by Sheikhan Al Hashmi, Amina Al-Yaqoobi, Hunaina Alkindi, Mina George and Zahra Alabri
Case Report
Cutaneous Atypical fibroxanthoma (AFX) typically occurs on the head and neck of sun-damaged areas in older Caucasians & it's a diagnosis by exclusion of other malignant neoplasms with similar histopathology or morphology. In this case report and literature review, we report a much less common presentation as the first case to our knowledge of AFX on a teenage female with darker skin, this lesion on the dominant hand that needed re-excision in order to get a clear margin. A high index of suspicion of this less common type in a younger patient presenting with a cutaneous nodule is to be kept in mind to minimize the number of excisions and increase patient's satisfaction.
American Journal of Medical Case Reports. 2022, 10(8), 210-213. DOI: 10.12691/ajmcr-10-8-9
Pub. Date: August 23, 2022
1619 Views2 Downloads
by Yaqub Nadeem Mohammed, Folake Ishola and Geetha Krishnamoorthy
Case Report
Diffuse Large B Cell Lymphoma (DLBCL) is the most frequently occurring type of Non-Hodgkin Lymphoma (NHL). Primary extra nodal Diffuse Large B Cell Lymphoma (PE-DLBCL) originating in the bone, specifically the thoracic spine, is rare. We describe the case of a 69-year-old male who presented to our facility with back pain and acute bilateral lower extremity paraplegia as Primary extra nodal Diffuse Large B Cell Lymphoma.
American Journal of Medical Case Reports. 2022, 10(8), 207-209. DOI: 10.12691/ajmcr-10-8-8
Pub. Date: August 21, 2022
1433 Views6 Downloads
by Eti Muharremi, Artur Xhumari, Pavllo Djamandi and Jera Kruja
Case Report
Nocardial brain abscesses are a rare cause of cerebral abscesses that usually arise in immunocompromised patients and are associated with high morbidity and mortality. We present the case of a 57-year old male who presented with fever, progressive vision loss and disorientation in the emergency room while on treatment for community acquired pneumonia. He has been using steroids for 20 years and has uncontrolled diabetes mellitus, and secondary adrenal insufficiency as a result. Chest computed tomography (CT) showed consolidation in left posterior-inferior lobe. Blood and cerebrospinal fluid (CSF) cultures were negative. Magnetic resonance imaging (MRI) of the head revealed multiple small dispersed lesions with peripheral ring enhancement after contrast administration, concerning for abscesses. Pus was sampled from a superficial occipital abscess and content grew Nocardia sensitive to trimethoprim/sulfamethoxazole (TMP/SMX) and imipenem so the patient was switched to targeted therapy. The following days he developed new motor deficits and became unresponsive to verbal stimulus. Another MRI revealed enlargement of the existing lesions and new lesions with signal restriction on diffusion (DWI) in the levels of the midbrain and pons. The patient developed respiratory insufficiency and passed away regarding of ongoing supportive treatment.
American Journal of Medical Case Reports. 2022, 10(8), 202-206. DOI: 10.12691/ajmcr-10-8-7
Pub. Date: August 14, 2022
by Christian Hailey Summa, Scarlett Somarriba, Laura Ziton and Michelle Demory Beckler
Original Research
Steven-Johnson Syndrome is a rare adverse skin reaction, which may progress to critical conditions. The presentation of SJS is a widespread, type-IV hypersensitivity, skin reaction typically induced by infection and numerous medications which occurs approximately 12 hours after exposure to infection or medication. Patients typically initially present with fever, headache, and general malaise. In these patients, within 4 days to 4 weeks [1] of causative medication usage, a diffuse rash develops. Severe cases of SJS can place the patient in critical condition. Complications of SJS can include bacterial infection, excessive fluid loss from denuded skin (or loss of epidermis), hypovolemic shock, or septic shock. [1] Prompt diagnosis and immediate discontinuation of medication is essential to prevent life threatening complications. Herein, we document a case of a patient presenting to the Emergency Department (ED) three days prior to follow up in our office with bilateral leg rash for which the ED prescribed hydrocortisone cream. Upon examination in office, the erythematous eruption had spread to the entire body including her palms. She had started the herbal supplement berberine a month prior to the initial presentation of the rash. Upon cessation of the berberine and completion of a Medrol dose pack, the rash resolved.
