by Andrew V. Doodnauth, Ahmad Jallad, Dahlia Rizk, Emmanuel Valery and Samy I. McFarlane
Original Research
COVID-19 caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is associated with significant cardiovascular dysfunction in patients with, and without, pre-existing cardiovascular disease [1]. There are now well-documented cardiac complications of COVID-19 infection which include myocarditis, heart failure, and acute coronary syndrome [2]. There is growing evidence showing that arrhythmias are also one of the major complications of COVID-19. We report a patient with no known cardiac conduction disease who presented with syncope, positive SARS-CoV-2 PCR, who was persistently bradycardic and subsequently developed sinus node dysfunction (SND). To date, there are a limited number of reports of sinus node dysfunction (SND) associated with COVID-19. We describe the clinical characteristics, potential pathophysiologic mechanisms and management of COVID-19 patients who experienced de novo SND.
American Journal of Medical Case Reports. 2021, 9(4), 263-267. DOI: 10.12691/ajmcr-9-4-15
Pub. Date: February 04, 2021
2786 Views6 Downloads
by Ademayowa Ademiluyi, Nicola Jackson, Shion Betty, James Appiah-Pippim and Krystal Alexander
Case Report
Eagle syndrome is a rare medical condition characterized by symptoms related to an elongated styloid process. CT scan of the neck and direct laryngoscopy was obtained and confirmed the diagnosis. Here we report a patient who presented with dysphagia and odynophagia and was found to have an elongated styloid process.
American Journal of Medical Case Reports. 2021, 9(4), 261-262. DOI: 10.12691/ajmcr-9-4-14
Pub. Date: February 04, 2021
2411 Views3 Downloads
by Aleem Azal Ali, Naji Maaliki, Michael Omar, Amy Roemer, Jose Ruiz and Khadeeja Esmail
Case Report
COVID-19 predominantly affects the lungs manifesting as respiratory illnesses including pneumonia and acute respiratory distress syndrome. Cardiac manifestations are also being increasingly reported such as pericardial disease, myocardial injury and dysfunction, arrhythmias and conduction abnormalities. A 70-year-old male with asymptomatic COVID-19 infection developed a transient episode of complete heart block just prior to his planned discharge from hospital. There are only few case reports purporting the development of a transient complete heart block in patients with moderate to severe COVID-19 infection. However, to date, this is the first report of incidentally detected, asymptomatic COVID-19 infection manifesting as third degree heart block.
American Journal of Medical Case Reports. 2021, 9(4), 259-260. DOI: 10.12691/ajmcr-9-4-13
Pub. Date: February 04, 2021
2482 Views6 Downloads
by Sufyan AbdulMujeeb, Faisal Masood, Dureshahwar Ali, Sarah Doleeb and Adib Chaus
Case Report
Introduction: Chest pain radiating to the jaw, is a classic symptom of acute myocardial infarction (AMI). Electrocardiogram (EKG) changes consistent with ischemia and elevated serum troponin I levels are used to confirm the diagnosis. Prompt management including medical or procedural intervention is required to help reduce mortality in patients with AMI. However, additional conditions may mimic those of classic primary coronary pathology. Case Report: We present the case of a 43-year-old male who came to the emergency department (ED) complaining of acute onset of chest pain radiating to the left jaw. His EKG revealed mild ST changes and T-wave inversion in the antero-lateral leads. Laboratory testing revealed an elevated serum troponin level of 0.18 ng/mL (normal: < 0.04 ng/mL). He was taken for a coronary angiogram and during the procedure, an aortogram was performed revealing a type A aortic dissection. Findings were confirmed by Computed Tomography Angiogram (CTA) showing a dissection extending from the aortic root to the iliac bifurcation. He was promptly taken to the operating room (OR) for surgical repair. Conclusion: Aortic dissection (AD) is included in the differential diagnosis in patients presenting with symptoms and signs consistent with AMI. However, in patients presenting with AD, there are some clues in history and physical exam, such as high blood pressure, history of noncompliance with antihypertensive medications, or location of pain that may provide a clue towards an underlying AD. Our case demonstrates that even if all evidence points towards an AMI, AD should still be on the differential until successfully ruled out by imaging.
American Journal of Medical Case Reports. 2021, 9(4), 253-258. DOI: 10.12691/ajmcr-9-4-12
Pub. Date: February 04, 2021
2817 Views11 Downloads
by Ahmad Jallad, Andrew V. Doodnauth, Justin Lee, Emmanuel Valery, Stephanie Myers, Dahlia Rizk and Samy I. McFarlane
Case Report
Various electrocardiographic (EKG) manifestations have been reported in patients with coronavirus disease 2019 (COVID-19). There is growing evidence showing that new onset QT-prolongation is a common EKG finding in COVID-19 patients. In this report, we present a case of a 71-year-old man who was found to have a new onset, irreversible, prolonged QT-interval requiring permanent biventricular pacemaker despite testing negative twice for RT-PCR COVID-19 and correction of all known reversible causes. To date, there are a limited number of reports of irreversible QT-prolongation associated with COVID-19. This case report emphasizes the importance of a physician's clinical judgment in the setting of negative RT-PCR COVID-19 testing. A robust systemic inflammatory state seen in active COVID-19 infection is possibly the key mechanism precipitating the new EKG findings.
