scholarly journals Haemoptysis: just another case of endocarditis? A case report

2021 ◽  
Vol 5 (6) ◽  
Author(s):  
Ronald Huynh ◽  
Lucy Morgan ◽  
John Yiannikas
Keyword(s):  
Ct Scanning ◽  
Pulmonary Angiography ◽  
Pulmonary Haemorrhage ◽  
Pacemaker Lead ◽  
Unique Case ◽  
Refractory Heart Failure ◽  
Case Summary ◽  
First Case ◽  
Pulmonary Artery Aneurysms ◽  
Left And Right

Abstract Background  Pulmonary arteriovenous malformations (PAVM) are rare, and most cases are congenital. They require prompt recognition and management particularly in patients presenting with hypoxia and haemoptysis. We describe a unique case of recurrent endocarditis causing pulmonary artery aneurysms (PAAs) and formation of PAVM. Case summary  A 60-year-old woman presented with dyspnoea, haemoptysis, and severe hypoxia. Her background was significant for previous pacemaker lead infection, refractory heart failure secondary to severe tricuspid valve distortion by her pacemaker lead, tricuspid and mitral valve replacements complicated by recurrent endocarditis over several years. Two years prior to her current presentation computed tomography (CT) scanning revealed new small PAAs thought possibly to be mycotic in origin. After her current presentation, prompt high-resolution CT scanning of her chest with contrast revealed significant pulmonary haemorrhage and new clusters of PAVM. Urgent pulmonary angiography confirmed PAVM and was successfully treated with coil embolization. Her dyspnoea, pulmonary haemorrhage, and hypoxia resolved. Discussion  Acquired causes account for a very small percentage of PAVM and the mechanism of their development is unknown. As she had recurrent right-sided endocarditis and her PAAs developed following this, with new PAVM developing 2 years later; we hypothesize that they were causally related. We believe this is the first case of recurrent left- and right-sided endocarditis leading to formation of PAAs and development of PAVM presenting with significant hypoxia and haemoptysis requiring prompt intervention.

Intestinal Heterotopic Pancreas Involved by Simultaneous PanIN-2 Lesion and Endocrine Microadenoma: a Unique Case

2017 ◽  
Vol 26 (2) ◽  
pp. 199-202
Author(s):  
Remus Cornea ◽  
Sorina Taban ◽  
Cristian Suciu ◽  
Codruta Lazureanu ◽  
Alis Dema
Keyword(s):  
Histopathological Examination ◽  
Intraepithelial Neoplasia ◽  
Heterotopic Pancreas ◽  
Pancreatic Intraepithelial Neoplasia ◽  
Unique Case ◽  
Intraductal Papillary Mucinous Neoplasms ◽  
Pancreatic Endocrine Neoplasm ◽  
First Case ◽  
Mucinous Neoplasms

We hereby present the case of a 58-year-old male who underwent a total gastrectomy for gastric neoplasm. During the surgery, a tumor mass in the jejunum was identified, considered as metastasis, and resected. The histopathological examination of the jejunal lesion showed ectopic pancreas. In this area, two pathological distinct lesions were identified, one histologically compatible with pancreatic intraepithelial neoplasia (PanIN) type 2 lesion and the other with morphologic criteria for endocrine microadenoma. To our knowledge, this is the first case that evidences the presence of a concomitant premalignant exocrine lesion and benign endocrine lesion in a heterotopic pancreas (HP).Abbreviations: HP: heterotopic pancreas; IPMN: Intraductal Papillary Mucinous Neoplasms; PanIN: Pancreatic Intraepithelial Neoplasia; PEN: pancreatic endocrine neoplasm.

scholarly journals Hypocalcemic cardiomyopathy after parathyroidectomy in a patient with uremia: A case report and literature review

2020 ◽  
Vol 48 (7) ◽  
pp. 030006052094211
Author(s):  
Wei Zhang ◽  
Feng Xue ◽  
Quandong Bu ◽  
Xuemei Liu
Keyword(s):  
Heart Failure ◽  
Case Report ◽  
Secondary Hyperparathyroidism ◽  
Calcium Supplementation ◽  
Severe Heart Failure ◽  
Cardiac Complications ◽  
Refractory Heart Failure ◽  
First Case ◽  
Insight Into

