scholarly journals Severe Rhabdomyolysis without Systemic Involvement: A Rare Case of Idiopathic Eosinophilic Polymyositis

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Ayesha Farooq ◽  
Vivek Choksi ◽  
Andrew Chu ◽  
Dhruti Mankodi ◽  
Sameer Shaharyar ◽  
...  
Keyword(s):  
High Dose ◽  
Peripheral Eosinophilia ◽  
Laboratory Findings ◽  
Case Presentation ◽  
Systemic Involvement ◽  
Systemic Corticosteroids ◽  
Muscle Tenderness ◽  
Common Causes ◽  
The Common ◽  
High Index Of Suspicion

Introduction. Eosinophilic polymyositis (EPM) is a rare cause of rhabdomyolysis characterized by eosinophilic infiltrates in the muscle. We describe the case of a young patient with eosinophilic polymyositis causing isolated severe rhabdomyolysis without systemic involvement.Case Presentation. A 22-year-old Haitian female with no past medical history presented with progressive generalized muscle aches without precipitating factors. Examination of the extremities revealed diffuse muscle tenderness. Laboratory findings demonstrated peripheral eosinophilia and high creatinine phosphokinase (CPK) and transaminase levels. Workup for the common causes of rhabdomyolysis were negative. Her CPK continued to rise to greater than 100,000 units/L so a muscle biopsy was performed which showed widespread eosinophilic infiltrate consistent with eosinophilic polymyositis. She was started on high dose systemic corticosteroids with improvement of her symptoms, eosinophilia, and CPK level.Discussion. This case illustrates a systematic workup of rhabdomyolysis in the presence of peripheral eosinophilia. Many differential diagnoses must be considered before establishing a diagnosis of idiopathic eosinophilic polymyositis. To our knowledge, our case of eosinophilic polymyositis is unique as it presented with severe rhabdomyolysis without another organ involvement. Clinicians should maintain a high index of suspicion for this physically debilitating disease to aid in prompt diagnosis.

scholarly journals Haemoptysis in a toddler: An uncommon presentation of unusual foreign body ingestion

2020 ◽  
pp. 102490792094405
Author(s):  
Sadesvaran Muniandy ◽  
Mohd Faiz Mohd Shukri ◽  
Nur Izzah Ghazali ◽  
Mohd Saiful Adli Ishak ◽  
Irfan Mohamad ◽  
...  
Keyword(s):  
Foreign Body ◽  
Foreign Body Ingestion ◽  
Case Presentation ◽  
Unusual Foreign Body ◽  
Uncommon Presentation ◽  
Common Causes ◽  
History Of ◽  
The Common ◽  
Tract Infections ◽  
High Index Of Suspicion

Introduction: Haemoptysis is uncommon in toddler. Lower respiratory tract infections and foreign body are among the common causes. Case Presentation: We are reporting a case of a child presented to emergency department with complaint of mild haemoptysis, whom was later found to have a piece of broken satay skewer at the tonsillar region. The foreign body was removed during the procedure without any complication. Discussion: Foreign body ingestion, particularly a piece of broken satay skewer, is difficult to suspect without a proper history and eyewitness. Therefore, parent’s supervision is important. Emergency residents should have a high index of suspicion of foreign body ingestion in a child with vague symptoms. Conclusion: Foreign body is among the commonest cause of haemoptysis in an afebrile toddler. Acute haemoptysis in otherwise healthy toddler should alert the emergency residents about foreign body ingestion. History of food intake should be more thorough even if trivial.

scholarly journals Early Intravenous Immunoglobulin as an Effective Drug for the Treatment of COVID-19: A Case Series and Case Review

2020 ◽  
Vol 15 (5) ◽  
Author(s):  
Rozita Khodashahi ◽  
Alireza Sedaghat ◽  
Mandana Khodashahi
Keyword(s):  
Public Health ◽  
Intravenous Immunoglobulin ◽  
Literature Search ◽  
Case Reports ◽  
Case Series ◽  
High Dose ◽  
Global Public Health ◽  
Case Review ◽  
Case Presentation ◽  
The Common

