American Journal of Medical Case Reports

Introduction: May-Thurner syndrome (MTS) is an entity caused by the compression of the left iliac vein that predispose to acute deep vein thrombosis (DVT) of left lower limb. While standar management is anticoagulant therapy, a review of the literature reveals that new endovascular therapies can offer more optimal outcome than anticoagulation alone, preserving normal venous valve function, and avoiding post-thrombotic syndrome. In addition, we have detected that the highest risk of complications appears when MTS is associated with another congenital or acquired prothrombotic factor (thrombophilia). Case presentation: We report four causes of MTS in caucasian patients treated with endovascular techniques in our hospital over the last years. All patients were middle-aged severe symptomatic women with positive venographic findings for acute or chronic extensive left lower-extremity DVT. In addition, all patients were positive for thrombophilia test. Conclusion: DVT study in patients with MTS must include a search for thrombophilia factors, as those patients are most likely to benefit from new technical approaches.

American Journal of Medical Case Reports. 2016, 4(5), 180-185. DOI: 10.12691/ajmcr-4-5-10
Pub. Date: May 31, 2016

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Case Report: A 12-Year History of Autoimmune Disease Systemic Lupus Erythematosus

by Eva Kovacs-Benke

Original Research

Systemic lupus erythematosus (SLE) is a chronic, autoimmune, connective tissue disorder with multi-organ involvement. Reported here is the case of a 33-year-young women with a 12-year history of lupus erythematosus. The article documents the development of lupus: First phase/ preliminary phase (13-21 years of life); Second phase/acute cutaneous lupus erythematosus (22-27 years of life); Third phase/systemic lupus erythematosus (from 28 years of life). The parameters of serological test and blood test were measured regularly during the course of the disease. The MRI-investigation was carried out three times. The clinical symptoms are evaluated in relation to the laboratory parameters All these data with the therapeutic modalities and the trigger factor(s) are disclosed.

American Journal of Medical Case Reports. 2016, 4(5), 175-179. DOI: 10.12691/ajmcr-4-5-9
Pub. Date: May 30, 2016

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Tension Pneumothorax as the Presentation of Pulmonary Langerhans Histiocytosis

by Conor McCartney, Andrew Freeman and Ravi Nayak

Case Report

A 36 year old male smoker presented to the emergency department with shortness of breath. A chest x-ray showed a tension pneumothorax. Chest tube was placed urgently. CT scan showed upper lobe predominant cystic lung lesions. Biopsy confirmed the diagnosis of pulmonary Langerhans Histiocytosis.

American Journal of Medical Case Reports. 2016, 4(5), 173-174. DOI: 10.12691/ajmcr-4-5-8
Pub. Date: May 30, 2016

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Pulmonary Hypertension in a Patient with Non-cirrhotic Portal Hypertension and Scleroderma Sine Scleroderma: A Case Report

by Ghassan Kamel, Joseph Espiritu, Adrian M. Di Bisceglie, Guilan Chen, Reema Syed and Ravi Nayak

Case Report

Porto-pulmonary hypertension is a known complication of liver cirrhosis but its association with non-cirrhotic portal hypertension patients is rare. We report a case of pulmonary hypertension in a patient with non-cirrhotic portal hypertension and scleroderma sine scleroderma. The two latter conditions have been shown to be independently associated with pulmonary arterial hypertension. DLCO is expected to decrease in scleroderma patients due to pulmonary vascular disease, which will result in an increased FVC/DLCO ratio. The low FVC/DLCO ratio in our patient suggests that pulmonary arterial hypertension was more likely to have been due to non-cirrhotic portal hypertension than scleroderma sine scleroderma.

American Journal of Medical Case Reports. 2016, 4(5), 170-172. DOI: 10.12691/ajmcr-4-5-7
Pub. Date: May 25, 2016

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Vertebral Osteomyleitis Caused by Candida Albicans in an IV Drug Abuser

by Nagadarshini Ramagiri Vinod, Hassan Tahir, Khandakar Hussain and Saad Ullah

Case Report

The incidence of back pain is listed only second to upper respiratory tract infection in symptomatic reason for office visits for a physician. Diagnosing rare and serious causes of back pain may be challenging in outpatient setting. We present a 31 year old male, an IV drug abuser, presenting with severe back pain radiating to his bilateral hips due to L1-L2 Osteomylelitis secondary to Candida Albicans infection.

American Journal of Medical Case Reports. 2016, 4(5), 168-169. DOI: 10.12691/ajmcr-4-5-6
Pub. Date: May 24, 2016

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Pyogenic Granuloma of the Urinary Bladder: A Rare Entity

by Paul Vincent D

Case Report

Introduction: Pyogenic granuloma is a reactive hyperplastic change commonly encountered in the skin and oral cavity. Very rarely they can occur in the urinary bladder. Case Report: 73 year old male presented with obstructive urinary symptoms and pain during micturition. He had an open prostatic surgery 25 years ago. His investigations were not contributory and there was no improvement with alpha blockers. Cystoscopy revealed a solitary, pedunculated 1 cm lesion in the posterior wall of the bladder along with inflammatory changes. Biopsy from the lesion revealed a diagnosis of pyogenic granuloma along with follicular cystitis. His symptoms resolved after the procedure and he was treated with a prolonged course of antibiotics. His imaging and follow up cystoscopy after six months were normal. He remains asymptomatic at 1 year of follow up. Conclusion: Pyogenic granuloma of the bladder is very rare and till now only eight cases have been reported worldwide. The important factor in management is to differentiate this condition from malignancy and treatment with transurethral resection and antibiotics may suffice.

