Jaundice and life-threatening hemobilia: An uncommon presentation of choledochal cyst

2013 ◽  
Vol 14 (8) ◽  
pp. 451-454
Author(s):  
Peng Soon Koh ◽  
Boon Koon Yoong ◽  
Anushya Vijayananthan ◽  
Ouzreiah Nawawi ◽  
Sanjiv Mahadeva
Keyword(s):  
Choledochal Cyst ◽  
Uncommon Presentation ◽  
Life Threatening

scholarly journals Rhabdomyolysis-induced acute kidney injury in a patient with non-compliance to levothyroxine therapy

2021 ◽  
Vol 2021 ◽  
Author(s):  
Ayesha Ghayur ◽  
Qurrat Elahi ◽  
Chinmay Patel ◽  
Rishi Raj
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Medical Condition ◽  
Kidney Injury ◽  
List Type ◽  
Progressive Decline ◽  
Uncommon Presentation ◽  
Common Medical Condition ◽  
Life Threatening ◽  
Elevated Creatinine

Summary Hypothyroidism is a common medical condition and is often easily managed with excellent outcomes, when treated adequately. Compliance with levothyroxine (LT4) therapy is often compromised because of the need for a daily and lasting schedule. Overt rhabdomyolysis due to under-treatment or non-compliance is a rare occurrence. We report a case of rhabdomyolysis leading to acute kidney injury (AKI) on chronic kidney disease (CKD) requiring hemodialysis (HD) in a 68-year-old Caucasian male due to non-compliance with levothyroxine (LT4) therapy. Our patient 'ran out of levothyroxine' for approximately 4 weeks and developed gradually progressive muscle pain. The diagnosis of severe AKI due to rhabdomyolysis was made based on oliguria, elevated creatinine kinase (CK), and renal failure. Resuming the home dose of LT4 failed to correct CK levels, and there was a progressive decline in renal function. Although increasing doses of LT4 and three cycles of HD improved CK levels, they remained above baseline at the time of discharge. The patient recovered gradually and required HD for 4 weeks. CK levels normalized at 6 weeks. Through this case report, we highlight that non-compliance with LT4 therapy can lead to life-threatening complications such as renal failure and hence the need to educate patients on the significance of compliance with LT4 therapy should be addressed. Learning points Non-compliance to levothyroxine therapy is common and can lead to serious complications, including rhabdomyolysis. Rhabdomyolysis is an uncommon presentation of hypothyroidism and severe rhabdomyolysis can result in renal failure requiring hemodialysis. Rhabdomyolysis associated with hypothyroidism can be further exacerbated by concomitant use of statins.

scholarly journals Gastric Diverticulum Presenting as Hematemesis: A Case Report Detailing an Uncommon Presentation of an Already Rare Entity

2020 ◽  
Vol 4 (4) ◽  
pp. 610-612
Author(s):  
Maddi Massa ◽  
Karla Newbold
Keyword(s):  
Case Report ◽  
Gastric Resection ◽  
Epigastric Pain ◽  
Gastrointestinal Symptoms ◽  
Rare Entity ◽  
Epigastric Discomfort ◽  
Treatment Regimens ◽  
Uncommon Presentation ◽  
Life Threatening

Introduction: Gastric diverticula (GD) are uncommon. Most are asymptomatic and diagnosed incidentally. Symptoms range from reflux and epigastric discomfort to life-threatening bleeding and perforation. We describe a case of symptomatic GD presenting as hematemesis requiring surgical treatment. Case Report: A 57-year-old female presented to the emergency department (ED) with one day of epigastric pain and hematemesis. Hemoglobin was found to be stable, but blood urea nitrogen was elevated. Imaging revealed a fundal GD. Esophagogastroduodenoscopy did not show other etiology of hematemesis. The patient underwent partial gastric resection for GD removal and did well without further symptoms on follow-up. Conclusion: Although rare, GD needs to be included on a differential diagnosis when evaluating gastrointestinal symptoms in the ED. Patients may present with an array of complaints but can potentially develop serious complications. Providers should be familiar with the diagnostic options and treatment regimens available to better care for patients presenting with GD.

