scholarly journals SAT-512 Thyrotoxicosis Followed by Hypothyroidism Post Total Laryngectomy and Hemithyroidectomy

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Faisal Aljehani ◽  
Katalina Funke ◽  
Jyotika Kanwar Fernandes
Keyword(s):  
Case Report ◽  
Laryngeal Cancer ◽  
Total Laryngectomy ◽  
Case Reports ◽  
Neck Surgery ◽  
Thyroglobulin Antibodies ◽  
Lymphocytic Thyroiditis ◽  
Thyroid Lobectomy ◽  
Patient Reported ◽  
History Of

Abstract BACKGROUND: Thyrotoxicosis has been described in few case reports after non thyroid neck surgeries but only in one case report after total laryngectomy and hemithyroidectomy. Subacute lymphocytic thyroiditis has been reported in one case post thyroid lobectomy in a patient with thyroid cancer. Total thyroidectomy or lobectomy are common practice as a part of laryngeal cancer treatment. Clinical Case: 57- year old male with history of laryngeal cancer was admitted for total laryngectomy, bilateral neck dissection, left hemithyroidectomy. Post-operative Day 3 patient reported feeling anxious and palpitations. On exam he had tachycardia up to a heartrate of 150s/min. His baseline TSH, FT4 and Ft3 were all normal one week before the surgery. On the 5th day after the surgery, TSH was undetectable, FT4 was 3.3(range 0.71 - 1.48), while FT3 was normal 2.66 (range 1.71 - 3.7). Thyroglobulin were high (range 2.8 - 40.9) while Thyroglobulin antibodies, anti TPO and TRAB were all normal. Thyroid US was not done because of technical difficulties given the patient neck surgery. The patient had Burch-Wartofsky Point Scale of 35 at that time. He was started on a beta-blocker and heart rate improved to 110-120. Over the next 5 days his FT4 Improved and was normal by day 10 after the surgery. His TSH and Ft4 showed hypothyroidism 6 weeks after the surgery and levothyroxine was started. He was seen 4 months after the surgery with high TSH concerning for medication noncompliance. Conclusion: On our review of literature this would be the second case report of a thyrotoxicosis after total laryngectomy and hemithyroidectomy. Unique to our case is the devolvement of hypothyroidism after the initial phase of thyrotoxicosis resolved while in the other case reported in literature the patient did not develop hypothyroidism. Subsequent hypothyroidism in our case could be from underlying subacute lymphocytic thyroiditis or secondary to hemithyroidectomy. Reference: 1. Blenke EJ, Vernham GA, Ellis G. Surgery-induced thyroiditis following laryngectomy. The Journal of laryngology and otology. 2004;118(4):313-4. 2. Choi YS, Han YJ, Yeo GE, Kwon SK, Kim BK, Park YH, et al. Subacute lymphocytic thyroiditis after lobectomy in a patient with papillary thyroid carcinoma: a case report. Journal of medical case reports. 2013;7:3.

scholarly journals “This Is Not the Original Timeline”: A Case Report of an Extended Dissociative Episode in a Healthy Young Male Accompanied with Severe Decline in Mental State

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Godwin Tong ◽  
Kieran Groom ◽  
Louisa Ward ◽  
Muhammad Naeem
Keyword(s):  
Case Report ◽  
Mental State ◽  
Young Male ◽  
Obsessive Compulsive ◽  
Psychiatric Admission ◽  
Compulsive Disorder ◽  
Psychiatric Setting ◽  
Patient Reported ◽  
History Of ◽  
Core Symptoms

