scholarly journals Hypercalcaemia Caused by Sunflower Seeds and Calcium Carbonate Supplements

2021 ◽  
Author(s):  
Iqra Patoli ◽  
Mehrunissa Kazim ◽  
Saad Bin Jamil ◽  
Syed Hassan Abbas
Keyword(s):  
Calcium Carbonate ◽  
Cell Lymphoma ◽  
Oral Intake ◽  
Altered Mental Status ◽  
Interesting Case ◽  
Case Description ◽  
Sunflower Seeds ◽  
Imaging Studies ◽  
Timely Manner ◽  
History Of

Introduction: Hypercalcaemia is commonly associated with malignancy or endocrinological disorders. However, sometimes it can occur due to increased oral intake of calcium. We present an interesting case of hypercalcaemia due to ingestion of sunflower seeds and calcium carbonate supplements. Case Description: We present the case of a 53-year-old man with history of T-cell lymphoma and gastroesophageal reflux disease who was brought to the emergency room due to altered mental status, nausea, vomiting and abdominal pain. His calcium level was 3.30 mmol/l (normal value 2.23–2.58 mmol/l). Imaging studies were unremarkable. The patient was hydrated with normal saline and calcium levels improved. Once he was more coherent, he disclosed that he had consumed significant amounts of sunflower seeds and calcium carbonate supplements, which were considered to be the cause of his hypercalcaemia. Conclusion: Hypercalcaemia is common and can lead to critical illness. Although hypercalcaemia is frequently associated with endocrinological disorders, sometimes the presentation is secondary to increased intake. The consumption of sunflower seeds and antacids containing calcium carbonate can cause symptomatic hypercalcaemia. It is important to recognize rare causes of hypercalcaemia in order to treat it in a timely manner and prevent recurrence.

Rare case of metastatic adenocarcinoma to the maxillary sinus

2021 ◽  
Vol 14 (9) ◽  
pp. e244485
Author(s):  
Apurwa Prasad ◽  
Taha Alrifai ◽  
Sumathi Vijaya Rangan ◽  
Jessica Garcia
Keyword(s):  
Metastatic Disease ◽  
Colorectal Adenocarcinoma ◽  
Metastatic Adenocarcinoma ◽  
Imaging Studies ◽  
Timely Manner ◽  
Posterior Aspect ◽  
Delay In Diagnosis ◽  
Immune Histochemistry ◽  
History Of ◽  
Intestinal Type Adenocarcinoma

Colorectal carcinoma metastases to the head and neck are exceedingly rare. Patients may present with vague symptoms that may lead to a delay in diagnosis. We report the case of a 51-year-old man with a known history of stage IIIB colorectal adenocarcinoma who presented with right-sided molar tooth bleeding and right-sided palate swelling that led to difficulty speaking, eating and weight-loss of 15 pounds. Imaging studies revealed a 3.1×4.8×3 cm mass that was centred around the posterior aspect of the maxilla. Pathology revealed moderately differentiated intestinal type adenocarcinoma of colonic subtype, immune histochemistry was positive for CDX2, CK20 and MUC2, thus confirming metastatic disease to the maxilla. The patient is undergoing chemoradiation therapy for palliation of his symptoms. Clinicians should be aware of this potentional site of metastatic disease and suspect the diagnosis in a timely manner to avoid delays in making a diagnosis.

scholarly journals A Bezoar Composed of Bilirubin Calcium, Calcium Carbonate, and Fatty Acid Calcium

2019 ◽  
Vol 2019 ◽  
pp. 1-7
Author(s):  
Masaya Iwamuro ◽  
Haruo Urata ◽  
Shoichiro Hirata ◽  
Toru Ueki ◽  
Tetsuro Hanabata ◽  
...  
Keyword(s):  
Fatty Acid ◽  
Calcium Carbonate ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Treatment Plan ◽  
Common Bile Duct Stones ◽  
Bile Duct Stones ◽  
Imaging Studies ◽  
Old Japanese ◽  
History Of

A 68-year-old Japanese man was diagnosed with bezoar in the stomach, which was endoscopically retrieved. The bezoar was composed of bilirubin calcium, calcium carbonate, and fatty acid calcium. Due to the presence of bilirubin calcium in the bezoar, we performed imaging studies of the bile duct; gallstones and common bile duct stones were identified. Although bezoar with components similar to bile is infrequently encountered, our findings suggest that a bezoar originating from bile should be considered among the differential diagnoses in patients without a recent consumption history of persimmons who demonstrate a mass in the digestive tract. This case highlights the importance of component analysis of gastric bezoars because its findings may alter the treatment plan.

