by Trika Irianta and Elisabeth Tanuwidjaja
Case Report
Vesical calculi are not commonly seen with pelvic organ prolapse. We report a case of a 64 years old multiparous woman, who presented with history of vaginal mass in the last 2 years. Gritty sensation was felt on palpating the cystocele and multiple calculi were suspected intraoperatively. A transvaginal hysterectomy was done followed by vaginal cystolithotomy, an anterior colporrhapy and posterior colpoperineorrhapy (Mc call culdoplasty technique). Multiple vesical calculus was removed. Post-operative course was unremarkable.
American Journal of Medical Case Reports. 2017, 5(9), 254-255. DOI: 10.12691/ajmcr-5-9-8
Pub. Date: September 28, 2017
11838 Views2556 Downloads3 Likes
by Geetha Wickrematilake
Case Report
Background: Evans syndrome associated with secondary anti-phospholipid syndrome has not been reported in case studies and we report a case of SLE and secondary anti-phospholipid syndrome diagnosed seven years after the initial diagnosis of Evans syndrome. Case presentation: A 21-years-old female was diagnosed with Evans syndrome since the age of 14 years, and was on treatment for seven years. At the onset of disease her immunological screening for ANA, Ds-DNA were negative. She was treated with immunosuppressants and steroids and the disease was complicated with Cryptococcal meningitis. Seven years later at the age of 21 years she started to have joint arthritis, and the ANA test converted to positive together with a positive Ds-DNA. Later on she had a single episode of unprovoked deep vein thrombosis in a leg (below knee), and became positive for lupus anticoagulant and IgM anticardiolipin antibodies. Her cardiac imaging (Echo-cardiogram) revealed that she had developed moderate pulmonary hypertension. She was treated with physiotherapy, Methotrexate, Hydroxychloroquine, Warfarin and Sildenafil with good control of the disease. Her lupus is in remission with treatment with no anaemia. Conclusion: Haematological manifestations of systemic lupus erythematosus could vary. Hence, Lupus should be kept in mind always during management of complicated hematological conditions as the patient might fulfill cumulative SLE classification criteria over time.
American Journal of Medical Case Reports. 2017, 5(9), 252-253. DOI: 10.12691/ajmcr-5-9-7
Pub. Date: September 28, 2017
8615 Views2889 Downloads1 Likes
by Balakrishnan Valliyot, Sarosh Kumar K, Harikrishnan Mohan, Sarin S, Kadeeja Beevi and Sudha Balakrishnan
Case Report
Disseminated nocardiosis is a serious opportunistic infection with very high mortality, especially in individuals with defective cell mediated immunity. The use of immunosuppressant therapy is associated with increased risk of opportunistic infections and in south-east Asian countries where tuberculosis is widely prevalent, Nocardia is an often overlooked and under diagnosed pathogen, with clinically very similar presentations. Here we report a case of disseminated nocardiosis presenting as multifocal brain, in a patient with Lepromatous Leprosy, who was on immunosuppressive therapy for Type 2 Lepra reactions. An early diagnosis requires high index of suspicion and interventions like stereotactic brain surgery and is a determinant for positive clinical outcome.
American Journal of Medical Case Reports. 2017, 5(9), 248-251. DOI: 10.12691/ajmcr-5-9-6
Pub. Date: September 28, 2017
11064 Views2662 Downloads
by Muhammad Asykar Palinrungi and Prihantono Prihantono
Case Report
Metanephric Adenoma is a rare benign renal epithelial tumor, only a few reports are found in the literature. Reported a 48-year-old female with a palpable mass at left flank, pain and microscopic haematuria. Radiological imaging shows a mass on left Kidney suspected of Renal Cell Carcinoma. Transperitoneal left radical nephrectomy was done. Histopathological results revealed a Metanephric adenoma. The patient is repatriated from the hospital four days after surgery. The patient is in good health, and there is no sign of recurrence on 48 months follow up after surgery.
American Journal of Medical Case Reports. 2017, 5(9), 244-247. DOI: 10.12691/ajmcr-5-9-5
Pub. Date: September 19, 2017
9560 Views2334 Downloads1 Likes
by Ganesh Kasinathan and Naganathan Pillai
Case Report
This case report highlights a 55 year old gentleman of Malay descent who presented to the hospital with chronic cough, dyspnoea and night sweats. He is a chronic smoker and works in a rubber plantation. On examination, he was tachypnoeic and tachycardia, febrile and in type 1 respiratory failure. Physical examination was consistent with a right sided spontaneous pneumothorax which was confirmed on a chest radiograph. The chest radiograph also showed evidence of active tuberculosis involving the right upper and middle lobes. His sputum samples smear and culture revealed Mycobacterium tuberculosis complex. He was immediately placed on an intercostal drain with air leak persisting after two weeks. A high resolution CT scan of the thorax showed a bronchopleural fistula measuring 7 mm in diameter in the anterior segment of the right lower lobe. With careful management of the chest drain and early administration of antituberculous chemotherapy, the air leak ceased and the repeated CT scan of the thorax showed obliteration of the fistula. He continued to improve and currently on the 5th month of treatment. Conclusion: An underlying tuberculosis infection resulting in a bronchopleural fistula should not be missed in a patient from a tuberculous endemic area. Effective careful management of the chest drain and early administration of antituberculous treatment are vital to facilitate the healing of a bronchopleural fistula.
