scholarly journals A rare extensive clinical presentation of calciphylaxis due to primary hyperparathyroidism

2020 ◽  
Vol 7 (11) ◽  
pp. 3827
Author(s):  
Mohamad Safwan A. ◽  
K. N. Vijayan ◽  
Akash S. ◽  
Ashwini T. ◽  
Muhammed Irfan K. P. C.
Keyword(s):  
Parathyroid Adenoma ◽  
Lower Limb ◽  
Multiorgan Failure ◽  
Skin Lesions ◽  
High Serum ◽  
Lower Limbs ◽  
Elevated Alkaline Phosphatase ◽  
Sestamibi Scan ◽  
Bilateral Lower Limb ◽  
Proximal Myopathy

Calciphylaxis is a dreadful condition predominantly seen in chronic kidney disease patients on haemodialysis or following renal transplant. Calciphylaxis occurring in patients with normal kidney function is extremely rare. Here we present 53-year-old women presented with painful, extensive eschar-like skin lesions involving bilateral lower limb of 3 months of duration. She had hypercalcemia, high serum parathyroid hormone (PTH) levels and elevated alkaline phosphatase. Ultrasound neck and sestamibi scan demonstrated left inferior parathyroid adenoma. Lower limb radiographic studies showed subcutaneous calcification. Cutaneous biopsy confirmed calciphylaxis. Cinacalcet to control hypercalcemia, antibiotics and pain control medications were started. Left inferior parathyroidectomy and debridement of gangrenous lesions of lower limbs were performed. Histopathology was consistent with parathyroid adenoma. Lower limb wound started granulating with Vacuum-assisted closure (VAC) dressing and skin graft was planned. Unfortunately, she succumbed 11 weeks from surgery due to proximal myopathy, aspiration pneumonitis, sepsis and multiorgan failure.

scholarly journals Trichotillomania and Dermatitis Artefacta: A Rare Coexistence

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Neeraj Varyani ◽  
Sunny Garg ◽  
Garima Gupta ◽  
Shivendra Singh ◽  
Kamlakar Tripathi
Keyword(s):  
Blood Pressure ◽  
Conservative Management ◽  
Lower Limb ◽  
Skin Lesions ◽  
The Body ◽  
Lower Limbs ◽  
Dermatitis Artefacta ◽  
Bilateral Lower Limb ◽  
Pedal Edema

A 24-year-old pregnant female patient presented with complains of bilateral lower limb swelling and fever for 1 month. On examination, blood pressure was 144/94 mmHg along with pitting pedal edema. She had bizarre skin lesions, aligned longitudinally and distributed over the approachable site of the body with tapering ends and in various stages of healing. Lower limbs examination also revealed similar lesions with signs of cellulitis. Her scalp had short and distorted hair suggesting pulling and plucking. These skin lesions and the denial of self-infliction by the patient made us reach the diagnosis of dermatitis artefacta with trichotillomania. Psychotherapy was advocated along with conservative management of skin lesions. The patient improved and is under our follow up.

Sensitivity of the Toe Height to Multijoint Angular Changes in the Lower Limbs During Unobstructed and Obstructed Gait

2020 ◽  
pp. 1-9
Author(s):  
Chuyi Cui ◽  
Brittney Muir ◽  
Shirley Rietdyk ◽  
Jeffrey Haddad ◽  
Richard van Emmerik ◽  
...  
Keyword(s):  
Young Adults ◽  
Lower Limb ◽  
Sagittal Plane ◽  
Frontal Plane ◽  
Singular Value ◽  
Lower Limbs ◽  
Joint Angles ◽  
Adult Lifespan ◽  
Main Contributor ◽  
Bilateral Lower Limb

Tripping while walking is a main contributor to falls across the adult lifespan. Trip risk is proportional to variability in toe clearance. To determine the sources of this variability, the authors computed for 10 young adults the sensitivity of toe clearance to 10 bilateral lower limb joint angles during unobstructed and obstructed walking when the lead and the trail limb crossed the obstacle. The authors computed a novel measure—singular value of the appropriate Jacobian—as the combined toe clearance sensitivity to 4 groups of angles: all sagittal and all frontal plane angles and all swing and all stance limb angles. Toe clearance was most sensitive to the stance hip ab/adduction for unobstructed gait. For obstructed gait, sensitivity to other joints increased and matched the sensitivity to stance hip ab/adduction. Combined sensitivities revealed critical information that was not evident in the sensitivities to individual angles. The combined sensitivity to stance limb angles was 84% higher than swing limb angles. The combined sensitivity to the sagittal plane angles was lower than the sensitivity to the frontal plane angles during unobstructed gait, and this relation was reversed during obstacle crossing. The results highlight the importance of the stance limb joints and indicate that frontal plane angles should not be ignored.

