by Anahat Kaur MD, Bhanujit Dwivedi MBBS, Tejasvi Dwivedi MBBS, Rubina Sharma MD and Angad Singh MD
Case Report
Evans syndrome is a rare autoimmune disorder characterized by the simultaneous or sequential presence of autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP). Secondary Evans syndrome refers to cases in which these autoimmune manifestations occur in the setting of an underlying condition or trigger. We report the case of a 36 year old male with no significant past medical history who presented with symptoms of easy bruising, and mucocutaneous bleeding. Laboratory investigations revealed severe thrombocytopenia and hemolytic anemia, consistent with the diagnosis of Evans syndrome. Further evaluation demonstrated the presence of triple positive anti-phospholipid antibodies, including lupus anticoagulant, anticardiolipin antibodies, and anti-beta-2 glycoprotein antibodies. Patient was initially treated with steroids and IVIG but had refractory ITP for several weeks requiring rituximab (four weekly doses) and fostamatinib before eventual improvement and stabilization of platelet count. Given the rarity of secondary Evans syndrome with positive anti-phospholipid antibodies, there is a lack of robust evidence-based treatment guidelines. Our case highlights the complexity and challenges encountered in managing this condition.
American Journal of Medical Case Reports. 2023, 11(7), 123-125. DOI: 10.12691/ajmcr-11-7-3
Pub. Date: August 04, 2023
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by Bethel Tesfaye Bizuneh, Tewodros Kassahun Tarekegn, Hayat Yassin Nuri, Evelyn Cantillo Aguila, Efrata Sentayehu Teshome, Adey Gizachew Alemayehu, Tereza Mulatu Tafesse, Rediet Habtu Lebelo, Solomon Endale Dagnachew, Erdachew Gallo Beyene, Rediet Abebe Mekonnen, Michael Million Minase, Helen Assefa Berhe, Edlawit Mebrahtu Jember, Elul Simeneh Abiy, Sebelwongel Esubalew Bitew and Bisrat Nigussie Alemayehu
Original Research
Background: Due to concerns about uncontrolled hemorrhage and peripartum hysterectomy, routine myomectomy at the time of caesarean section has historically been denounced. That is still a hotly contested subject everywhere. Nonetheless, numerous case reports of caesarean myomectomy have recently been published, proving their safety and the absence of any serious sequelae. Case presentation: A 34 years old gravid 3 para2 with one previous caesarean section (CS) presented with a complains of passage of liquor per vaginum for10 hours which was yellow in color and odorless accompanied by mild abdominal cramp. Gestational age calculated from early ultrasound was 40weeks. She hads regular antenatal care (ANC) follow up and pregnancy was planned, wanted, and supported. The most recent ultrasonography (USG) result indicated a single viable intrauterine pregnancy and an intramural fibroid measuring 8.6 by 6.1 cm in the lower uterine segment's left anterolateral wall. Due of the fibroid's protrusion into the incision line and fear off wound dehiscence and delay in uterine wound healing post-surgery, the decision of myomectomy was taken. In order to prevent post-partum hemorrhage, proflacis oxytocin infusion treatment were given. Conclusions: If conducted safely, it can avert the additional morbidity of a future operation, justifying the procedure's cost-effectiveness.
American Journal of Medical Case Reports. 2023, 11(7), 119-122. DOI: 10.12691/ajmcr-11-7-2
Pub. Date: August 04, 2023
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by Teren Yedikian, Cara Lescott, Erica Rego, Kyrillos Girgis, Saamia Javed, Dina Elsayed and Amee Sodha
Case Report
Staphylococcus aureus is a gram-positive round-shaped bacteria found in the environment and skin of humans and animals and commonly causes skin and soft tissue infections. Infections caused by drug resistant strains of Staphylococcus aureus, such as Methicillin-resistant Staphylococcus aureus (MRSA), are more difficult to treat due to a more limited pool of antibiotics available for use. We present a case of a 41-year-old man who presented to the emergency room with lower lip swelling after suffering a facial laceration from shaving. Physical exam indicated a desquamated, erythematous, and edematous lower lip lesion that was tender upon palpation. A computerized tomography of the lower lip showed diffuse swelling and fluid in the lower lip. Analysis of the purulent discharge from the wound grew MRSA and antibiotics were given to cover against this strain. The lower lip swelling decreased in size and the patient was discharged on oral antibiotics. This case demonstrates the importance of rapid identification of antibiotic-resistant strains of bacterial skin infections and an uncommon location of cellulitis.
American Journal of Medical Case Reports. 2023, 11(7), 116-118. DOI: 10.12691/ajmcr-11-7-1
Pub. Date: July 12, 2023
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