A Case of Unilateral Coccidioidal Chorioretinitis in a Patient with HIV-Associated Meningoencephalitis

Intraocular coccidioidomycosis is a rare condition, with the most commonly reported presentation being an idiopathic iritis in patients who live in or have traveled thorough endemic areas. A paucity of reports exists describing the chorioretinal manifestations of coccidioidomycosis. Here we report a case of unilateral coccidioidal chorioretinitis and meningoencephalitis in an AIDS patient that led to near complete unilateral loss of vision. A 48-year-old Hispanic female with poorly controlled HIV/AIDS in southern California presented with a three-week history of headache, nausea, vomiting, right eye blurry vision, and a one-day history of subjective fever. Examination of the right eye revealed vitritis and several large chorioretinal lesions scattered throughout the periphery and macula with optic disc pallor. Serum coccidioidomycoses complement fixation (CF) was positive (titers of 1 : 256). Neuroimaging revealed a new area of enhancement in the left anterior frontal lobe consistent with meningoencephalitis. The patient was treated with intravenous fluconazole and intravitreal voriconazole with resolution of systemic symptoms and vitritis but persistence of unilateral, severe chorioretinal scarring and vision loss. In conclusion, in spite of the rarity of intraocular coccidioidomycosis, one must carry a degree of suspicion for this vision- and life-threatening condition as a potential etiology of chorioretinitis in individuals with pertinent risk factors.

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Localized Aortic Dissection in a Patient with Polycystic Kidney Disease: A Case Report

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol06-i04/1101 ◽

2021 ◽

Vol 6 (04) ◽

pp. 285-287

Author(s):

Sarah A. Alkuraydis ◽

Abdulaziz S. Allihimy ◽

Osama Smettei ◽

Rami M Abazid

Keyword(s):

Chest Pain ◽

Aortic Dissection ◽

Acute Chest Pain ◽

Uncontrolled Hypertension ◽

Polycystic Kidney ◽

Threatening Condition ◽

Life Threatening ◽

History Of ◽

The Right ◽

Multiple Cysts

Aortic dissection (AD) is the most frequent life-threatening aortic disorder. It is commonly associated with hypertension; however, aortic dissection occasionally represents a complication of more complex syndromes. In this article we aim to report. A 40-year-old male patient, with a known case of ADPKD and a strong family history of ADPKD. He presented to the emergency department with prolonged sharp retrosternal chest pain radiating to the back and uncontrolled hypertension. Computed tomography angiography showed a localized dissection flap at the aortic root and multiple cysts in the right kidney. AD is a life-threatening condition and should be suspected in patients presenting with acute chest pain with history of ADPKD.

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A Challenging diagnosis that eventually results in a life-threatening condition: Addison’s disease and adrenal crisis

BMJ Case Reports ◽

10.1136/bcr-2019-231858 ◽

2019 ◽

Vol 12 (12) ◽

pp. e231858

Author(s):

Philippa Joersjö ◽

Linda Block

Keyword(s):

Rare Condition ◽

Addison’S Disease ◽

Actual Condition ◽

Adrenal Crisis ◽

Addison's Disease ◽

Gradual Onset ◽

Threatening Condition ◽

Life Threatening ◽

History Of ◽

Delays In Diagnosis

A young man endures many years with classic symptoms of Addison’s disease due to difficulties in distinguishing this rare condition, whose features are non-specific and insidious in nature. With all facts on hand, the patient’s notable history of psychiatric disorders, namely depression, anxiety and social isolation, as well as signs of extreme fatigue and syncope may well have been caused by a gradual onset of primary adrenal insufficiency. Long delays in diagnosis are not uncommon, as in this case where the actual condition was identified just in time when the patient presented with a life-threatening cardiovascular collapse.

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Unilateral Viable Twin Tubal Ectopic Pregnancy: A Case Report

Journal of Clinical Research and Reports ◽

10.31579/2690-1919/008 ◽

2020 ◽

Vol 2 (2) ◽

pp. 01-03

Author(s):

Afaf Felemban

Keyword(s):

Ectopic Pregnancy ◽

Standard Treatment ◽

Lower Abdominal Pain ◽

Rare Condition ◽

Surgical Removal ◽

Tubal Ectopic Pregnancy ◽

Threatening Condition ◽

Life Threatening ◽

Laparoscopic Salpingectomy ◽

The Right

Unilateral ectopic twin is a rare condition with only a few cases of viable ectopic twins reported. We report a 41 year- old, Gravida 6 Para 5 at 6 weeks gestation, presented to the Emergency Department with complaint of lower abdominal pain and vaginal spotting. Pelvic ultrasound showed twins with positive fetal heart beats in the right tube. Laparoscopic salpingectomy was performed to remove to fetus. Conclusion: viable ectopic pregnancy is a life threatening condition and can be diagnosed with ultrasound. Surgical removal is the standard treatment option.

