scholarly journals Delayed positive COVID19 nasopharyngeal test, a case study with clinical and pathological correlation

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lei Zhang ◽  
Syam P. Vunnamadala ◽  
Shigeo Yagi ◽  
Riffat Meraj ◽  
Michele Carbone
Keyword(s):  
Upper Airway ◽  
Nasopharyngeal Swab ◽  
Igg Antibody ◽  
Case Presentation ◽  
Ventilator Dependence ◽  
History Of ◽  
Bronchodilator Treatment ◽  
Artery Disease ◽  
Tract Damage

Abstract Background There are various reasons for delayed positive nasopharyngeal PCR tests for coronavirus disease 2019 (COVID19) in not only asymptomatic but also severely diseased patients. The pathophysiological attributes are not known. We explore this possibility through a case report. Case presentation A 64-year-old male with history of pulmonary fungal infection, asthma and chronic pulmonary obstructive disease (COPD), diabetes, coronary artery disease presented with shortness of breath, fever and chest image of ground opacity, reticular interstitial thickening, highly suspicious for COVID19. However, nasopharyngeal swab tests were discordantly negative for four times in two weeks, and IgG antibody for COVID19 was also negative. However, serum IgE level was elevated. No other pathogens are identified. His symptoms deteriorated despite corticosteroid, antibiotics and bronchodilator treatment. Bronchoalveolar lavage (BAL) and open lung wedge biopsy were performed for etiology diagnosis. They demonstrated COVID19 viral RNA positive fibrosing organizing pneumonia with respiratory tract damage characterized by suspicious viral cytopathic effect, mixed neutrophilic, lymphoplasmacytic, histiocytic and eosinophilic inflammation and fibrosis besides expected asthma and COPD change. One week later, repeated COVID19 nasopharyngeal tests on day 40 and day 49 became positive. Conclusion Our case and literature review indicate that allergic asthma and associated high IgE level together with corticosteroid inhalation might contribute to the delayed positive nasopharyngeal swab in upper airway; COPD related chronic airways obstruction and the addition of fibrosis induced ventilator dependence and poor prognosis in COVID19 pneumonia, and should be therapeutically targeted besides antiviral therapy.

scholarly journals Insidious coronary artery disease in a young patient with polyarteritis nodosa: a case report and literature review

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hong Huang ◽  
Yanjun Gong ◽  
Li Guo ◽  
Zhuoli Zhang
Keyword(s):  
Chest Pain ◽  
Coronary Artery ◽  
Young Patient ◽  
Coronary Arteries ◽  
Left Main Coronary Artery ◽  
Screening Strategy ◽  
Acute Phase Reactants ◽  
Case Presentation ◽  
History Of ◽  
Artery Disease

Abstract Background Polyarteritis nodosa (PAN) is a relatively rare systemic necrotizing vasculitis that typically affects medium-sized arteries. Although myocardial ischemia may occur due to involvement of the coronary arteries, overt myocardial infarction is uncommon. Case presentation A 22-year-old Chinese man experiencing chest pain for 7 months was admitted to our hospital. Consistently, the pain tended to last for a few minutes and then spontaneously subside. He had 7-year history of “stable” PAN. Coronary angiography revealed slight plaque infiltration of the left main coronary artery; however occlusion of all the three major coronary arteries with multiple aneurysms. A stent was implanted into the obtuse margin branch artery which was 95% stenosis, and then the chest pain was alleviated. Considering that the occlusion of coronary arteries was due to insidious vasculitis, prednisone 50 mg/day and methotrexate 15 mg/week were reinitiated, in combination with anti-angina medications. Conclusions We report a young patient with insidious occlusion of three main coronary arteries under the circumstance of stable PAN for 7 years, suggesting the necessity of assessing the heart, in spite of normal acute phase reactants. The appropriate screening strategy needs to be studied.

scholarly journals A 45-year-old Female with an Atypical Presentation of Pharyngitis

2020 ◽  
Vol 4 (2) ◽  
pp. 234-240
Author(s):  
Artur Schander ◽  
Andrew Glickman ◽  
Nancy Weber ◽  
Brian Rodgers ◽  
Michael Carney
Keyword(s):  
Sore Throat ◽  
Complete Blood Count ◽  
Differential Diagnoses ◽  
Prescription Medications ◽  
Over The Counter ◽  
Case Presentation ◽  
Common Causes ◽  
History Of

