scholarly journals Fever, pancytopenia, and elevated D-dimer in a 95‐year‐old woman with ehrlichiosis: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Christopher Radcliffe ◽  
Cynthia Tsay ◽  
Kimberly Glerum ◽  
Jane Liao ◽  
George Goshua ◽  
...  
Keyword(s):  
Hematological Malignancies ◽  
Reference Range ◽  
Peripheral Blood Smear ◽  
Symptomatic Improvement ◽  
Clinical Findings ◽  
Pulmonary Emboli ◽  
Case Presentation ◽  
Appropriate Treatment ◽  
Computed Tomography Angiogram ◽  
D Dimer

Abstract Background Pancytopenia, fever, and elevated D-dimer are significant clinical findings. The differential diagnosis includes hematological malignancies, severe coronavirus disease 2019 (COVID-19), tick-borne illnesses, and other etiologies. Case presentation We report the case of a 95-year-old woman who presented with high fever (103.6 °F), pancytopenia, and markedly elevated D-dimer (32.21 mg/L; reference range ≤ 0.95 mg/L) in late-autumn during the COVID-19 pandemic at a large academic institution. After remaining persistently febrile, a peripheral blood smear was ordered and revealed parasites consistent with Ehrlichia spp. Doxycycline monotherapy led to symptomatic improvement and resolution of her pancytopenia. During her hospital stay, a computed tomography angiogram of the chest revealed pulmonary emboli, and esophagogastroduodenoscopy uncovered arteriovenous malformations. After appropriate treatment, she was discharged on hospital day 7 and has since done well. Conclusions Overall, our case offers a dramatic, unexpected presentation of ehrlichiosis in a nonagenarian. To our knowledge, this is the first report of concurrent ehrlichiosis and pulmonary embolus.

scholarly journals Breast involvement of hematological malignancies: imaging and clinical findings

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Gamze Durhan ◽  
Figen Demirkazık
Keyword(s):  
Hematological Malignancies ◽  
Clinical Findings ◽  
Accurate Diagnosis ◽  
Radiological Findings ◽  
Breast Masses ◽  
Appropriate Treatment ◽  
Magnetic Resonance Imaging Mri ◽  
Type 3 ◽  
And Diffusion

Abstract Background Breast involvement of hematological malignancies is a very rare entity. Accurate diagnosis is essential for appropriate treatment. The aim of this study was to clarify the clinical and radiological findings of hematological malignancy breast involvement and to describe possible pitfalls in diagnosis. Results The images of 20 patients with breast involvement of hematological malignancies were retrospectively evaluated on ultrasonography, mammography, and magnetic resonance imaging (MRI) and the findings were reported. Bilaterality was seen only in cases with secondary involvement, and there was no marked difference between primary and secondary breast involvement of hematological malignancies. All patients underwent ultrasonography examination. According to ultrasonography, breast masses were most frequently irregular in shape (11/20, 55%) with non-circumscribed margins (11/20, 55%). Posterior acoustic enhancement was noted in 14 cases (70%). Posterior shadowing was not observed in any of the patients. Mammography was available in 10 patients. Microcalcification was not observed in any patient on mammography. MRI was available in four patients. Hyperintensity in T2-weighted images, type 2 or type 3 dynamic curve, and diffusion restriction were observed in all cases. Conclusions Hematological malignancies may mimic both benign breast lesions and breast carcinoma. Familiarity with the radiological features of hematological malignancies can help accurate diagnosis.

scholarly journals Pectoralis Minor Syndrome: Case Presentation and Review of the Literature

2016 ◽  
Vol 2016 ◽  
pp. 1-3
Author(s):  
Mohammed Abdallah ◽  
Mohammad Rachad Wehbe ◽  
Elias Elias ◽  
Muhammad Aghiad Kutoubi ◽  
Roger Sfeir
Keyword(s):  
Young Female ◽  
Clinical Findings ◽  
Axillary Vein ◽  
Rare Entity ◽  
Review Of The Literature ◽  
Case Presentation ◽  
Pectoralis Minor ◽  
Appropriate Treatment ◽  
Pectoralis Minor Muscle ◽  
Minor Muscle

