New HIV diagnoses in patients with COVID-19: two case reports and a brief literature review

Abstract Background COVID-19 is novel infectious disease with an evolving understanding of its epidemiology and clinical manifestations. Severe cases developed life-threatening complications, such as respiratory failure, shock, and multiple organs dysfunction. Immunocompromised patients often present atypical presentations of viral infected diseases. Case presentation We report newly diagnosed HIV infections in two patients with COVID-19 in China. In our two cases, both patients with elevated IL-6 received Tocilizumab treatment, but did not present obvious therapeutic effect. Conclusions These cases highlight possible co-detection of known immunocompromised diseases such as HIV. The two cases we reported stressed the risk of misdiagnosis, especially during the pandemic of an infectious disease and the importance of extended testing even if in immune-compromised condition the immune state may be ignored.

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Atypical presentations of malignant otitis externa

The Journal of Laryngology & Otology ◽

10.1017/s0022215110000307 ◽

2010 ◽

Vol 124 (11) ◽

pp. 1205-1208 ◽

Cited By ~ 7

Author(s):

Z Vourexakis ◽

M-I Kos ◽

J-P Guyot

Keyword(s):

Pseudomonas Aeruginosa ◽

Skull Base ◽

Diagnostic Criteria ◽

Otitis Externa ◽

Case Reports ◽

Clinical Manifestations ◽

Diabetic Patients ◽

Malignant Otitis Externa ◽

Life Threatening ◽

Atypical Presentations

AbstractIntroduction:Malignant otitis externa is a life-threatening infection of the skull base. Its presentation is not always typical.Case reports:We report three cases of malignant otitis externa which illustrate the diversity of its clinical manifestations and the difficulties in its diagnosis.Discussion:The perception of malignant otitis externa as an infection caused by Pseudomonas aeruginosa in diabetic patients is not always correct. The adoption of diagnostic criteria could be helpful in identifying atypical cases.

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Can we effectively predict the occurrence of cerebral edema in children with ketoacidosis in the course of type 1 diabetes? – case report and literature review

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2019-0440 ◽

2020 ◽

Vol 33 (2) ◽

pp. 319-322

Author(s):

Krzysztof Jeziorny ◽

Arleta Waszczykowska ◽

Dobromiła Barańska ◽

Agnieszka Szadkowska ◽

Wojciech Młynarski ◽

...

Keyword(s):

Type 1 Diabetes ◽

Cerebral Edema ◽

Diagnostic Methods ◽

Newly Diagnosed ◽

Cns Disorders ◽

Case Presentation ◽

Non Invasive ◽

Appropriate Treatment ◽

Life Threatening

AbstractBackgroundCerebral edema (CE) is one of the most serious complications of diabetic ketoacidosis (DKA) and can result in central nervous system (CNS) disorders and even lead to death of the patient.Case presentationWe present the case of a 11-year-old boy with severe DKA in the course of newly diagnosed type 1 diabetes (T1D). The delay in the diagnosis of DKA and some therapeutic problems contributed to the development of CE and direct life-threatening conditions. Early diagnosis of CE development in the course of DKA using non-invasive methods such as pachymetry or transorbital ultrasound seems to be a very important prognostic factor.ConclusionsThis case highlights the importance of appropriate treatment according to the newest recommendations and presents the usefulness of new diagnostic methods to assess the risk of CE in children with newly diagnosed T1D.

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Left Renal Vein Thrombus and Pulmonary Thromboembolism Caused by Nutcracker Syndrome: a Case Report

10.21203/rs.3.rs-377593/v1 ◽

2021 ◽

Author(s):

Kanta Hori ◽

Shota Yamamoto ◽

Maki Kosukegawa ◽

Noboru Yamashita ◽

Yuichiro Shinno

Keyword(s):

