scholarly journals Glycosylated haemoglobin: a false sense of security

2018 ◽  
Vol 11 (1) ◽  
pp. e227668
Author(s):  
Emily Finan ◽  
Joe Joseph
Keyword(s):  
Unusual Case ◽  
Hereditary Spherocytosis ◽  
Reticulocyte Count ◽  
Blood Film ◽  
Glycosylated Haemoglobin ◽  
Sense Of Security ◽  
Peripheral Blood Film ◽  
False Sense ◽  
History Of

We report the unusual case of a patient found to have a low glycosylated haemoglobin (HbA1c) despite having recently been diagnosed with diabetes mellitus type 2. The patient, who was not anaemic, with no symptoms or family history of haematological conditions, was subsequently found to have an elevated reticulocyte count, inferring increased red cell turnover as the culprit for the discordant HbA1c result. A diagnosis of hereditary spherocytosis was made based on characteristic peripheral blood film appearances and confirmed by eosin-5-maleimide binding test. Exposure of an undiagnosed haemolytic anaemia by virtue of a low HbA1c is uncommon. However, conditions that distort HbA1c measurements are not infrequent. This case should serve to remind clinicians of the limitations of HbA1c in specified situations, and to remain vigilant when interpreting results.

Cutibacterium acnes sternoclavicular joint osteomyelitis in an otherwise healthy 55-year-old man

2021 ◽  
Vol 14 (7) ◽  
pp. e241778
Author(s):  
Sean Yaphe ◽  
Kemal Bahcheli
Keyword(s):  
Unusual Case ◽  
Left Knee ◽  
Sternoclavicular Joint ◽  
Joint Injection ◽  
Cutibacterium Acnes ◽  
History Of ◽  
Haematogenous Spread ◽  
Body Joint ◽  
Full Body

Sternoclavicular joint osteomyelitis is extremely rare, with only 225 reported cases in the last 45 years. We present an unusual case in an otherwise healthy 55-year-old man with a history of well-controlled type 2 diabetes mellitus and hypertension. He presented to the emergency department after a week of left knee pain that worsened to full-body joint pain with left sternoclavicular swelling. He was started on antibiotics with multiple washouts of the left knee and treated for septic arthritis. By MRI and CT, he was found to have left sternoclavicular joint osteomyelitis and abscess and underwent debridement and resection. We believe that the initial joint injection resulted in haematogenous spread to the left sternoclavicular joint, stressing the importance of a sterile field for joint procedures.

scholarly journals Unusual presentations of a severe type 2 leprosy reaction mimicking sepsis induced by helminth infection

2021 ◽  
Vol 15 (7) ◽  
pp. e0009453
Author(s):  
Sri Linuwih Menaldi ◽  
Anastasia Asylia Dinakrisma ◽  
Hok Bing Thio ◽  
Iris Rengganis ◽  
Salma Oktaria
Keyword(s):  
Septic Shock ◽  
Unusual Case ◽  
Helminth Infection ◽  
Endoscopic Examination ◽  
Course Of Illness ◽  
Source Of Infection ◽  
Helminth Infections ◽  
History Of ◽  
Severe Type

We describe an unusual case of type 2 leprosy reaction (T2R) with septic shock–like features induced by helminth infection in a 31-year-old Moluccan male patient with a history of completed treatment of WHO multidrug therapy (MDT)–multibacillary (MB) regimen 2 years before admission. During the course of illness, the patient had numerous complications, including septic shock, anemia, and disseminated intravascular coagulation (DIC). Nevertheless, antibiotic therapies failed to give significant results, and the source of infection could not be identified. Helminth infection was subsequently revealed by endoscopic examination followed by parasitological culture. Resolution of symptoms and normal level of organ function–specific markers were resolved within 3 days following anthelmintic treatment. This report demonstrated the challenge in the diagnosis and treatment of severe T2R. Given that helminth infections may trigger severe T2R that mimics septic shock, health professionals need to be aware of this clinical presentation, especially in endemic regions of both diseases.

Primary lung abscess due to multidrug-resistant Klebsiella pneumoniae

2021 ◽  
Vol 14 (9) ◽  
pp. e244759
Author(s):  
Mascarenhas Chrystle ◽  
Acharya Vishak ◽  
Kamath Sindhu ◽  
Mendonca Jane
Keyword(s):  
Klebsiella Pneumoniae ◽  
Unusual Case ◽  
Early Recognition ◽  
Multidrug Resistant ◽  
Community Acquired Pneumonia ◽  
Lung Abscess ◽  
Drug Resistant ◽  
Management Guidelines ◽  
History Of