Introduction: Emergency physicians are trained to treat a variety of ailments in the emergency department (ED), some of which are emergent, while others are not. A common complaint seen in the ED is a sore throat. While most sore throats are easily diagnosed and treated, less common causes are often not considered in the differential diagnoses. Therefore, the purpose of this case study was to present an atypical case of sore throat and discuss differential diagnoses. Case Presentation: The patient was a 45-year-old female who presented to the ED with a three-day history of sore throat that was exacerbated by eating and drinking. The patient was not on any prescription medications, but tried over-the-counter medications for the sore throat without any improvement in symptoms. Review of systems was positive for sore throat, fevers, and chills. Physical examination of her oropharynx revealed mildly dry mucous membranes with confluent plaques and white patchy ulcerative appearance involving the tongue, tonsils, hard palate, and soft palate. Rapid streptococcal antigen, mononucleosis spot test, and KOH test were performed and found to be negative. Discussion: After initial testing was negative, a follow-up complete blood count with differential and complete metabolic profile were ordered. The patient was found to have decreased lymphocytes and platelets. Based upon those results, a diagnosis was made in the ED, the patient was started on medication, and further laboratory workup was ordered to confirm the diagnosis. ED providers should consider non-infectious as well as infectious causes for a sore throat, as this might lead to a diagnosis of an underlying condition.

Managing Voice and Communication for Tracheostomized and Ventilator Dependent Patients: Clinical Case Studies

2008 ◽  
Vol 18 (2) ◽  
pp. 66-75
Author(s):  
Karen J. Dikeman ◽  
Marta S. Kazandjian
Keyword(s):  
Clinical Practice ◽  
Case Studies ◽  
Clinical Case ◽  
Upper Airway ◽  
Ventilator Dependence ◽  
Assessment And Treatment ◽  
Clinical Case Studies ◽  
Complex Population ◽  
History Of ◽  
Dependent Patient

Abstract This tutorial provides a background to the history of tracheostomy and ventilator-dependence, as well as two clinical case studies that describe the management of voice and communication. The rationale for establishment of upper airway flow in the tracheostomized and ventilator-dependent patient is explained. Assessment and treatment paradigms are described for the clinician working with this complex population, in order to provide guidelines for daily clinical practice.

scholarly journals Extensive Upper Airway Hematoma Secondary to Supratherapeutic Warfarin Anticoagulation

2020 ◽  
Vol 4 (4) ◽  
pp. 634-635
Author(s):  
Taofiq Oyedokun ◽  
Kevin Durr
Keyword(s):  
Upper Airway ◽  
Mass Effect ◽  
Endoscopic Examination ◽  
Past Medical History ◽  
Fatal Complication ◽  
Case Presentation ◽  
History Of ◽  
Retropharyngeal Hematoma ◽  
Significant Mass Effect ◽  
Significant Mass

Case Presentation: A 63-year-old female presented to the emergency department complaining of cough, neck swelling, dysphagia, and dysphonia for two days, with a past medical history of atrial fibrillation managed with warfarin. Investigations revealed a supratherapeutic international normalised ratio (greater than 10). Imaging and endoscopic examination showed an extensive retropharyngeal hematoma with significant mass effect on the airway. Discussion: A rare but potentially fatal complication of warfarin anticoagulation is upper airway hematoma, with violent coughing described as an inciting cause. Signs of airway compromise necessitate specialist consultation and definitive airway management, while mild cases without airway concerns can be managed conservatively with medical anticoagulation reversal.

