by Hana Manzoor, Eman El-Sawalhy, Wehbi Hnayni, Gustavo Tataje Renfigo and Anthony G. Ashkar
Case Report
Obstructive shock is one of the rarest types of shock. It is caused by the reduction of cardiac output despite normal intravascular volume or cardiac function. In this case report, we present a case of a seventy-four-year-old female, who was sent to our emergency department (ED) for evaluation of one week history of dyspnea and abnormal chest X-ray. Initial Contrast Tomography (CT) scan of the chest showed a large necrotic left upper lobe mass with multiple pulmonary nodules, small left-sided pleural effusion and mediastinal lymphadenopathy. Few days later, she developed worsening dyspnea and hypotension, requiring intubation and vasopressors for hemodynamic support. A repeat CT scan showed large left-sided pleural effusion with rightward mediastinal shift that required thoracostomy tube insertion to immediately improve the underlying obstructive shock.
American Journal of Medical Case Reports. 2021, 9(5), 305-307. DOI: 10.12691/ajmcr-9-5-12
Pub. Date: March 14, 2021
3387 Views6 Downloads
by Eman EL-Sawalhy, Najlaa Al-Sudani, Wehbi Hnayni and Shahina Patel
Case Report
Immunoglobulin D (IgD) multiple Myeloma (MM) is a very rare subtype of myeloma. It accounts for only 1-2% of all MM patients. It is associated with a rapidly progressive disease and poorer outcomes compared with other MM subtypes. In this case report, we present a case of a sixty-year-old man who presented to our hospital with fatigue, anemia, thrombocytopenia, and acute renal failure. His bone marrow biopsy during admission showed 75.9% of plasma cells with significant light chain burden. He was also found to have severe immunoglobulin deficiency along with a lambda to kappa ratio was <0.01. The diagnosis of IgD MM was established, and he was started on CyBorD (Bortezomib, cyclophosphamide, and dexamethasone). Our patient also required hemodialysis for his kidney failure.
American Journal of Medical Case Reports. 2021, 9(5), 301-304. DOI: 10.12691/ajmcr-9-5-11
Pub. Date: March 14, 2021
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by Eman EL-Sawalhy, Wehbi Hnayni, Sarah Lonardo and Shahina Patel
Case Report
Grey zone lymphoma (GZL) remains a challenging diagnosis because it has mixed features of diffuse large B cell lymphoma (DLBCL) and classic Hodgkin lymphoma (cHL). In this case report, we present a 69-year-old man who was diagnosed with GZL after an incidental finding of right axillary lymphadenopathy on Computed tomography (CT) scan during a recent hospitalization for an ischemic stroke. Excisional biopsy of the axillary node pathology was consistent with classic Hodgkin lymphoma (Nodular Sclerosing type). Subsequent Positron Emission Tomography (PET)/CT scan showed adenopathy above and below the diaphragm, as well as possible liver, bone, and colon disease. Liver biopsy revealed pathology consistent with DLBCL contrary to the Hodgkin disease seen on axillary biopsy resulting in an eventual diagnosis of GZL on further pathology review.
American Journal of Medical Case Reports. 2021, 9(5), 298-300. DOI: 10.12691/ajmcr-9-5-10
Pub. Date: March 14, 2021
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by Neeraj Salhotra, Mahmood Al Hattali, Livingston C., Nawal Al Kindy, Amal Al Jabri, Jospaul Lucas, Kauther Al Zakwani and Yasir Ahmad Fouad Al-jubouri
Original Research
Cerebral Nocardiosis is a rare, challenging, opportunistic infectious disease of the central nervous system occurring in both immunocompetent and immunocompromised hosts. It often results in intraparenchymal abscess formation, which represents only 2% of all cerebral abscesses. The diagnosis of cerebral Nocardiosis is seldom based on imaging. Bacteriological diagnosis is often reached only after surgical excision of the abscess. We herewith reports 37 yr old patient with cerebellar abscess which grew nocardia.
American Journal of Medical Case Reports. 2021, 9(5), 295-297. DOI: 10.12691/ajmcr-9-5-9
Pub. Date: March 05, 2021
2703 Views7 Downloads
by Julian C. Dunkley, Krunal H. Patel, Andrew V. Doodnauth, Pramod Theetha Kariyanna, Emmanuel Valery and Samy I. McFarlane
Case Report
Contrast-induced encephalopathy (CIE) or contrast-induced neurotoxicity is a rare, elusive, and puzzling diagnostic entity, even for most astute clinicians. Only a handful of publications have been written describing this rare phenomenon. A recent systematic review has only identified a total of 52 cases between 1970 - 2017 [1]. The most common neurological complication associated with cardiac catheterization is an atheroembolic stroke. CIE is not a well-known complication. Clinicians involved in administering high volumes of contrast solutions, as seen in coronary catheterizations, should be aware of this complication as it may be misdiagnosed as an acute stroke, leading to unnecessary additional contrast administration for imaging, as well as invasive and non-invasive interventions. In this report we present a case of an 87-year-old woman known coronary artery disease (CAD) who presented with acute coronary syndrome (ACS) and underwent a successful cardiac catheterization with stent placement followed by left-sided weakness a few hours later due to CIE. We also provide review of the literature and discuss management strategy of this rather rarely encountered diagnosis.
