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Journal of Investigative Medicine High Impact Case Reports

Thein Swe, Akari Thein Naing, Aama Baqui, Ratesh Khillan
To our knowledge and literature search, Staphylococcus schleiferi subspecies coagulans infection in human beings has rarely been described in the medical literature. Furthermore, we believe that this is a first detailed case report of methicillin-resistant Staphylococcus schleiferi subspecies coagulans infection in a patient with hepatocellular carcinoma. Because of the possible association of Staphylococcus schleiferi infection and immunosuppression, any isolates of this bacterium in human beings should be presumed to be pathogenic, unless proven otherwise...
July 2016: Journal of Investigative Medicine High Impact Case Reports
Marc Heincelman, Nithin Karakala, Don C Rockey
Acute lymphoblastic leukemia (ALL) in adults is a relatively rare malignancy. The typical presentation includes signs and symptoms associated with bone marrow failure, including fevers, infections, fatigue, and excessive bruising. In this article, we report an unusual systemic presentation of ALL in a previously healthy 18-year-old man. He initially presented with several-day history of nausea and vomiting, 10-pound weight loss, and right upper quadrant abdominal pain with evidence of acute hepatocellular liver injury (elevations in aspartate aminotransferase/alanine aminotransferase) and elevation in serum creatinine...
July 2016: Journal of Investigative Medicine High Impact Case Reports
Khandakar Hussain, Saad Ullah, Hassan Tahir, Waseem Zaid Alkilani, Muhammad Naeem, Nagadarshini Ramagiri Vinod, Samuel Massoud
Multidrug-resistant enterococcal nosocomial invasive infections are a rising concern faced by the medical community. Not many options are available to treat these highly virulent organisms. Risk factors for developing these highly resistant organisms include prolonged hospital stay, previous antibiotic use, and immunosuppression. In this article, we report a case of daptomycin-resistant enterococcal native infective endocarditis treated with off-label use of quinupristin-dalfopristin.
July 2016: Journal of Investigative Medicine High Impact Case Reports
Stephen L Lambert, Frank J Williams, Zhora Z Oganisyan, Lionel A Branch, Edward C Mader
Fetal-type or fetal posterior cerebral artery (FPCA) is a variant of cerebrovascular anatomy in which the distal posterior cerebral artery (PCA) territory is perfused by a branch of the internal carotid artery (ICA). In the presence of FPCA, thromboembolism in the anterior circulation may result in paradoxical PCA territory infarction with or without concomitant infarction in the territories of the middle (MCA) or the anterior (ACA) cerebral artery. We describe 2 cases of FPCA and concurrent acute infarction in the PCA and ICA territories-right PCA and MCA in Patient 1 and left PCA, MCA, and ACA in Patient 2...
July 2016: Journal of Investigative Medicine High Impact Case Reports
Jeffrey Genda, Elizabeth A Negron, Mona Lotfipour, Samyuktha Balabhadra, Diana S Desai, David W Craft, Michael Katzman
Babesiosis, due to infection by a tick-borne protozoan (predominantly Babesia microti in North America), is an emerging health risk that is expanding into new areas and may be unfamiliar to clinicians in locations not previously considered endemic. Manifestations of infection can range from asymptomatic to life threatening, with severe disease more likely in those who have had a splenectomy, are immunocompromised, have chronic medical conditions, or are over 50 years of age. In this article, we describe an elderly but otherwise healthy man from an area not generally considered endemic for babesiosis who presented with severe hemolysis, acute renal failure, and high-level Babesia microti parasitemia; serological results suggestive of possible coinfection by Borrelia burgdorferi (the agent of Lyme disease, which is carried by the same tick as is Babesia microti) also was found...
July 2016: Journal of Investigative Medicine High Impact Case Reports
Vedha Sanghi, Aanchal Kapoor
Hypernatremia is a frequent cause of intensive care unit admission. The patient presented in this article had hypernatremia refractory to D5W (dextrose 5% water) therapy, which led to a complex investigation. Workup revealed central diabetes insipidus most likely secondary to flare up of neurosarcoidosis. The challenge in terms of diagnosis was a presentation with low urine output in the setting of hypernatremia resistant to treatment with desmopressin. This case unfolded the role of hypothyroidism causing secondary renal dysfunction and hence needed continued treatment with thyroxine in addition to treatment for hypernatremia...