Dependent Erythema of the Legs Associated With Mild Autonomic Nervous System Dysfunction

2017 ◽  
Vol 21 (6) ◽  
pp. 556-558
Author(s):  
Bahar Bahrani ◽  
Christopher S. Sladden
Keyword(s):  
Literature Search ◽  
Chronic Diarrhea ◽  
Autonomic Nervous System Dysfunction ◽  
Erect Posture ◽  
Case Presentation ◽  
Sympathetic Dysfunction ◽  
Full Physical Examination ◽  
History Of ◽  
Artery Disease ◽  
Shed Light

Introduction: Dependent erythema or rubor is an erythematous discoloration of the limbs, most commonly associated with peripheral artery disease. We present a case of florid dependent erythema, associated with additional autonomic symptoms. Methods: Examination and full workup of a 16-year-old healthy girl with an 8-year history of dependent erythema, chronic diarrhea, and mild hyperhidrosis. A literature search was performed to review any similar cases and generate a differential diagnosis. Results: Examination of our patient showed symmetrical, asymptomatic fiery to dusky erythematous patches of the lower legs and feet, with intermittent areas of pallor. These florid changes occurred with erect posture. Resolution to near normal occurred within minutes when the patient was in the supine position. Full physical examination revealed mild erythema and hyperhidrosis of the hands. Conclusions: To our knowledge, there have been no reports of painless dependent rubor associated with sympathetic dysfunction. Literature search reports a few cases of gravitational erythema and angiodyskinesia. This case presentation is most likely part of the spectrum of dependent erythema and may shed light on the underlying aetiology.

Jarcho-Levin Syndrome: A Case Study

2004 ◽  
Vol 23 (5) ◽  
pp. 9-21
Author(s):  
Peggy Ables
Keyword(s):  
Respiratory Failure ◽  
Medical Care ◽  
Genetic Disorder ◽  
Disease Process ◽  
Case Presentation ◽  
Rare Genetic Disorder ◽  
Spondylocostal Dysostosis ◽  
Rib Anomalies ◽  
History Of

Jarcho-Levin syndrome is a rare genetic disorder characterized by multiple vertebral and rib anomalies. There are two types of Jarcho-Levin syndrome, spondylothoracic dysplasia and spondylocostal dysostosis. Spondylothoracic dysplasia has a grimmer prognosis than spondylocostal dysostosis. Many of the infants born with this disorder succumb to respiratory failure. With new advances in medical care, even the more severely affected children have an improved chance of survival. This is a case presentation of one child with spondylothoracic dysplasia and a brief history of the disease process.

scholarly journals Sudden neck swelling with rash as late manifestation of COVID-19: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Caterina Giannitto ◽  
Cristiana Bonifacio ◽  
Susanna Esposito ◽  
Angela Ammirabile ◽  
Giuseppe Mercante ◽  
...  
Keyword(s):  
Subcutaneous Tissue ◽  
Esophageal Wall ◽  
Nasopharyngeal Swab ◽  
Neck Swelling ◽  
Case Presentation ◽  
Patient Reported ◽  
Good Clinical Condition ◽  
History Of ◽  
Collateral Findings ◽  
Polymerase Chain

Abstract Background Although there are reports of otolaryngological symptoms and manifestations of CoronaVirus Disease 19 (COVID-19), there have been no documented cases of sudden neck swelling with rash in patients with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection described in literature. Case presentation We report a case of a sudden neck swelling and rash likely due to late SARS-CoV-2 in a 64-year-old woman. The patient reported COVID-19 symptoms over the previous three weeks. Computed Tomography (CT) revealed a diffuse soft-tissue swelling and edema of subcutaneous tissue, hypodermis, and muscular and deep fascial planes. All the differential diagnoses were ruled out. Both the anamnestic history of the patient’s husband who had died of COVID-19 with and the collateral findings of pneumonia and esophageal wall edema suggested the association with COVID-19. This was confirmed by nasopharyngeal swab polymerase chain reaction. The patient was treated with lopinavir/ritonavir, hydroxychloroquine and piperacillin/tazobactam for 7 days. The neck swelling resolved in less than 24 h, while the erythema was still present up to two days later. The patient was discharged after seven days in good clinical condition and with a negative swab. Conclusion Sudden neck swelling with rash may be a coincidental presentation, but, in the pandemic context, it is most likely a direct or indirect complication of COVID-19.

scholarly journals Basal ganglia infarction and COVID-19 infection in an elderly patient: A case report

