scholarly journals A Rare Case of Acute Renal Failure Secondary to Rhabdomyolysis Probably Induced by Donepezil

2014 ◽  
Vol 2014 ◽  
pp. 1-3
Author(s):  
Osman Zikrullah Sahin ◽  
Teslime Ayaz ◽  
Suleyman Yuce ◽  
Fatih Sumer ◽  
Serap Baydur Sahin
Keyword(s):  
Emergency Department ◽  
Renal Failure ◽  
Creatine Kinase ◽  
Acute Renal Failure ◽  
Rare Case ◽  
Laboratory Studies ◽  
Case Presentation ◽  
History Of ◽  
One Year ◽  
Renal Function Tests

Introduction. Acute renal failure (ARF) develops in 33% of the patients with rhabdomyolysis. The main etiologic factors are alcoholism, trauma, exercise overexertion, and drugs. In this report we present a rare case of ARF secondary to probably donepezil-induced rhabdomyolysis.Case Presentation. An 84-year-old male patient was admitted to the emergency department with a complaint of generalized weakness and reduced consciousness for two days. He had a history of Alzheimer’s disease for one year and he had taken donepezil 5 mg daily for two months. The patient’s physical examination revealed apathy, loss of cooperation, and decreased muscle strength. Laboratory studies revealed the following: urea: 128 mg/dL; Creatinine 6.06 mg/dL; creatine kinase: 3613 mg/dL. Donepezil was discontinued and the patient’s renal function tests improved gradually.Conclusion. Rhabdomyolysis-induced acute renal failure may develop secondary to donepezil therapy.

scholarly journals Bilateral Foot Skin Eruption in a Hepatitis C Patient

2020 ◽  
Vol 4 (3) ◽  
pp. 491-492
Author(s):  
Shane Davis ◽  
Angela Creditt
Keyword(s):  
Emergency Department ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Skin Eruption ◽  
Zinc Supplementation ◽  
Case Presentation ◽  
Acral Erythema ◽  
History Of ◽  
Necrolytic Acral Erythema ◽  
One Year

Case Presentation: A 58-year-old female with history of hepatitis C virus presented to the emergency department with a bilateral skin eruption to her feet for one year. Following skin biopsy, the patient was diagnosed with Necrolytic acral erythema (NAE). She was treated with clobetasol ointment, zinc supplementation, and mupirocin, which resulted in improvement in her symptoms. Discussion: NAE is a rash described as sharply demarcated, lichenified plaques on the dorsal foot and is a rare extra-hepatic manifestation of hepatitis C. This case details a patient with a skin eruption consistent with NAE.

scholarly journals Dantrolene for the treatment of MDMA toxicity

CJEM ◽  
2010 ◽  
Vol 12 (05) ◽  
pp. 457-459 ◽  
Author(s):  
Brian E. Grunau ◽  
Matthew O. Wiens ◽  
Marc Greidanus
Keyword(s):  
Emergency Department ◽  
Mechanical Ventilation ◽  
Renal Failure ◽  
Creatine Kinase ◽  
Acute Renal Failure ◽  
Case Report ◽  
Acute Illness ◽  
Primary Role ◽  
Appetite Suppressant ◽  
Level Of Consciousness

ABSTRACTMDMA (3,4-methylenedioxymethamphetamine), popularly known as “Ecstasy,” was first introduced and patented by Merck & Co., Inc., in 1914 as an appetite suppressant. Currently, its primary role is as an illegal stimulant used to produce a euphoric effect during parties. This case report describes a 31-year-old man who, after taking 3 tablets of Ecstasy, presented to an emergency department with a decreased level of consciousness and became progressively hyperthermic and rigid. During the course of his acute illness, his temperature reached 42.2°C rectally. He was given mechanical ventilation. He was aggressively cooled and dantrolene was initiated. Soon after the administration of dantrolene his temperature decreased and his rigidity began to resolve. The only complication was rhabdomyolysis with a creatine kinase level increasing to over 150 μkat/L. This did not progress to acute renal failure. The patient made a full recovery and was discharged to psychiatry for assessment.

scholarly journals MON-369 Calcium Gone Crazy: Recurrent Hypercalcemia in Patient with History of Hypoparathyroidism

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Omer H Tarar ◽  
Ambika Rao
Keyword(s):  
Atrial Fibrillation ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Kidney Disease ◽  
Calcium Excretion ◽  
Calcium Balance ◽  
Case Presentation ◽  
Calcium Supplements ◽  
Safety Mechanism ◽  
History Of

