by Sabina Kumar, John Carvalho, Chukwuemeka Umeh, Pranav BarveJose Penaherrera, Ratan Tiwari and Shivang Shah
Original Research
Thirty-Three states in the US have passed laws to legalize marijuana usage, increasing its prevalence by 50% within the last year. Though society generally regards cannabis as safe, the exponential increase in users can evince dangerous side effects in patients presenting to physicians, such as the case presented below. A 37-year-old female presented to the ED with chest pain and an initial troponin of 24 that peaked at 29. The coronary arteries were found to be angiographically normal. She was discharged without any definitive diagnosis. Now 38, she again presented with complaints of crushing, substernal chest pain radiating down her left arm, unrelieved by nitro. Since the onset of pain, she progressively developed shortness of breath, nausea, diaphoresis, and anxiety, stating that she felt like she “was going to die.” Her presentation and impending sense of doom were ominous harbingers for a myocardial infarction; concerns that were validated with an initial troponin of 11.4. EKG showed normal sinus rhythm with nonspecific ST changes. CT Angiogram showed no evidence of pulmonary thrombo-embolism or dissection. Significant CAD leading to this extent of troponin elevation was not suspected as the patient had a normal angiogram a year prior. Stress-Induced Cardiomyopathy was unlikely based on the unremarkable echocardiogram findings. Coronary-Thrombus was considered, however, the hypercoagulable workup was negative along with lack of coronary thrombus on prior angiogram. Under these circumstances, the only explanation for the extent of troponin elevation was myocarditis. Viral infections are the most common cause of myocarditis, however the patient denied any associated symptoms. After ruling out viral etiologies, we subsequently evaluated and eliminated rheumatological disorders and medication-induced myocarditis. The patient’s history revealed that she led a healthy lifestyle, but had struggled with chronic back pain, which led to her cannabis use. By the time of her admission, she smoked up to 1.5 grams of cannabis a day, and stated that chest pain began immediately following smoking cannabis. Her previous episodes also correlated with her cannabis usage. Given the strong correlation of the patient’s symptoms with cannabis use, we theorized her cardiac stress was resultant from it, and recommended that she discontinue its use. To date there have been four reported cases of cannabis-induced myocarditis, making this a fifth case. Of note, the contaminants of marijuana may be variable and include substances like aluminum from soil or pesticides in grass that could traverse the marijuana plant. Inhaling such components has been correlated with an upregulation of cannabinoid receptors in platelets, vascular smooth muscle, and endothelium. CB1R activation has been observed to induce oxidative stress, inflammation, and fibrosis of the cardiomyocyte. With increased cannabis use, it is imperative that we document adverse events to definitively connect its use to cardiac damage.
American Journal of Medical Case Reports. 2021, 9(10), 519-521. DOI: 10.12691/ajmcr-9-10-11
Pub. Date: July 01, 2021
2418 Views6 Downloads
by Shawn Philip, Luz Sullivan and Nour Parsa
Case Report
Autoimmune metaplastic atrophic gastritis is an important pathological finding associated with neoplasia and pernicious anemia. Defined guidelines on surveillance endoscopy for this diagnosis are lacking. We present a rare case of a patient with a known history of pernicious anemia that presented with blood-tinged sputum. The patient underwent endoscopic evaluation with random gastric biopsies that showed a two-month progression from diffuse inflammation to intestinal metaplasia in the background of autoimmune metaplastic atrophic gastritis (AMAG) on surveillance endoscopy. AMAG is an important finding that deserves close endoscopic surveillance as complications can include autoimmune conditions, pernicious anemia,gastric carcinoid, and gastric adenocarcinoma.
American Journal of Medical Case Reports. 2021, 9(10), 516-518. DOI: 10.12691/ajmcr-9-10-10
Pub. Date: June 25, 2021
2390 Views3 Downloads
by Alexander M. Balinski, Neil J. Khatter, Jeffrey M. Gold, Krishna S. Pothugunta, Vamshi K. Garlapaty, Steven M. Rankin, Christopher A. Thorburn and Jamal Abu-khaled
Case Report
Hypercalcemia of malignancy (HCM) can present secondary to hypersecretion of parathyroid hormone (PTH)-related protein (PTHrP) from malignant tumors, but rare cases of HCM have also been documented due to inappropriate PTH secretion from ectopic neoplasms. Here, we report an unusual case of HCM due to hypersecretion of PTH suspected secondary to a disseminated mucinous ovarian adenocarcinoma. A 45-year-old female presented with severe hypercalcemia and significant elevations in both PTH and PTHrP two weeks after total abdominal hysterectomy with bilateral salpingo-oophorectomy and suboptimal debulking of a newly discovered left ovarian mucinous adenocarcinoma with numerous metastases. Ectopic PTH secretion was highly suspected after a negative parathyroid ultrasound. Pamidronate, calcitonin, and fluid resuscitation were unable to normalize her serum calcium, resulting in the need for dialysis and subsequent continuous renal replacement therapy. Further intervention with denosumab, etelcalcetide, and cinacalcet was attempted. Serum calcium began to decline, but repeat PTH resulted greater than 2,500 pg/mL. Unfortunately, the patient died just one week into her hospital course from septic shock and multi-organ system failure. While patients with localized PTH-secreting tumors carry a good prognosis, disseminated malignancies can result in significant morbidity and mortality due to severe treatment-resistant hypercalcemia.
