by Pramod Theetha Kariyanna, Jonathan Francois, Amog Jayarangaiah, Yuvraj Singh Chowdhury, Richard Grodman, Moro O. Salifu and Isabel M. McFarlane
Case Report
Quadricuspid aortic valve (QAV) is a rare congenital valvular abnormality with less than 200 cases reported to date. The first QAV was reported in 1862 by Balington. Clinical manifestations of patients with a QAV depend on the functional status of the QAV and the associated cardiac disorders. Most QAV are asymptomatic and are incidentally found. Severe aortic regurgitation and/or stenosis can develop overtime, requiring aortic valve replacement or repair. Transesophageal echocardiography is the preferred modality to diagnose QAV. We present a case of QAV which was incidentally diagnosed in a 43-year-old woman who presented with gastroenteritis.
American Journal of Medical Case Reports. 2020, 8(8), 253-256. DOI: 10.12691/ajmcr-8-8-11
Pub. Date: May 18, 2020
4151 Views630 Downloads
by Chukwuemeka A. Umeh, Mohammad A. Yousuf and Hycienth Ahaneku
Case Report
Immunocompromised patients, especially those with cell-mediated immune deficiency are susceptible to legionella infection. We report the case of a hairy cell leukemia patient with legionella pneumonia and neutropenic fever. Patient was diagnosed with legionella pneumonia after two weeks of antimicrobial treatment for non-responding pneumonia and neutropenic fever. This case highlights the importance of high suspicion for legionella in immunocompromised pneumonia patients with neutropenic fever and the need for empiric coverage of atypical microbes in treatment of pneumonia in neutropenic immunocompromised patients.
American Journal of Medical Case Reports. 2020, 8(8), 250-252. DOI: 10.12691/ajmcr-8-8-10
Pub. Date: May 17, 2020
3375 Views480 Downloads
by Yuvraj Chowdhury, Shakil A. Shaikh, Ali Salman, Jonathan D. Marmur and Isabel. M. McFarlane
Case Report
An aberrant right subclavian artery (ARSA) is a rare developmental anomaly (0.4-1.8%) of the aorta in which the right subclavian artery arises from the aortic arch distal to the origin of the left subclavian artery often coursing behind the esophagus to reach the right arm. It courses behind the esophagus in about 80% of cases, between the esophagus and the trachea in 15%, and anterior to the trachea or mainstem bronchus in 5%. Patient with this anomaly rarely have symptoms (90-95%) but when symptomatic the ARSA give rise to symptoms of dysphagia lusoria, dyspnea and chronic cough. In a vast majority of patients ARSA is clinically silent till right radial angiography is performed. We are reporting a case of dissection of the retroesophageal right subclavian artery with extension to the descending thoracic aorta (Stanford Type B).
American Journal of Medical Case Reports. 2020, 8(8), 247-249. DOI: 10.12691/ajmcr-8-8-9
Pub. Date: May 14, 2020
3824 Views493 Downloads
by Chukwuemeka A. Umeh
Case Report
Iliopsoas hematoma is a rare complication in patients on warfarin and usually presents as lower abdominal, groin or thigh pain. The author presents a case of spontaneous iliopsoas hematoma in an 89-year-old female that was initially suspected to be a hip fracture. A review of 12 case reports on iliopsoas hematoma in patients on warfarin shows that the mean age of reported cases was 72 years. Patients present with lower abdominal, groin, flank or thigh pain (100%), lower extremity weakness and/or difficulty in walking (50%) and loss of or abnormal sensation in the lower extremity (17%). Forty two percent of the hematoma cases were in patients with therapeutic or sub-therapeutic international normalized ratio (INR). Iliopsoas hematoma should be considered in elderly patients on warfarin who present with lower abdominal or groin pain, even in patients with therapeutic or sub-therapeutic INR.