Abstract Introduction Patients with post-operative hypoparathyroidism mostly require Calcium supplements and Calcitriol with goal of maintaining calcium levels in low normal range. However, calcium balance can further be dysregulated by other factors including renal failure in patients with otherwise stable levels. We present a case of recurrent symptomatic hypercalcemia leading to multiple hospital visits in a patient with otherwise stable longstanding post-operative hypoparathyroidism that was precipitated after episode of Acute Renal Failure. Case Presentation 71 Year old male with past medical history of Atrial fibrillation, Hypertension, Primary Hyperparathyroidism status post Parathyroidectomy (Parathyroid hyperplasia with removal of 3/12 glands) in 2003 with subsequent Hypoparathyroidism presented with lethargy and confusion few days after cardioversion attempt for atrial fibrillation. He was noted to have bradycardia and hypotension post procedure which improved subsequently. His medications included Calcitriol 0.25 mcg twice daily and Calcium Carbonate 1.25 grams twice daily. His Calcium had remained stable over the years on this regimen. On presentation, he was found to have elevated corrected calcium of 12.5 mg/dl and Acute Renal failure with Creatinine of 8.3 mg/dl which was normal 1 week prior. He underwent hydration and subsequently required few sessions of hemodialysis with improvement in kidney function and further hemodialysis was not needed. On discharge his corrected calcium was 8.6 mg/dl and Creatinine was 3.9 mg/dl. His Calcitriol and Calcium were resumed on discharge. However, 3 weeks later he presented again with lethargy and calcium was again elevated at 14.8 mg/dl. All other workup for hypercalcemia including PTHRP, Bone marrow biopsy, Serum electrophoresis were negative. Subsequently, he had 2 more admissions for hypercalcemia and 1 admission for hypocalcemia within 1 month. Finally his calcium levels stabilized with reduced dose of Calcitriol and Calcium with close weekly monitoring initially as outpatient. Discussion In advancing kidney disease, the kidneys are no longer able to increase urine calcium excretion, and this removes an important safety mechanism to prevent calcium excess in patients with Chronic kidney disease. In patients with hypoparathyroidism on Calcitriol and Calcium supplements, renal failure may offset the calcium balance leading to dysregulation and erratic levels with increased tendency towards hypercalcemia. Conclusion Acute Renal Failure may lead to hypercalcemia in patients with otherwise stable levels. However, limited understanding of calcium balance/ regulation in renal failure, especially in setting of hypoparathyroidism further complicates the situation and may lead to difficult titration of medications.

A Rare Case of Bilateral Incarcerated Obturator Hernias and a Right-Side Femoral Hernia

2020 ◽  
pp. 1-3
Author(s):  
Jinping Xu ◽  
Jinping Xu ◽  
Ruth Wei ◽  
Salieha Zaheer
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Femoral Hernia ◽  
Rare Case ◽  
Hernia Recurrence ◽  
High Morbidity ◽  
Diagnostic Challenge ◽  
Abdominal Ct ◽  
Abdominal Ct Scan ◽  
History Of

Obturator hernias are rare but pose a diagnostic challenge with relatively high morbidity and mortality. Our patient is an elderly, thin female with an initial evaluation concerning for gastroenteritis, and further evaluation revealed bilateral incarcerated obturator hernias, which confirmed postoperatively as well as a right femoral hernia. An 83-year-old female presented to the outpatient office initially with one-day history of diarrhea and one-week history of episodic colicky abdominal pain. She returned 4 weeks later with diarrhea resolved but worsening abdominal pain and left inner thigh pain while ambulating, without changes in appetite or nausea and vomiting. Abdominal CT scan then revealed bilateral obturator hernias. Patient then presented to the emergency department (ED) due to worsening pain, and subsequently underwent hernia repair. Intraoperatively, it was revealed that the patient had bilateral incarcerated obturator hernias and a right femoral hernia. All three hernias were repaired, and patient was discharged two days later. Patient remained well postoperatively, and 15-month CT of abdomen showed no hernia recurrence.

scholarly journals A case of sigmoid volvulus in an unexpected demographic

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Mohammad Saba ◽  
Joshua Rosenberg ◽  
Gregory Wu ◽  
Gudata Hinika
Keyword(s):  
Abdominal Pain ◽  
Severe Pain ◽  
Rare Case ◽  
Young Female ◽  
Sigmoid Volvulus ◽  
Case Presentation ◽  
Operative Complications ◽  
History Of ◽  
Male Sex ◽  
Emergent Laparotomy

