American Journal of Medical Case Reports

In the present case with primary pseudohypoaldosteronism, severe hypekalemia was treated with salbutamol inhalation in acute phase. Transcellular hypokalemic effect of salbutamol is related to the activation of Na-K pump on the cell membrane. Although use of salbutamol inhalation in hyperkalemia was previously described, it has not been widely used. The administration of salbutamol by inhalation is a simple, safe and reasonably effective method for treatment of hyperkalemia even in children.

American Journal of Medical Case Reports. 2015, 3(3), 91-92. DOI: 10.12691/ajmcr-3-3-11
Pub. Date: March 04, 2015

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Health Care Associated Cutaneous Abscess – A Rare Form of Primary Gonococcal Infection

by Jasmina Vraneš, Ivana Lukšić, Jasna Knežević and Sunčanica Ljubin-Sternak

Case Report

A rare form of extragenital gonococcal infection was recorded after accidental exposure in laboratory during the identification of Neisseria gonorrhoeae. Three days after needlestick injury, on the left index finger of exposed technician very painful abscess developed. Beside local symptoms presented on the finger, fever or any other signs or symptoms of infection have not been observed. Oral antibiotic therapy with azithromycin was administered, and upon appearance of pus in the center of erythematous area surgical incision was performed. After incision the abscess was healed.

American Journal of Medical Case Reports. 2015, 3(3), 88-90. DOI: 10.12691/ajmcr-3-3-10
Pub. Date: March 04, 2015

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Femoral Nerve Paralysis Following Open Inguinal Hernia Repair

by Stephen Larson, Ray Laird and Fred Brody

Case Report

Open inguinal hernia repair remains the gold standard to treat inguinal hernias and is associated with a low recurrence and complication rate [1,2,3,4]. The majority of inguinal hernia repairs are completed on an outpatient basis. Local, spinal, epidural, and general endotracheal anesthesia are used depending on patient comorbidities and surgeon preference. Overall, patient recovery is relatively quick and patients return to their normal activities in approximately four weeks. Complications may include hematoma, seroma, chronic groin pain, surgical site infection, and injury to adjacent organs. Femoral nerve injury may occur but is an exceedingly rare event following an open inguinal hernia repair. This manuscript details a patient with a transient sensorimotor paralysis of the femoral nerve following an open inguinal hernia repair. Various etiologies are discussed along with a review of the literature.

American Journal of Medical Case Reports. 2015, 3(3), 85-87. DOI: 10.12691/ajmcr-3-3-9
Pub. Date: February 18, 2015

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Diclofenac Related Spontaneous Extensive Ecchymosis and Hematoma despite Normal Coagulation Parameters

by Ilhami BERBER, Mehmet Ali ERKURT, Ilknur NIZAM, Irfan KUKU, Emin KAYA, Serkan UNLU and Mikail YILMAZ

Case Report

Diclofenac is a member of nonsteroidal anti-inflammatory drugs. In Turkey, ıt is often used as a analgesic. Diclofenac may very occasionally lead to spontaneous extensive ecchymosis and hematoma despite a normal coagulation parameters. In this paper, we report one patient who presented with spontaneous extensive ecchymosis and was diagnosed with a hematoma in the anterior chest wall associated with diclofenac use despite normal coagulation parameters. In countries like Turkey where NSAID are used extensively, drug history should be questioned in patients presenting with spontaneous bleeding and have normal coagulation parameters by physicians.

American Journal of Medical Case Reports. 2015, 3(3), 82-84. DOI: 10.12691/ajmcr-3-3-8
Pub. Date: February 19, 2015

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Atypical Presentation of Malignant Melanoma in a 16 Months Old Child

by Liv Schoellhammer, Torben Stamm Mikkelsen, Henrik Schmidt and Lene Birk-Soerensen

Case Report

Malignant melanoma in childhood and adolescence is rare but incidences have been seen to rise. Prognostic factors, risk factors and prognosis have similarities to melanoma in adulthood but paediatric melanoma presents a diagnostic challenge as it often lacks the classical features of adult pigmented malignant melanoma and histologically is difficult to diagnose. This case report describes a clinically atypical presentation of melanoma on the thigh of a 16 month old boy. Initially seen at five months old by a dermatologist were a punch biopsy of the element was made with histological diagnosis; unusual congenital nevus. The element hereafter evolved and at the time of diagnosis measured 7.5 mm in Breslow thickness. Sentinel node biopsy and full body scans were made with no sign of metastasis. Like other cases reported, the melanoma did not exhibit the classical characteristics of the ABCD criteria which may have played a part in delaying diagnosis. Studies suggest that delayed diagnosis in children is not uncommon and younger patients present with more advanced disease at the time of diagnosis. To facilitate earlier recognition of melanoma in children additions to the conventional ABCD criteria have been suggested. This report illustrates that malignant melanoma should always be taken into consideration when presented with lesions of the skin and that a high level of clinical awareness and suspicion is required in order to hasten diagnosis and maybe improve prognosis in cutaneous malignant melanoma in children and adolescents.

