by Alessandra Giuliano, Francesca Mandreucci, Alida Benfante, Maria Noemi Cicero, Gabriele Seminara, Nicola Scichilone, Antonio Carroccio, Erica Maria Bruno, Daniele Castellucci, Marta Chiavetta, Stella Compagnoni, Noemi Monachino, Giulia Teresi, Giuseppe Martorana and Simonetta Maisano
Case Report
Chronic eosinophilic pneumonia is a rare idiopathic form of pneumonia. A differential diagnosis is crucial to distinguish idiopathic from secondary forms and it requires clinical, laboratory and imaging investigations. In this case report we present a case of Chronic eosinophilic pneumonia and discuss differential diagnosis in a patient with a history of uncontrolled chronic asthma and moderate peripheral eosinophilia. Benralizumab, an anti-Interleukin-5 receptor drug, was administered to our patient, who remained asymptomatic throughout a ten-month follow-up. Further studies are essential to confirm the favorable effect of this novel therapy for Chronic eosinophilic pneumonia.
American Journal of Medical Case Reports. 2021, 9(9), 482-484. DOI: 10.12691/ajmcr-9-9-10
Pub. Date: May 31, 2021
3778 Views4 Downloads
by Mada Hamwi, Sufyan Abdul Mujeeb, Christopher Kang and Abdallah Hamdallah
Case Report
Tolosa-Hunt syndrome (THS) is a rare inflammatory disorder of unknown etiology with an incidence of one case per million each year. The syndrome is characterized by painful diplopia due to cranial nerve III, IV, or VI palsy. No specific risk factors have been reported, however, in some cases it has been associated with a recent upper respiratory tract infection. THS usually responds well to steroids and they remain the mainstay of treatment. Here, we report a case of a young Hispanic male with no previous health conditions presenting with ophthalmoplegia and retro-orbital pain. After excluding other etiologies of his presentation, a final diagnosis of THS was made. He initially responded well to a course of high-dose steroids, however, he later developed recurrent symptoms and worsening Magnetic resonance imaging (MRI) findings for which he needed an extended course of steroids.
American Journal of Medical Case Reports. 2021, 9(9), 479-481. DOI: 10.12691/ajmcr-9-9-9
Pub. Date: May 30, 2021
2179 Views10 Downloads
by Pramod Theetha Kariyanna, Bayu Sutarjono, Naga Pranavi Ellanti, Apoorva Jayarangaiah, Amog Jayarangaiah, Sushruth Das, Harshith Priyan Chandrakumar and Isabel M. McFarlane
Review Article
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. 5 species of Gemella were identified. Typical patient affected were male 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. 1 in 4 reported a history of congenital heart disease, and a recent oral infection. 1 in 2 patients underwent surgical procedure. Laboratory tests revealed anemia, leukocytosis, and elevated erythrocyte sedimentation in all age groups, as well as elevated C-reactive protein in 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 therapy of at least 6 weeks resulted in superior clinical improvements than durations under 6 weeks. Finally, 1 in 2 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(9), 467-478. DOI: 10.12691/ajmcr-9-9-8
Pub. Date: May 25, 2021
2615 Views8 Downloads
by Arisa Takada, Kei Jitsuiki, Ken-ichi Muramatsu and Youichi Yanagawa
Case Report
This is a case of fatal fulminant Legionella pneumonia in which the chest computed tomography findings had been negative the previous day. A repeated examination may be necessary to detect new lesions in the lung fields and obtain clues for a correct diagnosis of patients with a compromised status.
American Journal of Medical Case Reports. 2021, 9(9), 464-466. DOI: 10.12691/ajmcr-9-9-7
Pub. Date: May 23, 2021
2231 Views6 Downloads
by Eman EL-Sawalhy, Marwa Sokrab, Paige Spagna, Mohammad Arman, Said Hafez-Khayyata, Victoria Badia and Shahina Patel
Case Report
Primary malignant melanoma of the esophagus (PMME) is a very rare and highly aggressive tumor, representing <1% of esophageal malignancies. We are reporting a case of PMME in a 54-year-old White, Non-Hispanic male, who presented to the hospital with dysphagia and weight loss. Computed tomography (CT) of the chest revealed a large mid-to-distal esophageal mass with mass effect on adjacent structures, with no evidence of invasion. The patient subsequently underwent esophagogastroduodenoscopy (EGD) with guided biopsy of the esophageal mass. Histopathology and immunohistochemistry of the biopsied specimen were performed and consistent with malignant melanoma. Tumor staging by positron emission tomography and computed tomography (PET/CT) scans revealed extensive, locally advanced disease with lymph node involvement. Subsequently, esophageal ultrasound (EUS) with biopsy of the involved lymph node was performed and was positive for malignant melanoma. The mass was deemed unresectable due to the extensive degree of locally advanced disease. To assist in our therapeutic decision making, the patient was screened for the presence of a BRAF V600 mutation. He was then started on a combination of the BRAF inhibitor (dabrafenib) in combination with the mitogen-activated extracellular kinase (MEK) Inhibitor (trametinib) given the presence of a BRAF V600 mutation.