Multiorgan thromboembolic shower and its ethical implications

2021 ◽  
Vol 14 (2) ◽  
pp. e238580
Author(s):  
Amedra Basgaran ◽  
Sayani Khara ◽  
Aravinth Sivagnanaratnam
Keyword(s):  
Lower Limb ◽  
Arterial Occlusion ◽  
Kidney Injury ◽  
Lower Limbs ◽  
Limb Ischaemia ◽  
Ethical Implications ◽  
Ct Angiogram ◽  
Bilateral Lower Limb ◽  
St Elevation ◽  
Full Body

A 54 year-old man was admitted after being found on the floor of his home, thought to have been there for approximately 5 days. He was diagnosed with a non-ST elevation myocardial infarction and bilateral cerebral ischaemic infarcts, as well as an acute kidney injury driven by rhabdomyolysis. The following day, bilateral lower limb ischaemia was observed. A full body CT angiogram revealed a complete thromboembolic shower with bilateral arterial occlusion in the lower limbs, bilateral pulmonary emboli, a splenic infarct and mesenteric ischaemia. An echocardiogram revealed a large thrombus in the left ventricle as the likely thromboembolic source. Bilateral lower limb amputations were recommended, commencing a complex discussion regarding the best course of management for this patient. The discussion was multifaceted, owing to the patient’s lack of capacity, and input from multiple teams and the patient’s relatives was required. Both ethical and clinical challenges arise from this case of a thromboembolic shower.

Dual mutation (MTHFR A1298C with PAI (4G) mutation) manifesting with bilateral lower limb gangrene in a neonate

2021 ◽  
Vol 14 (1) ◽  
pp. e237340
Author(s):  
Ashutosh Kumar ◽  
Sateesh Ramachandran ◽  
Pranati Swain ◽  
Vandana Negi
Keyword(s):  
Lower Limb ◽  
Methylenetetrahydrofolate Reductase ◽  
Plasminogen Activator Inhibitor ◽  
Lower Limbs ◽  
Homozygous Mutation ◽  
Single Mutation ◽  
Prothrombotic State ◽  
Life Threatening ◽  
Bilateral Lower Limb ◽  
The Individual

Neonates are at highest risk of thrombosis among paediatric patients. The relative prothrombotic state in a well neonate is compensated by other factors preventing spontaneous thrombosis; however, in a neonate with genetic predisposition, the balance is tilted predisposing them to a life-threatening thrombotic episode. We describe a rare case of methylenetetrahydrofolate reductase A1298C (homozygous) mutation along with plasminogen activator inhibitor (4G) mutation in a neonate who developed bilateral lower limb gangrene following thrombosis of the iliac vessels without any triggering factor. The neonate underwent thrombectomy as debulking measure along with thrombolytic therapy followed by unfractionated heparin and low-molecular-weight heparin which is still being continued along with oral aspirin. The neonate had to undergo amputation of both the involved lower limbs in view of dry gangrene. This case highlights that the dual mutations causing the prothrombotic state predispose the individual to the spontaneous life-threatening thrombotic episode as compared with the single mutation.

scholarly journals Severe Rhabdomyolysis due to Presumed Drug Interactions between Atorvastatin with Amlodipine and Ticagrelor

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Iouri Banakh ◽  
Kavi Haji ◽  
Ross Kung ◽  
Sachin Gupta ◽  
Ravindranath Tiruvoipati
Keyword(s):  
Cytochrome P450 ◽  
Renal Replacement Therapy ◽  
Replacement Therapy ◽  
Lower Limb ◽  
Enzyme Inhibitors ◽  
Multiorgan Failure ◽  
Lower Limbs ◽  
Cytochrome P450 3A4 ◽  
Rare Side Effect ◽  
Lower Limb Function

Atorvastatin and ticagrelor combination is a widely accepted therapy for secondary prevention of ischaemic heart disease. However, rhabdomyolysis is a well-known rare side effect of statins which should be considered when treatments are combined with cytochrome P450 3A4 enzyme inhibitors. We report a case of atorvastatin and ticagrelor associated severe rhabdomyolysis that progressed to multiorgan failure requiring renal replacement therapy, inotropes, intubation, and mechanical ventilation. Despite withdrawal of the precipitating cause and the supportive measures including renal replacement therapy, creatinine kinase increased due to ongoing rhabdomyolysis rapidly progressing to upper and lower limbs weakness. A muscle biopsy was performed to exclude myositis which confirmed extensive myonecrosis, consistent with statin associated rhabdomyolysis. After a prolonged ventilatory course in the intensive care unit, patient’s condition improved with recovery from renal and liver dysfunction. The patient slowly regained her upper and lower limb function; she was successfully weaned off the ventilator and was discharged for rehabilitation. To our knowledge, this is a second case of statin associated rhabdomyolysis due to interaction between atorvastatin and ticagrelor. However, our case differed in that the patient was also on amlodipine, which is considered to be a weak cytochrome P450 3A4 inhibitor and may have further potentiated myotoxicity.