Hypocalcemia is a rare, but reversible, cause of dilated cardiomyopathy. Although cardiomyopathy may cause severe heart failure, calcium supplementation can reverse heart failure. We report here a patient with uremia and secondary hyperparathyroidism, who was complicated by persistent hypocalcemia and refractory heart failure. The cardiac failure was refractory to treatment with digitalis and diuretics, but dramatically responded to calcium therapy and restoration of normocalcemia. As a result, the patient was eventually diagnosed with hypocalcemic cardiomyopathy. To the best of our knowledge, this is the first case of this disease to be reported in a patient with uremia. Findings from our case may help clinicians to better understand hypocalcemic cardiomyopathy. Our case might also provide new insight into long-term cardiac complications and prognoses of patients undergoing parathyroidectomy due to secondary hyperparathyroidism.

scholarly journals Acute upper airway obstruction as a life-threatening complication of ventral bulla osteotomy: report of two consecutive cases

2021 ◽  
Vol 7 (1) ◽  
pp. 205511692110059
Author(s):  
Michal Vlasin ◽  
Richard Artingstall ◽  
Barbora Mala
Keyword(s):  
Airway Obstruction ◽  
Clinical Signs ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Single Session ◽  
Inflammatory Polyp ◽  
Case Summary ◽  
First Case ◽  
Life Threatening

Case summary This paper presents two cases of acute postoperative upper airway obstruction following ventral bulla osteotomy (VBO) in cats. The first cat underwent a unilateral left-sided VBO for a suspected inflammatory polyp. The second cat underwent a single-session bilateral VBO procedure for bilateral otitis media. In the first case, immediate re-intubation and a gradual lightening of the anaesthetic plane resolved the clinical signs; in the second case, the patient deteriorated and went into acute cardiorespiratory arrest and received cardiopulmonary resuscitation. Both patients recovered well and were discharged home 3 days after surgery. Both cases were reported to show no further clinical signs on postoperative follow-up 3 weeks and 4 months after surgery, respectively. Relevance and novel information Upper airway obstruction should be regarded as a potential complication of VBO in cats.

Syncopal Episodes Associated with Cisapride and Concurrent Drugs

1998 ◽  
Vol 32 (6) ◽  
pp. 648-651 ◽  
Author(s):  
Vanessa Seals Gray
Keyword(s):  
English Language ◽  
Motor Vehicle ◽  
Concomitant Administration ◽  
Qt Prolongation ◽  
Azole Antifungals ◽  
Vehicle Accidents ◽  
Cardiac Dysrhythmias ◽  
Case Summary ◽  
First Case ◽  
Patients At Risk

OBJECTIVE: To report a case of QT prolongation and syncopal episodes resulting from concomitant use of cisapride and agents known to inhibit its metabolism. CASE SUMMARY: A 53-year-old white woman was involved in two motor vehicle accidents on the same day after experiencing syncopal episodes. Cardiac and neurologic evaluations were negative; the syncopal episodes were attributed to QT prolongation associated with the concomitant use of cisapride and agents known to inhibit its metabolism. DISCUSSION: This is the first case published in the English-language literature describing QT prolongation resulting from the concomitant use of cisapride and agents known to inhibit its metabolism. Clarithromycin inhibits CYP3A4, the isoenzyme responsible for the metabolism of cisapride. Concomitant administration of cisapride with agents known to inhibit CYP3A4 (i.e., azole antifungals, erythromycin, clarithromycin) may result in elevated cisapride concentrations. Elevated cisapride concentrations have been associated with QT prolongation, syncopal episodes, and cardiac dysrhythmias. CONCLUSIONS: Acquired QT prolongation is a well-recognized adverse effect of several drugs. Recognition of newer drugs and drug combinations that place patients at risk for this potentially fatal adverse event is imperative for appropriate monitoring and prevention.

Persistent fever with chills and an endocardial mass in a child: an unusual presentation of Hughes–Stovin syndrome

2016 ◽  
Vol 27 (3) ◽  
pp. 605-608 ◽  
Author(s):  
Marianna Fabi ◽  
Francesca Lami ◽  
Maurizio Zompatori
Keyword(s):  
Pulmonary Artery ◽  
Jugular Vein ◽  
Anticoagulation Therapy ◽  
Pulmonary Haemorrhage ◽  
Acute Phase Reactants ◽  
Pulmonary Lesions ◽  
Pulmonary Artery Aneurysms ◽  
Peripheral Arterial ◽  
Respiratory Complaints ◽  
Venous Thromboses

