicate this issue. In this article, we report a case of an 84-year-old Caucasian male who was diagnosed with Shewanella pneumonia treated with cefepime with minimal to no improvement in his symptoms. To the best of our knowledge, this is the third reported case of Shewanella putrefaciens nosocomial pneumonia and first case of bacteremia secondary to pneumonia by Shewanella putrefaciens ...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Furqan Khattak, Muhammad Khalid, Ghulam Murtaza, Timir K Paul
Takotsubo cardiomyopathy, also known as "broken heart syndrome," is a transient left ventricular dysfunction associated with stress (usually emotional) induced myocardial injury and stunning. It often presents as myocardial infarction on surface electrocardiogram (EKG). Diagnosis is made by coronary angiography, which rules out coronary artery disease and shows pathognomonic apical ballooning. In this article, we present a case of a 72-year-old woman who initially presented with an ST segment elevation myocardial infarction on EKG...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Sumit Dahal, Dipesh K C Ghimire, Saroj Sapkota, Suyash Dahal, Paritosh Kafle, Manjul Bhandari
Renal and neurological involvements are frequently seen in thrombotic thrombocytopenic purpura (TTP). Cardiac involvement, however, has been rarely reported. In this article, we present 2 cases of myocardial infarction in patients with TTP. In the first case, a young man presented with non-ST-segment elevation myocardial infarction that resolved promptly with plasmapheresis. The second patient developed ST-segment elevation myocardial infarction early in the course of the disease and died before plasmapheresis could be initiated...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Roopam Jariwal, Arash Heidari, Ahana Sandhu, Janushe Patel, Kamelia Shoaepour, Piruthiviraj Natarajan, Everardo Cobos
Invasive fungal infections are commonly associated with some form of immunosuppression. On the nasal epithelial surface, Aspergillus flavus , under favorable conditions, can aggressively breach multiple cell lines invading the local tissues. We present the case of a 35-year-old woman with granulomatous invasive Aspergillus flavus infection involving the nasal sinuses and the brain. Antifungal agents administered in the previous episodes contained the infection; however, the infected site evolved over time surrounded with calcified tissues in the left maxillary sinus...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Ali Raza Ghani, Faisal Inayat, Nouman Safdar Ali, Reema Anjum, Michael Viray, Arsalan Talib Hashmi, Iqra Riaz, Bruce D Klugherz, Hafeez Ul Hassan Virk
Spontaneous coronary artery dissection is an increasingly recognized nonatherosclerotic cause of acute coronary syndrome. Reports regarding the prognosis and natural history of this disease are limited. In addition to the diagnostic difficulty, this condition poses a significant therapeutic challenge due to the lack of specific management guidelines. We present here a case series of 9 patients with spontaneous coronary artery dissection. Additionally, this article reviews the incidence, clinical characteristics, risk factors, diagnostic modalities, therapeutic approaches, and patterns of recurrence in patients with spontaneous coronary artery dissection...
January 2018: Journal of Investigative Medicine High Impact Case Reports
John T Denny, Zoe M Rocke, Valerie A McRae, Julia E Denny, Christine Hunter Fratzola, Sajjad Ibrar, Joyce Bonitz, James T Tse, Shaul Cohen, Scott J Mellender, Geza K Kiss
Varicella zoster virus causes varicella (chickenpox). It can be reactivated endogenously many years later to cause herpes zoster (shingles). Although varicella is usually a benign disease in healthy children, it resulted in over 11 000 hospitalizations and over 100 deaths every year, in all ages, in the United States. Morbidity was considerably worse in older teenagers and adults. Between 5% and 15% of cases of adult chickenpox will produce some form of pulmonary illness. Progression to pneumonia risk factors include pregnancy, age, smoking, chronic obstructive pulmonary disease, and immunosuppression...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Precious Macauley, Mark Rapp, Sarah Park, Olaoluwatomi Lamikanra, Pratibha Sharma, Michael Marcelin, Kavita Sharma
Tuberculosis is one of the top 10 causes of death worldwide according to the World Health Organization. Central nervous system involvement is usually the least common presentation of tuberculosis occurring in about 1% of all cases but yet can have very devastating outcomes. Lupus nephritis is one of the most common complications of systemic lupus erythematosus with up to two thirds of patients presenting with some degree of renal dysfunction. The mainstay of treatment is glucocorticoids; however, to sustain remission, steroid sparing agents such as cyclophosphamide, azathioprine and mycophenolate mofetil are used...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Tamer Akel, Emad Barsoum, Jad Mroue, Nikhil Nalluri, Frank Tamburino, Marc Bogin
