scholarly journals Tuberculous Pyomyositis: A Rare but Serious Diagnosis

2013 ◽  
Vol 2013 ◽  
pp. 1-4 ◽  
Author(s):  
Vikram Krishnasamy ◽  
Matthew Joseph
Keyword(s):  
Lower Extremity ◽  
Poor Prognosis ◽  
Multiorgan Failure ◽  
Laboratory Data ◽  
The United States ◽  
Past Medical History ◽  
Blood Cell Count ◽  
Large Area ◽  
Left Lower Extremity ◽  
History Of

Tuberculous pyomyositis is a rare clinical entity with serious consequences if a diagnosis is not established early. A 53-year-old female with a past medical history of sarcoidosis and pulmonary fibrosis presented from an outside hospital with persistent fevers and a rash. She had been hospitalized multiple times at an outside hospital without any improvement in her symptoms. On examination, she was noted to have a large area of left upper lower extremity (LUE) tenderness with superimposed erythema. Laboratory data revealed a white blood cell count of 22,300. Computed tomography (CT) scans of the LUE, chest, and left lower extremity (LLE) showed multiple intramuscular abscesses in those regions without evidence of osteomyelitis. Subsequent drainage of the abscesses and resulting cultures revealedMycobacterium tuberculosis. The patient was started on therapy with rifampin, isoniazid, pyrazinamide, and ethambutol. However, the patient developed hepatitis on these agents and subsequently went into septic shock with multiorgan failure. Care was eventually withdrawn as a result of a poor prognosis. This case illustrates the severe consequences of TB pyomyositis if not diagnosed promptly. While tuberculosis is uncommon in the United States, it should be an important consideration in the differential diagnosis of immunocompromised patients.

scholarly journals Shigella sonneiBacteremia Presenting with Profound Hepatic Dysfunction

2017 ◽  
Vol 2017 ◽  
pp. 1-5 ◽  
Author(s):  
Oluwaseun Shogbesan ◽  
Andrew Rettew ◽  
Bilal Shaikh ◽  
Abdullateef Abdulkareem ◽  
Anthony Donato
Keyword(s):  
Laboratory Data ◽  
Abdominal Ultrasound ◽  
The United States ◽  
Shigella Sonnei ◽  
Public Health Issue ◽  
Watery Stool ◽  
Normal Limits ◽  
Significant Public Health ◽  
History Of

Worldwide, Shigellosis is a significant public health issue, associated with nearly one million deaths annually. About half a million cases ofShigellainfection are reported annually in the United States.Shigellabacteremia is uncommon and generally seen in children and immunocompromised adults. We present a case of aShigella sonneibacteremia with marked hepatic derangement in a 27-year-old previously healthy homosexual male with history of Roux-en-Y gastric bypass, who presented to the emergency room with a 4-day history of loose watery stool, abdominal cramps, nausea and vomiting, and yellow skin of 2-day duration. He reports similar diarrhea illness in two close contacts in preceding days. On examination, he was fully oriented but dehydrated, icteric, and febrile. Laboratory data revealed WBC of 2200/μL, elevated AST and ALT (201 IU/L, 73 IU/L resp.), normal alkaline phosphatase, elevated total and direct bilirubin of 8.2 mg/dL and 4.4 mg/dL, albumin of 3.2 g/dL, INR of 2.9, prothrombin time of 31.7, and platelet of 96,000/μL. Workup for infectious, autoimmune and medication-induced hepatitis, Wilson’s disease, and hemochromatosis was negative. Abdominal ultrasound and computed tomography of the abdomen showed hepatic steatosis and right-sided colitis. Stool and blood cultures were positive forShigella sonnei. He was treated with ciprofloxacin with improvement in liver function. Follow-up blood test 4 months later was within normal limits.

scholarly journals A Possible Association of Diindolylmethane with Pulmonary Embolism and Deep Venous Thrombosis

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Peter V. Bui ◽  
Maan Moualla ◽  
Dona J. Upson
Keyword(s):  
Pulmonary Embolism ◽  
Venous Thromboembolism ◽  
Lower Extremity ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Single Case ◽  
The United States ◽  
Middle Lobe ◽  
History Of ◽  
Right Middle Lobe

Introduction.3,3′-Diindolylmethane is available as a supplement in the United States for “cancer prevention” and “augmentation of physical fitness.” A derivative of indole-3-carbinol found in plants, diindolylmethane, binds to receptors associated with the sex steroid pathways and has unclear effects on estrogen and androgen physiology. We present a patient who had been taking diindolylmethane and developed right lower extremity deep venous thrombosis and bilateral pulmonary embolism.Case Presentation.A 65-year-old man presented with swelling, erythema, and warmth of his right lower extremity for three to four weeks. He had been taking diindolylmethane one tablet daily for three to four months. Risk factors for venous thromboembolism included tobacco use, personal history of possible pulmonary embolism, body mass index, and age. Imaging studies found extensive deep venous thrombosis in his right lower extremity and bilateral pulmonary embolism with probable right middle lobe infarction. Follow-up imaging showed chronic deep venous thrombosis in his right lower extremity.Discussion.As suggested in this single case, patients who take diindolylmethane may be at greater risk for venous thromboembolism. Further reports and studies are necessary in order to elucidate this possible association. Clinicians should question patients about supplements in the setting of venous thromboembolism.

scholarly journals Is Footedness Driving Right Lower Extremity Arthroplasty Becoming Commoner Than Left Lower Extremity Arthroplasty?

