American Journal of Medical Case Reports

The material has not been previously published elsewhere and is being considered solely by the American Journal of Medical Case Reports. This case report determined to be “A Healthcare Operations Activity and does not include Human Research – Institutional Review Board approval is not required” by Maimonides Institutional Review Board, an institutional ethics committee.

American Journal of Medical Case Reports. 2016, 4(4), 148-149. DOI: 10.12691/ajmcr-4-4-10
Pub. Date: May 03, 2016

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Unexpected Intravascular Hemolysis and Methemoglobinemia during Treatment for Lymphoma

by James O. Ballard, Edward J. Wyluda, Hong Zheng and Michael H. Creer

Case Report

A patient undergoing chemotherapy for relapsed non Hodgkin lymphoma developed tumor lysis syndrome, hypoxia and the abrupt onset of intravascular hemolysis. A past history of unexplained anemia and the finding of blister cells on peripheral smear led to the suspicion of congenital glucose phosphate dehydrogenase (G6PD) deficiency with intravascular hemolysis induced by the drug rasburicase. G6PD deficiency was confirmed by quantitative G6PD assay one month after the episode. Retrospective review of arterial blood gas data confirmed the transient presence of methemoglobinemia accompanying the hemolytic event. Health care providers should be aware of the potential for patients with previously undiagnosed G6PD deficiency to develop hemolysis and methemoglobinemia when oxidant drugs such as rasburicase are administered.

American Journal of Medical Case Reports. 2016, 4(4), 144-147. DOI: 10.12691/ajmcr-4-4-9
Pub. Date: May 03, 2016

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Unexpected Brain Death in a 20-year-old Man with Chiari Type I Malformation after Trauma: Case Report and Review of Literature

by Iskender KARA, Fatma YILDIRIM, Hamit KÜÇÜK and İsmail KATI

Case Report

The Chiari I malformation is a congenital anomaly of unknown origin consisting of caudal displacement of the cerebellar tonsils protruding through the foramen magnum, whereas the brainstem and fourth ventricle remain in the cranial vault. We present a case of a sudden brain death of a 20-year-old adult man with trauma who subsequently was found to have a previously undiagnosed Chiari I malformation.

American Journal of Medical Case Reports. 2016, 4(4), 140-143. DOI: 10.12691/ajmcr-4-4-8
Pub. Date: April 29, 2016

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Acute Delirium Caused by Single Small Dose of Zolpidem

by Hassan Tahir, Muhammad Adeel Saleemi, Christopher Wolfe and Vistasp Daruwalla

Case Report

Zolpidem, a non benzodiazepine hypnotic, exhibits minimal anxiolytic, muscle relaxant, and anticonvulsant properties due to its minimal effect on BZ2 receptors. Due to low drug abuse and better safety profile, Zolpidem has been increasingly used in practice. More number of patients with rare side effects is being reported due to increasing use of this drug. Zolpidem is considered safe and frequently used in hospitals when patients complain of insomnia during their stay in the hospital. In recent years, there have been reported cases of acute delirium and psychosis after zolpidem use. Majority of these rare neuropsychiatric side effects were seen in patients with the history of psychiatric illness and those taking more than 10mg of zolpidem. We present a case of acute agitation, confusion and hallucinations after administration of a small one time dose (5mg) of zolpidem in a male with no prior history of any psychiatric or substance abuse.

American Journal of Medical Case Reports. 2016, 4(4), 137-139. DOI: 10.12691/ajmcr-4-4-7
Pub. Date: April 28, 2016

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Eosinophilic Colitis Presenting with Haemorrhagic Diarrhea

by Ferda Akbay Harmandar, Zahide Taş, Ayhan Hilmi Çekin and Seyit Uyar

Case Report

Eosinophilic colitis is a rare condition and very uncommonly it presents with acute surgical emergency such as haemorrhage and peritonitis. We describe a rare presentation of eosinophilic colitis with severe haemorrhage and abdominal pain with ischemic bowel.