scholarly journals Transcranial resection of a juvenile psammomatoid ossifying fibroma of the orbit: A case report with 2-year follow-up

2020 ◽  
Vol 11 ◽  
pp. 293
Author(s):  
Muhammad Junaid ◽  
Syed Sarmad Bukhari ◽  
Majid Ismail ◽  
Anisa Kulsoom
Keyword(s):  
Case Report ◽  
Rapid Growth ◽  
Ossifying Fibroma ◽  
Case Description ◽  
Craniofacial Skeleton ◽  
Imaging Studies ◽  
Orbital Roof ◽  
History Of ◽  
Psammomatoid Ossifying Fibroma

Background: Juvenile psammomatoid ossifying fibromas (JPOFs) are benign, locally invasive lesion of the craniofacial skeleton that may undergo rapid growth resulting in damage to cranial and facial structures. They usually occur before the age of 15 years and should be carefully treated as their diagnosis may be confused with other lesions such as psammomatous meningioma. Case Description: A 14-year-old male presented to the clinic with a history of progressive left proptosis. Imaging studies revealed a well-circumscribed lesion involving the left orbital roof and showing internal areas of calcification and sclerosis. He underwent a transcranial resection of the lesion and follow-up imaging revealed no evidence of recurrence. Conclusion: JPOFs are locally invasive lesions that require careful diagnosis and meticulous excision to prevent recurrence.

scholarly journals Testicular non-Hodgkin’s lymphoma – a rare tumor

2021 ◽  
Vol 8 (8) ◽  
pp. 2509
Author(s):  
Debarghya Chatterjee ◽  
Rakesh Vakil ◽  
Richa Jindal
Keyword(s):  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Pet Scan ◽  
Primary Lymphoma ◽  
Imaging Studies ◽  
Active Lesion ◽  
Chop Regimen ◽  
Large B Cell Lymphoma ◽  
Positron Emission ◽  
History Of

Primary lymphoma of the testis is an exceedingly rare disease. We present a case of a 65 years old gentleman who presented with a brief history of testicular pain. Imaging studies and serum tumour markers indicated a testicular lesion of suspicious aetiology. High inguinal orchidectomy was performed. Histopathology and immunohistochemistry revealed diffuse large B-cell lymphoma. Positron emission tomography (PET) scan revealed a metabolically active retroperitoneal lymph node in aortocaval location. Subsequently he underwent chemotherapy with Rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) regimen plus intravenous Methotrexate, following which PET scan showed disappearance of the previously detected metabolically active lesion.

Primary diffuse large B cell lymphoma (DLBCL) of the prostate presenting with lower urinary tract symptoms (LUTS)

2020 ◽  
Vol 13 (12) ◽  
pp. e236280
Author(s):  
Ayesha Nusrat ◽  
Syed Muhammad Nazim
Keyword(s):  
Urinary Tract ◽  
B Cell ◽  
Lower Urinary Tract ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Large B Cell Lymphoma ◽  
Urinary Tract Symptoms ◽  
History Of ◽  
Large B Cell ◽  
Lower Urinary

Malignant lymphomas of the prostate are very rare tumours and are generally not considered in the clinical or pathological diagnosis of prostatic enlargement. We report a case of a 56-year-old man who presented with long-standing history of low back pain and a 2-month history of voiding lower urinary tract symptoms. He denied any history of urinary retention, trauma, catheterisation or any constitutional symptoms. Examination revealed no lymphadenopathy and hepatosplenomegaly. Digital rectal examination showed an irregular, moderately enlarged nodular prostate. His prostate-specific antigen was 1.54 ng/mL. MRI of the pelvis did not show any focal lesion apart from abnormal signal intensity in the central zone. Bone scan was negative. Transrectal ultrasound-guided prostate biopsy revealed diffuse large B cell lymphoma. Bone marrow biopsy and whole body positron emission tomography/CT were unremarkable. The patient achieved complete remission after receiving six cycles of R-CHOP chemotherapy.

