Laryngocoele causing airflow obstruction--a case report and summary of clinical manifestations in five other patients.

RESUMOIntrodução: Alergia à Proteína do Leite de Vaca (APLV) é uma doença inflamatória secundária à reação imunológica contra uma ou mais proteínas do leite de vaca (LV) que afeta principalmente a faixa pediátrica. A real prevalência é discutida em muitos estudos. As manifestações clínicas dependem do tipo da resposta imunológica, ser IgE mediada ou não. Os sintomas se iniciam por volta dos 06 meses de vida e na maioria dos casos, esse processo alérgico regride, com o paciente desenvolvendo tolerância até a adolescência. Casuística: Relata-se um caso de um paciente do sexo masculino, apresentando desde os 6 meses de idade de anafilaxia e broncoespasmo. Nesta época foi levado em hospitais e ambulatórios sendo diagnosticado e tratado como asma apenas, porém sem sucesso. Aos 18 anos, em consulta com especialista foi diagnosticado com APLV, apesar da dieta de exclusão, apresentou diversas reações anafiláticas, devido a ingestão acidental do alérgeno. Discussão: O paciente iniciou os primeiros sintomas quando houve contato com LV e apresentou teste laboratorial com valores compatíveis a patologia. Segundo a literatura a prevalência de APLV cai para menos de 1% aos 6 anos de vida e está persistência pode estar associada a múltiplos fatores, no caso relatado, o paciente não apresentou tolerância até o presente momento. Conclusão: APLV é uma doença usualmente de criança em que, se estas não adquirirem tolerância, complicações podem perdurar indefinidamente. O Diagnóstico precoce e o manejo adequado desta condição, revela grande importância na qualidade de vida e na prevenção de anafilaxia.Palavras chave: Alergia, Proteína do leite de vaca, Anafilaxia. ABSTRACT Introduction: Allergy to cow's milk (CMPA) is an inflammatory disease Introduction: Allergy to cow's milk (CMPA) is an inflammatory disease secondary to immune response against one or more cow's milk proteins (LV) which primarily affects pediatric patients. The current prevalence is discussed in many studies. The clinical manifestations depend on the type of immune response, being IgE mediated or not. Symptoms start at about 06 months of life and in most cases, the allergic process subsides, and the patient develops tolerance through adolescence. Case Report: We report the case of a male patient, who was presenting, since his 06 months of age, anaphylaxis and bronchospasm. At that time he was taken into hospitals and clinics being diagnosed and treated as asthma, but without success. At 18, in consultation with expert was diagnosed with CMPA, and despite the exclusion diet, presented several anaphylactic reactions due to accidental ingestion of the allergen. Discussion: The patient began the first symptoms when there was contact with LV and presented laboratory test values compatible with the pathology. According to the literature the prevalence of CMPA drops to less than 1% to 6 years of life and this persistence can be associated with multiple factors, in our case, the patient did not develop tolerance to date. Conclusion: CMPA is usually a child disease but ,if they do not acquire tolerance, complications can last indefinitely. Early diagnosis and appropriate management of this condition, reveals a great deal on quality of life and prevention of anaphylaxis. Keywords: Allergy, Cow’s milk protein, Anaphylaxis.

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Apresentação e Evolução Atípicas da Granulomatose de Wegener: Relato de Caso/Atypical Presentation and Evolution of Wegener's Granulomatosis: Case Report

REVISTA CIÊNCIAS EM SAÚDE ◽

10.21876/rcsfmit.v5i3.379 ◽

1970 ◽

Vol 5 (3) ◽

pp. 53-67

Author(s):

Aline Dos Santos ◽

Ana Caroline Balducci Scafi ◽

Luciene Azevedo Morais ◽

Pablo Girardelli Mendonça Mesquita

Keyword(s):