Case Report ◽

Renal Vein ◽

Pulmonary Thromboembolism ◽

Case Reports ◽

Left Renal Vein ◽

Clinical Manifestations ◽

Venous Hypertension ◽

Nutcracker Syndrome ◽

Case Presentation ◽

Renal Venous Hypertension

Abstract Background: Nutcracker syndrome (NCS) refers to compression of the left renal vein (LRV) between the aorta and superior mesenteric artery (SMA), which results in renal venous hypertension and its resultant clinical manifestations. Left renal vein thrombus (LRVT) complicating NCS is relatively rare. To the best of our knowledge, there are only four case reports of LRVT complicating NCS. Furthermore, there are no reports of pulmonary thromboembolism (PTE) caused by NCS. Herein, we describe a rare case of NCS causing LRVT and PTE and its clinical management. Case Presentation: A 40-year-old man was admitted to our hospital with acute left flank pain. Computed tomography angiography (CTA) revealed compression of the LRV between the aorta and the SMA with an LRVT. Furthermore, CTA revealed bilateral PTE. Rivaroxaban was administered as an anticoagulant. Twenty days after initiation, CTA revealed complete resolution of PTE and LRVT, and repeat CTA at 3 and 6 months showed no recurrence. Conclusions: This case report demonstrates that NSC may be a possible cause of LRVT and PTE. We review the reported cases of NCS complicated by LRVT and discuss the imaging modalities for NCS.

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Selected Infectious Disease Emergencies

Pediatric Emergencies ◽

10.1093/med/9780190073879.003.0013 ◽

2020 ◽

pp. 115-122

Author(s):

Scott Kobner ◽

Emily Rose

Keyword(s):

Infectious Disease ◽

Bartonella Henselae ◽

Viral Meningitis ◽

Brain Parenchyma ◽

Retropharyngeal Abscess ◽

Cat Fleas ◽

Life Threatening ◽

Tissue Space ◽

Atypical Presentations ◽

The Brain

Fever is common in children, and serious etiologies with significant sequelae must be identified and treated. This chapter discusses the classic and atypical presentations of several important pediatric infectious disease conditions, including bacterial and viral meningitis (inflammation of the meninges that typically occurs in response to an infectious process), infectious encephalitis (inflammation of the brain parenchyma that presents clinically with neurologic dysfunction), retropharyngeal abscess (a potentially life-threatening airway emergency secondary to an infection of the retropharyngeal soft tissue space), and cat scratch disease secondary to Bartonella henselae infection (an infectious lymphadenopathy after exposure to cats or cat fleas). Diagnostic confirmation and treatment of these conditions are also discussed.

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Peritoneal-Pleural Leaks Demonstrated by CT Peritoneography

Case Reports in Nephrology and Dialysis ◽

10.1159/000430806 ◽

2015 ◽

Vol 5 (2) ◽

pp. 135-139 ◽

Cited By ~ 6

Author(s):

Tian Xu ◽

Jingyuan Xie ◽

Weiming Wang ◽

Hong Ren ◽

Nan Chen

Keyword(s):

Pleural Effusion ◽

Ct Scan ◽

Case Reports ◽

Noninvasive Treatment ◽

Case Presentation ◽

Ct Value ◽

Satisfactory Outcome ◽

Ionic Contrast ◽

Life Threatening ◽

Ionic Contrast Medium

Introduction: Acute hydrothorax is an uncommon complication of peritoneal dialysis (PD). Currently, there is no specific diagnostic method. Although it is not a life-threatening complication, hydrothorax often requires interrupting or quitting PD. Misdiagnosis often leads to more serious consequences. Case Presentation: A 49-year-old woman (height 163 cm, weight 58 kg, BMI 21.82), who started PD 3 months previously, suddenly presented with acute dyspnea and a right pleural effusion. Blood routine examination, serum albumin and a series of laboratory tests were immediately performed. Except for the serum creatinine, all of the other tests were within normal range. Thoracentesis was performed to obtain pleural fluid specimens; there was also no evidence of a tumor or inflammation. Congestive heart failure, infection and hypoalbuminemia were excluded as well. Because PD-associated pleural leakage was suspected, computerized tomography (CT) peritoneography was performed next. The first CT scan showed that the CT value of pleural effusion was 6 Hounsfield units (HU). On the evening of the same day, 100 ml ionic contrast medium was mixed with 2 l dialysate and infused into the peritoneal cavity. The next morning, a CT scan was performed again. The CT value of pleural effusion at the same site increased to 40 HU. At the end, pleural leakage was clearly diagnosed. Subsequently, she received temporary hemodialysis and a small dose of automated PD. After 3 months, she successfully returned to PD without any recurrence of hydrothorax. Conclusion: Although similar case reports are not rare, this report provided a simple and effective method for diagnosing pleural leakage. Furthermore, noninvasive treatment of pleural effusion will also get a satisfactory outcome.

