Appropriate Evaluation of Psychiatric Patients Highlighted by Creutzfeldt-Jakob Disease: A Case Report

Introduction: Determination of medical stability for patients presenting with psychiatric complaints is common for emergency clinicians. A thorough history and physical examination is important. Case Report: A 53-year-old male presented to the emergency department (ED) with depression, suicidal ideation, and decline in activities of daily living over six months. While his initial neurologic examination was non-focal, subsequent re-evaluations demonstrated significant changes, and he was ultimately diagnosed with Creutzfeldt-Jakob disease. Conclusion: This case demonstrates how a detailed history of the present illness could have led to a more accurate and timely medical disposition from the ED.

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A141 SPONTANEOUS ESOPHAGEAL PERFORATION: AN UNREPORTED COMPLICATION OF LYMPHOCYTIC ESOPHAGITIS

Journal of the Canadian Association of Gastroenterology ◽

10.1093/jcag/gwab002.139 ◽

2021 ◽

Vol 4 (Supplement_1) ◽

pp. 128-129

Author(s):

A LAGROTTERIA ◽

A W Collins ◽

A Someili ◽

N Narula

Keyword(s):

Computed Tomography ◽

Emergency Department ◽

Case Report ◽

Proton Pump Inhibitor ◽

Proton Pump ◽

Esophageal Perforation ◽

Distal Esophagus ◽

Chest Discomfort ◽

History Of ◽

Lymphocytic Esophagitis

Abstract Background Lymphocytic esophagitis is a new and rare clinicopathological entity. It is a histological pattern characterized by lymphocytic infiltrate without granulocytes. Its etiology and clinical significance remains unclear. The clinical manifestations are typically mild, with reflux and dysphagia the most commonly reported symptoms. Aims We describe a case report of spontaneous esophageal perforation associated with lymphocytic esophagitis. Methods Case report Results A previously well 31-year-old male presented to the emergency department with acute food impaction. His antecedent symptoms were acute chest discomfort and continuous odynophagia following his most recent meal, with persistent globus sensation. The patient had no reported history of allergies, atopy, rhinitis, or asthma. A previous history of non-progressive dysphagia was noted after resuscitation. Emergent endoscopy revealed no food bolus, but a deep 6 cm mucosal tear in the upper-mid esophagus extending 24 to 30 cm from the incisors. Chest computed tomography observed small volume pneumoperitoneum consistent with esophageal perforation. The patient’s recovery was uneventful; he was managed conservatively with broad-spectrum antibiotics, proton pump inhibitor therapy, and a soft-textured diet. Endoscopy was repeated 48 hours later and revealed considerable healing with only a residual 3-4cm linear laceration. Histology of biopsies taken from the mid and distal esophagus demonstrated marked infiltration of intraepithelial lymphocytes. There were no eosinophils or neutrophils identified, consistent with a diagnosis of lymphocytic esophagitis. Autoimmune indices including anti-nuclear antibodies and immunoglobulins were normal, ruling out a contributory autoimmune or connective tissue process. The patient was maintained on a proton pump inhibitor (pantoprazole 40 mg once daily) following discharge. Nearly six months following his presentation, the patient had a recurrence of symptoms prompting representation to the emergency department. He described acute onset chest discomfort while eating turkey. Computed tomography of the chest redemonstrated circumferential intramural gas in the distal esophagus and proximal stomach. Conclusions Esophageal perforation is a potentially life-threatening manifestation of what had been considered and described as a relatively benign condition. From isolated dysphagia to transmural perforation, this case significantly expands our current understanding of the clinical spectrum of lymphocytic esophagitis. Funding Agencies None

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Non-painful severe variant form of eruptive lingual papillitis: A case report and literature review

Dermatology Reports ◽

10.4081/dr.2021.9020 ◽

2021 ◽

Vol 13 (2) ◽

Author(s):

Manal Ahmed Halwani

Keyword(s):

Emergency Department ◽

Case Report ◽

Literature Review ◽

Oral Hygiene ◽

Rare Case ◽

Dorsal Surface ◽

Variant Form ◽

Girl Child ◽

Rare Case Report ◽

History Of

Eruptive lingual papillitis is a common benign disorder manifested by inflammation of fungiform papillae on the dorsolateral surface of the tongue. Several variants of lingual papillitis have been reported since 1997, most or all of them with painful erythematous papules. Here we report a case of 6 years old girl child with non-painful severe variant form of eruptive lingual papillitis presented to the emergency department. The entire dorsal surface of the tongue was surfaced by 2-3mm by multiple erythematous papules and some with a white or yellowish colour. The papules were excessively inflamed, pigmented, aggregated, and crusted. The cause was idiopathic which resolved within ten days. The parent and patient were reassured with advice to practice oral hygiene. This is a rare case report describing non-painful lingual papillitis without a history of any prior episodes.