American Journal of Medical Case Reports. 2021, 9(5), 291-294. DOI: 10.12691/ajmcr-9-5-8
Pub. Date: March 03, 2021
9570 Views11 Downloads
by Nicola Jackson, Alicia Pollard, Shion Betty and Jasdeep Boparai
Case Report
Myelodysplastic syndrome (MDS) is a group of stem cell disorders characterized by ineffective hematopoiesis resulting in cytopenias and is rarely seen in patients younger than the age of 40 years old. MDS tends to be more aggressive in the younger population. We report a case of a 26-year-old male who presented with MDS.
American Journal of Medical Case Reports. 2021, 9(5), 289-290. DOI: 10.12691/ajmcr-9-5-7
Pub. Date: March 03, 2021
2368 Views6 Downloads
by Tian Li, Clara E. Wilson, Harry Zinn, Moro O. Salifu and Isabel M. McFarlane
Case Report
Background: Pancreatic ascites is a rare entity resulting from pancreatic duct leakage into peritoneum. The most common etiology is chronic pancreatitis or abdominal trauma. Case Presentation: A 23-year-old female with history of chronic pancreatitis secondary to alcohol abuse presented with acute on chronic epigastric pain with unintentional weight loss. Physical exam revealed epigastric and right upper quadrant tenderness without rebound or guarding. Labs were significant for low serum albumin and elevated lipase level. CT of abdomen without contrast demonstrated large volume ascites with normal looking pancreas. MRI of abdomen with intravenous contrast revealed two dilated tubules within the pancreatic neck communicating with the pancreatic duct, representing pancreatic fluid leakage into the peritoneal cavity. Paracentesis was performed yielding large volume of ascitic fluid with high amylase level, characteristic of pancreatic ascites. Patient was managed conservatively with bowel rest and octreotide. Conclusion: Pancreatic ascites is uncommon among the differential diagnosis of ascites. Diagnosis is suspected in a patient with chronic alcoholism or pancreatitis presenting with high amylase exudative ascites and/or pleural effusion. Though limited evidence, interventional therapy especially endoscopic procedure is recommended as initial treatment.
American Journal of Medical Case Reports. 2021, 9(5), 286-288. DOI: 10.12691/ajmcr-9-5-6
Pub. Date: March 02, 2021
2423 Views11 Downloads
by Ahmed Hashim, Raai Mahmood, Mohamedanwar Ghandour, Hammam Shereef, Ammar ELJack, Cecilia Big, Kevin Jamil and Rajiv John
Original Research
We report a case of Sternoclavicular Joint (SCJ) infection in a 52-year-old male who developed an empyema over six days. During the first three visits, he had worsening pectoral and shoulder pain and was symptomatically treated and discharged. During the first ED visit, a computed tomography (CT) scan of the neck was negative. During the second ED visit, CTA chest was negative for pulmonary embolism. Three days later, CTA of the neck showed density from the left first rib to the left sternoclavicular joint, suggesting a hematoma. During the final ED visit, CT of the chest showed a left anterior chest wall abscess contiguous with a left upper lobe empyema. VATS confirmed empyema and revealed costochondral and SCJ abscess. Decortication, SCJ resection, and pectoralis muscle debridement were performed. Methicillin-susceptible Staphylococcus Aureus (MSSA) was isolated from surgical cultures. After the pectoralis muscle flap closure, he was treated with IV cefazolin for a total of six weeks. Health care professionals should have a high index of suspicion for SCJ infections in patients with a similar clinical presentation. This case highlights the importance of early and prompt diagnosis of MSSA SCJ infections to prevent sequelae of the disease.
American Journal of Medical Case Reports. 2021, 9(5), 281-285. DOI: 10.12691/ajmcr-9-5-5
Pub. Date: February 24, 2021
3404 Views21 Downloads
by Abdalla Khalil, Khalil Hossenbux and Yusuf Ibidapo
Case Report
Viral meningitis is the most common identified cause of meningitis in the United Kingdom and represents a challenge to diagnose early and a burden on health care service. A young healthy female was admitted to the hospital with a headache, nausea, vomiting, meningeal irritation, and a strong family history of a cerebral aneurysm. She had no fever or rash and her cerebrospinal fluid CSF showed lymphocytic pleocytosis with high protein and normal glucose. Initially, she was treated empirically with antiviral and antibiotics for acute meningitis and her final workup confirmed the varicella zoster viral meningitis. Rarely, Varicella zoster viral meningitis can affect immune-competent patients. It can also rarely present without a skin lesion or fever. Virology study of the cerebrospinal fluid may reveal the diagnosis of viral meningitis early and reduce the health care burden.