American Journal of Medical Case Reports. 2016, 4(4), 134-136. DOI: 10.12691/ajmcr-4-4-6
Pub. Date: April 27, 2016

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Cushing Syndrome Following Single Steroid Injection: A Case Report and Review of the Literature

by Mohamad Motawea, Heba Mosaad, Nabil M. Aladeeb and Ahmed M. Abd El-khalek

Case Report

Iatrogenic Cushing’s syndrome (ICS) is a well-known adverse effect of glucocorticoids. It usually develops after prolonged exposure to excessive amounts of synthetic glucocorticoids. The manifestations of ICS are generally dose and time dependent. We will report on our own case of ICS followed by a review/highlight of published cases of ICS following single steroid injection. The development of ICS after a single and low dose of synthetic glucocorticoid is an exceptional event and only a few patients have been reported to date in the literature. Here we will report on the case of a twenty-one -year-old female patient who developed ICS with striae rubra which appeared fifteen days after irrational use of a single intramuscular injection of betamethasone (Diprofos). Endocrinological evaluation confirmed hypothalamic-pituitary-adrenal axis suppression. Her striae showed gradual fading over the next two months leaving only thin white striae similar to stretch marks. We performed a review of the literature using a computer search in the Science Direct, Google Scholar, and National Library of Medicine from 1950 to January 2016 for ICS following single injection of synthetic glucocorticoids using the terms ‘single injection’, ‘iatrogenic’, ‘betamethasone’, ‘triamcinolone’, ‘hydrocortisone’ ‘dexamethasone’ ‘adrenal suppression’ ‘Cushing case report’ and ‘Cushing’s syndrome’. Nine case reports of ICS were found in both children and adults following a single steroid injection. There are multiple factors affecting the response to steroids that make one develop Cushing’s syndrome while the others do not. Governments in developing countries must make more serious efforts to enforce the existing laws that prohibit the irrational use of steroids.

American Journal of Medical Case Reports. 2016, 4(4), 130-133. DOI: 10.12691/ajmcr-4-4-5
Pub. Date: April 27, 2016

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A Case of Relapsed Chronic Myeloid Leukemia Admitted with the Complaints of Paraplegia and Urinary Incontinence

by Ali Kutlucan, Mehmet Daglı, Leyla Kutlucan, Seher Kır, Abdulkadir Basturk, Ceyhan Ugurluoglu, Hasan Acar, Mehmet Sozen and Kubra Turkay

Case Report

Chronic myeloid leukemia (CML) is a clonal hematopoietic stem cell malignancy. In CML, extramedullary blastic crisis is a very rare condition in which the prognosis is even worse. Herein we presented a rare case of relapsed CML patient as blastic crisis with serious neurological symptoms because of central nervous system (CNS) infiltration. A 69-year-old male patient diagnosed with CML was admitted to hospital with complaints of weakness in legs, urinary incontinence, abnormal speech, and impaired vision. Deep tendon reflexes were bilaterally hypoactive in lower and upper extremities and Babinski reflex was negative. Immunophenotyping and cytological examination of CSF showed blastic cell infiltration. Also BCR-ABL mutation was positive in CSF and MR showed CNS involvement. So the patient diagnosed as “Myeloid blastic phase of CML with CNS involvement”. İmatinib therapy was replaced with dasatinib and intrathecal methotrexate, cytarabine and dexamethasone treatment was applied. Complaints of weakness, fatigue, urinary incontinence, leg weakness and inability to walk were completely resolved in three months. Extramedullary blastic crisis such as CNS involvement has been reported in a limited number in CML. Even if hematological and cytogenetic remission is provided, CML patients should be followed regularly. Any new clinical detail should be considered carefully and extramedullary involvement including CNS should be kept in mind.

