by Ikuto Takeuchi, Kei Jitsuiki and Youichi Yanagawa
Case Report
An 80-year-old woman had suffered a mamushi bite to the left hand 3 days ago and visited a local hospital. She was admitted for observation but received only tetanus toxoid, antibiotic and cepharanthine. Physicians hesitated to administer antivenin due to the risk of severe side effects, as she had previously received antivenin for mamushi bite at 50 years old. On the third day, the swelling had reached her left chest (grade V), so she was transferred to our hospital via ambulance. She had two bite wounds from a mamushi on her left hand and showed swelling with subcutaneous hemorrhaging from the finger to her chest and upper back. Chest computed tomography showed left pleural effusion. She underwent infusion of mamushi antivenin after premedication using a subcutaneous injection of 0.3 mg of adrenaline and drip infusion of 10 mg of chlorpheniramine, 20 mg of famotidine and 100 mg of hydrocortisone. She was not complicated with an anaphylactic reaction. After the infusion of the antivenin, her swelling and pleural infusion gradually improved, so she discharged on the seventh hospital day. Even after discharge, she showed no complication with serum sickness. This case showed a favorable course after a second infusion of antivenin using premedication. As there have been few reports of multiple infusions of antivenin for the same patient, a further analysis with the accumulation of similar cases is necessary.
American Journal of Medical Case Reports. 2021, 9(2), 137-139. DOI: 10.12691/ajmcr-9-2-10
Pub. Date: December 20, 2020
2735 Views32 Downloads
by Emily Waddick, Ameya Asarkar, Mansour Mirfakhraee and Cherie-Ann O. Nathan
Case Report
Introduction: A 60 year-old white female presented with a dry cough of 8 months duration. Case report: On examination, there was a reddish mass at the inferior right tympanic membrane and bilateral upper neck fullness. Subsequent imaging revealed five paragangliomas - right glomus jugulare, left glomus vagale, left carotid body tumor, right glomus vagale, and left superior mediastinum paraganglioma. Discussion: This case highlights the presenting symptoms, multidisciplinary workup, and management of a rare case of five paragangliomas.
American Journal of Medical Case Reports. 2021, 9(2), 134-136. DOI: 10.12691/ajmcr-9-2-9
Pub. Date: December 20, 2020
2670 Views35 Downloads
by Louis Costanzo, Chetana Pendkar, Amara Shafi and Joseph Gorga
Original Research
Patients taking antipsychotic medications have a well-established increased risk of developing metabolic syndrome. These medications interfere with an intracellular signaling pathway leading to insulin resistance; that of which can lead to dangerous complications including diabetic ketoacidosis (DKA) and severe hypertriglyceridemia. We report a case of a 21-year-old man who developed DKA and severe hypertriglyceridemia secondary to the use of olanzapine used for the management of schizophrenia.
American Journal of Medical Case Reports. 2021, 9(2), 131-133. DOI: 10.12691/ajmcr-9-2-8
Pub. Date: December 20, 2020
2824 Views49 Downloads
by Krunal H Patel, Vaibhavi Uppin, Harshith Chandrakumar, Yuvraj Singh Chowdhury, Jonathan Ramalho, Basil Elamir, Loius Sacicciioli, Harjinder Gill, Sarah Hennis and Samy I. McFarlane
Case Report
Although uncommon, aortic dissection can be rapidly fatal with a 20% out-of-hospital mortality which increases at a rate of 1 to 3% every hour [1]. An expeditious diagnosis of acute aortic dissection is therefore imperative. One of the most advantageous diagnostic modalities utilized in the setting of acute aortic dissection is a transesophageal echocardiogram (TEE). In an acute setting, TEE is preferred because of its ability to provide a timely and definitive diagnosis [2]. Despite its diagnostic convenience, clinicians must be aware that there are several entities that may mimic aortic dissection. One of these entities includes a dilated accessory hemiazygos vein. In this report, we present a case of a 66-year-old woman who was found to have a possible Stanford type B dissection in the descending thoracic aorta on a TEE exam in the context of work up prior to an elective electrophysiology study and ablation for paroxysmal atrial fibrillation. CT angiography, however, revealed a dilated accessory hemiazygos vein, a rare congenital vascular anomaly that could potentially mimic aortic dissection leading to misdiagnosis and potentially unnecessary interventions.
