by Muzammil Khan, Shaza Khalid, Asghar Marwat, Salah Aldergash, Medha Joshi and Varun Malhotra
Case Report
Gabapentin, an anti-epileptic drug (AED) is commonly used off label for management of neuropathic pain and psychiatric disorders. Dosing of gabapentin requires taking into consideration the renal function as it is entirely cleared by the kidneys. Acute kidney injury and end stage renal disease increase the risk of developing myoclonic activity, an infrequent manifestation of gabapentin toxicity. We report a case of confusion and myoclonic activity related to gabapentin toxicity coincident with acute kidney injury that resolved with discontinuation of gabapentin and treatment with intravenous fluid hydration. As gabapentin is commonly used off label across multiple specialties, clinician recognition of the significance of renal dosing and understanding of the potential association with myoclonus and neurotoxicity is important.
American Journal of Medical Case Reports. 2017, 5(8), 232-233. DOI: 10.12691/ajmcr-5-8-8
Pub. Date: September 05, 2017
8928 Views3006 Downloads1 Likes
by Ekamjeet Randhawa, John R. Woytanowski, Sara Schultz and Benjamin Bluen
Pasteurella multocidais a gram-negative coccobacillus that causes a spectrum of illnesses. P multocidalives as commensal bacteria in the upper respiratory tracts of fowl and mammals. Infections most commonly result from cat or dog bites; however, direct inoculation via saliva has been reported. Although the majority of P. multocidainfections manifest in skin and soft tissue, it may cause bacteremia with disseminated infection in an immunocompromised host. Dissemination is responsive to treatment but carries a significant mortality risk of about 30%. We present a case of a 46 year old male with type 2 diabetes mellitus, coronary artery disease and chronic kidney disease with stage 4 neuropathic heel ulcer who presented with hypothermia and chills. One day into admission, 4/4 blood culture bottles were positive for Pasteurella multocida. MRI of the foot was concerning for osteomyelitis which was confirmed via I&D. The patient did report having a dog and a cat at home, but adamantly denied any bites from either animal. Examination of his boot used for support with his foot containing the ulcer revealed extensive animal hair stuck to the boot. It was deemed likely that the route of inoculation occurred from contamination of his neuropathic ulcer from his dog’s saliva, likely from a lick, for which his diabetic neuropathy may have impaired initial sensation of the contamination. The patient was treated with ampicillin-sulbactam while admitted and discharged with oral levofloxacin 6 week course for residual osteomyelitis.
American Journal of Medical Case Reports. 2017, 5(8), 229-231. DOI: 10.12691/ajmcr-5-8-7
Pub. Date: September 04, 2017
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by Al Shehhi. Wafaa, Alkindi. Hanan, Macki. Nabil and AL Hashami. Hilal
Case Report
A five years old Yemeni boy presented with a 5 months history of progressive neurological deterioration in picture of progressive cognitive decline , seizures and hyperkinetic movements. Patient came from an area with political instability and low socio-economic status. There was history suggestive of measles at 2 years of age. He never received measles vaccination. Diagnosis of sub acute sclerosing pan encephalitis (SSPE) was made based on clinical symptoms, serum and CSF findings of high measles IgG, neuroradiological findings as well as neurophysiological findings. We report this case to highlight the role of intravenous immunoglobulin and steroid in improving his symptoms.
American Journal of Medical Case Reports. 2017, 5(8), 226-228. DOI: 10.12691/ajmcr-5-8-6
Pub. Date: August 28, 2017
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by Mohit Kukreja, V G Telang and Chetan Anchan
Case Report
Introduction: The Ewing family of tumors comprises Ewing's sarcoma (EWS), extraskeletal EWS, primitive neuroectodermal tumor (PNET) of bone and soft tissue, and chest wall tumor (Askin tumor). The translocation t(11; 22) (q24; q12) is identified in more than 90% of cases.EWS is the second most common primary bone malignancy in childhood. In contrast to long bone involvement, delays in spinal EWS diagnosis may occur because symptoms may not be present until neurological deficits occur. To date, although there have been reported cases of EWS in the lumbosacral region, the reported cases are very less and the presentations might drastically differ. Case Presentation: A 14 year old boy comes with a 12 weeks h/o urinary incontinence and constipation. Over the next 4 months, the patient had new-onset intermittent abdominal pain with worsening urinary symptoms.MRI confirmed a diagnosis of Koch's spine. However, the histopathology reported it as an “Ewings sarcoma/Primitive Neuroectodermal Tumor”. Discussion: Ewing’s tumor of sacrum is rare, but should be suspected in low backache in children. Cauda equina syndrome can be a valid presentation for EWS spine. MRI can identify cases early and enables early treatment though it is not specific. Histopathological diagnosis is a must before any definitive management.EWS spine can mimick Tuberculosis both clinico-radiologically, only to be confirmed with a tissue biopsy. Conclusion: Ewing’s sarcoma of the lumbosacral spine can have an atypical presentation and there should be a high degree of suspicion to diagnose it early.
