Disseminated genitourinary histoplasmosis in a patient with AIDS with negative urine antigen testing

2021 ◽  
Vol 14 (11) ◽  
pp. e243375
Author(s):  
Candice Theodora Joseph ◽  
Michael Feely ◽  
Nicole Iovine
Keyword(s):  
Histoplasma Capsulatum ◽  
Surgical Pathology ◽  
Rare Presentation ◽  
Persons Living With Hiv ◽  
Pathological Evaluation ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
High Index Of Suspicion ◽  
Living With Hiv

Disseminated histoplasmosis is a life-threatening condition in immunocompromised patients. The majority of healthy persons have benign disease not requiring treatment. However, in persons living with HIV, mortality is high and accurate diagnosis is paramount. We present a case of a 48-year-old HIV-positive woman who presented with haematuria and flank pain. She had a history of recurrent urinary tract infection and nephrolithiasis with obstructive hydronephrosis. During cystoscopy, a bladder lesion was found. Pathological evaluation demonstrated abundant intracellular organisms with apparent budding. Subsequent urine histoplasma antigen was negative. Given the high index of suspicion for histoplasmosis based on the surgical pathology findings and epidemiological history, the patient was started immediately on antifungal therapy. One week later, PCR results of the bladder lesion confirmed the presence of Histoplasma capsulatum. This case highlights a rare presentation of genitourinary histoplasmosis and the utility of surgical pathology evaluation and PCR for diagnosis.

scholarly journals Silent primary ovarian ectopic pregnancy following ovulation induction: diagnostic dilemma

2021 ◽  
Vol 10 (9) ◽  
pp. 3654
Author(s):  
Kalyani Saidhandapani ◽  
Yashaswi Pandey ◽  
Priya Shaunthini
Keyword(s):  
Ovulation Induction ◽  
Diagnostic Challenge ◽  
Diagnostic Dilemma ◽  
Ovarian Pregnancy ◽  
Threatening Condition ◽  
Reproductive Techniques ◽  
Life Threatening ◽  
History Of ◽  
High Index Of Suspicion ◽  
Urine Pregnancy Test

Early diagnosis of an ovarian pregnancy, of all the diagnoses relating to extrauterine gestations, is perhaps a diagnostic challenge faced by an obstetrician and a radiologist. About 0.5% of extrauterine implantations occur in the ovary. Recent studies have demonstrated infertility and Assisted reproductive techniques (ARTs), multiparity, use of intrauterine devices as risk factors for ovarian ectopic. Knowledge pertaining to ovulation induction and risk of ovarian ectopic is even more scant. In this article, we report a case report of ovarian pregnancy following ovulation induction with letrozole. Patient visited with history of missed menstrual period, mild abdominal pain and a weakly positive urine pregnancy test. Provisional diagnosis of right tubal ectopic was made. Diagnosis of ruptured ovarian ectopic was made on explorative laparoscopy which was later confirmed histopathologically. Patient had normal intra and post-operative course. An ovarian ectopic can present as a life-threatening condition and a high index of suspicion can prevent morbidity as well as mortality. Ovarian pregnancy in a primigravida with ovulation induction without an alarming sign, as in this case, is the rarest entity came across till date.

scholarly journals Transient binocular blindness: A rare presentation of aortic dissection

2018 ◽  
Vol 27 (4) ◽  
pp. 236-240
Author(s):  
Abdul Hafiz Shaharudin ◽  
Muhamad Hafiq Ab Hamid ◽  
Rosliza Yahaya ◽  
Nik Ahmad Shaiffudin Nik Him ◽  
Nik Arif Nik Mohamed ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Carotid Artery ◽  
Aortic Dissection ◽  
Sudden Onset ◽  
Rare Presentation ◽  
Diagnostic Dilemma ◽  
Threatening Condition ◽  
Life Threatening ◽  
High Index Of Suspicion