American Journal of Medical Case Reports. 2021, 9(2), 125-130. DOI: 10.12691/ajmcr-9-2-7
Pub. Date: December 18, 2020
5649 Views31 Downloads
by Hussam Alkaissi, Srinivas Kolla, Cameron Page, Latif Salam, Moro O. Salifu and Isabel M. McFarlane
Case Report
Fluoroquinolones are antimicrobial agents that inhibit bacterial DNA synthesis by binding to DNA gyrase and DNA topoisomerase IV. Fluoroquinolones have also been associated with the development of tendinopathy, tendon rupture, and arthropathy. The postulated mechanisms for quinolone-associated tendinopathy are alteration of the tendon extracellular matrix, impairment of tenocyte proliferation, and enhanced apoptosis due to the quinolone cation chelation properties. We present a case of a man who developed multiple tears of the rotator cuff after exposure to levofloxacin. Although marketed quinolones are well tolerated, adverse events involving gastrointestinal, cardiovascular, neurological, and tendinopathy and at-risk patient populations should be kept in mind by clinicians.
American Journal of Medical Case Reports. 2021, 9(2), 122-124. DOI: 10.12691/ajmcr-9-2-6
Pub. Date: December 18, 2020
2852 Views34 Downloads
by YIN Ai-wu and GAO Peng-fei
Original Research
The present study was aimed to investigate the anti-diabetic activity of Anemarrhena asphodeloides Bge. Polysaccharides (AAP). Wistar rats were injected with streptozotocin(STZ)to induce diabetes. The APP was prepared at first. After the rats were orally administered for 28 days, related biochemical indicator were determined. AAP was composed of mannose, galacturonic acid, galactose, glucose and xylose in the molar ratio of 12:8.1:2.7:1.3:1 with the average molecular weight of 52.4 kDa. After treatment with AAP (100 and 200 mg·kg-1) for 28 days there was a significant decrease in blood glucose, SGPT, SGOT, ALP, TC, TG, LDL, BUN and significant increase in body weight, fasting serum insulin, pancreatic insulin and HDL. The activities of SOD and CAT in liver and kidneys also increased. The results of the experiments showed that AAP exerted significant anti-diabetic activity.
American Journal of Medical Case Reports. 2021, 9(2), 116-121. DOI: 10.12691/ajmcr-9-2-5
Pub. Date: December 14, 2020
2410 Views43 Downloads
by Pramod Theetha Kariyanna, Bayu Sutarjono, Naga Pranavi Ellanti, Apoorva Jayarangaiah, Amog Jayarangaiah, Harshith Priyan Chandrakumar, Ashkan Tadayoni, Moro O. Salifu and Isabel M. McFarlane
Original Research
Background. The diagnosis of infective endocarditis is difficult, especially when it involves atypical organisms. Therefore, our study identified risk factors of infective endocarditis caused by rare pathogen, Gemella spp. Methods. A systematic review was conducted to investigate characteristics of endocarditis patients infected with Gemella spp. using the search term “Gemella” and “endocarditis.” Case reports were gathered by searching Medline/Pubmed, Google Scholar, CINAHL, Cochrane CENTRAL, and Web of Science databases. 83 articles were selected for review. Results. Five species of Gemella were identified. Typical patients were males between 31 and 45 years of age. On admission, patients had fever, tachycardia, and normal blood pressure. Common clinical manifestation other than fever included fatigue and weakness, chills and sweating, and nausea, vomiting, diarrhea, and weight changes. One in four reported a history of congenital heart disease, and a recent oral cavity infection. Laboratory tests reveal anemia, leukocytosis, and elevated erythrocyte sedimentation in all age groups, elevated C-reactive protein is observed among adult and geriatric populations only. Mitral and aortic valves were most commonly infected by Gemella spp.. The most common Gemella spp.-susceptible antibiotics were penicillin, vancomycin, cephalosporin, macrolide, and aminoglycosides. However, antibiotic resistance was observed against penicillin, aminoglycoside, and fluoroquinolone. Antibiotic course of at least six weeks resulted in superior clinical improvements than durations under six weeks. Finally, one in two patients underwent valve replacement or repair, with common complications affecting the cardiovascular, neurological, and renal systems. Finally, death occurred in 1 in 8 patients, half of which occurred post-surgical procedure, and the majority occurring equal to or greater than 1 week from admission. Conclusion. Our systematic review highlights the importance of considering rare pathogens, particularly in the presence of predisposing risk factors.
