Clostridium septicum arthroplasty infection: beware of occult aortitis and malignancy

2018 ◽  
Vol 63 (4) ◽  
pp. 132-139 ◽  
Author(s):  
Gareth Turnbull ◽  
Euan Spierits ◽  
David Russell ◽  
Jon Clarke ◽  
Frédéric Picard ◽  
...  
Keyword(s):  
Haematological Malignancy ◽  
Gas Gangrene ◽  
Review Of The Literature ◽  
Clinical Infection ◽  
Clostridium Septicum ◽  
Case Presentation ◽  
First Case ◽  
Underlying Malignancy ◽  
Life Threatening

Introduction The Clostridia species are responsible for life-threatening conditions such as tetanus, botulism and gas gangrene. Clostridium septicum is a rare cause of clinical infection, accounting for less than 1% of blood culture samples that test positive for Clostridia. However, C. septicum bacteraemia is associated with greater than 60% mortality and in over 80% of cases is associated with an underlying malignancy. Case presentation We present a review of the literature and the first case of an acute arthroplasty infection and concurrent infective aortitis caused by this organism in the absence of an identified underlying malignancy. Early diagnosis and multi-disciplinary input resulted in the patient surviving a rare and potentially fatal infective aortitis and septic arthritis. Conclusion This case demonstrates the importance of early systemic investigation to exclude occult infective aortitis in C. septicum infection. The key role of multi-disciplinary input into the management of this often fatal infection is also discussed along with the requirement to exclude occult gastrointestinal and haematological malignancy.

scholarly journals Multiple polyurethane implant punctures during fat grafting: case report and review of the literature

BMC Surgery ◽  
2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Dmitry Batiukov ◽  
V. Podgaiski ◽  
D. Mikulich ◽  
S. Kalinin
Keyword(s):  
Case Report ◽  
Breast Reconstruction ◽  
Breast Augmentation ◽  
Surgical Procedure ◽  
Fat Grafting ◽  
Review Of The Literature ◽  
Level Of Evidence ◽  
Case Presentation ◽  
Tissue Ingrowth ◽  
First Case

Abstract Background Breast augmentation with implants continues to be the most popular aesthetic surgical procedure performed worldwide. Fat grafting may improve the results of breast augmentation and breast reconstruction with implants. However, fat grafting to the breast with implants carries the risk of implant puncture. To our best knowledge this is the first case in which polyurethane implant puncture during fat grafting is described. Case presentation We report multiple bilateral implant punctures with the cannula during fat grafting in a patient who previously underwent breast reconstruction with polyurethane implants. Conclusions Implants that promote tissue ingrowth may be more prone to puncture with the cannula during fat grafting. Specific planning and surgical maneuvers decrease the risk of implant puncture. Level of evidence Level V, case report.

Adult Presentation of a Familial-Associated Vein of Galen Aneurysmal Malformation: Case Report

Neurosurgery ◽  
2010 ◽  
Vol 67 (6) ◽  
pp. E1845-E1851 ◽  
Author(s):  
David S Xu ◽  
Asad A Usman ◽  
Michael C Hurley ◽  
Christopher S Eddleman ◽  
Bernard R Bendok
Keyword(s):  
Case Report ◽  
Natural History ◽  
Vein Of Galen ◽  
Review Of The Literature ◽  
Time Resolved ◽  
Presenting Symptoms ◽  
First Case ◽  
Life Threatening ◽  
History Of ◽  
Asymptomatic Adult