Introduction: Aortic dissection is a clinical chameleon that can have variable presenting features that require a careful history and physical examination. A non-specific presentation of this life-threatening condition causes a diagnostic dilemma among clinicians especially in the emergency department leading to grave consequences. Case Presentation: We present a case of aortic dissection that presented as an acute bilateral blindness that was associated with a sudden onset of loss of consciousness and central chest pain. Bedside carotid ultrasound showed a double lumen carotid artery suggesting an intraluminal flap. Computed tomography angiography revealed extensive dissection of the entire length of the aorta. Discussion: This case illustrated the need for a high index of suspicion to diagnose patients with aortic dissection especially as the patient presented with an acute binocular visual loss and chest pain. Conclusion: A bedside carotid artery ultrasound in the emergency department was found useful in screening and diagnosing a carotid artery–related pathology.

scholarly journals Wandering airway foreign body in early infancy

2020 ◽  
Vol 7 (8) ◽  
pp. 1798
Author(s):  
Rajkumar M. Meshram ◽  
Nilesh Nagdive ◽  
Vishal S. Gajimwar ◽  
Parameshappa N. Nandikoppa ◽  
Suraj P. Gondase
Keyword(s):  
Foreign Body ◽  
Male Infant ◽  
Tracheobronchial Tree ◽  
Respiratory Passage ◽  
Impacted Foreign Body ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
Appropriate Therapy ◽  
High Index Of Suspicion

Accidental impaction of objects in the respiratory passage is a life-threatening condition. A 9-month-old male infant was admitted with fever, cough and respiratory distress without history of choking. He was treated as wheezy bronchitis with appropriate therapy but, did not show response. HRCT showed an impacted foreign body in the trachea which caused a partial luminal compromise. Two attempts to remove foreign body by rigid bronchoscope failed, and tracheostomy was performed due to fall in oxygen saturation. After stabilization, again saturation was falling and air entry was absent on right hemithorax. Considering the possibility of movement of foreign body in right bronchus, bronchoscope was reintroduced and foreign body was removed in piecemeal. This process was complicated with cardiorespiratory arrest, twice from which the patient was revived. Postoperative period was uneventful. So, high index of suspicion is required to diagnose such a foreign body of the tracheobronchial tree to prevent morbidity and mortality.      

Intraorbital Abscess: A Rare Cause of Orbit Compression

FACE ◽  
2021 ◽  
pp. 273250162110050
Author(s):  
Samuel Ruiz ◽  
Rizal Lim
Keyword(s):  
Pediatric Population ◽  
Rare Complication ◽  
Disease Process ◽  
Rare Condition ◽  
External Drainage ◽  
Direct Extension ◽  
Life Threatening ◽  
History Of ◽  
High Index Of Suspicion ◽  
Prompt Diagnosis

Introduction: Intraorbital abscess is a rare complication of rhinosinusitis that affects most commonly the pediatric population. It is thought to be caused by direct extension or venous spread of infections from contiguous sites and can lead to life-threatening complications, like permanent visual loss and cerebral abscesses. Objectives: Intraorbital abscess is a rare condition that requires prompt diagnosis and treatment to avoid serious complications. Our objectives are to provide an overview of this rare disease process and its management including our successful treatment experience. Case Description: We present a 2 case report of a 13-year-old pediatric male and a 66-year-old male with history of chronic sinusitis who presented with a right intraorbital abscess successfully treated with external drainage with decompression of the orbit. Conclusion: When intraorbital abscess is encountered, a high index of suspicion is needed to allow prompt and accurate diagnosis for this infrequent condition. Timely surgical drainage of the abscess is needed to prevent the development of fatal complications.

scholarly journals A Rare Case of Autoimmune Polyglandular Syndrome Type 2 in a Child With Persistent Fatigue

2019 ◽  
Vol 6 ◽  
pp. 2333794X1984507 ◽  
Author(s):  
Ryan Kenneth Smith ◽  
Peter M. Gerrits
Keyword(s):  
Adrenal Insufficiency ◽  
Autoimmune Polyglandular Syndrome ◽  
Threatening Condition ◽  
Viral Illness ◽  
Persistent Fatigue ◽  
Life Threatening ◽  
Local Emergency Department ◽  
Autoimmune Polyglandular Syndrome Type ◽  
High Index Of Suspicion