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Gastrointestinal symptoms as first remarkable signs of ANCA-associated granulomatosis with polyangiitis: a case report and reviews

BMC Gastroenterology ◽

10.1186/s12876-021-01730-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Nóra Ledó ◽

Ákos Géza Pethő

Keyword(s):

Gastrointestinal Bleeding ◽

Granulomatosis With Polyangiitis ◽

Systemic Vasculitis ◽

Case Reports ◽

Gastrointestinal Symptoms ◽

Case Presentation ◽

Life Threatening ◽

Proper Diagnosis ◽

Duodenal Bleeding ◽

Inflammatory Bowel

Abstract Background Systemic vasculitis associated with antineutrophil cytoplasmic autoantibodies (ANCA) have an extremely wide variety of symptoms, therefore the fast and proper diagnosis is difficult to establish even for experienced physicians. Gastrointestinal manifestations in ANCA-associated granulomatosis with polyangiitis (GPA) may be present, however, severe, life-threatening complications (such as perforations) are rare. Case presentation A case of an 18-year-old male patient is presented, where gastrointestinal symptoms (abdominal pain, vomiting, diarrhoea) were the first remarkable signs of GPA. The initial diagnosis of inflammatory bowel disease delayed the administration of proper immunosuppressive therapy, which might have contributed to the rare and life-threatening complication of arterial duodenal bleeding with perforation. Our systematic review of the literature found only a few case reports where gastrointestinal symptoms were the first signs of GPA, however, this entity might be more frequent if physicians would think of this possibility more often. Conclusions Gastrointestinal bleeding is a rare but potential lethal complication of vasculitis. Consequently, we recommend investigating the patients diagnosed with GPA for gastrointestinal bleeding during the treatment.

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Acetazolamide-Triggered Acute Flaccid Paralysis and Toxic-Metabolic Encephalopathy in a Toddler with Gastroenteritis: A Case Report

Journal of Child Science ◽

10.1055/s-0040-1718562 ◽

2020 ◽

Vol 10 (01) ◽

pp. e159-e162

Author(s):

Jack Green ◽

Pooja Nawathe

Keyword(s):

Acute Flaccid Paralysis ◽

Case Reports ◽

Flaccid Paralysis ◽

Medication History ◽

Metabolic Derangement ◽

Metabolic Encephalopathy ◽

Case Presentation ◽

Adult Disease ◽

Neurologic Sequelae ◽

Life Threatening

AbstractAcetazolamide is an infrequently prescribed medication in the outpatient pediatric setting, as one of its major indications is for the treatment of glaucoma, which is a largely adult disease. Though incredibly rare, serious neurologic side effects such as stroke, flaccid paralysis, and coma can occur after its administration. This case presentation of acute flaccid paralysis with metabolic derangement underscores the unusual, yet possible, toxic-metabolic and neurologic sequelae that can occur in an already acidotic host (in this case, caused by gastroenteritis) with acetazolamide ingestion. Life-threatening conditions must always be ruled out in patients who present with encephalopathy, but a medication history was crucial in clinching this case's unifying diagnosis. While there are case reports highlighting the rare central nervous system toxicities associated with acetazolamide ingestion, to our knowledge, none exist in the pediatric literature.

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Echinococcal hepatic lesion mimicking metastasis from colon cancer: two case reports

BMC Surgery ◽

10.1186/s12893-021-01150-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Marionna Cathomas ◽

Paolo Abitabile ◽

Rok Dolanc ◽

Christine Glaser ◽

Gieri Cathomas

Keyword(s):