Scrub typhus and lateral rectus palsy: an uncommon presentation of a common illness

2021 ◽  
Vol 14 (5) ◽  
pp. e240882
Author(s):  
Ajay Chauhan ◽  
Aditya Jandial ◽  
Kundan Mishra ◽  
Rajeev Sandal
Keyword(s):  
Scrub Typhus ◽  
Clinical Manifestations ◽  
Central Nervous System Involvement ◽  
Febrile Illness ◽  
Acute Febrile Illness ◽  
Orientia Tsutsugamushi ◽  
Cranial Nerve Involvement ◽  
Uncommon Presentation ◽  
Life Threatening ◽  
Multiorgan Dysfunction Syndrome

Scrub typhus is a zoonosis, which usually manifests as an acute febrile illness. It is caused by a rickettsia, Orientia tsutsugamushi, which is endemic in the Asian region. It can present with varied clinical manifestations, ranging from acute febrile illness to life-threatening multiorgan dysfunction syndrome. Central nervous system involvement in the form of altered sensorium and/or meningitis is frequently observed in scrub typhus. However, isolated cranial nerve involvement is uncommon and so far only a few such cases have been reported in the literature. We present a rare case of scrub typhus with fever and diplopia at presentation, which completely improved with doxycycline-based treatment.

scholarly journals An Uncommon Presentation of Cryptococcal Meningitis in an Immunocompetent Patient: A Case Report

2021 ◽  
Vol 5 (4) ◽  
pp. 450-454
Author(s):  
Kelly Correa ◽  
Scott Craver ◽  
Amar Sandhu
Keyword(s):  
Case Report ◽  
Cryptococcal Meningitis ◽  
Altered Mental Status ◽  
Immunocompetent Patient ◽  
Significant Past Medical History ◽  
Atypical Symptoms ◽  
Presenting Symptoms ◽  
Uncommon Presentation ◽  
Life Threatening ◽  
Immunocompetent Patients

Introduction: Meningitis is a serious and potentially life-threatening infection of the central nervous system. Cryptococcus neoformans is a rare fungal cause of meningitis that commonly presents with atypical symptoms. Although this infection is most common in immunocompromised patients, it also occurs in immunocompetent patients. This case report describes an atypical presentation of cryptococcal meningitis in a seemingly immunocompetent patient. Case Report: A 40-year-old immunocompetent patient with no significant past medical history had visited the emergency department (ED) five times within a span of 30 days reporting dental pain and headache. Throughout each of the visits, no clear symptoms signaling the need for a meningitis workup were observed, as the patient had been afebrile, displayed no nuchal rigidity, and his presenting symptoms subsided within the ED after treatment. A lumbar puncture was performed after emergency medical services brought the patient in for his sixth ED visit, initially for stroke-like symptoms and altered mental status. Spinal fluid was indicative of cryptococcal meningitis. Conclusion: This case highlights the challenge of identifying cryptococcal meningitis in the ED, particularly in immunocompetent patients who do not display classic meningitis symptoms. It also highlights the importance of keeping a broad differential and carefully ruling out diagnoses when patients return to the ED multiple times for the same complaint.

scholarly journals Massive Pulmonary Hemorrhage from Dual Circulation Pulmonary Arteriovenous Malformations in Hereditary Hemorrhagic Telangiectasia

2004 ◽  
Vol 11 (8) ◽  
pp. 597-598 ◽  
Author(s):  
Krishna B Sharma ◽  
Lutz Forkert
Keyword(s):  
Young Woman ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Arteriovenous Malformations ◽  
Pulmonary Hemorrhage ◽  
Arterial System ◽  
Massive Hemoptysis ◽  
Pulmonary Arteriovenous Malformations ◽  
Uncommon Presentation ◽  
Life Threatening ◽  
Pulmonary Arterial

Pulmonary arteriovenous malformations (AVMs) are commonly supplied by the pulmonary arterial system and rarely by the systemic bronchial circulation. The authors outline the case of a young woman with pulmonary AVMs as part of hereditary hemorrhagic telangiectasia with the uncommon presentation of massive hemoptysis. Management of her recurrent, life-threatening pulmonary hemorrhage was complicated by pulmonary AVMs that were supplied by both the pulmonary and systemic bronchial arterial circulatory systems. Transcatheter embolotherapy of the higher pressure bronchial systemic circuit was necessary for acute hemostasis.