Adrenal insufficiency is a rare, potentially life-threatening condition whose diagnosis requires a high index of suspicion. Adrenal insufficiency may be primary, secondary, or tertiary with varied etiologies. Primary insufficiency may be part of a cluster of autoimmune diseases, referred to as autoimmune polyglandular syndrome(s) (APS). We describe a case of a 15-year-old male who presents to a local emergency department complaining of fatigue, fever, abdominal pain, nausea, and vomiting for a few days with a preceding viral illness. The patient was hyponatremic and hyperkalemic with skin hyperpigmentation, raising concern for adrenal insufficiency. Laboratory workup confirmed autoimmune primary adrenal insufficiency, with subsequent laboratory studies revealing autoimmune thyroiditis and celiac disease. Concomitant Addison’s and Hashimoto’s diseases led to a diagnosis of APS type 2. The patient was started on steroid replacement with rapid clinical improvement.

Heterotopic pregnancy; case report

2019 ◽  
Vol 7 (05) ◽  
Author(s):  
Vipul R. Khandagale
Keyword(s):  
Risk Factors ◽  
Ectopic Pregnancy ◽  
Adnexal Mass ◽  
Heterotopic Pregnancy ◽  
Free Fluid ◽  
Threatening Condition ◽  
Life Threatening ◽  
Ectopic Pregnancies ◽  
High Index Of Suspicion ◽  
Low Risk Women

Heterotopic pregnancy is a rare clinical condition in which intrauterine and extrauterine pregnancies occur at the same time. It can be a life threatening condition and easily missed with the diagnosis. We present the case of a 37 year old patient who was treated for a heterotopic pregnancy with live intrauterine gestation and ruptured left adnexal gestation.The ectopic pregnancy was not suspected at her initial presentation. A high index of suspicion is needed in women with risk factors for an ectopic pregnancy and in low risk women who have free fluid with or without an adnexal mass with an intrauterine gestation.It is difficult to estimate exactly the incidence of ectopic pregnancies, but on an average it is approximately 1:300 normal pregnancies worldwide.

Stridor: a rare presentation of motor neuron disease

2021 ◽  
Vol 14 (7) ◽  
pp. e241923
Author(s):  
Brian Gordon ◽  
Eimear Joyce ◽  
Timothy J Counihan
Keyword(s):  
Motor Neuron ◽  
Motor Neuron Disease ◽  
Vocal Cord ◽  
Poor Response ◽  
Vocal Cord Palsy ◽  
Pharmacological Therapy ◽  
Rare Presentation ◽  
Emergency Tracheostomy ◽  
Life Threatening ◽  
History Of

A 74-year-old farmer presented to the emergency department with a subacute history of progressive dyspnoea, wheeze and dysphonia. He was treated for an exacerbation of asthma with poor response to pharmacological therapy. Investigation of dysphonia via laryngoscopy identified a bilateral vocal cord palsy. Subsequently, the patient developed an episode of life-threatening stridor and hypercapnic respiratory failure requiring an emergency tracheostomy. Neurology input identified evidence of widespread muscle fasciculations on clinical examination. MRI of the brain and cervical spine were unremarkable. Electromyogram testing identified changes of acute denervation in several limbs consistent with a diagnosis of motor neuron disease (MND). Bilateral vocal cord palsy has been rarely reported in the literature as the heralding symptom resulting in the diagnosis of MND. In patients with a subacute onset of dysphonia, dyspnoea and stridor, MND should be a differential diagnosis.

