American Journal of Medical Case Reports

Staphylococcus aureus (S. aureus) is a versatile pathogen capable of producing several types of toxins often associated with food poisoning and life-threatening infections. We herein describe the case of a 69-year-old non-diabetic woman presented with diarrhea, buttock pain and fever, which was finally identified as an iliopsoas abscess. Blood and pus cultures were positive for methicillin-resistant S. aureus. Following a full course of antibiotics and abscess drainage, our patient recovered uneventfully. Complications of S. aureus bacteremia are often difficult to identify. Clinical picture of psoas abscess is nonspecific and the common role of S. aureus playing for septic manifestations is complicated. Raised awareness, early diagnosis, and appropriate treatment are crucial to avoid debilitating complications and mortality associated with S. aureus infection.

American Journal of Medical Case Reports. 2015, 3(11), 383-386. DOI: 10.12691/ajmcr-3-11-10
Pub. Date: November 02, 2015

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Hematemesis in a Child on Olanzapine

by Richard Pescatore DO, Dunisha Ranasuriya MD, Lisa Drago DO, Julie Whitney DO and Sandra Nairn DO

Case Report

The case of a 13-year old boy with hepatic steatosis secondary to atypical antipsychotic use is described. The patient presented with a single episode of moderate-volume hematemesis and was found to have severe fatty infiltration and ductal dilatation of the liver. These changes were attributed to the patient’s use of olanzapine for behavioral disorders related to autism spectrum disorder. The differential diagnosis of pediatric hematemesis is described, as well as the importance of considering adverse drug affects in patients maintained on olanzapine and other antipsychotics.

American Journal of Medical Case Reports. 2015, 3(11), 380-382. DOI: 10.12691/ajmcr-3-11-9
Pub. Date: November 02, 2015

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Surgical Treatment for Popliteal Artery Entrapment Syndrome, a Common Cause of a rare Clinical Entity: Report of One Case

by Osmar Max Gonçalves Neves, Fabio Guilherme Gonçalves Miranda, Wilson Barbosa Leão, João Batista Chaves Júnior and José Aderval Aragão

Case Report

Context: Popliteal artery entrapment syndrome (PAES) is a non-atherosclerotic cause of claudication and acute ischemia of the legs in young individuals. Objective: To report on a case of popliteal artery entrapment that was treated surgically. Case report: The patient was a 46-year-old hypertensive male diver who had been experiencing pain in his right leg for around six months, which worsened upon exertion. Physical examination showed absence of posterior tibial pulse and dorsal pulse in the right foot. Arterial duplex scan and angiotomography showed a popliteal artery with a tortuous path that passed behind the medial head of the gastrocnemius muscle, where its lumen was compromised when the knee was extended. This case of PAES was classified as type 1 and the surgical treatment implemented consisted of arterial decompression through sectioning the medial bundle of the gastrocnemius muscle, combined with a popliteal-to-popliteal graft from the great saphenous vein (inverted). Conclusion: Popliteal artery entrapment is a rare syndrome, but it may affect physically active young adults and worsen their quality of life. If this disease is suspected, diagnostic evaluation and surgical treatment need to be performed, and this will probably avoid the risk of losing the limb in cases of irreversible vascular injury.

American Journal of Medical Case Reports. 2015, 3(11), 377-379. DOI: 10.12691/ajmcr-3-11-8
Pub. Date: October 20, 2015

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Osteochondritis Dissecans Treated With Autograft Cartilage Transplantation System (Mosaicplasty): MRI Contribution on Patient Follow-up - Case Report

by Francisco Abaete Chagas-Neto, Francisco Jose Magalhaes Pinto, Claudia Fontenele Bruno, Elizabeth Maria de Araujo Lucena Tenorio, Izabel Rene Leitao, Afonsina Pereira de Aquino and Marcello Henrique Nogueira-Barbosa