American Journal of Medical Case Reports. 2015, 3(3), 79-81. DOI: 10.12691/ajmcr-3-3-7
Pub. Date: February 16, 2015

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Cervical Teratoma: A Rare Neck Swelling in an Adult

by Sze Li Siow and Hans Alexander Mahendran

Case Report

Cervical neck teratoma in adult is rare. It has a distinctly different clinicopathological behavior compared to those of the neonate and infant. We report an 18-year-old man who presented with a benign cervical neck teratoma, and present a review of cervical neck teratoma in the literature. Surgery is the primary modality of treatment as malignant transformation occurs during adulthood. The diagnosis of malignancy is based on histopathologic examination. Adjuvant chemotherapy is indicated when malignancy is confirmed.

American Journal of Medical Case Reports. 2015, 3(3), 75-78. DOI: 10.12691/ajmcr-3-3-6
Pub. Date: February 10, 2015

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Shrinking Lung Syndrome in Systemic Lupus Erythematosus Department of Internal Medicine. La Rabta.University Hospital

by Monia SMITI KHANFIR, Nabil BEL FEKI, Fatma SAID, Amira HAMZAOUI, Thouraya BEN SALEM, Imed BEN GHORBEL, Mounir LAMLOUM and Mohamed Habib Houman

Case Report

In systemic lupus erythematosus (SLE), the respiratory system is frequently compromised. One of its uncommon manifestations is the shrinking lung syndrome (SLS), characterized by unexplained dyspnea, a restrictive pattern on pulmonary function tests, and an elevated hemidiaphragm. The pathogenesis of the SLS remains unknown. We report three consecutive cases of women with systemic lupus erythematosus, aged 32, 33, and 35 years. Clinical features included dyspnea and chest pain. Onset of the SLS manifestations occurred in the absence of a SLE flare, in patients treated with low dose of corticosteroids. Diagnosis was based on clinical and laboratory patterns, particularly chest RMI showing basilar atelectasis, elevated diaphragms, and small lung volumes in two cases. Corticosteroid treatment induced improvement in the three cases and no relapse was noted. Clinical, laboratory, physiopathological, and therapeutic aspects of this syndrome are reviewed, particularly RMI findings, never discussed in previous studies.

American Journal of Medical Case Reports. 2015, 3(3), 66-68. DOI: 10.12691/ajmcr-3-3-4
Pub. Date: February 05, 2015

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Hypercalcemia in Advanced Prostatic Carcinoma: A Rare Event

by Mary Mathews, Abhishek Kumar, Nelly Awkar, Deepak Dhaliwal and Michael Maroules

Case Report

Prostate cancer is typically associated with metastatic osteoblastic lesions, hypocalcemia and hypophosphatemia. Hypercalcemia is a rarely encountered phenomenon i.e. 1-2% in prostate cancer, although it is well associated with other malignant cancers involving breast, lung, head, neck and multiple myelomas. We present the case of a 63 year old Mexican man with history of advanced prostatic adenocarcinoma and trans-urethral resection of prostate presented to ER with nausea, vomiting, polydipsia and altered mental status. Clinically, he appeared dehydrated and pale, with no other remarkable findings. Laboratory findings indicated severe hypercalcemia with calcium-16.1 mg/dL, with imaging studies revealing extensive metastatic osteoblastic lesions. Our patient was treated with aggressive hydration, calcitonin and pamidronic acid, his clinical status improved with complete resolution of hypercalcemia. We have discussed the possible underlying mechanisms and their interplay involved in the presentation of hypercalcemia in prostate cancer, and that its occurence is unlikely due to skeletal metastases.

American Journal of Medical Case Reports. 2015, 3(3), 64-65. DOI: 10.12691/ajmcr-3-3-3
Pub. Date: February 05, 2015

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Coarctation of Aorta with Supravalvular Pulmonary Stenosis in an Adult Patient: A Rare Exception of the Fetal Flow Pattern Theory

by Manish Ruhela, Harneesh Randhawa, Prachi Bagarhatta, Rajeev Bagarhatta and Anoop Jain

Case Report

Coarctation of the aorta is a common congenital defect whose overall incidence is 5–8% of all congenital cardiac anomalies. Associated cardiac anomalies have been well described in previous studies examining specific subgroups of coarctation of aorta patients, particularly infants, excluding older children, adolescents, and adults. The association of coarctation with left-sided obstructive lesions ( Bicuspid aortic valve, Parachute mitral valve, Mitral atresia, Aortic atresia ) were well documented in the literature. The association of coarctation of aorta with right- sided obstructive lesions is rare and a hemodyanamic explanation based on fetal flow pattern was given for this. Herein we report a case of coarctation of aorta with right sided obstructive lesion in form of supravalvular pulmonary stenosis in an adult female. To the best of our knowledge this is the first case report where an adult female presented with coarctation of aorta along with supravalvular pulmonary stenosis.

American Journal of Medical Case Reports. 2015, 3(3), 53-58. DOI: 10.12691/ajmcr-3-3-1
Pub. Date: February 04, 2015

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