scholarly journals A Case of Anterior Spinal Artery Syndrome Caused by Streptococcus mitis Endocarditis

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Aria Mahtabfar ◽  
Hamoon Eshraghi ◽  
Melroy D’Souza ◽  
William Berrigan ◽  
Kathleen Casey
Keyword(s):  
Heart Valves ◽  
Vital Signs ◽  
Anterior Spinal Artery ◽  
Prosthetic Heart Valves ◽  
Streptococcus Mitis ◽  
Anterior Spinal Artery Syndrome ◽  
History Of ◽  
The Right ◽  
High Index Of Suspicion ◽  
Spine Mri

Background. Infectious endocarditis (IE) typically occurs in the setting of intravenous drug use, prosthetic heart valves, or rheumatic heart disease. However, there are a few reports of IE occurring in the setting of immunosuppression secondary to cancer and/or chemotherapy. Here, we present a case of a cancer patient who developed anterior spinal artery (ASA) syndrome secondary to a septic embolus from IE. Case Presentation. A 78-year-old male with a history of gastroesophageal cancer treated with chemotherapy and radiation presented to the hospital after a fall at home. He reported experiencing dyspnea and orthopnea for two weeks prior to presentation. In the ED, his vital signs were stable, and his examination was significant for a flaccid paralysis of the right lower extremity. Diagnosis of septic emboli secondary to IE was made after the echocardiogram showed the presence of vegetations on the aortic valve, blood cultures were positive for Streptococcus mitis, and thoracic spine MRI was indicative of an infarction at T10. Discussion. This case highlights the presence of IE in the setting of cancer and chemotherapy. Although cancer is a rare cause of IE, clinicians must maintain a high index of suspicion in order to minimize the sequelae of IE.

scholarly journals Pulmonary Tuberculosis mimicking a right Eventration on Radiography: The falsity of single view radiograph in the diagnosis of a precursor of pulmonary disease: A Case Report

2021 ◽  
Vol 4 (1) ◽  
pp. 33-37
Author(s):  
John Ogunkoya ◽  
Oluwatosin Yetunde Adesuyi
Keyword(s):  
Pulmonary Tuberculosis ◽  
Lower Lobe ◽  
Middle Lobe ◽  
The Body ◽  
Single View ◽  
Lymph Node Enlargement ◽  
History Of ◽  
Chest X Ray ◽  
The Right ◽  
High Index Of Suspicion

Background: The diaphragm is one of the most important muscles of respiration in the body separating the abdomen from the thorax. Abnormalities of the diaphragm could be congenital or acquired, morphological or functional while pulmonary infection e.g. pulmonary tuberculosis, is implicated in its etiology. Case presentation: A 63-year- old man with six weeks history of cough productive of yellowish sputum. Chest X-ray showed a uniform well-circumscribed opacity in the right lower lobe abutting on or in continuum with the right diaphragm consistent with a diaphragmatic hump. Sputum Gene Xpert was positive for Mycobacterium tuberculosis. Chest CT scan revealed bilateral lymph node enlargement with hyperdense lesions in the anterior basal segment of the right lower lobe and medial bronchopulmonary segments of the right middle lobe. He was treated for 6 months with first-line anti-tuberculosis drugs. Discussion: The incidence of the diaphragmatic hump on chest radiograph worldwide and among Nigerians is unknown. The association of diaphragmatic hump with chest infection has been well document. The association of diaphragmatic hump with pulmonary tuberculosis is uncommon. Conclusion: A high index of suspicion is needed to diagnose pulmonary tuberculosis with atypical clinical and radiological presentations. Such prompt diagnosis will aid the treatment of the disease.

scholarly journals Rumpel-Leede Phenomenon: A Case Report

1970 ◽  
Vol 9 (4) ◽  
Author(s):  
Rehman HU, MBBS, FRCPC ◽  
Kambo J, MD
Keyword(s):  
Complete Blood Count ◽  
Vital Signs ◽  
Liver Function Tests ◽  
Left Hand ◽  
Lower Base ◽  
Associated Symptoms ◽  
Chest Auscultation ◽  
History Of ◽  
Artery Disease ◽  
The Right

A 72-year-old woman presented with a one-week history of fever, non-productive cough, and three unwitnessed syncopal episodes, with no other associated symptoms. She had poor recollection of the episodes, but denied urinary/fecal incontinence, tongue biting, numbness, parasthesias, or weakness. Her medical history was significant for hypertension, dyslipidemia, leg ulcers, psoriasis, stress incontinence, and gastroesophageal reflux disease. She did not have diabetes, coronary artery disease, or peripheral vascular disease. Her medications included Atorvastatin, Enalapril, Hydrochlorothiazide, Lansoprazole, and Calcium. She did not smoke or drink. On examination, her vital signs were stable and she was afebrile. Chest auscultation revealed crackles in the right lower base. She developed an erythematous, lacy sharply demarcated rash on her left hand that lasted for 3–4 hours after her blood pressure was taken on the same arm (Figures 1 and 2). Blood tests were unremarkable and included glucose, complete blood count, electrolytes, urea, creatinine, liver function tests, and coagulation studies.