2021 ◽  
Author(s):  
Deepak Gupta
Keyword(s):  
Lower Extremity ◽  
Automatic Transmission ◽  
Revision Arthroplasty ◽  
The United States ◽  
Left Lower Extremity ◽  
Institutional Review ◽  
Number Of Patients ◽  
Wear And Tear ◽  
Primary Hip Arthroplasty ◽  
Set Up

The question arises whether footedness transforms into asymmetrical incidence of wear and tear within lower extremity joints. After obtaining institutional review board approval for exempt research, the author manually counted the number of patients who underwent right or left or bilateral, hip or knee, primary or revision arthroplasty over a five-year period (2016-2020) at a university-affiliated hospital in the United States. Overall, right lower extremity arthroplasty was significantly commoner than left lower extremity arthroplasty (P=0.002). Individually, only right primary hip arthroplasty (P=0.033) and right revision knee arthroplasty (P=0.041) were significantly commoner procedures than their left counterparts. These results should set up the stage for future investigations into footedness retrospectively and prospectively to rule out if commoner right footedness in itself is driving this asymmetrical incidence of lower extremity arthroplasty or whether automatic transmission vehicular driving is independently contributing to this asymmetrical incidence.

scholarly journals October 2021 Critical Care Case of the Month: Unexpected Post-Operative Shock

2021 ◽  
Vol 23 (4) ◽  
pp. 93-97
Author(s):  
Sharanyah Srinivasan ◽  
◽  
Sooraj Kumar ◽  
Benjamin Jarrett ◽  
Janet Campion
Keyword(s):  
Lower Extremity ◽  
Pulseless Electrical Activity ◽  
Spontaneous Circulation ◽  
Intravenous Drug Use ◽  
Past Medical History ◽  
Incision And Drainage ◽  
Lower Extremity Wound ◽  
History Of ◽  
The Right ◽  
Operative Assessment

No abstract available. Article truncated after 150 words. History of Present Illness: A 55-year-old man with a past medical history significant for endocarditis secondary to intravenous drug use, osteomyelitis of the right lower extremity was admitted for ankle debridement. Pre-operative assessment revealed no acute illness complaints and no significant findings on physical examination except for the ongoing right lower extremity wound. He did well during the approximate one-hour “incision and drainage of the right lower extremity wound”, but became severely hypotensive just after the removal of the tourniquet placed on his right lower extremity. Soon thereafter he experienced pulseless electrical activity (PEA) cardiac arrest and was intubated with return of spontaneous circulation being achieved rapidly after the addition of vasopressors. He remained intubated and on pressors when transferred to the intensive care unit for further management. PMH, PSH, SH, and FH: • S/P Right lower extremity incision and drainage for suspected osteomyelitis as above • Distant history of endocarditis related …

scholarly journals Interleukin-8 Producing Hepatocellular Carcinoma with Pyrexia

HPB Surgery ◽  
2009 ◽  
Vol 2009 ◽  
pp. 1-5 ◽  
Author(s):  
Norifumi Harimoto ◽  
Ken Shirabe ◽  
Tomoyuki Abe ◽  
Kiyoshi Kajiyama ◽  
Takashi Nagaie ◽  
...  
Keyword(s):  
Proinflammatory Cytokine ◽  
Preoperative Diagnosis ◽  
Poor Prognosis ◽  
Tumor Thrombus ◽  
Laboratory Data ◽  
Chief Complaint ◽  
Interleukin 8 ◽  
Immunohistochemical Stain ◽  
History Of ◽  
Poorly Differentiated

We discuss a patient who had poorly differentiated HCC with pyrexia and high CRP in laboratory data, which are not commonly observed in the usual HCC. A 50-year-old man with a history of liver dysfunction was admitted with a chief complaint of a prolonged fever and general fatigue. Preoperative diagnosis was HCC with portal vein tumor thrombus. Posterior segmentectomy of the liver and thrombectomy was performed. Rapid tumor recurrence occurred after surgery, and he died 79 days after the operation. Immunohistochemical stain of HCC in this patient revealed the production of proinflammatory cytokine, interleukin-8 (IL-8). IL-8 production may have contributed to the high fever, high inflammatory reaction, and poor prognosis in this case.

