by Manuel De La Cruz Seoane, Ingrid Lopez Rodriguez, Sahar S Abdelmoneim, Madeleidis Lopez Leon, Sandy Espinosa Hernandez, Hamlet Monteagudo, Rishabh Dua and Odalys Frontela
Case Report
It is imperative that internists and hospitalists who are the frontier of care seen by the patient are aware of the red flags associated with Rhabdomyolysis. This case report discusses the clinical evaluation of Exertional Rhabdomyolysis (ER) highlighting the utility of various laboratory tests and clinical hospital course. We here in discusses the clinical evaluation of a 44-year-old male with a sedentary lifestyle who presented with an episode of acute soreness of the proximal muscles, and a near faint in the field in the heat summer month during a basketball game. He reported a prior weightlifting and aerobic running exercise 48 hours before the event. ER was complicated with an acute kidney injury (AKI). The patient’s symptoms improved during hospital admission and labs including creatinine kinase and liver enzymes and kidney function gradually was restored close to reference ranges.
American Journal of Medical Case Reports. 2022, 10(9), 249-252. DOI: 10.12691/ajmcr-10-9-10
Pub. Date: September 27, 2022
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by Muhammad Shabbir Ijaz, Julvet C Mbianda, Mahvish Afza and Mashal Mumtaz
Case Report
Although the incidence of hiatal hernias increases with age, respiratory and cardiac symptoms caused by hiatal hernias remain uncommon. A large hiatal hernia with intrathoracic herniation of abdominal contents can clinically mimic presentation of acute coronary syndrome (ACS), impair physical capacity and possibly increase BNP (B-Type Natriuretic Peptide) levels. We report a rare case of a 78-year-old female who presented with typical cardiac chest pain and was found to have a symptomatic large hiatal hernia.
American Journal of Medical Case Reports. 2022, 10(9), 247-248. DOI: 10.12691/ajmcr-10-9-9
Pub. Date: September 23, 2022
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by Muhammad Shabbir Ijaz, Syed Ali Akhtar Tirmizi, Muhammad Usman Mustafa, Nawal Usman Mustafa, Mahvish Afza and Mashal Mumtaz
Case Report
We present a case of iatrogenic distal coronary artery obstruction secondary to staples recently used to control massive bleeding from cardiac stab wound. Coronary artery occlusion was discovered on elective cardiac catheterization done for anginal chest pains a few weeks after initial cardiac laceration repair surgery. Due to the potential risk of coronary artery rupture with endovascular intervention in this case with metallic staples around the distal coronary artery, conservative management was adopted. This is a case of a rare but clinically important iatrogenic complication.
American Journal of Medical Case Reports. 2022, 10(9), 244-246. DOI: 10.12691/ajmcr-10-9-8
Pub. Date: September 23, 2022
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by Muhammad Shabbir Ijaz and H.K. Reddy
Case Report
Hypertrophic cardiomyopathy (HCM) is a genetic disorder of cardiac myocytes with variable penetrance and heterogenous phenotypic expression leading to different morphologies of left ventricular (LV) hypertrophy which are usually associated with dynamic left ventricular outflow tract (LVOT) obstruction. Up to 2 percent of cases of HCM have a morphology of mid-cavity or mid-ventricular obstruction in which LV cavity is divided into two cavities by apposition of the hypertrophied septum and free wall, and is many times associated with pressure gradients between both cavities usually in the range of 50-70 mmHg but as high as 110 mmHg has been reported (3). We present a case of this rare form of mid-cavity obstruction with an exceptionally high intraventricular pressure gradient of 154 mmHg and apical aneurysm formation.
American Journal of Medical Case Reports. 2022, 10(9), 239-243. DOI: 10.12691/ajmcr-10-9-7
Pub. Date: September 20, 2022
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by Oadi N. Shrateh, Raneen R. Sweity and Rabee S. Adwan
Case Report
Introduction: Mediterranean spotted fever (MSF) is an emerging and zoonotic disease caused by Rickettsia conorii. The main arthropod vector of this bacterium is Rhipicephalus sanguineus, also called “brown dog tick”. We report a 3-month-old infant affected by MSF as the first reported case of the condition in Palestine. Clinical report: in July 2022, a previously healthy 3-month-old child was admitted to the hospital due to fever, diffuse maculopapular rash and a black spot on his leg. Laboratory assessment revealed thrombocytopenia, hypoalbuminemia, and elevated liver enzymes. Polymerase chain reaction (PCR) testing was positive for Rickettsia Conorii and a diagnosis MSF was ascertained. The patient was completely recovered with doxycycline treatment. Conclusion: Mediterranean spotted fever (MSF) is endemic in Africa, India, Europe and Mediterranean countries; including Palestine. In this case study, we affirm the significance of suspecting MSF in patients presenting with fever and rash even in those who stay in their homes apart from environments with high tick-exposure possibility.
American Journal of Medical Case Reports. 2022, 10(9), 235-238. DOI: 10.12691/ajmcr-10-9-6
Pub. Date: September 20, 2022
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by Oadi N. Shrateh, Hashem M. Khdour, Duha Y. Jawaada, Haneen Owienah, Thaer Sweileh, Samer Barahmeh and Ahmad Al-Sarahneh
Case Report
Objective: Cerebral venous sinus thrombosis (CVST) is an uncommon but serious sequalae of severe hyperemesis gravidarum. Pregnancy and puerperium are important risk factors for CVST. Here, we report a case of CVST induced by hyperemesis gravidarum. Case report: A 25-year-old Palestinian woman, gravida 3, para 2 in the first trimester of her pregnancy. The patient was first diagnosed with severe hyperemesis gravidarum due to recurrent episodes of nausea and vomiting. As the condition advanced, the patient had headache and generalized weakness for a one-week duration. Neuroimaging revealed extensive thrombosis in the cerebral sinuses; thereby CVST was diagnosed. The patient was treated with anticoagulant and had a complete recovery. Conclusion: Although rare, it is important to include cerebral venous sinus thrombosis (CVST) in the differential diagnosis of any brain syndrome during all trimesters of pregnancy and puerperium. In this case study, we affirm the significance of suspecting CVST in pregnant women complaining of any neurological syndrome, especially in the setting of severe hyperemesis gravidarum.
