American Journal of Medical Case Reports

Ceftriaxone is commonly used in pediatric practice and has been associated to biliary pseudolithiasis, nephrolithiasis and bladder sludge. We report a case of a 5-month old male toddler previously treated with high ceftriaxone doses for interstitial pneumonia; after one week an improvement of respiratory symptoms was noticed but extreme agitation and excessive crying occurred. He eliminated small white crystals that were found in the diaper and were proven to be constituted from calcium carbonate; abdominal ultrasound showed also a hyperechoic image of 4 mm in the gallbladder. Laboratory data were within normal rangers except a slight increase of the urinary calcium and calcium/creatinine ratio. The patient didn’t have any risk factor for ceftriaxone- induced lithiasis except high dosage of the antibiotic together with idiopathic hypercalciuria. Antibiotic interruption together with hydrochlorothiazide, adequate hydration and antispasmodics led to the remission of the symptoms and disappearance of the gallbladder image within 5 weeks. Ceftriaxone treatments should be routinely monitored by ultrasounds for the urinary and biliary system; appropriate dosage and administration with an adequate hydration are required.

American Journal of Medical Case Reports. 2015, 3(12), 422-424. DOI: 10.12691/ajmcr-3-12-11
Pub. Date: December 16, 2015

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Atypical Myositis Presenting with Peripheral Neuropathy

by Imene Boukhris, Samira Azzabi, Ines kechaou, Eya Chérif, Anis Hariz, Chékib Kooli, Lamia Ben Hassine and Narjes Khalfallah

Case Report

Necrotizing Autoimmune Myositis (NAM) is an Acute autoimmune disease of the proximal skeletal muscle. The increased rate of morbidity and mortality in NAM is related to the severety and extant of muscle weakness. Patients with NAM develop antibodies to a specific signal recognition particle (anti-SRP ab). Peripheral neuropathy is extremely rare during the course of the disease. We report the case of a 35 y old male, hospitalized for severe proximal and distal muscle weakness with positive anti-SRB ab and concomitant peripheral neuropathy. The outcome was severe respiratory failure and death.

American Journal of Medical Case Reports. 2015, 3(12), 419-421. DOI: 10.12691/ajmcr-3-12-10
Pub. Date: December 16, 2015

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Posterior Interosseous Nerve Compression Syndrome: Imaging Findings Highlights

by Jose Elmadan Albuquerque Barroso-Junior, Jovelino Coimbra-Neto and Francisco Abaete Chagas-Neto

Case Report

Posterior interosseous nerve (PIN) compression syndrome is a condition resulting from the compression of the deep branch of the radial nerve, which may lead to paresis or paralysis of the fingers and thumb. Anatomically, there are five potential sites for nerve compression in its course along the radial tunnel, the “Arcade of Fröhse” being the most usual. Clinically, patients start feeling pain in the lateral aspect of the elbow, which may be confused in the initial clinical diagnosis with lateral epicondylitis. The aim of this study is to present the case of a patient with clinical posterior interosseous nerve compression syndrome and to demonstrate that imaging studies can be used to localize and distinguish compressive neuropathy from other possible causes.

American Journal of Medical Case Reports. 2015, 3(12), 415-418. DOI: 10.12691/ajmcr-3-12-9
Pub. Date: December 07, 2015

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Vulvar Lipoma-A Rare Case Report

by Hasija Shweta, Khoiwal Susheela and Bilwal Bharat

Case Report

Lipomas are the most common benign tumor of soft tissues. Lipomas are usually soft, fluctuant, painless, subcutaneous lump measuring from 2-20cm diameter. However conventional lipomas have been reported, lipoma of vulva is a rare occurrence and very few cases have been reported in literature. We present a case of vulvar lipoma in 58 year old woman.

