American Journal of Medical Case Reports

Chronic myeloid leukemia(CML) usually remains asymptomatic and has varied clinical presentation. The disease usually has a chronic course till it goes into blast crisis when it develops fever, other constitutional symptoms and bleeding manifestations as seen in acute leukemia. Here, we present a case that came to our emergency department as a case of acute abdomen in the form of massive retroperitoneal hematoma and subsequently proved to be a case of Philadelphia positive CML with blast crisis.

American Journal of Medical Case Reports. 2014, 2(10), 227-228. DOI: 10.12691/ajmcr-2-10-8
Pub. Date: October 31, 2014

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Simultaneous Presentation of Metastatic Cancer and Primary Hyperparathyroidism – A Case Series

by Hiang Leng Tan, Muhammad Imran Butt and Najeeb Waheed

Case Report

The objective of our two case reports is to increase awareness of the simultaneous occurrence of primary hyperparathyroidism and malignancy in patients that presents with hypercalcaemia. This report reviews the case reports from the history, investigation, treatment and outcome for these two patients. A literature review of the association between malignancy and primary hyperparathyroidism was also performed. Both patients had metastatic cancer and primary hyperparathyroidism but died within months of diagnosis despite treatment for their primary malignancy. This serves as a reminder that these two separate diagnoses do exist, though it did not alter the outcome of our patients. However, we propose that in patients with malignancy who presents with hypercalcaemia and non-suppressed PTH level, further workup should be instigated to rule out primary hyperparathyroidism as surgical option is potentially curative for the latter.

American Journal of Medical Case Reports. 2014, 2(10), 225-226. DOI: 10.12691/ajmcr-2-10-7
Pub. Date: October 30, 2014

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Malignant Peripheral Nerve Sheath Tumor of Buccal Mucosa: An Oncological Surprise

by Ram Abhinav Kannan, Kirthi Koushik, Usha Muniyappa, Ritika Harjani and Arvind Murthy

Case Report

Malignant peripheral nerve sheath tumors are aggressive sarcomas with poor prognosis. It is usually encountered in lower extremities. Only a few cases have been reported in head and neck region with buccal mucosa being an unusual site.

American Journal of Medical Case Reports. 2014, 2(10), 222-224. DOI: 10.12691/ajmcr-2-10-6
Pub. Date: October 27, 2014

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Successful Percutaneous Retrieval of a Dislodged Chemo-port Catheter Using Snare Technique in a Three Year Old Child: A Case Report

by Manish Ruhela, Rajeev Bagarhatta, Sanjeev Patni and Mishal Shah

Case Report

Chemoport, a central venous infusion system is commonly used in cancer patients for administration of chemotherapy. Dislodgement with subsequent migration of chemoport catheter in to the heart is rare but potentially catastrophic complication. The treatment of choice is immediate retrieval of dislodged part of catheter by either surgery or percutaneous approach. Percutaneous removal is safer and less invasive making it the standard treatment modality. We herein report the case of a 3 year old child who was referred to us for the management of a dislodged chemoport catheter. In this article we discuss the treatment approach in this particular case as well as review the existing literature.

American Journal of Medical Case Reports. 2014, 2(10), 218-221. DOI: 10.12691/ajmcr-2-10-5
Pub. Date: October 27, 2014

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Hazards of Herbal Prescriptions: A Case Report and a Review

by Shimaa M. Motawei

Case Study

Abstract Introduction: Herbal products are increasingly gaining popularity for treatment of common diseases, despite their limited utility. Public people are not aware of the many hazards resulting from unsupervised use of herbal products. Moreover, many physicians are not aware of this risk of alternative medicine. All of these factors make true challenges for clinical practitioners because of the hazards of herbal prescriptions that may lead to many health effects, organ damage and even death. Case presentation: A 16-years old Egyptian male was presented to the Toxicology Unit of the Emergency Hospital in Mansoura University in a bad condition, one dayafter ingestion of a substance, which they use for treatment of parasitic infestation. After ingestion, he experienced vomiting, diarrhea and abdominal cramps. There was no past history of medical diseases, surgical operations or drug therapy. Also, there was family history of diseases relevant to this current condition. Examination and bedside investigations showed a confused patient with tachycardia and hypertension not responsive to treatment. The patient was admitted to ICU and gastric lavage, after air way protection, was done. Laboratory investigations were completed that showed striking elevations of serum ALT, AST, serum creatinine, serum creatine kinase and potassium levels, that remained risingdespite daily renal dialysis and supportive care by a team of nephrologist, medical internist, ICU care and a chest care with the toxicologist. The patient condition, despite this, remained very bad and developed bleeding from orifices and DIC, pleural effusion, lung collapse and respiratory depression supervenes despite ventilator care in monitored ICU setting. Finally, the patient was arrested and continuous resuscitation efforts failed and he died. Conclusion: Unsupervised herbal products use may carry extreme hazards upon health, up to death of the individual. Orientation of this hazard is essential for both the public and physicians. Herbal products use should be inquired upon in case of sudden deterioration of individual’s health. Unsupervised traditional medicine practice may lead to many health problems that can be faced during clinical practice and should be considered by physicians.