We present a case of a healthy young female with axillary vein compression caused by the pectoralis minor muscle. Diagnosis was made by clinical findings and dynamic venography. After pectoralis minor tenotomy, the patient had total resolution of her symptoms. Compression of the axillary vein by the pectoralis minor is a rare entity that needs a careful exam and imaging to reach its diagnosis and establish the appropriate treatment.

scholarly journals Multiple simultaneous embolic cerebral infarctions 11 months after COVID-19

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Rajiv Advani ◽  
Torbjørn Austveg Strømsnes ◽  
Espen Stjernstrøm ◽  
Sebastian T. Lugg
Keyword(s):  
Case Report ◽  
Thromboembolic Event ◽  
Pulmonary Emboli ◽  
Shortness Of Breath ◽  
Foramen Ovale ◽  
Case Presentation ◽  
Stroke Etiology ◽  
The One ◽  
D Dimer

Abstract Background The coronavirus disease (COVID-19) pandemic has led to an unprecedented worldwide burden of disease. However, little is known of the longer-term implications and consequences of COVID-19. One of these may be a COVID-19 associated coagulopathy that can present as a venous thromboembolism (VTE) and further, as multiple paradoxical cerebral emboli. Case presentation A 51 year old man presented to the emergency department with multiple simultaneous embolic cerebral infarctions 11 months after mild COVID-19. In the subacute phase of the COVID-19 illness the patient developed increasing shortness of breath and was found to have an elevated D-dimer and multiple bilateral segmental pulmonary emboli. He was subsequently treated with 3 months of anticoagulation for a provoked VTE. The patient then presented 11 months after the initial COVID-19 diagnosis with multiple simultaneous cerebral infarctions where no traditional underlying stroke etiology was determined. A patent foramen ovale (PFO) and an elevated D-dimer were found suggesting a paradoxical thromboembolic event due to an underlying coagulopathy. Conclusions This case report highlights the one of the potentially more serious complications of long-term COVID-19 where VTE due to a persistent coagulopathy is seen almost a year after the initial illness. Due to the highly prevalent nature of PFO in the general population, VTE due to COVID-19 associated coagulopathy could lead to ischemic stroke. This case report highlights the possibility for an underlying COVID-19 associated coagulopathy which may persist for many months and beyond the initial illness.

scholarly journals Multiple Simultaneous Embolic Cerebral Infarctions 11 Months After COVID-19

2021 ◽  
Author(s):  
Rajiv Advani ◽  
Torbjørn Austveg Strømsnes ◽  
Espen Stjernstrøm ◽  
Sebastian Thomas Lugg
Keyword(s):  
Case Report ◽  
Thromboembolic Event ◽  
Pulmonary Emboli ◽  
Shortness Of Breath ◽  
Foramen Ovale ◽  
Case Presentation ◽  
Stroke Etiology ◽  
The One ◽  
D Dimer

Abstract BackgroundThe coronavirus disease (COVID-19) pandemic has led to an unprecedented worldwide burden of disease. However, little is known of the longer-term implications and consequences of COVID-19. One of these longer-term complications is a COVID-19 associated coagulopathy that can present as a venous thromboembolism (VTE) and, as yet unreported, multiple paradoxical cerebral emboli. Case PresentationA 51 year old man presented to the emergency department with multiple simultaneous embolic cerebral infarctions 11 months after mild COVID-19. In the subacute phase of the COVID-19 illness the patient developed increasing shortness of breath and was found to have an elevated D-dimer and multiple bilateral segmental pulmonary emboli. He was subsequently treated with 3 months of anticoagulation for a provoked VTE. The patient then presented 11 months after the initial COVID-19 diagnosis with multiple simultaneous cerebral infarctions where no traditional underlying stroke etiology was determined. A patent foramen ovale (PFO) and an elevated D-dimer were found indicating a paradoxical thromboembolic event due to an underlying coagulopathy. ConclusionsThis case report highlights the one of the potentially more serious complications of long-term COVID-19 where VTE due to a persistent coagulopathy is seen almost a year after the initial illness. Due to the highly prevalent nature of PFO in the general population, VTE due to COVID-19 associated coagulopathy could lead to ischemic stroke. This case report therefore highlights the challenge posed by the underlying COVID-19 associated coagulopathy which can persist for many months and beyond from the initial illness.

