scholarly journals Septic Shock Predisposed by an Underlying Chronic Neutrophilic Leukemia with an Atypical Presentation; A Case Report

2018 ◽  
Vol 11 (3) ◽  
pp. 871-879
Author(s):  
Vincent Louie Mendiola ◽  
You-Wen Qian ◽  
Bagi Jana
Keyword(s):  
Septic Shock ◽  
Myeloproliferative Neoplasm ◽  
Myeloid Cell ◽  
Case Presentation ◽  
Chronic Neutrophilic Leukemia ◽  
Plasma Cell Neoplasm ◽  
Work Up ◽  
Diagnostic Criterion ◽  
Cell Clonality ◽  
Rule Out

Background: Chronic neutrophilic leukemia (CNL) is an extremely rare myeloproliferative neoplasm (MPN). Due to the difficulty in its diagnosis, the diagnostic criterion was just recently revised in 2016. CNL is defined as: A clonal disorder with sustained primary neutrophilia, with normal neutrophil maturation, that does not meet other MPN criteria, as well as no identifiable mutations of the PDGFRA, PDGFRB or FGFR1 or PCM1-JAK2 genes, and, either, the presence of a CSF3R mutation, or if absent, the presence of sustained neutrophilia (> 3 months), splenomegaly and no other identifiable cause of reactive neutrophilia including the absence of a plasma cell neoplasm, or, if present, demonstration of myeloid cell clonality by cytogenetics. Only about 200 cases have been reported. Case Presentation: We report a 61-year-old Caucasian male patient who initially presented with unexplained leukocytosis. An outpatient work-up was planned to rule out a myeloproliferative disorder but the patient was acutely admitted for MRSA septic shock. The patient was stabilized prior bone marrow work-up and was then diagnosed with an atypical type of CNL (JAK2 positive, CSF3R negative). The patient refused further treatment due to social circumstances and requested palliative care instead. Conclusion: This case aims to present atypical findings of an extremely rare MPN. Even though a recent revision has been made to help in its diagnosis, atypical findings must still be considered. This, in turn, will help to further improve the current CNL diagnostic criteria.

scholarly journals Emphysematous pyelonephritis with air bubble in the inferior vena cava

2020 ◽  
Vol 26 (1) ◽  
Author(s):  
Tiffany A. Perkins ◽  
Alberic Rogman ◽  
Murali K. Ankem
Keyword(s):  
Septic Shock ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Rare Presentation ◽  
Emphysematous Pyelonephritis ◽  
Case Presentation ◽  
Air Bubble ◽  
First Case ◽  
The Right

Abstract Background Emphysematous pyelonephritis (EPN) with gas in the inferior vena cava (IVC) is a rare presentation and to our knowledge, this is the first case report in the urologic literature. Case presentation A 35-Year-old obese diabetic Hispanic female presented to the emergency room with a clinical picture of septic shock. Prompt computerized tomography scan revealed EPN with gas throughout the right renal parenchyma and extending to the right renal vein, IVC, and pulmonary artery. She died before surgical intervention Conclusion This case demonstrates that patients presenting with severe EPN have a high mortality risk and providers should acknowledge that septic shock, endogenous air emboli, or a combination of both could result in cardiovascular collapse and sudden death.

scholarly journals Cerebral fat embolization with paroxysmal sympathetic hyperactivity syndrome and septic shock at high altitude: a case report and literature review

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Min Li ◽  
Gang Zhu ◽  
Hao Guo ◽  
Shun Nan Ge ◽  
Guo Dong Gao ◽  
...  
Keyword(s):  
Septic Shock ◽  
Differential Diagnosis ◽  
Case Report ◽  
Literature Review ◽  
High Altitude ◽  
Fat Embolism ◽  
Neurological Rehabilitation ◽  
Case Presentation ◽  
Sympathetic Hyperactivity ◽  
Paroxysmal Sympathetic Hyperactivity