American Journal of Medical Case Reports. 2016, 4(4), 126-129. DOI: 10.12691/ajmcr-4-4-4
Pub. Date: April 26, 2016

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Idiopathic Orbital Inflammatory Disease Mimicking a Carotid Cavernous Fistula

by Norhayati Abdul Kadir, Syed Shoeb Ahmad and Shuaibah Abdul Ghani

Case Report

Idiopathic orbital inflammatory disease (IOID) is a common orbital disorder. However, it has a highly variable clinical presentation depending on the site, degree of inflammation and size of the lesion, which produces a mass effect in the orbital cavity. IOID has no pathognomonic clinical features, thus radiologic and occasionally histopathologic studies are required to confirm the diagnosis of IOID. Here we report a case of a healthy elderly gentleman who presented to us with proptosis, dilated and tortuous conjunctival and retinal vessels and a positive response to Valsalva maneuver. These clinical features were suggestive of a carotid cavernous fistula (CCF). An initial CT scan showed an intraconal orbital mass. Hence, an MRI was subsequently performed which did not show features of CCF, however, there was again a large intraorbital mass noted. The radiologic differential diagnosis suggested was IOID, lymphoma and metastasis. Hence, a biopsy of the intraorbital mass through the transnasal approach was performed. That confirmed the lesion to be IOID and not CCF. Hence, although proptosis with conjunctival congestion, dilated tortuous conjunctival and retinal vessels with positive Valsalva maneuver are the usual clinical features of CCF, this case illustrates these features may also occur in patients with IOID.

American Journal of Medical Case Reports. 2016, 4(4), 122-125. DOI: 10.12691/ajmcr-4-4-3
Pub. Date: April 22, 2016

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Idiopathic Constrictive Pericardial Disease in a Patient with Cystic Fibrosis

by Conor McCartney and Ravi Nayak

Original Research

Introduction We report on a case of a patient with cystic fibrosis and co-existent constrictive pericardial disease. This unique presentation has been presented only once before in the literature. Our case is the first documented case where a patient with cystic fibrosis has undergone curative pericardial stripping. Case The case is about a patient who was diagnosed with cystic fibrosis at the age of 45. His sweat chloride level was 77.0mmol/L and genotype heterozygous for RII7H and delta F508. His FEV1 was 75% predicted at the time of admission. The patient was hospitalized for a presumed pulmonary exacerbation of his cystic fibrosis. He presented with cough with scant mucous production and no hemoptysis. He also noted dyspnea on exertion and new onset peripheral edema. He was treated for a pulmonary exacerbation with intravenous antibiotics and airway clearance measures and discharged home after two days. He worsened despite optimal therapy for a pulmonary exacerbation. A simultaneous right and left heart catheterization was performed that was suggestive of constrictive pericardial disease. The patient underwent a pericardial stripping that resolved his symptoms. He was discharged home after surgery and has been doing well. Discussion Constrictive pericardial disease is an extremely rare complication that is not frequently seen in cystic fibrosis. Simultaneous left and right heart catheterization can be used to make the diagnosis. Surgery is curative. Although pulmonary exacerbation is the most common cause of shortness of breath in patients with cystic fibrosis other diagnosis should be considered.

American Journal of Medical Case Reports. 2016, 4(4), 118-121. DOI: 10.12691/ajmcr-4-4-2
Pub. Date: April 20, 2016

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A Young Man with Cerebral Venous Thrombosis and Hyperhomocystinemia

by Md Enayet Hussain, Afzal Momin, Mahmudul Islam, Sk Rezaul Haque, Sharmin Jahan and Md Azharul Hoque

Case Report

Cerebral venous sinus thrombosis is an uncommon condition and can be precipitated by various conditions. Here we report a case of cerebral venous sinus thrombosis in a young man in whom the serum homocysteine level was found to be elevated. A 36-year-old man was admitted with sudden severe headache, vomiting and visual obscuration. Investigations revealed widespread cerebral venous sinus thrombosis. All investigations to find out the etiology came out normal except the serum homocysteine level which was found to be elevated. Further studies are required to evaluate the importance of estimation of serum homocysteine level in cases of CVST, especially where a clear risk factor has not been identified and where other investigations failed to find out any known etiological factor.

American Journal of Medical Case Reports. 2016, 4(4), 115-117. DOI: 10.12691/ajmcr-4-4-1
Pub. Date: April 20, 2016

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