American Journal of Medical Case Reports. 2014, 2(10), 214-217. DOI: 10.12691/ajmcr-2-10-4
Pub. Date: October 24, 2014

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A Case Report of Thrombotic Thrombocytopenic Purpura Associated with Systemic Lupus Erythematosus: Overlapping Features

by Ali Taha A. Hassan, Mahmoud Ibrahim Yousef Elbadry and Mohammad Adel Tawfik

Case Report

The association between thrombotic thrombocytopenic purpura (TTP) and systemic lupus erythematosus (SLE) is rare. Herein, we present a case with overlapping features between TTP and SLE. A 17-year old girl admitted to our hospital with an initial complaint of high grade fever, persistent headache, and microangiopathic hemolytic anaemia (negative Coombs test with schistocytes), thrombocytopenia with thrombotic event with central nervous system involvement and probably renal involvement. Also, our patient fulfilled the criteria for SLE- fever, hair loss, oral ulcers, central nervous system involvement, renal involvement, positive ANA, positive dsDNA and normal C3 and C4. The patient was rescued by extensive plasma exchange started promptly after the diagnosis. After 8 months of treatment, TTP recurred, successfully managed with plasma exchange, steroids and cyclophosphamide. It was difficult to discriminate TTP from SLE. Our case presented simultaneous features of both SLE and TTP who reinforce the importance of early diagnosis of TTP by the observation of fragmented RBCs and the intensive therapy, including plasma exchange and careful follow-up, not only to ensure diagnosis and treatment of a relapsed episode of TTP, but also to ensure proper management of the patient’s physical and mental health due to its high morbidity.

American Journal of Medical Case Reports. 2014, 2(10), 206-213. DOI: 10.12691/ajmcr-2-10-3
Pub. Date: October 19, 2014

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Polyglandular Autoimmune Syndrome Type 2 Presenting With Ventricular Tachycardia

by Olusegun Sheyin, Taiwo Falade and Olufemi Fasanmade

Case Report

Introduction: Polyglandular autoimmune syndrome (PGA) describes a condition where dysfunction of two or more endocrine glands occurs in association with circulating organ-specific antibodies directed against the involved glands. Case Presentation: A 36 year old female, known type 1 diabetic presented with a 3 week-history of heat intolerance and intermittent palpitations, associated with dyspnea and light-headedness. On examination, a cachexic, lethargic woman with an unrecordable pulse and blood pressure was found. She was found to have sustained monomorphic ventricular tachycardia on cardiac monitor at a rate of 186 beats per minute, confirmed on 12-lead electrocardiogram. The patient was immediately cardioverted, with restoration of sinus rhythm and pulse. Further examination revealed generalized hyperpigmentation with patches of depigmentation, alopecia, a goiter, proptosis and lid lag. Thyroid function test was consistent with thyrotoxicosis and co-syntropin test confirmed adrenal insufficiency. Complete blood count was significant for a macrocytic anemia; with low level of vitamin B12 on testing. A diagnosis of sustained ventricular tachycardia in a patient with PGA type 2 was made and the patient was admitted to the intensive care unit. She was treated with hydrocortisone, fludrocortisone, carbimazole, propanolol and cyanocobalamin. The patient was maintained on amiodarone for one week and she remained in sinus rhythm for the remainder of her hospitalization. Discussion: PGA type 2 is characterized by the occurrence of adrenal insufficiency with thyroid autoimmune disease (hypo or hyperthyroidism) and insulin-dependent diabetes mellitus. Electrolyte abnormalities are frequently found in adrenal insufficiency and may predispose to arrhythmias on a background of increased adrenergic effect of thyrotoxicosis. Conclusion: The presence of an immunoendocrinopathy warrants the search for other endocrine hypofunction. In situations where a life-threatening arrhythmia is present, urgent identification and treatment of the arrhythmia is top priority.

American Journal of Medical Case Reports. 2014, 2(10), 204-205. DOI: 10.12691/ajmcr-2-10-2
Pub. Date: October 17, 2014

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Rehabilitation of Disfigurement Associated with Maxillectomy by a Cheek Plumper Prosthesis

by Khurshid Mattoo, Manas Singh and Shuja Rahman

Case Report

Patients having undergone maxillectomy as a result of carcinoma in the region or facial trauma are left with severe facial disfigurement that is associated with long term psychosocial effects. As one side of the face loses the crucial support from the maxilla, innovative customized treatment options become the choice of rehabilitation. Ideally, such treatment should be preceded by consultation with a prosthodontist which unfortunately most of the times is not the case. Rehabilitation of maxillectomy patients is not possible without incorporating the dynamics of facial expression. This article discusses a patient having undergone maxillectomy who was successfully rehabilitated with an obturator that had an additional lip/cheek plumper incorporated in its design.

American Journal of Medical Case Reports. 2014, 2(10), 200-203. DOI: 10.12691/ajmcr-2-10-1
Pub. Date: October 16, 2014

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