July 2016: Journal of Investigative Medicine High Impact Case Reports
Pedro Pallangyo, Frederick Lyimo, Paulina Nicholaus, Ulimbakisya Kain, Mohamed Janabi
Malaria remains a significant public health problem of the tropical world. Falciparum malaria is most prevalent in the sub-Saharan African region, which harbors about 90% of all malaria cases and fatalities globally. Infection by the falciparum species often manifests with a spectrum of multi-organ complications (eg, cerebral malaria), some of which are life-threatening. Spontaneous subdural empyema is a very rare complication of cerebral malaria that portends a very poor prognosis unless diagnosed and treated promptly...
July 2016: Journal of Investigative Medicine High Impact Case Reports
Saad Ullah, Omar Elbita, Mahmoud Abdelghany, Hassan Tahir, Puneet Tuli, Waseem Zaid Alkilani, Joshan Suri
Gram-negative bacterial endocarditis causes 5% of all bacterial endocarditis. Among gram-negative bacteria, Klebsiella species are rare causes of native valve endocarditis. Klebsiella oxytoca is an extremely rare subspecies that can infrequently cause endocarditis and is associated with poor outcome. We report a case of Klebsiella oxytoca endocarditis in an elderly man who initially presented with stroke but later developed sepsis and heart block secondary to endocarditis.
July 2016: Journal of Investigative Medicine High Impact Case Reports
Jessica Turner, Tahmina Begum, Roger D Smalligan
INTRODUCTION: Sodium-glucose co-transporter 2 (SGLT-2) inhibitors are relatively new antihyperglycemic agents that lower renal glucose reabsorption. They are used as adjunctive therapy to standard diabetes treatment. CASE REPORT: We present the case of a 62-year-old woman with a past medical history of type 2 diabetes mellitus and sudden-onset diabetic ketoacidosis (DKA). Use of canagliflozin, a SGLT-2 inhibitor, was determined to be the cause of the DKA. The patient ultimately recovered after 5 days in the intensive care unit...
July 2016: Journal of Investigative Medicine High Impact Case Reports
Joey V Louis, Saw Sein, Claudia Lyon, George Apergis
Unexplained rhabdomyolysis after eating fish is a rare condition caused by an unidentified toxin. Most of the incidences in the United States have been linked to consuming buffalo fish or crawfish. We present 2 cases of Haff disease in which the patients consumed grass carp as opposed to the usual suspects of buffalo fish or crawfish.
July 2016: Journal of Investigative Medicine High Impact Case Reports
Melissa Matzumura, Javier Arias-Stella, James E Novak
Erdheim-Chester disease (ECD) is a rare, xanthogranulomatous, non-Langerhans cell histiocytosis with frequent systemic involvement. Although the diagnosis is based on characteristic histological and radiological findings, its identification can be challenging because of its heterogeneous presentation. Osteosclerosis of long bones, often associated with bone pain, is the most common initial manifestation, followed by extraskeletal manifestations in approximately 50% of cases. There is no standard treatment for ECD, although recommendations have been made on the basis of small studies...
July 2016: Journal of Investigative Medicine High Impact Case Reports
Taiwo Ngwa, Jennifer L Peng, Euna Choi, Sucharat Tayarachakul, Suthat Liangpunsakul
Spirochetes, a genetically and morphologically distinct group of bacteria, are thin, spiral-shaped, and highly motile. They are known causes of several human diseases such as syphilis, Lyme disease, relapsing fever, and leptospirosis. We report a case of colonic spirochetosis in a healthy patient presenting for surveillance colonoscopy. The diagnosis of intestinal spirochetosis was made accidentally during the histological examination of colonic polyps, which were removed during colonoscopy. We also performed an extensive review on intestinal spirochetosis with a focus on clinical presentation and outcomes of reported cases from the past two decades...
July 2016: Journal of Investigative Medicine High Impact Case Reports
Makiko Ban-Hoefen, Richard Burack, Lynn Sievert, Deepak Sahasrabudhe
Ipilimumab is a human monoclonal IgG1 antibody against CTLA-4 that has been shown to prolong the overall survival of advanced melanoma. The most common adverse events associated with ipilimumab are immune-related. Severe hematological toxicity is rare. We report a case of severe neutropenia following ipilimumab therapy that fully resolved after the administration of prednisone, cyclosporine, and anti-thymocyte globulin therapies.
July 2016: Journal of Investigative Medicine High Impact Case Reports
Adlai L Pappy, Nelson Oyesiku, Adriana Ioachimescu
We present the first case of iatrogenic hypothyroidism as a result of compounded thyroid hormone (T4/T3) therapy. The thyroid replacement was changed from 175 µg levothyroxine (LT4) to 57/13.5 µg compounded T4/T3 daily in order to improve the T3 level, despite normal thyroid-stimulating hormone (TSH). This resulted in clinical manifestations of hypothyroidism and high TSH level (150 µIU/mL). Six months later, the patient was referred to our clinic for abnormal pituitary magnetic resonance imaging. On reinitiating a physiologic dose of LT4, clinical and biochemical abnormalities resolved and the pituitary gland size decreased...