American Journal of Medical Case Reports. 2020, 8(8), 244-246. DOI: 10.12691/ajmcr-8-8-8
Pub. Date: May 14, 2020
2999 Views370 Downloads
by Ferdous Ara Begum, Md Arifur Rahman, Mohammed Kamal and Qamruzzaman Chowdhury
Case Report
Involvement of NHL in ovary is seen in disseminated Lymphoma but primary ovarian lymphoma still not commonly seen. We presented the case where the patient had suffered for unexplained fever for more than 1 year and lately presented with gross weight loss as well as painless lower abdominal lump. CT scan showed a huge heterogeneous mass of about 15x12.4cm in pelvic cavity with mild ascites. Surgery was performed in view of ovarian neoplasm as CA125 was also raised. Histopathology confirmed the diagnosis of diffuse large B cell lymphoma with Immunohistochemistry confirmation. Treated with R-CHOP protocol for 6 cycles as IHC expressed CD20 positive. Post chemotherapy follow up PET scan showed complete response of treatment, though in spite of all treatment Primary ovarian lymphoma have a poor outcome with a range from 0% to 36% expected to survive for less than three years.
American Journal of Medical Case Reports. 2020, 8(8), 240-243. DOI: 10.12691/ajmcr-8-8-7
Pub. Date: May 14, 2020
837 Views264 Downloads1 Likes
by Obed Agyei, Sakshi Joshi, Jeffrey Nalesnik MD, Arman Froush DO and Everardo Cobos MD
Case Report
Priapism, according to the American Urological Association is defined as a persistent penile erection that continues hours beyond sexual stimulation; typically, greater than 4 hours. Although priapism is a rare condition and has an unpredictable course in most presentation, it affects 5.36 per 100,000 male subjects per year [1]. Priapism is a urological emergency and delay in treatment or refractory cases can result in cavernous smooth muscle necrosis, fibrosis and penile shortening [2]. There are 2 categories of priapism-namely low-flow (ischemia, veno-occlusive) and high-flow (non-ischemic, arterial) [3,4]. There is a subset of ischemic priapism known as stuttering priapism which presents with recurrent incidences of ischemic priapism varying in length and is usually self-limiting [4]. Low-flow priapism occurs when an occlusive process inhibits the relaxation of the corpus cavernosum, thus the outflow of blood is impaired. The conditions associated with low-flow/ischemic priapism are as follows: sickle cell disease, vasoactive drugs, neoplastic diseases of the penis, urethra, prostate, bladder, kidney, gastrointestinal tract, leukemia, polycythemia, traumatic injury, hyperlipidemic parenteral nutrition, hemodialysis, heparin treatment, Fabry disease and neurologic conditions [3]. On the other hand, high-flow priapism occurs when there is increased arterial blood flow or pooling of blood. Conditions associated with high-flow priapism include traumatic arterio-cavernous fistula, vasoactive drugs, penile revascularization surgery, and neurologic conditions [3]. The mechanism of penile erection is a multifocal phenomenon that involves the nervous system, molecules (nitric oxide, cGMP, calcium), enzymes, and blood vessels. We present an interesting case of a patient with a history of recurrent priapism who converted from a low-flow priapism to a high-flow priapism, thought to be secondary to an arterio-cavernous fistula. Upon further review of PubMed and NIH database, there has been only few of such cases reported. We discuss the diagnostic process and management of high-flow priapism in this report.
American Journal of Medical Case Reports. 2020, 8(8), 237-239. DOI: 10.12691/ajmcr-8-8-6
Pub. Date: May 11, 2020
3600 Views331 Downloads
by Mohammad Alhamaydeh, Hassan Awais, Majed Ghaly and Genevieve Everett
Case Report
Myxedema coma is a severe hypothyroidism which usually occurs due to long-standing, undiagnosed, or untreated hypothyroidism. Fortunately, Myxedema coma is now a rare presentation of hypothyroidism, likely due to earlier diagnosis as most of physicians are familiar with classic signs and symptoms of hypothyroidism and widespread availability of thyroid-stimulating hormone (TSH) assays. However it might be associated with several cardiac arrhythmias including; sinus bradycardia, ventricular tachycardia, and torsade de pointes. We report a case of a 53 year old female who presented with several episodes of syncope that was associated with intermittent torsade de pointes found to have severe hypothyroidism with complete reversal of her symptoms after she was started on thyroid hormonal replacement.
