Subacute Thyroiditis After SARS-CoV-2 Infection Presenting With Pyrexia of Unknown Origin

Abstract Subacute thyroiditis(SAT) is associated with viral(destructive) or post-viral(inflammatory) origin.[1]The most common clinical characteristics of SAT are female sex preponderance, anterior neck pain and fever.[2,3] Heart rhythm disorders and silent cervical forms have been described in SAT associated with SARS-CoV-2 infection,which occurs 16 to 36 days after resolution of COVID-19.[1,3] Symptomatic improvement occurs in a few days after initiation of therapy with sterods or NSAID.[3] Pyrexia of Unknown Origin (PUO) is a very rare presentation of SAT.[2] Hereby, a case of SAT, presenting with painful neck swelling and persistent fever (5weeks duration), two weeks after resolution of COVID-19, is being discussed. The index patient was a 50-year old obese,normotensive, diabetic (10 years duration, HbA1c-6.6% on SU, metformin, sitagliptin and dapagliflozin) male. TSH was suppressed (0.02 mIU/L), FT4 (3.06 ng/dl, upper limit of normal-1.48ng/dl) and FT3 (3.9 pg/ml, upper limit of normal-3.71 pg/ml) were elevated. Total T4 and T3 were normal. HS-CRP was markedly elevated. IL-6 and TBG were not estimated. Cervical USG revealed diffuse hypoechogenecity of thyroid gland and thyromegaly. There was reduced uptake in thyroid scan (technetium). The patient became afebrile after 4 days of initiation of 30 mg prednisolone (tapered by 10 mg every 5 days). The initial tachycardia reverted to sinus rhythm with marked reduction of neck tenderness. This case highlights certain considerations for SAT associated with SARS-CoV-2 infection. Firstly, it can present with PUO (first case report). Secondly, it may be associated with normal total T4 and T3 which can happen due to reduced TBG consequent upon increased IL-6.[4] References: 1. Caron Philippe: Thyroid disorders and SARS-CoV-2 infection: From pathophysiological mechanism to patient management. Ann Endocrinol (Paris), 2020, Sept. 2. Fever of Unknown Origin as a Sole Presentation of Subacute Throiditis in an Elderly Patient. A Case Report with Literature Review. Raj R, Yada S, Jacob A et al: Hindawi Case Reports in Endocrinology, 2018, Article ID 5041724 3. Brancatella A, Ricci D, Latrofa F et al: Is subacute thyroidits an underestimated manifestation of SARS-CoV-2 infection? Insights from a case serie. J Clin Endocrinol Metab, 2020, Aug 11, dgaa537. 4. Bartaleno L, Brogioni S, Grasso L and Martino E: Increased serum interleukin-6 concentration in patients with subacute thyroiditis:relationship with concomitant changes in serum T4-binding globulin concentration. Journal of Endocrinological Investigation, 1993, 16, 213-218.

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Proteus syndrome in pregnancy: A case report

Obstetric Medicine ◽

10.1177/1753495x20970791 ◽

2020 ◽

pp. 1753495X2097079

Author(s):

Niccole Ranaei-Zamani ◽

Mandeep K Kaler ◽

Rehan Khan

Keyword(s):

Case Report ◽

Case Reports ◽

Proteus Syndrome ◽

Cutaneous Lesions ◽

Genetic Syndrome ◽

Skeletal Tissue ◽

First Case ◽

Large Teaching Hospital ◽

Clinical Presentations ◽

In Pregnancy

Proteus syndrome is a rare, multi-system, genetic syndrome characterised by atypical and excessive growth of skeletal tissue. Clinical presentations include abnormal musculoskeletal growth and cutaneous lesions. Due to its rarity, there have been a limited number of published case reports of Proteus syndrome. This is the first case report on the management of Proteus syndrome in pregnancy. We present the case of a pregnant woman with Proteus syndrome in her first pregnancy in a large teaching hospital and discuss the considerations and challenges faced in her antenatal, intrapartum and postnatal care.

