by Sahra Ahmadi and Usha Anand
Case Report
Hyperthyroidism is a state of excess circulating thyroid hormone. These hormones control many of the body’s most important functions such as breathing, heart rate, weight, digestion, and moods. The extreme manifestation of thyrotoxicosis is referred to as thyroid storm. Thyroid storm manifests as an acute, severe, life-threatening hypermetabolic state caused by either excess release of thyroid hormones or an altered peripheral response to thyroid hormone following the presence of one or more precipitants. Thyroid storm is an uncommon but potentially fatal endocrine emergency. Mortality reaching between 80 – 100% without treatment in thyroid storm with multiple organ failure as the most common cause of death. During thyroid storm, precipitants multiply the effect of thyroid hormones by freeing thyroid hormones from binding sites, increased sensitivity in tissue receptors, or post-receptor modifications in signaling pathways. The most common precipitating factor is infection along with a host of other causes. Of interest, iodinated contrast is an important precipitating factor to consider as it is commonly used in the hospital setting through imaging modalities. Elderly patients are at higher risk due to the increased prevalence of nodular thyroid disease. Care must be taken to quickly recognize and treat this potentially fatal illness.
American Journal of Medical Case Reports. 2021, 9(8), 436-437. DOI: 10.12691/ajmcr-9-8-14
Pub. Date: May 13, 2021
2294 Views3 Downloads
by Kourosh Shargani, Caleb V Wutawunashe and Anu Menon
Case Report
Acute pancreatitis is an inflammation of the pancreas that can be caused by many etiologies. Drug induced pancreatitis is one of the rarer causes. This case will show an unusual presentation of acute pancreatitis that may have been caused by methylprednisolone or colchicine use. Both medications have been linked as a rare cause of drug induced pancreatitis.
American Journal of Medical Case Reports. 2021, 9(8), 434-435. DOI: 10.12691/ajmcr-9-8-13
Pub. Date: May 13, 2021
2267 Views6 Downloads
by Kourosh Shargani and Harry Fischer
Case Report
Gout, or monosodium urate crystal deposition, is a common presentation in adults usually affecting the great toe. Gout is caused by an elevated level of uric acid in the blood, which leads to painful crystal deposition in the joints. Common causes of gout are Hypertension (HTN), Chronic Kidney Disease (CKD), Diabetes Mellitus (DM), alcohol use, diuretics, and high purine meals such as red meat or seafood. Gout flares present with sudden onset pain, warmth, and swelling in a single joint. These symptoms are very similar to an acute septic joint presentation. This case will demonstrate the workup required to differentiate between the two pathologies.
American Journal of Medical Case Reports. 2021, 9(8), 432-433. DOI: 10.12691/ajmcr-9-8-12
Pub. Date: May 10, 2021
2254 Views8 Downloads
by Yi Zou, Lai Wei, Yanan Tang and Gaoyin Kong
Case Report
Subcutaneous emphysema (SE) is not an uncommon complication in laparoscopic surgery, it may cause severe hypercapnia and acidosis. The trocar related SE is usually caused by multiple attempts at the abdominal entry and leakage of gas into the subcutaneous tissue, this kind of SE usually causes refractory hypercapnia and may induce severe complications. However, Intraoperative treatment for this kind of SE is still limited. Here we present a case of refractory hypercapnia caused by trocar related SE, after failed attempts of hyperventilation and decreasing intra-abdominal pressure, the SE and hypercapnia were finally controlled by using a balloon trocar.
American Journal of Medical Case Reports. 2021, 9(8), 428-431. DOI: 10.12691/ajmcr-9-8-11
Pub. Date: May 10, 2021
2474 Views12 Downloads
by Silfat Azam, Abdalla Khalil and Ahmad Taha
Case Report
Since the COVID-19 pandemic has started in December 2019, millions of people have been infected all over the world and few vaccines have been invented recently. Extremely rare, Guillain-Barre Syndrome (GBS) was reported as a neurological complication after H1N1 flu vaccination. Currently, Pfizer and AstraZeneca vaccines are available to prevent infection with COVID-19. The first case of post-COVID-19 vaccine GBS has been detected in a secondary care hospital after vaccination with AstraZeneca. A 67-year-old man presented with an acute progressive ascending flaccid symmetrical motor neuropathy, and bilateral facial weakness which developed two weeks after receiving the first dose of AstraZeneca COVID-19 vaccine. His cerebrospinal fluid findings, nerve conduction result, and MRI brain result were all in favour of GBS diagnosis. The patient’s workup for all known infections associated with immune-mediated GBS was negative.