AbstractBackgroundCerebral fat embolism (CFE) syndrome at high altitude was rare complicated with paroxysmal sympathetic hyperactivity (PSH) syndrome and septic shock. It is a challenge to differential diagnosis and treatment at high altitude.Case presentationThis case presents a CFE with PSH and septic shock of a 23-year-old man occurred at high altitude of 3800 m above sea level, transferred by airplane successfully and cured in the department of neurosurgery, Xi’an Tangdu Hospital.ConclusionsIt is key that CFE with PSH can be rapid diagnosed and treatment bundles of septic shock should be initiated as soon as possible. Early neurological rehabilitation played an important role for good outcome.

scholarly journals Septic shock due to Yersinia pseudotuberculosis infection in an adult immunocompetent patient: a case report and literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Takehiro Hashimoto ◽  
Ryuichi Takenaka ◽  
Haruka Fukuda ◽  
Kazuhiko Hashinaga ◽  
Shin-ichi Nureki ◽  
...  
Keyword(s):  
Septic Shock ◽  
Therapeutic Strategy ◽  
Yersinia Pseudotuberculosis ◽  
Immunocompromised Host ◽  
Immunocompetent Patient ◽  
Case Presentation ◽  
Gram Negative ◽  
Old Japanese ◽  
The Right ◽  
Immunocompetent Patients

Abstract Background Yersinia pseudotuberculosis infection can occur in an immunocompromised host. Although rare, bacteremia due to Y. pseudotuberculosis may also occur in immunocompetent hosts. The prognosis and therapeutic strategy, especially for immunocompetent patients with Y. pseudotuberculosis bacteremia, however, remains unknown. Case presentation A 38-year-old Japanese man with a mood disorder presented to our hospital with fever and diarrhea. Chest computed tomography revealed consolidation in the right upper lobe with air bronchograms. He was diagnosed with pneumonia, and treatment with intravenous ceftriaxone and azithromycin was initiated. The ceftriaxone was replaced with doripenem and the azithromycin was discontinued following the detection of Gram-negative rod bacteria in 2 sets of blood culture tests. The isolated Gram-negative rod bacteria were confirmed to be Y. pseudotuberculosis. Thereafter, he developed septic shock. Doripenem was switched to cefmetazole, which was continued for 14 days. He recovered without relapse. Conclusions We herein report a case of septic shock due to Y. pseudotuberculosis infection in an adult immunocompetent patient. The appropriate microorganism tests and antibiotic therapy are necessary to treat patients with Y. pseudotuberculosis bacteremia.

Muscle Tone Assessment under General Anesthesia for Sjögren-Larsson Syndrome and Spasticity

2021 ◽  
Vol 56 (2) ◽  
pp. 163-165
Author(s):  
George Georgoulis ◽  
Argyrios Dinopoulos ◽  
Emmanouil Gkliatis
Keyword(s):  
General Anesthesia ◽  
Muscle Tone ◽  
Muscle Relaxants ◽  
Spastic Diplegia ◽  
Case Presentation ◽  
Neurosurgical Procedure ◽  
Dorsal Rhizotomy ◽  
Severe Spasticity ◽  
Larsson Syndrome ◽  
Rule Out

Introduction: Study of muscle tone in individuals with severe spasticity (Modified Asworth Scale – MAS:3) under general anesthesia can confirm or rule out the eventual necessity of the impending spasticity relieving ablative neurosurgery by observing the hypertonia reduction and passive range of motion expansion. Therefore, what we measure under muscle relaxants is practically a fixed deformity. Case Presentation: The study was performed on a girl with Sjögren-Larsson syndrome, presenting with icthyosis and spastic diplegia. Proposed intervention was Dorsal Rhizotomy. Under general anesthesia, with and without muscle relaxants, hypertonia was significantly reduced (MAS:1), but the angle of motion did not increase much. Conclusion: We decided not to perform such a neurosurgical procedure. In ambiguous situations, the proposed study can help in decision-making for spasticity treatment.

scholarly journals Neonate born with ischemic limb to a COVID-19 positive mother: management and review of literature

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Shahana Perveen ◽  
Karmaine A. Millington ◽  
Suchitra Acharya ◽  
Amit Grag ◽  
Vita Boyar
Keyword(s):  
Differential Diagnosis ◽  
Compartment Syndrome ◽  
Upper Extremity ◽  
Preterm Neonate ◽  
Review Of Literature ◽  
Case Presentation ◽  
Ischemic Limb ◽  
History Of ◽  
Hand Amputation ◽  
Work Up