Haemophagocytic lymphohistiocytosis secondary to brucellosis in a young child

2021 ◽  
Vol 14 (3) ◽  
pp. e240759
Author(s):  
Jashan Mittal ◽  
Prawin Kumar ◽  
Jagdish Prasad Goyal ◽  
Abhishek Purohit
Keyword(s):  
Haemophagocytic Lymphohistiocytosis ◽  
Appetite Loss ◽  
Specific Therapy ◽  
Adequate Treatment ◽  
Underlying Condition ◽  
Persistent Fever ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
Life Threatening Complication

Brucellosis is a common zoonotic disease worldwide. It has protean clinical manifestation and sometimes may has a life-threatening complication. A 4-year-old boy presented with a history of fever, myalgia and appetite loss for 3 weeks. On examination, he had hepatosplenomegaly. The initial working diagnosis was an infection, autoimmune disease and malignancy. Investigations showed positive Brucella serology, and he was started on rifampicin and cotrimoxazole. He was further investigated because of persistent fever, which revealed evidence of haemophagocytic lymphohistiocytosis (HLH). He continued treatment for brucellosis, except rifampicin which was replaced with doxycyclin due to a worsening liver function. The child showed complete clinical and biochemical improvement after 6 weeks of therapy. HLH is a life-threatening condition and should be suspected in children with brucellosis, who did not respond to appropriate antibiotics treatment. Secondary HLH does not always require specific therapy; it may improve with adequate treatment of the underlying condition.

scholarly journals Late traumatic diaphragmatic rupture complicated by haemothorax and strangulation of the stomach: A case report

2020 ◽  
Vol 48 (6) ◽  
pp. 030006052093086
Author(s):  
Jian-Chun Xiao ◽  
Li-Yuan Ma ◽  
Bing-Lu Li
Keyword(s):  
Penetrating Trauma ◽  
Diaphragmatic Rupture ◽  
Uneventful Recovery ◽  
Trauma Symptoms ◽  
Traumatic Diaphragmatic Rupture ◽  
Left Pleural Effusion ◽  
Threatening Condition ◽  
Diaphragmatic Repair ◽  
Life Threatening ◽  
High Index Of Suspicion

Traumatic diaphragmatic rupture (TDR) is an uncommon but life-threatening condition often caused by blunt or penetrating trauma. Symptoms may appear late resulting in delayed or missed diagnosis. We report here a case of a 28-year-old man who presented with left subcostal pain and vomiting after recently binge drinking alcohol. He had experienced bilateral rib fractures two years previously. Computed tomography (CT) showed massive left pleural effusion and pleural fluid drained by thoracentesis had a bloody appearance. The patient developed septic shock but emergency surgery showed no active bleeding. Enhanced-CT showed herniated stomach with ischemic necrosis in the left thoracic cavity. Total gastrectomy and diaphragmatic repair were successful and the patient had an uneventful recovery. A high index of suspicion is necessary when evaluating haemothorax, especially in patients with recent or previous thoraco-abdominal injury.

scholarly journals Non-occlusive mesenteric ischaemia associated with anorexia nervosa

2019 ◽  
Vol 12 (5) ◽  
pp. e229703
Author(s):  
Takashi Sakamoto ◽  
Alan Kawarai Lefor ◽  
Tadao Kubota
Keyword(s):  
Anorexia Nervosa ◽  
Distal Ileum ◽  
Interdisciplinary Management ◽  
Emergency Laparotomy ◽  
Diffuse Peritonitis ◽  
Chronic Haemodialysis ◽  
Mesenteric Ischaemia ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of

Non-occlusive mesenteric ischaemia (NOMI) is a life-threatening condition that requires emergent intervention and anorexia nervosa is a chronic eating disorder that requires careful medical and nutritional management. A 54-year-old woman with a history of anorexia nervosa and undergoing chronic haemodialysis developed abdominal pain and called an ambulance. On arrival, she was in shock and abdominal examination was consistent with diffuse peritonitis. Computed tomography scan suggested ischaemia from the distal ileum to the ascending colon. Emergency laparotomy revealed NOMI from the distal ileum to the transverse colon. The treatment strategy included staged operations and careful medical management to optimise nutritional support and electrolyte management with survival of the patient. NOMI and anorexia nervosa are both difficult to manage. Meticulous interdisciplinary management can result in a good outcome.

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