American Journal of Medical Case Reports. 2020, 8(8), 235-236. DOI: 10.12691/ajmcr-8-8-5
Pub. Date: May 11, 2020
895 Views390 Downloads
by Jorge Avila, Inés Reyes, Larissa Villacrés, Diego Rosado and Jhoanna Ramírez
Case Report
We present the case of a 77-year-old female patient, who is derived from her primary care physician to our department with fatigue and laboratory exams that revealed hemoglobin 7.8 g / dl, leukocytes 6.3000/mm3, platelets 210000/mm3, total bilirubin 3.8 mg/dl, indirect bilirubin 2.09 mg/dL, LDH 936 U/I, Vitamin B12 <100, VCM 118 fl, folic acid > 24 ng/ml, total iron 215 mcg/dl, ferritin 187 ng/ml and antibodies against parietal cells, so pernicious anemia (PA) was diagnosed. She later received reposition treatment of vitamin b12 and was scheduled for endoscopic studies. Colonoscopy showed the presence of two diverticula in the sigmoid colon; while her upper endoscopy revealed a 2.5 cm stomach polyp. A biopsy was performed and it resulted positive for synaptophysin, with a Ki67 index <1%, so gastric neuroendocrine tumor (NET) type I was diagnosed, and it was subsequently resected by partial gastrectomy. Patients with a diagnosis of pernicious anemia have a higher risk of developing NETs in the gastrointestinal (GI) system, however, endoscopic screening is not performed in all patients with this disease. The purpose of this report is to encourage medical professionals to perform complete studies of the GI system to all patients that are diagnosed with PA.
American Journal of Medical Case Reports. 2020, 8(8), 232-234. DOI: 10.12691/ajmcr-8-8-4
Pub. Date: May 11, 2020
3805 Views402 Downloads
by Obed Kwame Agyei, Rakesh Alva and Heath McCullough
Case Report
Background: Hematochezia is a common presentation that typically indicates a lower gastrointestinal pathology. The differential diagnoses for lower GI bleed include malignancy, inflammatory bowel disease, hemorrhoids, diverticulosis, ischemic colitis, arterio-venous malformations etc. Rarely is a ruptured iliac artery associated with a lower GI bleed. Case Report: A 45-year-old woman with metastatic squamous carcinoma of the cervix status post External Beam Radiotherapy, High Dose Rate Brachytherapy, diverting loop ileostomy and takedown due to sigmoid perforation presented with acute onset hematochezia complicated by hemorrhagic shock and pulseless electrical activity arrest with Return of Spontaneous Circulation following volume resuscitation with crystalloids, blood products, CPR and epinephrine. Sigmoidoscopy revealed active bleeding at the recto-sigmoid junction. CT Aortography revealed right common iliac artery aneurysm rupture with contrast extravasation in the pelvis. She successfully underwent stenting of the right common iliac artery with cessation of contrast extravasation. Unfortunately, the patient died due to her complicated clinical course. Conclusion: Radiation arteritis can result in peripheral arterial disease, coronary artery disease, stroke, subdural hematoma and spontaneous arterial rupture. In the apropriate context, it carries a high mortality risk if missed. Clinicians should have high suspicion of radiation induced arterial injury in patients who have undergone radiotherapy.
American Journal of Medical Case Reports. 2020, 8(8), 229-231. DOI: 10.12691/ajmcr-8-8-3
Pub. Date: May 06, 2020
3746 Views445 Downloads
by Pramod Theetha Kariyanna, Naseem A. Hossain, Apoorva Jayarangaiah, Nimrah A. Hossain, Vaibhavi Uppin, Sudhanva Hegde, Violeta Capric, Moro O. Salifu and Samy I. McFarlane
Case Report
Coronavirus disease 2019 (COVID-19) is a pandemic that started in China in December 2019 and carries a high risk of morbidity and mortality. To-date (4-22-2020) it affected over 2.6 million people and resulted in nearly 200,000 death worldwide mainly due to severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2). Among the major underlying pathophysiologic mechanisms in COVID 19 is hypercoagulability, leading to increased risk for deep vein thrombosis and pulmonary embolism that contribute to increased morbidity and mortality. In this report, we present the case of a 55-year-old man who presented with COVID-19 pneumonia, and was found to have a thrombus in transit by routine point of care ultrasound (POCUS). While computer tomography (CT) angiography is the test of choice, the utilization of point of care ultrasound (POCUS) has gained traction as an adjunctive means of surveillance for the development of VTE in patients with COVID-19. In this report, we discuss the clinical utility of POCUS in diagnosing thrombus in transit in COVID 19 populations.
American Journal of Medical Case Reports. 2020, 8(8), 225-228. DOI: 10.12691/ajmcr-8-8-2
Pub. Date: May 05, 2020
4488 Views625 Downloads