A cervical anterior spinal artery syndrome after diagnostic blockade of the right C6-nerve root

Pain ◽  
2001 ◽  
Vol 91 (3) ◽  
pp. 397-399 ◽  
Author(s):  
Paul J.A.M Brouwers ◽  
Ella J.B.L Kottink ◽  
Marc A.M. Simon ◽  
Rik L. Prevo
Keyword(s):  
Nerve Root ◽  
Anterior Spinal Artery ◽  
Anterior Spinal Artery Syndrome ◽  
The Right

scholarly journals 175. There Was a Fungus Among Us: A Cohort of Fungal Infectious Endocarditis Cases in East Tennessee

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S110-S111
Author(s):  
Morgan K Morelli ◽  
William Lorson ◽  
Mahmoud Shorman
Keyword(s):  
Risk Factors ◽  
Fungal Pathogen ◽  
Heart Valves ◽  
University Hospital ◽  
Prosthetic Heart Valves ◽  
Inclusion Criteria ◽  
Persons Who Inject Drugs ◽  
East Tennessee ◽  
High Index Of Suspicion ◽  
Healthcare Associated

Abstract Background Fungal infective endocarditis (IE) represents less than 2% of all IE cases, but it carries a mortality rate as high as 50%. While cases of IE are on the rise in recent years due to the increased prevalence of persons who inject drugs (PWID), there are few published studies of fungus as the cause. Candida species is the most likely fungal pathogen in IE. Known risk factors include prosthetic heart valves, healthcare-associated infections, and injection drug use. Since fungi are a rare culprit in endocarditis, there is little information on incidence, treatment recommendations, and outcomes. Methods A retrospective cohort of patients with Candida IE was analyzed between October 2013 and September 2018 at a university hospital in East Tennessee. Demographic, microbiologic, substance use status, mortality, and echocardiographic data were collected. Results Nine patients with Candida IE met inclusion criteria. Mean age was 37, 67% were males. Risk factors included PWID, oral opioid abuse, previous valve surgery and autoimmune disease. 5 (55%) were caused by Candida albicans, 3 (33.3%) Candida paraipsalosis, and 1 (11%) grew both Candida tropicalis and albicans. Valves involved: 4 (66.7%) native tricuspid, 2 (22%) native aortic. 2 (22%) had native mitral, 1 (11%) had both tricuspid and mitral valve involvement. Echinocandins were used in 5 (55%) and 2 (22%) underwent surgery. There was 1 (11%) in-hospital mortality and 2 (22%) within 1 year of discharge (Table 1). Conclusion Fungal IE is a rare disease with high mortality and increasing incidence, especially in PWID. High index of suspicion is required for early diagnosis. Treatment is traditionally a combination of surgery and antifungal therapy. Although, medical treatment alone can be successful in patients who are not surgical candidates, such as in PWID. Disclosures All authors: No reported disclosures.

scholarly journals Atypical case of mucous membrane pemphigoid in a 26-year-old man

2018 ◽  
pp. bcr-2018-225872
Author(s):  
Deepak Sambhara ◽  
Ji Hyae Lee ◽  
Seth M Pantanelli
Keyword(s):  
Mucous Membrane ◽  
Previous History ◽  
Immunohistochemical Analysis ◽  
Mucous Membrane Pemphigoid ◽  
Epithelial Basement Membrane ◽  
The Face ◽  
History Of ◽  
The One ◽  
The Right ◽  
High Index Of Suspicion

A 26-year-old Caucasian man with no previous history of chemical injury presenting with an inability to open his right eye was investigated for mucous membrane pemphigoid and treated. Examination was notable for symblepharon of the right eye and impetigo-like lesions on the face and neck. A biopsy with immunohistochemical analysis was significant for linear deposits of C3 and immunoglobulin G at the level of the epithelial basement membrane, confirming the diagnosis of mucous membrane pemphigoid. Although mucous membrane pemphigoid classically presents bilaterally in women in the sixth and seventh decades of life, our patient was a young man with unilateral cicatrising conjunctivitis who may have been easily misdiagnosed without a high index of suspicion. A biopsy is required in cases of cicatrising conjunctivitis so that even atypical cases such as the one presented herein can be appropriately managed.

scholarly journals A young female with double mechanical prosthetic heart valves presenting with coronary embolism-a rare case report

2020 ◽  
Vol 9 (1) ◽  
pp. 37-39
Author(s):  
Suman Adhikari ◽  
Ratna Mani Gajurel ◽  
Chandra Mani Paudel ◽  
Surya Devkota ◽  
Smriti Shakya ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Heart Valves ◽  
Young Patients ◽  
Young Female ◽  
Complete Revascularization ◽  
Prosthetic Heart Valves ◽  
Coronary Syndrome ◽  
Rare Case Report ◽  
History Of ◽  
Coronary Embolism