American Journal of Medical Case Reports. 2022, 10(8), 199-201. DOI: 10.12691/ajmcr-10-8-6
Pub. Date: August 14, 2022
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by Ilse Novis, Hailey Novis, Ingie Sorour and Khaled Sorour
Case Report
A patient receiving Norepinephrine infusion through a peripheral IV experienced vasopressor extravasation. Due to an unavailability of phentolamine in the hospital, it was decided to attempt a new method of extravasation treatment through intraarterial injection of nitroprusside, restoring blood flow to the affected area. To mitigate the recurrence of vasospasms given the short half-life of nitroprusside, ropivacaine was injected. This regime successfully alleviated the extravasation-induced vasospasm and the patient recovered full function.
American Journal of Medical Case Reports. 2022, 10(8), 197-198. DOI: 10.12691/ajmcr-10-8-5
Pub. Date: August 09, 2022
1373 Views2 Downloads
by Anphong Nguyen, Chukwuemeka A. Umeh and Jose Penaherrera
Case Report
We present a case of an elderly female patient presenting with symptoms strongly suggestive of Myasthenia Gravis (MG), but later serological workup was shown to be more consistent with Lambert Eaton Myasthenic Syndrome (LEMS). On presentation, the patient had both profound ptosis and generalized weakness of the upper and lower extremities that were suspected clinically to be due to MG. The case was further complicated by the administration of several medications, which were believed to have unmasked her disease. Diagnostic imaging to assess for thymoma and lung cancer was negative. Screening with the ice-pack test was positive; however, serology for MG was negative. This case illustrates the importance of keeping the differential of LEMS in view in every suspected MG case, even if there is a low suspicion of LEMS initially. In addition, it demonstrates the possibility that the "ice-pack test" can also be positive in LEMS, and MG-unmasking medications may also unmask LEMS, an association that has not been described in our literature review.
American Journal of Medical Case Reports. 2022, 10(8), 194-196. DOI: 10.12691/ajmcr-10-8-4
Pub. Date: August 08, 2022
by Nasrin Mansouri, Babak Izadi and Mazaher Ramezani
Case Report
Primary lymphoma of the female genital tract, including the uterine cervix, is rare. The clinical picture is nonspecific, which complicates the timely diagnosis. Treatment and prognosis are considerably different in the long list of differential diagnoses, including other malignancies and inflammatory processes. Sometimes multiple biopsies and immunohistochemistry are needed for a definite diagnosis. Here we report a 34-year-old female with a mass on the uterine cervix and the final diagnosis of Diffuse Large B-Cell Lymphoma, Non-Germinal Center Type. The pathologist and clinician must be aware of this entity in daily practice, for appropriate diagnosis and treatment.
American Journal of Medical Case Reports. 2022, 10(8), 190-193. DOI: 10.12691/ajmcr-10-8-3
Pub. Date: August 08, 2022
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by Folake Ishola, Yaqub Nadeem Mohammed and Geetha Krishnamoorthy
Case Report
Median Arcuate Ligament Syndrome (MALS) is due to compression of the celiac axis by a fibrous arc shaped band of tissue connecting the right and left diaphragmatic crus. It is characterized by postprandial abdominal pain, weight loss, and intermittent abdominal bruit. Due to lack of specificity in clinical presentation, MALS is typically a diagnosis of exclusion and is low on the differential diagnosis for chronic abdominal pain. Here, we present a case of MALS in a young female.
American Journal of Medical Case Reports. 2022, 10(8), 188-189. DOI: 10.12691/ajmcr-10-8-2
Pub. Date: August 08, 2022
1479 Views2 Downloads
by Si Yuan Khor, Bo Ren Zhang, Sara AlAttal, Amira Kamboj and Richa Tikaria
Case Report
A 78-year-old female presented with chief complaints of nausea and vomiting for three days associated with generalized weakness and altered mental status. On examination, she was tachycardic and tachypneic with suprapubic distension and generalized tenderness with guarding. Urinalysis revealed urinary tract infection picture. Initial blood work showed leukocytosis, hyperkalemia, lactic acidosis, and acute kidney injury. CT Abdomen without contrast showed marked fluids surrounding the left kidney, bilateral hydronephrosis, and distended urinary bladder. She was treated with intravenous antibiotics and fluids for urosepsis secondary to complicated urinary tract infection with acute kidney injury due to obstructive uropathy. Follow-up renal ultrasound later revealed resolution of left perinephric fluids 3 days after alleviation of obstructive uropathy, thus suggesting a likely diagnosis of spontaneous left renal calyceal rupture.
American Journal of Medical Case Reports. 2022, 10(8), 185-187. DOI: 10.12691/ajmcr-10-8-1
Pub. Date: August 08, 2022
1522 Views4 Downloads