Case Reports in Medicine最新文献

{"title":"Pseudo-Thrombotic Microangiopathy Secondary to Vitamin B12 Deficiency.","authors":"Dylan Morrissey,&nbsp;Yuheng Sun,&nbsp;Sarina Koilpillai,&nbsp;Jacqueline Kropf,&nbsp;Steve J Carlan","doi":"10.1155/2022/7306070","DOIUrl":"https://doi.org/10.1155/2022/7306070","url":null,"abstract":"<p><strong>Background: </strong>Clinical B₁₂ deficiency with hematological or neurological manifestations is rare. An unusual manifestation of B₁₂ deficiency is pseudo-thrombotic microangiopathy (TMA), which is characterized by hemolytic anemia, thrombocytopenia, and schistocytosis and only occurs in 2.5% of those with B₁₂ deficiency. Pseudo-TMA is misdiagnosed as thrombotic thrombocytopenic purpura (TTP) in 40% of cases, resulting in misguided treatment including plasmapheresis.</p><p><strong>Case: </strong>A 44-year-old Hispanic presented with 3 weeks of progressively worsening non-radiating chest pain, fatigue, and shortness of breath (SOB). Laboratory findings revealed severe pancytopenia and macrocytosis with a hemoglobin of 5.4 g/dL, mean corpuscular volume of 116.3 fL, and vitamin B₁₂ low at 149 pg/mL. She was diagnosed with pseudo-TMA and after starting 1000 micrograms of parenteral vitamin B₁₂ injections daily and discontinuing plasmapheresis and steroid administration, she improved.</p><p><strong>Conclusion: </strong>Failure to recognize pseudo-TMA often results in unnecessary treatment with plasmapheresis and delays appropriate treatment with vitamin B₁₂ supplementation. It is therefore extremely important to consider pseudo-TMA as a differential diagnosis in patients that present with hemolytic anemia, thrombocytopenia, and schistocytosis.</p>","PeriodicalId":9627,"journal":{"name":"Case Reports in Medicine","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9464104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33464844","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":"Guillain-Barré Syndrome Associated with COVID-19: Two Cases from a Public Hospital in Damascus, Syria.","authors":"Tagrid Ahmad,&nbsp;Somar Hamdan,&nbsp;Imad Saadeh","doi":"10.1155/2022/9722736","DOIUrl":"https://doi.org/10.1155/2022/9722736","url":null,"abstract":"<p><strong>Objective: </strong>To report two cases of COVID-19 complicated with Guillain-Barré syndrome (GBS) from a public hospital in Damascus, Syria.</p><p><strong>Results: </strong>Two unvaccinated patients, 49-year-old and 34-year-old men, presented with a history of paresthesia followed by ascending symmetric weakness with absent tendon reflexes. They were diagnosed with coronavirus disease 2019 (COVID-19) using chest CT and RT-PCR. Clinical status and lumbar puncture (LP) findings were consistent with GBS. They were treated with plasma exchange (PE). However, the first patient developed hallucinations and later deteriorated. He passed away after the second session of PE, while the second patient had four sessions of plasma exchange and was later discharged for home rehabilitation.</p><p><strong>Conclusion: </strong>It is important to consider GBS in COVID-19 patients who present with acute ascending weakness or cranial nerves involvement. More studies are needed to evaluate correlation between COVID-19, GBS, and development of psychiatric disturbances besides investigating the discrepancy between lung parameters and respiratory failure.</p>","PeriodicalId":9627,"journal":{"name":"Case Reports in Medicine","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9462972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33461173","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":"Oral and Lower Extremity Ulcers as the Initial Presentation of Granulomatosis with Polyangiitis.","authors":"Mohammed Omar Al Salihi,&nbsp;Bianca Dominguez,&nbsp;Viresh Mohanlal,&nbsp;S J Carlan","doi":"10.1155/2022/2737242","DOIUrl":"https://doi.org/10.1155/2022/2737242","url":null,"abstract":"<p><strong>Background: </strong>Granulomatosis with polyangiitis (GPA) is a small vessel vasculitis characterized by lung and kidney involvement. It is typically a disease of white females and has a poor prognosis with the average life expectancy of 5 months for a patient without treatment. Oral and skin ulcers are considered to be rare presentations.</p><p><strong>Case: </strong>A 39-year-old black male presented to the hospital with oral and skin ulcers and was diagnosed with GPA based on the biopsies of both cutaneous lesions and kidney. He was started on rituximab with minimal improvement. Later he was admitted to the ICU and had plasmapheresis, and he gradually improved and was discharged home 8 days after admission.</p><p><strong>Conclusion: </strong>GPA is an aggressive vascular disorder resulting in possible organ system damage and failure. The role of the sickle cell trait in this patient is undefined, but this combination of gender, race, and presenting symptoms in GPA is extremely unusual.