Dissociation is a disconnection between a person’s thoughts, memories, feelings, actions, or sense of who he or she is. Dissociative disorders can be described and understood using the combination of five core symptoms: amnesia, depersonalisation, derealisation, identity confusion, or identity alteration. They are frequently associated with previous experience of trauma. The challenge in diagnosis and the lifetime prevalence of approximately 10% in the general population and clinical psychiatric setting ensures the relevance of this case. We write about a 21-year-old gentleman with history of autism and obsessive compulsive disorder, but no significant medical history was presented to the emergency department with increased anxiety, subsequently progressing to agitation, pacing, and becoming nonverbal. No significant findings were uncovered on laboratory blood testing (other than prolactin 737 mu/L and phosphate 0.35 mmol/L), lumbar puncture, or brain imaging. Consequently, he was admitted to a psychiatric unit for assessment. The patient continued to present with severe disorientation, limited speech, and altered state of consciousness with occasional spastic-like movements. Antipsychotic and benzodiazepine medication was initiated, with no significant change in presentation. The patient continued to be witnessed wandering and having incoherent speech. First signs of improvement came 21 days postadmission with brief conversation and lucidity. This continued to improve over the next 7 days where he was reported to be at his baseline mental state. Environmental stressors including university examinations, the COVID-19 pandemic, and recent contact with his estranged father were possible precipitants to the episode. The patient reported almost complete unawareness of the psychiatric admission. A diagnosis of dissociative disorder, unspecified, was given. This case shows the management and diagnostic challenges of patients presenting with the aforementioned symptoms. There are no formal guidelines for the management of treating dissociative episodes, and this case report suggests the possible benefits of a drug-free period of watchful waiting upon admission.

scholarly journals Metastatic Pancreatic Cancer with BRAF and P53 Mutations: Case Report of Therapeutic Response to Doublet Targeted Therapy

2020 ◽  
Vol 13 (3) ◽  
pp. 1239-1243
Author(s):  
Shenthol Sasankan ◽  
Lorraine Rebuck ◽  
Gloria Darrah ◽  
Moises Harari Turquie ◽  
Ian Rabinowitz
Keyword(s):  
Pancreatic Cancer ◽  
Case Report ◽  
Targeted Therapy ◽  
Therapeutic Response ◽  
Case Reports ◽  
Clinical History ◽  
P53 Mutation ◽  
Metastatic Pancreatic Cancer ◽  
First Case ◽  
History Of

We report on the clinical history of a 49-year-old female with metastatic pancreatic cancer. She was initially treated with standard chemotherapy as per current guidelines. She was found to have both a BRAF and P53 mutation, and received dabrafenib and trametinib with deep responses, both radiographically and biochemically (CA19-9). Her response has been more clinically relevant than responses in previous case reports of patients with BRAF-positive pancreatic cancer treated with targeted therapy. To the best of our knowledge, this is the first case report showing a dramatic therapeutic response to combination therapy with dabrafenib and trametinib in metastatic pancreatic cancer.

Bevacizumab-induced dysphonia: A case report with brief review of literature

2019 ◽  
Vol 26 (4) ◽  
pp. 1032-1036
Author(s):  
So Yi Lam ◽  
Chung-Shien Lee ◽  
Sandhya Sharma ◽  
Kit Cheng
Keyword(s):  
Ovarian Cancer ◽  
Case Report ◽  
Side Effect ◽  
Case Reports ◽  
Palliative Therapy ◽  
Ovarian Adenocarcinoma ◽  
Voice Changes ◽  
Patient Reported ◽  
Rare Side Effect

Introduction Anti-angiogenic treatment in adjunct with chemotherapy is widely used for the treatment of various cancers. These agents inhibit vascular endothelial growth factor (VEGF) signaling thereby inhibiting tumor proliferation and invasion. Dysphonia, or voice changes, has been documented, but is an underreported side effect of anti-angiogenic agents. We report a case of intermittent dysphonia in a patient with metastatic, platinum-refractory ovarian cancer treated with bevacizumab. Case report A 48-year-old female with high grade mixed type ovarian adenocarcinoma and concurrent left sided breast cancer was transitioned to palliative therapy with gemcitabine-bevacizumab for her ovarian cancer. At a follow-up visit after three cycles of the new therapy, the patient complained of intermittent changes in her voice, describing periods of hoarseness or softness in her voice after the chemotherapy—sometimes to the point that her voice was inaudible. Management and outcome: A new pelvic thrombus was discovered upon assessment of the patient’s disease. Bevacizumab was held and she was referred to ear, nose, and throat evaluation for dysphonia. Laryngoscopic examination showed normal vocal cord, with normal movements and no lesion or necrosis. During subsequent follow-up, the patient reported improvement in her voice with no additional dysphonia. Discussion Vocal adverse effects of anti-VEGF agents have been documented in landmark trials and case reports; however, clinicians are often unaware of this rare side effect. Although VEGF-induced dysphonia may be rare and may not impede the patient’s quality of life in some cases, it is critical to acknowledge and not underestimate this adverse effect.