Abstract BACKGROUND AND IMPORTANCE: Vein of Galen aneurysmal malformations (VGAMs) arise from persistent arteriovenous shunting from primitive choroidal vessels into the median prosencephalic vein of Markowski, the embryonic precursor of the vein of Galen. VGAMs rarely present past infancy, and their natural history in adults is unknown. We report the first case of a familial-associated VGAM in an asymptomatic adult female patient. The clinical features of this case are presented alongside a systematic review of the literature on adult VGAM cases to assess the natural history, clinical management, and genetic basis of this rare neurovascular lesion. CLINICAL PRESENTATION: A previously healthy 44-year-old woman with a family history of a VGAM in a stillborn presented with an 8-week onset of dizziness and vertigo that spontaneously resolved. Time-resolved magnetic resonance angiography identified a choroidal VGAM. No intervention was undertaken at this time because of the patient's asymptomatic status after 9 months of follow-up. CONCLUSION: Based on our review of the literature, this is the first case report of a familial-associated VGAM in an adult patient and suggests that VGAM development can be genetically linked. Of 15 adult VGAM cases previously reported, all patients were either symptomatic or treated, thus precluding determination of VGAM natural history in adults. Patient outcomes correlated with the severity of presenting symptoms, which ranged from asymptomatic to immediately life-threatening. We hypothesize that self-selection may render VGAMs to be more benign for them to persist past childhood. Further investigation of the molecular biology underlying VGAM development is warranted.

Autoimmune-related encephalitis during treatment with nivolumab for advanced head and neck cancer: a case report

2020 ◽  
Vol 106 (6) ◽  
pp. NP23-NP28
Author(s):  
Alessandro Guidi ◽  
Martina Violati ◽  
Miriam Blasi ◽  
Elettra Ferrari ◽  
Andrea Luciani ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Locally Advanced ◽  
Review Of The Literature ◽  
Concomitant Chemoradiotherapy ◽  
First Line ◽  
First Case ◽  
Life Threatening ◽  
One Year

Introduction: Head and neck cancer represents a variety of tumors involving different organs in the cervical district, burdened by poor prognosis when diagnosed in an advanced stage. Immunotherapy with both anti-PD-1 nivolumab and pembrolizumab has the aim of increasing overall survival for patients with this malignancy. We report the first case of immune-related encephalitis caused by nivolumab in this setting of disease and present a brief review of the literature. Case description: A 60-year-old woman had been treated with concomitant chemoradiotherapy for a locally advanced human papillomavirus–negative squamous cell carcinoma of the tonsil. After local recurrence, she was treated with platinum-based first-line chemotherapy, followed by nivolumab at further progression within 6 months. Nivolumab was administered for 19 weeks, then discontinued due to the occurrence of immune-related hypothyroidism and grade 2 diarrhea. A month after the onset of the endocrinopathy, the patient also developed steroid-responsive encephalitis, considered as a consequence of anti-PD-1 therapy. One year after discontinuation of immunotherapy, toxicities have resolved and the patient is maintaining a complete radiologic response. Conclusions: Immunotherapy is a relatively new and promising therapy in the field of oncology. Its mechanism of action, which aims to stimulate the immune system against cancer cells, is not comparable to systemic and cytotoxic chemotherapy, which directly attacks and destroys malignant cells. Despite these differences, immunotherapy is not to be considered free from side effects, sometimes life-threatening.

scholarly journals The Role of Trichoscopy in Keratosis Follicularis Spinulosa Decalvans: Case Report and Review of the Literature

2020 ◽  
pp. 1-7
Author(s):  
Aurora Alessandrini ◽  
Giancarlo Brattoli ◽  
Bianca Maria Piraccini ◽  
Ambra Di Altobrando ◽  
Michela Starace
Keyword(s):  
Case Report ◽  
Female Patient ◽  
Clinical Features ◽  
Diagnosis And Treatment ◽  
Skin Involvement ◽  
Review Of The Literature ◽  
Case Presentation ◽  
Keratosis Follicularis ◽  
Scarring Alopecia

<b><i>Introduction:</i></b> Keratosis follicularis spinulosa decalvans (KFSD) is a rare, X-linked, hereditary disorder of keratinization, characterized by skin involvement and progressive scarring alopecia of scalp, eyebrows, and eyelashes. The diagnosis is helped by the particular clinical features, but pathology is mandatory. <b><i>Case Presentation:</i></b> We described a case of a female patient referred to the outpatient’s hair consultation of our department, in which we performed trichoscopy as a very useful tool for the diagnosis, followed by pathology that confirmed KFSD. <b><i>Conclusion:</i></b> In our article, we underlined the importance of trichoscopy for the diagnosis of this hair disease, with also a review of the literature on diagnosis and treatment.

