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Volume 10, Issue 3

Primary Central Nervous System ALK-Negative Anaplastic Large Cell Lymphoma: A Case Report and Literature Review
Original Research
Primary central nervous system (CNS) lymphoma represents approximately 4% of CNS tumors, among which majority are originated from B-cells and only 2% from T-cells. Anaplastic large cell lymphoma (ALCL), a subtype of T-cell lymphoma, is classified into anaplastic lymphoma kinase (ALK)-positive and -negative subtypes. While the former accounts for 70-80% of cases, ALK-negative ALCL represents only a minority of cases. Here we present a case of primary CNS ALK-negative ALCL in a 73-year-old black male. He initially presented with significant fatigue and was treated for malaria with minimal improvement. He was subsequently found to have leukocytosis and developed left-sided weakness and facial droop. MRI showed a large temporoparietal intra-axial mass with vasogenic edema and mass effect. Initial brain biopsy was non-diagnostic. He was placed on steroids and pursued further workup in our institution. Upon tapering steroid, he developed left leg weakness. Repeat MRI revealed multiple intracranial lesions with one showing progression after steroid tapering. Repeat biopsy was performed and a diagnosis of primary CNS ALK-negative ALCL was rendered 47 days after the initial nondiagnostic biopsy. Literature review showed 39 reported cases of primary CNS ALCL, among which only 11 cases were ALK-negative. We present this case to demonstrate; a. the non- specific clinical presentation poses a diagnostic challenge. b. multiple intracranial lesions, along with waxing and waning clinical course with steroid administration, could be a sign of CNS lymphoma and c. biopsy prior to start of steroids is preferred for diagnosis.
American Journal of Medical Case Reports. 2022, 10(3), 77-83. DOI: 10.12691/ajmcr-10-3-9
Pub. Date: March 29, 2022
2047 Views4 Downloads
Patient with Systemic Lupus Erythematosus who Presented with Area Postrema Syndrome after COVID-19 Vaccination
Case Report
Area postrema syndrome is a disorder that is included within the neuromyelitis optica spectrum (NMOSD), a group of severe inflammatory disorders of the central nervous system that primarily affect the optic nerve and spinal cord. The cause of NMOSD is unknown, but it has been linked to infections, vaccines and associated with autoimmune diseases. We present the case of a patient with a history of systemic lupus erythematosus who presented with area postrema syndrome after vaccination with COVID-19.
American Journal of Medical Case Reports. 2022, 10(3), 72-76. DOI: 10.12691/ajmcr-10-3-8
Pub. Date: March 20, 2022
1767 Views3 Downloads
Combination of Ultrasound-Guided Serratus Anterior Plane Block and Rectus Sheath Block Provide Analgesia for Open Hepatectomy: A Report on 3 Cases
Case Report
Perioperative analgesia in open hepatectomy is challenging because a large subcostal arc incision is often required. Extensive dissection of muscles and nerves is associated with severe intraoperative hemodynamic fluctuations and postoperative pain. Serratus anterior plane block (SAPB) and rectus sheath block (RSB) are commonly used for anesthesia and postoperative analgesia in patients undergoing chest wall surgery and abdominal surgery, respectively. In this case-series report, we present our experience with three patients in whom open hepatectomy and early extubation were performed successfully under a combination of ultrasound-Guided SAPB and RSB. Three patients were scheduled for open hepatectomy, all of them were diagnosed with severe hepatitis B cirrhosis. After due deliberation and with the consent of patients and their family, ultrasound-guided right SAPB and bilateral RSB were performed with the patient in the supine position. A total of 0.7mL/kg of 0.25% ropivacaine was used for nerve block. Sensory loss to pinprick from T5 to T10 was achieved in all three patients 20 min after administration of blocks. The operation went smoothly for all the patients. All three patients experienced quiet recovery and early extubation, and none of them complained of discomfort in the surgical site in the first 12 h after surgery. Here we present three cases of a combination of ultrasound-guided SAPB and RSB that may be an attractive option for anesthetic management of open hepatectomy in clinical practice.
