by Hussein Gaith, Jad Said, Antoine Egbe, Myles Hardeman and Priscella Holland
Case Report
In chronic lymphocytic leukemia (CLL), hyperleukocytosis has a prevalence of 20-40%, but leukostasis is extremely rare. In this case, a 53-year-old male with no known medical history presented to the emergency department with acute bilateral hearing loss, shortness of breath, diffuse lymphadenopathy, weight loss, and an abdominal mass, and was found to have hyperleukocytosis (WBC: 1075.5 bil/L), anemia (Hb: 2.2 g/dL), and thrombocytopenia (Platelets: 33 bil/L). Flow cytometry and lymph node biopsy found chronic lymphocytic leukemia with a 13q14.3 deletion, and subsequently started on venetoclax resulting in resolution of the leukocytosis and thrombocytopenia. Persistent hearing loss led to attempting oral and intratympanic corticosteroids, which also failed to restore hearing. No lesions were found in the bilateral internal auditory canals on MRI. Unlike previous cases of hearing loss in CLL-related leukostasis, this patient's hearing loss did not resolve with CLL resolution, which suggests that increased viscosity versus other unidentified etiologies are the cause. Further studies need to be conducted in this subset of patients to better understand and combat the mechanisms behind CLL-related leukostasis hearing loss.
American Journal of Medical Case Reports. 2023, 11(8), 150-151. DOI: 10.12691/ajmcr-11-8-5
Pub. Date: August 31, 2023
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by Sheen J. Arora, Aman Arora, Ritu Sangwan and Shailesh Jain
Case Report
Fracture of the conventional acrylic denture is one of the most common complaints of the patient. This is more evident in patients with heavy masticatory loads and those with parafunctional habits. This calls for the need for better material with good mechanical properties capable of withstanding all the functional loads effectively without fracture. A metal-based denture base due to its superior mechanical properties in this respect is a good alternative to acrylic dentures. This article discusses a case report of successful oral rehabilitation of a completely edentulous maxillary and mandibular arch in a patient with the heavy occlusal stresses. The patient had a habit of bruxism and clenching due to which he had fractured two complete dentures before. The cast metal base was fabricated first and then tried in the mouth following which other clinical procedures were performed. The patient after 1 year of follow up claimed to be extremely satisfied with the outcome of the prosthodontic treatment.
American Journal of Medical Case Reports. 2023, 11(8), 146-149. DOI: 10.12691/ajmcr-11-8-4
Pub. Date: August 16, 2023
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by Anahat Kaur MD, Bhanujit Dwivedi MBBS, Angad Singh MD, Tejasvi Dwivedi MBBS, Rubina Sharma MD and Sherrie White MD
Case Report
Adenocarcinoma of the small intestine is one of the most uncommon gastrointestinal malignancies, comprising <5% of all GI cancers. Krukenberg tumors are also uncommon, making up only 3-5% of ovarian malignancies. We are reporting a rare case of a patient with small bowel adenocarcinoma presenting with Krukenberg metastasis. A 79-year-old female initially presented with abdominal pain and diarrhea and was found to have a long segment of irregularly thickened distal ileum suspicious for malignancy. The patient was unable to maintain consistent follow-up for almost a year after which she presented with early satiety, abdominal bloating, palpable abdominal mass and 20 lb weight loss. US and CTAP now revealed a large complex cystic mass in the pelvis with persistent bowel wall thickening and elevated CA- 125 tumor marker. The site of origin could not be determined on FNA biopsy so the patient underwent surgical resection with pathology showing adenocarcinoma of the ileum with metastatic involvement of the right ovary (Krukenberg metastasis). Molecular somatic mutation testing showed microsatellite instability (MSI-High status). She completed 12 cycles of consolidative chemotherapy with FOLFOX and currently remains in remission on pembrolizumab maintenance.This case highlights the rarity of presentation, diagnostic challenges and successful treatment of patients with ileal adenocarcinoma presenting with Krukenberg metastasis.
American Journal of Medical Case Reports. 2023, 11(8), 142-145. DOI: 10.12691/ajmcr-11-8-3
Pub. Date: August 13, 2023
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by Antoine Egbe, Chris Agyingi, Hussein Gaith, Khurram Arshad, Ahmed Subahi, Shahana Ishfaque and Ahmed Abdelrahim
Original Research
A spontaneous perinephric hematoma is a rare entity that frequently presents with flank pain. We present the case of a 44-year-old female who presented to the emergency department with severe left flank pain, and hypotension. Her initial investigations were remarkable for the presence of a left perinephric hematoma measuring up to 10.1 cm (about 3.98 in). Renal arteriography did not show any signs of active bleeding, hence a conservative approach of not intervening was the initial decision. The hemoglobin on arrival was 10.2 and it remained stable during her hospital stay. She was discharged home with a follow-up visit in 2 months for a repeat computed tomography scan of the abdomen. About 4 weeks after leaving the hospital, she presented again with excruciating flank pain which was managed with analgesics. The repeat CT scan of the abdomen/pelvis showed a stable hematoma of the same size, so once again no intervention was done. Unfortunately, she presented about 4 weeks later with a fever of 101 F, altered mental status, and severe respiratory distress. She had a significant leukocytosis of 37,000 and lactic acid was 15.5 mg/dl. A CT scan of the abdomen showed a left retroperitoneal fluid collection, measuring 16.3 x 19.5 x 25.8 cm which was a perinephric abscess. The fluid collection was drained percutaneously, and surgical cultures grew E. coli. Her blood culture was also positive for E. coli. She received antibiotic therapy for about a month. The patient's hospital stay lasted about a month with about 2 weeks of that stay being in the intensive care unit. The main takeaway point of this case report is the answer to whether conservative management is always the best treatment for a stable perinephric hematoma.
American Journal of Medical Case Reports. 2023, 11(8), 138-141. DOI: 10.12691/ajmcr-11-8-2
Pub. Date: August 09, 2023
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