American Journal of Medical Case Reports. 2021, 9(2), 103-115. DOI: 10.12691/ajmcr-9-2-4
Pub. Date: December 13, 2020
3151 Views50 Downloads
by Krunal H. Patel, Elina Shtridler, Violeta Capric, Sunny Paghdal and Samy I. McFarlane
Case Report
Emery Dreifuss Muscular Dystrophy (EDMD) is an inherited disorder which leads to progressive worsening of muscular function. In this report, we present a case of a 29 years old woman with EDMD who presented with sudden left anterior chest pain and was diagnosed with recurrent pneumothoraces. We will highlight how a patient with EDMD-related pneumothoraces can develop rapidly worsening ventilatory function resulting in acute hypercapnic respiratory failure. Patients with muscular dystrophies require a high level of acuity on part of the physician to predict. Physician should be on high alert when treating patients with EDMD and pneumothorax given the potential for rapid respiratory deterioration and the requirements of immediate ventilation support. Having the ability to predict the severity of respiratory involvement in patients with EDMD is a key for favorable outcomes, besides prognostication, it also allows physicians to develop an earlier interventional plan for management of potential respiratory failure. In this report, we also provide in-depth review regarding the approach to the assessment of respiratory function in patients with EDMD and the current literature on the management of respiratory complications seen in patients with EDMD, a highly vulnerable population.
American Journal of Medical Case Reports. 2021, 9(2), 98-102. DOI: 10.12691/ajmcr-9-2-3
Pub. Date: December 13, 2020
2898 Views43 Downloads
by Richmond L. Laryea, Aja E. Adams and Michele L. Richards M.D.
Case Report
Background: Laryngeal schwannomas are rare benign tumors of schwann cell origin and commonly present in the supraglottic area. Patients present with non-specific symptoms such as dysphagia and dysphonia with the occasional patient presenting with more severe symptoms such as stridor. Case Presentation: A 65-year-old female presented to the clinic with symptoms of hoarseness and globus sensation for three months. Fiberoptic flexible nasolaryngoscopy revealed a mass at the right arytenoid, appearing consistent with a mucosally covered cyst-like lesion. Computed Tomography (CT) of the neck showed a lobular hypoenhancing mass at the level of the aryepiglottic fold. A schwannoma was diagnosed via histopathology, positive for S-100. Conclusion: Tailored surgical excision via an intraoral approach successfully removed the laryngeal schwannoma with no recurrence at one-year follow up. This case highlights the clinical presentation, diagnosis, surgical treatment with outcome of this rare laryngeal tumor.
American Journal of Medical Case Reports. 2021, 9(2), 95-97. DOI: 10.12691/ajmcr-9-2-2
Pub. Date: December 13, 2020
2631 Views50 Downloads
by Hiromasa Suzuki and Youichi Yanagawa
Case Report
A 71-year-old woman with a history of diabetes mellitus, hypertension, dyslipidemia and ischemic heart disease, had appetite loss and difficulty moving. She had had one daughter via vaginal delivery. On arrival, she had uterine prolapse from the vagina, stage IV. Whole-body computed tomography indicated uterine prolapsed, distended bladder, bilateral hydro-ureter and nephrosis. An indwelling balloon catheter showed pyuria. The results of a biochemical blood analysis showed acute kidney infection and an inflammatory response. She underwent infusion of Ceftriaxone and was admitted to the general ward. On the second hospital day, she underwent insertion of an intravaginal ring. On the third hospital day, she showed improvement of inflammation and a return to the normal renal function. After physical rehabilitation, she was discharged on the 14th hospital day with an indwelling balloon catheter. We herein report a rare case of sepsis and renal dysfunction caused by uterine prolapse. A prompt diagnosis followed by early relief of the obstruction resulted in improvement of the renal function.
American Journal of Medical Case Reports. 2021, 9(2), 92-94. DOI: 10.12691/ajmcr-9-2-1
Pub. Date: December 07, 2020
2809 Views130 Downloads