</p>","PeriodicalId":9627,"journal":{"name":"Case Reports in Medicine","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9453098/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33461170","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 Rare Case of Meningitis Caused by <i>Alcaligenes faecalis</i> in an Immunocompetent Patient.","authors":"Kevin Cantillo García,&nbsp;Oscar Calderón Duran,&nbsp;Tomás Acosta Pérez,&nbsp;Ángel Vásquez Jiménez,&nbsp;Emerson Madrid Pérez,&nbsp;María Cristina Martínez-Ávila,&nbsp;Tomás Rodríguez Yánez,&nbsp;Amilkar Almanza-Hurtado","doi":"10.1155/2022/1559360","DOIUrl":"https://doi.org/10.1155/2022/1559360","url":null,"abstract":"<p><p><i>Alcaligenes faecalis</i> (<i>A. faecalis</i>) is a Gram-negative rod rarely isolated as an infective bacterium worldwide. The first cases of infections caused by this microorganism, such as pneumonia, soft tissue infections, urinary tract infections, bacteremia, and meningitis, date back more than 40 years and are almost entirely in newborns and immunosuppressed hosts. Optimal antibiotic therapy for <i>A. faecalis</i> has not been well established in the literature. We report a case of an immunocompetent patient in Colombia who had meningitis due to <i>A. faecalis</i> after a dental procedure. It is important to know about this microorganism that nowadays could be considered a potentially emerging pathogen in immunocompetent adults.</p>","PeriodicalId":9627,"journal":{"name":"Case Reports in Medicine","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9453059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33461172","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":"Biopsychosocial Approach for Conservative Management of Abdominal Pregnancy in Previously Infertile Mother.","authors":"Junita Indarti,&nbsp;Yudianto Budi Saroyo,&nbsp;Beta Andewi Resti Anggraheni,&nbsp;Andika Widyatama","doi":"10.1155/2022/3021097","DOIUrl":"https://doi.org/10.1155/2022/3021097","url":null,"abstract":"<p><strong>Background: </strong>Abdominal pregnancy is a rare condition in which early termination is generally recommended. However, there are cases of abdominal pregnancies treated using expectant management with satisfactory outcomes. This management may be considered in special cases, such as previously infertile couples.</p><p><strong>Case: </strong>A case of a 27-year-old woman with infertility history complaining of vaginal bleeding was presented. Physical and ultrasound examination revealed an abdominal pregnancy with 18 weeks of gestation. Although she was ready to abort the pregnancy, she insisted to try expectant management for her pregnancy. Her baby was finally born at 25 weeks via laparotomy.</p><p><strong>Conclusion: </strong>Abdominal pregnancy is a rare and highly morbid form of ectopic pregnancy. It demands a skilled approach in management. A comprehensive and holistic approach is required to deliver the best outcome for the patient and her family.</p>","PeriodicalId":9627,"journal":{"name":"Case Reports in Medicine","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9448616/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33454997","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":"Insulin Edema Syndrome due to Rapid Glucose Correction in a Diabetic Patient.","authors":"Siham M Hussien,&nbsp;Hasan Imanli,&nbsp;Dena H Tran,&nbsp;Robert D Chow,&nbsp;Aseem Sood","doi":"10.1155/2022/3027530","DOIUrl":"https://doi.org/10.1155/2022/3027530","url":null,"abstract":"<p><p>Edema resulting from the initiation of insulin therapy or intensification of glycemic control is a rare and under-recognized complication. In this report, we present a case of a 46-year-old patient with insulin-dependent diabetes mellitus (IDDM) who avoided insulin treatment due to associated peripheral edema. Though rare, this phenomenon is typically seen in patients with elevated glucose levels who are initiated on insulin treatment, resulting in rapid correction and tight control of glucose levels. The diagnosis of insulin-induced edema is made after other causes of acute edema are ruled out. Furthermore, in this case report, we will also discuss the postulated mechanisms for the edema-causing property of insulin.</p>","PeriodicalId":9627,"journal":{"name":"Case Reports in Medicine","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9398878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33438249","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":"Acute Generalized Exanthematous Pustulosis following SARS-CoV-2 Virus: Remdesivir as a Suspected Culprit.","authors":"Fatemeh Mohaghegh,&nbsp;Parvaneh Hatami,&nbsp;Zeinab Aryanian,&nbsp;Farahnaz Fatemi,&nbsp;Zeinab Mohseni Afshar","doi":"10.1155/2022/9880827","DOIUrl":"https://doi.org/10.1155/2022/9880827","url":null,"abstract":"<p><p>Acute generalized exanthematous pustulosis (AGEP) is an exanthematous condition, predominantly occurring as a result of drug reactions. We, hereby, present the first case of AGEP following treatment with remdesivir in a patient with COVID-19, without hydroxychloroquine use, which serves as a reminder to consider remdesivir as a possible causative agent when dealing with AGEP presentation in COVID patients.