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Preventive strategies for acute kidney injury in cancer patients

Clinical Kidney Journal ◽

10.1093/ckj/sfaa127 ◽

2020 ◽

Author(s):

Laura Cosmai ◽

Camillo Porta ◽

Marina Foramitti ◽

Valentina Perrone ◽

Ludovica Mollica ◽

...

Keyword(s):

Risk Factors ◽

Acute Kidney Injury ◽

Cancer Patients ◽

Kidney Injury ◽

Clinical Approach ◽

Related Risk ◽

Threatening Condition ◽

Huge Impact ◽

Life Threatening ◽

History Of

Abstract Acute kidney injury (AKI) is a common complication of cancer that occurs in up to 50% of neoplastic patients during the natural history of their disease; furthermore, it has a huge impact on key outcomes such as overall prognosis, length of hospitalization and costs. AKI in cancer patients has different causes, either patient-, tumour- or treatment-related. Patient-related risk factors for AKI are the same as in the general population, whereas tumour-related risk factors are represented by compression, obstruction, direct kidney infiltration from the tumour as well by precipitation, aggregation, crystallization or misfolding of paraprotein (as in the case of multiple myeloma). Finally, treatment-related risk factors are the most common observed in clinical practice and may present also with the feature of tumour lysis syndrome or thrombotic microangiopathies. In the absence of validated biomarkers, a multidisciplinary clinical approach that incorporates adequate assessment, use of appropriate preventive measures and early intervention is essential to reduce the incidence of this life-threatening condition in cancer patients.

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Phlebosclerotic Colitis – An Enigma Among Ischemic Colitis

Journal of Clinical Imaging Science ◽

10.25259/jcis-30-2019 ◽

2019 ◽

Vol 9 ◽

pp. 18 ◽

Cited By ~ 1

Author(s):

Rishi Philip Mathew ◽

Safwat Girgis ◽

Malcolm Wells ◽

Gavin Low

Keyword(s):

North America ◽

Ischemic Colitis ◽

Crucial Role ◽

Herbal Medication ◽

Documented Case ◽

Asian Descent ◽

Threatening Condition ◽

Life Threatening ◽

History Of ◽

The Right

Phlebosclerotic Colitis is a rare, potentially life-threatening condition of unclear etio-pathogenesis seen almost exclusively in Asians and people of Asian descent. The condition predominantly affects the right hemicolon and imaging plays a crucial role in its diagnosis. Here we report the only second documented case of phlebosclerotic colitis in North America in a 60-year-old Canadian resident of Vietnamese descent with a history of consuming herbal medication (sanshishi) in soup for 2-3 decades.

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May-Thurner syndrome – Are we aware enough?

VASA ◽

10.1024/0301-1526/a000775 ◽

2019 ◽

Vol 48 (5) ◽

pp. 381-388 ◽

Cited By ~ 6

Author(s):

Katalin Mako ◽

Attila Puskas

Keyword(s):

Contraceptive Use ◽

Iliac Vein ◽

Common Iliac Vein ◽

Vein Thrombosis ◽

Compression Syndrome ◽

Threatening Condition ◽

Life Threatening ◽

Iliac Vein Compression ◽

Iliac Vein Compression Syndrome ◽

The Right

Summary. Iliac vein compression syndrome (May-Thurner syndrome – MTS) is an anatomically variable clinical condition in which the left common iliac vein is compressed between the right common iliac artery and the underlying spine. This anatomic variant results in an increased incidence of left iliac or iliofemoral vein thrombosis. It predominantly affects young women in the second or third decades of life with preponderance during pregnancy or oral contraceptive use. Although MTS is rare, its true prevalence is underestimated but it can be a life-threatening condition due to development of pulmonary embolism (PE). In this case based review the authors present three cases of MTS. All patients had been previously confirmed with PE, but despite they were admitted to hospital, diagnosed and correctly treated for PE and investigated for thrombophilia, the iliac vein compression syndrome was not suspected or investigated. With this presentation the authors would like to emphasize that MTS is mostly underdiagnosed, and it needs to be ruled out in left iliofemoral vein thrombosis in young individuals.