Original Research

Articular cartilage injuries may be caused by several mechanisms, including metabolic, genetic, vascular and traumatic events. A single episode of knee trauma or chronic and repetitive mechanical stress overloading the subchondral bone can start the process. The authors report a case of a young male patient with regular exercise routine, diagnosed with osteochondritis dissecans after sudden severe right knee pain. This patient underwent surgical treatment with autograft cartilage transplantation (mosaicplasty). Comparison between initial MRI, one-‐year and two-‐year follow-‐up MRIs was performed. This case report illustrates the importance of the MRI in the evaluation of mosaicplasty treatment for osteochondritis dissecans. We further discuss prognostic factors related to chondral repair and MRI assessment of implant integration.

American Journal of Medical Case Reports. 2015, 3(11), 374-376. DOI: 10.12691/ajmcr-3-11-7
Pub. Date: October 15, 2015

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Carcinoma Causing Thrombotic Thrombocytopenic Purpura and Myelonecrosis: A Very Rare Event

by Ilknur Nizam, Mehmet Ali Erkurt, Ilhami Berber, Mustafa Koroglu, Emin Kaya, Irfan Kuku and Nese Karadag

Case Report

We report a case of thrombotic thrombocytopenic purpura (TTP) which was explored to be the clinical presentation of carcinoma. Plasma exchange therapy failed to respond for the patient, so bone marrow aspiration and biopsy were performed to find out the reason of microangiopathic hemolytic anemia. Bone marrow examination revealed non hematopoetic cell infiltration and myelonecrosis. Carcinoma metastasis was demonstrated at bone marrow trephine biopsy. The primary tumor was found at small bowel after scanning for the source of tumor by computerized tomography.

American Journal of Medical Case Reports. 2015, 3(11), 372-373. DOI: 10.12691/ajmcr-3-11-6
Pub. Date: October 15, 2015

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A Rare Presentation of Lymphoma: Pancreatic and Thyroid Involvement

by Semra Ayturk, Mehmet Celik, Nuray Can, Ebru Tastekin, Onur Mert, Ahmet Kucukkarda, Atakan Sezer, Sibel Guldiken and Armagan Tugrul

Case Report

Primary thyroid lymphoma is a rare form of thyroid malignancies. It is usually seen in middle aged and elderly females. Its diagnosis is not always easy because it is rare and has not specific signs and symptoms. The risk of development of thyroid lymphoma is higher after Hashimoto’s thyroiditis. The most common form of thyroid lymphoma is diffuse large B cell lymphoma. Patients may present with obstructive symptoms due to progressive growth of mass. In the present report, we aimed to present a 59-year-old female patient admitted with rapidly growing neck mass, severe dyspnea, stridor and dysphagia.

American Journal of Medical Case Reports. 2015, 3(11), 367-371. DOI: 10.12691/ajmcr-3-11-5
Pub. Date: October 13, 2015

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Catamenial Haemothorax Masquerading Pulmonary Tuberculosis? A Case Report of a 28 Year Old Woman who Presented with Recurrent Haemothorax and Empyema Thoracis

by Solomon Gumanga, Godfred Takyi, Hakeem Ofosu, Sunday Imogie and Bill Koomson

Case Report

Catamenial haemothorax is a clinical manifestation of endometriosis of the pleural cavity. This is a case report of a 28 year old woman who presented with recurrent catamenial haemothorax who had histological confirmation of pelvic endometriosis and uterine leiomyoma. A presumptive diagnosis of catamenial haemothorax was made as it was not possible to get a histological confirmation of endometriosis of the pleural cavity. She was treated effectively with gonadotropin-releasing hormone GnRH agonist-leuprorelin. Antituberculosis treatment was however added when she developed empyema thoracis instead of haemothorax at a time she was experiencing amenorrhoea. Pulmonary tuberculosis being an endemic disease remained the main differential diagnosis but was never confirmed at any stage by investigations conducted. She has since not experienced any recurrence in eighteen months of follow-up after treatment was completed. Conclusion: Pulmonary or thoracic endometriosis though rare; should be considered seriously in women of reproductive age who present with recurrent catamenial haemothorax. Due to obscured locations of the endometriosis lesions in the thoracic cavity; the diagnosis may be difficult to confirm since access to investigative tools is limited in developing countries.

