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Volume 9, Issue 6

Melkersson-Rosenthal Syndrome Associated to Behçet Disease
Case Report
Melkersson-Rosenthal syndrome (MRS) is an extremely rare disorder whose complete and typical form associates the triad: recurrent nonpitting orofacial edema, facial paralysis, and lingua plicata (fissured dorsal tongue). The exact pathogenesis of this disease is not yet fully understood. Its association with several other autoimmune disorders and the granulomatous nature of this syndrome suggest a dysimmune origin. The association with systemic vasculitis remains unusual with only two cases previously reported. We report the original case of MRS associated with Behçet disease in a 36-year-old Tunisian woman with favorable outcome under colchicine. Our observation is, to our knowledge, the first to report this association.
American Journal of Medical Case Reports. 2021, 9(6), 342-344. DOI: 10.12691/ajmcr-9-6-10
Pub. Date: March 30, 2021
4268 Views11 Downloads
Multiple Sclerosis Spastic Pain Relief Secondary to Medicinal Marijuana
Case Report
A 57-year-old male presented to an outpatient Multiple Sclerosis (MS) clinic for excruciating spastic pain secondary to MS. After a trial of multiple pain management drugs with no success, he began a trial of marijuana. In this paper, we report the extent of improvement in quality of life secondary to cannabinoid use after failing multimodal pain management regimens.
American Journal of Medical Case Reports. 2021, 9(6), 339-341. DOI: 10.12691/ajmcr-9-6-9
Pub. Date: March 30, 2021
2441 Views10 Downloads
Cutaneous Leuckocytoclastic Vasculitis Revealing Acute Brucellosis: A Case Report
Case Report
The clinical presentations of human brucellosis are very polymorphic, representing a real challenge for clinicians. Among the unusual manifestations of this infection, vasculitis is particularly uncommon with only few sporadic cases in the world literature. We report an original observation of isolated cutaneous leuckocytoclastic vasculitis revealing acute brucellosis in a 44-year-old Tunisian man who was admitted for a rash with fever that had been evolving for two days. Somatic examination noted fever at 38°C, red-purple infiltrated and tender petechial lesions on feet, legs, and hands, small periungual necrotic lesions, and subungual splinter hemorrhages. The basic biological tests showed a biological inflammatory syndrome with an erythrocyte sedimentation rate of 82mmH1 and a C-reactive protein at 62mg/l. The skin biopsy concluded in leukocytoclastic vasculitis, without signs of malignancy and with a negative direct immunofluorescence. The specific etiological assessment of this vasculitis was negative. Wright's serology was positive at 1/1,280 confirming the diagnosis of acute septicemic brucellosis with brucellian vasculitis. The patient was treated with the combination: Doxycycline 200mg/d and Rifampicin 600mg/d with a rapidly favorable evolution. Healthcare professionals should be aware of the possibility of brucellosis in front of any unproven vasculitis, especially in endemic countries. This better knowledge will make it possible to avoid diagnostic delay and improve the prognosis of this infection.
American Journal of Medical Case Reports. 2021, 9(6), 335-338. DOI: 10.12691/ajmcr-9-6-8
Pub. Date: March 25, 2021
2768 Views1 Downloads
Acute Respiratory Distress Syndrome Induced by COVID-19 successfully Treated by Multidisciplinary Treatment Including Steroid Pulse Therapy
Case Report
The patient was a 72-year-old woman who developed headache, fever, dyspnea, and taste disorder over a three-day period. A COVID-19 polymerase chain reaction (PCR) test was positive. As she was elderly and required oxygen supplementation, and was therefore admitted to our hospital on day 7 after the onset of headache. Her relevant past history included hypertension, which was treated by enalapril maleate. She was initially treated by dexamethasone (6 mg) per day, remdesivir and heparinization. However, her oxygenation deteriorated and she was transferred to the intensive care unit after tracheal intubation and mechanical ventilation on the 6th hospital day. Her initial PaO2/FiO2 (P/F) value was 150. She underwent additional treatment with glycyrrhizin and γ-globulin on the same day. Her P/F value fluctuated from <200 to the 260 within one day. She underwent tracheotomy on the 13th hospital day, and steroid pulse therapy (methylprednisolone [1 g per day for 3 days]) was administered on the 14th hospital day, following the administration of methylprednisolone (10 mg). Mechanical ventilation was withdrawn from the 19th hospital day. On the 27th hospital day, she was moved to a general ward with 2 L/min of oxygen. Consideration regarding the necessity of steroid pulse therapy is the key to the treatment of COVID-19 patients with ARDS. The indication of pulse steroid therapy, including the dosage duration, and subsequent steroid treatment is a further clinical question in relation to the treatment of COVID-19-induced ARDS.