American Journal of Medical Case Reports. 2021, 9(4), 249-252. DOI: 10.12691/ajmcr-9-4-11
Pub. Date: February 03, 2021
3219 Views8 Downloads
by Pramod Theetha Kariyanna, Naseem A. Hossain, Neema Jayachamarajapura Onkaramurthy, Apoorva Jayarangaiah, Nimrah A. Hossain, Amog Jayarangaiah and Isabel M. McFarlane
Case Study
Löffler endocarditis is an uncommon, but known complication of hypereosinophilic syndrome (HES). It is a relatively rare entity, and remains poorly understood. To this point in time, the compendium of knowledge about this disease consists of various case reports, prospective studies and review articles. We aim to present a scoping study about this disease. Our goals are to identify the characteristic features found in case reports to identify characteristic features found in patients with Löffler endocarditis as a result of hypereosinophilic syndrome. An analysis of the 26 case reports showed a mean age of 41.6 years with a standard deviation of 17.1 years. Dyspnea was the most common presenting complaint (64%) followed by fatigue (23%), cough (19%), fever (19%), orthopnea/paroxysmal nocturnal dyspnea (19%), stroke related symptoms (15%), chest pain (15%) and lower extremity edema (15%). The most common cardiac structure affected was the mitral valve (65%), followed by the tricuspid valve (42%), left ventricle (23%), with 35% of cases having involvement of two valves. The most common therapeutic modality was immunosuppression (85%), followed by anticoagulation (73%) and mitral valve replacement (23%). Death was reported in 19% of the cases. Löffler’s endocarditis continues to be associated with high morbidity and mortality. Further research must aim to develop guidelines for management of this uncommon manifestation of hypereosinophilic syndrome.
American Journal of Medical Case Reports. 2021, 9(4), 241-248. DOI: 10.12691/ajmcr-9-4-10
Pub. Date: February 03, 2021
2582 Views10 Downloads
by Donny Sutrisno Winardo and John J. E. Wantania
Original Research
Heterotopic pregnancy is a rare condition found. The incidence is around 1 in 30,000 spontaneous pregnancies. Ovarian pregnancies occur around 0.5-3% and heterotopic pregnancies around 2% of all ectopic pregnancies. The diagnosis is intricate and based on surgical and histopathological observations. The management is, in spite of medical improvement. We presented an ectopic pregnancy suspected of being a right ovarian pregnancy and undergoing surgery, then 1 month later an ectopic pregnancy reappeared in a tubal rupture on the opposite side. We describe based on the literature review, diagnosis criteria and case management.
American Journal of Medical Case Reports. 2021, 9(4), 238-240. DOI: 10.12691/ajmcr-9-4-9
Pub. Date: February 03, 2021
2421 Views2 Downloads
by Eman EL-Sawalhy, Muna Shaaeli and Essa Kadiri
Case Report
This case report aims to draw attention to the possible occurrence of metoclopramide-induced bronchospasm. We report a case of bronchospasm reaction to metoclopramide in a mechanically ventilated patient treated for cardiogenic shock. Metoclopramide can cause severe adverse events, such as bronchospasm, and should be used with caution in patients on mechanical ventilation.
American Journal of Medical Case Reports. 2021, 9(4), 236-237. DOI: 10.12691/ajmcr-9-4-8
Pub. Date: February 02, 2021
2565 Views5 Downloads
by Kitigon Vichairuangthum
Case Report
Coronary artery perforation is a rare but fatal complication of percutaneous coronary intervention. Cardiac tamponade constitutes the most severe clinical consequence. If not properly and promptly treated, it is burdened by a high mortality rate. This article report the case of an intra-stent coronary perforation after simple revascularization, followed by an immediate impairment of hemodynamic compensation, due to significant pericardial effusion and sub-sequent cardiac tamponade. While prompt surgical intervention may be lifesaving, expertise in the use of stent graft may provide a valuable rescue option for this serious complication. Interventional cardiologists should be able to recognize and know available treatment options of this serious complication.