Renal Failure ◽

Renal Function ◽

Case Report ◽

Chronic Renal Failure ◽

Early Diagnosis ◽

Wegener’S Granulomatosis ◽

Immunosuppressive Treatment ◽

Clinical Manifestations ◽

Wegener's Granulomatosis ◽

Creatinine Concentration

RESUMOIntrodução: A Granulomatose de Wegener (GW) é uma vasculite rara e idiopática associada à presença do anticorpo Anticitoplasma de Neutrófilo (ANCA) que acomete, preferencialmente, os pequenos vasos. As manifestações clínicas são diversas, ocorrendo em mais de 90% dos casos, sintomas do trato respiratório. O comprometimento renal é tardio e preditor de mau prognóstico. Sua morbidade a médio e longo prazo inclui insuficiência renal crônica. A probabilidade de sucesso de manutenção da função renal depende da concentração sérica de creatinina ao início do tratamento, o que indica a importância do diagnóstico e terapêutica adequada precoces. Casuística: Relata-se o caso de uma paciente do sexo feminino, 61 anos, portadora de GW com comprometimento renal avançado à apresentação não precedido por sintomas pulmonares esperados. O tratamento imunossupressor associado a plasmaferese permitiu a melhora da função renal da paciente poupando-a de tornar-se dialítica- dependente. Discussão: A paciente iniciou a doença através de insuficiência renal assintomática, com valores de função renal compatíveis com o estágio mais avançado de doença renal crônica, ultrassonografia dos rins sem alterações compatíveis e sem os sintomas respiratórios esperados. Segundo a literatura, a combinação de imunossupressores e plasmaferese associa-se à recuperação renal em três meses com sobrevivência sem necessidade de diálise por 12 meses, no caso relatado, obteve-se tal resultado em 22 dias sem a necessidade de diálise após um ano. Conclusão: Devido ao diagnóstico precoce, o tratamento adequado foi instalado rapidamente proporcionando à paciente um aumento da expectativa e da qualidade de vida, evitando dependência de terapia renal substitutiva.Palavras-Chave: Granulomatose de Wegener, Plasmaferese, Doença renal crônica. ABSTRACTIntroduction: The Wegener's Granulomatosis (WG) is a rare and idiopathic vasculitis associated with the presence of Antineutrophil Cytoplasmic Antibody (ANCA), that affects, preferentially, the small vessels. The clinical manifestations are diverse, occurring in over 90% of cases, symptoms in the respiratory tract. Kidney damage is a late and bad prognostic predictor. Morbidity in the medium and long term includes chronic renal failure. The probability of renal function maintenance success depends on serum creatinine concentration at the beginning of treatment that indicates the importance of early diagnosis and deployment of an appropriate therapy. Case Report: We present a case of a 61-year-old female patient, carrier of GW with advanced renal impairment presentation, not preceded by expected pulmonary symptoms. The immunosuppressive treatment associated with plasmapheresis allowed the improvement of the patient’s renal function, saving her from becoming dialysis-dependent Discussion: The patient developed the disease through asymptomatic renal failure, renal function with values that are compatible with the most advanced stage of chronic kidney disease, ultrasound of the kidneys without compatible changes and without the expected respiratory symptoms. According to the literature, the combination of immunosuppressive drugs and plasmapheresis is associated with renal recovery in three months with survival without dialysis for 12 months. In this case, a result was obtained in 22 days without the need for dialysis after one year. Conclusion: Due to the early diagnosis, appropriate treatment was quickly installed giving the patient increased life expectancy and quality, preventing dependence on renal replacement therapy.Keywords: Wegener’s granulomatosis, Plasmapheresis, Chronic renal failure.

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Herpes zoster recurrence within 1 month: A case report

European Journal of Inflammation ◽

10.1177/20587392211021214 ◽

2021 ◽

Vol 19 ◽

pp. 205873922110212

Author(s):

Nan Zhao ◽

Yulan Geng ◽

Yexian Li ◽

Lijuan Liu ◽

Yanjia Li ◽

...

