scholarly journals Uterus didelphys and successful pregnancy: case reports

2021 ◽  
Vol 13 (3) ◽  
pp. e6571
Author(s):  
Hilka Quinelato ◽  
Renata dos Santos Ribeiro Guzman ◽  
Roberta Faria ◽  
Valquiria Quinelato
Keyword(s):  
Past History ◽  
Case Reports ◽  
Successful Pregnancy ◽  
Uterus Didelphys ◽  
Risk Pregnancy ◽  
Uterine Malformation ◽  
Patient Reported ◽  
History Of ◽  
Final Consideration ◽  
Clinical Cases

Objective: To report a clinical cases of uterus didelphys and successful pregnancy. Case details: Case 1: patient with high-risk pregnancy due to Hypothyroidism, overweight and the presence of uterus didelphys. In the past history: anemia, the patient reported menstrual irregularity. The pregnancy went according to the proper procedures, however, a significant increase in weight was observed, as a consequence, gestational arterial hypertension was detected. Cesarean delivery occurred at 37 weeks and three days without complications. Case 2: patient diagnosed with uterus didelphy at 65, history of treatment for becoming pregnant, intense menstrual flow, cramps and two successful pregnancies. However, the patient was not aware of the uterine malformation and there was no information about this fact in the medical record. All patients included in this study provided informed consent. Final consideration: Despite pregnancy being considered the presence of the uterus didelphys, the pregnancies went according to the appropriate procedures considering the guidelines recommended by the Ministry of Health (MS). Therefore, the therapeutic approach applied to clinical cases was successful.

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.

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 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.

scholarly journals Mixed cortico-medullary adrenal carcinoma in children: looks are deceptive!!

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Arti Khatri ◽  
Nidhi Mahajan ◽  
Niyaz Ahmed Khan ◽  
Natasha Gupta
Keyword(s):  
Past History ◽  
Case Reports ◽  
Final Diagnosis ◽  
Adrenal Carcinoma ◽  
Case Presentation ◽  
First Case ◽  
Contrast Enhanced ◽  
Paediatric Age ◽  
History Of ◽  
Enhanced Computed Tomography

Abstract Background Mixed cortico-medullary adrenal carcinoma (MCMAC) is an extremely rare entity with scarce literature on its cytomorphology. Case presentation A 2-year-old girl presented with abdominal pain for 3 days and a past history of fever with significant weight loss. On examination, a non-tender left hypochondrial firm mass and an enlarged left supraclavicular node were found. Twenty-four-hour urinary levels of VMA were marginally high. Contrast-enhanced computed tomography of the abdomen showed a suprarenal heterogeneous mass encasing major vessels. Aspiration cytology of both mass and node showed similar features comprising a predominant population of singly scattered large cells with moderate cytoplasm, eccentric nucleus and prominent nucleolus in a necrotic background. Tumour cells expressed Synaptophysin and Melan-A. In view of increasing respiratory distress, debulking surgery was performed, and histopathology of the specimen revealed the presence of both malignant medullary and cortical components supported by immunohistochemistry making a final diagnosis of MCMAC. The patient succumbed to death in the postoperative period. The cytology slides were reviewed and were seen to show a dual cell population. Conclusion Coexistent malignant cortical and medullary tumour of the adrenal gland is the first case reported in the paediatric age group in the literature with only three previous case reports in adults.

Recurrent Limb Pain and Migraine: Case Reports and A Clinical Review

Cephalalgia ◽  
2009 ◽  
Vol 29 (8) ◽  
pp. 898-905 ◽  
Author(s):  
S Prakash ◽  
ND Shah ◽  
SY Dholakia
Keyword(s):  
Migraine Headache ◽  
Temporal Relationship ◽  
Preventive Measures ◽  
Case Reports ◽  
Limb Pain ◽  
Patient Reported ◽  
History Of ◽  
Clinical Profiles ◽  
Relationship Of ◽  
Close Temporal Relationship

Recurrent limb pain (RLP) is a well-known entity in childhood. It is considered a precursor of migraine. The temporal relationship of RLP with headache in childhood is lacking in the literature. However, there are many cases with limb pain in a close temporal relationship with migraine headache in adults. We report six female patients with RLP and migraine and delineate the temporal relationship between the two. Three patients had a history of RLP in childhood and developed migraine headache after many years. Conversely, two patients had a long history of migraine headache and later developed RLP. One patient developed RLP and migraine headache at the same age. Isolated limb pain was frequent in all six patients. It was mild to severe, for a few minutes to a few days, and predominantly located in the upper extremities. Only one patient reported allodynia. The patients showed response to preventive measures (all six patients) and abortive therapies (four patients), even in those attacks of RLP that were not associated with headache episodes. We also review the clinical profiles of the patients in whom RLP and migraine were related to each other, and speculate on the possible mechanisms for RLP in the patients with migraine.

