by Mohammed Al-Sadawi, Arismendy Nunez Garcia, Muhammad Ihsan, Erdal Cavusoglu and Samy I. McFarlane
Case Report
Hypotension is a common complication during coronary angiography. Multiple factors can lead to hypotension in cath lab including bleeding and vasovagal reaction. Vagal induced hypotension is commonly associated with severe pain and anxiety. However, other causes of hypotension in cath lab should be considered. Here we present a case of 76-year-old male was brought for coronary angiography and the procedure was complicated by hypotension from an overlooked bladder distention.
American Journal of Medical Case Reports. 2019, 7(8), 180-183. DOI: 10.12691/ajmcr-7-8-8
Pub. Date: July 14, 2019
9780 Views1702 Downloads
by Mohammed Al-Sadawi, Violeta Capric, Adam Budzikowski and Samy I. McFarlane
Case Report
Patients with cardiomyopathy (CM) are at increased risk for sudden cardiac death (SCD), specifically, secondary to ventricular arrhythmias such as ventricular tachycardia (VT) or ventricular fibrillation (VF). Those that have CM are further stratified based on risk of death from ventricular arrhythmias. If determined high risk, implantable cardioverter-defibrillators (ICD), anti-arrhythmic medication or even ablation procedures are considered in order to minimize the risk of SCD. Ablation procedures have increased in number over the years, along with the recognition of high-risk CM patients. Along with the increase in number of ablation procedures, complications from such procedures have decreased in number and the ventricular arrhythmia ablation remains a relatively low-risk procedure. Here we describe a patient with known CM, specifically hypertrophic cardiomyopathy (HCM) with a relatively rare and high-risk complication, being ventricular aneurysm. HCM patients with ventricular aneurysm are often referred for ablation procedures as they are at a significantly higher risk for SCD due to arrhythmias. Our patient not only underwent an ablation procedure, but suffered from the rare complication of tamponade, which occurs on average <2% annually. Although, risk assessments exist for stratifying CM as high-risk prior to invasive procedures, risk assessments are lacking for the specific population of HCM patients with LV aneurysm, thus presenting us with an area for further research.
American Journal of Medical Case Reports. 2019, 7(8), 176-179. DOI: 10.12691/ajmcr-7-8-7
Pub. Date: July 11, 2019
6794 Views1614 Downloads
by Tariq Sharman and Jeffrey Song
Case Report
Chronic cough is a common presenting complaint in pulmonary clinics. We present a patient who had undergone extensive work up for chronic intractable cough that was finally diagnosed as diffuse pulmonary carcinoid tumorlets. Pulmonary tumorlet is an incidental finding at histopathologic examination of lung parenchyma that is often located adjacent to bronchogenic tumors or carcinoid tumors or particularly in lung scarred by bronchiectasis or other chronic inflammatory processes. Tumorlets are usually smaller than 5 mm in diameter and are multiple. Tumorlets are composed of small uniform cells that appear cytologically benign; they tend to form compact aggregates or nests and may grow into the mucosa of the airways. Also, tumorlets, like carcinoids, contain neurosecretory granules and have distinctive electron microscopic and immunohistochemical findings. Our case is a 61 year old Caucasian female, non-smoker, was followed in pulmonary clinic because of chronic dry cough which was associated with dyspnea and wheezing. Normal physical examination except for occasional wheezes. Pulmonary function test showed restrictive pattern, FEV1 75%, FEV1/FVC 88% and TLC 67% of predicted. High resolution chest CT had shown multiple non-calcified well circumscribed pulmonary nodules scattered throughout the lungs, the largest 5 mm. She had been treated as a case of asthma. Inhaled bronchodilators and corticosteroids partially improved her symptoms. Later her cough had become intractable with worsening exertional dyspnea. Otolaryngology evaluation and EGD had been inconclusive. Bronchoscopy with bronchoalveolar lavage and multiple transbronchial biopsies came with normal results. VATS biopsy showed multiple small nodules less than 1 cm in the right upper, middle, and lower lobes, predominantly peripheral lesions. The lesions were found to represent carcinoid tumorlets. Usually the lesions are asymptomatic and discovered incidentally on CT scan and can be confused with metastases, however they can present with chronic cough or dyspnea.
American Journal of Medical Case Reports. 2019, 7(8), 173-175. DOI: 10.12691/ajmcr-7-8-6
Pub. Date: July 11, 2019
6558 Views1260 Downloads4 Likes
by Salem Bouomrani, Rim Mesfar, Moez BenAyed, Mouna Guermazi, Hassène Baïli and Souad Yahyaoui
Case Report
Familial Mediterranean Fever (FMF) is a rare hereditary auto-inflammatory disease that can be exceptionally associated with many other dys-immune disorders; the most reported associations were with systemic vasculitis, spondyloarthropathies, inflammatory bowel diseases, systemic lupus erythematous, multiple sclerosis, and juvenile chronic arthritis. The association of FMF with primary inflammatory myopathy remains exceptional and unusual; it has only been noted once before with adult polymyositis. We report an original observation of FMF associated with juvenile dermatomyositis in an eight-year-old boy, which, to our knowledge, has not been reported previously.