AbstractObjectivesTo describe challenges in diagnosis and treatment of congenital neonatal gangrene lesions associated with history of maternal coronavirus disease 2019 (COVID-19) infection.Case presentationA preterm neonate was born with upper extremity necrotic lesions and a history of active maternal COVID-19 infection. The etiology of his injury was challenging to deduce, despite extensive hypercoagulability work-up and biopsy of the lesion. Management, including partial forearm salvage and hand amputation is described.ConclusionsNeonatal gangrene has various etiologies, including compartment syndrome and intrauterine thromboembolic phenomena. Maternal COVID-19 can cause intrauterine thrombotic events and need to be considered in a differential diagnosis.

scholarly journals Tétanos en un preescolar de 5 años con abandono familiar: Reporte de caso

2019 ◽  
Vol 30 (3) ◽  
Author(s):  
Juan Pablo Guillermo-Durán ◽  
Salvador Gómez-Carro ◽  
Nina Mendez-Dominguez
Keyword(s):  
Foreign Body ◽  
Clinical Findings ◽  
Battered Child Syndrome ◽  
Clostridium Tetani ◽  
Case Presentation ◽  
Battered Child ◽  
Symptomatic Management ◽  
Child Syndrome ◽  
Terapia Intensiva ◽  
Rule Out

Introducción: El tétanos es una enfermedad infecciosa causada por Clostridium tetani, con un cuadro clínico grave y una elevada mortalidad. En Yucatán, la tasa de incidencia es baja (0.09 por 100,000 habitantes), reportándose únicamente dos casos en 2017, por lo que actualmente es una enfermedad de baja sospecha diagnóstica en la región. Caso clínico: Preescolar masculino de 5 años, originario de una comunidad rural de Yucatán y con esquema de inmunización incompleto, quien fue atendido por espasmos musculares generalizados, así como heridas recientes por cuerpo extraño y síndrome del niño maltratado. En la Unidad de Terapia Intensiva, se integró el diagnóstico de tétanos, por lo que recibió manejo etiológico y sintomático, logrando mejoría a su egreso. Discusión: Yucatán es una de las entidades federativas con mayor índice de maltrato infantil. Ante la presencia de dicha problemática social, es importante descartar un esquema de inmunización incompleto, mismos que con la coexistencia de hallazgos clínicos típicos y herida reciente por cuerpo extraño, se debe sospechar tétanos.Background: Tetanus is an infectious disease caused by Clostridium tetani, with severe symptoms and a high mortality rate.  In Yucatan, the incidence rate is low (0.09 per 100,000 population), reporting only two cases in 2017, so it is now a disease of low diagnostic suspicion in the region. Case presentation: A 5-year-old male preschool, from a rural community of Yucatán and with incomplete immunization scheme, who was attended by generalized muscle spasms as well as recent foreign body wounds and battered child syndrome. In the Intensive Care Unit, the diagnosis of tetanus was integrated, for which he received etiological and symptomatic management, achieving improvement at his discharge. Discussion: Yucatan is a state with high child abuse rate of. In the presence of this social problem, it is important to rule out an incomplete immunization scheme, which with the coexistence of typical clinical findings and recent foreign body wound, tetanus should be suspected. 

scholarly journals Dysfunctional Uterine Bleeding

2021 ◽  
Vol 7 (2) ◽  
pp. 01-02
Author(s):  
Shawky Badawy
Keyword(s):  
Adolescent Girls ◽  
Uterine Bleeding ◽  
Dysfunctional Uterine Bleeding ◽  
Proper Management ◽  
Perimenopausal Women ◽  
Work Up ◽  
Rule Out

Dysfunctional uterine bleeding occurs as a result of dysfunction of the hypothalamic pituitary ovarian axis. It is common in adolescent girls, and perimenopausal women. Proper evaluation to rule out organic causes for this bleeding is an essential part of the work up so that the proper management can applied.