American Journal of Medical Case Reports. 2021, 9(9), 460-463. DOI: 10.12691/ajmcr-9-9-6
Pub. Date: May 23, 2021
2656 Views5 Downloads
by Ryan Lee, Whitney Liehr and Candice Lovelace
Original Research
Relatively few cases have been reported of electrocardiographic findings associated with pneumothoraces. This case report seeks to add to the literature regarding the transient ECG findings associated with a right-sided tension pneumothorax. Based on our extensive review, these findings have not been previously documented. Our patient was found to have a right-sided tension pneumothorax after intubation for acute hypoxic respiratory failure secondary to COVID-19 pneumonia. A 12-lead ECG revealed an accelerated junctional rhythm, left axis-deviation, and ST depressions in the anterolateral leads. All of these abnormalities resolved on repeat ECG two hours later after insertion of a chest tube. Based on these findings, we propose a possible mechanism explaining these ECG findings. Although not all pneumothoraces present with ECG findings, this case demonstrates that physicians must be aware of these changes, particularly because they may present as a mimicker of myocardial infarction.
American Journal of Medical Case Reports. 2021, 9(9), 456-459. DOI: 10.12691/ajmcr-9-9-5
Pub. Date: May 20, 2021
2529 Views3 Downloads
by Vikram Sumbly, Raheel Siddiqui, Mohsen Alshamam, Tamara Kurbanova and Vincent Rizzo
Case Report
Aplastic anemia (AA) is a potentially life-threatening acquired bone marrow failure syndrome which leads to central pancytopenia. Although the exact pathogenesis of this disorder is yet to be fully understood, it is thought to be primarily caused by auto-immunity. Unlike other viruses, the association between SARS CoV-2 and AA remains insufficiently explored in current literature. Based on the few cases of COVID-19-induced central pancytopenia and the available literature on virus-induced AA, we propose that the development of AA in COVID-19 patients may be attributable to SARS CoV-2. We report the case of a 29-year-old female that developed AA after being hospitalized for COVID-19. She had a favorable clinical outcome after several courses of immunosuppressive therapy.
American Journal of Medical Case Reports. 2021, 9(9), 451-455. DOI: 10.12691/ajmcr-9-9-4
Pub. Date: May 20, 2021
4354 Views7 Downloads
by David Polman, Michael Freilich and Isabel M. McFarlane
Literature Review
Cardiovascular syphilis is a manifestation of tertiary syphilis, and is one that can have many complications, including syphilitic aortitis. In this review article, we review the epidemiology and pathophysiology of syphilitic aortitis and focus in on one of its complication, coronary ostial stenosis. Next, we will discuss the diagnosis and treatment options for both cardiovascular syphilis as well as coronary ostial stenosis. Finally, we present the findings of case reports in patients who had syphilitic aortitis with coronary ostial stenosis and their outcomes.
American Journal of Medical Case Reports. 2021, 9(9), 445-450. DOI: 10.12691/ajmcr-9-9-3
Pub. Date: May 19, 2021
2338 Views5 Downloads
by Ismail Malik, Ibrahim Omore, Kesiena Akpoigbe, Abimbola Fadairo-Azinge and Luqman Salahudeen
Case Report
Hepatocellular cancer (HCC) is known to be among one of the commonest primary liver tumors globally with rising incidence and it is often implicated as a frequent cause of cancer-related death. It usually carries a poor prognosis because it is not often diagnosed early until the advanced stages of the disease with distant metastatic spread, vascular invasion, and thrombus formation. The pathophysiologic evolution of HCC is complicated involving prolonged inflammatory damage with sequelae of hepatocyte necrosis, regeneration, and fibrosis. Involvement of the vasculature portends a dismal outcome (less than 6 month survival) although inferior vena cava (IVC) tumor thrombus occur far less commonly than portal and hepatic veins. This can present a significant challenge in patient management despite advances in diagnostic and therapeutic modalities, due to late clinical presentation and lack of consensus regarding treatment. We report a 71-year old man who presented with syncope with incidental finding of large hepatocellular cancer with IVC thrombosis. Following extensive workup, the patient was ineligible for surgical intervention and was referred for chemoembolization with possible immunotherapy. This case highlights vigilance for occult malignant processes in patients that may present atypically.
American Journal of Medical Case Reports. 2021, 9(9), 441-444. DOI: 10.12691/ajmcr-9-9-2
Pub. Date: May 17, 2021
2551 Views6 Downloads
by Komal Ejaz, Mousa Thalji, Muhammad Ali Raza and Hassan Awais
Case Report
Amyopathic dermatomyositis (AMD) is a subtype of dermatomyositis characterized by more prominent involvement of the skin rather than muscle and often positive for melanoma differentiation-associated gene 5 (MDA-5) antibodies. The most frequent pulmonary involvement in MDA-5 positive AMD is nonspecific interstitial pneumonia. However, rare cases of pulmonary alveolar proteinosis (PAP) have also been reported. Here, we present a case of a 28-year-old male who was recently diagnosed with AMD presenting with shortness of breath and dry cough was eventually diagnosed with secondary pulmonary alveolar proteinosis. This case underscores the multidisciplinary approach and diagnostic challenges associated with the diagnosis of PAP secondary to the rarity of the condition.
American Journal of Medical Case Reports. 2021, 9(9), 438-440. DOI: 10.12691/ajmcr-9-9-1
Pub. Date: May 17, 2021
2290 Views4 Downloads