{"title":"Prolonged SARS-CoV-2 Viremia in an Immunocompromised Patient.","authors":"Mohammed Abdulrasak, Sohail Hootak","doi":"10.14740/jmc5064","DOIUrl":"https://doi.org/10.14740/jmc5064","url":null,"abstract":"<p><p>Immunocompromised patients, especially those receiving B-cell depleting therapies, are at risk for developing atypical presentation with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with the potential for diagnostic delay and adverse outcomes if such delay occurs. A 66-year-old female with history of granulomatosis with polyangiitis (GPA) with previous pulmonary involvement, treated with rituximab and low-dose prednisolone, presented with prolonged fever and cough after having been treated at home for a mild SARS-CoV-2 infection in early July 2023. The patient had a prolonged course over several months with constitutional symptoms such as fever, cough and malaise. During the investigation, which encompassed a wide range of microbiological and immunological tests, the patient was initially thought to have a flare of GPA which she was treated for without appreciable improvement, then for multiple microbiological organisms without appropriate resolution of the patient's symptoms. The differential diagnosis of prolonged SARS-CoV-2 infection was reconsidered in October 2023, and then confirmed by the presence of SARS-CoV-2 viremia through polymerase chain reaction (PCR) testing of the blood. The patient received a prolonged course of antiviral therapy with complete clinical, virological and radiological resolution. Prolonged SARS-CoV-2 infection with viremia in immunocompromised individuals needs to be considered on the differential diagnosis list in such patients presenting with constitutional symptoms, with PCR testing of the blood as a simple and effective way to establish the diagnosis.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"16 1","pages":"6-10"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699861/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142934358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Case of Autoimmune Neutropenia That Responded to Rituximab.","authors":"Justin Dejia Wang, Danielle Brazel, Emily Nagler","doi":"10.14740/jmc4306","DOIUrl":"10.14740/jmc4306","url":null,"abstract":"<p><p>Autoimmune neutropenia (AIN) refers to the immune-mediated destruction of neutrophils. It is a rare condition with an estimated prevalence of less than 1 case per 100,000 per year. Typical treatment involves supportive care with granulocyte colony-stimulating factor (G-CSF) and management of secondary infections with antibiotics. Other therapies targeted at the immune system such as steroids, intravenous immunoglobulin (IVIG), and rituximab have not been thoroughly evaluated, but recently rituximab has shown promising results in one case series. We present a 76-year-old man with the diagnosis of antineutrophil antibody-negative AIN and concurrent immune thrombocytopenic purpura (ITP), whose AIN was treated initially with G-CSF which had a short-lived effect, then treated with rituximab which induced a lasting remission. We then review this case in context of other cases described in the literature, given the paucity of available publications.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"15 12","pages":"396-400"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11602177/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rebecca L Shakour, Oriana Tascione, Nathan Carberry, Ramon Flores-Gonzalez
{"title":"Exploring Overlap Syndromes: An Atypical Case of Multiple Sclerosis With Anti-Sjogren's Syndrome Type B Antibody.","authors":"Rebecca L Shakour, Oriana Tascione, Nathan Carberry, Ramon Flores-Gonzalez","doi":"10.14740/jmc4336","DOIUrl":"10.14740/jmc4336","url":null,"abstract":"<p><p>Evaluating patients with symptoms suggestive of demyelinating disease such as multiple sclerosis (MS) is common in both the inpatient and outpatient setting but may be difficult if atypical neurological symptoms are present. In this case, a 39-year-old female presented with new onset weakness and paresthesias. The patient reported 3 weeks of progressively worsening left face and hemibody numbness, along with gait abnormality. She was found to have absent lower extremity reflexes, unexpected imaging findings, and a positive anti-Sjogren's syndrome type B (SSB) antibody despite lacking the typical sicca symptoms associated with Sjogren's syndrome (SS). This case report underscores the diagnostic complexity of overlapping MS and SS, highlighting the need for a comprehensive differential diagnosis when atypical neurological symptoms are present. It also emphasizes the importance of considering autoimmune overlap syndromes in such cases, as the co-occurrence of these conditions can significantly impact both diagnosis and treatment strategies, requiring a multidisciplinary approach for optimal patient care.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"15 12","pages":"387-395"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11602178/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shiva Kothari, Basim Ahmed Khan, Molly Nguyen, Sara H Gleason