American Journal of Medical Case Reports. 2021, 9(8), 424-427. DOI: 10.12691/ajmcr-9-8-10
Pub. Date: May 10, 2021
4459 Views13 Downloads
by Wanling Huang, Obiageli Offor, Anahat Kaur, Lewis Steinberg and Abhishek Kumar
Case Report
Squamous cell carcinomas (SCC) account for the majority of all primary oropharyngeal carcinomas. These tumors can progress locally as well as metastasize to lymph nodes, the lung, bone, and liver. Metastases of primary laryngeal SCC to the small bowel is exceedingly rare and portends a poor prognosis as they often present with catastrophic symptoms. HPV-related head and neck SCC (HNSCC) is a peculiar subset of all HNSCC, and available data from prospective studies suggest better survival outcomes with HPV-related HNSCC compared to non-HPV-related HNSCC. In this article, we report the case of a patient who was managed at a tertiary hospital for a HPV-related laryngeal SCC with metastases to the small bowel presenting as small bowel obstruction (SBO). We also conducted a systematic review of HNSCC metastatic to small bowel with a focus on relation to HPV. We identified 13 reported cases of HNSCC metastatic to the small bowel. Of these, only 1 case was positive for p16 (a marker of HPV infection in HNSCC). We present the second case of HPV-related HNSCC with metastases to the small bowel.
American Journal of Medical Case Reports. 2021, 9(8), 420-423. DOI: 10.12691/ajmcr-9-8-9
Pub. Date: May 07, 2021
2531 Views5 Downloads
by Rohan Madhu Prasad, Caitlin Heenan, Keerthi Gullapalli, Priyal Agarwal, Tyler Kemnic and Richa Tikaria
Case Report
Pasteurella (P.) canis bacteremia is rare with only five reported cases in the literature, which was likely correlated with a state of immunosuppression. A 59-year-old male with a history of right lower extremity (RLE) squamous cell carcinoma (SCC) and non-alcoholic cirrhosis presented for a two week duration of RLE pain, swelling, erythema, and open wounds. The patient admitted that his dog has regularly licked his wounds in the past week. Laboratory investigations and imaging confirmed cellulitis and P. canis bacteremia. Additionally, punch skin biopsies showed his SCC is well differentiated and invasive. The patient was started on empirical intravenous antibiotics. Once deemed medically stable and asymptomatic, the patient was discharged from the hospital on culture directed oral antibiotics. He was also educated on wound care and wound hygiene with his dog. It is important for the general practitioner to know that P. canis bacteremia is possible, although rare. Additionally, it is useful to know that patients without animal bites and immunosuppression are at risk of bacteremia. Finally, with the appropriate antibiotics, P. canis bacteremia can have a favorable prognosis.
American Journal of Medical Case Reports. 2021, 9(8), 414-419. DOI: 10.12691/ajmcr-9-8-8
Pub. Date: May 05, 2021
5538 Views16 Downloads
by Madiha Iqbal, Bushra jamil, Marium Khurshid and Fatima Anam Farooqi
Case Report
Infective endocarditis remains an important clinical condition which if not picked and treated at time leads to devastating course. We present a case of middle aged female with prolong illness of around 2 months , developed devastating septic complications of infective endocarditis and underwent surgical resection of unusually giant vegetation with mitral valve replacement along with antibiotic treatment showed recovery soon after surgery, although her Blood cultures and tissue cultures remained negative. This case is of major interest that she was early recognized for all possible complications of the disease and treated accordingly with difficult surgery despite of prolong illness and complications.
American Journal of Medical Case Reports. 2021, 9(8), 411-413. DOI: 10.12691/ajmcr-9-8-7
Pub. Date: April 29, 2021
3461 Views6 Downloads
by Sharif Al Qadhi, Simin Laiq, Neeraj Salhotra, Jospaul Lukas, Zahra Al Hajri, Bashar Al Tunbi, Fahad Al Kheder, Mohammad Hashim, Muna Al Jabri and Afaf Rashid Al Hatmi
Original Research
Neurenteric cysts, also known as endodermal cysts and enterogenous cysts, are rare benign cysts. Neurenteric cysts may be associated with congenital malformations, such as spinal dysraphism, or may occur as solitary lesions. Most are located in the spine, in the intradural, extramedullary and intraspinal space. Rare examples may occur intracranially, and rarer examples may occur at the craniovertebral junction. Clinically, solitary neurenteric cysts present with mass effect symptoms such as compression of spinal cord and adjacent nerve roots. We present a case of a 28-year-old male patient with a histologically confirmed neurenteric cyst located at the cervicomedullary or craniovertebral junction with presenting symptoms of neck pain and severe debilitating weakness of all four limbs. The patient underwent successful surgical resection, with gradual improvement in his symptoms. We also present a review of literature, including the clinical features, histological characteristics, and management options for patients with neurenteric cyst in the craniovertebral junction.
