American Journal of Medical Case Reports

Background: Mediastinitis is an inflammatory process that can be presented acute or chronic. Acute mediastinitis occurs secondary due to esophagus perforation or induced by infections of odontogenic or retrapharyngealorigins. The most common form is the postsurgical mediastinitis after cardiovascular interventions. Descending necrotizing mediastinitis and acute infectious mediastinitis has often a fulminate and fatal course. Chronic mediastinitis (or sclerosing fibrosing mediastinitis) appears to be associated with long standing mediastinitis, which induces collagenous and fibrous overgrowth. Case Report: Forty-one year-old male patient without significant past medical history presented with 2-weeks history of progressive shortness of breath, productive cough, generalized dental pain and, facial swelling. In the further workup he was found to have an acute odontogenic mediastinitis complicated by deep neck abscess after recent history of dental extraction. Hospital course included respiratory failure induced by sepsis and possible airway compression from the deep neck abscess. He was intubated, placed on mechanical ventilation, and required multiple surgical interventions including but not limited to drainage, chest tubes, and thoracentesis. Intravenous antibiotic treatment with Metronidazole and Ceftriaxone was initiated. After long-standing treatment his condition improved and was discharged home. Conclusion: Odonotogenic mediastinitis with deep neck abscess should be considered in patients with recent tooth aches/infection or dental surgery. Early recognition, surgical, and antimicrobial treatment are implemented with good prognosis and outcome.

American Journal of Medical Case Reports. 2014, 2(2), 44-47. DOI: 10.12691/ajmcr-2-2-5
Pub. Date: March 21, 2014

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Prolonged Coma after Single, Unintentional Overdose of Insulin: Concurring Factors Leading to a Persistent Neurological Condition

by Luljeta Çakërri, Elira Myrtaj, Gentian Vyshka and Florian Toti

Case Report

We refer the case of a 62-year old female diabetic patient, under insulin therapy since twelve year. She was found unconscious from her husband and the emergency team assisting the patient on site found a newly opened insulin vial of 10 ml half empty. Supposedly she had injected almost five ml of insulin glargine, with a total of 500 UI of insulin, and the plasma glucose value of 29 mg/dl supported the overdose diagnosis. The patient was emergently admitted in an intensive care unit with profound hypoglycemia and hypokalemia, and in deep coma. Dextrose bolus and continuous infusions normalized her glycemic levels only after three days of uninterrupted perfusions, with the patient remaining in coma for another two days after glycemia normalization. Discharged with a paraparetic gait as neurological sequelae, she improved considerably within the next month from the event. The reason of overdose was not clearly formulated, but a tricyclic antidepressant was added on in the therapy after psychiatric consultancy was obtained.

American Journal of Medical Case Reports. 2014, 2(2), 41-43. DOI: 10.12691/ajmcr-2-2-4
Pub. Date: March 19, 2014

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Effect of Intravitreal Moxifloxacin in Acute Post Traumatic Endophthalmitis

by Muhammad Khizar Niazi, Muhammad Dawood Khan, Muhammad Aamir Arain, Lubna Adeeb and Shazia Yasir

Case Report

We describe results of intravitreal moxifloxacin in a case of acute post traumatic endophthalmitis & cataract developed after sustaining a penetrating ocular injury. Management included topical and intravitreal moxifloxacin. The intravitreal injection was given at the time of presentation and then was repeated after 48 hours when lens aspiration and anterior vitrectomy was performed. The patient showed a rapid recovery, and achieved 6/6 vision following surgery. To our knowledge this is the first reported case of therapeutic use of intravitreal moxifloxacin in a human case of acute post traumatic endophthalmitis. Presentation of Case: We report a case of a twenty one year old male referred to us with two days history of penetrating injury in left eye due to a piece of metallic wire. After five days of hospitalization, he was discharged with 6/6 partial best corrected vision. Consent: The patient and his family have given informed consent for the publication of this case report.

American Journal of Medical Case Reports. 2014, 2(2), 39-40. DOI: 10.12691/ajmcr-2-2-3
Pub. Date: March 09, 2014

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Non-Hodgkin's Lymphoma Complicated with Marked Hypercalcemia Caused by Parathyroid Hormone Related Protein, Presenting with Adams-Stokes Attack

by Motoharu Shibusawa, Sayuri Motomura, Hiroko Hidai, Hidetaka Ina, Satoshi Murasaki and Hisashi Tsutsumi

Case Report

A rare case of non-Hodgkin's lymphoma (NHL) complicated with marked hypercalcemia caused by parathyroid hormone related protein (PTHrP) and presenting with Adams-Stokes attack is reported. A 72-year-old woman was involved in a traffic accident, and was transferred to our hospital. Blood examination revealed marked hypercalcemia (5.3 mmol/l (21.3 mg/dl)). A diagnosis of NHL (B-cell lymphoma, clinical stage IVA) was made by the results of the bone marrow biopsy, CT features showing multiple masses, and the gallium scintigraphy showing strong accumulation. Because of high blood level of PTHrP, hypercalcemia was considered to be due to PTHrP as a mediator acting on calcium metabolism. Hypercalcemia complicated with malignancy has a risk resulting in a fatal outcome. In the cases of malignant lymphoma complicated with hypercalcemia, we should pay attention to PTHrP as a mediator.

American Journal of Medical Case Reports. 2014, 2(2), 35-38. DOI: 10.12691/ajmcr-2-2-2
Pub. Date: March 04, 2014

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Pernicious Anemia: Non – Gastroscopic Diagnosis of Autoimmune Atrophic Gastritis with Positive Serological Marker

by Shazia Yasir, Komal Owais, Faisal Moin, Mahmud Z. Jilani, Ejaz Ahmad Vohra and Abdul Ghani

Case Report

For the last many decades pernicious anemia has been treated as a separate clinical feature. Pernicious anemia is also known as macrocytic anemia which originates due to the lack of vitamin B12 (cobalamin). A protein called intrinsic factor which helps vitamin B12 for its absorption through terminal ileum so, the deficiency of intrinsic factor result in a lack of vitamin B12 absorption, which, in turn, causes pernicious anemia. The gastric parietal cell normally produces chlorhydric acid and intrinsic factor. Atrophic body gastritis (ABG) is a condition which cause the destruction of the oxyntic mucosa and the reduction of the parietal cell hence result in the deficiency of intrinsic factor . Pernicious anemia can present in many different clinical patterns like fatigue (tiredness), headache, dizziness, shortness of breath, pale or yellowish skin, coldness in your hands and feet, and chest pain. Presentation of Case: We report a case of a 55 year old male who presented with one month history of fatigue ness, dizziness, abdominal pain and short of breath on exertion. On further investigation, it is turnout to be atrophic gastritis which is treated conservatively.

American Journal of Medical Case Reports. 2014, 2(2), 32-34. DOI: 10.12691/ajmcr-2-2-1
Pub. Date: February 28, 2014

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