American Journal of Medical Case Reports. 2021, 9(10), 512-515. DOI: 10.12691/ajmcr-9-10-9
Pub. Date: June 25, 2021
3728 Views9 Downloads
by Anjuman Sultana and Shohael Mahmud Arafat
Case Report
Background: Endometriosis is defined as the presence of endometrial glands and stroma outside the uterus. Recurrent hemorrhagic ascites as a clinical manifestation of endometriosis is rare. On the other hand endometriosis as a cause of ascites is not considered in current practice. We report the case of a 25 year old woman who presents recurrent hemorrhagic ascites with endometriosis. Case summary: A 25 year old para nil Bangladeshi woman suddenly developed huge ascites with abdominal pain. Ascitic fluid was reddish in color with plenty of RBC. The Initial diagnosis was considered as TB. But as symptom did not subside after administration of anti-TB drug further investigations was carried out including laparoscopy. The diagnosis was established by histology proven endometriosis, exclusion of other causes and treatment response. Conclusion: This case requires long-term follow-up with continuing medical management at least until the patient's family is complete when a surgical option as bilateral salpingo-oophorectomy with or without hysterectomy can be discussed.
American Journal of Medical Case Reports. 2021, 9(10), 509-511. DOI: 10.12691/ajmcr-9-10-8
Pub. Date: June 14, 2021
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by Ken-ichi Muramatsu, Hiroki Nagasawa, Soichiro Ota, Kei Jitsuiki, Hiromichi Ohsaka and Youichi Yanagawa
Case Report
A 17-year-old boy was found in an unconscious state. He had had neurofibromatosis type 2 (NF2) since 9 years old. His history included multiple operations for NF2 at the left jugular vein foramen, thoracic spinal cord, and cervical spinal cord at 9 and 10 years old. However, remaining bilateral acoustic tumors resulted in the onset of aspirated pneumonia within a few months. He was found unconscious in his dormitory. When emergency medical technicians checked him, he was in cardiac arrest. Saburra was identified in his mouth. He did not achieve return of spontaneous circulation with advanced cardiac life support. Autopsy imaging revealed residual bilateral acoustic tumors compressing the brain stem. NF2 is a serious disease that can rapidly become life-threatening. We hope new treatments that will improve the survival of NF2 patients will be developed soon.
American Journal of Medical Case Reports. 2021, 9(10), 507-508. DOI: 10.12691/ajmcr-9-10-7
Pub. Date: June 14, 2021
2439 Views13 Downloads
by Ken-ichi Muramatsu, Kei Jitsuiki, Hoshiko Furusawa, Hiroki Nagasawa, Hiromichi Ohsaka and Youichi Yanagawa
Case Report
A 28-year-old female with central obesity, moon face and multiple sites of acne vulgaris began to experience generalized convulsions after complaining of severe back pain during hospitalization on post-first-delivery day 5. After an infusion of diazepam, she showed severe hypoxia and underwent tracheal intubation. She had a history of gestational diabetes mellitus (DM), acne vulgaris, osteoporosis and thoracolumbar fracture. She also felt severe back pain after falling down two weeks previously and underwent Caesarean section. Her blood pressure was remained 100–160 mmHg during the perinatal period. Whole body computed tomography revealed bilateral low density in the parieto-occipital white matter, bilateral aspirated lesions in her lungs, and enlargement of the right adrenal gland. The tentative diagnosis was posterior reversible encephalopathy syndrome (PRES) with convulsion, aspirated pneumonia and Cushing syndrome with DM and pathological fracture due to osteoporosis. She underwent an infusion of levetiracetam, sedatives, analgesics and a depressor were administered to control blood pressure strictly. She was extubated two days after her respiratory function showed improvement. After controlling her pain and treating osteoporosis, a blood test was compatible with Cushing syndrome. She finally underwent adenectomy in four months. Pathology was adenoma. This is a rare case of Cushing syndrome complicating pathological spinal fractures and PRES in the post-delivery phase. Aggressive control of pain and blood pressure in the perinatal period may be required to prevent the onset of PRES.