Colorectal Cancer ◽

Cancer Metastasis ◽

Case Reports ◽

Liver Lesion ◽

Newly Diagnosed ◽

Case Presentation ◽

Granulomatous Lesions ◽

Colorectal Cancer Metastasis ◽

Polymerase Chain ◽

Hepatic Lesions

Abstract Background Echinococcus is a worldwide zoonosis, primarily causing liver lesions. Accidentally detected, these lesions enter the differential diagnosis of a tumor, including metastasis. This situation is especially challenging in patients with colorectal cancer, as both diseases affect mainly the liver. Case presentation We report two patients with a newly diagnosed colorectal cancer. Pre- and intraoperatively radiological imaging revealed hepatic lesions which were resected on suspicion of colorectal cancer metastasis. Histology showed granulomatous lesions with characteristic parasitic membrane consistent with an echinococcal cyst. The diagnosis was confirmed by specific polymerase chain reaction. Conclusions Focal hypoechoic liver lesion in patients with colorectal cancer should be primarily considered as a liver metastasis and resected whenever feasible. Other uncommon etiologies, including parasitic lesion as echinococcal cysts, should be taken in consideration, as this could lead to major changes of the management and prognosis of the affected patients.

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Neglected human Rickettsia felis infection in Taiwan: A retrospective seroepidemiological survey of patients with suspected rickettsioses

PLoS Neglected Tropical Diseases ◽

10.1371/journal.pntd.0009355 ◽

2021 ◽

Vol 15 (4) ◽

pp. e0009355

Author(s):

Wan-Hsiu Yang ◽

Meng-Shiuan Hsu ◽

Pei-Yun Shu ◽

Kun-Hsien Tsai ◽

Chi-Tai Fang

Keyword(s):

Scrub Typhus ◽

Q Fever ◽

Current Knowledge ◽

Medical Center ◽

Case Reports ◽

Clinical Manifestations ◽

Murine Typhus ◽

Rickettsia Felis ◽

Elevated Liver Enzymes ◽

Life Threatening

Background Current knowledge on Rickettsia felis infection in humans is based on sporadic case reports. Here we conducted a retrospective seroepidemiological survey of R. felis infection among febrile patients visiting a medical center in Taipei. Methodology/Principal findings A total of 122 patients with suspected rickettsioses presenting with fever of unknown origin (FUO) but tested negative for scrub typhus, murine typhus, or Q fever were retrospectively identified during 2009 to 2010. The archived serum samples were examined for the presence of antibodies against R. felis, Rickettsia japonica, and Rickettsia typhi using microimmunofluorescence (MIF) assay. Serological evidence of Rickettsia exposure was found in 23 (19%, 23/122) patients. Eight patients had antibodies reactive to R. felis, including four with current infection (a ≥4-fold increase in IgG titer between acute and convalescent sera). The clinical presentations of these four patients included fever, skin rash, lymphadenopathy, as well as more severe conditions such as pancytopenia, hepatomegaly, elevated liver enzymes/bilirubin, and life-threatening acute respiratory distress syndrome. One of the patients died after doxycycline was stopped after being tested negative for scrub typhus, Q fever, and murine typhus. Conclusions Rickettsia felis is a neglected flea-borne pathogen in Taiwan, and its infection can be life-threatening. Further prospective studies of the prevalence of R. felis among patients with FUO and compatible clinical manifestations are warranted.

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The Insidious Cardiac Tumor: A Primary Left Atrium Intimal Cardiac Sarcoma in a Young Patient

Case Reports in Cardiology ◽

10.1155/2019/7245676 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Chika-Nwosuh Ogechukwu ◽

Nnaoma Christopher ◽

Sossou Christoph ◽

Okundaye Etinosasere ◽

Bustillo Jose

Keyword(s):

Benign Tumor ◽

Case Reports ◽

Pulmonary Angiography ◽

Pulmonary Emboli ◽

Transesophageal Echocardiogram ◽

Computed Tomography Pulmonary Angiography ◽

Case Presentation ◽

Mitral Orifice ◽

Life Threatening ◽

The Right

This case presentation discusses a rare cardiac malignancy initially thought to be a benign tumor. A 36-year-old presented with syncope, dyspnea, Computed Tomography Pulmonary angiography study obtained was negative for pulmonary emboli but revealed a left atrial mass. A transesophageal echocardiogram (TEE) confirmed a mass with multiple lobes and a broad base attached to the septum, encroaching into the right atrium, aortic root wall, base of the anterior mitral leaflet flowing to the mitral orifice in diastole also obstructing the right pulmonary vein. Despite a quick diagnosis and plan to begin treatment, the patient rapidly declined owing to the extent and aggressive nature of this cardiac malignancy. This case reports the insidious nature of these tumors as well as how challenging and life threatening they are at the time of their clinical manifestation.

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