American Journal of Medical Case Reports. 2015, 3(12), 413-414. DOI: 10.12691/ajmcr-3-12-8
Pub. Date: December 04, 2015

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Uncommon Presentation of Non-Hodgkin’s Lymphoma of Maxillary Sinus: A Case Report

by Taoufik Adouly, Choaib Adnane, Tarek Oubahmane, Sami Rouadi, Redallah Abada, Mohamed Roubal and Mohamed Mahtar

Case Report

Non-Hodgkin’s Lymphoma is a group of neoplasms that originate from the cells of the lymphoreticular system. In 40% of cases, it arises from extranodal sites. The nasal cavities and paranasal sinuses are rarely affected by primary Non hodgkin’s lymphoma. We report the case of a 60-year-old man admitted for Non-Hodgkin’s Lymphoma of maxillary sinus. CT scan demonstrated an extensive lesion destroying the medial and anterior walls. The patient received 6 cycles of the chemotherapy. The follow-up for the last 1 year was normal without recurrence. The difficulty encountered in the diagnosis of this clinicopathological entity owing to its radiological and clinical expression, particularly the evolution was discussed. Though rare, the signs and symptoms of the case suggest that Non hodgkin’s lymphoma should be considered in the differential diagnosis of nasal cavity lesions.

American Journal of Medical Case Reports. 2015, 3(12), 410-412. DOI: 10.12691/ajmcr-3-12-7
Pub. Date: November 23, 2015

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Comparison of the Efficacy of Multi Level Cervical Discectomy and Corpectomy Using Titanium Cage with and without Anterior Cervical Plate

by Ali Mahad Musallam Al-Mashani, Santosh Lad, Neeraj Salhotra, Azmat Ali, Rashid M Khan and Naresh Kaul

A Clinical Study

Cervical corpectomy/discectomy is a well-recognized treatment option for multilevel anterior compression of the cervical spinal cord. We undertook a retrospective study of 47 patients treated with anterior cervical discectomy/corpectomy fusion for multi-level cervical spondylosis. Titanium mesh was placed in all patients with (Anterior cervical plate group: n= 25) or without anterior cervical plate (Non-anterior cervical plate group: n= 22)). The study objective was to compare the role of anterior cervical plate on clinical outcome, fusion rates, and complications if any after anterior cervical discectomy/corpectomy. At an average follow up time of 7 months after the surgery, we did not observe any significant difference in clinical outcome as per Odom’s score or bony fusion between the two groups (p>0.05). The bony fusion rate was 59.1% and 68.0% with and without ACP respectively. The finding of this study suggests that presence of anterior cervical plate does not contribute to better Odom’s score or bony fusion.

American Journal of Medical Case Reports. 2015, 3(12), 406-409. DOI: 10.12691/ajmcr-3-12-6
Pub. Date: November 23, 2015

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Unclassified Avulsion Injury of the Flexor Digitorum Profundus Tendon

by Nedhal Abdullah Alqumber and Eman Hassan Albahhar

Case Study

Traumatic avulsions of the flexor digitorum profundus tendon are usually presented in young adults engaged in athletic activities like football. Increased attention to injuries acquired during this form of activity is suggested. In this report the authors present a case of pure avulsion of the FDP with tendon retraction to the level of PIP (type II) and concomitant transverse fracture to distal phalanx secondary to injury during motor cycle accident.

American Journal of Medical Case Reports. 2015, 3(12), 403-405. DOI: 10.12691/ajmcr-3-12-5
Pub. Date: November 21, 2015

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Giant Prolactinoma: Case Report and Review of Literature

by Khalid S.Aljabri, Samia A. Bokhari and Ahmad Akl

Case Report

Prolactin (PRL) secreting adenomas are the most common secreting pituitary tumors, accounting for approximately 45% of all pituitary tumours. Giant prolactinomas are a rare subset of macroadenomas, characterized by large size (more than 40 mm in diameter (an arbitrary size), high aggressiveness and massive extrasellar involvement. We describe an unusual giant prolactin producing macroadenoma of pituitary gland in female patients with type 2 diabetes mellitus and its response to cabergoline.

