by Aman Kataria, Hema Chagarlamudi, Jordan Carbono, Aazim Arif and Melodie Mope MD
Case Report
Background: Hand, foot and mouth disease (HFMD) is a viral illness that presents mainly in children but also in adults with constitutional symptoms such as low-grade fever, malaise, and myalgia in addition to macular, maculopapular, or papulovesicular skin lesions on hands, feet, and mouth. No specific antiviral therapy is available for HFMD as most cases have a benign clinical course with complete resolution of symptoms and signs within 7 to 10 day. To our knowledge, three previous studies have demonstrated prompt symptomatic relief and shortened disease course after initiating treatment with acyclovir. Case Presentation:Three cases of intra-familial transmission HFMD including two young siblings (2-year-old boy and 4-year-old boy) and their 37-year-old immunocompetent mother. The diagnosis was made clinically and therapy with oral acyclovir was initiated within 24 hours of first lesion appearance for all three cases. The young siblings received oral acyclovir 200 mg four times daily, while their immunocompetent mother received acyclovir 800 mg four times daily. In the two young siblings, new lesions stopped appearing and most existing lesions showed noticeable involution after a single day of treatment. Significant reduction in pruritus and defervescence were also noted at this time. Complete resolution was achieved with three days of acyclovir therapy. The single vesicle observed on their mother showed complete resolution after a single day of treatment. Conclusion: We present three studies of HFMD successfully treated with acyclovir to demonstrate the therapeutic benefit of acyclovir for symptomatic HFMD in young children and adults. Early initiation of oral acyclovir may influence the disease course by shortening the duration and intensity of symptoms. In the case of outbreaks, in particular, acyclovir should be considered as it may offer benefit to the population at large. We recommend a randomized, controlled trial to further investigate the therapeutic role of acyclovir in HFMD.
American Journal of Medical Case Reports. 2019, 7(9), 219-222. DOI: 10.12691/ajmcr-7-9-10
Pub. Date: July 21, 2019
10539 Views1503 Downloads
by Hiro Matsukura, Satomi Inomata and Tomomi Tanaka
Case Report
Cerebral cavernous malformations (CCMs), which occur in a sporadic or familial form, can predispose a person to seizures, focal neurological impairment, and hemorrhage. Upon discovery floating in a swimming pool, a 3-year-old boy was unresponsive and not breathing, but he achieved uneventful recovery after adequate cardiopulmonary resuscitation. Diagnostic head magnetic resonance imaging confirmed multiple CCMs. Absence of affected family members was indicative of the sporadic form. Subsequently, he developed social communication deficits and restricted and repetitive behaviors, suggestive of autism spectrum disorders (ASD). Comorbidity of CCMs and ASD is rare. Seizure associated with multiple CCMs might precipitate unintentional drowning.
American Journal of Medical Case Reports. 2019, 7(9), 217-218. DOI: 10.12691/ajmcr-7-9-9
Pub. Date: July 21, 2019
5997 Views1412 Downloads
by Herry Garna, Hendro Sudjono Yuwono and Maya Tejasari
Case Report
Case reports of a chronic diabetic wound treated topically using coffee powder. It is a useful dressing that changed every week with keep dry without repeated manipulation to wound bed to protect the new cell growth. It claimed to be a safe procedure to preserve the vulnerable cells in wound bed by the coffee powder producing the best healing with acceptable wound scar.
American Journal of Medical Case Reports. 2019, 7(9), 214-216. DOI: 10.12691/ajmcr-7-9-8
Pub. Date: July 21, 2019
8035 Views1583 Downloads
by Dennis Miraglia and Orlando Marini
Case Report
We report a case of an 87-year-old man with unstable supraventricular tachycardia (SVT) with intermittent Wolff-Parkinson-White (WPW) syndrome refractory to biphasic synchronized electrical cardioversion terminated by adding intravenous amiodarone. We conclude that the unique properties of intravenous amiodarone might make it especially effective in emergency situations when urgent intervention is needed to terminate life-threatening wide-complex tachycardias (WCTs) with evidence of hemodynamic instability refractory to synchronized electrical cardioversion.