scholarly journals Life threatening abscess in the visceral space with penicillin and metronidazole resistant Prevotella Denticola following use of a laryngeal mask airway: case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hervé Vanden Eede ◽  
Elizabeth Norris ◽  
Michaël Torfs ◽  
Olivier Vanderveken
Keyword(s):  
Early Recognition ◽  
Laryngeal Mask ◽  
Pharyngeal Wall ◽  
Case Presentation ◽  
Respiratory Problems ◽  
First Case ◽  
Amoxicillin Clavulanate ◽  
Life Threatening ◽  
Single Use ◽  
Day Care Centre

Abstract Background Laryngeal mask airways (LMA) are commonly used for airway management. Complications with this device are rare. However, when they do occur, there is a high risk for respiratory problems, necessitating early diagnosis and treatment. We present the first case of a life-threatening abscess spreading in the visceral space caused by a penicillin and metronidazole resistant Prevotella Denticola after the use of an LMA. Case presentation A female patient was admitted to our day care centre for bunion surgery. A single use LMA size 3 (Solus®, intersurgical, Wokingham, Berkshire, United Kingdom) was successfully inserted. After surgery, the patient complained of a sore throat and amoxicillin was prescribed by the general practitioner. Three days after surgery the patient was admitted to the Intensive Care Unit (ICU) for obstructive breathing, due to an abscess in the visceral space. Retropharyngeal and certainly parapharyngeal abscesses in adults are already rare. This case however, is unique because it is the first case of abscess spreading into the visceral space after the use of an LMA. Amoxicillin/clavulanate and vancomycin were started. The abscess was incised 5 days later and microbiology showed 3 positive cultures of the anaerobe Prevotella denticola, resistant for penicillin and metronidazole, but sensitive for amoxicillin/clavulanate. The patient fully recovered. Conclusion LMA’s are easy to use and are established, safe tools to support ventilation of the airway. In this case, the authors hypothesise a small wound in the lateral pharyngeal wall probably created an opening into the visceral space causing infection with Prevotella denticola, supporting the idea that the pharyngeal mucosal space must be part of the visceral space. Additionally, early recognition and treatment of an LMA induced abscess is necessary to prevent evolution of complications leading to airway obstruction.

Fatal Case of Vulvar Pyoderma Gangrenosum with Pulmonary Involvement: Case Presentation and Literature Review

2014 ◽  
Vol 18 (6) ◽  
pp. 424-429 ◽  
Author(s):  
Joshua M. Mercer ◽  
Paul Kuzel ◽  
Muhammad N. Mahmood ◽  
Alain Brassard
Keyword(s):  
Literature Review ◽  
Pyoderma Gangrenosum ◽  
Rare Case ◽  
Fatal Case ◽  
Pulmonary Involvement ◽  
Review Of The Literature ◽  
Treatment Resistant ◽  
Case Presentation ◽  
First Case ◽  
Systemic Therapies

Introduction: We report a case of a 61-year-old woman with locally destructive vulvar pyoderma gangrenosum (PG) with pulmonary involvement who was refractory to numerous systemic therapies and developed complications resulting in her demise. Objective: To report a rare case of treatment-resistant vulvar PG with pulmonary involvement that proved to be fatal. Methods: PubMed was used to search for other reports that discuss PG, or more specifically perigenital PG, with pulmonary involvement. Results and Conclusion: A thorough review of the literature revealed 33 cases of PG with pulmonary involvement, with only 4 involving the perigenital region. We report the second case of a female with vulvar PG and pulmonary involvement. In contrast to the first case described, our patient did not respond to systemic therapy, and, ultimately, her disease was fatal. It is hoped that with continued documentation of this rare and potentially lethal presentation of PG, physicians will determine more effective treatments.