AbstractA 12-year-old boy with a right atrium endocardial mass was initially diagnosed as having Lemierre’s syndrome on the basis of previous mastoiditis and jugular vein and cerebral venous thrombosis. Lack of response to antibiotics, persistent high fever with chills, acute-phase reactants, and peripheral arterial pseudoaneurysms made us reconsider the diagnosis. Only after the late appearance of radiological pulmonary lesions and recognition of pulmonary artery aneurysms, Hughes–Stovin syndrome was diagnosed. Hughes–Stovin syndrome is an exceedingly rare vasculitis, especially in childhood, consisting of multiple pulmonary artery aneurysms and deep venous thromboses. The lack of formal diagnostic criteria and the rarity of the disease make the diagnosis very challenging, especially when respiratory complaints are not present at onset, as in the presented case. The treatment aims to reduce inflammation, although there is debate about anticoagulation therapy because of the risk of pulmonary haemorrhage.

Fatal Neutropenia and Thrombocytopenia Associated with Ticlopidine

1994 ◽  
Vol 28 (11) ◽  
pp. 1236-1238 ◽  
Author(s):  
James A. Carlson ◽  
Jon E. Maesner
Keyword(s):  
Renal Function ◽  
Absolute Neutrophil Count ◽  
Neutrophil Count ◽  
Impaired Renal Function ◽  
Healthcare Professionals ◽  
Severe Neutropenia ◽  
Gram Negative ◽  
Case Summary ◽  
First Case

OBJECTIVE: To report the first case of ticlopidine-associated neutropenia resulting in sepsis and death. CASE SUMMARY: An 83-year-old Filipino man was started on ticlopidine 250 mg bid. By the seventh week of therapy his absolute neutrophil count (ANC) had dropped to 2700 from 7600 × 106 cells/L. The ticlopidine was stopped. Six days later, he was admitted to the hospital. He died 18 hours later of gram-negative sepsis. DISCUSSION: Although ticlopidine therapy was discontinued four days after the patient's ANC was 2700 × 106 cells/L, the ANC dropped to and remained at 0 until his death eight days later. This may be associated with the patient's decreased clearance of ticlopidine given his age and impaired renal function. This is the first reported case of moderate or severe neutropenia in a nonwhite patient and the first reported case of sepsis and death caused by ticlopidine CONCLUSIONS: Healthcare professionals must be aware of the possibility of severe neutropenia and death caused by ticlopidine, even when the manufacturers' monitoring guidelines are followed.

scholarly journals A UNIQUE CASE OF ATEZOLIZUMAB-INDUCED AUTOIMMUNE DIABETES

2020 ◽  
Vol 6 (1) ◽  
pp. e30-e32
Author(s):  
Mimi Wong ◽  
Nirjhar Nandi ◽  
Ashim Sinha
Keyword(s):  
Cell Death ◽  
Programmed Cell Death ◽  
Autoimmune Diabetes ◽  
Case Reports ◽  
Zinc Transporter ◽  
Prior History ◽  
Unique Case ◽  
Cell Lung Carcinoma ◽  
Zinc Transporter 8 ◽  
First Case

Objective: Immunotherapy is a novel treatment that can cause autoimmune diabetes in rare cases. More cases occur following use of the inhibitor to the protein programmed cell death-1 rather than the inhibitor to programmed cell death-ligand 1. Methods: We report a unique case of autoimmune diabetes following atezolizumab use. Results: A 55-year-old, Aboriginal Australian female with no prior history of diabetes was commenced on atezolizumab for recurrent squamous cell lung carcinoma. Two months following its commencement, there was the onset of fatigue, polyuria, polydipsia, and new hyperglycemia. Subsequently she was found to have a borderline-low C peptide level of 0.6 nmol/L (reference range is 0.5 to 1.0 nmol/L), and positive zinc transporter-8 antibodies. Following the diagnosis of autoimmune diabetes, 5 units of glargine insulin was commenced which maintained euglycemia and resolved her symptoms of hyperglycemia. Conclusion: There are few case reports of atezolizumab-induced autoimmune diabetes. We present the first case associated with zinc transporter-8 antibodies, and a unique case of autoimmune diabetes in a patient of Aboriginal Australian background.