American Journal of Medical Case Reports. 2019, 7(9), 210-213. DOI: 10.12691/ajmcr-7-9-7
Pub. Date: July 21, 2019
9241 Views3267 Downloads1 Likes
by Pramod Theetha Kariyanna, Bayu Sutarjono, Apoorva Jayarangaiah, Remi Okwechime, Amog Jayarangaiah, Perry Wengrofsky and Isabel M. McFarlane
Case Report
Background. Myasthenic crisis can induce Takotsubo cardiomyopathy leading to transient systolic and diastolic left ventricular dysfunction and wall-motion abnormalities, including the characteristic apical ballooning. We aimed to define the clinical features of this disease entity. Methods. A systematic review was conducted to examine the characteristics of Takotsubo cardiomyopathy presenting in myasthenia gravis patients. Case reports were accessed by searching MEDLINE/PubMed, Google Scholar, CINAHL, and Web of Science databases. 523 articles were identified and 14 were selected for review. Results.Takotsubo cardiomyopathy presenting in myasthenia gravis’ patients tends to affect women between the ages of 40 to 77. History of atrial fibrillation or hypertension was found in a minority of cases. Generalized weakness, fatigue, dysphagia and respiratory distress were common at presentation. Vital signs demonstrated normal blood pressure without tachycardia or bradycardia. Elevated values of troponins, creatine kinase (CK), and CK-MB isoenzymes were recorded. ST-segment elevation followed by T-wave inversion were predominantly found on electrocardiograms. Apical abnormalities in the form of ballooning, hypokinesia, or sparing and reduced left ventricular ejection fraction (≤45%) were observed using transthoracic echocardiogram or left ventriculography. Coronary angiography demonstrated no obstructive lesions. Ventilatory support, cholinesterase inhibitors and glucocorticoids resulted in the recovery or improvement of the left ventricular ejection fraction and hemodynamic stability. Only a minority of patients died of refractory heart failure. Treatment with inotropes and/or vasopressors led to poorer outcomes, including death or intractable heart failure. Conclusion. The management of Takotsubo cardiomyopathy developing in myasthenia gravis patients should focus on addressing the myasthenic crisis, while proving supportive care in and intensive care setting.
American Journal of Medical Case Reports. 2019, 7(9), 203-209. DOI: 10.12691/ajmcr-7-9-6
Pub. Date: July 19, 2019
8241 Views1708 Downloads
by Abin Sajan, Judah Horowitz, Noriyuki Murakami and Isabel M. McFarlane
Case Report
Background: Metabolic acidosis refers to any process that increases the hydrogen ions in the body and reduces the bicarbonate concentration. Metabolic acidosis is subdivided based on presence of anion gap (AG), and AG metabolic acidosis is most often due to ketoacidosis, lactic acidosis, renal failure, or toxic ingestions. AG metabolic acidosis is frequently encountered in the clinical practice. Rarely, the underlying cause of the AG metabolic acidosis is considered a diagnostic dilemma as the established algorithm allows the physicians to identify the etiology. Case presentation: A fifty-three-year-old Black woman with well-controlled human immunodeficiency virus (HIV), hypertension, and asthma presented with recurrent episodes of severe anion gap metabolic acidosis. The patient’s AG metabolic acidosis always corrected with the administration of intravenous normal saline. Laboratory studies were always negative for common causes of acidosis. Conclusion: Nucleoside reverse transcriptase inhibitors-associated lactic acidosis has been reported in the literature. The shift to anaerobic mitochondrial metabolism induced by the HIV medications used in this patient could be explain the recurrent severe metabolic acidosis.
American Journal of Medical Case Reports. 2019, 7(9), 200-202. DOI: 10.12691/ajmcr-7-9-5
Pub. Date: July 19, 2019
6032 Views1534 Downloads
by Hiro Matsukura and Shinichi Tsubata
Case Report
Acute appendicitis is the most common surgical emergency in children. A Japanese 8-year-old boy with attention deficit hyperactivity (ADHD) and comorbid autism spectrum disorder (ASD) exhibited fever, anorexia, and frequent vomiting. Gastrointestinal symptoms were initially regarded as associated with streptococcal pharyngitis and adverse effects of ADHD medication. Empirical antibiotic therapy did not improve his clinical condition. Absence of abdominal distension and tenderness led to a misled diagnosis and delayed diagnosis and treatment of acute appendicitis. Surgical intervention was made eventually for perforated appendicitis. He recovered without sequelae. Streptococcal pharyngitis with concurrent appendicitis is rare. Children with ASD sometimes have difficulty explaining their signs because of communication problems and insensitivity to pain. Special consideration is necessary when examining children with neurodevelopmental disorders, especially in emergency surgical conditions.
