by Fray Arroyo-Mercado, Aleksandr Khudyakov, Gurasees S. Chawla, Onix Cantres-Fonseca and Isabel M. McFarlane
Original Research
Red Man syndrome (RMS) occurs with the rapid infusion of intravenous (IV) vancomycin. RMS induced by oral vancomycin has been the focus of a limited number of case reports. We present a case of a 75-year-old female admitted with severe Clostridium difficile colitis who received oral vancomycin and by the second day of therapy, she developed flushing, erythema, and pruritus involving the face, neck and upper torso. Oral vancomycin was immediately withheld, and diphenhydramine was initiated. Clinical improvement was apparent 24 hours after discontinuation of oral vancomycin. Our case adds to the published literature on this rare clinical entity that should be considered when severe colitis patients prescribed oral vancomycin, as part of the standard of care, develop the typical signs and symptoms of RMS.
American Journal of Medical Case Reports. 2019, 7(1), 16-17. DOI: 10.12691/ajmcr-7-1-5
Pub. Date: January 27, 2019
10401 Views2180 Downloads
by Hanna M. Crow, Tiffany Samples and Jane T. Purser
Original Research
Alpha-gal syndrome, also known as mammalian meat allergy, is characterized by a hypersensitivity reaction to galactose-alpha-1,3-galactose. Reactions typically manifest hours after consumption of red meat products such as beef, pork, and lamb. We describe the case of a 64-year-old male resident of rural Oklahoma who presented with anaphylaxis and myocardial infarction. The patient suffered complications that were attributed to porcine-derived heparin in the setting of undiagnosed alpha-gal syndrome. We describe the clinical course of this patient that lead to the diagnosis of alpha-gal syndrome to raise awareness of this disease.
American Journal of Medical Case Reports. 2019, 7(1), 13-15. DOI: 10.12691/ajmcr-7-1-4
Pub. Date: January 23, 2019
6762 Views1422 Downloads
by Apoorva Jayarangaiah, Pramod Theetha Kariyanna, Tanuj Chokshi, Maya Srinivasan, Seline Asun, Michael Ashamalla, Irini Youssef and Samy I McFarlane
Original Research
Leukocytosis, specifically granulocytosis in malignancy is a common finding with various etiologies. Graulocytosis associated with esophageal cancer has not commonly been reported in case reports in the United States. Furthermore, granulocyte colony stimulating factor (G-CSF) producing tumors have been associated with a variety of cancers. However, G-CSF producing esophageal tumors are rare. The diagnosis is established through serum G-CSF levels and immunohistochemistry staining of tumor cells. Here, we report a case of a 72-year-old woman with persistent granulocytosis leading to the diagnosis of esophageal squamous cell carcinoma (ESCC). Although, our case did not report serum G-CSF levels, we strongly suspect it to be the underlying etiology in our case. Additionally, through our missed opportunity, we hope to emphasize and increase awareness of G-CSF producing ESCC.
American Journal of Medical Case Reports. 2019, 7(1), 9-12. DOI: 10.12691/ajmcr-7-1-3
Pub. Date: January 22, 2019
7756 Views1904 Downloads
by Abin Sajan BS, Soombal Zahid DO, Jordan Stumph MD, Daniel Griepp BE, Sami Saba MD, Nazish Ilyas MD and Isabel M. Mc Farlane MD
Case Report
Background: Acute inflammatory demyelinating polyneuropathy (AIDP) is an uncommon form of neuropathy in HIV-infected patients that can cause pain, sensory disturbance, and motor weakness. Case presentation: A 23-year-old African American male with past medical history of Guillain-Barre Syndrome (GBS), Lyme disease, and sexually transmitted infections including syphilis and chlamydia presented with acute back pain radiating to bilateral lower extremities with worsening right foot weakness for four days. Cerebrospinal fluid (CSF) studies including meningoencephalitis panel were negative as well as blood tests for Lyme disease and HIV antibody testing. Patient was initially treated with penicillin for positive treponemal serology but without improvement in lower extremity weakness. Electromyogram showed evidence of early demyelinating motor polyneuropathy. Four days after presentation, repeat HIV antibody testing returned positive. Recurrent AIDP in this case was suspected to be secondary to acute HIV infection, and highly active antiretroviral therapy (HAART) was administered along with intravenous immunoglobulin (IVIG). Muscle strength improved with therapy and patient was expected to have continued improvement with intensive rehabilitation after discharge. Conclusion: Acute inflammatory demyelinating polyneuropathy (AIDP) tends to present early in course of HIV infection. Therefore, HIV testing should be obtained in individuals presenting with new neurological deficits. Our patient received HAART therapy, in addition to the traditional modalities to manage AIDP, which led to a substantial recovery of his sensorimotor function.
American Journal of Medical Case Reports. 2019, 7(1), 5-8. DOI: 10.12691/ajmcr-7-1-2
Pub. Date: January 21, 2019
7022 Views1839 Downloads
by Pyong Wha Choi
Case Report
In the adult population, psychiatric disorders and mental retardation are risk factors for foreign body ingestion. Most cases of foreign body ingestion are managed by close observation or endoscopic intervention. However, surgical intervention is mandatory in some cases. Here, we present the case of an unusually huge amount of gastric foreign bodies, which were removed by surgical intervention. A 54-year-old male patient presented with epigastric pain. He was born with mental retardation and had a 10-year history of anxiety disorder. Before the presentation, a colonic foreign body (coin) was identified 5 months ago, and the foreign body had been passed through the colon without morbidity. Plain radiography showed several foreign bodies occupying the whole stomach, and computed tomography showed multiple oval-shaped radiopaque foreign bodies in the stomach without complications. Although gastroscopy was attempted to extract these foreign bodies, it was impossible to extract all of them. Thus, surgery was performed. The foreign bodies (pebbles and coins) were extracted by surgery, and plain radiography was performed to confirm that there were no residual foreign bodies. The postoperative course was uneventful. Three months after the surgery, a radiopaque round foreign body was detected, and it was resolved without any intervention. Thereafter, the patient course was uneventful during the 1-year follow-up. Although a case with such a large number of gastric foreign bodies is extremely rare in humans, it is important to have a close follow-up after the removal of foreign bodies in patients with psychiatric disorders.
American Journal of Medical Case Reports. 2019, 7(1), 1-4. DOI: 10.12691/ajmcr-7-1-1
Pub. Date: January 21, 2019
12279 Views2866 Downloads