American Journal of Medical Case Reports. 2021, 9(6), 331-334. DOI: 10.12691/ajmcr-9-6-7
Pub. Date: March 25, 2021
2520 Views2 Downloads
Cold Agglutinin Hemolytic Anemia Induced by COVID-19
Case Report
Autoimmune hemolytic anemia (AIHA) is an acquired autoimmune disorder characterized by the production of antibodies against red blood cell (RBC) antigens causing reduced circulation time. Diagnosis is based on clinical and laboratory signs of hemolysis and a positive direct antiglobulin test (DAT) after excluding alternative causes for those findings. AIHA is sub-classified according to auto-antibody, cold versus warm, and whether primary or secondary in nature. Warm AIHA is associated with the IgG antibody type and generally causes extravascular hemolysis in the spleen. Cold AIHA is less common, associated with the IgM antibody type, and leads to intravascular hemolysis after activating the classical complement pathway. Throughout the COVID-19 pandemic, it has been noted that hospitalized patients are in a pro-inflammatory state (e.g. elevated D-dimer, ferritin, C-reactive protein) that predisposes them to hematological complications such as venous thromboembolisms (VTE). Although the exact pathophysiology remains unclear, evidence points towards fatal cytokine release. Moreover, there have been case reports of AIHA in a subset of COVID-19 patients and researchers postulate molecular mimicry amongst the epitopes of Ankyrin 1 and viral spike protein as a potential culprit. This case report discusses an elderly patient with multiple co-morbidities who was admitted for acute hypoxemic respiratory failure from COVID-19 and found to have cold agglutinin hemolytic anemia. We are looking to contribute to the current understanding of AIHA as a complication of COVID-19 infection.
American Journal of Medical Case Reports. 2021, 9(6), 328-330. DOI: 10.12691/ajmcr-9-6-6
Pub. Date: March 18, 2021
2288 Views3 Downloads
Perforated before Biopsy: A Case of Eosinophilic Esophagitis Complicated by Esophageal Perforation
Case Report
Dysphagia occurs when there is a disruption is the swallowing mechanism. Patients with esophageal dysphagia often reports a sensation of feeling food boluses getting ‘lodged’ or ‘stuck’ during meals. In a young patient with recurrent dysphagia to solid food a mechanical etiology of dysphagia such as Eosinophilic esophagitis must be entertained. This is especially the case if patient has history of other atopic conditions such as asthma or atopic dermatitis. Conclusion: There is need for physicians to be aware of unusual etiologies of esophageal dysphagia such as eosinophilic esophagitis given the availability of treatment options which may reduce disease complication rates.
American Journal of Medical Case Reports. 2021, 9(6), 325-327. DOI: 10.12691/ajmcr-9-6-5
Pub. Date: March 18, 2021
2406 Views4 Downloads
Kikuchi Fujimoto Disease: An Unusual Association with Bicytopenia Mimicking Lymphoma
Original Research
We report a case of Kikuchi-Fujimoto disease (KFD) in an 18-year-old African American female who presents with a high-grade fever, sweating, and painful right-sided cervical lymphadenopathy. Lab analysis showed leukopenia, thrombocytopenia, and an elevated C-reactive protein. The remaining infectious and autoimmune work-up was negative. Given her clinical presentation, an infectious etiology was suspected, and broad-spectrum antibiotics were empirically started. Bicytopenia in the setting of lymphadenopathy raised the suspicion for lymphoma with bone marrow infiltration. An excisional biopsy was performed, and a histological exam of the lymph nodes showed necrotizing histiocytic lymphadenitis consistent with KFD. She was discharged on Naproxen and Tylenol with a referral to Rheumatology. This case highlights the rarity of bicytopenia in KFD and the importance of early and prompt diagnosis in order to avoid unnecessary testing and inappropriate treatment.