American Journal of Medical Case Reports. 2021, 9(10), 502-506. DOI: 10.12691/ajmcr-9-10-6
Pub. Date: June 10, 2021
2532 Views12 Downloads
by G P Mishra, Neeraj Salhotra, Simin Laiq, Zahra Al Hajri, Jospaul Lukas, Samit Biniwale, Ahmed Tolba and Faraz Qayyum Khan
Original Research
Choroid plexus tumors (CPTs) account for 2-4% of all brain neoplasms in the pediatric age group, and 14% of brain tumors occurring in the 1st year of life. On the basis of their histological features, as per 2016 WHO classification of tumors of the central nervous system, these tumors are classified as choroid plexus papilloma (CPP; WHO Grade I), atypical CPP (ACPP; WHO Grade II), and choroid plexus carcinoma (CPC; WHO Grade III). Atypical CPP was first recognized as a distinct entity in the 2007 WHO classification of tumors of the central nervous system. They were characterized by increased mitotic activity and a higher probability of recurrence as compared with CPP. The prognostic features of and clinical outcome rates for ACPP are between those displayed by CPP and CPC. Choroid plexus tumors can metastasize as solid nodules or as sub-arachnoid seeding, especially to the spine cord in patients with posterior fossa tumors. Metastases from CPP are rare and few cases have been reported. Whereas ACPP and CPC metastasize with greater frequency. We herewith report one child with ACPP managed by surgical excision and is currently under follow up with oncology.
American Journal of Medical Case Reports. 2021, 9(10), 499-501. DOI: 10.12691/ajmcr-9-10-5
Pub. Date: June 09, 2021
3800 Views4 Downloads
by Pramod Theetha Kariyanna, Amog Jayarangaiah, David D. Song, Apoorva Jayarangaiah, Sushruth Das, Ashkan Tadayoni and Samy I. McFarlane
Case Report
Rumpel - Leede phenomenon (RLP) was described as early 1909 by Theodore Rumpel and by Stockbridge Leede in 1911 in patients suffering from scarlet fever. Acute development of petechial rashes distal to the application of blood flow occlusive devices such as a blood pressure cuff or tight wrapped bandage, is a typical finding in this phenomenon. Multiple isolated cases of RLP associated with coronary angiogram have been reported. In this report, we present a case of a 53-year-old male who developed RLP after percutaneous intervention of the proximal-mid left anterior descending artery after application of a sphygmomanometer cuff to contain a right forearm hematoma and application of a trans-radial band. We here discuss the etiopathogenesis and management of RLP that develops post coronary angiogram.
American Journal of Medical Case Reports. 2021, 9(10), 495-498. DOI: 10.12691/ajmcr-9-10-4
Pub. Date: June 08, 2021
2961 Views22 Downloads
by Kamyar Asadipooya, Roohollah Narimani, Ashraf Aminorroaya, Bijan Iraj, Mohammadreza Kalantarhormozi, Novin Afshar Moghadam, Elaheh Kavoussi and Mitra Dashtizadeh
Case Report
Primary pigmented nodular adrenocortical disease (PPNAD) is a rare cause of Adrenocorticotropic hormone-independent Cushing syndrome. In this case, we present a case of PPNAD in 25 y/o women who presented with a 3 years history of weight gain, hirsutism, and abnormal menstruation. Our findings were suggestive of PPNAD in the pathological study of adrenal biopsy.
American Journal of Medical Case Reports. 2021, 9(10), 492-494. DOI: 10.12691/ajmcr-9-10-3
Pub. Date: June 08, 2021
2376 Views4 Downloads
by Kourosh Shargani, Danielle Sherlock, Cheng-Hung Tai and Harry Fischer
Case Report
Reactive Arthritis, formerly known as Reiter’s syndrome, is a delayed autoimmune mediated inflammatory reaction in the joints that occurs from a response to an infection elsewhere in the body. It usually occurs in young males in response to a genitourinary or gastrointestinal infection. These males may have a predisposition to reactive arthritis by being Human Leukocyte Antigen-B27 (HLA-B27) positive. This report will display an unusual case of reactive arthritis in an elderly female.
American Journal of Medical Case Reports. 2021, 9(10), 489-491. DOI: 10.12691/ajmcr-9-10-2
Pub. Date: June 03, 2021
2710 Views5 Downloads
by Kyle Martin S. Alimurung, Darleen Sy and Benjamin N. Alimurung
Case Report
The COVID-19 pandemic has led to a diverse spectrum of medical conditions, including stress (Takotsubo) cardiomyopathy, which may be triggered by severe emotional or physical distress leading to reversible acute heart failure. This case highlights stress cardiomyopathy complicated by pulmonary edema and cardiogenic shock in an 86-year-old female, confirmed COVID-19 negative by RT PCR for SARS-CoV-2, brought about by intense emotional stress triggered by the ongoing pandemic.
American Journal of Medical Case Reports. 2021, 9(10), 485-488. DOI: 10.12691/ajmcr-9-10-1
Pub. Date: June 03, 2021
2536 Views8 Downloads