Primary lung abscess as a complication of necrotising community-acquired pneumonia due to multidrug-resistant (MDR) Klebsiella pneumoniae is rare. A 63-year-old man with a medical history of type 2 diabetes mellitus and chronic kidney disease was diagnosed with lung abscess due to MDR Klebsiella pneumoniae, a rare organism as a causative agent for community-acquired pneumonia. This unusual case revealed therapeutic challenges faced owing to factors such as drug-resistant pathogen, longer duration of antibiotics required for lung abscess and the chronic kidney status of the patient limiting the dosage of antibiotics. The clinical nuggets discussed in this case might pave the way in the future for management guidelines to be formulated in optimising the selection and duration of therapy for lung abscesses with MDR aetiology and in early recognition of this rare but dreaded entity.

scholarly journals A Case of Gilbert’s Syndrome

1970 ◽  
Vol 19 (1) ◽  
pp. 67-68
Author(s):  
A Wazib ◽  
MZ Hossain ◽  
JK Saha ◽  
KA Al-Mamun ◽  
SB Shahid ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Serum Albumin ◽  
Prothrombin Time ◽  
Peripheral Blood ◽  
Reticulocyte Count ◽  
Serum Alkaline Phosphatase ◽  
Blood Film ◽  
Gilbert’S Syndrome ◽  
Gilbert's Syndrome ◽  
Peripheral Blood Film

A middle aged lady presented with recurrent jaundice with normal SGPT, serum alkaline phosphatase, serum albumin and prothrombin time. Haemolysis was excluded by normal haemoglobin, peripheral blood film and reticulocyte count and finally she was diagnosed to have Gilbert's syndrome. Key words: Gilbert's Syndrome; Hyperbilirubinaemia. DOI: 10.3329/jdmc.v19i1.6257 J Dhaka Med Coll. 2010; 19(1) : 67-68.

scholarly journals Hereditary Spherocytosis in a 22 Month Old Child

2018 ◽  
Vol 30 (2) ◽  
pp. 79-82
Author(s):  
Mst Musarrat Sultana ◽  
Md Shafiqul Islam ◽  
Md Sanaul Haque Mia
Keyword(s):  
Family History ◽  
Hereditary Spherocytosis ◽  
Positive Family History ◽  
Osmotic Fragility ◽  
Blood Film ◽  
College Hospital ◽  
Negative Family History ◽  
Medical College ◽  
Antiglobulin Test ◽  
History Of

Hereditary spherocytosis (HS) is a familial hemolytic disorder with marked heterogeneity of clinical features, ranging from asymptomatic condition to a fulminant hemolytic anemia. Although a positive family history of spherocytosis increases the risk for this disorder, it may be sporadic in some case. A 22-month old girl was admitted in Rajshahi Medical College Hospital with pallor and jaundice. Her parents gave history of repeated episodes of pallor and jaundice since 8 month of age with negative family history. Blood film showed plenty of spherocytes, reticulocytosis of 15.0%, negative direct antiglobulin test& positive osmotic fragility test. She was managed conservatively on nutritional supplements& one unit of blood transfusion. To the best of our knowledge, this is the first reported case of hereditary spherocytosis from Rajshahi Medical College Hospital.TAJ 2017; 30(2): 79-82

The Therapist’s Duty to Protect Victims of Domestic Violence: Where We Have Been and Where We Are Going

1986 ◽  
Vol 1 (3) ◽  
pp. 205-214 ◽  
Author(s):  
Daniel Jay Sonkin ◽  
Jean E. Ellison
Keyword(s):  
Domestic Violence ◽  
Family Violence ◽  
Clinical Response ◽  
Court Decisions ◽  
Violence Prediction ◽  
Sense Of Security ◽  
False Sense ◽  
History Of ◽  
Duty To Protect ◽  
Verbal Threat

After ten years of court decisions that have gradually broadened the scope of the psychotherapist’s duty to protect potential victims from violence, California has recently passed legislation that limits liability only to those cases where a patient has made a specific threat to an identifiable victim. Although this legislation has articulated the appropriate clinical response in such situations, it may have created a false sense of security for therapists treating patients who are perpetrators or victims of family violence. Though some perpetrators of violence do make a specific verbal threat, therapists are likely to encounter many more who do not verbalize a threat, but nevertheless pose a serious danger to their family members. This article briefly discusses the recent history of the duty-to-protect issue and the violence prediction literature as they relate to domestic violence. Specific interventions are suggested for clinicians in cases where the violence potential is great but no specific threat is made by the client.

scholarly journals Pancytopenia with Hyperpigmentation – Fanconi Anaemia : A Case Report

2018 ◽  
Vol 25 ◽  
pp. 84-86
Author(s):  
MB Uddin ◽  
J Ferdous ◽  
KI Jahan ◽  
MH Tarafder ◽  
F Zaman ◽  
...  
Keyword(s):  
Fanconi Anemia ◽  
Autosomal Recessive ◽  
Age Of Onset ◽  
Autosomal Recessive Disorder ◽  
Blood Film ◽  
Fanconi Anaemia ◽  
Café Au Lait Spots ◽  
Peripheral Blood Film ◽  
History Of ◽  
Bone Marrow Study