scholarly journals Acute Aortic Occlusion with Acute Onset of Paraplegia and Severe Hyposthenia

2020 ◽  
pp. 1-3
Author(s):  
Stefania Tamburrini ◽  
Daniela Viola ◽  
Fabio Spinetti ◽  
Giuseppe Mercogliano ◽  
Giuseppe Sarti ◽  
...  
Keyword(s):  
Lower Limb ◽  
Mesenteric Artery ◽  
Limb Ischemia ◽  
Acute Onset ◽  
Lower Limbs ◽  
Motor Deficit ◽  
Acute Limb Ischemia ◽  
Neurological Assessment ◽  
Bilateral Lower Limb ◽  
Acute Aortic Occlusion

A 75-years-old man presented at our ED with acute onset of paraplegia and severe bilateral lower limb hyposthenia. The patient ‘s neurological assessment was negative except for lower limbs positive Mingazzini test. CT angiography detected a complete lack of opacification of the abdominal aorta immediately below the emergency of the inferior mesenteric artery, caused by a coarse thrombus in the left ventricle. We present a case of acute aortic and lumbar arteries thrombosis with paraplegia and no clear symptoms of acute limb ischemia, in which the motor deficit in the lower extremities was explained by anterior spinal cord syndrome secondary to acute occlusion of lumbar arteries.

scholarly journals Siliconomas of the lower limb: Tumour-like excision and reconstruction

2016 ◽  
Vol 49 (03) ◽  
pp. 384-389
Author(s):  
Tommaso Agostini ◽  
Raffaella Perello
Keyword(s):  
Lower Limb ◽  
Silicone Oil ◽  
Multiorgan Failure ◽  
Fat Grafting ◽  
Lower Limbs ◽  
Immediate Reconstruction ◽  
Silicone Injection ◽  
Aesthetic Appearance ◽  
The Mean ◽  
Oil Injection

ABSTRACTBackground: Silicone oil injection can cause several complications including pain, cellulitis, abscesses, skin compromise, migration, embolism and multiorgan failure. Oil-infested tissue excision remains the solely treatment to prevent such complications. Objectives: The authors evaluate tumor-like excision of the oil-infested tissue as a treatment for patients experiencing silicone injections in the lower limbs, to both preserve aesthetic appearance and solve further risk of complication from silicone. Methods: Between January 2004 and January 2011 a total of 12 consecutive, nonrandomized female patients underwent surgical management of siliconoma of the lower limb. The mean age was 41-years, range from 22 to 61 years and all patients didn’t referred comorbidities. Eight siliconomas were located on the leg and 4 were on the thigh. The mean area of siliconoma was 35 cm2, range from 25 to 60 cm2. Each patient was evaluated by ultrasonography and EchocolorDoppler of the soft tissue and in order to achieve a “staging” of siliconoma. Results: Healing was uneventful in all cases. Three patients (25%) suffering hypertrophic scarring underwent further injection of corticosteroids to improve hypertrophic scars quality. Two patients (16.6%) required a further session of structural fat grafting to improve thigh’s profile. All patients were satisfied with the cosmetic results and indispositions requiring medical therapy disappeared. Conclusions: Tumor-like excision and immediate reconstruction appears to be a safe and consistent surgical option that preserves aesthetic appearance for patients victims of illegal oil silicone injection of the lower limbs.

scholarly journals A Rare Case of Eosinophilic Granulomatosis with Polyangiitis Associated with Cryoglobulinemia Presenting with a Bullous Skin Eruption of the Lower Limbs

2018 ◽  
Vol 2018 ◽  
pp. 1-3
Author(s):  
D. D. K. Abeyaratne ◽  
C. Liyanapathirana ◽  
C. L. Fonseka ◽  
P. W. M. C. S. B. Wijekoon
Keyword(s):  
Skin Eruption ◽  
Lower Limb ◽  
Rare Case ◽  
Granulomatosis With Polyangiitis ◽  
Early Recognition ◽  
Lower Limbs ◽  
Small Vessel Vasculitis ◽  
Eosinophilic Granulomatosis With Polyangiitis ◽  
Bilateral Lower Limb ◽  
Eosinophilic Granulomatosis