American Journal of Medical Case Reports. 2015, 3(11), 362-366. DOI: 10.12691/ajmcr-3-11-4
Pub. Date: October 09, 2015

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Atypical Manifestations of Visceral Leishmaniasis in Children

by Estibaliz Valdeolmillos, Belén Borrell, Francisco J. Merino, Begoña Corral and Cristina Calvo

Case Report

Visceral leishmaniasis (VL) or kala-azar is an endemic parasitic disease caused predominantly, in its Mediterranean type, by Leishmania infantum. Fever and splenomegaly are the most common clinical manifestations, detected in more than 80% of patients. We present two cases with atypical manifestations, without fever and with spleen nodules in the context of an outbreak of VL in Spain.

American Journal of Medical Case Reports. 2015, 3(11), 359-361. DOI: 10.12691/ajmcr-3-11-3
Pub. Date: October 08, 2015

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Recurrent Respiratory Papillomatosis Successfully Treated with Gefitinib: A Case Study

by Kultan J., Kolek V., Fajkosova L., Hajduch M., Drabek J., Tichy T. and Tachezy R.

Case Report

Background: Recurrent respiratory papillomatosis (RRP) is a rare condition caused by infection of the respiratory tract mucosa with human papillomaviruses. The disease is characterized by a growth of mucosal papillomas, mostly in the laryngeal region and rarely in the more distal parts of the airways. The therapy is often difficult, including both mechanical removal of papillomas and pharmacological therapy. Methods: Presented in the article is a case of regression of papillomatosis in the larynx, trachea and lung parenchyma after administration of gefitinib, an endothelial growth factor receptor inhibitor. The literature review is added into this article to give more information about the etiology, clinical features and treatment. Results: The authors report a case of 42-year-old Caucasian female, recurrent respiratory papillomatosis was diagnosed in her first year of life. Papillomas were primarily diagnosed in the vocal cord region. Both pharmacological and frequently repeated invasive treatment brought no effective solution; by contrast, papillomas spread to the distal airways. A decision to administer gefitinib was made after other treatment modalities had failed. As early as two months later, the therapeutic effect was observed, with regression of both laryngotracheal and pulmonary involvement. Conclusions: Tyrosine kinase inhibitors of epidermal growth factor receptor represent a new treatment possibility for a long-term benefit for patients with recurrent respiratory papillomatosis in whom other modalities failed.

American Journal of Medical Case Reports. 2015, 3(11), 352-358. DOI: 10.12691/ajmcr-3-11-2
Pub. Date: October 08, 2015

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A Rapidly Growing Pseudoaneurysm Secondary to Aortic Arch Periaortitis

by Rong-Hsin Yang, Chien-Hsin Ting and Yum-Kung Chu

Case Report

We herein report a case of rapidly growing pseudoaneurysm developed shortly after a diagnosis of aortic arch periaortitis. Pseudoaneurysm is a blood leak constrained by compliance of perivascular tissues, in persistent communication with the feeding artery. Chronic periaortitis is characterized by inflammatory involvement of the outer layer of the aorta and surrounding tissues. The major pathogenetic process leading to periaortitis is inflammation, caused by advanced atherosclerosis. Autoimmunity has been proposed as a contributing factor. The present case illustrates an ongoing process of aortic arch periaortitis toward aneurysm formation. Aortic arch pseudoaneurysm is highly susceptible to rupture and sudden death. Our patient achieved a complete remission by a month after receiving an endovascular stent repair and combined treatment with steroid and antibiotics. The disease process was documented by serial CT and radionuclide scanning.

American Journal of Medical Case Reports. 2015, 3(11), 347-351. DOI: 10.12691/ajmcr-3-11-1
Pub. Date: September 24, 2015

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