by Nawal Al-Kindi, Jalila Mohsin and Azza Al-Rashdi
Case Report
Granullicatella elegansis a nutritionally variant streptococci (NVS) known to cause a board spectrum of infections including infective endocarditis(IE), pneumonitis, peritonitis, meningitis, urinary tract, genital tract and other infections. NVS does not grow on routine laboratory media and requires specific biochemical tests for identification. We report a case of Granullicatella eleganscausing infective endocarditis and a rare complication of septic emboli to brain manifested as meningitis in a previously healthy patient with mild dental manipulation. The patient was managed with empiric antibiotics until final identification was made. The patient made a full recovery after 6 to 8 weeks of treatment with no complications. NVS including Granullicatella species is a well known cause of IE which could be missed and should be considered in the differential of culture negative IE. Molecular testing is very helpful in the definite diagnosis and identification of of NVS.
American Journal of Medical Case Reports. 2018, 6(2), 41-42. DOI: 10.12691/ajmcr-6-2-9
Pub. Date: April 04, 2018
7387 Views2257 Downloads
by Hasan. M, Iriarte. B, Patel. S and Madison. G MD
Case Report
Plasmodium falciparum (PF) causes the most deadly form of malaria. This is a case of a 43 year old male with sickle cell disease who presented to a community hospital in Philadelphia and was admitted for sickle cell crisis secondary to Plasmodium falciparummalaria. His last visit to malaria endemic area (Nigeria) was 13 months prior, when he contracted malaria and was treated successfully by the local health center. Sickle cell disease is known to have a protective effect against malaria. This case illustrates the importance of high index of suspicion that clinician must have when encountering patients with prior histories of malaria or traveling to remote, endemic areas, even in patients with sickle cell disease and those who are outside of the one year window period of exposure.
American Journal of Medical Case Reports. 2018, 6(2), 39-40. DOI: 10.12691/ajmcr-6-2-8
Pub. Date: April 02, 2018
7898 Views1968 Downloads
by Murat Ferhat Ferhatoglu
Case Report
Abdominal wall hernias are one of the most common reason for surgery globally. Spigelian hernia is a rare kind of this disease with an incidence of less than 2%. Because of its unic anatomical characteristics, it can be misdiagnosed or overlooked by physicians. Developments in radiological diagnostic tools facilitate correct and early diagnosis. Herein we presented a 76 year-old Spigelian hernia case and discussed anatomical characteristics, diagnosis and treatment methods of this rare kind of hernia with the literature knowledge.
American Journal of Medical Case Reports. 2018, 6(2), 36-38. DOI: 10.12691/ajmcr-6-2-7
Pub. Date: March 31, 2018
7399 Views1462 Downloads
by Zahra Janamiri and Omid Sadeghpour Moradi
Original Research
Introduction: Optic Neuritis is defined as inflammation of the optic nerve, which is mostly idiopathic, while demyelinating lesions secondary to auto-immune conditions are among other causes. These lesions are demonstrated on Magnetic Resonance Imaging (MRI) as hyper intensities. In this study, authors plan to investigate the relationship between MRI pattern of patients suffering from optic neuritis, and their pain and visual loss patterns. Materials and Methods: From June 2017 to December 2017, we have enrolled 127 patients suffering from optic neuritis. These patients were referred to neurology and ophthalmology clinic of a private hospital in Tehran. Demographic data of all patients were collected and they underwent MRI for evaluation of optic nerve abnormalities and possible lesions and enhancements. Also, detailed pain score regarding their ocular pain were recorded by an expert blind neurologist, categorizing them into pain with movement, pain during rest and no pain. Also, visual field assessments were performed by an expert blinded ophthalmologist. Statistical analysis performed using SPSS version 17.00 and Student T-test and Mann-whitney test and Chi-square test. Results: There were 110 females and 17 males, with mean age of 35.2 years for females and 39.8 for males. Statistical analysis revealed no significant difference between demographic data of patients. (P value=0.12) Of these patients, 116 cases have abnormalities in their neuro-imaging, which 60 cases have pain in eye movement (group A), 37 cases experienced pain during rest (group B) and 19 cases have no pain (group C). Also, 78 patients have optic nerve enhancement in the orbital segment (39 cases of group A, 28 cases of group B, 11 cases of group C), 16 patients have canalicular segment enhancement (4 cases of group A, 9 cases of group B, 3 cases of group C) and 22 patients have intracranial segment enhancement (13 cases of group A, 6 cases of group B, 3 cases of group C). Also we have found that enhancements longer than 8 mm are consistent with more severe ocular pain, whether during movement or rest. (P value < 0.05) Visual field assessment revealed no significant correlation between type and length of optic nerve enhancement on MRI and visual field loss. (P value=0.09). Conclusion: Authors have found that most of the patients suffering from optic neuritis may demonstrate their symptoms as ocular pain during movement, which most of them have orbital segment involvement of optic nerve. Also, we have found that canalicular optic nerve enhancement were mostly associated with ocular pain at rest, opposed to other types of enhancement (orbital and intracranial). Also, we have found a specific threshold defined as 8 mm of optic nerve enhancement and severity of pain, which is less than other studies in literature.