American Journal of Medical Case Reports. 2019, 7(9), 197-199. DOI: 10.12691/ajmcr-7-9-4
Pub. Date: July 18, 2019
6336 Views1394 Downloads
by Pramod Theetha Kariyanna, Apoorva Jayarangaiah, Oleg Yurevich, Jonathan Francois, Denis Yusupov, Angelina Zhyvotovska, Louis Salciccioli, Sudhanva Hegde and Samy I. McFarlane
Original Research
Marijuana is the most commonly abused recreational substance. With the increasing legalization of marijuana, its use is expected to rise. Delta-9-tetrahydrocannabinol (THC) is the psychotropic component of marijuana, acting via CB1 and CB2 G-protein coupled cannabinoid receptors. Marijuana has serious cardiovascular effects including tachycardia, orthostatic hypotension, angina and myocardial infarction to name a few. Previous reports by our group and others documented various arrhythmias other than atrioventricular nodal reentrant tachycardia (AVNRT) that are associated with marijuana use. In this report, we present a case of AVNRT associated with marijuana use. Marijuana in high doses stimulates parasympathetic nerves. While parasympathetic stimulation can increase the refractory period of the fast conduction pathway, it has no effect on the slow and retrograde pathways, therefore its use creates an ideal milieu for AVNRT initiation and maintenance. Our case report highlights the importance of including marijuana use in the differential diagnosis, as a possible trigger, for patients presenting with AVNRT that is otherwise unexplainable.
American Journal of Medical Case Reports. 2019, 7(9), 193-196. DOI: 10.12691/ajmcr-7-9-3
Pub. Date: July 16, 2019
8061 Views1929 Downloads1 Likes
by Mohamed Saad Eldin, Sadaquat Liaqat, Khaled Awad and Salah Aldergash
Case Report
Lactobacilli are normal commensal bacteria of human. They can cause fatal infections in an immunocompromised host. We present a case of an immunocompromised patient with stage IV non-small cell lung cancer receiving Nivolumab who had high grade lactobacillus bacteremia and fungal blood stream infection.
American Journal of Medical Case Reports. 2019, 7(9), 191-192. DOI: 10.12691/ajmcr-7-9-2
Pub. Date: July 14, 2019
5444 Views1327 Downloads
by Mohammed Al-Sadawi, Michael Haddadin, Violeta Capric and Samy I. McFarlane
Case Report
Heparin induced thrombocytopenia (HIT) is serious disorder that occurs in a small percentage of patients following exposure to heparin. HIT can further be classified into two types: HIT type 1 and type 2. Type 2 HIT is a potentially life threatening with clinically significant outcomes. It presents with thrombocytopenia and evidence of thrombus formation in the presence of antibody formation. Additionally, several variations of HIT exist, including delayed onset HIT and refractory HIT, known collectively as autoimmune HIT (aHIT). Here we present a case of delayed onset and refractory HIT in a patient with little heparin exposure, discovered only after cardiac intervention for suspected STEMI. Significant thrombotic events occurred thereafter, including radial artery stenosis and intracardiac thrombus. Treatment with argatroban was ineffective. Significant resolution of thrombocytopenia was seen several weeks after infusion with IVIG, thus depicting further suspicion for refractory HIT. IVIG for aHIT treatment is traditionally chosen only if the disease process is refractory to other anticoagulation efforts due to the potential risk for increasing thrombotic risk with IVIG infusion. Our case illistrate the rare presentation of aHIT and the use if IVIG to successfully treat thrombocytopenia in refractory HIT.
American Journal of Medical Case Reports. 2019, 7(9), 184-190. DOI: 10.12691/ajmcr-7-9-1
Pub. Date: July 14, 2019
4376 Views1226 Downloads1 Likes