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Intraperitoneal ampicillin treatment for peritoneal dialysis- related peritonitis with Listeria monocytogenes – a case report

BMC Nephrology ◽

10.1186/s12882-020-02068-1 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Kristina Boss ◽

Ina Wiegard-Szramek ◽

Jan Dziobaka ◽

Andreas Kribben ◽

Sebastian Dolff

Keyword(s):

Peritoneal Dialysis ◽

Case Report ◽

Listeria Monocytogenes ◽

Case Reports ◽

Chronic Kidney Disease Stage ◽

Disease Stage ◽

Serum Concentrations ◽

Duration Of Treatment ◽

First Case ◽

Listeria Infection

Abstract Background Peritoneal dialysis (PD)-related peritonitis is a rare but serious complication and is associated with increased morbidity and mortality rates. It is most commonly caused by Staphylococcus aureus or Staphylococcus epidermidis, but infection with Listeria monocytogenes may also occur. Recommendations for antibiotic treatment of a Listeria infection are currently based on a small number of case reports and suggest the administration of ampicillin. But unlike vancomycin or gentamicin, for ampicillin the route of application, the dosage, and the duration of treatment have not yet been established. We report a case in which PD-associated peritonitis due to Listeria infection was treated with ampicillin administered intravenously and intraperitoneally, separately and in combination. Case presentation A 72-year-old man with chronic kidney disease stage 5 dialysis (CKDG5D) secondary to hypertension and diabetes was hospitalised in April 2020 because of PD-related peritonitis caused by a Listeria infection. In accordance with the results of resistance tests, the patient was treated with intravenous ampicillin at a dosage of 6 g twice daily. After initial treatment the leukocyte count in the PD effluent had decreased substantially, but it was permanently reduced only with the addition of intraperitoneal ampicillin (4 g daily). Efficient serum concentrations of ampicillin were determined for both routes of administration, intravenous and intraperitoneal. Conclusion This is the first case report demonstrating that PD-related peritonitis due to Listeria monocytogenes infection can be treated with intraperitoneal ampicillin and monitored by the determination of peripheral serum concentrations of ampicillin.

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Pericardial effusion and cardiac tamponade requiring pericardial window in an otherwise healthy 30-year-old patient with COVID-19: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-020-02467-w ◽

2020 ◽

Vol 14 (1) ◽

Author(s):

Christina Walker ◽

Vincent Peyko ◽

Charles Farrell ◽

Jeanine Awad-Spirtos ◽

Matthew Adamo ◽

...

Keyword(s):

Case Report ◽

Pericardial Effusion ◽

Cardiac Tamponade ◽

Case Reports ◽

Healthy Woman ◽

Signs And Symptoms ◽

Rare Presentation ◽

Pericardial Window ◽

Acute Pericarditis ◽

Novel Coronavirus

Abstract Background This case report demonstrates pericardial effusion, acute pericarditis, and cardiac tamponade in an otherwise healthy woman who had a positive test result for coronavirus disease 2019. Few case reports have been documented on patients with this presentation, and it is important to share novel presentations of the disease as they are discovered. Case presentation A Caucasian patient with coronavirus disease 2019 returned to the emergency department of our hospital 2 days after her initial visit with worsening chest pain and shortness of breath. Imaging revealed new pericardial effusion since the previous visit. The patient became hypotensive, was taken for pericardial window for cardiac tamponade with a drain placed, and was treated for acute pericarditis. Conclusion Much is still unknown about the implications of coronavirus disease 2019. With the novel coronavirus disease 2019 pandemic, research is still in process, and we are slowly learning about new signs and symptoms of the disease. This case report documents a lesser-known presentation of a patient with coronavirus disease 2019 and will help to further understanding of a rare presentation.

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Leptospirosis presenting as severe cardiogenic shock: A case report

Journal of the Intensive Care Society ◽

10.1177/1751143718754993 ◽

2018 ◽

Vol 19 (4) ◽

pp. 351-353

Author(s):

E Forbat ◽

MJ Rouhani ◽

C Pavitt ◽

S Patel ◽

R Handslip ◽

...

Keyword(s):

Case Report ◽

Cardiogenic Shock ◽

Social History ◽

Rare Case ◽

Clinical Course ◽

Unknown Origin ◽

Case Presentation ◽

Pyrexia Of Unknown Origin ◽

Severe Cardiogenic Shock ◽

Infectious Illness

Background Leptospirosis is a rare infectious illness caused by the Spirochaete Leptospira. It has a wide-varying spectrum of presentation. We present a rare case of severe cardiogenic shock secondary to leptospirosis, in the absence of its common clinical features. Case presentation A 36-year-old woman presented to our unit with severe cardiogenic shock and subsequent multi-organ failure. Her clinical course was characterised by ongoing pyrexia of unknown origin with concurrent cardiac failure. She was initially managed with broad-spectrum antibiotics and inotropes. Percutaneous cardiac biopsy excluded major causes of myocarditis. On day 21 after presentation, she was found to be IgM-positive for leptospirosis. Conclusions This is a rare case of severe cardiogenic shock secondary to leptospirosis infection. The case also highlights the importance of obtaining a thorough social history when assessing a patient with an unusual presentation, as clues can often be missed.

