American Journal of Medical Case Reports

Clinical deterioration during treated with anti-tuberculosis drug (ATD) is not common occured in immunocompetent children, remains a great dilemma. It requires medical attention, practitioners should be considered as multi-drug resistant tuberculosis (MDR-TB) or paradoxical response. We report a challenging case of a-12-year-old girl presented with clinical deterioration severe respiratory distress transferred to isolated pediatric intensive care unit while on TB treatment. On admission, chest X-ray revealed pneumothorax in left lung and bilateral pulmonary infiltration. During evalution, she had seizure and decreased consciousness, and later diagnosed as as tuberculous meningitis (TBM). She had close contact with her acid–fast bacillus (AFB)–positive, Gene Xpert MTB/RIF negative-mother. Five other siblings were diagnosed as having TB as well. The patient was first suspected as having MDR-TB, while Gene Xpert MTB/RIF test revealed still positive. The patient then showed good clinical improvement after TB treatment.

American Journal of Medical Case Reports. 2015, 3(10), 344-346. DOI: 10.12691/ajmcr-3-10-10
Pub. Date: September 18, 2015

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Aortic Dissection with Hemopericardium and Thrombosed Left Common Iliac Artery Presenting as Acute Limb Ischemia: A Case Report and Review

by Vinod Namana, Ram Balasubramanian, Pramod Theetha Kariyanna, Rajeswer Sarasam, Sruthi Namana and Vijay Shetty

Case Report

Aim: An aortic dissection is an uncommon serious condition, which usually presents with chest pain or upper back pain. Symptoms of aortic dissection may mimic those of other diseases, often leading to delay in diagnosis. Methods: We report an unusual case of aortic dissection with hemopericardium and thrombosed left common iliac artery presenting as acute limb ischemia. Conclusion: Maintaining a high index of clinical suspicion for aortic pathology could possibly lead to identification and timely management of a greater number of patients who have atypical presentations. This would be especially true for patients who have catastrophic presentations with unexplained symptoms.

American Journal of Medical Case Reports. 2015, 3(10), 338-343. DOI: 10.12691/ajmcr-3-10-9
Pub. Date: September 16, 2015

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Efficiency of Thrombodynamics for Analysis of Hemostasis in Case of Transitory Ischemic Attack after Radio-frequency Ablation in a Patient with Paroxysmal Atrial Fibrillation

by Tatiana Vuimo, Eugny Belikov, Olga Litinskaya and Karapet Davtyan

Case Report

Efficiency of thrombodynamics for analysis of hemostasis in case of transitory ischemic attack after radio-frequency ablation in a patient with paroxysmal atrial fibrillation.

American Journal of Medical Case Reports. 2015, 3(10), 333-337. DOI: 10.12691/ajmcr-3-10-8
Pub. Date: September 15, 2015

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Recurrent Nasal Sebaceous Carcinoma in Human Immunodefiency Virus/ Hepatitis B Virus (HIV/HBV) Coinfection Patient: A Case Report

by Adel Alothman and Hythum Salah H. Mohamed

Case Report

Background: Human Immunodefiency Virus (HIV) since the first case was reported is recognized as a major risk factor for development of different types of malignancies, Sebaceous carcinoma is a rare and aggressive form of cutaneous carcinoma and very rare in HIV Patients. Method: A case report and literature review of 46 years old male, known to have HIV/HBV coinfection presented with a history of four months of gradual growth Nasal mass. Result: Excisional biopsy performed for the nasal mass and histopathology examination showed sebaceous cell carcinoma, Surgical removal of the nasal mass was done and nasal reconstruction with right paramedian forehead flap plus full thickness skin graft taken from the abdomen for reconstruction of the inner nose also was done, after two years patient came back with recurrent at same site. Conclusion: sebaceous cell carcinoma is an extremely rare in HIV patients, but should be considers for any skin tumor in HIV patient, follow up also needed for the risk of recurrent.

American Journal of Medical Case Reports. 2015, 3(10), 329-332. DOI: 10.12691/ajmcr-3-10-7
Pub. Date: September 21, 2015

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Impact Of the 2014/2015 Ebola Virus Disease Epidemic on Malaria Cases and Control in Some West African Countries. A Mini Review

by Ukpai O. M and Ubiaru P.C.