2021 ◽  
Vol 12 (1) ◽  
pp. 444-447
Author(s):  
Manar Ahmed Kamal
Keyword(s):  
Elderly Patient ◽  
Emergency Department ◽  
Basal Ganglia ◽  
Respiratory Symptoms ◽  
Prior History ◽  
Nasopharyngeal Swab ◽  
Swab Sample ◽  
Limb Weakness ◽  
Case Presentation ◽  
History Of

Abstract Background Coronavirus disease 2019 (COVID-19) has spread rapidly worldwide since the first cases were observed in Wuhan, China. Patients with COVID-19 develop multiple neurological symptoms, including headache, disturbed consciousness, and paresthesia, in addition to systemic and respiratory symptoms. Case presentation We presented a 57-year-old woman admitted to the emergency department – in December 2020 – with complaints of slurred speech, confusion, and left upper limb weakness after one week of positive nasopharyngeal swab sample SARS-CoV-2. Conclusions While the patient had previous comorbidities like hypertension and diabetes, she had no prior history of ischemic stroke or thrombosis, so we conclude that unilateral acute basal ganglia infarction may be a unique neurological manifestation after COVID-19 infection in an elderly patient with previous comorbidities.

scholarly journals A case study of the first pregnant women with COVID-19 in Bukavu, Eastern DR Congo.

2020 ◽  
Author(s):  
Etienne KAJIBWAMI BIRINDWA ◽  
Guy MULINGANYA MULUMEODERHWA ◽  
Olivier NYAKIO ◽  
Guy-Quesney MATESO MBALE ◽  
Serge ZIGABE MUSHAMUKA ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Microscopic Examination ◽  
Sub Saharan Africa ◽  
Dr Congo ◽  
Case Presentation ◽  
History Of ◽  
Sub Saharan ◽  
In Pregnancy

Abstract Introduction: Vertical transmission of covid-19 is possible; its risk factors are worth researching. The placental changes found in pregnant women have a definite impact on the foetus.Case presentation: We report a case of a 25-year-old woman, gravida 3, para 2 (2 alive children), with a history of two caesarean deliveries, who was infected by the SARS-Cov-2 during the last term of her pregnancy. She gave birth by caesarean after 34 weeks of gestation to a new-born baby also infected with SARS-Cov-2. The per-operative observations noted several eruptive lesions in the pelvis, bleeding on contact. Microscopic examination of the foetal appendages revealed thrombotic vasculopathy in the placenta and in the umbilical cord vessels.Conclusion: This case is one of the first documented cases of COVID-19 in pregnancy in sub-Saharan Africa. We strongly suggest obstetricians to carefully examine the aspect of the peritoneum, viscera and foetal appendages in affected pregnant women.

scholarly journals Trans-septal course of anomalous left main coronary artery originating from single right coronary ostium presenting with atrial fibrillation in a severely obese patient: a case report

2020 ◽  
Vol 72 (1) ◽  
Author(s):  
Armando Ugo Cavallo ◽  
Emanuele Muscogiuri ◽  
Marco Forcina ◽  
Antonio Colombo ◽  
Flavio Fiore ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Left Coronary Artery ◽  
Invasive Coronary Angiography ◽  
Interventricular Septum ◽  
Case Presentation ◽  
Severely Obese ◽  
History Of ◽  
Artery Disease ◽  
The Right

Abstract Background To present a case of anomalous origin of the left coronary artery evaluated with invasive coronary angiography (ICA) and ECG-gated coronary computed tomography (CCT). Case presentation A patient (55 years old, male) with a past medical history of respiratory failure and atrial fibrillation underwent ICA to rule out coronary artery disease. Subsequently, the patient underwent ECG-gated CCT to evaluate a suspected anomalous aortic origin of the left coronary artery, since the interventional cardiologist was not able to properly identify the left coronary artery and its distal branches. CCT showed left coronary artery originating from the right coronary Valsalva sinus, coursing within the interventricular septum and emerging at the middle segment of the interventricular sulcus, where the left anterior descending and circumflex arteries originated. Conclusion The case we presented highlights the value of ECG-gated CCT in the evaluation of coronary anomaly anatomy and thus risk stratification derived by proper coronary anatomy assessment. Although ICA was not helpful in the diagnosis, it also has a pivotal role regarding the therapeutic management of this condition.

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