Introduction: The outbreak of coronavirus disease 2019 (COVID-19) should be considered a serious threat to global public health. Due to a large number of infected and dead people, the development of approaches to control the epidemic condition, as well as effective and available drugs, is very important. Case Presentation: In this study, we presented three cases with COVID-19 admitted to the Imam Reza Hospital. A high dose of intravenous immunoglobulin (IVIG) was used for patients as potent and safe treatment. Moreover, case reports and case series focusing on the patients with COVID-19 were reviewed in the present study. During the literature search, 27 patients with COVID-19 were identified in 14 studies. Fever, sore throat, dry cough, fatigue, chills, and muscle pain were the common primary complications of the patients. Kaletra, oseltamivir, ceftriaxone, hydroxychloroquine, azithromycin, and IVIG were the most prevalent drugs for the treatment of COVID-19. Conclusions: Except for the current study, IVIG was utilized in two other studies to treat patients with COVID-19, who did not respond to other therapies.

scholarly journals Lung Ultrasound in Early Diagnosis of Neonatal Ventilator Associated Pneumonia before Any Radiographic or Laboratory Changes

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
Mohammed Ibrahim ◽  
Ahmed Omran ◽  
Mostafa Ibrahim ◽  
Nouran Bioumy ◽  
Sonya El-Sharkawy
Keyword(s):  
Early Diagnosis ◽  
Lung Ultrasound ◽  
Ventilator Associated Pneumonia ◽  
Laboratory Findings ◽  
X Ray ◽  
Common Causes ◽  
Chest X Ray ◽  
The Common ◽  
Laboratory Changes ◽  
Radiographic Changes

Neonatal pneumonia is reported to be the primary cause of neonatal respiratory failure and one of the common causes of neonatal hospitalization and death in developing countries. Chest X-ray was considered the gold standard for diagnosis of neonatal pneumonia. Lung ultrasonography has been described as a valuable noninvasive tool for the diagnosis of many neonatal pulmonary diseases. We report a case of ventilation associated neonatal pneumonia with very early diagnosis using lung ultrasound before any significant radiographic changes in chest X-ray or laboratory findings suggestive of infection.

scholarly journals Postvaginal Delivery Caecal Volvulus and Perforation

2012 ◽  
Vol 2012 ◽  
pp. 1-2
Author(s):  
M. M. Abdullah Agha
Keyword(s):  
Intestinal Obstruction ◽  
Vaginal Delivery ◽  
Adverse Outcomes ◽  
High Index ◽  
Initial Presentation ◽  
Common Causes ◽  
The Common ◽  
High Index Of Suspicion ◽  
Caecal Perforation ◽  
Uncommon Complication

Intestinal obstruction is an uncommon complication of pregnancy and pueperium. It has different etiologies and voluvlus is one of the common causes. High index of suspicion is needed to diagnose it as initial presentation is nonspecific and that is critical to avoid adverse outcomes. We presented here one of these cases that followed vaginal delivery and ended with caecal perforation and hemicolectomy.

scholarly journals True Serum Sickness, Pearls for Clinical Diagnosis

2021 ◽  
Vol 5 (3) ◽  
pp. 311-315
Author(s):  
Jack Lee ◽  
Patrick Carr ◽  
Barrett Zlotoff ◽  
Darren Guffey
Keyword(s):  
Transplant Rejection ◽  
Serum Sickness ◽  
Direct Immunofluorescence ◽  
Drug Reactions ◽  
Laboratory Findings ◽  
Case Presentation ◽  
Common Causes ◽  
Clinical Triad ◽  
Systemic Symptoms ◽  
Type 3

