by Michael D. Ross, John M. Cheeks, John P. Sanko and Michael A. Tall
Case Report
The patient was a 53 year-old woman who was seen by a home health physical therapist following a lumbar spinal fusion revision surgery which was performed 2 weeks prior. In addition to low back pain, the patient had chronic bilateral shoulder, left upper extremity, chest, mid-back, and lower extremity pain and required moderate assistance for transfers, ambulation and activities of daily living with routine complaints of shortness of breath, lightheadedness, and fatigue. Due to concern over a progressively worsening cardiac condition, the physical therapist immediately consulted a cardiologist, who agreed to see the patient the next day. The patient was subsequently diagnosed with severe coronary artery disease and was treated with coronary artery bypass grafting, after which she was independent with all activities of daily living with only minimal complaints of low back pain.
American Journal of Medical Case Reports. 2016, 4(8), 296-297. DOI: 10.12691/ajmcr-4-8-10
Pub. Date: September 20, 2016
9928 Views3507 Downloads
by Imene Boukhris, Hana Zoubaidi, Ines kechaou, Eya Chérif, Ines mahmoud, Anis Hariz, Nédia Znaidi and Narjes Khalfallah
Case Report
In Langerhans cell histiocytosis pulmonary involvement is often isolated. It is rarely a part of a multifocal form. Tenosynovitis is exceptional. Hand bones involvement is atypical. We report the case of a 75-year-old, non-smoker man, without medical history, who presented with arthritis and fever. Examination found arthritis affecting large and small joints. In biology, there was an inflammatory syndrome. Radiographs of the hands showed erosions of the carpal bones. Doppler ultrasonography of the hands showed active synovitis. Tc99 bone scintigraphy highlighted joint uptake in the hands, knees, spine and right upper jaw. Blood cultures and infectious investigations were negative. Anti-nuclear antibodies and rheumatoid factor were negatives. CT scan showed cystic lung lesions and nodular aspect. Bronchoalveolar lavage fluid revealed positivity of anti-CD1a at 6%. A surgical biopsy showed an infiltrate of eosinophilic cells, positive for CD1a in immunohistochemistry studies. The diagnosis of Langerhans cell histiocytosis was retained.
American Journal of Medical Case Reports. 2016, 4(8), 293-295. DOI: 10.12691/ajmcr-4-8-9
Pub. Date: September 14, 2016
16279 Views4628 Downloads1 Likes
by Csaba Tóth and Zsófia Clemens
Original Research
Introduction: Myoepithelial tumor of the soft palate is associated with rapid progression and poor outcome. The standard care includes surgery with optional radiotherapy and/or chemotherapy. Case report: Here we present a case with myoepithelial tumor of the soft palate where the patient denied conventional treatment options. Instead, the patient started the paleolithic ketogenic diet which resulted in a halted progression of the tumor as evidenced by imaging follow-up. Currently, the patient is on the diet for 20 months, without symptoms and side effects. Conclusion: We conclude that the paleolithic ketogenic diet was effective and safe in this patient.
American Journal of Medical Case Reports. 2016, 4(8), 288-292. DOI: 10.12691/ajmcr-4-8-8
Pub. Date: September 12, 2016
17193 Views3908 Downloads17 Likes
by Vinay Minocha, Dat Pham, Arun Gopinath, Madhu Emani and Lara Zuberi
Case Report
Introduction. Patients with Waldenström macroglobulinemia (WM) can present with a diverse array of findings. One such manifestation is autoimmune thrombocytopenia which may occur as a consequence of autoantibody activity against platelets. Case Presentation. We report a case of a 57-year- old African American male who presented with a two-week history of fatigue, recurrent epistaxes and gingival hemorrhage. His past medical history was significant for liver cirrhosis secondary to Hepatitis C and a splenectomy 2 years prior for traumatic rupture of the spleen. Complete blood count demonstrated platelets 3 x109/l. Serum protein electrophoresis and immunofixation demonstrated an IgM Lambda monoclonal paraprotein of 7.6 g/dl. Serum viscosity was elevated at 10.8 cP. He was diagnosed with a hyperviscosity syndrome secondary to suspected Waldenstrom’s Macroglobulinemia (WM) and plasmapheresis was emergently initiated due to bilateral retinal vein thrombosis. A bone marrow aspirate and biopsy revealed an interstitial plasmacytoid proliferation which was CD138 positive and lambda restricted. With plasmapheresis, his serum IgM was lowered to less than 4 g/dl and his serum viscosity decreased to 4.4 cP. A weekly regimen of bortezomib, dexamethasone and rituximab (BDR) was used for treatment. On follow-up three months later he continued on the weekly BDR regimen and his platelet count had normalized to 219 x109/l. Conclusion. Severe thrombocytopenia is an uncommon presentation of WM that may be secondary to complement mediated thrombocytopenia associated with monoclonal IgM antiplatelet antibody. In such cases, therapies for ITP such as corticosteroids and high-dose immunoglobulins may not be as effective as anti-tumor chemotherapy.