Keyword(s):

Flow Cytometry ◽

Case Report ◽

Herpes Zoster ◽

B Cells ◽

Varicella Zoster Virus ◽

Lower Limit ◽

Skin Disease ◽

Clinical Manifestations ◽

Varicella Zoster ◽

Humoral Immune

Herpes zoster (HZ), caused by the varicella-zoster virus, is an infectious skin disease that rarely recurs after initial presentation. The mechanism underlying HZ recurrence is currently under investigation. In this article, we report a case of HZ relapse within 1 month. Analysis of patient’s clinical manifestations, histopathological features, and flow cytometry results indicated that the absolute and percentage values of B cells were below the lower limit. We hypothesized that the patient had abnormal humoral immune function, which may be one reason leading to the HZ relapse within 1 month. The findings of this case will serve as useful reference for HZ recurrence for clinicians. This case was impactful and added to the literature on HZ recurrence.

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The Diagnosis and Clinical Manifestations of Activated Protein C Resistance: A Case Report and Review of the Literature

Vascular Medicine ◽

10.1177/1358863x9600100406 ◽

1996 ◽

Vol 1 (4) ◽

pp. 275-280 ◽

Cited By ~ 5

Author(s):

Howard Daniel Hoerl ◽

Aldo Tabares ◽

Kandice Kottke-Marchant

Keyword(s):

Case Report ◽

Protein C ◽

Activated Protein C ◽

Clinical Manifestations ◽

Factor V Leiden ◽

Laboratory Diagnosis ◽

Factor V ◽

Review Of The Literature ◽

Activated Protein C Resistance ◽

Genetic Anomaly

Activated protein C resistance (APCR) is a recently discovered, medically important cause of venous thrombosis. More than 95% of cases are due to factor V Leiden (FVL), a mutated form of factor V that is resistant to degradation by activated protein C. The prevalence of this disorder, which is inherited in an autosomal dominant fashion, is approximately 5% among asymptomatic people of European heritage. In addition, 20 to 60% of patient cohorts with previous thrombosis demonstrate APCR, making it the most common known genetic cause of abnormal thrombophilia. Current laboratory techniques available for diagnosis include functional assays, such as the APC ratio, as well as DNA-based tests that detect the specific genetic anomaly responsible for FVL. A case report is presented, along with a review of the literature highlighting epidemiology, pathogenesis, clinical features and methods for laboratory diagnosis.

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Epidermoid brain cysts: a case report and a literature review

Vestnik nevrologii, psihiatrii i nejrohirurgii (Bulletin of Neurology, Psychiatry and Neurosurgery) ◽

10.33920/med-01-2105-04 ◽

2021 ◽

pp. 358-371

Author(s):

Maksim Vladimirovich Shpagin ◽

Anton Viktorovich Yarikov ◽

Denis Nikolaevich Nikitin ◽

Igor Anatolievich Lobanov ◽

Ivan Aleksandrovich Laganin ◽

...

Keyword(s):

Case Report ◽

Literature Review ◽

Cerebellopontine Angle ◽

Clinical Manifestations ◽

Complex Treatment ◽

Brain Pathology ◽

Epidermoid Cysts ◽

Histological Picture ◽

Clinical Observations ◽

Brain Cysts

The article is devoted to rare brain pathology, i.e. epidermoid cysts. The histological picture of the tumor is described; the classification is given. On the basis of our own clinical observations and a literature review, the features of the clinical manifestations of cholesteatoma of the cerebellopontine angle, modern approaches to the diagnosis and tactics of complex treatment are presented.

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Strangulated internal hernia through the lesser omentum with intestinal necrosis: a case report

Sao Paulo Medical Journal ◽

10.1590/s1516-31802002000300006 ◽

2002 ◽

Vol 120 (3) ◽

pp. 84-86 ◽

Cited By ~ 15

Author(s):

Gustavo Gibin Duarte ◽

Belchor Fontes ◽

Renato Sérgio Poggetti ◽

Marcos Roberto Loreto ◽

Paulo Motta ◽

...