scholarly journals Medical errors during COVID-19 pandemic: the role of emergency medicine

2020 ◽  
Vol 7 (2) ◽  
pp. 133-134
Author(s):  
Shaghayegh Rahmani ◽  
Kosar Deldar ◽  
Sara Hemati Ali
Keyword(s):  
Emergency Medicine ◽  
Healthcare Workers ◽  
Delayed Diagnosis ◽  
Health Concern ◽  
Critical Conditions ◽  
Case Presentation ◽  
Academic Center ◽  
The World ◽  
Life Threatening

Objective: Nowadays, many countries all over the world are involved with COVID-19 and the number of new cases and deaths are on a rise. The role of emergency medicine and physician-led triage is important in this period. We report some near missed cases in our academic center related to this pandemic. Case Presentation: We report 5 cases that missed triage or received delayed diagnosis because of COVID-19 suspicion. Some cases are life threatening. Conclusion: Although COVID-19 is the main health concern these days, other critical conditions should be considered. Stabilizing patients before transferring them between hospitals should be the essential goal of emergency department whether the patient is Corona virus infected or not. And before any intervention, the safety of healthcare workers must be ensured.

scholarly journals Role of Radiology in Pica Syndrome: A Case Report

2020 ◽  
Author(s):  
Isil Yurdaisik
Keyword(s):  
Developmental Level ◽  
Severe Anemia ◽  
Case Presentation ◽  
Active Involvement ◽  
The Third ◽  
First Case ◽  
History Of ◽  
Laboratory Investigations ◽  
Intestinal Obstructions

Abstract Background: Pica syndrome is a mental disorder defined as eating non-food and not-nutritive substances at least for 1 month. The diagnosis of pica syndrome is based on severe anemia which is not compatible with the developmental level, intestinal obstructions, or several conditions depending on content of the substance intaken such as lead poisoning etc. The diagnosis of pica syndrome requires active involvement of pediatrics, psychiatrists, radiologists and patients/family members. Case Presentation: In this report, we present a 50-year-old female patient who presented to the emergency department with abdominal pain and radiologically diagnosed with pica syndrome. Patient’s physical and laboratory investigations were normal, while all abdominal tomography revealed hyper-density areas. It was found in the detailed history of the patient that she was receiving psychiatric therapy and had habit of eating cigarette ashes. Upon this, cigarette ashes soaked in water were radiologically examined, similar hyper-density areas were found, and the diagnosis of pica syndrome was established. Conclusion: This case is the third case of eating cigarette ashes pica presented in the literature, and the first case diagnosed radiologically.

Early recognition and critical management of adult epiglottitis in the emergency department: a case report and review of the literature

2021 ◽  
Keyword(s):  
Emergency Department ◽  
Airway Management ◽  
Early Recognition ◽  
Pediatric Population ◽  
Delayed Diagnosis ◽  
Lateral Neck ◽  
Review Of The Literature ◽  
Acute Epiglottitis ◽  
Case Presentation ◽  
Life Threatening

Background: Acute epiglottitis was considered a disease of the pediatric population. However, it has constantly been a report of a certain number of adult cases. Death by airway obstruction is caused by delayed diagnosis and untimely invasive airway management contributing to the higher mortality rate in adults. Case presentation: We presented a case of a 24-year-old male patient without significant underlying condition, who presented at our emergency department with a progressive sore throat and high-graded fever for one day. After a set of investigations, the patient was diagnosed with acute epiglottitis, and airway management was managed accordingly. His conditions improved after a course of antibiotic treatment during hospital admission. Conclusion: Acute epiglottitis in adults is not frequently encountered in the emergency department. This case underlines the importance of clinical suspicions in cases with consistent symptoms as well as the excellent utility of lateral neck radiography for the diagnosis of this life-threatening entity.

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