by Ruixia Yang, Weijuan Song, Ting Cui, Qiuxia Ge, Li Jiang and Lujiang Yi
Case Report
Immunoglobulin G4-related disease (IgG4-RD) is a chronic progressive autoimmune disease. Mammary gland, parotid gland and orbit involvement in IgG4-RD is extremely rare. Herein, we report a case of IgG4-RD presenting with pain in breasts, parotid masses and bilateral exophthalmos. A 52-year-old woman came to our breast disease clinic for treatment, because of pain in her breasts. After examination, eliminated the possibility of breast cancer. Physical examination indicated bilateral parotid hypertrophy and a small amount of clear liquid flowed out while pressed lightly, space-occupying lesions in the upper and outer orbits of the both eyes, this condition had been existing for 6 years. The results of immunohistochemical staining indicated IgG4-positive plasma cells in parotid masses and laboratory tests revealed elevated serum IgG4 (1480 mg/dL, normal range: 3-201 mg/dL), a diagnosis of IgG4-RD of the mammary gland, parotid gland and orbit was formulated.
American Journal of Medical Case Reports. 2019, 7(4), 71-73. DOI: 10.12691/ajmcr-7-4-5
Pub. Date: April 26, 2019
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by Michelle Likhtshteyn, Sadat Iqbal, Samy I. McFarlane and Savanna Thor
Case Report
With the advent of hydroxyurea, the sickle cell population has been enjoying a prolonged life span as compared to the pre-hydroxyurea era. Traditionally, acute complications of sickle cell disease includes acute chest syndrome, MI and stroke. In this report we present a case of an elderly man with sickle cell disease who presented with intrahepatic cholestasis (SCIC); a rather rare and fatal complication of sickle cell hemoglobinopathy. The patient presented with jaundice and elevated bilirubin up to 53, his hospital course was complicated by coagulopathy and encephalopathy, and expired on day 43 of presentation after failing multiple therapeutic interventions including exchange transfusion. In this report, we will provide literature review and discuss the underlying pathophysiologic mechanisms of intrahepatic cholestasis in the sickle cell population highlighting the need for immediate recognition and institution of therapy for this fatal complication of sickle cell disease, particularly in elderly populations with low metabolic reserve.
American Journal of Medical Case Reports. 2019, 7(4), 67-70. DOI: 10.12691/ajmcr-7-4-4
Pub. Date: April 25, 2019
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by Sadat Iqbal, Michelle Likhtshteyn, Daniel O’Brien, Samy I. McFarlane and Manuel Martinez
Case Report
Duodenal varices are a rare complication of portal hypertension; with cirrhosis being the most common cause. Reports regarding the disease prognosis and natural history are limited. In addition to the diagnostic difficulty, ectopic duodenal varices pose a significant therapeutic challenge owing to the lack of specific management guidelines. Given the high risk of rupture, they can have devastating clinical outcomes. Rupture typically presents as a gastrointestinal hemorrhage and requires emergent interventions. We present a case of duodenal varix seen on upper endoscopy in a patient with portal hypertension and cirrhosis, together with review of the literature outlining the current understanding of this disease entity. We also highlight the pathogenetic mechanisms as well as the current diagnostic and therapeutic approaches for this potentially fatal disease.
American Journal of Medical Case Reports. 2019, 7(4), 62-66. DOI: 10.12691/ajmcr-7-4-3
Pub. Date: April 24, 2019
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by Mohammed Al-Sadawi, Hassan Alkhawam, Angeleque Hartt, Aron Soleiman and Samy I. McFarlane
Case Report
Background: Brugada phenocopies are clinical entities etiologically distinct from congenital Brugada syndrome; differentiation is crucial for management. Case: A 29 year-old male with a history of cocaine abuse, brought in by Emergency Medical Services (EMS) after he was found unresponsive and given naloxone. He was found altered but arousable with verbal stimuli. He reported snorting a white powder to get “high”. He denied family history of sudden death or previous history of syncope. His ECG on presentation showed coved, ≥2 mm ST elevation with T-wave inversion in V2 consistent with Brugada EKG pattern (Figure 1). His troponin was trending up with elevated creatinine 1.6 mg/dl, liver enzymes and lactic acid, and urine toxicology was positive for cocaine. Decision‐making: The presentation of altered mental status is multifactorial: metabolic derangement, drugs misuse and Brugada. Finding Brugada EKG pattern should be investigated to differentiate congenital Brugada syndrome and Brugada phenocopies. This patient has no family history of sudden death and no prior history of syncope. Serial EKG showed a gradual resolution of the coved and ST elevation in V2.Conclusion: our case demonstrates the importance of careful history taking including family history, as well as serial ECGs and treating the possible underlying etiology such as drugs abuse or electrolytes abnormality. It is also warranted to differentiate between Brugada phenocopies from congenital Brugada syndrome because therapeutic strategies are quite different with each diagnosis.
American Journal of Medical Case Reports. 2019, 7(4), 59-61. DOI: 10.12691/ajmcr-7-4-2
Pub. Date: April 14, 2019
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by Ketan Vagholkar, Yash Kripalani, Shivangi Garima and Suvarna Vagholkar
Case Report
Delayed development of a haemothorax after central venous cannulation of the right internal jugular vein is extremely rare. Awareness of this rare complication by the trauma surgeon is essential to avoid attributing the complication to a missed thoracic injury. Prompt chest x-ray is necessary to confirm the diagnosis. Removal of the central line followed by tube thoracostomy remains the mainstay of management. A case of delayed haemothorax following central venous cannulation of the internal jugular vein is presented to highlight this complication followed by a brief review of literature.
American Journal of Medical Case Reports. 2019, 7(4), 56-58. DOI: 10.12691/ajmcr-7-4-1
Pub. Date: May 10, 2019
8752 Views1546 Downloads