Fanconi Anemia (FA) is a rare autosomal recessive disorder associated with pancytopenia, spontaneous chromosomal instability and a variety of congenital anomalies. A variable phenotype and age of onset of anemia makes the diagnosis difficult in some cases. We report a case of Fanconi anemia who had triangular facies, hyperpigmentation, a few café-au-lait spots, microcephaly and short stature. Peripheral blood film showed pancytopenia, bone marrow study revealed aplasia and the patient had history of sibling (elder brother) death from same problem consistent with Fanconi anaemia.TAJ 2012; 25: 84-86

scholarly journals Adult Type Chronic Myeloid Leukaemia in An 11 Year Old Girl- A Very Unusual Case Report

2015 ◽  
Vol 25 (2) ◽  
pp. 72-75
Author(s):  
Homayra Tahseen Hossain ◽  
Quazi Tarikul Islam ◽  
Munshi MB Md Shoaib Adnan ◽  
Md Abul Kashem Khandaker
Keyword(s):  
Chronic Myeloid Leukaemia ◽  
Myeloid Leukaemia ◽  
Unusual Case ◽  
Philadelphia Chromosome ◽  
Blood Film ◽  
Biological Behavior ◽  
Adult Type ◽  
Juvenile Type ◽  
Peripheral Blood Film ◽  
Unusual Case Report

Chronic Myeloid Leukaemia is very uncommon in children. It accounts for 2 to 5% of all the childhood leukaemias. The incidence is < 1 case per 1,00,000 population in younger than 20 years of age per year. Two distinct forms have been described- namely the Juvenile and Adult type. Absence of Philadelphia chromosome is the hallmark of Juvenile type CML ( JCML). Adult type CML is extremely rare in childhood. Here, we report one such a case of adult type of CML in an 11 year old girl who presented to us with pallor, fever and hepato-splenomegaly. At presentation, it seems to be a case of Visceral Leishmaniasis. But, peripheral blood film and bone marrow features were consistent with CML. Philadelphia chromosome was positive. Though biological behavior and prognosis are identical to that of adult CML, we are reporting this case because of its extremely uncommon incidence.Bangladesh J Medicine Jul 2014; 25 (2) : 72-75

scholarly journals An Unusual Case of Drug-Induced Acute Pancreatitis

2016 ◽  
Vol 30 (1&2) ◽  
pp. 26
Author(s):  
Andrea Vo ◽  
Stanley Yakubov ◽  
Colleen Smith ◽  
Mark Tratenberg ◽  
Elizabeth Sedlis-Singer ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Rare Case ◽  
Unusual Case ◽  
Causal Link ◽  
Drug Induced ◽  
Antidiabetic Therapy ◽  
Patient Reported ◽  
History Of ◽  
Relationship Of

We report a rare case of drug-induced pancreatitis in a patient receiving repaglinide antidiabetic therapy. A patient with type 2 diabetes mellitus presented with severe abdominal cramping, nausea, and vomiting. Three months prior to symptoms, repaglinide was added to the patient’s current regimen of metformin. The patient was diagnosed with acute pancreatitis, treatment was initi- ated, and repaglinide was discontinued. There was no history of pancreatitis or other risk factors such as history of gallstones, alcohol abuse, or hypertriglyceridemia. The patient reported resolution of symptoms following discontinuation of repaglinide. Considering the temporal relationship of his symptoms to the addition of repaglinide to his existing antidiabetic regimen, this case strongly suggests a possible causal link between repaglinide and the etiology of acute pancreatitis in this patient. 

scholarly journals And the Oscar goes to peripheral blood film for detection of lead poisoning in a complicated toxic patient: A case report with review of laboratory clues

2021 ◽  
Author(s):  
Amir Zamani ◽  
Ehsan Sarraf Kazerooni ◽  
S Saeed Kasaee ◽  
Mohammad Hossein Anbardar ◽  
Sahand Mohammadzadeh ◽  
...  
Keyword(s):  
Case Report ◽  
Lead Poisoning ◽  
Peripheral Blood ◽  
Screening Test ◽  
Blood Film ◽  
Marijuana Abuse ◽  
Peripheral Blood Film ◽  
History Of

PBS provides the hematologic and/or non-hematologic picture of a case.A 40-year-old man with history of alcohol and marijuana abuse presented with extremities and abdominal pain.After extensive investigations, finding basophilic stippling on PBS led to the diagnosis of lead poisoning.PBS is the simplest screening test which provide rich morphological information.

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