American Journal of Medical Case Reports

Cutis Laxa (CL) is a rare disease in which the skin loses its elasticity and hangs in large folds. It is an inherited or acquired connective tissue disorder. We report the case of a 29 year-old woman followed up since 4 years for a dermatomyositis treated with glucocorticosteroids and methotrexate. She was hospitalized in February 2012 for fever, arthralgia, pelvic and shoulder muscle weakness with myalgia, malar rash, thrombocytopenia, leucopenia and lymphocytopenia Immunological tests showed Antinuclear Antibodies (ANA) (+) to 1/640, AC anti-DNA (+) and AC anti-SSA (+). Histology of the salivary glands showed grade III lymphocytic sialadenitis. The systemic lupus erythematosus and secondary Sjögren’s syndrome were diagnosed. The patient was treated with glucocorticostroids, methotrexate, nivaquine and bissolvon. One year later, the patient presented a skin aging that began in hands which has expanded rapidly in the face. The skin biopsy confirmed the diagnosis of a "Cutis Laxa". The esthetic treatment is proposed.

American Journal of Medical Case Reports. 2014, 2(11), 259-261. DOI: 10.12691/ajmcr-2-11-10
Pub. Date: November 27, 2014

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Arachnoid Cyst in the Sphenoid Sinus Presented with Headache and Proptosis

by Asif Salimov, Serdar Ozer, Celil Gocer, Burce Mocan, Riza Onder Gunaydin and Omer Taskin Yucel

Case Report

Arachnoid cysts are benign lesions that contain content similar to cerebrospinal fluid. Arachnoid cysts may cause neurological symptoms but they are commonly asymptomatic. They are commonly located in the middle cranial fossa. Paranasal sinuses are rare locations of them. We present a case with a preoperative diagnosis dilemma about young male patient with headache, vomitting and proptosis. Cranial MR scanning showed large left temporal arachnoid cyst and other cystic lesion with different signal changes in the left sphenoid sinus which leads to enlargement of the sinus. In this article we are discussing the patient, that had cerebrospinal fluid (CSF) rinorrhea; after his left sphenoid sinus explored at outside clinic, then getting up with conservative follow-up, with radiological imagings and literature findings. We should consider arachnoid cysts within differrential diagnosis of intrasphenoidal cystic lesions.

American Journal of Medical Case Reports. 2014, 2(11), 256-258. DOI: 10.12691/ajmcr-2-11-9
Pub. Date: November 19, 2014

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Clinical Application of the Levothyroxine Absorption Test in the Diagnosis of Pseudo-Malabsorption

by Muhammad Imran Butt, Nidhi Gupta, Hiang Leng Tan and Najeeb Waheed

Case Report

We present a variation and clinical application of the Levothyroxine Absorption Test (LAT) in the identification of pseudo-malabsorption of levothyroxine in uncontrolled hypothyroidism, for which there is no current gold standard protocol, and a variety of methods proposed in the literature. The LAT was conducted over 5-days with thyroid function tests conducted pre-LAT, then at day 1 and 5. The thyroid stimulating hormone levels became completely suppressed indicating that there had been previous non-compliance with medication.

American Journal of Medical Case Reports. 2014, 2(11), 253-255. DOI: 10.12691/ajmcr-2-11-8
Pub. Date: November 18, 2014

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Synchronous Triple Distinct Urological Tumors in a Patient: Urothelial Carcinoma of Bladder, Unilateral Renal Oncocytoma and Papillary Adenoma

by Sevinç Şahin, Selda Seçkin, Kürşad Zengin, Serhat Tanık and Mesut Gürdal

Case Report

Synchronous multiple primary tumors of the urinary tract are quite rare. The medical literature refers to a small percentage (around 4%) of the incidence of oncocytomas synchronous with other kidney tumors as renal cell carcinoma, pelvic urothelial carcinoma, angiomyolipoma etc. Papillary adenoma is one of those tumors that may rarely coexist with oncocytoma. In this study, we present a case of 69-year-old male patient with synchronous occurrence of concomittant unilateral renal oncocytoma and papillary adenoma, and urothelial carcinoma in bladder. To the best of our knowledge, this is the first case report combining those urinary tumors in the medical literature.