Keyword(s):

Case Report ◽

Intestinal Obstruction ◽

Internal Hernia ◽

Clinical Manifestations ◽

Acute Intestinal Obstruction ◽

Main Task ◽

Intestinal Necrosis ◽

Lesser Omentum ◽

Lesser Sac ◽

Internal Hernias

CONTEXT: Internal hernias account for only 0.2 to 0.9% of the cases of intestinal obstruction. They do not have specific clinical manifestations, and are usually diagnosed during laparotomy for acute intestinal obstruction. Internal hernias through the lesser omentum are extremely rare. CASE REPORT: We report here the case of a 36-year-old patient who underwent exploratory laparotomy for acute intestinal obstruction. An internal hernia through the lesser omentum was found, with a strangulated ileal segment passing through the perforation into an abscess within the lesser sac. The surgical procedures included ileal resection, primary anastomosis, abscess removal, and placement of a drain in the lesser sac. The patient was reoperated 6 days later for abdominal sepsis; a lesser sac abscess was removed and the abdominal incision was left open. The patient stayed in the Intensive Care Unit for 15 days, and eventually left the hospital on the 28th post-admission day, with complete recovery thereafter. CONCLUSION: The early diagnosis of acute intestinal obstruction and immediate indication for laparotomy is the main task of the surgeon when faced with a case of acute abdomen with a hypothesis of internal hernia, so as to minimize severe postoperative complications, as illustrated by the present case.

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Esophageal Variceal Bleeding as the First Manifestation of COVID-19 Infection: A Case Report

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol07-i01/1326 ◽

2022 ◽

Vol 7 (01) ◽

pp. 41-45

Author(s):

Christos Sotiropoulos, MD, MSc ◽

Eftichia Sakka, MD ◽

Georgios Theocharis, MD, PhD ◽

Konstantinos Thomopoulos, MD, PhD

Keyword(s):

Liver Cirrhosis ◽

Case Report ◽

Variceal Bleeding ◽

Clinical Manifestations ◽

Polymerase Chain Reaction Test ◽

Variceal Hemorrhage ◽

Esophageal Variceal ◽

Esophageal Variceal Bleeding ◽

Wide Range ◽

Upper Gastrointestinal

Liver cirrhosis is a defined liver disease with a wide range of clinical manifestations. Variceal bleeding is the main source of gastrointestinal hemorrhage among cirrhotic patients induced by several factors, such as alcohol consumption or infections. This is a report of a cirrhotic patient presenting with esophageal variceal bleeding in the context of COVID-19 infection. We report the case of a 53-year-old patient with liver cirrhosis and multifocal hepatocellular carcinoma presenting with upper gastrointestinal bleeding as the first manifestation of COVID-19 infection. Upon admission, the patient had no symptoms suggestive of a respiratory tract infection or any contact with positive SARS-CoV-2 individual and upper gastrointestinal endoscopy revealed variceal hemorrhage. After a few hours the patient manifested with fever, cough and dyspnea and a SARS-CoV-2 polymerase chain reaction test obtained was positive. The patient was initially treated with endoscopic band ligation and transferred in the COVID-19 infection clinic, where after a few days of hospitalization he passed away. The devastating pandemic of coronavirus disease 2019 had altered the pathophysiology and clinical presentation of several chronic diseases. This case report suggests that coronavirus disease as a potential triggering factor of variceal bleeding.

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Ornidazole-Induced Recurrent Encephalopathy in a Chinese Man: A Rare Case Report and Literature Review

Frontiers in Neurology ◽

10.3389/fneur.2021.706094 ◽

2021 ◽

Vol 12 ◽

Author(s):

Rong Tang ◽

Jia Liang ◽

Yuanfang Li ◽

Tingting Wu ◽

Yuhao Zhang ◽

...