Review Article

Ebola hemorrhagic Disease (EHD) is a severe, often fatal disease in humans and nonhuman primates (monkeys, gorillas, and chimpanzees) that has appeared sporadically since its initial recognition in 1976. Malaria is a life-threatening disease caused by Plasmodium that is transmitted to people through the bites of infected mosquitoes. Increased malaria prevention and control measures are dramatically reducing the malaria burden in many places. Disease outbreaks and catastrophes can affect countries at any time, causing substantial human suffering, deaths, and economic losses. Ebola virus disease outbreak in Western African countries; Guinea, Liberia and Sierra Leone caused the cases of malaria to increase and death rate from malaria also increased in that region. Capacity health systems and external health related aid to Guinea, Liberia and Sierra Leone increased in combating the disease neglecting malaria. The lack of balanced investment in the health systems contributed to the challenges of controlling and combating malaria cases. Ebola caused a spike in malaria cases in the three West African countries heavily affected by the disease which have undermined previous efforts to curb malaria. Thousands of malaria cases went untreated in Guinea in 2014 as people with symptoms avoided health clinics for the fear of being sent into isolation at Ebola treatment centers as the early symptoms of malaria mimic those of Ebola virus disease. Ebola overwhelmed health care systems in the year 2014, making adequate care for malaria impossible and disrupted the distribution of bed nets in the affected areas. Rather than label one disease as more important than the others, equal attention or near equal attention should be given to all the diseases of the public health concern to lower the death tolls for all of them. Malaria control efforts must be kept on track during an Ebola epidemic so that progress made in malaria control is not jeopardized.

American Journal of Medical Case Reports. 2015, 3(10), 325-328. DOI: 10.12691/ajmcr-3-10-6
Pub. Date: September 14, 2015

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Rickettsia (Spotted Fever Group) Infection with Multiorgan Dysfunction

by Anuj Sarma

Case Report

In recent times Rickettsial disease has been an important cause of re-emerging infection all over the world. On most occasion they are difficult to diagnose as their presention resembles that of viral, bacterial or protozoal diseases. This may lead to unnecessary investigation and treatment and may lead to considerable morbidity, irreversible damage to vital organ and finally death if not treated earlier. However the positive aspect of this condition lies in the fact that they can easily be diagnosed by cheap, inexpensive blood test (Weil Felix test) and can be treated with less expensive oral drugs like doxycycline if high degree of suspicion is maintained. Here I present a case of rickettisia infection caused by spotted fever group who came with fever, rash, multiorgan dysfunction diagnosed outside as viral fever but was successfully treated in our icu with complete recovery.

American Journal of Medical Case Reports. 2015, 3(10), 322-324. DOI: 10.12691/ajmcr-3-10-5
Pub. Date: September 14, 2015

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Exceptional Cause of Massive Lymph Node Enlargement: Primary Localized Amyloidosis

by Imene Boukhris, Samira Azzabi, Ines kechaou, Eya Chérif, Chékib Kooli, Nédia Znaidi, Lamia Ben Hassine and Narjess Khalfallah

Case Report

Amyloidosis is very rarely the cause of lymph node enlargement. In the localized form of the disease, amyloidosis commonly attains the bladder, the lung and the skin. Lymph node amyloid deposition is very unusual in the localized form of the disease. In particular, cervical and mediastinal sites are uncommon. We report an exceptional case of primary localized AL amyloidosis presenting as generalized lymph node enlargement. Our patient was initially treated by colchicine but in front of disease progression, a treatment with prednisone and melphalan was necessary for stabilization. Clinician should consider primary amyloidosis in the check-list of etiologies causing lymph node enlargement.

