by Youichi Yanagawa, Ken-ichi Muramatsu, Yoichiro Maekawa, Soichiro Ota and Ikuto Takeuchi
Original Research
An 81-year-old man was found unconscious in a bathtub by his wife after having taken a long bath. He was rescued by his wife and son, and they dressed him while calling for an ambulance. On arrival, he was in a shock state with convulsion. After exposing him, he was found to have multiple macular skin rashes with eschar with a red halo on his lower right abdomen. He was treated with anticonvulsant and massive infusion. He had had right lower abdominal skin lesions for more than two weeks, general fatigue and skin rash for one week, and a fever for four days before the arrival. A biochemical analysis of his blood on arrival indicated inflammation, hepatic, renal disturbance, and coagulopathy. As he had the triad of tick-mediated infectious diseases, he received minocycline. His general condition improved, and he regained his consciousness on day 6. On day 9, we obtained positive results for scrub typhus. Finally, he was discharged home. Physicians should perform a full body skin examination of patients with a coma or fever in order not to miss fatal diseases.
American Journal of Medical Case Reports. 2023, 11(1), 10-13. DOI: 10.12691/ajmcr-11-1-3
Pub. Date: January 12, 2023
by Kei Jitsuiki, Ken-ichi Muramatsu, Atsuhiko Mogami, Akira Itoi and Youichi Yanagawa
Case Report
Unstable pelvic fracture is related to high-energy trauma and serious trauma that threatens the patient’s life and functional prognosis. Complete traumatic fracture-dislocation of the lumbar spine is a rare spinal injury often leading to death. We herein report a very rare case of unstable pelvic fracture with complete lumbar dislocation fracture that achieved a survival outcome.
American Journal of Medical Case Reports. 2023, 11(1), 6-9. DOI: 10.12691/ajmcr-11-1-2
Pub. Date: January 12, 2023
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by Abegail Narose O. Atanacio, Sherwin Joseph P. Sarmiento and Flordeluna Zapata-Mesina
Case Report
Rationale and objective: HLH is the aggressive proliferation of activated macrophages and histiocytes phagocytosing blood cells. [1] This report demonstrates the clinical and laboratory approach and therapeutic management to a patient suspected of HLH. Case: This is a case of an 18-year old female with nine-month history of on and off fever. She was previously admitted and diagnosed with erythema nodosum probably secondary to pulmonary tuberculosis, congenital heart disease, atrial septal defect. She was discharged but there was still note of intermittent fever, tachycardia, progressive edema on upper and lower extremities, and increasing abdominal girth, hence readmission. Initial laboratory work up showed anisopoikilocytosis with a predominance of microcytic, hypochromic red blood cells, schistocytes and elliptocytes were seen with few burr cells and nucleated RBCs, normal WBC count, and with toxic granulation. Bone marrow aspiration was done revealing erythrophagocytosis and hemophagocytic lymphohistiocytosis. Patient was started with cotrimoxazole and fluconazole, induction therapy with corticosteroid-dexamethasone, chemotherapy with etoposide and cyclosporine, and blood transfusion. Clinical signs, symptoms, and laboratory parameters improved. Discussion and Summary: HLH does not have specific manifestations as it is capable of mimicking other diseases which contributes to its high mortality rate. With this, a high index of suspicion and a thorough clinical, immunological, and genetic workups are required. As in our patient, HLH should be considered when there is persistent high fever and cytopenias. With prompt recognition and appropriate treatment, prognosis may be improved.
American Journal of Medical Case Reports. 2023, 11(1), 1-5. DOI: 10.12691/ajmcr-11-1-1
Pub. Date: January 12, 2023
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