American Journal of Medical Case Reports. 2021, 9(8), 407-410. DOI: 10.12691/ajmcr-9-8-6
Pub. Date: April 29, 2021
3834 Views6 Downloads
by Samuel J Apple, Justin Lee, Meagan Freeze, Dahlia Rizk, Andrea Trimmingham and Samy I. McFarlane
Case Report
Constrictive physiology is most commonly caused by pericardial effusions, constrictive pericarditis or large pleural effusions. Rarely, alternative etiologies may cause cardiac compression. In this report, we present a case of a 70-year-old woman with squamous cell carcinoma who was referred by her cardiologist for evaluation of pericardial and pleural effusions found on echocardiography. Initial clinical findings suggesting constrictive pericarditis, However, after further evaluation we determined that tense ascites was the underlying etiology of constrictive physiology in this patient. This diagnosis requires an integrative interpretation of multiple imaging modalities. Our case highlights the interdependent relationship between cardiac and hepatic pathology that needs to be considered on a case by case basis. Additionally, this case underscores the importance of maintaining a high degree of suspicion for extracardiac compression in the setting of cirrhosis, with prompt paracentesis to adequately prevent the life-threatening sequela of cardiac tamponade.
American Journal of Medical Case Reports. 2021, 9(8), 402-406. DOI: 10.12691/ajmcr-9-8-5
Pub. Date: April 26, 2021
3412 Views8 Downloads
by David Pisarcik, Gabriel Kousourou and Nagadarshini Vinod
Case Report
Hypertrophic Osteoarthropathy (HOA) is a rare condition that presents with arthralgias, digital clubbing, and abnormal periosteal bone deposition seen on x rays. The secondary form of HOA may be associated with an underlying malignancy, thus highlighting the importance of early clinical recognition. We present the case of a 44-year-old woman who presented with several weeks of lower extremity swelling, arthralgias, and digital clubbing who was later found to have non-small cell lung cancer. Diagnosis can be challenging due to variable presentations that can often mimic other forms of inflammatory arthritis. Treatment is focused on addressing the underlying cause. Nonsteroidal anti-inflammatory drugs (NSAIDS) are commonly used for pain relief while intravenous bisphosphonates have been trialed with some success in case reports.
American Journal of Medical Case Reports. 2021, 9(8), 397-401. DOI: 10.12691/ajmcr-9-8-4
Pub. Date: April 25, 2021
2895 Views5 Downloads
by Hafsa Parpia, Eman EL-Sawalhy, Maher Khadra, Raisa Mayers, Samyuktha Madishetty and Faisal Musa
Case Report
Immune Thrombocytopenic Purpura (ITP) is an autoimmune disorder caused by different entities, one of them being the administration of certain vaccines, most commonly MMR vaccines that have been linked with the development of this disease. We report a 26-year-old female presented to the hospital with a petechial rash and mucosal bleeding after three weeks of administration of the COVID-19 vaccine. Thrombocytopenia workup was done, ITP was diagnosed. The ITP in this case was refractory to initial treatment of IVIG and steroid. Rituximab was initiated and she had an excellent response to it.
American Journal of Medical Case Reports. 2021, 9(8), 394-396. DOI: 10.12691/ajmcr-9-8-3
Pub. Date: April 24, 2021
4280 Views8 Downloads
by Jonathan Jimenez DO, Michaela Knaggs, Wesley High DO and Kelly Shortridge DO
Original Research
This is a case of a portal vein aneurysm and the presentation of symptoms. There are currently less than 200 cases documented in English literature. The focus of this report is to detail the presentation of symptoms as well as to discuss appropriate work up and management of portal vein aneurysms. Unfortunately, this patient left against medical advice prior to further work up of his aneurysm.
American Journal of Medical Case Reports. 2021, 9(8), 389-393. DOI: 10.12691/ajmcr-9-8-2
Pub. Date: April 23, 2021
2667 Views6 Downloads
by Hiroka Matsuda, Kei Jitsuiki, Ken-ichi Muramatsu, Hiroki Nagasawa, Ikuto Takeuchi and Youichi Yanagawa
Original Research
A 34-year-old man was transported by ambulance to our hospital after experiencing generalized convulsions. He had been of short stature since birth, and had been diagnosed with growth hormone deficiency, which was treated with growth hormone therapy from 10 to 14 years of age. He experienced convulsions two times at 32 and 33 years of age, respectively, with spontaneous recovery. He had no specific family history. On arrival, he had clear consciousness and sinus tachycardia. A physical examination revealed short stature. A biochemical analysis of venous blood revealed hypocalcemia and a low level of parathyroid hormone. Head computed tomography (CT) revealed diffuse hyperostosis of the cranial vault and truncal CT revealed cartwheel apperance in the thoracic vertebral bodies from Th9 to Th12. He was treated with levetiracetam, alfacalcidol and calcium agents. Next-generation sequencing suggested heterozygous large deletion of T-box transcription factor (TBX1) gene. This is the first report of hypoparathyroidism with cartwheel-like change in the thoracic vertebral body. The further accumulation of cases is necessary to determine whether this change is specific to hypoparathyroidism.
American Journal of Medical Case Reports. 2021, 9(8), 386-388. DOI: 10.12691/ajmcr-9-8-1
Pub. Date: April 23, 2021
2533 Views6 Downloads