American Journal of Medical Case Reports. 2022, 10(3), 68-71. DOI: 10.12691/ajmcr-10-3-7
Pub. Date: March 17, 2022
1813 Views3 Downloads
A Case of Pediatric Myocarditis that was Initially Misdiagnosed as Cerebral Concussion
Case Report
A seven-year-old girl suddenly fell and became unconscious in her house. Her mother, who witnessed the fall called an ambulance. While waiting for the ambulance, she experienced generalized convulsions. The emergency medical technicians reported to the hospital that the patient had experienced cerebral concussion and immediate post-traumatic seizure. During transportation, she experienced generalized convulsions again. Electrocardiography (ECG) showed complete atrioventricular block without QRS complex during the generalized convulsions. On arrival, she regained consciousness. ECG revealed sinus tachycardia with left axis deviation and negative T wave at the I, aVL, V1-V3 leads. Cardiac echo showed good wall motion with a highly echoic epicardium. Head computed tomography revealed no specific findings. The main blood test results were increased cardiac enzyme and inflammatory reaction. The diagnosis was myocarditis and fatal arrhythmia followed by generalized convulsions and/or syncope, not cerebral concussion. She was transported to a children’s hospital for advanced medical care. Her post-admission course was uneventful. Adenovirus was the causative virus of myocarditis. The present case suggests that the heart should be evaluated in addition to the brain when children experience a prolonged period of unconsciousness after a fall.
American Journal of Medical Case Reports. 2022, 10(3), 64-67. DOI: 10.12691/ajmcr-10-3-6
Pub. Date: March 15, 2022
1912 Views4 Downloads
Base Metal Denture Bases - Clinical indications
Case Study
It has been more than eight decades since the introduction of polymethylmethacrylate (PMMA) in prosthetic dentistry. Despite so many advances in material science, the use of PMMA is unabated. Its ability to be molded into desired shape and biocompatibility, are significant for its success. Certain clinical conditions do however contraindicate its uses in prosthesis, and pave way for base metal alloy denture bases. These conditions are so common, yet they are missed clinically by even most astute clinicians. This case series in the form of multiple case reports provides the reader a glance into the clinical indications for metal denture bases in complete denture prosthodontics. Each case has been explained on the basis of its particular indication. The advantages and disadvantages of metal denture bases in such situations has been discussed. A case of menopause, sorption related denture changes, need for improving oral stereognostic ability and cases where poor adaptation of denture base acrylic is inevitable are key description of this article.
American Journal of Medical Case Reports. 2022, 10(3), 59-63. DOI: 10.12691/ajmcr-10-3-5
Pub. Date: March 15, 2022
3435 Views32 Downloads
Corona Lungs and Strawberry Tongues
Case Report
Multisystem inflammatory syndrome in children (MIS-C) is one of several severe complications of COVID-19 seen in children. The United States Center for Disease Control diagnostic guidelines for MIS-C include age <21 years, 24-hour history of fever ≥38.0ºC, severe illness necessitating hospitalization, two or more organ system involvement, laboratory evidence of inflammation, laboratory or epidemiologic evidence of SARS-CoV-2, and a lack of alternative diagnosis. This case report focuses on one patient who met six out of the seven cardinal features of MIS-C but fell outside the average age range. Unfortunately, the patient died from complications of COVID-19. Since our patient had multiple risk factors, including obesity and Hispanic ethnicity the pathogenesis of the disease occurring in our patient was likely identical to that which occurs in MIS-C. Due to a significant chance of mortality in patients with MIS-C and COVID-19, it is important to consider this diagnosis in older adolescents and young adults. This patient’s unfortunate outcome urges prompt greater suspicion for this rare and life-threatening complication, even though this patient is older than the typical MIS-C patient.