American Journal of Medical Case Reports. 2018, 6(2), 33-35. DOI: 10.12691/ajmcr-6-2-6
Pub. Date: March 31, 2018
6554 Views1826 Downloads
by Zahra Janamiri, Vahid Shahmaei and Hamidreza Haghighatkhah
Original Research
Introduction: Migraine is one of the most common disabling disorders affecting more than 20% of general population at least for once in their lifetime. There are generally two types of migraine headaches, classified as with and without auras, presenting as visual, sensory or motor symptoms. In this study, authors plan to investigate the structural difference between these patients group by Magnetic Resonance Imaging (MRI) in a prospective case-control study. Materials and Methods: From August 2015 to October 2017, we have enrolled 40 patients suffering from migraine with aura symptoms into group A, and also we have categorized another 40 patients diagnosed with migraine without any types of aura in group B. These patients were referred to our neurology clinic of one of private hospitals in Tehran. Demographic data and thorough neurological examination performed and they underwent 1.5 Tesla MRI for further assessment of neuro-structures by an expert blinded neuro-radiologist. Statistical analysis was performed by SPSS 17.0 program using Student’s T-test and Chi-square test. Results: In group A, there were 9 males and 31 females with mean age of 34.3 years, while there were 13 males and 27 females with mean age of 37.6 years in group B. (P value=0.08) Twenty-five patients in group A experienced visual symptoms, followed by 9 patients with sensory symptoms and 6 patients with motor symptoms. MRI study for group A revealed normal neuro-imaging in 18, pineal and choroid plexus calcification in 8, hyperintense lesions on optic nerve and tract in 4, vascular malformation in 4, hyperintense signal on centrum semiovale in 3 and lateral ventricle asymmetry in 3 patients. While MRI study in group B revealed normal neuro-imaging in 24, hyperintense signal on centrum semiovale in 6 and lateral ventricle asymmetry in 4, dilated ventricles defined by Evans’ ratio in 3, pineal and choroid plexus calcification in 2 and brain tumor consistent with meningioma in 1 patient. Conclusion: Authors have found that some specific MRI pattern such as hyperintense lesions on optic nerve and tract and vascular malformation were exclusive to patients who experienced migraine with aura. Also we have noticed that patients without aura tend to have more normal neuro-imaging rather than patients with aura experience. Also we have found that pineal and choroid plexus calcifications were frequent in patients with migraine and aura experience. These findings, especially hyperintense lesions on optic nerve may prompt further evaluation for possible underlying demyelinating and auto-inflammatory and/or auto-immune diseases.
American Journal of Medical Case Reports. 2018, 6(2), 30-32. DOI: 10.12691/ajmcr-6-2-5
Pub. Date: March 31, 2018
7265 Views2404 Downloads
by Mazaher Ramezani, Shima Jalalvandi, Fatemeh Rezaali and Masoud Sadeghi
Case Report
Medullary Breast carcinoma (MBC) is an infrequent type of breast cancer and is in the differential diagnosis of invasive ductal carcinoma (IDC) with medullary features. We reported a 35-year-old lady with left breast since 6 months ago. CEA tumor marker serum level and CA15-3 were within normal limits. The patient underwent the incomplete left mastectomy. Gross specimen revealed gray-yellow hemorrhagic tumor lesion with pushing border. Histopathology demonstrated highly atypical cells with lymphocytic infiltration and mainly pushing border but with infiltrative margin in few areas. The permanent diagnosis was “invasive ductal carcinoma with medullary features“. We conclude that careful histopathological evaluation and considering strict criteria is necessary for definitive diagnosis and subsequent proper treatment.
