by Soichiro Ota, Ken-ichi Muramatsu, Ikuto Takeuchi and Youichi Yanagawa
Case Report
A 75-year-old woman fell down after tripping over a step and suffered blunt face, neck and left shoulder injuries. On arrival, she had clear consciousness, tachycardia, tachypnea, posterior neck tenderness, left shoulder motion pain without motor or sensory disturbance at each extremity, and contused wounds at the forehead, nasion, upper lip, and left leg. Computed tomography (CT) showed congenital fusion of C3 and C4 (Klippel Feil syndrome) and separation of the dens body, which was initially diagnosed as acute dens fracture. Subsequent magnetic resonance imaging (MRI) showed dens body bruising and soft tissue injuries around the cervical spine. However, there was no sign of injury at the junction of the separated dens. She received a diagnosis of congenital os odontoideum without instability. She was treated with only a soft collar and pain killers and discharged on foot on day 10. To manage a patient with os odontoideum and blunt neck trauma, MRI is necessary to make a correct diagnosis, identify associated injuries and provide appropriate treatment.
American Journal of Medical Case Reports. 2023, 11(2), 41-42. DOI: 10.12691/ajmcr-11-2-9
Pub. Date: February 23, 2023
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by Ken-ichi Muramatsu, Ikuto Takeuchi, Soichiro Ota and Youichi Yanagawa
Case Report
A 52-year-old male was transported to a local medical facility due to unconsciousness and involuntary movement. His past history included only hypertension. He consumed over 2 L of soft drink per day. His body mass index was 34. As he had hyperosmolar hyperglycemic syndrome and COVID-19 infection, he was transferred to our department. On arrival, he was in a coma and pre-shock state. He was therefore intubated. Initially, his blood C-peptide level was low, and he showed hyperglycemia with ketosis. Whole body computed tomography (CT) showed pneumonia. He was diagnosed with hyperosmolar hyperglycemic syndrome with ketosis, COVID-19 infection, convulsion, hemoconcentration, liver dysfunction, rhabdomyolysis, pancreatitis, renal failure and hypernatremia. He was admitted to the intensive care unit, where he was successfully treated. His blood C-peptide returned to the normal range (2.2 ng/mL) on day 20, and he returned to the local medical facility on day 21. This is the first report of transient decrease in insulin secretion after COVID-19 infection in a patient with a combination hyperosmolar hyperglycemic syndrome and ketosis. Further prospective studies are needed to clarify the characteristics of the insulin secretion function following COVID-19 infection.
American Journal of Medical Case Reports. 2023, 11(2), 37-40. DOI: 10.12691/ajmcr-11-2-8
Pub. Date: February 23, 2023
794 Views17 Downloads
by Chiara Rosenbaum, Jamila Asif, Amer Kadri and Rajiv John
Case Report
Congestive Hepatopathy (CH) is an important differential diagnosis when evaluating patients who present with right upper quadrant pain, hyperbilirubinemia, and jaundice. We describe a 54-year-old male with a chronic pericardial effusion who develops cholestatic jaundice and acute hepatic injury as a result of early cardiac tamponade. This case report demonstrates the challenges in diagnosing congestive hepatopathy and reviews the pathophysiology that leads to variable presentations of the condition.
American Journal of Medical Case Reports. 2023, 11(2), 33-36. DOI: 10.12691/ajmcr-11-2-7
Pub. Date: February 21, 2023
1642 Views6 Downloads
by Obed Agyei, Zonera Ali and Yanmin Zhang
Case Report
Non-functioning paragangliomas are rare tumors. I describe a case of a 74-year-old woman who presented with worsening neck mass and subsequently discovered to have a non-functioning paraganglioma after surgical resection. These tumors are associated with paraneoplastic diseases including MEN Syndromes, Neurofibromatosis and Von Hippel Lindau. Patients should be referred for genetic counseling once diagnosis is established.
American Journal of Medical Case Reports. 2023, 11(2), 31-32. DOI: 10.12691/ajmcr-11-2-6
Pub. Date: February 19, 2023
758 Views3 Downloads
by Jamila Asif, Ahmad El-Gammal, Jad Said, Crystal Seudeal, Wehbi Hanayni and Steven Werns
Case Report
Colorectal cancer (CRC) is the third most common cancer worldwide. Cardiac metastasis from CRC is extremely rare with only a few cases reported, with the clinical presentation being silent in over 90% of cases. Here we discuss a case of 62 -year-old male who presented with abdominal pain, distention,and weight loss. Computed Tomography (CT) chest/abdomen showed a multiseptated left hepatic lobe lesion, bilateral lung nodules, and a mass-like hypodensity in the right ventricle (RV). A transesophageal echocardiogram (TEE) confirmed the RV mass with normal cardiac function. A liver biopsy showed metastatic colorectal adenocarcinoma. Two months after diagnosis, the patient developed progressive abdominal distention, shortness of breath, and pedal edema. Hospice care was initiated after he did not tolerate palliative chemotherapy, and he passed away three months later. Metastatic cardiac involvement secondary to CRC is extremely uncommon. From 1948 to 2007, the incidence of cardiac metastasis was noted to be 2.3 - 18.3% in the literature. The clinical presentation is silent in 90% of cases. Symptoms can range from being asymptomatic to chronic fatigue and shortness of breath due to reduced cardiac output, to sudden cardiac death from embolization of metastatic tumor. Metastatic cardiac tumors progress rapidly and have poor outcomes. It is crucial to recognize the underestimated prevalence of cardiac metastasis as it may have implications for the management and prognosis of CRC. Given the asymptomatic presentation of cardiac metastasis in the context of CRC, future integration of genetic sequencing may help delineate further guidelines on screening for cardiac metastasis.