American Journal of Medical Case Reports. 2017, 5(9), 242-243. DOI: 10.12691/ajmcr-5-9-4
Pub. Date: September 15, 2017
9498 Views2519 Downloads
by Shirmila Syamala, Hanadi Khamis Mubarak Alhamad, Essa Al-Sulaiti and Asma Mirghani Sayed Abbas
Case Report
Introduction: Mirtazapine is an antidepressant commonly used and considered safe in the elderly. It is favored in elderly patients suffering from insomnia and weight loss secondary to depression. Here, we present a case where mirtazapine caused an unexpected adverse effect of agitation and hallucinations contrary to the expected reaction of sedation. Case Presentation: An 86 year old female was admitted with complaints of poor oral intake. She was very frail and weighed 23 kilos. She was malnourished and suffering from hypoalbuminemia and electrolyte abnormalities. Her evaluation did not reveal an organic cause for weight loss. Her cognition was intact. She was started on mirtazapine 7.5 mg for depression and received 2 doses. During the second night, she was unable to sleep and started having visual hallucinations. The hallucinations were described as people in the wall, boxes, and cars coming from the window to hit her. Subsequently Mirtazapine was discontinued and hallucinations stopped 48 hours after the last dose. Discussion: Mirtazapine is a tetracyclic antidepressant with serotonergic and noradrenergic activity. Mirtazapine has been shown to be very effective in treating depression in elderly. The decision to treat with mirtazapine is also based on its side effect profile. Somnolence happens in 50 % of people and weight gain in 15% of patients. Therefore mirtazapine is commonly used to treat depression in patients with concomitant insomnia and anorexia. The relative tolerability of mirtazapine makes it a first-line medication for many elderly with major depression. Peak plasma concentrations are reached within 2.2 to 3.1 hours after single oral doses of 15 to 75mg. Mirtazapine is extensively metabolized in the liver. Protein binding is 85%. Mean elimination half-life is 22 hours, so it can be administered once a day. Despite its known sedative effect, there have been reports of visual and auditory hallucinations and insomnia occurring with the use of mirtazapine, which could be related to increase in dopamine levels in the frontal cortex. Our patient was elderly, frail and malnourished. Her hypoalbuminemia related to malnutrition and low protein binding could also be a factor as increased free drug will be available to enter the CNS. Although she was started at half the adult dose, it may still have been high for her due to her low weight. Per the Naranjo criteria, Mirtazapine was determined as the probable cause of hallucination in this case. This case illustrates that although Mirtazapine is a relatively safe drug to use in elderly, we need to be cautious when starting the drug or increasing the dose, especially in malnourished patients.
American Journal of Medical Case Reports. 2017, 5(9), 239-241. DOI: 10.12691/ajmcr-5-9-3
Pub. Date: September 11, 2017
11496 Views2362 Downloads
by Munawwar Hussain and Nazish Malik
Original Research
Takotsubo cardiomyopathy is one of the acquired cardiomyopathies which occurs due to physical or emotional stress. Its most common manifestations are chest pain, dyspnea but may be accompanied with myalgia, abdominal symptoms, palpitations syncope or presyncope. These symptoms can vary from mild to severe forms. It mimics myocardial infarction as greater than 80% of patients with takotsubo cardiomyopathy have ST segment elevation on electrocardiogram, followed by diffuse deep T-wave inversion and QT prolongation. Ventriculography often shows transient hypo kinesis of left ventricular apex but cardiac catheterization shows no coronary artery disease and it resolves completely within days to weeks. Electrocardiographic and echocardiographic disturbances are seen with reduced LVEF and normal angiography. In this report, we present a case of 67 years old lady who was scheduled for right breast lumpectomy and underwent stress cardiomyopathy due to anesthesia effects. Case description will further illustrate the patient, procedure and anesthetic management.
American Journal of Medical Case Reports. 2017, 5(9), 237-238. DOI: 10.12691/ajmcr-5-9-2
Pub. Date: September 09, 2017
9136 Views3245 Downloads2 Likes
by Muhammad Sohaib Afzal, Saleha Sharif Dar, Tayyaba Sarwar and Muhammad Zubair Afzal
Case Report
Hydrogen peroxide is a well-known remedy used in homeopathic medicine. Accidental ingestion can have a broad range of side effects depending upon the quantity and concentration of ingestion. Air emboli to the brain have been reported in very few case reports. We present an interesting case of accidental ingestion of 35% hydrogen peroxide resulted in ischemic stroke and seizures due to air embolism. Our patient was an elderly woman who accidentally drank industrial strength hydrogen peroxide thinking of water. Upon ingestion of approximately two tablespoons of hydrogen peroxide, she developed respiratory distress within few minutes. She was reported to have a frothy mouth and soon became unresponsive. EMS arrived and intubated her on her way to the hospital. A CT of the chest/abdomen/pelvis showed air in the heart, spleen, splenic and portal veins. A CT, MRI of head and EEG were performed to evaluate her altered mental status. She was treated with phenytoin, midazolam for seizure prophylaxis and hyperbaric oxygen for the air embolism without improvement. The family ultimately decided to transition to comfort measures only. This is a rare case of air embolism. About 20% of air-embolism occurs in contrast enhanced CT’s. Very rarely it can be because of hydrogen peroxide poisoning. Hydrogen peroxide has many common uses but has a great potential for misuse. Hyperbaric oxygen has a role in both limiting damage and enhancing recovery. This is the current standard of care as documented in previously reported case.
American Journal of Medical Case Reports. 2017, 5(9), 234-236. DOI: 10.12691/ajmcr-5-9-1
Pub. Date: September 08, 2017
11567 Views3337 Downloads