American Journal of Medical Case Reports. 2022, 10(3), 56-58. DOI: 10.12691/ajmcr-10-3-4
Pub. Date: March 11, 2022
1982 Views3 Downloads
Pregnant Patient with Severe COVID-19 Pneumonia Treated by Intensive Immune Suppression Therapy during the Omicron (B.1.1.529) Variant Outbreak: A Successfully Treated Case
Case Report
A 35-year-old pregnant woman (gestational age, 35 weeks) developed general fatigue, headache, and joint pain following the onset fever, cough, and nasal discharge after the outbreak of the Omicron variant in Japan. The patient had obesity (body mass index, 41), depression and gestational diabetes mellitus, which was treated with insulin. On the 8th day after the onset of initial flu-like symptoms, she was admitted to our hospital because polymerase chain reaction for COVID-19 became positive. Initially, her vital signs were stable without any oxygen demand. On day 11, she required oxygen therapy (4 L/min). Chest computed tomography (CT) showed multiple bilateral centrilobular patch consolidations with several subpleural lesions. As she had multiple risk factors for acute respiratory distress syndrome (ARDS), she underwent emergency cesarean section and immune modulation therapy was initiated. After the operation, her oxygenation deteriorated and she underwent tracheal intubation and mechanical ventilation on day 13. After multimodal therapy, her lung function improved and she was extubated on day 16. After rehabilitation and baby care training, she was discharged on day 27 without sequelae. This is the case of a pregnant woman with severe COVID-19 pneumonia who was successfully treated by emergency cesarean section, intensive immune suppression therapy and mechanical ventilation during the Omicron variant outbreak in Japan. The present case suggests that even pregnant women should receive COVID-19 vaccination to avoid the onset of ARDS, a potentially fatal condition.
American Journal of Medical Case Reports. 2022, 10(3), 51-55. DOI: 10.12691/ajmcr-10-3-3
Pub. Date: March 11, 2022
1838 Views2 Downloads
Type II Decompression Illness after Diving Seven Meters
Case Report
A 30-year-old man went occupational diving 2 times. The first was a 20-min dive at a depth of 3.3 m, and the second was a 10-min dive at a depth of 7.7 m. During the second dive, he felt chest pain and suddenly surfaced. After reaching the surface, he felt dyspnea and headache. He also felt dysesthesia in every extremity during transportation. Upon arrival, he was in hypertensive bradycardia state. A physical study demonstrated no remarkable findings except for his complaints. His electrocardiogram, chest roentgen, whole-body computed tomography, and blood test findings were negative. He was diagnosed with decompression illness (DCI) and transported to another hospital for hyperbaric oxygen therapy. During his transfer, he showed quadriparesis, which was compatible with decompression sickness type II. He was treated as outlined in United States Navy Treatment Table 6. He ultimately obtained a complete recovery and was reinstated. We reported a concrete case of DCI after a shallow dive. DCI should be strongly considered when divers report feeling unwell after diving.
American Journal of Medical Case Reports. 2022, 10(3), 48-50. DOI: 10.12691/ajmcr-10-3-2
Pub. Date: March 01, 2022
1855 Views2 Downloads
Pauci-immune Crescentic Glomerulonephritis: Case Report
Case Report
Pauci-immune glomerulonephritis ( PIGN) is a potentially life-threatening condition that progresses rapidly to renal failure within days or weeks. Here we present a 62 -year-old African American female who was found to have acute kidney injury at the time of presentation. Further workup including renal biopsy showed anti-neutrophilic cytoplasmic antibodies (ANCA) associated pauci-immune crescentic glomerulonephritis. The patient was started on steroids and cyclophosphamide however, the patient’s kidney function continued to get worse and required hemodialysis. Unfortunately, our patient passed away after two months of diagnosis secondary to cardiac arrest.
American Journal of Medical Case Reports. 2022, 10(3), 45-47. DOI: 10.12691/ajmcr-10-3-1
Pub. Date: March 01, 2022
1929 Views4 Downloads