by Prince Adu Amoako and Eugene V Vivitsky
Case Report
Background: Anterior Mediastinal tumors include but not limited to thymomas, terrible lymphomas, thyroid tumors, malignant germ cell tumors and teratomas. Anterior mediastinal lipomas remain exceedingly rare benign tumors and account for less than 2-5% of all lung tumor cases. These tumors can mimic malignant lung tumors and can present with but not limited to chest pain upon coughing, chronic shortness of breath, fever, night sweats and hoarseness, while some patients do not get any symptoms at all. Case Presentation: We present a 54-year-old Caucasian female who came in with concerns of an anterior mediastinal mass that was found on a routine lung cancer screening imaging that was ordered due to her long-standing history of tobacco smoking. CT (Computed Tomography) imaging done during that time confirmed the anterior mediastinal mass. The mass was also visualized and appreciated on a follow up PET (Positron Emission Tomography) scan and showed no signs of metastasis. Upon presentation months later, a left video assisted thoracoscopic surgery was done to visualize the mass and to retrieve a sample of the mass for biopsy. The specimen demonstrated segments of benign adipose tissue with patchy stromal hemorrhage and small portions of incorporated brown fat was seen, confirming the diagnosis of a left anterior mediastinal lipoma. Conclusion: Anterior mediastinal lipomas are exceedingly rare and only a few cases have been reported in the United States according to the American Cancer Society. The etiology of this rare condition remains unclear. These masses can resemble malignant lung neoplasms in presentation and on imaging. A minimally invasive video assisted thoracoscopic surgery can be done to retrieve a sample of the mass for biopsy to confirm the diagnosis. Surgical interventions like resection can be curative. Small size lipomas do not usually require surgical interventions until the mass size becomes appreciable.
American Journal of Medical Case Reports. 2022, 10(5), 163-166. DOI: 10.12691/ajmcr-10-5-11
Pub. Date: May 27, 2022
2301 Views4 Downloads
by Shujaa Faryad, Habiba Hussain, Mawwra Faryad and Subramanyam Chittivelu
Case Report
Cutaneous blastomycosis is the second most common presentation of Blastomyces Dermatitidis infection. Commonly, skin involvement results from hematogenous spread of infection from a distant site but direct skin involvement can also occur from trauma and animal scratch or bite resulting in cutaneous inoculation blastomycosis. Clinical features of cutaneous blastomycosis are nonspecific and overlap with other fungal and bacterial infections and skin malignancies. A high degree of suspicion is required for diagnosis while evaluating a patient with recurrent skin lesions not responding to antibiotics. In these cases, fungal cultures and histology are of paramount importance for prompt diagnosis and treatment. We present a case of primary cutaneous blastomycosis with secondary lung involvement.
American Journal of Medical Case Reports. 2022, 10(5), 160-162. DOI: 10.12691/ajmcr-10-5-10
Pub. Date: May 27, 2022
2012 Views7 Downloads
by Ahmet Serhan Dagistanli and Mustafa Erelel
Original Research
It is known that tuberculosis (TB) can mimic many clinical conditions and differential diagnosis can be difficult. Pulmonary TB may present with infiltration in the lung parenchyma with or without mediastinal lymphadenopathy. Pulmonary tuberculosis cases with the appearance of a mass in the lung are available in the literature. It may be difficult to exclude lung malignancy and to prove the diagnosis of tuberculosis in these patients. In this case, a case who applied to our outpatient clinic for routine control and had a mass appearance on thorax computed tomography (CT) is discussed. We think that our case, which was thought to have lung cancer with imaging findings, is important in terms of drawing attention to non-Covid pathologies that may be overlooked during the pandemic period.
American Journal of Medical Case Reports. 2022, 10(5), 157-159. DOI: 10.12691/ajmcr-10-5-9
Pub. Date: May 26, 2022
1541 Views6 Downloads
by Oadi N. Shrateh, Zainab Omarion, Iyas Tanib, Samir Adwan and Mashhour Naasan
Case Report
Uterine arteriovenous malformation (UAVM) is an infrequent vascular condition although it can be fatal and threaten the patient’s life. UAVM can be categorized as congenital or acquired. The majority of cases usually present with heavy intractable abnormal uterine bleeding in the childbearing age and/or recurrent miscarriages that’s why the diagnosis of UAVM requires a high index of clinical suspicion. The exact incidence of UAVM remains to be elucidated but recent years have seen an increase in reported cases particularly after pregnancy, miscarriage and uterine surgical procedures such as Dilation and curettage (D&C). The Initial assessment of UAVM usually begins with transvaginal ultrasound (TUS) whereas angiography remains the modality of choice to confirm the diagnosis. Despite several medical agents have been employed in the treatment of the condition, In the past years, Embolization has become widely used as a first option in the management of UAVM because of its highly satisfying outcomes and more importantly avoidance of invasive procedures use with subsequent complications, especially hysterectomy which is reserved as a last resort. We herein report a young female with a confirmed congenital UAVM managed successfully via bilateral embolization of the uterine artery without the need for hysterectomy.