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Intraorbital Abscess: A Rare Cause of Orbit Compression

FACE ◽

10.1177/27325016211005062 ◽

2021 ◽

pp. 273250162110050

Author(s):

Samuel Ruiz ◽

Rizal Lim

Keyword(s):

Pediatric Population ◽

Rare Complication ◽

Disease Process ◽

Rare Condition ◽

External Drainage ◽

Direct Extension ◽

Life Threatening ◽

History Of ◽

High Index Of Suspicion ◽

Prompt Diagnosis

Introduction: Intraorbital abscess is a rare complication of rhinosinusitis that affects most commonly the pediatric population. It is thought to be caused by direct extension or venous spread of infections from contiguous sites and can lead to life-threatening complications, like permanent visual loss and cerebral abscesses. Objectives: Intraorbital abscess is a rare condition that requires prompt diagnosis and treatment to avoid serious complications. Our objectives are to provide an overview of this rare disease process and its management including our successful treatment experience. Case Description: We present a 2 case report of a 13-year-old pediatric male and a 66-year-old male with history of chronic sinusitis who presented with a right intraorbital abscess successfully treated with external drainage with decompression of the orbit. Conclusion: When intraorbital abscess is encountered, a high index of suspicion is needed to allow prompt and accurate diagnosis for this infrequent condition. Timely surgical drainage of the abscess is needed to prevent the development of fatal complications.

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P043 Fascinating phosphate: seek and you will find

Rheumatology ◽

10.1093/rheumatology/keab247.040 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Jyoti Bakshi ◽

Clare Batten

Keyword(s):

Back Pain ◽

Degenerative Change ◽

Nasal Bone ◽

Rare Condition ◽

Whole Body ◽

Excision Biopsy ◽

Small Lesion ◽

History Of ◽

The Right ◽

Fgf 23

Abstract Background/Aims A 62-year-old accountant was referred to the metabolic bone clinic with a 2 year history of thoracic back pain and a persistently raised ALP. There were no associated red flags for her back pain. She had a history of a gluteal lump, thought to be benign, for which she had declined excision. She has hypertension and had a previous navicular fracture. Medications included bendroflumethiazide and Adcal D3. She had restriction in neck movements and was tender to percussion in the thoracic spine. There was no proximal weakness or focal neurology. Systems and joint exam were unremarkable. Methods The case is discussed below. Results Salient abnormal results on presentation were a raised ALP of 207 and corrected calcium of 2.34. PTH was elevated at 8.2 (NR:1.6-6.9), Vitamin D 79 and a low phosphate of 0.34 (NR:0.8-1.50). Alkaline phosphatase isoenzymes showed the raised level came from bone. Protein and urine electrophoresis were normal. A bone density scan was normal, and a recent thoracic MRI showed only degenerative change. An isotope bone scan was requested and was reported to show increased activity in the nasal bone, maxilla and both orbits, raising the possibility of Paget’s disease. However, when reviewed in the Radiology meeting with a skull x-ray, the appearances were not felt to be in keeping with Paget’s. Despite physiotherapy, hydrotherapy, acupuncture and neuropathic medication the patient’s back pain continued. Her phosphate remained low and her calculated tubular reabsorption of phosphate from a 24h urine collection (TmP/GFR) was low at 0.42mmol/l (NR 0.80-1.35). She was started on phosphate replacement and calcitriol, and Adcal D3 was continued. The Fibroblast Growth Factor (FGF) 23 levels were sent and came back significantly elevated at 1380 (NR < 100). A 68Ga DOTA-TATE scan (whole body PET/CT scan), confirmed the right gluteal lump as the source of the FGF 23. The patient went on to have an excision biopsy and histology confirmed a mesenchymal tumour of the right buttock. Her phosphate replacement was gradually weaned, but on reducing the dose phosphate levels dropped and her symptoms returned. The repeat TmP/GFR was again low at 0.61, and FGF 23 levels were still raised at 204. A repeat 68Ga DOTA-TATE scan, 4 years after the first one, showed recurrence of the right gluteal lesion and a possible small lesion in the left gluteal muscle. She has been sent for further excision. Conclusion Tumour induced osteomalacia (TIO) is a rare condition and should be considered in cases of hypophosphataemia. Classical symptoms are proximal weakness and muscle and bone pain. They are typically associated with small benign tumours (most commonly mesenchymal tumours) which may be difficult to find. Excision is curative but if small amounts of tumour remain, relapses may occur. Disclosure J. Bakshi: None. C. Batten: None.