scholarly journals Lower Extremity Musculoskeletal Injury in US Military Academy Cadet Basic Training: A Survival Analysis Evaluating Sex, History of Injury, and Body Mass Index

2021 ◽  
Vol 9 (10) ◽  
pp. 232596712110398
Author(s):  
Darren W. Hearn ◽  
Zachary Y. Kerr ◽  
Erik A. Wikstrom ◽  
Donald L. Goss ◽  
Kenneth L. Cameron ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Lower Extremity ◽  
Body Mass ◽  
The United States ◽  
Musculoskeletal Injury ◽  
Injury Incidence ◽  
Basic Training ◽  
Military Academy ◽  
Survival Curves ◽  
History Of

Background: Injury incidence for physically active populations with a high volume of physical load can exceed 79%. There is little existing research focused on timing of injury and how that timing differs based on certain risk factors. Purpose/Hypothesis: The purpose of this study was to report both the incidence and timing of lower extremity injuries during cadet basic training. We hypothesized that women, those with a history of injury, and those in underweight and obese body mass index (BMI) categories would sustain lower extremity musculoskeletal injury earlier in the training period than men, those without injury history, and those in the normal-weight BMI category. Study Design: Cohort study; Level of evidence, 2. Methods: Cadets from the class of 2022, arriving in 2018, served as the study population. Baseline information on sex and injury history was collected via questionnaire, and BMI was calculated from height and weight taken during week 1 at the United States Military Academy. Categories were underweight (BMI <20), middleweight (20-29.99), and obese (≥30). Injury surveillance was performed over the first 60 days of training via electronic medical record review and monitoring. Kaplan-Meier survival curves were used to estimate group differences in time to the first musculoskeletal injury. Cox proportional hazard regression was used to estimate hazard ratios (HRs). Results: A total of 595 cadets participated. The cohort was 76.8% male, with 29.9% reporting previous injury history and 93.3% having a BMI between 20 and 30. Overall, 16.3% of cadets (12.3% of male cadets and 29.7% of female cadets) experienced an injury during the follow-up period. Women experienced significantly greater incident injury than did men ( P < .001). Separation of survival curves comparing the sexes and injury history occurred at weeks 3 and 4, respectively. Hazards for first musculoskeletal injury were significantly greater for women versus men (HR, 2.63; 95% CI, 1.76-3.94) and for those who reported a history of injury versus no injury history (HR, 1.76; 95% CI, 1.18-2.64). No differences were observed between BMI categories. Conclusion: Female cadets and those reporting previous musculoskeletal injury demonstrated a greater hazard of musculoskeletal injury during cadet basic training. This study did not observe an association between BMI and injury.

scholarly journals Cauda equina syndrome caused by lumbar leptomeningeal metastases from lung adenocarcinoma mimicking a schwannoma

2020 ◽  
Vol 11 ◽  
pp. 225 ◽  
Author(s):  
Giovanni Federico Nicoletti ◽  
Giuseppe Emmanuele Umana ◽  
Francesca Graziano ◽  
Alessandro Calì ◽  
Marco Fricia ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Lung Adenocarcinoma ◽  
Lung Carcinoma ◽  
Cauda Equina ◽  
Leptomeningeal Metastases ◽  
Subtotal Resection ◽  
Left Lower Extremity ◽  
Metastatic Lung ◽  
History Of ◽  
Gamma Knife Stereotactic Radiosurgery

Background: Cauda equina syndromes (CESs) due to leptomeningeal metastases from primitive lung tumors are rare. Despite recent advancements in neuro-oncology and molecular biology, the prognosis for these patients remains poor. Here, we present a case in which a patient developed lumbar leptomeningeal metastases from lung carcinoma that contributed to a CES and reviewed the appropriate literature. Case Description: A 55-year-old female presented with the left lower extremity sciatica/weakness. Two years ago, a then 53-year-old female had received Gamma Knife stereotactic radiosurgery (SRS) for a cerebellopontine angle schwannoma. Recently, she underwent resection of lung carcinoma and SRS for a right hemispheric cerebellar metastasis. Now at age 55, she presented with the left lower extremity sciatica/weakness. When her new lumbar MR was interpreted as showing a L5 schwannoma, a L4-L5 laminectomy was performed at surgery, the authors encountered multifocal leptomeningeal metastases densely infiltrating the cauda equina. Although only subtotal resection/decompression of tumor was feasible, she did well for the ensuing year. The histological diagnosis confirmed the lesion to be a poorly differentiated lung adenocarcinoma. Conclusion: Patients with a history of prior metastatic lung cancer may present with spinal leptomeningeal metastases resulting in a CES.

scholarly journals Persistent cough and asthma-like symptoms post COVID-19 hospitalization in children