</p>","PeriodicalId":9627,"journal":{"name":"Case Reports in Medicine","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9385380/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40414672","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":"Unusual Presentation of Multisystemic Inflammatory Syndrome.","authors":"Farah Alnoor Ebrahim,&nbsp;George Moturi,&nbsp;Newnex Mongare,&nbsp;Reena Shah","doi":"10.1155/2022/8442855","DOIUrl":"https://doi.org/10.1155/2022/8442855","url":null,"abstract":"<p><p>COVID-19 pneumonia in children presents with very mild symptoms through an entity of multisystem inflammatory syndrome and can result in a life-threatening hyperinflammatory condition, with involvement of at least four organ systems and a marked inflammatory state. We present an 18-year-old high school student who presented with a sore throat, macular rash, abdominal pain, diarrhea, fevers, and joint pains. He presented with acute kidney injury and confusion with multiple tests and was eventually diagnosed with multisystem inflammatory syndrome in children (MIS-C).</p>","PeriodicalId":9627,"journal":{"name":"Case Reports in Medicine","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9385351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40414673","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":"Massive Acquired Renal Cysts Presenting with Bowel Obstruction-Like Symptoms.","authors":"Chutikarn Teparak,&nbsp;Weeratian Tawanwongsri","doi":"10.1155/2022/5252051","DOIUrl":"https://doi.org/10.1155/2022/5252051","url":null,"abstract":"<p><p>Acquired cystic kidney disease (ACKD) is rarely massive in size. The great majority is asymptomatic and incidentally found on imaging studies for unrelated causes. We reported a case of an 85-year-old male with bilateral multiple huge acquired renal infected cysts, initially presenting with bowel obstruction-like symptoms. The computed tomography (CT) scan later aided in an accurate diagnosis. Symptomatic huge ACKD has, to our knowledge, scarcely been described. In addition, retroperitoneal lesions resulting in abdominal pain remain unusual and underrecognized in general practice.</p>","PeriodicalId":9627,"journal":{"name":"Case Reports in Medicine","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-08-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9385368/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40414671","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":"Managing Post COVID-19 Patient with Breathlessness.","authors":"Yen Shen Wong,&nbsp;Muhammad Amin Ibrahim,&nbsp;Mohd Arif Mohd Zim,&nbsp;Mohd Fauzi Abdul Rani","doi":"10.1155/2022/7512400","DOIUrl":"https://doi.org/10.1155/2022/7512400","url":null,"abstract":"<p><strong>Background: </strong>Chronic respiratory disease may be associated with severity of coronavirus disease 2019 (COVID-19) infection. We review a case of chronic obstructive pulmonary disease (COPD) patient who developed acute breathlessness post COVID-19 infection, also focusing on the diagnostic approach.</p><p><strong>Case: </strong>A 69-year-old gentleman with background history of COPD GOLD D and ischemic heart disease was admitted with severe COVID-19 infection. He required high-flow nasal cannula upon presentation. A computed tomography pulmonary angiography (CTPA) thorax at day 10 of illness revealed moderate organizing pneumonia (OP) with emphysematous changes, without pulmonary embolism. He received oral baricitinib and intravenous methylprednisolone for 3 days, which was then followed by tapering prednisolone starting dose of 1 mg/kg/day (60 mg/day) with reduction of 10 mg prednisolone every 3 days. COPD pharmacotherapy was optimized with early utilization of dual bronchodilators and inhaled corticosteroid was withheld. He underwent inpatient pulmonary rehabilitation and was discharged with home oxygen therapy. Unfortunately, he was re-admitted after 2 weeks with shortness of breath and fever for 3 days. Blood results revealed leucocytosis with raised C-reactive protein. A repeat CTPA showed increase reticulations and crazy paving pattern with reduction in lung volume. Multidisciplinary team discussion concluded it as interstitial pneumonia with COVID-19 OP and fibrosis progression. Prednisolone was stopped and he responded well with antibiotics. A follow-up at 3 months post COVID-19 infection showed improvement of clinical symptoms with radiological resolution of ground glass changes.</p><p><strong>Conclusion: </strong>Corticosteroid inhaler should be cautioned in this case, in view of recent pneumonia and non-elevated serum eosinophil count. These groups of patients should be closely followed up to unmask interstitial lung disease that may present prior to COVID-19 and worsen post-infection. Optimizing pre-existing medical conditions should be the paramount intervention.</p>","PeriodicalId":9627,"journal":{"name":"Case Reports in Medicine","volume":null,"pages":null},"PeriodicalIF":0.8,"publicationDate":"2022-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9371804/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40615197","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}