American Journal of Medical Case Reports. 2016, 4(8), 275-278. DOI: 10.12691/ajmcr-4-8-7
Pub. Date: September 09, 2016
13597 Views4632 Downloads
by Arjowan Mustafa, Lina Azzam and Hussam M. Azzam
Case Report
Struma ovarii is the presence of thyroid tissue as a major cellular component in an ovarian teratoma and it is usually benign but malignant changes has been reported in 3%–5% of all Struma ovarii tumors [1,2]. The symptoms of Struma ovarii are similar to those of other ovarian tumors and are nonspecific in nature. The tumor can be characterized by imaging, but the final diagnosis is made by pathological and histological examination. Surgical resection remains the definitive treatment for benign disease. Our case is 47 -year-old old multiparous woman, who presented with a palpable pelvic mass and symptoms of pelvic discomfort and vague abdominal pain. The pelvic ultrasound showed a large complex ovarian mass with cystic and solid component with no suspicion of malignancy. She underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histology showed Struma ovarii. Post operatively the patient did very well with no complications and TFT was normal.
American Journal of Medical Case Reports. 2016, 4(8), 272-274. DOI: 10.12691/ajmcr-4-8-6
Pub. Date: September 01, 2016
11114 Views2951 Downloads
by Pramod Theetha Kariyanna, Mirela Andrei, Cherif Abdelmalek, Ajay Kundra, Boris Avezbakiyev, James E. O’Donnell and Alexander Rozin
Case Report
Carcinoid tumors are rare neuroendocrine tumors that arise from neural crest amine precursor uptake decarboxylation cells. Most of carcinoid tumors originate in the midgut. The vasoactive secretory products of carcinoid tumor upon metastasis to liver reach systemic circulation as they bypass the metabolism by liver. 50% of patients with carcinoid syndrome eventually develop carcinoid heart disease. We here present a rare case of carcinoid tumor with metastasis to liver that solely presented with right heart failure. The patient did not have any symptoms of typical carcinoid syndrome features such as flushing, diarrhea, and bronchoconstriction.
American Journal of Medical Case Reports. 2016, 4(8), 265-271. DOI: 10.12691/ajmcr-4-8-5
Pub. Date: September 01, 2016
18744 Views4200 Downloads
by Xiaoming Jia and Niraj Mehta
Original Research
Tuberculosis (TB) is best known as a pulmonary disease but can infect any organ system. Presentation of extrapulmonary TB is often non-specific and slow in onset, though morbidity is often significant. We report a case of osteoarticular and genitourinary tuberculosis in a patient who travelled from an endemic region.
American Journal of Medical Case Reports. 2016, 4(8), 263-264. DOI: 10.12691/ajmcr-4-8-4
Pub. Date: August 31, 2016
10920 Views3280 Downloads
by Qiaofang Chen, Carol Huibregtse and Cheruppolil R. Santhosh-Kumar
Case Study
A 54-year-old white woman presented to the emergency department with inability to smile, difficulty in closing her right eye and drooling when attempting to drink liquids for two days prior to presentation. Neurological examination revealed classic signs of right peripheral seventh cranial nerve paresis. The patient also complained of fatigue, general malaise and weight loss of 20 pounds during the past few weeks.
American Journal of Medical Case Reports. 2016, 4(8), 261-262. DOI: 10.12691/ajmcr-4-8-3
Pub. Date: August 30, 2016
11554 Views3047 Downloads
by Edward Charbek, Rajaa AlMourani, Rugheed Ghadban and David A. Stoeckel
Case Report
The relationship between some infections and vasculitides especially antineutrophil cytoplasmic antibodies (ANCA) mediated disease is well established. However, the mechanisms by which infection triggers ANCA formation are not fully understood. We report a case of granulomatosis with polyangiitis (GPA) occurring concurrently with human monocytic ehrlichiosis (HME) and discuss the possible relation between the two disease processes. A 49 year old Caucasian female presented with septic shock with multiple organ dysfunction syndrome that was attributed to HME. The patient was noted to have a small crusted lesion on the left nasolabial fold. Over the course of her hospitalization, it gradually expanded and eroded into the nasal cavity. After appropriate workup, she was diagnosed with GPA. HME hasn’t been clearly linked to any type of vasculitis. Review of the literature revealed scarce evidence limited to case reports and retrospective studies describing the association between GPA and HME. We highlight in this case a possible link between HME and GPA, however, the exact relationship between HME and GPA remains unclear and warrants further study.amoxicillin bivirkninger
link amoxicillin rash
American Journal of Medical Case Reports. 2016, 4(8), 258-260. DOI: 10.12691/ajmcr-4-8-2
Pub. Date: August 18, 2016
11892 Views3809 Downloads
by Muneeb Shah, Rehan Feroz and Luke Maxfield DO
Case Report
Percutaneous nephrolithotomy is a minimally invasive procedure to remove large renal calculi. Complications can range from infection to bowel damage but only rarely does the procedure result in pulmonary injury. We present the first case of chylothorax secondary to percutaneous nephrolithotomy for removal of a large renal calculus. The patient was treated with a decortication procedure and discharged to rehab shortly thereafter.
American Journal of Medical Case Reports. 2016, 4(8), 255-257. DOI: 10.12691/ajmcr-4-8-1
Pub. Date: August 12, 2016
12547 Views2679 Downloads2 Likes