Suspected Lamotrigine-Induced Toxic Epidermal Necrolysis

1997 ◽  
Vol 31 (6) ◽  
pp. 720-723 ◽  
Author(s):  
Julie J Chaffin ◽  
Steven M Davis
Keyword(s):  
Valproic Acid ◽  
Toxic Epidermal Necrolysis ◽  
Case Reports ◽  
Stevens Johnson Syndrome ◽  
Complex Partial Seizures ◽  
Skin Reactions ◽  
Johnson Syndrome ◽  
Patient Reported ◽  
History Of ◽  
Relationship Of

OBJECTIVE: To describe a patient who developed toxic epidermal necrolysis (TEN) possibly secondary to lamotrigine use. CASE SUMMARY: A 74-year-old white man with a history of probable complex partial seizures was admitted to the neurology service for a prolonged postictal state. His antiepileptic regimen was changed while he was in the hospital to include lamotrigine. After 19 days of hospitalization and 14 days of lamotrigine therapy, the patient became febrile. The next day he developed a rash which progressed within 4 days to TEN, diagnosed by skin biopsy. All suspected drugs were discontinued, including lamotrigine. The patient was treated with hydrotherapy in the burn unit. His symptoms improved and he was discharged from the hospital 26 days after the rash developed. DISCUSSION: During lamotrigine's premarketing clinical trials, the manufacturer reported several cases of Stevens-Johnson syndrome and TEN. There are several published case reports of lamotrigine-induced severe skin reactions. All of these reports included patients being treated with both valproic acid and lamotrigine. Our patient was exposed to phenytoin, carbamazepine, clindamycin, and lamotrigine, but not valproic acid. The patient reported prior use of phenytoin with no skin rash. Carbamazepine was the antiepileptic drug the patient was maintained on prior to his hospital admission, and the symptoms of TEN resolved while he was still receiving carbamazepine. The patient received only two doses of clindamycin, which makes this agent an unlikely cause of TEN. CONCLUSIONS: Because of the temporal relationship of the onset of the patient's rash and several drugs that are known to cause severe rashes, it is not certain which drug was the definite culprit. However, based on the evidence from the literature, lamotrigine appears to be the causative agent.

Agranulocytosis Associated with Waldenström Macroglobulinemia

2018 ◽  
Vol 140 (1) ◽  
pp. 42-45 ◽  
Author(s):  
Iuliana Vaxman ◽  
Daniel Shepshelovich ◽  
Lucille Hayman ◽  
Pia Raanani ◽  
Meir Lahav
Keyword(s):  
Case Report ◽  
Febrile Neutropenia ◽  
Medical History ◽  
Case Reports ◽  
Neutropenic Fever ◽  
Severe Neutropenia ◽  
Past Medical History ◽  
Waldenström Macroglobulinemia ◽  
Waldenstrom Macroglobulinemia ◽  
History Of

Currently, there are only 2 case reports of Waldenström macroglobulinemia (WM) associated with severe neutropenia. This is a case report of a woman with a past medical history of WM who presented with neutropenic fever. The patient’s febrile neutropenia resolved after RCD chemotherapy (cyclophosphamide 750 mg/m2, dexamethasone 20 mg, and rituximab 375 mg/m2). Fourteen days after administration, the neutrophil level had started to rise and normalized after 6 days. To the best of our knowledge, this is the 3rd reported case of agranulocytosis due to WM.

scholarly journals Temporomandibular joint alterations: two clinical case-reports of bifid condyle and temporomandibular joint ankylosis

Revista CEFAC ◽  
2019 ◽  
Vol 21 (2) ◽  
Author(s):  
Mariana Campos Limongi ◽  
Flávio Ricardo Manzi ◽  
José Benedito Fonseca Limongi
Keyword(s):  
Case Report ◽  
Temporomandibular Joint ◽  
Case Reports ◽  
Temporomandibular Joint Disorders ◽  
Psychological State ◽  
Facial Trauma ◽  
Temporomandibular Joint Ankylosis ◽  
History Of ◽  
Joint Ankylosis ◽  
Bifid Condyle

