by Mohammed A. M. El Habiel, Mohammed Hidayathullah Khan and Javereeya Abduljabbar
Case Report
Foley catheterization is a common daily procedure done in our practice. Iatrogenic rectal perforation during urethral Foley catheterization is a very rare complication. There are multiple underlying risk factors that can lead to this devastating complication, including friable rectal tissues due to underlying trauma, radiation. Additionally, the type of Foley catheter and the technique of insertion can lead to this complication. The presentation of the patient is always alarming and can aid in making the diagnosis. The management, always, depends on the whole patient clinical condition, and it ranges from conservative management and changing the catheter under vision, to laparotomy and rectal perforation repair. We are presenting a case report of a comorbid patient suffered this complication in our facility.
American Journal of Medical Case Reports. 2023, 11(5), 104-106. DOI: 10.12691/ajmcr-11-5-6
Pub. Date: June 29, 2023
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by Teren Yedikian, Lisa Piñero, Erica Rego, Radhika Malhotra, Juan Bello and Ravi Upadhyay
Case Report
Pseudomonas aeruginosa and Pseudomonas fluorescens are gram-negative bacilli that are ubiquitous in the environment and are known to cause folliculitis, pneumonia, and otitis externa typically in immunocompromised patients. Pseudomonas spp. are rarely associated with cellulitis. We present a case of a 47-year-old woman who presented to the emergency room with left lower leg edema and erythema after being exposed to the multi-purpose cleaning product, Fabuloso®. Recently, a recall regarding multiple lots of this cleaner was made as some of the products have been found to grow both Pseudomonas aeruginosa and Pseudomonas fluorescens. Physical exam revealed a warm, erythematous, and lower left leg lesion that was tender to touch. A computerized tomography of the lower left leg indicated a soft tissue infection with no abscesses or collections. Antibiotics were administered to cover against bacterial causes of nonpurulent cellulitis. The lesion continued to spread, and only began to decrease in size when antimicrobial coverage was broadened to target Pseudomonas spp. This case demonstrates the importance of detailed history taking including environmental exposures as well as rapid recognition of antimicrobial failure.
American Journal of Medical Case Reports. 2023, 11(5), 101-103. DOI: 10.12691/ajmcr-11-5-5
Pub. Date: June 29, 2023
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by Jesus Romero, Sherif Elkattawy, Sohail Sodhi, Ana L. Romero, Omar Elkattawy, Rachel Abboud, Razan Shamoon and Fayez Shamoon
Case Report
Noonan syndrome is an inherited disorder that involves various organs, such as dysmorphic facial features, cardiac defects, and cryptorchidism, among others. Its pathophysiology is linked to germ-line mutations in the RAS/mitogen-activated protein kinase (MAPK) pathway. The most frequent cardiac defect in this syndrome is pulmonary valve stenosis. Conversely, mitral valve involvement is rare, and a parachute-like asymmetric mitral valve presentation is even rarer. In cases where surgery is necessary, mitral valve repair is preferred over mitral valve replacement. Here we present a case of a 20-year-old gentleman with Noonan syndrome who was found to have a parachute-like mitral valve evidenced by a 2D-Echocardiogram.
American Journal of Medical Case Reports. 2023, 11(5), 98-100. DOI: 10.12691/ajmcr-11-5-4
Pub. Date: June 29, 2023
by Antoine Egbe, Agyingi Chris, Hussein Gaith and Khurram Arshad
Original Research
Pulmonary embolism (PE) is also known as the great faker. It is difficult to diagnose and entails a lot of suspicion from a clinician. Our case talks about the appearance of a complete heart block in a patient with PE who had a pre-existing left bundle branch block. We present the case of a 75-year-old lady with a pre-existing left bundle branch block, diabetes and hypertension presented to the emergency department because of shortness of breath which had been ongoing for 4 days. She was tachycardic and hemodynamically stable initially on arrival. Computed tomography pulmonary angiogram done in the emergency department showed an embolus in the distal right main pulmonary artery, which was extending to and involving the proximal right lower lobe of the pulmonary arterial tree. Follow-up cardiac echography showed an enlarged right ventricle with decreased right ventricular systolic function. Initial electrocardiogram (EKG) only showed a left bundle branch block. However later during the day, the patient became hemodynamically unstable before thrombectomy. The thrombectomy was planned for the following day. Repeat electrocardiogram at this point in time showed a third-degree heart block. The patient received atropine and a transvenous pacemaker was placed. She later on underwent thrombectomy. Electrocardiogram post-thrombectomy repeatedly showed complete heart block, hence the decision was made to place a permanent pacemaker. Pulmonary embolism can present in a variety of ways. It could possibly present as a complete heart block. In patients with a pre-existing left heart block, a PE could easily cause a complete heart block especially in the scenario where we have a right ventricular strain evident on a transthoracic echocardiogram (TTE). The presence of right ventricular strain on EKG, be it T wave inversion in V1 like in my patient or new onset complete right bundle branch block could be used as an indicator of massive/sub-massive(severe) pulmonary embolism.
American Journal of Medical Case Reports. 2023, 11(5), 95-97. DOI: 10.12691/ajmcr-11-5-3
Pub. Date: May 24, 2023
528 Views3 Downloads
by Khurshid Mattoo, Rishabh Garg and Vishwadeepak Singh
Review Article
In terms of mortality, covid 19 pandemic left most dead in the elderly age group of 75 years and above. With such impact on a specific age group, it becomes significant to know the association of such deaths under the prism of widespread elder abuse among the elderly population. The effect of the pandemic on the global economy by laying off employees has just begun. Whether it will increase or decrease elder abuse remains to be seen. Interventions in elder abuse have been undertaken at primary, secondary, tertiary and quaternary levels. They can be targeted to an individual, formal/informal caregiver, hospital staff or to a broader community. Health care workers have been requested to report and/or intervene at any/all levels including their visiting patients. Interventions can be psychoeducational, psychotherapeutic, supportive or service based. The strength of evidence in most of the intervention studies has been not only found to be weak but also lack quality study designs. This brief review presents an insight on the types of elder abuse interventions and the strength and limitations of such interventions. The aim of the review is to broadly configure the idea of elder abuse intervention types and methods that have been scrutinized through various reviews and systematic reviews. The objective of this review is to present the recent research outcomes in elder abuse interventions.
American Journal of Medical Case Reports. 2023, 11(5), 90-94. DOI: 10.12691/ajmcr-11-5-2
Pub. Date: May 21, 2023
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by Austin Hamp, Nate Hansen, Jamila Asif, Jarett Anderson, Arjun Bal, Cecilia Big and Wehbi Hanayni
Original Research
Ecthyma gangrenosum (EG) is a well-recognized but rare skin infection most commonly occurring in the setting of immunocompromised individuals with bacteremia. Currently, there are very few reports of EG caused by methicillin-resistant Staphylococcus aureus (MRSA) and even fewer cases caused by methicillin-sensitive Staphylococcus aureus (MSSA). We present only the second case of bacteremic EG associated with MSSA bacteremia and aim to review the literature as well as examine common findings amongst patients with EG associated with Staphylococcus aureus.
American Journal of Medical Case Reports. 2023, 11(5), 86-89. DOI: 10.12691/ajmcr-11-5-1
Pub. Date: May 14, 2023
980 Views6 Downloads