American Journal of Medical Case Reports. 2015, 3(12), 399-402. DOI: 10.12691/ajmcr-3-12-4
Pub. Date: November 17, 2015

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A Fatal Case of Multiple Mycotic Aortic Aneurysms Following Septic Arthritis and Complicated by Aneurysm Rupture and Aortoenteric Fistula

by Mokhtarodin Shakibani, Hassan Tahir and Vistasp daruwalla

Case Report

Mycotic aneurysms are rare infectious vascular disorders, which predominantly occur in aorta and peripheral vessels. Clinically apparent mycotic aneurysms are usually well advanced at the time of presentation as early clinical diagnosis of infected aneurysms is challenging owing to vague and non-specific symptoms. Delayed treatment of mycotic aneurysms often lead to life threatening complications including rupture, hemorrhage and aortoenteric fistula resulting in poor outcome and high mortality and morbidity. High degree of suspicion is required to accurately diagnose mycotic aneurysms and prevent complications. Despite surgery and aggressive medical management, mortality rate is high. Septic arthritis is one of the rare causes of mycotic aneurysm, which usually occur if there is delayed, or no treatment. We report a case of complicated mycotic aortic aneurysms in a patient with septic arthritis resulting in a fatal outcome. This case report not only highlights the importance of early recognition and management of Mycotic aneurysms, but also stresses accurate diagnosis and treatment of predisposing conditions like septic arthritis, as aggressive management of predisposing conditions can safely prevent life threatening mycotic aortic aneurysms.

American Journal of Medical Case Reports. 2015, 3(12), 394-398. DOI: 10.12691/ajmcr-3-12-3
Pub. Date: November 13, 2015

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Nonmucinous Cystadenoma of the Pancreas with Pancreatobiliary Phenotype and Ovarian-like Stroma. Case Report of a Recently Described Entity

by Adriana Fabiola Romano-Munive M.D., Mario C Peláez M.D., Jorge Hernández-Calleros M.D., Carlos Chan-Nuñez M.D. and Luis Uscanga-Domínguez M.D.

Case Report

The World Health Organization (WHO) classification of cystic pancreatic tumors defines mucinous cystic neoplasms as large, thick-walled, septated cysts with no communication with the main pancreatic duct, associated with the presence of ovarian-like stroma. Serous cystic neoplasms, on the contrary, present with a cuboidal or simple squamous epithelium and fibrous or hyalinized stroma without ovarian-like stroma. We present the case of a 23-year-old woman presenting with abdominal pain related to a new type of cystic pancreatic neoplasm characterized by non-mucinous pancreaticobiliary cystic epithelium and ovarian-like stroma that was surgically removed.

American Journal of Medical Case Reports. 2015, 3(12), 391-393. DOI: 10.12691/ajmcr-3-12-2
Pub. Date: November 11, 2015

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Flexible Retrograde Endoscopy before Reconstructive Surgery in Esophageal Atresia-A Case Report

by Diaconescu Smaranda, Stanca Raluca, Aprodu Gabriel Sandu, Sarbu Ioan, Ciongradi Iulia and Ciubotariu Gabriela

Case Report

In esophageal atresia multiple surgical techniques were designed to repair the esophageal conduct, the decision of choosing a specific type of intervention being strictly related to the length of esophageal gap which is mandatory for operative planning. We present a case of a newborn male with type III LADD esophageal atresia with an anastomotic leak and severe mediastinitis that complicated the primary surgical procedure and imposed cervical esophagostomy and gastrostomy. At the age of one year the child was admitted again in our unit for the esophageal reconstruction. In order to choose between an end to end suture and a procedure of esophageal replacement we tried to estimate the esophageal gap using flexible retrograde endoscopy. The operative decision was finally the esophageal replacement because the esophageal gap was longer than four vertebral bodies. Depending on endoscopist’s skills the fiber optic endoscopy with radio opaque landmark and X-ray might be considered as a useful procedure in measure the gap length and surgical decision.

American Journal of Medical Case Reports. 2015, 3(12), 387-390. DOI: 10.12691/ajmcr-3-12-1
Pub. Date: November 03, 2015

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