{"title":"An Abnormal Case of Malignant Catatonia in a Previously Healthy Young Female With Unexplained Neurological Symptoms.","authors":"Shiva Kothari, Basim Ahmed Khan, Molly Nguyen, Sara H Gleason","doi":"10.14740/jmc4327","DOIUrl":"10.14740/jmc4327","url":null,"abstract":"<p><p>This is a case report of a previously healthy 26-year-old female with unexplained neurological symptoms that eventually developed malignant catatonia. Because malignant catatonia has a range of clinical manifestations, making prompt diagnosis a challenging task. Due to her relapsing symptoms, the patient was admitted to the inpatient psychiatric unit three times in less than 2 months, and eventually recovered with high doses of lorazepam and several electroconvulsive therapy (ECT) treatments after a stay in the intensive care unit (ICU). This case highlights the importance of avoiding of antipsychotics with dopamine blockade prior to administering a standardized catatonia rating scale in patients with negative symptoms, especially those who have unexplained neurological symptoms or vital sign abnormalities. It also emphasizes the importance of definitive decision-making in pursuing ECT treatment for patients with suspected malignant catatonia, as our patient showed remarkable improvement after ECT. Ultimately, more research is needed to study this rare illness to standardize procedures for treatment of malignant catatonia.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"15 12","pages":"382-386"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11602172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752687","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Daniela Pato Pais, Sara Andrade, Ines Bertao Colaco, Margarida Luis, Nuno Azenha, Ana Couceiro, Jose Valente Cecilio
{"title":"Gastric Schwannoma: A Rare Cause of Gastric Bleeding.","authors":"Daniela Pato Pais, Sara Andrade, Ines Bertao Colaco, Margarida Luis, Nuno Azenha, Ana Couceiro, Jose Valente Cecilio","doi":"10.14740/jmc4312","DOIUrl":"10.14740/jmc4312","url":null,"abstract":"<p><p>Gastric schwannomas and gastrointestinal stromal tumors (GISTs) are two types of mesenchymal tumors, which represent a group of rare tumors of the gastrointestinal tract. The differential diagnosis between these two tumors is difficult given their very similar appearance and clinical features. The authors present a case of a 63-year-old man with melena and epigastric pain. An upper digestive endoscopy was performed, revealing an ulcerated gastric subepithelial lesion suspected to be a GIST. Further imaging with a computed tomography (CT) scan revealed a well-defined hypodense solid nodular mass, with homogeneous enhancement, measuring 22 × 18 mm, on the anterior wall of the transition between the body and gastric antrum, situated within the submucosal layer. The patient subsequently underwent a laparoscopic atypical gastrectomy, which proceeded without complications. The pathological examination of the excised lesion confirmed it to be a gastric schwannoma, with complete excision. This case report illustrates a rare cause of gastrointestinal bleeding, that requires immediate action, and <i>en bloc</i> resection is usually curative. Given the excellent prognosis after complete resection, a correct diagnosis is essential.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"15 12","pages":"371-375"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11602179/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Khaled H Aburisheh, Hamza M K Enabi, Nora A Alodah, Bassam H Alotary, Linah A Algheryafi, Ayman M Almairi, Amani A Aldhewaila
{"title":"New Onset of Type 1 Diabetes Mellitus Post-COVID-19 Vaccine.","authors":"Khaled H Aburisheh, Hamza M K Enabi, Nora A Alodah, Bassam H Alotary, Linah A Algheryafi, Ayman M Almairi, Amani A Aldhewaila","doi":"10.14740/jmc4307","DOIUrl":"10.14740/jmc4307","url":null,"abstract":"<p><p>Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with an increased morbidity and mortality worldwide. Coronavirus disease 2019 (COVID-19) vaccines have shown high efficacy in preventing the infection but with many possible side effects such as hyperglycemia. New-onset diabetes mellitus (DM) and severe metabolic complications have been reported post-vaccination. Here we report a 45-year-old woman who came to the hospital complaining of polyurea, polydipsia, and weight loss 3 weeks after the first activation dose of COVID-19 vaccine. Her hemoglobin A1c (HbA1c) upon presentation was 9% without any prior history of DM. She was diagnosed with type 1 diabetes mellitus (T1DM), as the anti-glutamic acid decarboxylase (GAD) antibody was positive and complicated during follow-up with diabetic ketoacidosis (DKA). This is the first case in Saudi Arabia suggesting that the COVID-19 RNA-based vaccines might cause new onset of T1DM, complicated by late DKA.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"15 12","pages":"367-370"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11602176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sabrina Nguyen, Denzil Robinson, Alexander T Phan, Haroon Azhand, Dan Vo