American Journal of Medical Case Reports. 2014, 2(11), 250-252. DOI: 10.12691/ajmcr-2-11-7
Pub. Date: November 17, 2014

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Hyperphagia- A Rare Clinical Presentation of Acute Lymphoblastic Leukemia Relapse

by Yasir Bashir, Nusrat Bashir, Sajad Geelani, Asif Ahmed, Manzoor Parry, Shabeer Ahmad and Javid Rasool

Case Report

Hyperphagia (also referred to as polyphagia) is a serious eating disorder defined as an extreme unsatisfied drive to consume food and the most common sign that aperson has hyperphagia is obesity. It can be caused commonly by variety of congenital obesity syndromes and rarely by acquired hypothalamic dysfunction.Here we report a clinical manifestation of a child who was a diagnosed case of acute lymphoblastic leukemia and was on maintenance chemotherapy when parents noted her overeating and on evaluation she proved to have central nervous system relapse.

American Journal of Medical Case Reports. 2014, 2(11), 247-249. DOI: 10.12691/ajmcr-2-11-6
Pub. Date: November 11, 2014

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Isolated Forearm Swelling - A Rare Presentation of Soft Tissue Cysticercosis

by Parul Dubey, Rohit Chodankar, Lokesh Chawla, Trivikram Bhat and Vidya Rani

Case Report

Cysticercosis is a common human infestation in the developing world. Neurocysticercosis is the most common clinical presentation of cysticercal infestation in the human body, but it may be rarely encountered in other body parts like skeletal muscle, subcutaneous tissue and eye. We report this case of an uncommon clinical presentation of soft tissue cysticercosis as an isolated forearm swelling. Only a few cases of cysticercosis presenting as isolated swelling in any body part have been reported in literature. A 30 year old lady presented with a painless swelling in the left forearm for about one year. It was diagnosed as cysticercosis located in the intermuscular plane between the brachioradialis and pronator teres and above the supinator muscles. Magnetic resonance imaging (MRI) and ultrasonography (USG) of the forearm confirmed a cystic lesion and revealed a scolex. She was treated with albendazole and steroids for three weeks but did not respond to medical treatment. The swelling was surgically excised. Hisptopathological examination of the cyst confirmed cysticercosis. Soft tissue cysticercosis presenting as an isolated forearm swelling is a rare presentation of cysticercosis. Treating physicians and surgeons need to have a high index of clinical suspicion for cysticercosis, especially in endemic areas in the developing nations, to facilitate an early diagnosis. Through this case report we also highlight that cysticercosis can be easily diagnosed by non invasive investigations like MRI and USG. It is usually medically treatable but may occasionally require surgical intervention as was needed in our case. This document gives formatting instructions for authors preparing papers for publication in the journal. Authors are encouraged to prepare manuscripts directly using this template. This template demonstrates format requirements for the Journal.

American Journal of Medical Case Reports. 2014, 2(11), 243-246. DOI: 10.12691/ajmcr-2-11-5
Pub. Date: November 11, 2014

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Simultaneous Maxillary and Mandibular Brown Tumors as the First Presentation of Secondary Hyperparathyroidism

by Btissaam. Belhoucha, Hiroual abelatif, Hassan. Nouri, Youssef. Rochdi, Bouaichi amine, lahcen. Aderdour, N. Mansouri Hattab and Abdelaziz. Raji

Case Report

Brown tumor represents a serious and late bony complications of advanced hyperparathyroidism with a frequency of 1.5–1.75 percent in secondary hyperparathyroidism and 3–4 percent in primary hyperparathyroidism. Here we describe an extremely rare case of a 19-year-old male patient with a brown tumor localised in the maxilla and mandibular due to secondary hyperparathyroidism compromising mastication, phonation and social ease of the patient. An early diagnosis and a timely parathyroidectomy in a medically resistant hyperparathyroidism are an optimal option to control the growth of the bony lesion

American Journal of Medical Case Reports. 2014, 2(11), 240-242. DOI: 10.12691/ajmcr-2-11-4
Pub. Date: November 05, 2014

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A Transient Proteinuria: An Unusual Complication of Hypothyroidism

by R. Hajji, F. Derbali, K. Mnafgui, S. Zribi, M. Elleuch, N. Kammoun and Z. Jallali