Reverse takotsubo cardiomyopathy is an uncommon cardiomyopathy characterized by reversible regional wall motion abnormalities in the basilar segment of the left ventricle. This happens in the absence of any coronary artery pathology. Although it shares some pathogenic mechanisms with its more common variant, takotsubo cardiomyopathy, differences exist in terms of echocardiographic features, demographics, clinical manifestations, laboratory features, and prognosis. Cases of postoperative reverse takotsubo cardiomyopathy are less described in the literature...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Apurva D Patel, Thomas Haldis, Kais Al Balbissi, Timir Paul
Transcatheter aortic valve replacement in the setting of failed surgical bioprosthesis (valve-in-valve) is a valuable option for patients with bioprosthetic aortic stenosis or regurgitation who are deemed high risk for repeat open heart surgery. Although the procedure is successful with proper preprocedural assessment, instances of left main (LM) coronary artery ostium obstruction have been documented. We present a case of LM coronary obstruction in the immediate postoperative period following implantation of a 20-mm Edwards Sapien 3 valve inside the degenerated 21-mm Mitroflow bioprosthesis stenosis, which was treated with double stenting alongside the Edwards Sapien 3 valve creating a channel ("neo left main") that extended from mid-LM to the upper margin of the Edwards Sapien 3 valve...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Asghar Marwat, Hassan Mehmood, Ali Hussain, Muzammil Khan, Asad Ullah, Medha Joshi
The relationship between reactive arthritis and enteric infections caused by Yersinia enterocolitica, Campylobacter jejuni , and Salmonella typhimurium is well documented. Clostridium difficile colitis is a less recognized cause of reactive arthritis. We present a case of a 58-year-old woman with Clostridium difficile colitis complicated by reactive arthritis. A 58-year-old woman with no significant past medical history presented to our hospital with complaints of nonbloody watery diarrhea, abdominal pain for the past 1 week, and right knee pain starting 1 day prior...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Tagore Sunkara, Eric Omar Then, Krishna Sowjanya Yarlagadda, Manan Jhaveri, Vinaya Gaduputi
An esophageal mucosal bridge is a rare finding that is seldom encountered on upper endoscopy. They most commonly present secondary to an underlying inflammatory disorder and cause chest pain and dysphagia, among other symptoms. More rarely, they present asymptomatically with no identifiable inflammatory conditions. Our case consists of a 31-year-old woman who presented with an asymptomatic, noninflammatory mucosal bridge of the esophagus. To our knowledge, this makes the third such case. The rarity of this condition coupled with the lack of epidemiologic data available make this case worthy for literature review...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Catherine Langevin, Hugo Chapdelaine, Jean-Maxime Picard, Pierre Poitras, Raymond Leduc
Cronkhite-Canada syndrome is a rare syndrome consisting of extensive gastrointestinal polyposis and ectodermal changes including cutaneous hyperpigmentation, alopecia, and onychodystrophy. We report the case of a 45-year-old Caucasian male patient who failed multiple treatments over 2 years including steroids, azathioprine, adalimumab, and cyclosporine. He had recurrent and prolonged hospitalizations because of diarrhea, abdominal pain, weight loss, and malnutrition. Sirolimus was initiated with a significant clinical and endoscopic benefit apparent within, respectively, 2 and 8 weeks...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Mazin Khalid, Vijay Gayam, Sumit Dahal, Ebad Ur Rahman, Kamal Fadllala, Jaspreet Kaler, Mowyad Khalid, Alix Dufresne
Introduction. Eosinophilic myocarditis is an infiltrative disease that affects the myocardium leading to various presentations. It can be precipitated by medications, helminthiasis, or hypereosinophilic syndrome. Case. We present the case of a young, male patient who presented with palpitations and dyspnea and was found to have heart failure with reduced ejection fracture of 12%. His past medical history was significant for recent lung problem treated with steroids. Based on his history and laboratory findings, he was started on intravenous steroids for treatment of eosinophilic myocarditis...
January 2018: Journal of Investigative Medicine High Impact Case Reports
Lauren LaBryer, Rohan Sharma, Kaustubh Suresh Chaudhari, Mitali Talsania, Robert Hal Scofield
Background. Kratom is a drug derived from the leaves of the tree Mitragyna speciose , which is native to southern Thailand. The route of administration is oral. Kratom has become increasingly available in the United States. The active ingredients in the drug bind the opioid mu-receptor; therefore, kratom has similar physiological effects as mu-opioids. Elevated prolactin is a common medical condition frequently caused by a variety drugs, including opioids. Case Report. A 42-year-old man presented with poor energy and low libido...
January 2018: Journal of Investigative Medicine High Impact Case Reports
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