Laparoscopic Small Bowel Resection And Anastmosis For Small Proximal Jejunal Gastrointestinal Stromal Tumor Presented With Acute Massive Lower Gastrointestinal Bleeding: Case report and Literature review

2020 ◽  
Author(s):  
khaled S ahmad ◽  
Mohamed S Essa ◽  
Naif A Alenazi
Keyword(s):  
Small Bowel ◽  
Gastrointestinal Bleeding ◽  
Bowel Resection ◽  
Small Bowel Resection ◽  
Gi Bleeding ◽  
Case Presentation ◽  
Pressure Necrosis ◽  
Lower Gi Bleeding ◽  
Small Intestinal ◽  
Work Up

Abstract Background Gastrointestinal stromal tumors (GISTs) is the most common primary nonepithelial neoplasms of the gastointestinal tract, mostly expressing the KIT protein determined by immunohistochemical staining for the CD117 antigen. Jejunal GISTs represent approximately 10% of all GISTs. Abdominal discomfort is the usual presentation. Jejunal GISTs may present with complications such as intestinal obstruction or hemorrhage. Gastrointestinal bleeding occurs due to pressure necrosis and ulceration of overlying mucosa, and patients who develop significant bleeding may suffer from fatigue and malaise. Small-bowel GISTs are classified based on size, and several guidelines have recommended conservative treatment for small jejunal GISTs (<2 cm).Case presentation In this report, we describe a 35-year-old male, with a jejunal GIST, who presented with an unusual massive lower GI bleeding. After resuscitation extensive work up, he was taken finally for a diagnostic laparoscopy and resection of the mass.Conclusion Small intestinal GISTs are rare and unusual to present with massive lower GI bleeding.

scholarly journals Two Cases of Oculofaciocardiodental (OFCD) Syndrome due to X-Linked BCOR Mutations Presenting with Infantile Hemangiomas: Phenotypic Overlap with PHACE Syndrome

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
T. M. Morgan ◽  
J. M. Colazo ◽  
L. Duncan ◽  
R. Hamid ◽  
K. M. Joos
Keyword(s):  
Genetic Testing ◽  
Posterior Fossa ◽  
Case Reports ◽  
Infantile Hemangioma ◽  
Cardiac Defects ◽  
Case Presentation ◽  
Female Patients ◽  
Phace Syndrome ◽  
Diagnostic Criterion ◽  
Arterial Anomalies

Background. Oculofaciocardiodental (OFCD) syndrome is due to mutations in BCOR (BCL-6 corepressor). OFCD has phenotypic overlaps with PHACE syndrome (Posterior fossa anomalies, Hemangioma, Arterial anomalies, Cardiac defects, Eye anomalies). Infantile hemangiomas are a key diagnostic criterion for PHACE, but not for OFCD. A previous study reported two cases of infantile hemangiomas in OFCD, but the authors could not exclude chance association. Case Presentation. We describe two novel cases of female patients (one initially diagnosed with PHACE syndrome), both of whom had infantile hemangiomas. Ophthalmological findings were consistent with oculofaciocardiodental (OFCD) syndrome. Upon genetic testing, these two females were determined to have X-linked BCOR mutations confirming OFCD syndrome diagnoses. Conclusion. These case reports add support to the hypothesis that infantile hemangiomas may be a feature of OFCD. BCOR may potentially be within a pathway of genes involved in PHACE syndrome and/or in infantile hemangioma formation.

scholarly journals A rare but treatable cause of recurrent chest pain - Ictal chest pain

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ching Soong Khoo ◽  
Dongah Lee ◽  
Kang Min Park ◽  
Byung In Lee ◽  
Sung Eun Kim
Keyword(s):  
Chest Pain ◽  
Cardiac Work ◽  
Case Presentation ◽  
Neurology Clinic ◽  
Work Up

Abstract Background Chest pain as the primary manifestation of epilepsy is extremely rare and has only been reported once to date. Case presentation We herein describe a 47-year-old woman with recurrent chest pain for 3 years. The cause of her chest pain remained elusive despite extensive investigations including comprehensive cardiac work-up. She was referred to the neurology clinic for one episode of confusion. Video-electroencephalographic monitoring detected unequivocal ictal changes during her habitual chest pain events. She has remained chest pain (seizure) free with a single antiseizure drug. Conclusions This case underlines the importance of epilepsy as a rare yet treatable cause of recurrent chest pain. Further studies are required to determine the pathophysiology of ictal chest pain.

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