ABSTRACT The etiology of alterations of the temporomandibular joint, such as ankylosis and bifid condyle, comprises several causes including trauma. However, otological infections cannot be overlooked as a probable cause of alterations of the temporomandibular joint, because the proximity between the external auditory canal and the temporomandibular joint facilitates the spread of infection in the region. This article presents a case-report of a patient with bifid condyle of the temporomandibular joint, in which the patient had no history of facial trauma, but had suffered recurrent otitis infections during her childhood. In parallel, a second case-report is described of temporomandibular joint ankylosis in a 12-year-old patient with a history of facial trauma during her childhood. The purpose of this study was to highlight and emphasize the importance of early diagnosis of temporomandibular joint disorders to avoid the development of facial asymmetries, restore function, esthetics, and the psychological state of the patient.

CASE REPORT: POURFOUR DU PETIT SYNDROME IN A PATIENT WITH MIGRAINE

2015 ◽  
Vol 86 (11) ◽  
pp. e4.169-e4
Author(s):  
Aseel Al-Ansari ◽  
Richard Jon Llewellyn Walters
Keyword(s):  
Case Report ◽  
Case Reports ◽  
Sympathetic Chain ◽  
Horner’S Syndrome ◽  
Eyelid Retraction ◽  
Horner's Syndrome ◽  
Blurred Vision ◽  
History Of ◽  
Cervical Sympathetic ◽  
Unusual Symptoms

A 45-year old woman presented with a twelve-month history of intense migraines. She described episodes of blurred vision in association with the headaches, during which she invariably found that one or other of her pupils became dilated with a degree of eyelid retraction on the affected side. These unusual symptoms resolved spontaneously with improvement of the headache.After exclusion of a lesional cause with brain and neck imaging, we concluded that her symptoms were secondary to autonomic dysfunction in relation to her headache.Horner's syndrome is due to paralysis of the ipsilateral cervical sympathetic chain and comprises ptosis, miosis, enopthalmos and anhidrosis. A Reverse Horner's syndrome, otherwise known as Pourfour du Petit, in theory, is the opposite, and comprises eyelid retraction, mydriasis and hyperhidrosis. Where documented, it is attributed to irritation, rather than complete deficiency of the ipsilateral sympathetic chain. Previous case reports have shown that Pourfour du Petit can occur due to the same mechanisms as a Horner's syndrome. In only one other case report has it been described as an autonomic feature in relation to headache.

scholarly journals SAT-LB87 Golimumab Induced Thyroiditis

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Mo M Mai ◽  
Jocelyne G Karam ◽  
Nyein Lynn ◽  
Gurbaj Singh ◽  
Elizabeth Sedlis Singer
Keyword(s):  
Thyroid Nodules ◽  
Case Reports ◽  
Elevated Serum ◽  
Subacute Thyroiditis ◽  
Abnormal Behavior ◽  
Weight Changes ◽  
Drug Induced ◽  
Thyroid Cells ◽  
Patient Reported ◽  
History Of