{"title":"Mirtazapine-Induced Premature Ventricular and Atrial Contractions.","authors":"Sabrina Nguyen, Denzil Robinson, Alexander T Phan, Haroon Azhand, Dan Vo","doi":"10.14740/jmc4265","DOIUrl":"10.14740/jmc4265","url":null,"abstract":"<p><p>Mirtazapine, an alpha-2 adrenergic receptor, 5-hydroxytryptamine (5-HT)2, and 5-HT3 antagonist, is commonly used in patients for depression and anorexia. Its mechanism disinhibits serotonin and norepinephrine. Though typically a well-tolerated medication, a rare adverse effect is arrhythmia, including ventricular bigeminy. To date, no case report has cited normal dosing of mirtazapine as a cause of premature ventricular or premature atrial contractions. Only cases of mirtazapine overdose have been associated with arrhythmias, including QT prolongation and bradycardia. We report on a unique case of a 64-year-old female who developed sinus tachycardia with premature ventricular and atrial contractions after starting mirtazapine.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"15 12","pages":"376-381"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11602173/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Gastrointestinal Bleeding/Angiodysplasia in Patients With Glanzmann Thrombasthenia.","authors":"Raghad A Tarawah, Ahmad M Tarawah","doi":"10.14740/jmc4340","DOIUrl":"10.14740/jmc4340","url":null,"abstract":"<p><p>Glanzmann thrombasthenia (GT) is a common type of bleeding disorder, with a prevalence of 1/10,000 in Al Madinah, Saudi Arabia. GT causes bleeding owing to the lack of platelet aggregation associated with glycoprotein IIb/IIIa deficiency, which is characterized by mucocutaneous bleeding symptoms, such as epistaxis, gingival bleeding, and menorrhagia. Gastrointestinal angiodysplasia (GIAD) is a rare presentation of GT, where eight cases have been reported. GIAD is a vascular malformation of the digestive system caused by abnormal angiogenesis. Treatment of GIAD include surgical resection, electrocoagulation, embolization, and medical therapy with octreotide, thalidomide, and bevacizumab. GIAD has a high tendency to recur. We report the cases of eight patients of different ages who were diagnosed with GT and presented with gastrointestinal bleeding.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"15 12","pages":"401-405"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11602174/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mohammad Radwan, Basel Darawsha, Subhi Mansour, Safi Khuri
{"title":"Diffuse Type Pancreatic Ductal Adenocarcinoma: The Linitis Plastica Type of the Pancreas.","authors":"Mohammad Radwan, Basel Darawsha, Subhi Mansour, Safi Khuri","doi":"10.14740/jmc5062","DOIUrl":"10.14740/jmc5062","url":null,"abstract":"<p><p>Pancreatic malignant tumors are diverse and characterized by aggressive nature with high mortality rates. Pancreatic ductal adenocarcinoma (PDAC) is the most common type of pancreatic malignant tumors and accounts for approximately 90% of pancreatic malignancies. A subtype of PDAC, diffuse type PDAC (DTP), is a very rare and underreported tumor, known for its aggressive traits. Although little data are available about this tumor subtype characteristics, it usually presents with distinct features that are different from the known ones in PDAC. Herein, we present a case of a 61-year-old male patient, who presented with abdominal discomfort, weight loss and newly diagnosed diabetes mellitus. An abdominal computed tomography (CT) scan showed an ill-defined mass at the uncinate process with diffuse dilatation of the main pancreatic duct. Endoscopic ultrasound (EUS)-guided fine-needle biopsy showed cellular atypia suspicious for malignancy. The patient underwent total pancreatectomy with Roux-en-Y reconstruction. His postoperative course was uneventful. The final histopathological report showed well-differentiated diffuse ductal adenocarcinoma involving the pancreatic head, neck and body.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"15 12","pages":"406-410"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11602175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nithisha Thatikonda, Alexandru Lerint, Vijaya Valaparla, Chilvana Patel
{"title":"Rapid Resolution of Delayed Facial Palsy in Miller Fisher Syndrome With Steroid Therapy.","authors":"Nithisha Thatikonda, Alexandru Lerint, Vijaya Valaparla, Chilvana Patel","doi":"10.14740/jmc4305","DOIUrl":"10.14740/jmc4305","url":null,"abstract":"<p><p>Miller Fisher syndrome (MFS), a variant of Guillain-Barre syndrome (GBS), is characterized by the classic triad of ataxia, areflexia, and ophthalmoplegia. Approximately 20% of MFS patients experience facial weakness, with a subset developing delayed facial palsy (DFP) after other neurological symptoms have peaked or begun to improve. Initially, DFP was considered a natural progression of MFS, leading to recommendations against additional treatment. However, DFP persisted for more than 50 days without additional treatment in some patients, prompting additional steroid therapy, resulting in quicker resolution of DFP. We describe an MFS patient who presented with the classic triad of MFS and subsequently developed DFP. The patient was treated with methylprednisolone pulse therapy (1,000 mg/day for 3 days) followed by oral prednisolone (60 mg/day) with a gradual taper, resulting in rapid and complete resolution of DFP, suggesting an alternative mechanism behind DFP, opening avenues for further research and insights into this matter. MFS-DFP is rarely reported in the literature. In addition to this case, we aim to provide a comprehensive literature review on MFS-DFP, to further expand the existing knowledge on the current concepts of DFP-MFS.</p>","PeriodicalId":101328,"journal":{"name":"Journal of medical cases","volume":"15 11","pages":"341-346"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11483148/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}