2021 ◽  
Author(s):  
hossein esmaeilzadeh ◽  
Anahita Sanaei Dashti ◽  
Negar Mortazavi ◽  
Fatemian Fatemian ◽  
Mohebat Vali
Keyword(s):  
Risk Factors ◽  
Allergic Rhinitis ◽  
Medical History ◽  
Laboratory Data ◽  
Previous History ◽  
Hospitalized Children ◽  
Past Medical History ◽  
Persistent Cough ◽  
History Of

Abstract Backgrounds: Respiratory viruses are the main triggers of asthma. Coronavirus is shown to contribute to infections of the respiratory tract that can lead to prolong cough and asthma. Objectives: Present study aimed to determine the risk of developing Persistent cough and asthma-like symptoms in hospitalized children due to COVID-19. Methods: This prospective study was carried out in a tertiary referral center. During the COVID-19 pandemic, 69 hospitalized pediatric patients admitted with COVID-19 were observed from February2020 to January 2021. Clinical and laboratory data were recorded, and after discharge, patients were followed and visited for cough and asthma evaluation in one, 2 and 6 months later. Patients with asthma-like diagnosis in follow up define as asthma-like group and patients without any sign of asthma categorized as the non-asthma group. Asthma-like co-morbids and risk factors were evaluated and compared between two groups. Results: Most of the COVID-19 hospitalized patients (N=42) (58.5%) were not affected by asthma-like symptoms in follow-up. 60.9% of the COVID-19 patients were male. The asthma-like group cases had a significantly familial history of asthma (63.0%), past medical history of asthma (33.3%), and Allergic rhinitis (85.2%). Rates of signs and symptoms during hospitalization were significantly higher in patients with COVID-19 and past medical history of asthma. Conclusions: We found an asthma-like prevalence of 41.5% in the cohort of COVID-19 hospitalized children. Family history of asthma and previous history of asthma and allergic rhinitis are risk factors for asthma-like after COVID-19 hospitalization. COVID-19 presentations are more severe in the asthma-like group.

scholarly journals A case of shiitake dermatitis in the United States

2021 ◽  
Vol 2021 (8) ◽  
Author(s):  
Jesus Gomez ◽  
Krishna Sharma ◽  
Albert Huho ◽  
Neal Gregory
Keyword(s):  
United States ◽  
Topical Steroid ◽  
The United States ◽  
Prior History ◽  
Past Medical History ◽  
Diagnostic Odyssey ◽  
Dermatology Clinic ◽  
Shiitake Mushrooms ◽  
History Of ◽  
Exposure History

ABSTRACT A 65-year-old male presented to our dermatology clinic with a two-day intensely pruritic rash covering his back. The lesions were predominantly on his chest, upper extremity, and back. He denied any prior history of similar rashes and his past medical history was non-contributory. A detailed exposure history revealed the patient had eaten Shiitake mushrooms for dinner 48 hours previously. Physical examination showed a truncal dominant rash. Close-up examination confirmed the papulovesicular nature of the rash with multiple small vesicles grouped both along the breadth and length of each linear streak on an erythematous background. Biopsies showed spongiosis with micro-vesiculation. Blood work showed a nominal CBC and CRP/ESR and serum IgE. The patient was put on topical steroid and the rash resolved in one week. With increasing mushroom consumption [1], cognizance of this etiology avoids a diagnostic ‘odyssey’ and prevents recurrence of this very characteristic rash.

scholarly journals Type a Aortic Dissection Presenting with Acute Lower Extremity Vascular Insufficiency in the Absence of Chest Pain

2012 ◽  
Vol 5 ◽  
pp. OJCS.S8042
Author(s):  
Thomas J. Earl ◽  
Athena Poppas
Keyword(s):  
Chest Pain ◽  
Aortic Dissection ◽  
Lower Extremity ◽  
Type A ◽  
Type A Aortic Dissection ◽  
Non Invasive ◽  
Left Lower Extremity ◽  
Vascular Insufficiency ◽  
History Of ◽  
Aortic Dissections

We report a case of a 53 year-old man with a history of hypertension presenting with acute left lower extremity parasthesias and pulselessness initially presumed to be secondary to arterial thrombosis or embolism. Work-up included a transthoracic echocardiogram which revealed an aortic dissection at the level of the aortic root extending to the visualized portions of the descending aorta. Type A aortic dissections are relatively rare, with the vast majority of patients presenting with chest pain. Timely diagnosis of Type A aortic dissections are critical as to facilitate rapid surgical repair. To our knowledge, this is the first report of a painless Type A aortic dissection presenting with isolated lower extremity vascular insufficiency and demonstrates the potential role of transthoracic echocardiography as a rapid, non-invasive bedside modality in visualizing Type A aortic dissections.

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