scholarly journals Spontaneous Nasal Polypectomy Proceeded by Fluticasone Propionate (XHANCE®) and Zileuton (Xyflo®) Application

2020 ◽  
Vol 1 (2) ◽  
pp. 8-12
Author(s):  
Marija Rowane ◽  
Kelsey Graven ◽  
Robert Hostoffer
Keyword(s):  
Fluticasone Propionate ◽  
Treatment Regimen ◽  
Nasal Polyposis ◽  
Case Reports ◽  
Subcutaneous Immunotherapy ◽  
Intranasal Corticosteroids ◽  
Patient Reported ◽  
Oral Corticosteroids ◽  
History Of ◽  
New Treatment

Abstract Background: Nasal polyps (NPs) are inflammatory outgrowths of paranasal sinus mucosa that occur in one to four percent of the population and most commonly cause congestion, obstruction, or hyposmia. Intranasal corticosteroids, along with short courses of oral corticosteroids, are most often recommended for symptomatic nasal polyposis, prior to consideration of surgical intervention. We present the first reported case of spontaneous nasal polypectomy, occurring after use of fluticasone propionate (XHANCE®) and zileuton (Xyflo®). Methods: A 43-year-old Asian-Indian male with history of allergic rhinitis, asthma, and nasal polyposis had been prescribed subcutaneous immunotherapy for five years without effectiveness before another polypectomy was scheduled. After the polyps resurfaced, the patient was prescribed prednisone and underwent another polypectomy. He later presented with persistent NPs and congestion, as well as diffuse lymphadenopathy and pruritic eyes and ears. Fluticasone Propionate was continued as maintenance therapy and Zileuton was prescribed in place of Montelukast (Singulair®). Results: After several weeks of the new treatment regimen, the patient reported polyp irritation and movement, as well as influenza-like symptoms. Epistaxis soon occurred, followed by a spontaneous polypectomy. Three more polyps were expelled with bloody discharge. The patient reported resolved hyposmia and reduced symptoms thereafter. The treatment regimen was continued without change or further episodes of epistaxis and polypectomy. Conclusion: Few case reports in the literature describe polyp autoamputation. We report the first instance of spontaneous nasal polypectomy in the literature, induced by Fluticasone Propionate and Zileuton.

scholarly journals Clinical cases of myocardial infarction in pregnant women: the role of hereditary thrombophilia

2020 ◽  
Vol 48 (5) ◽  
pp. 341-347
Author(s):  
S. R. Mravyan ◽  
T. S. Kovalenko ◽  
I. O. Shuginin ◽  
T. S. Budykina ◽  
S. I. Fedorova
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Pregnant Women ◽  
Myocardial Injury ◽  
Past History ◽  
False Negative ◽  
Hereditary Thrombophilia ◽  
History Of ◽  
Pai 1 ◽  
Clinical Cases

Acute myocardial infarction during pregnancy is a threatening complication with high maternal and perinatal mortality. According to the literature, hereditary thrombophilia is commonly associated with obstetric disorders and susceptibility to venous thrombosis, whereas arterial part of the vasculature, including coronary, is rarely involved. The article describes two clinical cases of pregnant women with acute myocardial infarction and post-infarction cardiosclerosis, in whom hereditary thrombophilia, associated with the gene PAI-1-675 polymorphism, was diagnosed. Mothers of both patients had suffered myocardial infarction at a young age, while past history of only one pregnant woman was remarkable for multiple perinatal losses. Myocardial infarction may manifest with intense headache mirroring systemic angiospasm.Based on the clinical observations of acute myocardial infarction in pregnancy, one could conclude that measurements of troponin levels that might be false negative should be done repeatedly, while the signs of transmural myocardial injury at ECG can evolve into those of an intramural myocardial infarction. Miscarriage and fetoplacental insufficiency have been found in the patients with combination of hereditary thrombophilia and myocardial injury. Coronary artery damage in pregnant women can be the result of hereditary thrombophilia, most often associated with the PAI-1-675 gene polymorphism, as well as its combination with the heterozygous state of other genes.The absence of past perinatal losses and venous thromboembolism in pregnant women with myocardial infarction does not exclude hereditary thrombophilia, and additional work-up of the patient and the proband family is mandatory to exclude the underlying pathology. The course of myocardial infarction may not require an intracoronary intervention, and treatment may consist of non-fractionated or low molecular weight heparin and calcium antagonists.

