by Ladan Mohammadi, Noman Ahmed Jang Khan and Lavanya Vuppu Panghat
Case Report
Granulicatella genus , a nutritionally mutant variant of viridans streptococci was originally classified as a part of abiotrophia group until 1995 and later in 2000 as a separate genus are considered as a rare cause of blood stream infections. They are part of normal flora of human oral cavity, intestinal and urogenital tracts and are notorious for causing odontogenic infections. We present a rare case of sepsis in a 90 year old male caused by Granulicatella elegans and some of the proposed methods of diagnosis and treatment of this uncommon infection.
American Journal of Medical Case Reports. 2017, 5(3), 77-78. DOI: 10.12691/ajmcr-5-3-8
Pub. Date: April 15, 2017
9075 Views2430 Downloads
by Soumyabrata Roy Chaudhuri, Deep Das, Hindol Dasgupta, Dipnarayan Mukherjee and Kingshuk Bhattachacharjee
Original Research
Scrub typhus is an acute febrile illness which has varied manifestation from febrile illness to a more severe multi-organ dysfunction including CNS involvement in the form of meningitis and meningoencephalitis and in extremes cases, septic shock and death. Scrub typhus is prevalent in India and there have been reported case series from north-eastern regions of India and also from various institutes of south India. In sharp contrast, our case is a single incidence and classically showed features of lung involvement which predisposes to CNS involvement (in the form of meningitis or meningoencephalitis) later. All the published case reports/series from the subcontinent, it is unanimously stated that response is dramatic upon starting of oral doxycycline and the clinical scenario changes within 48- 72 hours. However in this anecdotal case of ours, intravenous doxycycline was started and still patient went downhill before he stabilised after 10 days of the therapy. Although doxycycline failures have been reported from Korea and the medical scientists have put forward their explanations about the questionable emerging resistance to doxycycline, still this case remains important because it is one of the first reported cases from the Indian subcontinent where the clinical features deteriorated even after starting Doxycycline ("The erstwhile gold standard antibiotic against Scrub Typhus) and that too via intravenous route. The case presents a dilemma in the minds of the clinician as to what strategy may be taken to achieve higher MIC values of Doxycycline (to overcome the emerging resistance) and also triggers the search for new antibiotic regimen which can help us to control scrub typhus early and prevent the more severe and life threatening complications of the disease.
American Journal of Medical Case Reports. 2017, 5(3), 69-76. DOI: 10.12691/ajmcr-5-3-7
Pub. Date: April 13, 2017
10902 Views2301 Downloads
by David Cadagan and Christopher Towlson
Original Research
Understanding the mechanisms of steroidogenic regulation in female fertility is fundamental to determining dysfunction. Research has revealed a strong relationship between fertility and metabolic disturbances. With many endocrine signals involved in activation of steroidogenic cascades, it has become necessary to map the complex cross-talk between these regulatory systems and this review looks to establish this based on current understanding. Luteininsing hormone is a vital endocrine hormone that is already known to signal via these pathways, although its involvement in metabolic disturbance is less understood. Studies investigating activation of the LH receptor in key steroidogenic cells, ovarian theca and granulosa, have highlighted overlaps in important signaling cascades including PKC/MAPK/PKA and PI3K. Here, we review LH and its signaling cross-talk in key steroidogenic pathways.
American Journal of Medical Case Reports. 2017, 5(3), 65-68. DOI: 10.12691/ajmcr-5-3-6
Pub. Date: April 12, 2017
9953 Views2678 Downloads
by Said Anajar, Mohammed Moutaa Tatari, Jawad Hassnaoui, Redallah Abada, Sami Rouadi, Mohammed Roubal and Mohammed Mahtar
Case Report
Introduction: Papillary carcinoma is the most frequent differentiated malignant thyroid neoplasm. Metastasis occurs frequently in regional lymph nodes and remote metastasis are late and rare, only 16 cases of initial cerebellar metastasis have been reported in the literature. Results: We report a rare case of cerebellar metastasis revealing papillary thyroid carcinoma in a 32-year-old patient, with a review of the literature on clinical features, radiological aspect, and treatment options. Discussion Conclusion: Cerebral metastasis of thyroid cancer are rare and the initial cerebellar metastasis revealing papillary carcinoma are exceptional, and due to their rarities and the relative lack of data on their management there is no treatment algorithm clearly defined.
American Journal of Medical Case Reports. 2017, 5(3), 62-64. DOI: 10.12691/ajmcr-5-3-5
Pub. Date: April 10, 2017
10777 Views2903 Downloads
by Qassim Al Hinai, Neeraj Salhotra, Munthir Al Zabin, Azmat Ali, Salim Al Abri, Mohammad Hashim and S.D Lad
Case Report
The ventriculoperitoneal shunt has been the preferred therapy for chronic hydrocephalus for a long time. Complications of this therapy include pseudocyst formation, perforation of the gastrointestinal tract, penetration into solid organs/abdominal wall, protrusion outside the body, disconnection and infection. Bowel perforation is rare complication of VP shunt placement [8]. Silent colonic perforation by ventriculoperitoneal shunt catheter and later patient presenting with catheter prolapsing from anal opening is seen less frequently [1]. We had 3 children 1-3 years old a case of hydrocephalus with ventriculoperitoneal shunt presenting in above scenario. Patients were completely asymptomatic with no features of toxemia indicating a chronic process [2]. Treatment involves pediatric surgical help in removing the shunt catheter, waiting for a sterile cerebrospinal fluid sample via repeated cultures and replacement of shunt catheter in a different quadrant in abdominal cavity.
American Journal of Medical Case Reports. 2017, 5(3), 59-61. DOI: 10.12691/ajmcr-5-3-4
Pub. Date: March 30, 2017
13585 Views2863 Downloads
by Pyong Wha Choi
Case Report
The role of radiotherapy in the treatment of rectal cancer has been well established. However, radiotherapy-associated complications are sometimes unavoidable. Chronic radiation proctitis is a representative complication, with the incidence ranging from 5% to 20%, which in turn, can cause other severe complications such as necrosis, perforation, fistula, and stricture. Although radiation influences anastomosis wound healing, delayed anastomotic disruption caused by severe radiation proctitis is extremely rare. Here, we present a case of delayed anastomotic disruption after postoperative radiotherapy. A 66-year-old woman presented with bloody diarrhea. She had undergone low anterior resection for rectal cancer 11 months ago, and had received 28 times radiotherapy for 6 weeks with a total radiation dose of 5040 cGy, postoperatively. Sigmoidoscopy showed circumferential necrosis and gangrenous change above the previous anastomosis site on the rectum, and pelvic magnetic resonance imaging revealed disruption of the previous anastomosis site. During the operation, the affected colonic segment, including the anastomosis site, was resected and coloanal pull-through anastomosis and ileostomy were performed. This case presents an unusually severe form of late radiation injury. Although radiotherapy is necessary for the treatment of advanced rectal cancer, predicting factors for radiation injury should be clarified for personalized treatment.
American Journal of Medical Case Reports. 2017, 5(3), 50-52. DOI: 10.12691/ajmcr-5-3-1
Pub. Date: March 10, 2017
12722 Views3256 Downloads