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Myelopathy in sickle cell disease: a case-oriented review

10.5327/1516-3180.563 ◽

2021 ◽

Author(s):

Igor Vilela Brum ◽

Guilherme Diogo Silva ◽

Diego Sant'Ana Sodre ◽

Felipe Melo Nogueira ◽

Samira Luisa dos Apostolos Pereira ◽

...

Keyword(s):

Spinal Cord ◽

Case Report ◽

Sickle Cell Disease ◽

Sickle Cell ◽

Case Reports ◽

Spinal Cord Infarction ◽

Sensory Level ◽

Cell Disease ◽

Hematopoietic Tissue ◽

First Case

Background: Although neurological complications are well recognized in sickle cell disease (SCD), myelopathy has been rarely described. We present the first case report of longitudinally extensive myelitis (LETM) in SCD and review the differential diagnosis of myelopathy in these patients. Design and setting: case-oriented review. Methods: We report the case of a 29-year-old African-Brazilian man with SCD, who experienced a subacute flaccid paraparesis, with T2 sensory level and urinary retention. CSF analysis showed a lymphocytic pleocytosis and increased protein levels. MRI disclosed a longitudinally extensive spinal cord lesion, with a high T2/STIR signal extending from C2 to T12. Serum anti-aquaporin-4 antibody was negative. We searched Medline/ PubMed, Embase, Scopus, and Google Scholar databases for myelopathy in SCD patients. Results: Spinal cord compression by vertebral fractures, extramedullary hematopoietic tissue, and Salmonella epidural abscess have been reported in SCD. We found only three case reports of spinal cord infarction, which is unexpectedly infrequent compared to the prevalence of cerebral infarction in SCD. We found only one case report of varicella-zoster myelitis and no previous report of LETM in SCD patients. Conclusion: Specific and time-sensitive causes of myelopathy should be considered in SCD patients. In addition to compression and ischemia, LETM should be considered as a possible mechanism of spinal cord involvement in SCD.

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

Case Reports in Oncology ◽

10.1159/000510096 ◽

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.

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First case report of infection by Mycobacterium wolinskyi after mammoplasty in Brazil

Infectious Disease Reports ◽

10.4081/idr.2013.e12 ◽

2013 ◽

Vol 5 (2) ◽

pp. 12 ◽

Cited By ~ 3

Author(s):

Andrea Santos Lima ◽

Maria Madileuza Carneiro Neves ◽

Karen Machado Gomes ◽

Klarissa Miranda Guarines ◽

Carlos Feitosa Luna ◽

...

Keyword(s):

Case Report ◽

Health Service ◽

Mycobacterium Smegmatis ◽

Case Reports ◽

Specific Gene ◽

Biochemical Tests ◽

Long Period ◽

First Case ◽

The World ◽

Mycobacterium Goodii

Mycobacterium wolinskyi is a rapidly growing mycobacterium, first described in 1999 as a member of the group Mycobacterium smegmatis (Mycobacterium smegmatis, Mycobacterium wolinskyi and Mycobacterium goodii). Only 19 case reports all over the world have been described on literature, none of them in Brazil. On this report, it is described one case of infection after a mammoplasty procedure performed in a private health service in the county of Recife, Pernambuco, Brazil, in 2009. The mycobacteria specie was identified using biochemical tests and sequencing the specific gene rpoB. To treat the infection by Mycobacterium wolinskyi it was necessary to combine antibiotics for a long period of time associated with surgical procedures of the breast abscesses.

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Burning Mouth Syndrome: Problem in the Mouth?