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P046 Pointing the finger: an unusual presentation of dactylitis

Rheumatology ◽

10.1093/rheumatology/keab247.043 ◽

2021 ◽

Vol 60 (Supplement_1) ◽

Author(s):

Natalia Cernovschi - Feasey ◽

Julekha Wajed

Keyword(s):

Pleural Effusion ◽

Soft Tissue ◽

Middle Finger ◽

Joint Involvement ◽

Long Bones ◽

History Of ◽

Systemic Symptoms ◽

The Right ◽

Hands And Feet ◽

Radiographic Changes

Abstract Background/Aims Dactylitis is commonly associated with psoriatic arthritis, and regularly presents at Rheumatology clinics. We discuss a case where progressive systemic symptoms lead to the consideration of alternate diagnoses. Methods A 46-year-old Nepalese woman presented to the Rheumatology department with a 3 month history of diffuse swelling of the right middle finger proximal interphalangeal joint, with the appearance of dactylitis. There was pain on movement, but no other joint involvement. Simultaneously she noticed blurred and decreased vision, which on review by the ophthalmologists, was diagnosed with bilateral uveitis. There was no history of psoriasis, inflammatory bowel disease, or other past medical history of note. There was no travel history in the past 12 months. A diagnosis of a presumed inflammatory arthritis was made. Results Blood tests showed elevated c-reactive protein 55 (normal <4 mg/l), erythrocyte sedimentation rate 138 (normal 0-22 mm/hr) and an iron deficiency anaemia. Rheumatoid factor and Anti-CCP antibody were negative. Hand radiographs were reported as normal. MRI of the third digit confirmed an enhancing soft tissue collection at the proximal phalanx of the right middle finger. She was referred for a biopsy of this lesion. Interestingly over the subsequent few months, she developed progressive breathlessness. Chest radiograph showed a left pleural effusion. Further tests showed negative serum ACE, Lyme and Toxoplasma screen. Quantiferon test was negative. Pleural aspirate showed a transudate with negative Acid-fast bacillus (AFB) test and culture. CT chest and abdomen showed a persistent pleural effusion, inflammatory changes in the small bowel and thickening of the peritoneum and omentum. In view of the systemic involvement, a peritoneal tissue biopsy was performed. This confirmed chronic granulomatous inflammation with positive AFB stain for mycobacterium tuberculosis. Our patient was started on quadruple anti- TB antibiotics for 6 months. Her systemic symptoms and dactylitis have improved, although there is on-going treatment for her ocular involvement. Conclusion Approximately 10% of all cases of extrapulmonary TB have osteoarticular involvement. Dactylitis is a variant of tuberculous osteomyelitis affecting the long bones of the hands and feet. It occurs mainly in young children; however adults may be affected also. The first manifestation is usually painless swelling of the diaphysis of the affected bone followed by trophic changes in the skin. The radiographic changes are known as spina ventosa, because of the ballooned out appearance of the bone, although this was not seen in our case. Fibrous dysplasia, congenital syphilis, sarcoidosis and sickle cell anaemia may induce similar radiographic changes in the metaphysis of long bones of hands and feet, but do not cause soft tissue swelling or periosteal reaction. This case highlights the importance of testing for TB, especially in atypical cases of dactylitis, with other systemic features. Disclosure N. Cernovschi - Feasey: None. J. Wajed: None.

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Heterotopic pregnancy; case report

National Journal of Research in Ayurved Science ◽

10.52482/ayurlog.v7i05.425 ◽

2019 ◽

Vol 7 (05) ◽

Author(s):

Vipul R. Khandagale

Keyword(s):

Risk Factors ◽

Ectopic Pregnancy ◽

Adnexal Mass ◽

Heterotopic Pregnancy ◽

Free Fluid ◽

Threatening Condition ◽

Life Threatening ◽

Ectopic Pregnancies ◽

High Index Of Suspicion ◽

Low Risk Women

Heterotopic pregnancy is a rare clinical condition in which intrauterine and extrauterine pregnancies occur at the same time. It can be a life threatening condition and easily missed with the diagnosis. We present the case of a 37 year old patient who was treated for a heterotopic pregnancy with live intrauterine gestation and ruptured left adnexal gestation.The ectopic pregnancy was not suspected at her initial presentation. A high index of suspicion is needed in women with risk factors for an ectopic pregnancy and in low risk women who have free fluid with or without an adnexal mass with an intrauterine gestation.It is difficult to estimate exactly the incidence of ectopic pregnancies, but on an average it is approximately 1:300 normal pregnancies worldwide.

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