American Journal of Medical Case Reports

Hepatic tuberculosis is a rare form of tuberculosis with non specific signs and symptoms which requires a high index of suspicion to reach a diagnosis. Usually has three forms of presentation in the form of miliary tuberculosis with liver involvement, granulomatous hepatitis and local hepatic tuberculosis. Usually requires guided tissue sample with histopathological examination for diagnosis. Here we are reporting a case of hepatic tuberculosis with multiple hepatic nodules who presented with fever and non specific symptoms and treated with anti-tubercular drugs followed by resolve of signs and symptoms.

American Journal of Medical Case Reports. 2014, 2(12), 303-305. DOI: 10.12691/ajmcr-2-12-11
Pub. Date: December 29, 2014

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Groove Pancreatitis or Pancreatic Neoplasm: A Surgical Dilemmas

by Eugenio Morandi, Marco Castoldi, Carlo Corbellini, Michela Monteleone, David Alessio Merlini, Gianandrea Vignati and Paolo Declich

Case Report

Background: Groove pancreatitis (GP) is a rare condition characterized by inflammatory fibrosis of the space between the dorsal-cranial part of the head of the pancreas, duodenum and common bile duct. Surgery is often the choice of treatment. Case report: A 44-year-old male patient with a history of a high alcoholic intake came with epigastric pain associated with a weight loss. An abdominal ultrasonography, a computer tomography (CT) and a gastro-duodenoscopy showed a mass of the pancreatic head with duodenal infiltration suggesting for adenocarcinoma of the pancreas. An endoscopic ultrasound - fine needle aspiration (EUS-FNA) did not show any sign of chronic inflammation. The patient underwent Whipple procedure. Histologic examination confirmed chronic inflammation in the groove area with a ruptured pancreatic-type cyst and some pseudocysts in depth of the wall. Conclusion: The diagnosis of GP is challenging. Radiological and endoscopic findings and symptoms are often not specific and they could also be present in patients with adenocarcinoma of the pancreas. The pancreaticoduodenectomy is often the choice of treatment when symptoms do not improve or when there is uncertainty over the diagnosis.

American Journal of Medical Case Reports. 2014, 2(12), 298-302. DOI: 10.12691/ajmcr-2-12-10
Pub. Date: December 28, 2014

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Extending the Use of a Diagnostic Occlusal Splint to overcome Existing Lacunae of Vertical Dimension Transfer in Full Mouth Rehabilitation Cases

by Nupur Rathi, Khurshid Mattoo and Shalya Bhatnagar

Case Report

Full mouth rehabilitation involving an increase in vertical dimension of occlusion presents lacunae in accurate and definite transfer of diagnosed and verified vertical dimension of occlusion, biologically compatible with the stomatognathic system. Currently, vertical dimension to be incorporated within the restorations is done arbitrarily by adjustment of vertical pin of articulators in the laboratory, which is graduated in difference of a minimum of 1 mm. This article describes an innovative and extended use of a diagnostic occlusal splint to overcome the lacunae. The technique utilizes the diagnostic occlusal splint to transfer vertical dimensions at various stages of mounting of working casts thereby incorporating the clinically verified vertical dimensions in the final prosthesis. The technique involves splitting the diagnostic occlusal splint into anterior and posterior half. On the posterior half further centric relation records are then made. At the same time the technique described eliminates errors incorporated as a result of frequent use of face bow index record and/or arbitrary adjustment of the articulator as well as the difference between clinical determination of vertical dimension and the arbitrary laboratory adjustment on the articulator.

American Journal of Medical Case Reports. 2014, 2(12), 291-297. DOI: 10.12691/ajmcr-2-12-9
Pub. Date: December 24, 2014

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Intrathoracic and Intraabdominal Tuberculosis Lymphadenitis without Lung Involvement in an Immunocompetent Patient

by Qiyuan Dai, Jia Qin and Mohamed Abdulla

Case Report

Extrapulmonary tuberculosis (EPTB) is defined as tuberculosis (TB) affecting organs other than lung. The most common site of EPTB is the lymph node. In adults, lymphadenopathy without a lung parenchymal infiltrate is rare and is usually observed in immunocompromised patients. We report a case of a 53 years old non-immunocompromised women from affected by intrathoracic and intraabdominal tuberculosis lymphadenitis without lung involvement. The patient presented with subacute fever, night sweat, fatigue, anorexia, abdominal pain, and weight loss. The diagnosis was made by the combination of computed tomography (CT) scans and histopathology studies. CT scans showed multiple lymph nodes involvement in the mediastinal and abdominal areas. Histopathology studies showed necrotizing lymphadenitis with positive acid-fast bacilli stain. The patient responded to (rifampin, isoniazid, pyrazinamide, ethambutol) therapy well and was discharged five days after initiating the treatment.