Oculogyric Crisis Possibly Related to Pentazocine

1993 ◽  
Vol 27 (7-8) ◽  
pp. 874-876 ◽  
Author(s):  
Aaron H. Burstein ◽  
Terence Fullerton
Keyword(s):  
Temporal Relationship ◽  
Opiate Receptors ◽  
Data Sources ◽  
Review Of Literature ◽  
Patient Case ◽  
Case Summary ◽  
First Case ◽  
Oculogyric Crisis ◽  
Plausible Mechanism ◽  
Relationship Of

OBJECTIVE: To report and describe the apparent first case of acute oculogyric crisis following administration of pentazocine, and to discuss the possible mechanism for this reaction. DATA SOURCES/CASE SUMMARY: Patient case and relevant review of literature. The patient, a 39-year-old woman, developed acute oculogyric crisis following administration of Talacen (pentazocine and acetaminophen) for pain relief. The crisis resolved after discontinuation of the medication and administration of intravenous diphenhydramine 50 mg. CONCLUSIONS: Based on the temporal relationship of drug administration to occurrence of the event, pentazocine is implicated as the cause of this acute oculogyric crisis. A plausible mechanism for precipitation of this crisis is the agonism of pentazocine on sigma opiate receptors, with postulated subsequent modulation of dopamine receptors.

A 13-Year-Old Presenting With Recurrent Angioma Serpiginosum

2018 ◽  
Vol 22 (5) ◽  
pp. 511-513 ◽  
Author(s):  
Michael Bishara ◽  
Michael Jiaravuthisan ◽  
Miriam Weinstein
Keyword(s):  
Blood Vessels ◽  
Clinical Spectrum ◽  
Disease Entity ◽  
Upper Arm ◽  
Vascular Abnormality ◽  
Histological Features ◽  
Case Summary ◽  
First Case ◽  
Dermal Papillae

Background: Angioma serpiginosum (AS) is a rare vascular abnormality consisting of proliferation and dilation of superficial blood vessels in the skin. AS typically presents in the first 2 decades of life and remains stable with time. Case Summary: We report the case of a 13-year-old female with an acquired, recurrent erythematous lesion with serpiginous borders on her left upper arm. Over several years, the lesion reappeared then disappeared 12 to 15 times. At one point, she developed a tender red nodule within the lesion; consequently, a biopsy was taken, revealing dilated telangiectatic vessels in the dermal papillae with mild, focal extravasation of erythrocytes. Conclusion: This case demonstrates a lesion with suggestive clinical and histological features of AS. However, this may be the first case of recurrent AS with a symptomatic episode. This case may contribute to the expanding clinical spectrum of this interesting disease entity.

Sustained regression of a primary choroidal melanoma under the influence of a therapeutic melanoma vaccine.

1994 ◽  
Vol 12 (2) ◽  
pp. 396-401 ◽  
Author(s):  
M S Mitchell ◽  
P E Liggett ◽  
R L Green ◽  
J Kan-Mitchell ◽  
A L Murphree ◽  
...  
Keyword(s):  
Elderly Patient ◽  
Cutaneous Melanoma ◽  
Specific Immunotherapy ◽  
Choroidal Melanoma ◽  
Ct Scanning ◽  
Melanoma Vaccine ◽  
Computed Tomographic ◽  
Active Specific Immunotherapy ◽  
First Case ◽  
The Right

PURPOSE To determine whether active specific immunotherapy with lysates of cutaneous melanoma cells, administered with immunologic adjuvant DETOX (Ribi ImmunoChem Research, Inc, Hamilton, MT), is effective in shrinking a primary choroidal melanoma, in an elderly patient already blind in the nontumorous eye. An 81-year-old man was referred with a primary choroidal melanoma of the left eye, with virtual blindness of the right eye due to macular degeneration. He was begun on active specific immunotherapy with an experimental melanoma vaccine (melanoma theraccine) and DETOX on weeks 1, 2, 3, 4, and 6, respected after a hiatus of 2 weeks. After a response was noted, monthly injections were given. RESULTS The patient had a significant shrinkage of his choroidal melanoma from a height of 4.2 mm to 2.4 mm within 2 months. This was sustained by continual treatment for 21 months until September 1991. After the patient failed to return for 9 months while recuperating from a stroke, the lesion regrew to a height of 3.7 mm and developed an additional lobe. On resumption of monthly treatments, the lesion shrank to 3.4 mm within 3 months, lost the additional lobe, and has since remained stable. No metastases have been found over a period of nearly 4 years on quarterly computed tomographic (CT) scanning of the chest and abdomen, and magnetic resonance imaging of the head. CONCLUSION Active specific immunotherapy with cutaneous melanoma lysates has caused a clinically useful protracted regression of a primary choroidal melanoma in an elderly patient in whom surgery and radiation therapy were contraindicated. This may represent the first case of a primary choroidal melanoma, and perhaps the only primary tumor, successfully treated with systemic immunotherapy alone. A formal trial of active specific immunotherapy for primary choroidal melanoma in selected patients may be warranted.

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