scholarly journals 2:1 Atrioventricular Block and Severe Hypotension Due to Wild Honey Poisoning: A Case Report

2021 ◽  
Vol 8 (8) ◽  
pp. 416-419
Author(s):  
Keshav Budhathok ◽  
Shyam Raj Regmi ◽  
Sudhir Regmi
Keyword(s):  
Atrioventricular Block ◽  
Altered Mental Status ◽  
The Black Sea ◽  
Medical College ◽  
Naturally Occurring ◽  
Uncommon Presentation ◽  
Severe Hypotension ◽  
Himalayan Belt ◽  
Life Threatening ◽  
Medicinal Properties

Wild Honey poisoning is caused by ingestion of wild honey obtained from the nectar of some species of Rhododendron, consuming leaves and flowers of Rhododendron found in the higher altitudes of Nepal which has traditionally been used by indigenous people of Nepal especially Himalayan belt of Nepal for its medicinal properties. The cause of poisoning is the toxin called grayanotoxin which is a naturally occurring sodium channel toxin that leads to life threatening bradycardia, hypotension and altered mental status but sometime it may present with rare life threatening atrioventricular block and cardiovascular collapse. Wild honey intoxication has widely been reported from Turkey, regions around the Black sea, Austria, Korea and some cases from Nepal. Wild honey poisoning is not the uncommon presentation to emergency department of Chitwan Medical College as it is located to central part of Nepal. We report a case of wild honey poisoning who was referred to our hospital with arrhythmia and hypotension. Keywords: 2:1 Atrioventricular block, Grayanotoxin, Hypotension, Nepal, Wild honey.

scholarly journals Green Herring Syndrome: Bacterial Infection in Patients With Mucormycosis Cavitary Lung Disease

2014 ◽  
Vol 1 (1) ◽  
Author(s):  
Driele Peixoto ◽  
Sarah P. Hammond ◽  
Nicolas C. Issa ◽  
Rachna Madan ◽  
Ritu R. Gill ◽  
...  
Keyword(s):  
Bacterial Infection ◽  
Lung Disease ◽  
Hematological Malignancies ◽  
Underlying Disease ◽  
Fungal Disease ◽  
Pulmonary Mucormycosis ◽  
Uncommon Presentation ◽  
Life Threatening

Abstract Mucormycosis is a life-threatening fungal disease in patients with hematological malignancies. The diagnosis of pulmonary mucormycosis is particularly challenging. We describe 3 mucormycosis cases with an uncommon presentation in patients whose cavitary lung disease was attributed to well documented bacterial infection, although evolution and reassessment established mucormycosis as the underlying disease.

Assembly of VP26 in herpes simplex virus-1 capsid implicated by 3-D structure of recombinant capsid

1995 ◽  
Vol 53 ◽  
pp. 840-841
Author(s):  
Z. Hong Zhou ◽  
Jing He ◽  
Joanita Jakana ◽  
J. D. Tatman ◽  
Frazer J. Rixon ◽  
...  
Keyword(s):  
Herpes Simplex Virus ◽  
Herpes Simplex ◽  
3D Structure ◽  
Structure Study ◽  
Herpes Simplex Virus 1 ◽  
Shell Proteins ◽  
Life Threatening ◽  
Infected Cells ◽  
Simplex Virus ◽  
Hsv 1

Herpes simplex virus-1 (HSV-1) is a ubiquitous virus which is implicated in diseases ranging from self-curing cold sores to life-threatening infections. The 2500 Å diameter herpes virion is composed of a glycoprotein spike containing, lipid envelope, enclosing a protein layer (the tegument) in which is embedded the capsid (which contains the dsDNA genome). The B-, and A- and C-capsids, representing different morphogenetic stages in HSV-1 infected cells, are composed of 7, and 5 structural proteins respectively. The three capsid types are organized in similar T=16 icosahedral shells with 12 pentons, 150 hexons, and 320 connecting triplexes. Our previous 3D structure study at 26 Å revealed domain features of all these structural components and suggested probable locations for the outer shell proteins, VP5, VP26, VP19c and VP23. VP5 makes up most of both pentons and hexons. VP26 appeared to bind to the VP5 subunit in hexon but not to that in penton.

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