Background: True serum sickness is a type 3 hypersensitivity reaction against foreign antibodies, resulting in vasculitis and an acute clinical presentation. Historically reported with anti-venin, currently anti-thymocyte globulin in the context of transplant rejection prophylaxis remains one of the most common causes. The classic clinical triad of fevers, arthralgias, and rash is not consistently present, and the rash is often difficult to distinguish from typical drug reactions. However, certain unique findings can assist with diagnosis. Case Presentation: We present a case of true serum sickness secondary to anti-thymocyte globulin featuring key exam and laboratory findings that enabled differentiation from other possible overlapping clinical entities, particularly drug reactions. Conclusions: Marked temporomandibular jaw pain is an important early clue to the diagnosis. Linear serpiginous erythema along the plantar margin may be a specific feature when rash is present. To our knowledge, neither have been reported in similar clinical entities including serum-sickness-like reaction. Serum complement levels and direct immunofluorescence (if skin biopsy done) are useful for distinguishing true serum sickness from primary differentials serum sickness-like reaction and drug rash with eosinophilia and systemic symptoms.

scholarly journals Endogenous Fusarium Endophthalmitis in Diabetes Mellitus

2016 ◽  
Vol 2016 ◽  
pp. 1-4 ◽  
Author(s):  
S. Balamurugan ◽  
Ashish Khodifad
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factor ◽  
Endogenous Endophthalmitis ◽  
Uncontrolled Diabetes ◽  
Common Causes ◽  
Masquerade Syndrome ◽  
The Common ◽  
Immunocompromised State ◽  
Poor Outcomes ◽  
High Index Of Suspicion

Endogenous endophthalmitis accounts for 2% to 8% of cases of endophthalmitis. Immunocompromised state and intravenous drug use are the 2 most common causes of endogenous endophthalmitis due to molds fungi. Aspergillus, Fusarium, and Scedosporium are the common organisms in mold endophthalmitis. We report a case of Fusarium endophthalmitis in a patient with uncontrolled diabetes. While diabetes mellitus is a well-known risk factor for endogenous endophthalmitis, we did not find any reported case of Fusarium endophthalmitis in a case of diabetes mellitus. The patient presented with granulomatous uveitis masquerading as noninfectious uveitis with a very good response to steroids. The characteristic clinical features were established late in the clinical course associated with poor outcome. This case highlights the significance of uncontrolled diabetes as a risk factor for Fusarium endophthalmitis and also the presentation of endophthalmitis as a masquerade syndrome. The clinician should have high index of suspicion as these cases have poor outcomes.

scholarly journals Disseminated Mycobacterium Sepsis with Bone Marrow, Liver, and Lung Involvement Following Intravesical Bacillus Calmette-Guerin (BCG) Therapy

2019 ◽  
Vol 14 (2) ◽  
pp. 34-37
Author(s):  
Drew Hager ◽  
Zeenib Kohja ◽  
Terry Wuerz ◽  
Arjuna Ponnampalam
Keyword(s):  
Bone Marrow ◽  
High Dose ◽  
Case Presentation ◽  
First Line Therapy ◽  
Elevated Liver Enzymes ◽  
Bcg Therapy ◽  
Intravesical Bcg ◽  
History Of ◽  
Muscle Invasive ◽  
High Index Of Suspicion

Introduction: BCG therapy is first line therapy for high grade non-muscle invasive bladder cancer (NMIBC).Case Presentation: A 54-year-old male presented with fevers, rigors and hematuria one week following intravesical BCG administration for treatment of NMIBC. He developed fever, pancytopenia, elevated liver enzymes and pulmonary infiltrates with progression of symptoms despite broad spectrum antimicrobial therapy. A bone marrow biopsy showed granulomatous infiltration; cultures of urine demonstrated growth of Mycobacterium bovis. A diagnosis of disseminated BCG infection secondary to intravesical administration was made; rifampin, isoniazid, ethambutol, and high dose prednisone were initiated.Conclusion: Adverse events associated with BCG administration have been attributed to both the primary mycobacterium infection and to hypersensitivity reactions. Timely collection of histopathology can lead to early treatment of disseminated BCG with good outcomes. Internists should have a high index of suspicion for patients presenting with organ dysfunction with an immediate or remote history of intravesical BCG administration.