Loperamide Induced Recurrent Torsades de Pointes: A Case Report

2021 ◽  
pp. 089719002110048
Author(s):  
Gregory G. Jackson ◽  
Christine R. Lopez ◽  
Elizabeth S. Bermudez ◽  
Nina E. Hill ◽  
Dan M. Roden ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Torsades De Pointes ◽  
Altered Mental Status ◽  
Spontaneous Circulation ◽  
Prior History ◽  
Common Phenomenon ◽  
Medical Providers ◽  
Return Of Spontaneous Circulation ◽  
History Of ◽  
Overdrive Pacing

Purpose: A case of loperamide-induced recurrent torsades de pointes is reported to raise awareness of an increasingly common phenomenon that could be encountered by medical providers during the current opioid epidemic. Summary: A 40 year-old-man with a prior history of opioid abuse who presented to the emergency department after taking up to 100 tablets of loperamide 2 mg daily for 5 years to blunt opioid withdrawal symptoms and was subsequently admitted to the intensive care unit for altered mental status and hyperthermia. The patient had prolonged QTc and 2 episodes of torsades de pointes (TdP) that resulted in cardiac arrest with return of spontaneous circulation. He was managed with isoproterenol, overdrive pacing, and methylnatrexone with no other events of TdP or cardiac arrest. Conclusion: A 40-year-old male who developed torsades de pointes from loperamide overdose effectively treated with overdrive pacing, isoproterenol, and methylnatrexone.

scholarly journals Recurrent noncirrhotic hyperammonemia causing acute metabolic encephalopathy in a patient with a continent ileocecal pouch: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
T. M. Skipina ◽  
S. Macbeth ◽  
E. L. Cummer ◽  
O. L. Wells ◽  
S. Kalathoor
Keyword(s):  
Emergency Department ◽  
Metabolic Acidosis ◽  
Mental Status ◽  
Rare Case ◽  
Liver Function Tests ◽  
Altered Mental Status ◽  
Potassium Citrate ◽  
Metabolic Encephalopathy ◽  
History Of ◽  
Normal Urine

Abstract Introduction Acute encephalopathy, while a common presentation in the emergency department, is typically caused by a variety of metabolic, vascular, infectious, structural, or psychiatric etiologies. Among metabolic causes, hyperammonemia is relatively common and typically occurs in the setting of cirrhosis or liver dysfunction. However, noncirrhotic hyperammonemia is a rare occurrence and poses unique challenges for clinicians. Case presentation Here we report a rare case of a 50-year-old Caucasian female with history of bladder cancer status post chemotherapy, radical cystectomy, and ileocecal diversion who presented to the emergency department with severe altered mental status, combativeness, and a 3-day history of decreased urine output. Her laboratory tests were notable for hyperammonemia up to 289 μmol/L, hypokalemia, and hyperchloremic nonanion gap metabolic acidosis; her liver function tests were normal. Urine cultures were positive for Enterococcus faecium. Computed tomography imaging showed an intact ileoceal urinary diversion with chronic ileolithiasis. Upon administration of appropriate antibiotics, lactulose, and potassium citrate, she experienced rapid resolution of her encephalopathy and a significant reduction in hyperammonemia. Her hyperchloremic metabolic acidosis persisted, but her hypokalemia had resolved. Conclusion This case is an example of one of the unique consequences of urinary diversions. Urothelial tissue is typically impermeable to urinary solutes. However, when bowel segments are used, abnormal absorption of solutes occurs, including exchange of urinary chloride for serum bicarbonate, leading to a persistent hyperchloremic nonanion gap metabolic acidosis. In addition, overproduction of ammonia from urea-producing organisms can lead to abnormal absorption into the blood and subsequent oversaturation of hepatic metabolic capacity with consequent hyperammonemic encephalopathy. Although this is a rare case, prompt identification and treatment of these metabolic abnormalities is critical to prevent severe central nervous system complications such as altered mental status, coma, and even death in patients with urinary diversions.

scholarly journals How Fear of COVID-19 Can Affect Treatment Choices for Anaplastic Large Cell Lymphomas ALK+ Therapy: A Case Report

Healthcare ◽  
2021 ◽  
Vol 9 (2) ◽  
pp. 135
Author(s):  
Antonello Sica ◽  
Caterina Sagnelli ◽  
Beniamino Casale ◽  
Gino Svanera ◽  
Massimiliano Creta ◽  
...  
Keyword(s):  
Cell Lymphoma ◽  
Large Cell ◽  
Brentuximab Vedotin ◽  
Caucasian Woman ◽  
Hematopoietic Stem ◽  
Drug Regulatory Agency ◽  
Clinical Center ◽  
History Of ◽  
Chemotherapy Patients ◽  
Pet Scans