European Psychiatry ◽

10.1016/j.eurpsy.2017.02.049 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S254-S254

Author(s):

S. Petrykiv ◽

L. de Jonge ◽

M. Arts

Keyword(s):

Case Report ◽

Case Reports ◽

Antidepressant Medication ◽

Burning Mouth Syndrome ◽

Psychiatric Ward ◽

Drug Induced ◽

First Case ◽

Painful Sensation ◽

Burning Mouth ◽

Competing Interest

IntroductionBurning mouth syndrome (BMS) is characterized by an intraoral burning sensation for which no medical or dental cause can be found. Sporadic evidence suggests that drug induced conditions may evoke BMS. Intriguingly, we observed a patient who developed BMS after induction of citalopram.Objectives & aimsA case report of patient with BMS from our psychiatric ward will be presented here, followed by a literature review on drugs induced BMS.MethodsBased on a recent literature search, we present a first case report of BMS that was apparently induced in patient shortly after beginning of citalopram. We performed a systematic search through PubMed, EMBASE and Cochrane's Library to find more cases of psychotropic induced BMS.ResultsMs. A. was a 72-year old woman meeting DSM-IV diagnostic criteria for melancholic depression, who was observed in a clinical setting. We started citalopram 10 mg. 1dd1, with 10 mg. 1dd1 increase over 7 days to 20 mg, 1dd1. The following day, she displayed a persistent burning painful sensation in the mouth. Other than BMS oropharyngological syndromes were excluded after consultation with qualified medical specialists. Citalopram therapy was discontinued, and nortrilen treatment was initiated. BMS symptoms resolved over four days. Twelve case reports have linked BMS to the use antidepressants and anxiolytics.ConclusionContrasting the statement that no medical cause can be found for BMS, we found that psychotropics may evoke the syndrome. Compared to other psychotropic drugs, antidepressant medication has the strongest association with BMS.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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Oral Phenytoin Toxicity Causing Sinus Arrest: A Case Report

Case Reports in Cardiology ◽

10.1155/2014/851767 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Ravi K. Thimmisetty ◽

Janardhana Rao Gorthi ◽

Mahmoud Abu Hazeem

Keyword(s):

Case Report ◽

Cardiac Toxicity ◽

Case Reports ◽

Sinus Node ◽

Seizure Disorder ◽

Sinus Arrest ◽

Rare Presentation ◽

Phenytoin Toxicity

We present a case of sinus node arrest leading to symptomatic junctional bradycardia from oral phenytoin toxicity, which is a rare presentation. Our patient had no prior cardiac history and was on phenytoin therapy for seizure disorder. Although bradycardia is more commonly associated with intravenous phenytoin and there were few case reports of bradycardia with oral phenytoin reported, the literature is limited. In this case report, we also reviewed the pathophysiology of phenytoin-induced cardiac toxicity.

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Citalopram–induced delusions in an older adult

European Psychiatry ◽

10.1016/j.eurpsy.2017.01.1399 ◽

2017 ◽

Vol 41 (S1) ◽

pp. S751-S752

Author(s):

J. Fennema ◽

S. Petrykiv ◽

L. De Jonge ◽

M. Arts

Keyword(s):

Case Report ◽

Older Adult ◽

Selective Serotonin Reuptake Inhibitors ◽

Case Reports ◽

Dose Range ◽

Early Morning ◽

Medical Evidence ◽

First Case ◽

Therapeutic Dose Range ◽

Competing Interest

IntroductionSelective serotonin reuptake inhibitors (SSRIs) are the most prescribed antidepressants worldwide. In older adults, citalopram is generally well tolerated and safe in the therapeutic dose range of 20 to 40 mg/day. In literature, there are cases of SSRI-induced psychosis, but mainly with fluoxetine. There are only three reported cases of citalopram-induced delusions, however, these case-reports did not involve an older adult.Objectives and aimsTo provide a case of citalopram–induced psychosis in an older adult, followed by the review of available literature.MethodsA case report is presented and discussed followed by a literature review.ResultsA 64-year-old woman without somatic illnesses was referred by a general practitioner with depressive symptoms. One week after initiation of citalopram 10 mg/day she suddenly developed delusions, predominantly in the early morning. No other medical evidence was found that could explain her delusions. After discontinuation of citalopram her delusions quickly resolved.ConclusionThis is the first case report of a SSRI-induced delusion in an older adult. Citalopram has been reported to be one of the safest SSRIs. Although most SSRI's have a mild side-effect profile, care should be taken when initiating SSRIs since unpredictable adverse effects may occur.Disclosure of interestThe authors have not supplied their declaration of competing interest.

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