American Journal of Medical Case Reports. 2022, 10(5), 153-156. DOI: 10.12691/ajmcr-10-5-8
Pub. Date: May 23, 2022
1792 Views7 Downloads
by Massimo Arcerito, Boris V Shlopov, Rafael Canseco and Thomas H Takei
Case Report
Splenic masses represent a clinical challenge when encountered by health care providers. These lesions must be excised completely and assessed histologically to differentiate benign and malignant diseases. Biopsy mass bleeding and false negative results are common. We report a 59 year old woman with no previous cancer history, with an incidental splenic mass found by abdominal ultrasound for left abdominal pain. Computer tomography scan and magnetic resonance imaging identified a solid nodular splenic lesion lacking definitive criteria for benign or malignant disease. Furthermore, liver/spleen scan ruled out hemangioma. After discussing the patient at tumor board, a robotic splenectomy was performed. The patient was discharged home 20 hours postoperatively. Sclerosing Angiomatoid Nodular Transformation (SANT) was confirmed by histology and immunohistochemistry. Imaging modalities are not helpful to clinch the diagnosis, leaving minimally invasive splenectomy and pathology to treat and assess this very rare splenic disease.
American Journal of Medical Case Reports. 2022, 10(5), 146-152. DOI: 10.12691/ajmcr-10-5-7
Pub. Date: May 23, 2022
2311 Views3 Downloads
by Rama Koneru, Jahnavi Mundluru and Abdul Subhan
Case Report
Melanoma is the third most prevalent skin cancer with the highest mortality rate amongst skin cancers. Recent therapeutic developments have improved its treatment options, however significant toxicity can be a limiting factor. In this report, we describe a case of a rare, delayed hypersensitivity-like reaction after treatment with dabrafenib-trametinib as a second line therapy in a metastatic melanoma patient treated with pembrolizumab initially. A 62-year-old Caucasian male presented with a left axillary mass, which was found to be BRAF V600E positive malignant melanoma upon biopsy. He proceeded to have full axillary node dissection and was scheduled to receive adjuvant immunotherapy with pembrolizumab. However, the treatment was delayed by 3 weeks due to COVID-19. The patient developed subcutaneous metastases within that time. Although he was started on pembrolizumab, the metastases continued to progress. The patient then opted to begin dabrafenib-trametinib and was started on full dose therapy. After two weeks, there was significant reduction of metastases clinically. Two days after the follow-up, he presented to the emergency room with diffuse non-pruritic hives all over the body without any symptoms of angioedema. In addition, there was a sudden increase in size of the subcutaneous metastases. He was treated with 50 mg Benadryl and 50 mg prednisone with almost immediate resolution and discharged on prednisone. Dabrafenib-trametinib was temporarily discontinued. Due to the limited treatment options, the patient was carefully restarted on his dabrafenib-trametinib regimen with slow prednisone tapering. Patient has had an excellent response with complete resolution of his disease with no measurable lesions found on the latest CT scan. After a thorough literature search of OVID Medline + EMBASE, it was concluded that this is a rare presentation and only a few similar cases have been reported. Therefore, health care provider education and strategies for reintroduction of immunotherapy, as presented through a prednisone regimen in this case, is imperative for proper management of adverse events.
American Journal of Medical Case Reports. 2022, 10(5), 140-145. DOI: 10.12691/ajmcr-10-5-6
Pub. Date: May 22, 2022
1732 Views3 Downloads
by Serrano Gomez Yaritza, Zonouzi-Zadeh Farideh and Guevara Sara
Case Report
Mesenteric panniculitis is a rare, benign, and chronic fibrosing inflammatory disease affecting the adipose tissue of the mesentery that can lead to intractable abdominal pain. We report a case of a 74-year-old male with multiple autoimmune disorders, including paroxysmal nocturnal hemoglobinuria (PNH) and hypothyroidism, that presented to the emergency department with abdominal pain for over three weeks. Abdominal CT showed diffuse stranding of the mesenteric fat compatible with mesenteric panniculitis. The patient received treatment with steroids, which led to resolution of his abdominal pain.