American Journal of Medical Case Reports. 2018, 6(2), 26-29. DOI: 10.12691/ajmcr-6-2-4
Pub. Date: March 30, 2018
11373 Views2802 Downloads
by Asghar Marwat, Hassan Mehmood and Muzammil Khan
Case Report
Epstein-Barr virus is a widely disseminated herpes virus. Humans are the main reservoir. Acute infectious mononucleosis is one of the most common presentations of acute EBV infection. Although mild thrombocytopenia is a common complication of EBV induced infectious mononucleosis, severe thrombocytopenia with counts less than 25,000/mm3 is extremely rare and infrequently reported. We herein, present a 22-year-old Caucasian male with no past medical history who came to our hospital with complaints of fever, sore throat, swollen lymph nodes and intermittent bleeding from his gums for the last 4 weeks. On physical examination, the patient had enlarged tonsils and cervical lymphadenopathy, however, no rashes or hepatosplenomegaly were noted. On initial Lab work the patient had a platelet count of 11,000/mm3, WBC count of 9,800 with 31% atypical Lymphocytes and a positive mono spot test. The patient also had a peripheral smear showing marked thrombocytopenia. EBV infection was further confirmed by serology including EBV-PCR. Other possible causes of thrombocytopenia including HIV and Hepatitis C were tested and found to be negative. The patient was treated with platelet transfusion and intravenous steroids. He was discharged three days later, after his platelet count improved to 36,000/mm3 on a tapering dose of steroids. Two weeks later repeat lab work revealed that his platelet count had dropped again significantly to 2000/mm3. He was readmitted and this time treated with Intravenous Immunoglobulin and intravenous steroids. The patient had dramatic improvement and his platelet count was 143,000/mm3two days later. The patient was discharged and continued to have normal platelet counts during routine clinic follow ups few months later. Severe thrombocytopenia is a potentially life-threatening condition. Although exceptionally rare, severe thrombocytopenia can occur as a complication of EBV induced Infectious mononucleosis and should be considered by physicians as a possible differential for thrombocytopenia in the right clinical setting. Steroids and Intravenous Immunoglobulin have been used with varying success to treat this complication.
American Journal of Medical Case Reports. 2018, 6(2), 24-25. DOI: 10.12691/ajmcr-6-2-3
Pub. Date: March 28, 2018
8831 Views2838 Downloads
by Ali Al Mashni, Neeraj Salhotra, Mohammad Hadad, Mohammad Hashim, Tariq Al Saidi and Samit Biniwal
Case Report
A three year child had presented to our OPD with complaints of nasal obstruction, change of voice and difficulty in ingestion. Patient was investigated and was seen having a mass in the nasopharynx. Further investigations revealed on CT and MRI brain a large tumour destroying the clival region with nasopharyngeal and intracranial extension with pressure effect on brain stem and lower cranial nerves. Patient underwent two stage surgery retromastoid craniectomy with excision of intracranial part and later a tracheostomy and transoral excision of the nasopharyngeal extension and part anterior to brain stem. Patient made a remarkable recovery and was discharged home after tracheostomy removal with advice to follow with pediatric oncology for chemotherapy as HPE revealed it to be clival chordoma a rare entity in children.
American Journal of Medical Case Reports. 2018, 6(2), 21-23. DOI: 10.12691/ajmcr-6-2-2
Pub. Date: March 07, 2018
9468 Views1766 Downloads
by Trika Irianta and Alexandra Ridjab
Case Report
Ureter fistulas are rare complications of obstetrics and gynecologic surgery. We report two cases of ureter fistulas; the first case is a 28-year-old with an ureterouterine fistula who underwent caesarean section four years ago. The second case is a 54-year-old with an ureterovaginal fistula and a history of an abdominal total hysterectomy 16 months ago. Both patients complained of urine leaks from the vagina. The extravesical ureteroneocystotomy using Lich-Gregoir technique was done on both cases successfully with uneventful post-operative course.
American Journal of Medical Case Reports. 2018, 6(2), 18-20. DOI: 10.12691/ajmcr-6-2-1
Pub. Date: March 07, 2018
11568 Views2009 Downloads1 Likes