American Journal of Medical Case Reports. 2014, 2(12), 288-290. DOI: 10.12691/ajmcr-2-12-8
Pub. Date: December 18, 2014

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Isolated Protein S Deficiency Presenting as Thromboembolic Pulmonary Arterial Hypertension in a Young Child

by Krishna Kumar Yadav, S N Singh and Anit Parihar

Case Report

A 13 months male child presented with progressive dyspnea of three months and recent cyanosis. Cardio-respiratory examination revealed tachypnea, cyanosis, left parasternal heave and loud P2. Echocardiography revealed thrombus in pulmonary artery and severe pulmonary arterial hypertension. Tests for throbmophilia demonstrated protein S deficiency. Treatment included anticoagulants, sildenafil, bosentan and supportive measures without embolectomy. The child get stabilized soon with echocardiographic evidence of thrombus resolution, however, tachypnea and oxygen dependency persisted. He discharged on bosentan, warfarin and home O2 inhalation. Follow-up CT pulmonary angiography showed organized thrombus in pulmonary artery and cystic lesions in lungs. During 14 months of follow-up he remained tachypneic and oxygen dependent despite discharge medication and additional sildenafil, and subsequently died of right ventricular failure and pulmonary hemorrhage. Thromboembolic pulmonary arterial hypertension due to protein S deficiency can present in early childhood and treatment with anticoagulants, bosentan and sildenafil without embolectomy may not be appropriate.

American Journal of Medical Case Reports. 2014, 2(12), 283-287. DOI: 10.12691/ajmcr-2-12-7
Pub. Date: December 17, 2014

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Idiopathic Encapsulating Peritoneal Sclerosis

by Raouf Hajji, Imed Ben Ghorbel, Amin Makni, Mohamed Jouini, Montassar Kacem, Zoubeir Ben Safta and Mohamed Habib Houman

Case Report

Encapsulating peritoneal sclerosis (EPS) also is a rare syndrome is usually characterized by a total or partial encasement of the small bowel by a thick ﬁbrotic membrane. It has primary or idiopathic and secondary types. Its clinical features are atypical and nonspeciﬁc; therefore, preoperative diagnosis is difficult. Herein, we present a case of a man who presented an idiopathic EPS conﬁrmed by a laparotomy and the histopathology and we detail its management and its outcomes after treatment.

American Journal of Medical Case Reports. 2014, 2(12), 280-282. DOI: 10.12691/ajmcr-2-12-6
Pub. Date: December 12, 2014

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Punctate Palmoplantar Keratoderma (Brauer-Buschke Fischer Syndrome) and Pituitary Adenoma

by Mouna ELLEUCH, Raouf HAJJI, Fatma DERBALI, Kais MNAFGUI, Noureddine LITAIEM, Naourez KAMMOUN, Nadia CHARFI and Mohammed ABID

Case Report

The type 1 punctate palmoplantar keratoderma/ Brauer-Buschke-Fischer syndrome (PKK 1) is a rare genodermatosis with a prevalence estimated at 1.17/100000. We report the case of a 70-year old patient, with type 2 diabetes, who presents a PPK 1 since the age of 30. Examination revealed an important family inbreeding, a significant family history as 38 members were affected by this disease: it was associated with different tumors (colorectal cancer, hepatocellular cancer and melanoma). Clinical examination showed multiple papular hyperkeratotic lesions with variable diameter between 2 and 10 mm on the palms and the soles. The histology confirmed the diagnosis of punctate palmo-plantar keratoderma. This patient presented at the age of 65 an acute adrenal insufficiency. Different explorations showed a non-secreting necrotic pituitary adenoma. In our knowledge, it is the first observation of association of PKK1 and pituitary adenoma. Its pathophysiological mechanism is still unclear. More studies are needed to will have to be clarify it.

American Journal of Medical Case Reports. 2014, 2(12), 276-279. DOI: 10.12691/ajmcr-2-12-5
Pub. Date: December 10, 2014

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Evaluation of Degree of Thanatophobia Associated with Prosthetic Rehabilitation of Oral Cancer Patients

by Khurshid A Mattoo and Rishabh Garg

Case Study

Psychosocial effects of oral cancer have been studied with less devotion to patient related problems like thanatophobia or fear of death in such individuals. Thanatophobia is measured using Death attitude profile (revised) along with four other dimensions of death. Fear of death that develops after definitive diagnosis of oral cancer has psychological impact and may affect patient compliance to any treatment. Oral cancers are mostly of squamous cell type which has high mortality rates as compared to other cancers of the oral cavity. Ten subjects treated for different types of oral cancer were followed prospectively and recalled after 1, 2, 3 and 6 months respectively. A questionnaire that would determine the degree of thanatophobia was filled by the patients and scored on a scale from 1 to 7 in the direction of strongly disagree (1) to strongly agree (7). Patients were found to have maximum fear at second month which declined at the end of six month.