Case Report

Background: Although the effect of thyroid hormones is very important on renal function and glomerular filtration rate, it is often overlooked. Hypothyroidism is sometimes accompanied by a decrease in the glomerular filtration rate and hyponatremia. Observation: A33-year-old man was admitted in intensive care unit for an inaugural diabetic ketoacidosis in December 2012. He has been diagnosed as hypothyroidism case since 2005. He had a replacement therapy that he had given up in 2011. On The physical examination he exhibited a general fatigue with fever and sweats. He suffered from myalgia and proximal muscle weakness, edema of renal type and a few crackles. The biology showed ketoacidosis, progressive acute renal failure of deterioration associated with important rhabdomyolysis and proteinuria of 5.7 g/24 h. Normal eye fundus was able to rule out diabetic nephropathy. In addition to the treatment of ketoacidosis, lung disease and the fluid overload, hormone replacement therapy was reinstituted. The evolution was marked bythe disappearance of edema, fever, rhabdomyolysis and proteinuria. Discussion: The rhabdomyolysis, secondary to hypothyroidism, is atthe origin of renal failure. In this case, proteinuria is exceptional. Themajor part of the renal manifestations during thyroid dysfunctions isreversible with hormone therapy. Conclusion: Transient proteinuria isexceptional in hypothyroidism. It is another face of kidney involvementin thyroid disorders.

American Journal of Medical Case Reports. 2014, 2(11), 237-239. DOI: 10.12691/ajmcr-2-11-3
Pub. Date: November 05, 2014

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Rhabdomyolysis Complicating Acute CO Poisoning: A Case Study and a Review

by Shimaa M. Motawei, Salwa M. El-Wasify, Sahar A. Eldakroury and Adel M. Elmansoury

Original Research

Introduction: Carbon Monoxide (CO) is a colourless, odourless, tasteless gas. Mild poisoning by CO can be Mistaken for a non-specific headache or a viral illness headache or viral illness. Moderate to severe CO poisoning produces significant morbidity and mortality that provokes treatment controversy. Rhabdomyolysis, compartment syndrome, renal failure and peripheral neuropathy are unusual complications of CO That can be faced during practice and should be considered by physicians. Case presentation: A 34-years old Egyptian male was referred to the Toxicology Unit from the ED for evaluation of his lower limb weakness. Initial examination revealed a fully conscious patient with stable vital signs and arterial blood gases. However, the patient cannot stand steadily or walk. Neurologic examination revealed hypotonia and diminished reflexes in both lower limbs. No history of toxin exposure but a condition of sudden acute illness affecting him and his parents and upon which his old-age parents, were transferred to ICUin coma. Investigations revealed increased serum alanine transaminase and serum creatinine. A work-up that involved appropriate imaging and serum creatinekinase (CK) measurement revealed extremely elevated serum CK, normal appearance of liver and increased echogenicity of both kidneys with preserved cortico-medullary differentiation. Based on the above-mentioned data, a diagnosis of rhabdomyolysis complicating acute CO exposure with secondary renal insult was made. The patient begins haemodialysis with follow up of his serum K⁺, creatinine and CK. After one month, levels of serum creatinine and alanine transaminase became normal. The patient underwent rehabilitation therapy to improve his neuromuscular state. Conclusion: Carbon monoxide poisoning should be suspected in patients presented with acute illness without prior medical or surgical cause, and rare complications of CO poisoning like rhabdomyolysis should be suspected particularly in patients with delayed seek of medical care. Timely prompt medical care involving team therapy is necessary to prevent further complications like RF and muscle wasting.

American Journal of Medical Case Reports. 2014, 2(11), 232-236. DOI: 10.12691/ajmcr-2-11-2
Pub. Date: November 04, 2014

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Torsion of Arteriovenous Malformation – A Rare Case of Acute Abdomen

by Linda Kokaine, Andis Lemanis, Sergejs Sapovalovs, Arnis Abolins and Arturs Balodis

Case Report

Arteriovenous malformation (AVM) is a rare finding in gastrointestinal tract usually asymptomatic, although sometimes causes gastrointestinal bleeding or pain. Even more rarely it can be found in other abdominal organs like liver, pancreas, spleen etc. We present a unique case of acute abdominal pain – a patient with torsion of arteriovenous malformation of gastroepiploic arteries with following ischemia and thrombosis causing severe pain. A search at the literature has not yielded any other case report describing similar cause of the acute abdomen.

American Journal of Medical Case Reports. 2014, 2(11), 229-231. DOI: 10.12691/ajmcr-2-11-1
Pub. Date: November 04, 2014

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