July 2016: Journal of Investigative Medicine High Impact Case Reports
Joel Cherian, Rahul Singh, Muralidhar Varma, Sudha Vidyasagar, Chiranjay Mukhopadhyay
Pyogenic liver abscesses are rare with an incidence of 0.5% to 0.8% and are mostly due to hepatobiliary causes (40% to 60%). Most are polymicrobial with less than 10% being caused by Staphylococcus aureus. Of these, few are caused by methicillin-resistant Staphylococcus aureus (MRSA) and fewer still by a community-acquired strain. Here we present a case study of a patient with a community-acquired MRSA liver abscess. The patient presented with fever since 1 month and tender hepatomegaly. Blood tests revealed elevated levels of alkaline phosphatase, C-reactive protein, erythrocyte sedimentation rate, and neutrophilic leukocytosis...
July 2016: Journal of Investigative Medicine High Impact Case Reports
Charles J Glueck, Kevin Lee, Marloe Prince, Vybhav Jetty, Parth Shah, Ping Wang
BACKGROUND: When exogenous testosterone or treatments to elevate testosterone (human chorionic gonadotropin [HCG] or Clomid) are prescribed for men who have antecedent thrombophilia, deep venous thrombosis and pulmonary embolism often occur and may recur despite adequate anticoagulation if testosterone therapy is continued. CASE PRESENTATION: A 55-year-old white male was referred to us because of 4 thrombotic events, 3 despite adequate anticoagulation over a 5-year period...
July 2016: Journal of Investigative Medicine High Impact Case Reports
Ragesh Panikkath, Deepa Panikkath, S Sanchez-Iglesias, D Araujo-Vilar, Joaquin Lado-Abeal
A 46-year-old African American woman presented with severe respiratory distress requiring intubation and was diagnosed with nonischemic cardiomyopathy. She had the typical phenotype of familial partial lipodystrophy 2 (FPLD2). Sequence analysis of LMNA gene showed a heterozygous missense mutation at exon 8 (c.1444C>T) causing amino acid change, p.R482W. She later developed severe coronary artery disease requiring multiple percutaneous coronary interventions and coronary artery bypass surgery. She was later diagnosed with diabetes, primary hyperparathyroidism, and euthyroid multinodular goiter...
July 2016: Journal of Investigative Medicine High Impact Case Reports
Nagadarshini Ramagiri-Vinod, Hassan Tahir, Sandhya Narukonda, Medha Joshi
Prosthetic arteriovenous (AV) graft is the second most common vascular access of choice in hemodialysis patients. Rare complications of such grafts are increasingly seen due to rising population of patients on hemodialysis. Infections and thrombosis are the most common complications. Though metallic implants are known to cause hypersensitivity skin reactions, prosthetic AV grafts are rarely known to cause such kind of reactions due to inert nature of materials used in their preparation. We present a case of 54-year-old male who developed contact dermatitis after AV graft creation which was mistreated initially as infection...
July 2016: Journal of Investigative Medicine High Impact Case Reports
Hassan Tahir, Vistasp Daruwalla, Jeremy Meisel, Samir E Kodsi
Pseudoperipheral palsy has been used to characterize isolated monoparesis secondary to stroke. Isolated hand nerve palsy is a rare presentation for acute cerebral stroke. Our patient presented with clinical features of typical peripheral radial nerve palsy and a normal computed tomography scan of the head, which, without a detailed history and neurological examination, could have been easily misdiagnosed as a peripheral nerve lesion deferring further investigation for a stroke. We stress the importance of including cerebral infarction as a critical differential diagnosis in patients presenting with sensory-motor deficit in an isolated peripheral nerve pattern...
July 2016: Journal of Investigative Medicine High Impact Case Reports
Sarah Safadi, Patrick Rendon, Teresa Rutledge, Shadi Mayasy
Ovarian cancer metastasis to the spinal cord is quite rare, and few case reports have been published previously. Herein, we present a case of a patient who was treated for ovarian cancer and was thought to be disease free for 17 months, then presented with lower limb weakness. She was found to have a T11-T12 metastatic intramedullary spinal cord lesion. On pathology, the diagnosis of metastatic ovarian adenocarcinoma was made. This report highlights the importance of maintaining a low threshold for ovarian cancer metastases to the spinal cord when patients present with neurologic sequelae, even in the setting of normal laboratory values, as early detection can prevent permanent neurological consequences...
July 2016: Journal of Investigative Medicine High Impact Case Reports
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