American Journal of Medical Case Reports. 2023, 11(2), 28-30. DOI: 10.12691/ajmcr-11-2-5
Pub. Date: February 05, 2023
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by Lydia Leavitt
Case Report
Brain death is a difficult determination, often involving legal, ethical, and moral dilemmas for care teams and families. Determination of brain death in the neonate is particularly difficult due to ambiguous and inconsistent guidelines, which have generated controversies and debates regarding several components of the brain death examination in neonates. The treatment team of a term neonate who suffered a severe hypoxic-ischemic brain injury during birth encountered numerous uncertainties as they navigated the brain death determination guidelines. This was the first time a neonatal brain death determination was performed at this 52-bed level III neonatal intensive care unit.
American Journal of Medical Case Reports. 2023, 11(2), 23-27. DOI: 10.12691/ajmcr-11-2-4
Pub. Date: February 05, 2023
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by Dov Vachss, Yasna Yusuf, Dylan Bobrow and Patrick Geraghty
Case Report
Lyme disease is a vastly underdiagnosed disease, and its frequency is steadily rising. It is commonly diagnosed clinically and treated empirically, due to the time required for testing and the inefficiency of laboratory testing methods. Although there are a few reported cases of Lyme carditis, the variation in the clinical presentation and the treatment provided differ significantly. Herein, we present the case of a man who presented in July 2022 with a non-productive cough and low-grade fever along with mild body aches. The patient had an incidental atrial flutter with a 2:1 atrioventricular block, a large thick-walled cavitary lesion in the apex of the left lung, left upper lobe ground-glass opacities, and scattered micronodules in the left lower lobe. He was clinically diagnosed with Lyme carditis despite testing negative for Lyme antibodies. This was in combination with Pseudomonal pneumonia. Here we review recent cases of Lyme carditis and discuss the difficulty of the efficiency of serological testing for Lyme disease.
American Journal of Medical Case Reports. 2023, 11(2), 19-22. DOI: 10.12691/ajmcr-11-2-3
Pub. Date: February 05, 2023
by Andrew Sagalov, Sujitha Ketineni, Mohammad Hussain and Ruchika Goel
Original Research
An elderly woman was brought to the emergency department following a one-week history of progressively worsening epigastric pain and generalized weakness. Her symptoms began approximately two years before admission; however, she did not seek medical attention as her symptoms were mild. Vital signs were stable on presentation, while her pain persisted following administration of morphine. A computed tomography scan of her abdomen did not identify any acute pathology. Laboratory evaluation revealed megaloblastic anemia, a critically low vitamin B12 count, and evidence of hemolytic anemia (HA). She was treated with cyanocobalamin injections and her abdominal pain resolved. This case demonstrates a rare instance of acquired HA as a complication of vitamin B12 deficiency. Furthermore, our manuscript emphasizes clinicians should recognize megaloblastic anemias are not always macrocytic and to conduct a thorough medical history when evaluating an anemia.
American Journal of Medical Case Reports. 2023, 11(2), 16-18. DOI: 10.12691/ajmcr-11-2-2
Pub. Date: February 02, 2023
715 Views4 Downloads
by Noriko Kuwae and Masahiro Yamasato
Case Report
The purpose of this report is to describe effectiveness and tolerability of medical treatment with sacubitril/valsartan in a patient treated with hemodialysis. We describe the case of a 68-year-old man with heart failure with ejection fraction more than 60%, that is HFpEF undergoing hemodialysis. He had several times heart failure due to diastolic dysfunction, he could tolerate a dose of 50/50mg, total 100mg daily. After initiation of sacubitril/valsartan, there was a symptomatic improvement with clear reduction NT-proBNP, left atrial dimension, E/e’ as well as EF. In conclusion, in this patient with diastoric dysfunction undergoing hemodialysis, treatment with sacubitril/valsartan was effective, safe, and improved heart failure symptoms.
American Journal of Medical Case Reports. 2023, 11(2), 14-15. DOI: 10.12691/ajmcr-11-2-1
Pub. Date: February 02, 2023
750 Views