American Journal of Medical Case Reports. 2021, 9(4), 232-235. DOI: 10.12691/ajmcr-9-4-7
Pub. Date: January 27, 2021
3141 Views5 Downloads
by Hammam Shereef, Mohamedanwar Ghandour, Sarah Abdelsamad, Ahmed Subahi, Ahmed S Yassin and Luis Afonso
Case Report
Propafenone is a Class 1 C anti-arrhythmic drug, frequently used in the treatment of supraventricular and ventricular arrhythmias. We herein are presenting a case of 67-year-old female who presented with wide complex tachycardia consistent with Propafenone toxicity and who responded immediately to sodium bicarbonate injections. This case shines the light on a common effect of Propafenone toxicity and aims to increase the clinician awareness about such a documented reaction, that can be reversed by a simple treatment like sodium bicarbonate.
American Journal of Medical Case Reports. 2021, 9(4), 229-231. DOI: 10.12691/ajmcr-9-4-6
Pub. Date: January 27, 2021
2554 Views3 Downloads
by Eman EL-Sawalhy, Wehbi Hnayni, Abir Tawil and Hanady Daas
Case Report
Mycobacteria Wolinskyi is a rapidly growing nontuberculous mycobacterium (RGM) that is associated with skin and soft tissue infection (SSTI) following cosmetic surgeries. The infections vary in severity and treatment requires a prolonged course of antibiotics as well as surgical intervention. Around 20 cases have been reported worldwide, only a handful in the United States. In this case report, we present a case of a 30-year-old woman with severe necrotizing infection due to M. Wolinskyi following abdominoplasty abroad.
American Journal of Medical Case Reports. 2021, 9(4), 226-228. DOI: 10.12691/ajmcr-9-4-5
Pub. Date: January 27, 2021
2881 Views3 Downloads
by Islam MA, Shahin MA, Haq SA and Choudhury MR
Original Research
Lipoma Arborescens is a rare benign intra-articular lesion most frequently found in the knee identified by the villous proliferation of the synovium. It usually presents as an enduring, slowly progressive swelling of one or more joints, which may or may not be associated with pain. Patients typically present with chronic and recurrent painless swelling of the joints. MRI demonstrated replacement of sub synovial tissue by mature fat cell, is clearly seen in STIR sequence.
American Journal of Medical Case Reports. 2021, 9(4), 219-225. DOI: 10.12691/ajmcr-9-4-4
Pub. Date: January 26, 2021
3172 Views5 Downloads
by Ahmed K A Ahmed, Ahamed Elkhair, Omeralfaroug Adam, Mohamedanwar Ghandour and Rabab Elhassan
Case Report
Anaplastic astrocytoma is a rare, malignant brain tumor that arises from astrocytes, with a poor prognosis. Herein, we report a challenging diagnostic case of a 76 years old female with an Anaplastic astrocytoma metastasized to the corpus callosum.
American Journal of Medical Case Reports. 2021, 9(4), 216-218. DOI: 10.12691/ajmcr-9-4-3
Pub. Date: January 24, 2021
3309 Views6 Downloads
by Mohammed Al Homsi, Ammar Al Homsi and Malay Jhancy
Case Report
Crouzon’s syndrome is a rare autosomal dominant disorder characterized by craniofacial malformations. It’s the most common syndrome among the craniosynostosis group accounting for about 4.8 % of all of them. Crouzon syndrome is caused by mutation in the fibroblast growth factor receptor-2 (FGFR-2) gene resulting in premature closure of suture lines. Our article describes a case report of a 3 years old girl who displayed characteristic dysmorphic skull and facial features of Crouzon’s syndrome.
American Journal of Medical Case Reports. 2021, 9(4), 213-215. DOI: 10.12691/ajmcr-9-4-2
Pub. Date: January 19, 2021
4210 Views3 Downloads
by Hammam Shereef, Mohamedanwar Ghandour, Mohamed Mustafa, Ahmed Hashim, Omar Nasser Rahal, Jeremy Powers, Ruaa Elteriefi and Faisal Musa
Case Report
Anaplastic thyroid cancer (ATC) is the rarest form of thyroid cancer known to humans. Among the other thyroid neoplasms, ATC is the deadliest, with unified mortality of almost 100%. With the advances in thyroid ultrasounds and screening protocols, the incidence of ATC increases, which correlates with the increase in papillary thyroid cancer (PTC) that is believed to be the precursor of most ATC. We herein describe a rare case of a 69-year-old Caucasian male with no known past medical or surgical histories who presented with a rapidly growing neck mass that was later confirmed as an undifferentiated anaplastic thyroid carcinoma with a mutation in NRAS and TP53 progressing in two months period into a complete seeding of lungs with metastasis. This case highlights the importance of studying and understanding thyroid oncogenesis's molecular aspects as recently targeted immunotherapy is promising for particular gene mutations by delaying this graving cancer progression.
American Journal of Medical Case Reports. 2021, 9(4), 208-212. DOI: 10.12691/ajmcr-9-4-1
Pub. Date: January 18, 2021
3872 Views6 Downloads