American Journal of Medical Case Reports. 2022, 10(5), 138-139. DOI: 10.12691/ajmcr-10-5-5
Pub. Date: May 19, 2022
1649 Views3 Downloads
by Khurshid A Mattoo, Iti Gupta, Areej Darraj and Muneera Gohal RA
Case Study
Child neglect is the outcome of poor parenting practices, which can be readily identified by the child’s dental status. Unhealthy eating practices by parents during one’s childhood has been found to be continued by the child when he attains adulthood. Self-regulation and self-care skills in adults, develop proficiencies when guided properly during childhood. Dental caries progression is slow and may not cause any warnings, unless damage is irreparable. We present three cases of adult patients who revealed three different themes of dental neglect during their childhood, namely dental care being sought only in case of emergency, multiple missing appointments after initiating dental care and patient presenting with the extensive untreated dental disease. All three cases, were comprehensively treated with full mouth rehabilitation using a multidisciplinary approach. While, the parental neglect may apply till an individual gains adulthood, what influences one to continue same behavior amounts to self-neglect. The relation between the two is unexplored. All patients received intensive dental rehabilitation that took months of planning. All patients were indifferent towards follow up and continued to disregard the protocol.
American Journal of Medical Case Reports. 2022, 10(5), 131-137. DOI: 10.12691/ajmcr-10-5-4
Pub. Date: May 12, 2022
1878 Views7 Downloads
by Shruti Jesani, Chidinma Ejikeme, Sherif El Kattawy and Jesus Romero
Case Report
Marijuana is one of the most commonly used psychotropic drugs in the United States. Recent legalization of cannabis and decriminalization in multiple jurisdictions in the United States has contributed to its increased availability and social acceptance, especially in young adults. The overall prevalence of cardiovascular disease in young adults has been increasing as a consequence of marijuana use. However, there remains a paucity of knowledge on its adverse effects, especially with regards to the cardiovascular system. Here, we present a case of a young adult with a history of marijuana use and minimal cardiovascular risk factors who presents following a seizure episode and was found to have coronary artery thrombosis. A high degree of suspicion, along with a better understanding of the biochemical pathways involved in cannabis associated myocardial ischemia is extremely important to treat this condition promptly and prevent fatal outcomes. After the legalization of cannabis in various states in the United States, there is an increasing need to understand and educate the public regarding health hazards, especially on the cardiovascular system.
American Journal of Medical Case Reports. 2022, 10(5), 128-130. DOI: 10.12691/ajmcr-10-5-3
Pub. Date: May 05, 2022
1710 Views2 Downloads
by Elli Novatcheva, Simranjit Randhawa, Aaron Safarian, Rocky Li, Chukwuemeka Umeh, Ryan Basak, Pranav Barve, Sumanta Chaudhuri and Sabina Kumar
Original Research
COVID-19 is primarily a pulmonary disease characterized by both pulmonary and extrapulmonary complications. While acute respiratory distress syndrome (ARDS) is the most common pulmonary complication, acute kidney injury is the most common extrapulmonary complication of acute COVID-19. In addition, COVID-19 is associated with a cytokine storm capable of stimulating an autoimmune disorder. Here we present an unusual case of P-ANCA associated vasculitis and diffuse, pauci-immune rapidly progressive glomerulonephritis in a 24-year-old COVID-19 patient, resulting in an (AKI) requiring hemodialysis. The patient improved clinically after starting hydrocortisone and rituximab. She was, however, still dependent on hemodialysis at the time of hospital discharge.
American Journal of Medical Case Reports. 2022, 10(5), 122-127. DOI: 10.12691/ajmcr-10-5-2
Pub. Date: May 05, 2022
1853 Views10 Downloads
by Sabina Kumar, Chukwuemeka Umeh, Prithi Choday, John Carvalho, Sobiga Ranchithan, Sumanta Chaudhuri and Pranav Barve
Case Report
Thrombotic microangiopathies (TMAs) are clinical conditions classified by a combination of low platelets causing microthrombi, which can ultimately lead to hemolytic anemia. The most common conditions include thrombotic thrombocytopenic purpura (TTP) and hemolytic uremic syndrome (HUS). In this case report, we focused on a rare subtype of HUS. A 25-year old female presented to our tertiary care facility from a community hospital with nausea, vomiting, and bloody diarrhea after consuming mussels. A presumptive diagnosis of TTP was given and unfortunately treatment efforts did not improve the patient’s status. Investigative laboratory studies showed leukocytosis, thrombocytopenia, presence of schistocytes on peripheral smear, and no evidence of hemoglobinuria. The patient had negative Shiga toxin and E.coli 0157 and imaging showed diffuse colitis. Despite antibiotics, dialysis and plasmapheresis efforts, the patient’s condition worsened and she developed severe sepsis and was then intubated. At that point, an atypical HUS genetic test result demonstrated a heterozygous missense variant, and she was emergently started on eculizumab and steroids which improved her condition. This case illustrates an atypical presentation for thrombotic microangiopathy, complicated by significant multiorgan dysfunction.
American Journal of Medical Case Reports. 2022, 10(5), 117-121. DOI: 10.12691/ajmcr-10-5-1
Pub. Date: May 05, 2022
2009 Views18 Downloads