American Journal of Medical Case Reports. 2022, 10(9), 230-234. DOI: 10.12691/ajmcr-10-9-5
Pub. Date: September 18, 2022
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by Shizhao Xiang and Yu Du
Case Report
Rhabdomyolysis caused by diquat is relatively rare. We herein report a case of acute diquat poisoning resulting in acute rhabdomyolysis. A 22-year-old female with anuria presented to the emergency department after intentional ingestion of a commercial herbicide containing diquat 100ml three days later. Acute rhabdomyolysis is the earliest manifestation. First-aid measures including gastric lavage, urine alkalinization, hemoperfusion and continuous renal replacement therapy were performed. After 15 days of hospitalization, she got a comprehensive rehabilitation and was discharged. Diquat intoxication should be suspected in patient presenting an acute rhabdomyolysis. The characteristics of diquat intoxication are complex. Diquat should undergo strict management.
American Journal of Medical Case Reports. 2022, 10(9), 227-229. DOI: 10.12691/ajmcr-10-9-4
Pub. Date: September 14, 2022
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by Oadi N. Shrateh, Ali N. Obeidat, Maysam Hamarsheh, Mohand Abulihya and Mashhour Naasan
Case Report
Introduction: Pure large cell neuroendocrine carcinoma (LCNEC) of the endometrium is a rare and inadequately researched gynecologic malignancy with an aggressive course. Our knowledge of pure LCNEC of the endometrium is restricted to case reports. Herein, we describe a very rare case of pure LCNEC of the endometrium. Case presentation: A 70-year-old female presented with post-menopausal uterine bleeding and abdomino-pelvic pain. A sufficient sample endometrial biopsy showed benign endometrial tissue. We performed total abdominal hysterectomy with bilateral salpingo-oophorectomy and the final histopathology and immunohistochemistry established the diagnosis of a pure type of LCNEC of the endometrium (positive for Synaptophysin, CD56, focal Pan-CK, P53, and OCT3/4). Conclusion: A pure LCNEC of the endometrium is extremely uncommon and is often mistaken for a poorly differentiated endometrial carcinoma. Pure LCNEC of the endometrium is a difficult diagnosis to establish. That is why, high clinical suspicion index is required along with performing histological and immunohistochemical testing. Although rare, it is very important to include pure LCNEC of the endometrium in the differential diagnosis of abnormal uterine bleeding and/or abdomino-pelvic pain, especially in the postmenopausal sitting.
American Journal of Medical Case Reports. 2022, 10(9), 224-226. DOI: 10.12691/ajmcr-10-9-3
Pub. Date: September 12, 2022
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by Abou Dargham Hanadi, Brar Rajvir, Dadashzadeh Shima, Hanna Mena and Chong Josebelo
Case Report
The COVID-19 pandemic has been one that has brought widespread suffering and grief throughout the world; and the complications associated-both short and long term have been widespread and autonomous. We present a case of a 68-year-old White Hispanic male who presented to the emergency department with worsening exertional dyspnea and fatigue eight days after testing positive for SARS-CoV-2. On arrival the patient was afebrile, hypotensive, tachycardic, tachypneic and hypoxemic. Initial workup was significant for high elevated inflammatory markers, troponin and β-natriuretic peptide. EKG was unremarkable. Transthoracic echocardiogram revealed severe global hypokinesis of the left ventricle, reduced ejection fraction of 25%-30%, grade II diastolic dysfunction, mild pulmonary hypertension and mild elevated right atrial pressures, and no pericardial effusion. PCR analysis for usual cardiotropic viruses were all negative, Antinuclear antibody (ANA) was negative, therefore the patient was diagnosed with fulminant COVID-19 myocarditis. Patient was treated with heparin drip, oxygen support, pressors, and high dose corticosteroid therapy in the intensive care unit for 5 days. After showing significant signs of improvement, the patient was discharged on hospital stay day 7. Cardio-respiratory complications are the leading cause of morbidity and mortality in terms of patients suffering with COVID-19. In this case we discuss the importance of early diagnosis and prompt management to reduce the high mortality and complications associated with these complications.
American Journal of Medical Case Reports. 2022, 10(9), 218-223. DOI: 10.12691/ajmcr-10-9-2
Pub. Date: September 12, 2022
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by Reece Vesperman, Shalinee Wayland, Shemar Crawford and Corinne Jackson
Original Research
Kratom (Mitragyna speciosa Korth), an indigenous herb of Southeast Asia, is popularly used to treat withdrawal symptoms associated with opiate addiction and a myriad of ailments including chronic pain, anxiety and hypertension. Its use has significantly increased in western countries because of its widespread advertisement on the internet as a safe, nonaddictive alternative treatment of pain and opioid dependent disorders. This report describes the first emergency case of toxic encephalopathy, rhabdomyolysis, and liver injury in relation to kratom withdrawal syndrome induced by naltrexone in a 49-year old male. The symptoms were resolved with a regimen of dexmedetomidine, lorazepam, oral lactulose, and a bicarbonate drip. Outpatient treatment with lorazepam and tramadol was recommended for further withdrawal symptoms.
American Journal of Medical Case Reports. 2022, 10(9), 214-217. DOI: 10.12691/ajmcr-10-9-1
Pub. Date: September 05, 2022
4009 Views3 Downloads