American Journal of Medical Case Reports. 2019, 7(8), 170-172. DOI: 10.12691/ajmcr-7-8-5
Pub. Date: July 11, 2019
6731 Views1115 Downloads
by Michael Haddadin, Mohammed Al-Sadawi, Sally Madanat, Devon S McKenzie, Robert Lewis and Samy I McFarlane
Original Research
Dietary Vitamin K is a well-known anti-hemorrhagic agent that plays an integral role in the coagulation pathway. Vitamin K is involved in synthesis of coagulation factors; II, VII, IX and factor X. Vitamin K deficiency leads to bleeding diathesis. Hemorrhages usually present in deep soft tissue, rather than mucosal or epithelial membranes, bleeding that is generally caused by disorders of platelets. Major causes of vitamin K deficiency include; medications and diseases involving fat metabolism with a resultant fat malabsorption. Warfarin and Cephalosporins are one of the commonly prescribed medications that lead to vitamin K deficiency. Disease affecting fat metabolism pathway, such as; diseases of the pancreas (cystic fibrosis), short gut syndrome and certain pathologies of the biliary tree. Vitamin K deficiency is more common in newborns. In adults it is uncommon because of its ubiquitous nature and the abundance of its sources. Hemorrhagic disorders in adults due to Vitamin K deficiency are not commonly encountered in practice. We are presenting a case of an adult who presented with a compartment syndrome secondary to a traumatic intramuscular bleeding. Our case highlights the importance of considering vitamin K deficiency in the differential diagnosis of unexplained hemorrhages resulting from a coagulopathy.
American Journal of Medical Case Reports. 2019, 7(8), 167-169. DOI: 10.12691/ajmcr-7-8-4
Pub. Date: July 11, 2019
5306 Views1070 Downloads
by Arroyo-Mercado Fray, Likhtshteyn Michelle, Huynh Chi Doan, Chokshi Tanuj, Chawla Gurasees S., Grossman Evan, Ramirez Miguel, Ojeda-Martinez Hector and McFarlane Samy I
Case Report
Background: The “Remission Hypothesis” suggests that in patients with both HIV and UC an immunosuppressed state allows for the remission of UC and decreased number of flares. While the exact mechanism is unknown, this theory considers the relationship between CD4 count and flare progression. However, currently literature does not take into account the role that viral load might play in modulating flare activity. Methods: This is a case series including three patients with concurrent HIV and IBD at two large urban academic centers. A retrospective chart review was done and clinical information such as CD4+ count, viral load and flare symptoms were collected for each patient. Results: Three patients with a total of eleven UC flares were evaluated between the years of 2007 and 2018. Of the eleven flares, nine flares occurred while the viral load was undetectable, one flare occurred while the viral load was unknown, and one flare while the viral load was detectable. Conclusions: Nine out of eleven UC flares occurred while the patients’ viral loads were undetectable, which can support a “Remission Hypothesis” which is inclusive of viral load instead of CD4+ count. However, it is important to note that the disease progression of Patient 3 does not completely support this version of the hypothesis. While we cannot comment on whether the “Remission Hypothesis” is true or not, we do believe a more inclusive theory including viral load should be considered.
American Journal of Medical Case Reports. 2019, 7(8), 162-166. DOI: 10.12691/ajmcr-7-8-3
Pub. Date: July 10, 2019
6477 Views1238 Downloads
by Munawwar Hussain, Ahmed Khalil and Nazish Malik
Case Report
Primary small cell carcinoma of urinary bladder is rare and aggressive neuroendocrine tumor. It is part of neuroendocrine tumor family that affects respiratory system, gastro intestinal tract and genitourinary system of male and female. We report a case of primary small cell carcinoma of urinary bladder treated with chemotherapy. Patient is 81 year old male who presented to emergency department with recurrent urinary retention associated with hematuria. Patient had cystoscopy and was diagnosed with small cell carcinoma of urinary bladder with no distant metastasis. Patient was treated with chemotherapy. Patient died with septic shock due to clostridium difficile colitis.
American Journal of Medical Case Reports. 2019, 7(8), 160-161. DOI: 10.12691/ajmcr-7-8-2
Pub. Date: July 09, 2019
4969 Views1013 Downloads3 Likes
by Jeffrey Song and Tariq Sharman
Case Report
Osteomyelitis (OM) is one of the most common invasive bacterial infections. Rib osteomyelitis is a rare disease that occurs in ~1% or less of all osteomyelitis. It can result from direct inoculation from traumatic wounds, by spreading from adjacent tissue affected by cellulitis or septic arthritis, or through hematogenous seeding. We present a case of a 32-year-old female with a history of Intravenous drug abuse who presented with localized left-sided chest pain. A CT thorax contrast study was obtained that showed edema around the anterior aspects of the left 3rd to fifth ribs and involves the inferior border of the pectoralis muscle with buckling of the left 4th rib with fluid density in the fascial planes. Subsequently, an MRI was done that revealed the pathological fracture of the anterior aspect of the left forth rib with evidence of osteomyelitis of the left 4th and 5th ribs, as well as early insufficiency fracture of the left fifth rib. Blood cultures were negative. She was treated conservatively with empiric antibiotics due to lack of seeding and bacteremia.
American Journal of Medical Case Reports. 2019, 7(8), 158-159. DOI: 10.12691/ajmcr-7-8-1
Pub. Date: July 08, 2019
6126 Views1002 Downloads8 Likes