A Comparative Analysis of D-Dimer Assays in Patients with Clinically Suspected Pulmonary Embolism

1993 ◽  
Vol 70 (03) ◽  
pp. 408-413 ◽  
Author(s):  
Edwin J R van Beek ◽  
Bram van den Ende ◽  
René J Berckmans ◽  
Yvonne T van der Heide ◽  
Dees P M Brandjes ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Comparative Analysis ◽  
High Probability ◽  
Pulmonary Emboli ◽  
Plasma Samples ◽  
Suspected Pulmonary Embolism ◽  
Lung Scan ◽  
D Dimer

SummaryTo avoid angiography in patients with clinically suspected pulmonary embolism and non-diagnostic lung scan results, the use of D-dimer has been advocated. We assessed plasma samples of 151 consecutive patients with clinically suspected pulmonary embolism. Lung scan results were: normal (43), high probability (48) and non-diagnostic (60; angiography performed in 43; 12 pulmonary emboli). Reproducibility, cut-off values, specificity, and percentage of patients in whom angiography could be avoided (with sensitivity 100%) were determined for two latex and four ELISA assays.The latex methods (cut-off 500 μg/1) agreed with corresponding ELISA tests in 83% (15% normal latex, abnormal ELISA) and 81% (7% normal latex, abnormal ELISA). ELISA methods showed considerable within- (2–17%) and between-assay Variation (12–26%). Cut-off values were 25 μg/l (Behring), 50 μg/l (Agen), 300 μg/l (Stago) and 550 μg/l (Organon). Specificity was 14–38%; in 4–15% of patients angiography could be avoided.We conclude that latex D-dimer assays appear not useful, whereas ELISA methods may be of limited value in the exclusion of pulmonary embolism.

scholarly journals The vagaries of IgM: a case report of EBV infection with concomitantly false-positive IgM for CMV, VZV, and HSV

2020 ◽  
Vol 32 (1) ◽  
Author(s):  
Raai Mahmood ◽  
Khalid Mohamed ◽  
Naba Saeed ◽  
Kadhim Al-Banaa ◽  
Jonathan Zimmerman ◽  
...  
Keyword(s):  
Infectious Mononucleosis ◽  
Total Bilirubin ◽  
Viral Infections ◽  
Total Bilirubin Level ◽  
Peripheral Blood Smear ◽  
Cross Reactivity ◽  
Immunoglobulin M ◽  
Case Presentation ◽  
Ebv Infection ◽  
Acute Infectious Mononucleosis

Abstract Background Serum IgM (immunoglobulin M) testing is commonly used to diagnose acute viral infections. However, most clinicians are unaware of the vagaries of IgM testing, including antigenic cross-reactivity between multiple viruses and risk misdiagnosis. Case presentation We report a case of infectious mononucleosis with concomitantly positive IgM for EBV, CMV, VZV, and HSV. A 26-year-old man presented with acute infectious mononucleosis picture. His blood work showed a total bilirubin level of 7.7 mg/dl, ALT 1077 U/L, AST 806 U/L, ALP 325 U/L, and INR 1.0. Monospot was positive; peripheral blood smear showed atypical lymphocytes; however, because EBV infectious mononucleosis does not typically cause elevation of liver enzymes over 1000, other etiologies were explored. Tests for hepatitis A, B, C, HIV, ANA, and ASMA returned negative. IgM for EBV-VCA, CMV, HSV, and VZV all returned positive, and the diagnosis of EBV IM was called into question. Subsequent tests of CMV and HSV PCR for viral load were negative (VZV was not clinically suspected), and later on, EBV-EBNA returned negative and EBV-VCA IgM and IgG returned positive, confirming the diagnosis of acute EBV infection. Conclusion We believe that IgM seropositivity can result from cross-reactivity among several viruses (especially herpes viruses), and although often relied on, a positive IgM should not serve as the sole determinant for diagnosis of acute viral infections.