Thyroid-Induced Mania in Hypothyroid Patients

1980 ◽  
Vol 137 (3) ◽  
pp. 222-228 ◽  
Author(s):  
Allan M. Josephson ◽  
Thomas B. Mackenzie
Keyword(s):  
Past History ◽  
Case Reports ◽  
Manic State ◽  
Affective Disturbance ◽  
Patients At Risk ◽  
History Of ◽  
The Relationship ◽  
Hypothyroid Patients ◽  
Insight Into ◽  
High Range

SummaryThis retrospective study, based on 18 case reports, describes an organic affective syndrome, manic type, occurring shortly after the initiation of thyroid replacement in hypothyroid patients. The symptomatology and homogeneity of the syndrome offers insight into the relationship between thyroid activity and affective disturbance. The patients experiencing mania showed concurrent psychopathology at the time of replacement therapy, frequently had a past history of personal or familial psychiatric disorder and were given dosages in the high range of normal. The potential morbidity of the manic state was considerable. These findings suggest that a group of hypothyroid patients at risk can be identified. In such a group, lower initial dosages and gradual increases in dosage may be indicated.

scholarly journals 353. Starry Night, Starry Bright, A Lil’ Doxy Will Help You See the Light

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S245-S246
Author(s):  
Brandon Smith ◽  
Erin K McCreary ◽  
J Alex Viehman
Keyword(s):  
Vision Loss ◽  
Past History ◽  
Bartonella Henselae ◽  
Rare Complication ◽  
Granulomatous Inflammation ◽  
Field Testing ◽  
Empiric Therapy ◽  
Patient Reported ◽  
History Of ◽  
Graded Challenge

Abstract Background Bartonella henselae neuroretinitis (BHNR) is a rare complication of cat scratch disease (CSD) occurring in 1–2% of cases. BHNR requires prompt diagnosis and treatment to prevent potential vision loss. Doxycycline, in combination with rifampin, is consider the treatment of choice. Empiric therapy is often started based on clinical suspicion prior to serologic confirmation. We present a case of BHNR requiring doxycycline graded challenge. Methods We report a case of a 45-year-old female with a past history of multiple sclerosis treated with natalizumab presenting with acute right-sided vision loss. She reported suffering a cat scratch 6 weeks prior and had noteworthy tick exposure. She was admitted to our hospital for progressively worsening vision loss. MRI brain demonstrated right-sided enhancement consistent with retinitis. Ophthalmology exam suggestive of infectious papillitis, neuroretinitis, and granulomatous inflammation. Results Infectious diseases (ID) was consulted with concern for BHNR and a history of a severe tetracycline allergy, throat swelling age 17. Given declining vision and a differential including both Lyme disease and BHNR, the decision was made to empirically treat with doxycycline while awaiting serologic studies. She successfully underwent doxycycline graded challenge (10mg administered IV followed by 100mg administered IV one hour later) and ultimately completed a 6-week course of doxycycline in combination with 2 weeks of rifampin followed by 4 weeks of azithromycin. Bartonella serologies returned positive 1:256 and her Lyme screen was negative. At her 6-week follow up, her vision had significantly improved but not yet returned to baseline. Retina images Visual field testing Conclusion Doxycycline serves as a treatment of choice for BHNR; however, our patient reported a severe, likely IgE-mediated reaction to tetracycline 28 years prior. She subsequently tolerated the first doxycycline graded challenge at our institution. Unlike B-lactam allergies, there is a paucity of literature exploring the cross-reaction potentials of various tetracyclines. Limited evidence has suggested that cross-reactions are not absolute. Tetracycline allergies present an opportunity for antimicrobial stewardship. Disclosures All Authors: No reported disclosures

Ladies with Leber's Hereditary Optic Neuropathy: An Atypical Disease

2002 ◽  
Vol 12 (6) ◽  
pp. 537-541 ◽  
Author(s):  
S.S. Dandekar ◽  
E.M. Graham ◽  
G.T. Plant
Keyword(s):  
Optic Neuropathy ◽  
Visual Loss ◽  
Dna Analysis ◽  
Past History ◽  
Case Reports ◽  
Leber’S Hereditary Optic Neuropathy ◽  
Leber's Hereditary Optic Neuropathy ◽  
Increased Risk ◽  
History Of ◽  
Hereditary Optic Neuropathy

Purpose Leber's Hereditary Optic Neuropathy (LHON) is considered to be a disease predominantly affecting young males. The risk of women becoming symptomatic if they are carriers of a primary mutation is 1/5 of that in males. The disease however appears to behave differently in women in some instances. We describe three cases of ladies with LHON and discuss the importance of making the diagnosis. Case Reports A 28-year-old female presented with blurring of vision in her left eye with bilateral small hyperemic discs and telangiectatic vessels adjacent to them. DNA analysis confirmed the 11778 mutation and the second eye remains unaffected 10 years later. The second case was 49 years old and presented with bilateral visual loss developing over 3 months. She had no family history of visual loss but had a past history of Wolf Parkinson White syndrome and 3460 mutation was confirmed. The last case was diagnosed with multiple sclerosis at age 24 and went on to develop visual loss with poor recovery. DNA analysis demonstrated the 11778 mutation and confirmed LHON. Conclusions All three cases, although not unique, posed considerable diagnostic difficulties over a long period of time. The authors have highlighted important associations of the disease and stress the importance of making the diagnosis in women. They are at increased risk of having affected children, unlike the affected males, especially if they are affected themselves and may wish to seek further genetic advice.

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