scholarly journals Scleromyxedema in a 21 year old female patient with acute lymphoblastic leukemia: a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Hadi Rabee ◽  
Leeda Tayem ◽  
Mohammad Gharbeyah ◽  
Dina Abugaber
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Female Patient ◽  
Lymphoblastic Leukemia ◽  
Skin Lesions ◽  
High Dose ◽  
Lower Abdomen ◽  
Case Presentation ◽  
Systemic Manifestations ◽  
High Index Of Suspicion ◽  
Lichen Myxedematosus

Abstract Background Scleromyxedema is a rare, para-neoplastic, chronic, progressive condition of the Lichen myxedematosus (LM) family. The clinical picture consists of generalized confluent papular eruptions with possible systemic manifestations, which may be fatal as it still constitutes a therapeutic dilemma. Histologically, it is characterized by dermal mucin deposition, fibroblast proliferation with fibrosis, with monoclonal gammopathy in the absence of thyroid disease. Some atypical forms of the disease were reported in the literature, but none were reported in acute leukemia. Case presentation Herein, we report a case of a 21 years old female patient, known case of acute lymphoblastic leukemia (ALL), who developed numerous hyper-pigmented erythematous papules and plaques, mainly over her thighs, lower abdomen, and sub-mammary flexures. Histopathology of skin lesions confirmed the diagnosis of atypical scleromyxedema. Her symptoms significantly improved with the use of high dose intravenous immunoglobulin (IVIG). Conclusions Despite that scleromyxedema is associated with many hematologic disorders, it is very rarely associated with acute lymphoblastic leukemia, and a high index of suspicion is needed for diagnosis. IVIG remains a reasonable management of such a disabling disease.

scholarly journals A rare cause of complete airway obstruction caused by a defective pilot tube of a reinforced endotracheal tube

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Rathna Paramaswamy
Keyword(s):  
Airway Obstruction ◽  
Endotracheal Tube ◽  
Critical Incident ◽  
Tension Pneumothorax ◽  
Case Presentation ◽  
Tube Obstruction ◽  
Pilot Balloon ◽  
Common Causes ◽  
The Common ◽  
Tracheal Cuff

Abstract Background The common causes of failure to inflate the lungs after placement of an endotracheal tube include mechanical obstruction of the tube by tight gauzes, tongue blade, tube kinking, patient biting on the tube, obstruction of the lumen by blood or foreign body, bronchospasm, haemothorax, tension pneumothorax or equipment malfunction. Case presentation We report a case of complete airway obstruction due to herniation of the pilot inflation line into the lumen at the proximal end of a reinforced tube when the tracheal cuff was inflated. Prior to use, the endotracheal tube was tested and functioned normally. The patient was uneventfully reintubated with a new endotracheal tube. With the endotracheal tube, device problems often involve the pilot balloon and cuff assembly and leaks are more common. Conclusion This case report highlights an unusual cause of complete proximal lumen obstruction due to a manufacturing defect which could have caused a critical incident in the theatre.

scholarly journals Juvenile systemic lupus erythematosus presenting as pancarditis

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
D. O’Leary ◽  
C. O’Connor ◽  
L. Nertney ◽  
E. J. MacDermott ◽  
D. Mullane ◽  
...  
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Lupus Erythematosus ◽  
Rare Complication ◽  
Disease Onset ◽  
Systemic Lupus ◽  
Case Presentation ◽  
Systemic Corticosteroids ◽  
High Index Of Suspicion ◽  
Chronic Autoimmune Disease ◽  
Caucasian Female

Abstract Background Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with marked variation in its clinical presentation. Juvenile SLE (jSLE) accounts for 15–20% of all cases and is diagnosed when SLE manifests before 18 years of age. Pancarditis is a rare complication of SLE, regardless of age of disease onset. Case presentation We report a case of jSLE in a 15 year old Caucasian female presenting with an acute episode of pancarditis and multiorgan dysfunction who was successfully treated with systemic corticosteroids and cyclophosphamide. Conclusion Pancarditis can be a presenting feature of jSLE which was previously unreported. A high index of suspicion for severe cardiac involvement is required at all stages of disease.

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