Background: The t (2; 5) chromosomal rearrangement of the ALK gene with nucleophosmin 1 gene (NPM1), resulting in an NPM1–ALK fusion, was first demonstrated in 1994 in anaplastic large cell lymphoma, (ALCL), a T-cell lymphoma responsive to cyclophosphamide, abriblastine, vincristine and prednisone in approximately 80% of cases; refractory cases usually respond favorably to brentuximab vedotin. These treatments are regarded as a bridge to allogeneic hematopoietic stem cell transplantation (allo-SCT). Nowadays, transplant procedures and the monitoring of chemotherapy patients proceed very slowly because the SARS-CoV-2 pandemic has heavily clogged the hospitals in all countries. Results: A 40-year-old Caucasian woman was first seen at our clinical center in June 2020. She had ALCL ALK+, a history of failure to two previous therapeutic lines and was in complete remission after 12 courses of brentuximab, still pending allo-SCT after two failed donor selections. Facing a new therapeutic failure, we requested and obtained authorization from the Italian drug regulatory agency to administer 250 mg of crizotinib twice a day, a drug incomprehensibly not registered for ALCL ALK +. Conclusions: The response to crizotinib was optimal since no adverse event occurred, and CT-PET scans persisted negative; this drug has proved to be a valid bridge to allo-SCT.

Episodic versus Chronic Dizziness: An Analysis of Predictive Factors

2021 ◽  
pp. 000348942110254
Author(s):  
Eric J. Formeister ◽  
Ricky Chae ◽  
Emily Wong ◽  
Whitney Chiao ◽  
Lauren Pasquesi ◽  
...  
Keyword(s):  
Multivariate Regression ◽  
Treatment Options ◽  
Depression And Anxiety ◽  
Imaging Studies ◽  
Comorbid Depression ◽  
Cross Sectional ◽  
Tertiary Center ◽  
Chronic Dizziness ◽  
Associated Symptoms ◽  
History Of

Objectives: To elucidate differences in demographic and clinical characteristics between patients with episodic and chronic dizziness. Methods: A cross-sectional, observational study of 217 adults referred for dizziness at 1 tertiary center was undertaken. Subjects were split into a chronic dizziness group (>15 dizzy days per month) and an episodic dizziness group (<15 dizzy days per month). Results: 217 adults (average age, 53.7 years; 56.7% female) participated. One-third (n = 74) met criteria for chronic dizziness. Dizziness handicap inventory (DHI) scores were significantly higher in those with chronic dizziness compared to those with episodic dizziness (53.9 vs 40.7; P < .001). Comorbid depression and anxiety were more prevalent in those with chronic dizziness (44.6% and 47.3% vs 37.8% and 35.7%, respectively; P > .05). Abnormal vestibular testing and abnormal imaging studies did not differ significantly between the 2 groups. Ménière’s disease and BPPV were significantly more common among those with episodic dizziness, while the prevalence of vestibular migraine did not differ according to chronicity of symptoms. A multivariate regression that included age, sex, DHI, history of anxiety and/or depression, associated symptoms, and dizziness triggers was able to account for 15% of the variance in the chronicity of dizziness (pseudo- R2 = 0.15; P < .001). Conclusions: Those who suffer from chronic dizziness have significantly higher DHI and high comorbid rates of depression and anxiety than those with episodic dizziness. Our findings show that factors other than diagnosis alone are important in the chronification of dizziness, an observation that could help improve on multimodal treatment options for this group of patients.

scholarly journals 170 Primary Breast Lymphoma-Mimicking Inflammatory Breast Disease: A Case Report

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
R Alam ◽  
B Basak ◽  
A Ahsan ◽  
A S Gupta ◽  
S Islam ◽  
...  
Keyword(s):  
Breast Carcinoma ◽  
B Cell ◽  
Cell Lymphoma ◽  
B Cell Lymphoma ◽  
Primary Breast Lymphoma ◽  
Palpable Mass ◽  
Large B Cell Lymphoma ◽  
Breast Lymphoma ◽  
History Of ◽  
Large B Cell

Abstract Primary breast lymphoma (PBL) is an unusual clinical entity accounting for 0.4–0.5% of all breast neoplasms. The usual presentation includes a painless palpable mass similar to that of breast carcinoma. Diffuse large B-cell lymphoma (DLBCL) is the most common identifiable type of PBL based on the histopathological examination. We report an unusual case of 22 years old Bangladeshi woman presented with a 6-month history of a lump on left breast. Although the lump was initially small, it began a rapid growth after 4 months. The swelling was localized and did not show any skin involvement or discharge and as she didn’t have any positive familial history of breast carcinoma her primary attending physician diagnosed it as a case of breast abscess. When local incision and drainage proved ineffective, she was referred to us. After doing an immunohistochemistry from incisional biopsy the diagnosis was confirmed as Diffuse Large B-cell Lymphoma. The patient was treated initially by chemotherapy with CHOP therapy followed by wide local excision. Early and accurate diagnosis of PBL is crucial for selecting the appropriate MDT treatment strategies to avert potentially harmful surgical interventions.

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