Coronary embolism, though uncommon, can occur in young patients with mechanical prosthetic heart valves. Coronary embolism has been reported in patients with prosthetic heart valves with or without thrombosis in literatures. It can cause acute coronary syndrome and lead to death if threshold of diagnosis of coronary embolism is not low. Here we report a case of coronary embolism in a 26 year old female with history of double mechanical prosthetic valve replacement, presenting to our centre with acute coronary syndrome. She was managed with thrombosuction establishing almost complete revascularization.  

scholarly journals A Young Woman with Ischemic Stroke: Should We Pay More Attention to Varicella Zoster Infection

2016 ◽  
Vol 8 (2) ◽  
pp. 145-150 ◽  
Author(s):  
Cláudia Borbinha ◽  
João Pedro Marto ◽  
Sofia Calado ◽  
Miguel Viana-Baptista
Keyword(s):  
Ischemic Stroke ◽  
Hemorrhagic Transformation ◽  
Vascular Events ◽  
Varicella Zoster ◽  
Fluid Analysis ◽  
History Of ◽  
The Right ◽  
High Index Of Suspicion ◽  
Varicella Zoster Infection

Ischemic and hemorrhagic stroke are recognized complications of Varicella zoster virus (VZV) infections, although uncommon and poorly documented. The authors report the case of a 31-year-old woman admitted with acute ischemic stroke of the right posterior cerebral artery and a history of a thoracic rash 1 month before. Aspirin and simvastatin were prescribed, but the patient suffered a stepwise deterioration the following days, with new areas of infarction on brain imaging. Despite no evidence of cardiac or large vessel embolic sources, anticoagulation was started empirically 6 days after stroke onset. One week later, symptomatic hemorrhagic transformation occurred. The diagnosis of VZV vasculopathy was then considered, and treatment with acyclovir and prednisolone was started with no further vascular events. Cerebrospinal fluid analysis and digital subtraction angiography findings corroborated the diagnosis. The patient was discharged to the rehabilitation center with a modified Rankin scale (mRS) score of 4. On the 6-month follow-up, she presented only a slight disability (mRS score 2). In conclusion, VZV vasculopathy needs to be considered in young adults with stroke. A high index of suspicion and early treatment seem to be important to minimize morbidity and mortality. Anticoagulation should probably be avoided in stroke associated with VZV vasculopathy.

scholarly journals Sacral Tuberculosis: An Atypical Manifestation

2018 ◽  
Vol 17 (1) ◽  
Author(s):  
Faisal Amir Si Mirah ◽  
Ahmad Faizal Roslan ◽  
Ed Simor Khan Mor Japar Khan ◽  
Rajandra Kumar Karupiah ◽  
Zamzuri Zakaria @ Mohamad
Keyword(s):  
Correct Diagnosis ◽  
Lower Limbs ◽  
Mantoux Test ◽  
Ct Guided ◽  
Walking Aids ◽  
Grade 5 ◽  
History Of ◽  
Prolapsed Intervertebral Disc ◽  
The Right ◽  
High Index Of Suspicion

Sacral tuberculosis (TB) is extremely rare and its unusual entity might delay the diagnosis and treatment of this treatable disease. A 38-year-old lady presented with a 1 year history of lower back pain with radiculopathy more to right lower limb. The patient was initially treated as Prolapsed Intervertebral Disc (PID), but showed no improvement despite regular physiotherapy and medication. Subsequently, the pain was confined to the right gluteal area and became more severe. Quality of life was impaired in which patient started using walking aids and stopped working. There was a weight loss of 20kg. No other symptom of TB infection or history of contact with TB patient. Bowel and urinary functions were normal. Examination showed localized tenderness at the right gluteal area. Neurological assessment of both lower limbs were MRC grade 5. Blood investigations were normal including the ESR level (17mm/hour). Mantoux test was positive with 18mm induration. MRI revealed a large rim enhancing paravertebral collection at pre-sacral space which extended into bilateral piriformis and gluteal muscles. The patient underwent CT-guided drainage of both gluteals and specimens taken to confirm the diagnosis of TB. Patient showed significant improvement clinically within 1 week after the drainage procedure and initiation of antituberculous chemotherapy. The initial presentation of this patient mimics PID due to irritation of sciatic nerve at piriformis level. However a change in the presentation and failure of conservative treatment should raise a high index of suspicion and necessitates further investigation to establish correct diagnosis hence proper treatment can be initiated.

The Clinical Life History of Explanted Prosthetic Heart Valves

1982 ◽  
Vol 34 (1) ◽  
pp. 22-33 ◽  
Author(s):  
John P. Marbarger ◽  
Richard E. Clark
Keyword(s):  
Life History ◽  
Heart Valves ◽  
Prosthetic Heart Valves ◽  
History Of
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