American Journal of Medical Case Reports. 2017, 5(8), 221-225. DOI: 10.12691/ajmcr-5-8-5
Pub. Date: August 24, 2017
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by Yusfitaria Alvina, Muhammad Nuralim Mallapasi, Rosie Rosie and Prihantono Prihantono
Case Report
Malignant Fibrous Histiocytoma (MFH) is a mesenchymal tumor from fibroblast differentiation and histiocyte like cells. This tumor found in 1964 and representing the biggest type of sarcoma. The Incidence of Malignant Fibrous Histiocytoma in lung about 20-24%, with the men and women ratio 2: 1. Diagnosis of Malignant Fibrous Histiocytoma’s hard because found in a patient without symptoms. In this case, a 62 years old patient, professional history as a gold miner for 36 years complained chest pain particularly in the left chest. Investigated by posteroanterior chest radiograph and thoracic CT scan obtained a picture of the left lung tumor, then performed thoracotomy surgery and excision of tumors. Histopathological examination showed a Malignant Fibrous Histiocytoma. Patient is repatriated from the hospital 5 days after surgery in good condition and undergoes routine follow up every six months. Follow up 3 years after Surgery patient is in good health and no sign of residif of the tumor.
American Journal of Medical Case Reports. 2017, 5(8), 217-220. DOI: 10.12691/ajmcr-5-8-4
Pub. Date: August 23, 2017
11230 Views2133 Downloads2 Likes
by Csaba Tóth and Zsófia Clemens
Case Report
Background: Ketogenic diets have repeatedly been suggested for the treatment of cancer. Yet, only a few case studies have been published that reported long term benefits associated with such diets. Case report: Here we present a case where rectal cancer was treated with an animal fat-meat based diet, which we refer to as the paleolithic ketogenic diet. Upon diet initiation, the patient discontinued three medicines he had been taking because of hypertension and hyperuricemia. The patient initially received 6 weeks of radiation therapy. Thereafter the patient used the diet as a stand-alone therapy for 22.5 months. The patient was not taking any medicines or dietary supplements while on the diet. During the first five month of the diet therapy the patient exhibited excellent adherence which was paralleled by improving laboratory parameters including decreasing tumor marker levels and decreasing tumor size. The patient was in a constant ketosis during the entire follow-up. From the seventh month on, however, his adherence level was fluctuating with periods of worse adherence paralleled with negative changes in laboratory parameters. Although MRI imaging showed that there was no increase in the size of the tumor, 22 months after diagnosis onset the patient reported an alteration in bowel habits and that the bloody stool had returned. Because of the emergence of these symptoms, 24 months after diagnosis onset, rectal surgery was performed.Conclusion: With using the paleolithic ketogenic diet the patient was able to postpone surgery for two years. During the first five months, when the patient was strictly adhering to the diet, the tumor regressed. Thereafter, with incomplete dietary adherence, disease seemed to be stable but symptoms suggested progression for the last few months of the follow-up. Deviations from diet rules, even those not affecting ketosis, resulted in the progression of the disease.
American Journal of Medical Case Reports. 2017, 5(8), 205-216. DOI: 10.12691/ajmcr-5-8-3
Pub. Date: August 19, 2017
24483 Views4583 Downloads1 Likes
by Arash Dooghaie Moghadam, Ali Keipourfard and Yasaman Arjmand
Original Research
Objectives: The natural course of un-ruptured vertebral artery dissecting aneurysms (VADAs) is not completely clear. We aim to retrospectively develop a strategy for treating un-ruptured VADAs based on long-term follow-up. Methods: We retrospectively studied 35 patients with un-ruptured VADAs. The initial symptom of 20 patients was headache, followed by ischemic symptoms and mass effect in 11 and 4 patients respectively. All of the patients underwent Magnetic Resonance Imaging (MRI) and Magnetic Resonance Angiography (MRA) at the time of admission and 2 weeks and 1, 4, 6, 12, and 24 months after initial presentation. Asymptomatic patients with enlarging dissection site defined on MRI and MRA, received further treatment and work up. Results:Two patients received emergency intervention due to symptom exacerbation and unstable status. The other 33 patients underwent conservative management. Lesion enlargement was observed in 2 cases during imaging follow up. In follow up period, additional interventions including dissection trap by surgery and coil embolization were conducted in 1 and 3 patients respectively. Other 31 patients remain symptom free and were managed conservatively. Dissection site remained unchanged in majority of patients (68.57%), improved in 28.57% and disappeared in 2.85% of the patients. Ten patients with recurrent ischemic attacks underwent anti-platelet therapy, without any bleeding complaint or permanent neurological deficits. Conclusion: The nature of an un-ruptured VADA is not highly aggressive. However, enlarged dissection site without new manifestations, occlusion is recommended. Also, anti-platelet therapy is suggested in patients with recurrent ischemic attacks.
American Journal of Medical Case Reports. 2017, 5(8), 202-204. DOI: 10.12691/ajmcr-5-8-2
Pub. Date: August 17, 2017
8822 Views2980 Downloads2 Likes
by Farate A, Yunusa GH, Umar UH, Ahmadu MS, Mustapha Z and Ahidjo A
Case Report
This report presents the "penumbra sign" of Brodie's abscess in a 17-year-old boy. The lesion was located in the proximal metaphysis of the left tibia. Histologic and microbiologic confirmation of the diagnosis was made. A "penumbra sign" on non-contrast enhanced T1-weighted magnetic resonance images is a helpful diagnostic sign of Brodie's abscess.
American Journal of Medical Case Reports. 2017, 5(8), 199-201. DOI: 10.12691/ajmcr-5-8-1
Pub. Date: August 16, 2017
12392 Views2704 Downloads8 Likes