Background. Eosinophilic granulomatosis with polyangiitis (EGPA) is an antineutrophil cytoplasmic antibody- (ANCA-) associated small vessel vasculitis with multisystem involvement. It is characterized with asthma, eosinophilia, and renal and peripheral nervous system involvement. However, EGPA presenting with bullous skin eruption is an uncommon dermatological manifestation. We report a rare case of EGPA overlapped with mixed essential cryoglobulinemia presenting with a bullous skin eruption. Case Presentation. A 49-year-old female presented with bilateral lower limb erythematous bullous rash with bilateral lower limb numbness. She had bilateral ankle edema with frothyuria and a recent onset wheeze. Blood investigations revealed a marked peripheral eosinophilia with positive P-ANCA. Skin biopsy was suggestive of leukocytoclastic vasculitis. She also had positive cryoglobulins with a high rheumatoid factor titre. The patient was diagnosed of having EGPA with overlapping mixed essential cryoglobulinemia. Her skin eruptions and systemic manifestations improved with prednisolone and cyclophosphamide therapy. Conclusion. EGPA can rarely present with a bullous skin eruption and may rarely associate with secondary cryoglobulinemia. Early recognition of these rare manifestations and prompt treatment would prevent further complications and death.

The Impact of COVID-19 Pandemic on Vascular Leg Ulcers

2021 ◽  
pp. 153473462110109
Author(s):  
Marianna Sallustro ◽  
Anna Florio
Keyword(s):  
Primary Care ◽  
Lower Limb ◽  
Deleterious Effect ◽  
Skin Lesions ◽  
Lower Limbs ◽  
Limb Amputation ◽  
Leg Ulcers ◽  
Skin Wounds ◽  
Primary Care Settings ◽  
The Impact

The aim of this study was to evaluate the impact of 2 lockdown periods during coronavirus disease 2019 (COVID-19) on the course and management of nonhealing vascular ulcers of lower limbs. A total of 41 patients were included in the study. Before the pandemic began they had been seen at our unit at weekly intervals. During lockdown from March 9, 2020, to May 18, 2020 subjects were not allowed to enter the hospital unless they needed urgency or emergency surgery, or oncological management. During the second lockdown, from October 19, 2020, to December 11, 2020 patients could be followed up at distance by direct outreach including telephoning contacts. Data obtained early after each lockdown were compared with those obtained prior to the pandemic. Data for the first lockdown show that pain intensified and there was an increase in the recurrence rate of wounds, of their severity, and of superimposed infections as compared with the prelockdown period. The risk of lower-limb amputation was also considerably greater. During the second and less restrictive lockdown, patients were followed up by telemedicine and data indicate that skin lesions had not worsened any further. The management of vascular wounds was impacted by the pandemic unfavorably with health care failures in the hospital as well as in the primary care settings. In conclusion, the treatment of vascular leg ulcers is challenged by the COVID-19 pandemic as this spreads worldwide. This seems to be in keeping with what happens for other diseases. The data we obtained indicate that the pandemic-related lockdown has a deleterious effect on vascular skin wounds, with an increase of severity and mortality risk. The impact appears to be proportional to the number and the degree of limitations imposed on people.

scholarly journals Spontaneous spinal epidural hematoma: a case report

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Ooi Chin Sheng ◽  
Ren-Chieh Wu ◽  
I-Hsin Chang
Keyword(s):  
Lower Limb ◽  
Epidural Hematoma ◽  
Lower Limbs ◽  
Spinal Epidural Hematoma ◽  
Limb Weakness ◽  
Female Ratio ◽  
Spontaneous Spinal Epidural Hematoma ◽  
Lower Limb Weakness ◽  
Bilateral Lower Limb ◽  
Spinal Epidural

Abstract Background Spinal epidural hematomas usually occur under certain conditions; they rarely occur spontaneously. The prevalence of spontaneous spinal epidural hematoma is ~ 0.1 per 100,000, and the male-to-female ratio is approximately 1.4 to 1. Herein, we describe a rare case of spontaneous spinal epidural hematoma. Case presentation A 63-year-old Taiwanese woman, with underlying hypertension, anemia, and a history of cardiovascular accident without sequela, was admitted to our emergency department with a chief complaint of sudden bilateral weakness in the lower limbs. Magnetic resonance imaging revealed a spontaneous epidural hematoma. The patient underwent emergency surgery to remove the epidural hematoma and laminectomy for decompression. The bilateral lower limb weakness was alleviated immediately after the surgery. Conclusion In patients with no risk factors related to spinal epidural hematoma, symptoms of bilateral lower limb weakness must be investigated carefully because this condition may occur spontaneously.

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