American Journal of Medical Case Reports. 2021, 9(5), 278-280. DOI: 10.12691/ajmcr-9-5-4
Pub. Date: February 23, 2021
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by Asghar Marwat, Assad Marwat, Hina Bangash, Sadaqat Liaqat, Muzammil Khan and Shaza Khalid
Case Report
Cerebral Amyloid Angiopathy (CAA) is characterized by amyloid beta-peptide deposits within the small to medium-sized vessels of the brain and leptomeninges. CAA is an important cause of intracerebral hemorrhage in older adults. Cerebral Amyloid Angiopathy Related Inflammation (CAA-ri) is, however, a rare variant of CAA that results from an autoimmune response to the deposits and is characterized by acute or subacute encephalopathy, headache, or focal neurological deficits. We present a case of a 62-year-old female who presented with a generalized tonic-clonic seizure witnessed by a family member. The event was preceded by a worsening of her dementia in the past few months. The patient had features suggestive of CAA-ri on Magnetic Resonance Imaging of the brain and was treated with high dose IV steroids. With an improvement in her cognitive symptoms and no further seizure episodes, she was discharged on oral steroids. Although CAA is well studied and well documented, its subset CAA-ri is uncommon with its clinical course and complications mentioned infrequently in medical literature. In conclusion, CAA-ri is underdiagnosed because of its rarity and remains a potentially treatable cause of subacute cognitive decline and seizures demanding further research in this area.
American Journal of Medical Case Reports. 2021, 9(5), 275-277. DOI: 10.12691/ajmcr-9-5-3
Pub. Date: February 22, 2021
2408 Views4 Downloads
by Chukwuemeka A. Umeh, Ankit Dubey, Mohammad Yousuf and Stella Onyi
Case Report
Background: Atrial fibrillation (AF) is associated with increased rates of stroke and other thrombo-embolic events, heart failure, reduced quality of life, reduced exercise capacity, left ventricular (LV) dysfunction and death. Atrial fibrillation can be a risk factor for pulmonary embolism (PE) or a consequence of PE. This case report highlights the complex relationship between AF and PE. Case report: We report a case of a hospitalized 69-year-old male with new onset AF with rapid ventricular response with concurrent newly diagnosed PE. The rate uncontrolled AF in the hospitalized patient triggered the investigation for PE in this patient. Conclusion: For hospitalized patients with new onset AF, PE should be considered and searched for even in patient on prophylactic venous thromboembolism anticoagulation especially if patient is symptomatic (palpitations, shortness of breath, syncope, hypoxia, chest pain) or echocardiogram shows signs of right heart strain.
American Journal of Medical Case Reports. 2021, 9(5), 272-274. DOI: 10.12691/ajmcr-9-5-2
Pub. Date: February 19, 2021
2448 Views6 Downloads
by Yuqiong An, Yong Liu and Ning Ma
Case Report
Background: Iliopsoas bursal cystic lesion (IBCL), a rare disease on groin area, posing a significant threat to the lower limb thrombosis, but it is easy to misdiagnose or missed diagnose. Doppler ultrasonography (DU) with certain advantages could be used to detect the enlarged iliopsoas bursa (EIB) and compression of lower extremity vein. Case presentation: A 60-year-old man was admitted to our department complaining of pain and swelling in his right groin area for 3 weeks. DU demonstrated that there was a well-defined, echo-free, cystic mass in the right inguinal region, which severely compressed the common femoral vein (CFV), and the blood flow velocity was extremely slow. Then, surgery was performed to exclude the lesion, consequently, corresponding signs and symptoms had resolved completely. Histopathological results suggested the mass is an iliopsoas bursa filled with mucinous materials. After that, DU was displayed again and the results suggested that the EIB has almost been excised and there was a slight echogenic structure in the deep layer communicating to the hip joint space. Conclusion: Although, IBCL is rare and easy to misdiagnose and missed diagnose, the DU with certain advantages could be used to diagnose effectively this disease and guide the clinical prevention and intervention of thromboembolic events.
American Journal of Medical Case Reports. 2021, 9(5), 268-271. DOI: 10.12691/ajmcr-9-5-1
Pub. Date: February 05, 2021
2773 Views2 Downloads