American Journal of Medical Case Reports. 2015, 3(10), 319-321. DOI: 10.12691/ajmcr-3-10-4
Pub. Date: September 14, 2015

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Spontaneous Intracranial Hypotension Following a Yoga Class: A Case Report

by Blumer V, Rosemberg D, Kaswan E and Lustgarten L

Case Report

Spontaneous intracranial hypotension (SIH) is an underdiagnosed syndrome and initially missed cause of headaches. The classical presentation is that of an orthostatic headache, mainly caused by spontaneous and difficult to detect spinal CSF leaks. The current case report describes a 38 year old female patient who presented with symptoms following a Yoga class. Despite being initially misdiagnosed, her clinical course and radiological findings made it clear that she had intracranial hypotension syndrome with bilateral chronic subdural hematomas and cerebellar descent. She responded to surgical drainage of both her subdural hematomas and conservative management for her suspected CSF leak. This case, to our knowledge, is the first report in the literature of spontaneous intracranial hypotension being caused by a Yoga class. The report highlights the fact that some cases of SIH can be difficult to diagnose as their symptoms may be very confusing. Thorough interrogation of patients is vital, as trivial efforts and some exercising activities could be the cause of spontaneous dural tears. Early recognition is important to prevent unnecessary investigations and procedures, and to minimize delay in treatment.

American Journal of Medical Case Reports. 2015, 3(10), 314-318. DOI: 10.12691/ajmcr-3-10-3
Pub. Date: September 07, 2015

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Laparoscopic Transhiatal Transabdominal Resection of Epiphrenic Diverticulum – A Case Report and Review of the Literature

by Hadjicostas Panayiotis, Christou Demetris, Nicolaou Nicolaos, Christodoulou Tasos and Papantoniou Adamos

Case Report

Epiphrenic diverticula are outpouchings of the distal third of the oesophagus and represent an uncommon benign oesophageal disease, the rarest of all oesophageal diverticula. Because of its rarity, the surgical treatment options and the directions towards management of complications, if sustained, only come from sporadic case reports in the literature. We report a case of a 52 year old patient with epiphrenic diverticulum treated with laparoscopic transhiatal transabdominal diverticulectomy complicated with a post-operative leak from the staple line which was managed conservatively. The challenges of surgical treatment and the recommendations towards management of complications are emphasised in this case report.

American Journal of Medical Case Reports. 2015, 3(10), 310-313. DOI: 10.12691/ajmcr-3-10-2
Pub. Date: September 07, 2015

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Amelioration of Autism by Autologous Bone Marrow Mononuclear Cells and Neurorehabilitation: A Case Report

by Alok Sharma, Nandini Gokulchandran, Hemangi Sane, Avantika Patil, Akshata Shetty, Hema Biju, Pooja Kulkarni and Prerna Badhe

Case Report

Autism is a clinically and etiologically heterogeneous disorder characterized by deficits in social interaction, communication, behavior and cognitive skills. The etiological basis of autism still remains poorly understood despite several attempts to decipher its neuropathology from different perspectives. Presently available treatment modalities address only limited autism-associated symptoms and are at best palliative. In this report, we present the case of a 7 year old boy with autism treated with intrathecal administration of autologous bone marrow derived mononuclear cells (BMMNCs). On regular follow ups conducted at 3 and 6 months post-treatment, clinically significant behavioral, social, communication and cognitive improvements were reported. These findings were well supported by objective improvements on the Indian Scale of Assessment of Autism (ISAA), Childhood Autism Rating Scale (CARS), Clinical Global Impression (CGI) and Pediatric Functional Independence Measure (WeeFIM). The ISAA score improved from 131 to 112, CARS improved significantly from 40.5 (severely autistic) to 32 (mild to moderate autism), along with an improved WeeFIM score from 31 to 36. Severity of illness on CGI (CGI I) changed from 4 (moderately ill) to 3 (mildly ill). Global improvement on CGI (CGI II) was measured at a score of 2 (much improved), along with an efficacy index (CGI III) of 5 showing moderate therapeutic effect. No adverse events were reported throughout the course of the treatment. Through this case report, we demonstrate that treatment with autologous BMMNCs is safe, feasible and has the potential to ameliorate autism.

American Journal of Medical Case Reports. 2015, 3(10), 304-309. DOI: 10.12691/ajmcr-3-10-1
Pub. Date: September 04, 2015

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