Significantly enlarged varix in the free-loop of the umbilical cord during the second trimester

2020 ◽  
Vol 9 (1) ◽  
Author(s):  
Akiko Kurasaki ◽  
Junichi Hasegawa ◽  
Natsumi Furuya ◽  
Chika Homma ◽  
Satoshi Harada ◽  
...  
Keyword(s):  
Umbilical Cord ◽  
Thrombus Formation ◽  
Umbilical Vein ◽  
Second Trimester ◽  
Venous Flow ◽  
Case Presentation ◽  
Neonatal Blood ◽  
High Concentrations ◽  
Venous Varix ◽  
D Dimer

Abstract Objectives Umbilical cord varix is an abnormal dilatation of the umbilical vein. There are two types of umbilical venous varix, of which the free-loop type is extremely rare, and the prognosis and etiology are unclear. In this report, we present a case of a significantly enlarged varix in the free loop of the umbilical cord found in the second trimester. Case presentation Cesarean section was performed at 28 weeks’ gestation due to enlargement of the varix and rapidly increased umbilical venous velocity at the outlet of the varix. Neonatal blood tests revealed anemia and high concentrations of D-dimer, and they were considered to be due to clot formation inside the umbilical cord venous varix. The neonate received blood transfusion but other neonatal course was generally favorable. Thrombus formation in the enlarged varix was due to the constriction of the umbilical cord. Conclusions This case showed that the assessment of umbilical venous flow velocity can be used for estimating the constriction of the umbilical vein and for determining the timing of delivery.

Exclusive Neurogenic Bladder and Fecal Incontinency in an Achondroplasic Child Successfully Treated with Lumbar Foraminal Decompression

2021 ◽  
pp. 1-6
Author(s):  
Flavio Giordano ◽  
Matteo Lenge ◽  
Pierarturo Donati ◽  
Lorenzo Mongardi ◽  
Gianpiero Di Giacomo ◽  
...  
Keyword(s):  
Fecal Incontinence ◽  
Neurogenic Bladder ◽  
Genetic Disorder ◽  
Motor Impairment ◽  
Foramen Magnum ◽  
Clinical Findings ◽  
Lumbar Stenosis ◽  
Endochondral Bone ◽  
Case Presentation ◽  
First Case

<b><i>Introduction:</i></b> Achondroplasia is a genetic disorder characterized by defects in the development of endochondral bone resulting in skeletal abnormalities like stenosis of the foramen magnum and of the spine, shortened limb bones, and macrocephaly. Congenital spinal stenosis is frequent and due to premature fusion of the pedicles to the laminae. <b><i>Case Presentation:</i></b> We report a case of neurogenic bladder and fecal incontinence due to lumbar stenosis successfully treated with L1–L5 partial laminectomy and foraminotomy in a 7-year-old achondroplasic child. <b><i>Discussion/Conclusion:</i></b> To our knowledge, this is the first case report of exclusive neurogenic bladder and fecal incontinence in an achondroplasic child. Neurogenic bladder and fecal incontinence without motor impairment may be early and exclusive clinical findings of lumbar stenosis in children with achondroplasia.

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 Reworsening of Recurrent Guillain-Barré Syndrome Triggered by COVID-19 Infection

2021 ◽  
Vol 15 (1) ◽  
pp. 48-51
Author(s):  
Gian Luca Vita ◽  
Carmen Terranova ◽  
Maria Sframeli ◽  
Antonio Toscano ◽  
Giuseppe Vita
Keyword(s):  
Viral Infection ◽  
Neurological Diseases ◽  
Intravenous Immunoglobulins ◽  
Guillain Barre Syndrome ◽  
Case Presentation ◽  
Appropriate Treatment ◽  
Immune Mediated ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

Introduction: Guillain-Barré Syndrome (GBS) is an acute, immune-mediated, generalized polyradiculoneuropathy often triggered by a bacterial or viral infection, vaccination, or surgery. During the SARS-CoV-2 pandemic, some patients were reported with GBS associated COVID-19 infection. Case Presentation: We report, herein, a patient who had a recurrent GBS after forty years. Intravenous immunoglobulins (IVIg) induced improvement, but her condition worsened suddenly after twenty days, coinciding with a COVID-19 infection. A second IVIg cycle was administered, and she improved again. Conclusion: The take-home message is that in the current pandemic, any re-worsening or lack of improvement after appropriate treatment of GBS or possibly other autoimmune neurological diseases must be checked to determine if it is related to COVID-19 infection.

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