Abstract Background A sigmoid volvulus occurs when a segment of the colon twists upon its mesentery. This infliction is associated with old age, multiple co-morbidities, and the male sex. We present a rare case of sigmoid volvulus that occurred in a healthy young female. Case presentation A 28-year-old female presented with a one week history of constipation and abdominal pain. Her symptoms suddenly worsened and became associated with vomiting and severe pain. A focused history taking and physical examination showed peritoneal signs that led to timely diagnostic imaging to be implemented. Computed tomography (CT) of the abdomen was consistent with sigmoid volvulus. Our patient underwent emergent laparotomy with a sigmoidectomy and recovered with no post-operative complications. Conclusion This case report emphasizes the importance of clinicians maintaining a sigmoid volvulus as a rare, yet important differential when approaching abdominal pain in young healthy patients.

scholarly journals Left-Sided Bochdalek's Hernia in a Young Adult: A Case Report and Literature Review

2021 ◽  
Vol 07 (03) ◽  
pp. e124-e126
Author(s):  
Mark Portelli ◽  
Mark Bugeja ◽  
Charles Cini
Keyword(s):  
Computed Tomography ◽  
Young Adult ◽  
Rare Case ◽  
Surgical Repair ◽  
Bochdalek Hernia ◽  
Case Presentation ◽  
Atypical Case ◽  
Accident And Emergency ◽  
History Of ◽  
Accident And Emergency Department

Abstract Purpose Bochdalek's hernia is a type of congenital diaphragmatic hernia occurring secondary to a defect in the posterior attachment of diaphragm. This condition commonly presents with respiratory insufficiency in infants. To date, there are less than 100 cases of Bochdalek's hernia presenting in adults published in the literature. The mainstay treatment of Bochdalek's hernia involves reduction of hernial contents back into the peritoneal cavity with a tensionless graft repair closing the diaphragmatic defect. Case Presentation We present an atypical case of the Bochdalek hernia presenting in a previously healthy 16-year-old male who presented to the Accident and Emergency department with a 2-day history of dysphagia and loss of breath. The Bochdalek hernia was confirmed on computed tomography (CT) imaging and the patient underwent surgical repair with Gore-Tex mesh. Conclusion The report shows a rare case of the Bochdalek hernia in a young adult, successfully managed with a laparotomy.

scholarly journals Cutaneous mucinosis of infancy: a rare case of joint involvement

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Cristina Morreale ◽  
Dario Bleidl ◽  
Angela Rita Sementa ◽  
Clara Malattia
Keyword(s):  
Rare Case ◽  
Steroid Injection ◽  
Left Knee ◽  
Joint Involvement ◽  
Normal Range ◽  
Reticular Dermis ◽  
Case Presentation ◽  
Left Elbow ◽  
Inflammatory Drugs ◽  
One Year

Abstract Background Primary cutaneous mucinosis are a heterogeneous group of diseases characterized by the deposition of glycosaminoglycans in the dermis and the follicles. These diseases are rare in children therefore their diagnosis and management are still challenging. Joint involvement has been reported in patients with secondary cutaneous mucinosis and, rarely, in primary mucinosis. We describe a case of Cutaneous Mucinosis of Infancy with joint involvement. Case presentation An healthy 5-year-old boy showed acute arthritis of the left knee and left elbow confirmed by ultrasound. Laboratory tests were within normal range. Symptoms disappeared after a course of nonsteroid anti-inflammatory drugs. One year later, the knee swelling reappeared; juvenile idiopathic arthritis was diagnosed and intra-articular steroid injection was performed. Due to persistence of arthritis of the knee he was admitted to our hospital. On physical examination variable skin-colored lesions were observed, which had been in existence for over 2 years. We performed a skin biopsy that showed an interstitial mucine deposition in the reticular dermis. Cutaneous Mucinosis of Infancy was diagnosed. Discussion and conclusions Cutaneous Mucinosis of Infancy is a persistent dermatosis with benign prognosis and no treatment is generally required. Our case report is particularly interesting because it is the first in which joint involvement has been reported in CMI, a disorder that has so far been described as limited to skin involvement. Further studies will be necessary in order to clarify the pathogenesis of joint involvement in primary mucinosis.