American Journal of Medical Case Reports. 2016, 4(5), 165-167. DOI: 10.12691/ajmcr-4-5-5
Pub. Date: May 19, 2016

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Corneal Manifestations of Tuberculosis: About 2 Cases

by Belghmaidi Sarah, Mouafik Sara Batoul, Hajji Ibtissam, Hocar Ouafa, Amal Said and Moutaouakil Abdeljalil

Case Report

Corneal tuberculosis is a rare ophthalmic manifestation of tuberculosis. The purpose of this study is to present clinical and histopathological findings in two cases of corneal tuberculosis. We reported corneal manifestation of tuberculosis in two patients including granulomatous lesion at upper third of the cornea in the first case, and sectorial interstitial keratitis in the second one. The diagnosis was based on various anamnestic, clinical, histological and evolutive arguments. An anti-tuberculosis treatment was prescribed.

American Journal of Medical Case Reports. 2016, 4(5), 160-164. DOI: 10.12691/ajmcr-4-5-4
Pub. Date: May 16, 2016

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In Front of Ischemic Stroke: Think about Pernicious Anemia

by Ines Kechaou, Eya Cherif, Imene Boukhris, Samira Azzabi, Chékib Kooli, Lamia Ben Hassine and Narjes Khalfallah

Case Report

Pernicious anemia can cause several neurologic impairment. Ischemic stroke has been reported as a rare complication of pernicious anemia. We report a case of 51-year-old woman, who presented with ischemic stroke. Hyperhomocysteinemia due to pernicious anemia was diagnosed while looking for secondary causes of the cerebral event. She was treated with vitamin B12 that improved her anemia but not her neurological impairment.

American Journal of Medical Case Reports. 2016, 4(5), 158-159. DOI: 10.12691/ajmcr-4-5-3
Pub. Date: May 13, 2016

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Mature (Benign) Cystic Retrovesical Teratoma in a 49-Year-Old Male: a Case Report and Literature Review

by V Vera and Ferry Safriadi

Case Report

Teratomas are congenital tumours that contain derivatives of all three germ layers. Teratomas have been reported to occur in various sites and organs. Retrovesical teratoma is a very rare extragonadal tumour, especially in adults, moreover in male patients. Grading and classification of teratoma is important for management and prognosis. We report a case of mature (benign) cystic retrovesical teratoma. The patient was a 49-year-old male who had chief complaints of abdominal mass and difficulty in urination. Ultrasonography (USG) showed a large mass in the pelvic region demonstrating a well-defined hypoechoic mass with septations at posterior of vesica urinaria. Abdominal Multislice Computed Tomography (MSCT) scan showed a large inhomogeneous hypodense mass with thin septations as well as multiple areas of fatty collections and coarse calcifications in pelvic region. We performed complete surgical resection per laparotomy. Grossly, the mass measured 12 x 10 x 5 cm and had rubbery consistency. Cut section of the mass revealed multilocular cystic spaces, whitish-gray walls, scattered yellowish adipose tissue collections, mucus secretions, and areas of calcifications. Pathological diagnosis of the resected tumour was a matured teratoma. The diagnosis was made because the tumour showed signs of a mature teratoma such as lined by stratified squamous and respiratory columnar eptithelium, fat and muscle tissue, nerve tissue, and calcifications. There were no neuroepithelium appearance. To our knowledge, this is the first retrovesical teratoma case being reported in Indonesia.

American Journal of Medical Case Reports. 2016, 4(5), 153-157. DOI: 10.12691/ajmcr-4-5-2
Pub. Date: May 06, 2016

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Mullerian Adenosarcoma Occurring in a Young Female and Originally Diagnosed as an Endometrial Stromal Nodule

by Modupeola O. Samalia, Tara Chang, M. Ruhul Quddus, C. James Sung, Katrine Hansen and W. Dwayne Lawrence

Case Report

Mullerian Adenosarcoma (MA) is most commonly encountered in postmenopausal females in the sixth decade of life. We present the case of a 21-year old female with a high BMI and a clinical presentation suggestive of polycystic ovarian disease; she presented with abnormal vaginal bleeding. A laparoscopy/hysteroscopy by her primary physician demonstrated an intracavitary and submucosal appearing mass which was clinically considered to be a polypoid submucosal leiomyoma. The patient underwent endometrial curettage. The specimen was comprised of multiple fragments of soft tan-red haemorrhagic tissues aggregating to 6.5 x 4.0 x 0.6 cm. An original diagnosis of endometrial stromal nodule was made on this material; however, on consultative review the diagnosis was changed to a mullerian adenosarcoma. No stromal overgrowth or heterologous differentiation was identified. Immunohistochemical studies demonstrated stromal cells were positive for oestrogen receptor (ER) and CD10. We emphasize the young age of this patient with a mullerian adenosarcoma as well as the pitfall of making a specific diagnosis of endometrial stromal neoplasms based on an endometrial curettage.

American Journal of Medical Case Reports. 2016, 4(5), 150-152. DOI: 10.12691/ajmcr-4-5-1
Pub. Date: May 04, 2016

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