American Journal of Medical Case Reports. 2021, 9(6), 321-324. DOI: 10.12691/ajmcr-9-6-4
Pub. Date: March 18, 2021
2670 Views4 Downloads
Recidiving Venous Thrombosis Revealing an Antiphospholipid Syndrome Associated with a Leiden Mutation of Factor V: A Case Report
Case Report
Recurrent thrombosis is a common complication in various pathologies and is part of the definition of antiphospholipid syndrome. We report an observation in which the patient presented with repeated thrombosis, due not only to an antiphospholipid syndrome with partial thromboplastin time with normal activator, but also to a resistance to active protein C linked to the existence of the Leiden factor mutation V. This observation confirms the most often multifactorial nature of thromboses and therefore encourages the search for resistance to activated protein C before an evocative clinic, especially if the routine coagulation assessment is normal.
American Journal of Medical Case Reports. 2021, 9(6), 318-320. DOI: 10.12691/ajmcr-9-6-3
Pub. Date: March 18, 2021
2230 Views9 Downloads
COVID-19 and Acute Limb Ischemia: A Systematic Review
Literature Review
The extraordinary prothrombotic manifestations of Coronavirus Disease-2019 (COVID-19), caused by severe acute respiratory syndrome CoV (SARS-CoV-2) virus, presenting as venous and arterial thrombosis have been reported in the literature. The incidence of arterial thrombosis is reported to be 4% in critically ill COVID-19 patients.. Arterial thrombosis in the setting of COVID-19 has been reported to occur in a multitude of organs leading to ischemic strokes, ST-segment elevation myocardial infarction, aortic thrombus and acute limb ischemia. Diffuse endothelial activation, along with aberrant immuno-thrombotic mechanisms have been implicated in the widespread thrombosis occurring in COVID-19 patients. We performed a literature review of 55 reported cases to delineate the clinical characteristics, management patterns and outcomes of patients with COVID-19 who developed complications of acute limb thrombosis and ischemia. Our systematic review revealed that acute limb ischemia had a male predominance, with either hypertension or diabetes mellitus as the most common underlying cardiovascular risk factors. Aortic thrombus was reported in 23.6% of the cases. The majority of the cases involved thrombosis in more than one limb, indicative of a diffuse thrombotic state. The most common artery affected was the left popliteal artery. Upper limb thrombosis occurred in 40% of the cases. Most of the cases (74.5%) were managed with urgent revascularization interventions and anticoagulation. Negative outcomes, including amputations (14.9%) and death (26.5%) occurred at a higher rate in this population, despite the use of standard management.
American Journal of Medical Case Reports. 2021, 9(6), 312-317. DOI: 10.12691/ajmcr-9-6-2
Pub. Date: March 18, 2021
2573 Views19 Downloads
COVID-19 and Coronary Stent Thrombosis: A Systematic Review of Literature
Literature Review
Coronavirus Disease-19 (COVID-19) is a worldwide pandemic and it has created many difficulties in providing medical care due to the various multi-organ disease manifestations caused by the virus. In this paper we explore cases of stent thrombosis which occurred in patients who were infected with COVID-19 and discuss its role in potentiating this complication through the variety of mechanisms in which it creates a prothrombotic state. Stent thrombosis is described as the thrombotic occlusion of a coronary stent. The incidence of this complication has decreased considerably (from 16% to 0.7%) since the advent of antiplatelet therapy and drug eluting stents. In this systematic review, 8 papers were found which detailed 11 patients who were infected with COVID-19 and suffered a stent thrombosis. Data from these cases were tabulated and analyzed. The ages of the patient’s ranged from 49-81 years and quite interestingly the time between the time of stent placement and occurrence of stent thrombosis had great variation between patients, with some occurring within minutes of stent placement and others occurring in a stent that was placed many years ago. 91% of the patients had ST-segment elevation myocardial infarction (STEMI) for presentation of stent thrombosis and 9% had a non-ST segment myocardial infarction (NSTEMI) on presentation. Therapy mainly involved antiplatelet therapy and Percutaneous Coronary Angioplasty with new stent placement. Despite this mortality rate among the cases present was quite high at 45%, with some patients dying as a result of COVID-19 related complications. Through various literature reviews, we have found that COVID-19 contributes in creating a prothrombotic state through various inflammatory mediated mechanisms. This prothrombotic state is a major risk factor towards stent thrombosis and we recommend that physicians be aware of this potentially fatal complication in COVID-19 patients.
American Journal of Medical Case Reports. 2021, 9(6), 308-311. DOI: 10.12691/ajmcr-9-6-1
Pub. Date: March 18, 2021
2264 Views7 Downloads