Keyword(s):

Case Report ◽

Literature Review ◽

Corpus Callosum ◽

Cerebellar Ataxia ◽

Drug Withdrawal ◽

Clinical Manifestations ◽

Good Prognosis ◽

Drug Discontinuation ◽

Imaging Features ◽

Mental Symptoms

Ornidazole-induced encephalopathy (OIE) is seldom seen in the clinic. In this study, we report a new case of a patient who had taken 1,000 mg ornidazole daily for nearly 4 years because of suspected diarrhea and proctitis and presented with subacute symptoms such as unsteady gait, slurred speech, and psychiatric disorder. These symptoms were significantly relieved 3 days after the patient stopped taking ornidazole. When he took this medicine again, however, similar symptoms occurred 4 months later, which were again reduced after 4 days of drug discontinuation. After the second onset, abnormal signals were identified around the aqueduct of the midbrain, around the fourth ventricle, and in the dentate nuclei of the cerebellum bilaterally. After 9 days of drug discontinuation, lesions disappeared in the magnetic resonance imaging (MRI) results. According to the clinical manifestations, imaging features, and the reduced symptoms after drug withdrawal, we clinically diagnosed the patient with OIE. This paper also reviews the literature on OIE. Only five cases (including our case) have been reported, all of whom presented with cerebellar ataxia and dysarthria and three with additional mental symptoms such as agitation and irritability. All five patients had abnormal lesions in the dentate nucleus of the cerebellum bilaterally, among whom four also had lesions in the corpus callosum and three around the periaqueduct of the midbrain. After withdrawal of ornidazole, the symptoms in all patients vanished or were alleviated, and three of them showed reduced or disappeared lesions in a head MRI reexamination. Overall, OIE has rarely been reported. Our case report and literature review show that the lesions in the cerebellum, corpus callosum, and brainstem can be reversed. The main manifestations of the lesions—cerebellar ataxia, dysarthria, and mental symptoms—quickly weaken or disappear after drug withdrawal, with good prognosis. Nevertheless, clear pathogenesis has yet to be further investigated.

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Bilateral temporal bone fractures: a case report

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20175640 ◽

2017 ◽

Vol 4 (1) ◽

pp. 271

Author(s):

Kiran Natarajan ◽

Koka Madhav ◽

A. V. Saraswathi ◽

Mohan Kameswaran

Keyword(s):

Hearing Loss ◽

Case Report ◽

Facial Nerve ◽

Temporal Bone ◽

Facial Paralysis ◽

Bone Fractures ◽

Clinical Manifestations ◽

Csf Leak ◽

The Right ◽

Temporal Bones

<p>Bilateral temporal bone fractures are rare; accounting for 9% to 20% of cases of temporal bone fractures. Clinical manifestations include hearing loss, facial paralysis, CSF otorhinorrhea and dizziness. This is a case report of a patient who presented with bilateral temporal bone fractures. This is a report of a 23-yr-old male who sustained bilateral temporal bone fractures and presented 18 days later with complaints of watery discharge from left ear and nose, bilateral profound hearing loss and facial weakness on the right side. Pure tone audiometry revealed bilateral profound sensori-neural hearing loss. CT temporal bones & MRI scans of brain were done to assess the extent of injuries. The patient underwent left CSF otorrhea repair, as the CSF leak was active and not responding to conservative management. One week later, the patient underwent right facial nerve decompression. The patient could not afford a cochlear implant (CI) in the right ear at the same sitting, however, implantation was advised as soon as possible because of the risk of cochlear ossification. The transcochlear approach was used to seal the CSF leak from the oval and round windows on the left side. The facial nerve was decompressed on the right side. The House-Brackmann grade improved from Grade V to grade III at last follow-up. Patients with bilateral temporal bone fractures require prompt assessment and management to decrease the risk of complications such as meningitis, permanent facial paralysis or hearing loss. </p>

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