scholarly journals Recurrent noncirrhotic hyperammonemia causing acute metabolic encephalopathy in a patient with a continent ileocecal pouch: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
T. M. Skipina ◽  
S. Macbeth ◽  
E. L. Cummer ◽  
O. L. Wells ◽  
S. Kalathoor
Keyword(s):  
Emergency Department ◽  
Metabolic Acidosis ◽  
Mental Status ◽  
Rare Case ◽  
Liver Function Tests ◽  
Altered Mental Status ◽  
Potassium Citrate ◽  
Metabolic Encephalopathy ◽  
History Of ◽  
Normal Urine

Abstract Introduction Acute encephalopathy, while a common presentation in the emergency department, is typically caused by a variety of metabolic, vascular, infectious, structural, or psychiatric etiologies. Among metabolic causes, hyperammonemia is relatively common and typically occurs in the setting of cirrhosis or liver dysfunction. However, noncirrhotic hyperammonemia is a rare occurrence and poses unique challenges for clinicians. Case presentation Here we report a rare case of a 50-year-old Caucasian female with history of bladder cancer status post chemotherapy, radical cystectomy, and ileocecal diversion who presented to the emergency department with severe altered mental status, combativeness, and a 3-day history of decreased urine output. Her laboratory tests were notable for hyperammonemia up to 289 μmol/L, hypokalemia, and hyperchloremic nonanion gap metabolic acidosis; her liver function tests were normal. Urine cultures were positive for Enterococcus faecium. Computed tomography imaging showed an intact ileoceal urinary diversion with chronic ileolithiasis. Upon administration of appropriate antibiotics, lactulose, and potassium citrate, she experienced rapid resolution of her encephalopathy and a significant reduction in hyperammonemia. Her hyperchloremic metabolic acidosis persisted, but her hypokalemia had resolved. Conclusion This case is an example of one of the unique consequences of urinary diversions. Urothelial tissue is typically impermeable to urinary solutes. However, when bowel segments are used, abnormal absorption of solutes occurs, including exchange of urinary chloride for serum bicarbonate, leading to a persistent hyperchloremic nonanion gap metabolic acidosis. In addition, overproduction of ammonia from urea-producing organisms can lead to abnormal absorption into the blood and subsequent oversaturation of hepatic metabolic capacity with consequent hyperammonemic encephalopathy. Although this is a rare case, prompt identification and treatment of these metabolic abnormalities is critical to prevent severe central nervous system complications such as altered mental status, coma, and even death in patients with urinary diversions.

Primary B-cell lymphoma presenting as bilateral ear lobule swelling

2007 ◽  
Vol 121 (12) ◽  
pp. 1207-1209 ◽  
Author(s):  
A K Sharma ◽  
S Chatterjee ◽  
V L Sharma
Keyword(s):  
B Cell ◽  
Rare Case ◽  
Cell Lymphoma ◽  
English Literature ◽  
B Cell Lymphoma ◽  
Excision Biopsy ◽  
History Of ◽  
One Year

AbstractWe report a rare case of primary B-cell lymphoma presenting as bilateral ear lobule swelling. A 56-year-old white man presented with a one-year history of painless swelling of both ear lobules. An excision biopsy confirmed B-cell lymphoma. Detailed systemic investigation confirmed the primary nature of the tumour. This tumour is rare in the ear lobule. A review of the English literature revealed no previously reported case of bilateral primary ear lobule involvement. Clinicians should be aware that this tumour can present as a primary in the ear lobules.

scholarly journals Seven-Digit Creatine Kinase in Acute Rhabdomyolysis in a Child

2017 ◽  
Vol 4 ◽  
pp. 2329048X1668439 ◽  
Author(s):  
Nuha Basheer ◽  
Sirin Mneimneh ◽  
Mariam Rajab
Keyword(s):  
Renal Failure ◽  
Creatine Kinase ◽  
Acute Renal Failure ◽  
Creatine Kinase Level ◽  
Peak Plasma ◽  
Renal Dialysis ◽  
Acute Rhabdomyolysis ◽  
Threatening Condition ◽  
Life Threatening ◽  
Plasma Creatine Kinase

Rhabdomyolysis is an acute life-threatening condition that can occur in childhood secondary to many causes. The authors report the case of a 3-year-old male child who presented with acute rhabdomyolysis. The peak plasma creatine kinase level was extremely high. The 2 main causes of rhabdomyolysis in childhood are viral myositis and trauma, which can sometimes lead to acute renal failure. The highest creatine kinase levels reported in the literature so far was a 6-digit level in 2014 case report. In this study, the authors report the case of a 7-digit creatine kinase level in a child secondary to viral myositis who did not require renal dialysis.

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