American Journal of Medical Case Reports. 2014, 2(12), 272-275. DOI: 10.12691/ajmcr-2-12-4
Pub. Date: December 07, 2014

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Syncope in a Previously Healthy Young Adult: Undiagnosed Aortic Stenosis, Dilation and Coarctation Requiring Emergent Surgery

by Edlira Rruci, Andi Kaçani, Gentian Vyshka and Efrosina Kajo

Case Report

Aortic stenosis is a valvular heart disease that needs particular attention; due to the fact that asymptomatic patients may go undiagnosed for periods of time long enough to cause severe morbidity. On the other hand, aortic stenosis frequently is accompanied with other cardiac pathologies, such as a post-stenotic dilation, and coarctation. Imputed as a possible causative factor for sudden cardiac death, among other, aortic stenosis is a common finding in the setting of a bicuspid valve. We present the case of a previously young adult that suffered an episode of syncope during a football game. Exertion and sport activities are well-known situations that might provoke an abrupt manifestation of the latent valvular pathology. We dealt with an aortic stenosis of severe grade, accompanied with dilation and coarctation of aorta, in an individual with bicuspid aortic valve. A major heart surgery intervention was performed, with replacement of the valve, correction of the dilated arch and removal of the coarcted segment. Close follow-ups and monitoring are warranted even in asymptomatic patients, when the stenosis is uncovered as an incidental finding, during routine checkups.

American Journal of Medical Case Reports. 2014, 2(12), 269-271. DOI: 10.12691/ajmcr-2-12-3
Pub. Date: December 03, 2014

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Non-secretory Primary Plasma Cell Leukemia – A Case Report

by Amira Humeida, Ihsan M. Osman, Hiba A Awooda and Manal M. ElTahir

Case Report

Plasma cell leukemia (PCL) is a rare disease and the least common variant of multiple myeloma. It accounts for 2-3% of all plasma cell dyscrasias with poor prognosis. We report a 65 year old Sudanese lady presented to oncology clinic with complaint of inability to walk for 2 weeks. Laboratory findings showed anemia, thrombocytopenia and white blood cell count of 49.4x109/L, 62% of which were plasma cells. Bone marrow aspirate showed infiltration by 75% plasma cells some with abnormal forms, Immunophenotyping revealed plasma cell population which were CD38 and CD138 positive, surface, cytoplasmic kappa and lambda were negative. Plasma protein electrophoresis was normal denoting it as non-secretory plasma cell leukemia. Unfortunately the patient passed away before doing further investigations or receiving any treatment.

American Journal of Medical Case Reports. 2014, 2(12), 266-268. DOI: 10.12691/ajmcr-2-12-2
Pub. Date: December 03, 2014

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Compartment Syndrome and Rhabdomyolysis Presenting with the Rare Pseudo-Infarction Pattern of Hyperkalemia

by Richard Pescatore, Mark Robidoux, Robert Cole, Brett Waldman and Catherine Ginty

Original Research

The rapid identification and treatment of patients with ST-segment elevation myocardial infarction (STEMI) is a priority for emergency department providers. Occasionally conditions other than acute coronary syndrome (ACS) can mimic the presence of ST-elevation on electrocardiogram (ECG), making the accurate identification of these patients challenging. We present a case in which severe metabolic derangements resulted in a rare pseudo-STEMI pattern on ECG. A 26 year old male was found at home by family after a reported fall. A pre-hospital ECG conducted by EMS personnel indicated STEMI and the cardiac catheterization team was activated prior to patient arrival. Before undergoing PCI, laboratory values revealed severe hyperkalemia and rhabdomyolysis. Treatment of the patient’s hyperkalemia resulted in resolution of ECG abnormalities. The patient later developed acute compartment syndrome and underwent emergent fasciotomy. This case demonstrates the rare pseudo-infarction pattern of hyperkalemia and underscores the importance of clinical context in the initial evaluation of the emergency patient.

American Journal of Medical Case Reports. 2014, 2(12), 262-265. DOI: 10.12691/ajmcr-2-12-1
Pub. Date: December 02, 2014

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