Abstract Background: Subacute thyroiditis is caused by an inflammation and a destruction of the thyroid cells, leading to hyperthyroidism due to leakage of thyroid hormones, followed by possible hypothyroidism and/or full recovery of thyroid function. This is a case report describing a rare occurrence of drug-induced thyroiditis secondary to golimumab. Clinical Case: A 79-year-old female with HTN, hyperlipidemia, dementia and rheumatoid arthritis was brought to the ER for abnormal behavior including visual hallucinating and insomnia.Initial ER evaluation showed UTI for which antibiotic therapy was initiated. Dementia workup was performed including a negative head CT, nonreactive RPR, and borderline low vitamin B12 level. TFT obtained showed low TSH of 0.2mlU/L, elevated serum FT4 of 1.72ng/ml (n=0.58-1.64ng/ml) and elevated serum FT3 4.38pg/ml (n=2.5-3.9pg/ml), suggestive of hyperthyroidism. The patient reported no heat intolerance, hyperdefecation, or weight changes, but had intermittent palpitations. She denied any history of thyroid problem and did not take thyroid medication, amiodarone, biotin, or any new drug. She reported no fever or URI symptoms within the few weeks prior to admission. In addition to prednisone and methotrexate, she was taking golimumab 50mg every 30 days for the last 22 months for RA. The patient had a family history of hypothyroidism of two daughters and sister. She denied smoking, alcohol, or any other recreational drug use. Her home medications included prednisone 5mg daily, methotrexate, folic acid, lisinopril, simvastatin, and golimumab. On physical examination, she did not appear thyrotoxic and had no exophthalmos, thyroid tenderness, thyroid enlargement or thyroid nodules. Her HR range was 80bpm.Further analysis revealed normal TSI, TPO, and TgAb levels. The thyroglobulin level was very high at 2505ng/ml (n=1.6-59.9ng/ml). Her thyroid sonogram revealed bilateral thyroid nodules, largest at 1.9cm in the right mid pole. A 24-hr RAIU scan showed very low uptake (1.8%) consistent with thyroiditis (hyperthyroid phase).Endocrinology team did not recommend any antithyroid medications. In addition, she did not warrant NSAIDs or beta blockers as she was not symptomatic or tachycardic. In the absence of an autoimmune or an obvious viral process, her subacute thyroiditis was thought to be induced by golimumab. Conclusion: TNFɑ inhibitors used to treat chronic inflammatory diseases, have been rarely associated with subacute thyroiditis as described in case reports with adalimumab and etanercept use. We report the first subacute thyroiditis associated with golimumab use. We suggest that drug-induced subacute thyroiditis should be one of the differential diagnoses of thyroid dysfunction in patients treated with golimumab.

scholarly journals Case Report: A Case of Perifoveal Exudative Vascular Anomalous Complex With a Good Prognosis

2021 ◽  
Vol 8 ◽  
Author(s):  
Min Fu ◽  
Pan Hu ◽  
Gang Zhang ◽  
Ludonghan Huang ◽  
Huan Xu ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Case Report ◽  
Optical Coherence Tomography Angiography ◽  
Case Reports ◽  
Good Prognosis ◽  
Optical Coherence ◽  
Irreversible Damage ◽  
Micropulse Laser ◽  
History Of

Significance: Perifoveal exudative vascular anomalous complex (PEVAC) is a unique clinical lesion. It manifests as isolated lesions and is easily misdiagnosed. Thus far, few PEVAC case reports have been published. PEVAC is typically inconsistent with other reported macular lesions.Purpose: To report our 24-month follow-up experience on the treatment of PEVAC with a micropulse laser (MPL).Case Report: A 56-year-old Chinese woman with no history of other diseases complained of decreased vision in her left eye that had persisted for more than 1 year. Comprehensive ophthalmic examinations were performed, including a vision test, slit lamp fundus exam, optical coherence tomography (OCT), optical coherence tomography angiography (OCT-A), fluorescein fundus angiography (FFA) and indocyanine green angiography (ICGA). Intravitreal injection of ranibizumab was ineffective, and bleeding, exudation and visual acuity were not improved. After two rounds of micropulse laser (MPL) treatment, the patient was followed up, and the prognosis was good.Conclusion: PEVAC is very rare, and early diagnosis is important, as the lesions readily cause irreversible damage. Our results indicate that an MPL can be used as an alternative treatment for PEVAC patients.

scholarly journals Hydatid disease with Aspergilloma: A unique case report

2021 ◽  
Vol 91 (1) ◽  
Author(s):  
Sandeep Sharma ◽  
Parikshit Thakare ◽  
Ketaki Utpat ◽  
Unnati Desai
Keyword(s):  
Case Report ◽  
Hydatid Disease ◽  
Past History ◽  
Case Reports ◽  
Unique Case ◽  
Rare Finding ◽  
History Of ◽  
One Year

The coexisting presence of hydatid disease with aspergillus colonization is a rare finding. The 20-year-old presented with symptoms of hemoptysis with past history of tuberculosis. On further evaluation, the patient was diagnosed as a case of aspergilloma and managed conservatively. After one year of presenting with similar complaints, the patient was turned out to be hydatid disease with aspergillus colonization on the basis of clinic-radiological and bronchoscopic evaluation. Till now only a few case reports have been reported. We report a unique case report of a similar presentation.

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