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Case report: MRI findings of acute uremic encephalopathy in a 1-year-old boy

BJR|case reports ◽

10.1259/bjrcr.20210057 ◽

2021 ◽

pp. 20210057

Author(s):

Amar Ajay Chotai ◽

Dipayan Mitra

Keyword(s):

Emergency Department ◽

Renal Function ◽

Case Report ◽

Extracellular Potassium ◽

Neurological Abnormality ◽

Normal Range ◽

Mri Findings ◽

Intracellular Space ◽

History Of ◽

Function Profile

We present a 1-year-old boy who presented to the emergency department with a 7-day history of diarrhoea and vomiting. The initial renal function profile demonstrated a urea of 55 mmol l−1 (normal range between 5 and 20 mmol l−1), creatinine 695 micromol/L (normal range between 62–106 micromol/L) and potassium 9.1 mmol l−1 (normal range between 3.5–5.0 mmol l−1), with a profound metabolic acidosis. Upon examination, there were no significant findings, specifically no neurological abnormality. He was prescribed back-to-back Salbutamol nebulisers, to increase the shift of extracellular potassium into the intracellular space, followed by i.v. calcium gluconate, with some improvement in potassium levels. A further 5 mmol of sodium bicarbonate was given, as well as a stat dose of 1 mg/kg furosemide, and per rectal calcium resonium. He was then commenced on an infusion with 10% dextrose with insulin. He was subsequently found to be in urinary retention and a catheter was inserted, which drained 1700 ml. A subsequent renal function profile, 24 hours after admission, demonstrated improvement with urea 39 mmol l−1, creatinine 300 micromol/L and potassium 3.0 mEq/L.

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Wound Management of a Pediatric Spina Bifida Patient Secondary to a Canine-Inflicted Fifth-Digit Amputation: A Case Report

Journal of the American Podiatric Medical Association ◽

10.7547/17-151 ◽

2021 ◽

Vol 111 (3) ◽

Author(s):

Brittany A. Lovett ◽

Cristóbal S. Berry-Cabán ◽

Deanna E. Duran ◽

Sharon P. McKiernan

Keyword(s):

Emergency Department ◽

Case Report ◽

Spina Bifida ◽

Human Infection ◽

Further Education ◽

Wound Management ◽

Treatment Facility ◽

Medical Treatment Facility ◽

The Family ◽

History Of

We present a case of a pediatric patient with a history of spina bifida who presented to the emergency department of a large Army medical treatment facility with a partially amputated right fifth digit she sustained while sleeping with the family canine. There are several reports in the popular press that suggest that an animal, particularly a dog, can detect human infection, and it is hypothesized that the toe chewing was triggered by a wound infection. This case provides an opportunity to provide further education in caring for foot wounds in patients with spina bifida.

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A case report of haemolytic disease of the foetus and newborn caused by Alloantibody D and Jka in a Rhesus D negative Nigerian woman: Justification for the implementation of universal access to prophylaxis and evidenced-based best practices

Human Antibodies ◽

10.3233/hab-200414 ◽

2020 ◽

Vol 28 (3) ◽

pp. 245-252

Author(s):

Osaro Erhabor ◽

Williams Bitty Azachi ◽

Erhabor Tosan

Keyword(s):

Case Report ◽

Best Practices ◽

Pregnant Women ◽

Universal Access ◽

Haemolytic Disease ◽

Nigerian Woman ◽

Intrauterine Transfusion ◽

History Of ◽

Evidenced Based

A case report of a 38 years old ABO group A and Rhesus D negative multiparous, gravidae 8 and para 2, Nigerian woman who had a case of premarital miscarriage and who was not offered anti-D prophylaxis as part of her management. Lady went on to develop alloantibody D and Jka. Lady has had 7 further pregnancies post the miscarriage. The first child who is B Rhesus D positive is the only surviving child. The surviving child was delivered severely jaundiced and needed management post-delivery for haemolytic disease of the foetus and newborn (HDFN). Lady has had a history of a stillbirth. She was given a non-clinically indicated anti-D prophylaxis during the second pregnancy despite having been previously sensitized. The second baby died 3 months after delivery from complications of HDFN. She had had a further history of 5 miscarriages. She has had challenge with conception since 2010. Alloantibody testing confirms the presence alloantibody D and anti-Jka. Finding from this is a clear case of sub-optimal laboratory, obstetric and neonatal care offered particularly to pregnant women who are Rh D negative and those with alloantibodies in Nigeria. The Nigerian government will need to implement evidenced-based best practices; determination of alloantibody status of pregnant women during their first antenatal visit; provision of facilities for alloantibody identification, titration, quantification and feto maternal haemorrhage testing (FMH); implementation of a policy on universal access to anti-D prophylaxis for pregnant Rh D negative women who are not previously sensitized; provision of facilities required for the optimal intrauterine management of HDFN (foetal genotype testing, intrauterine transfusion, doppler ultrasound to diagnose anaemia inutero and provision of donor blood that meet the minimum requirements for intrauterine transfusion); determination of Rh D status of women who require a termination of pregnancy and provision of prophylactic anti-D for those found Rh D negative within 72 hours of procedure and the optimization of the knowledge of Medical Laboratory Scientist, Obstetricians, Neonatologist, Pharmacist and Traditional Birth Attendants in a bid to reduce the residual number of women who become sensitized and the number of preventable deaths of babies with HDFN.

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Case Report: Pediatric POCUS: 4 month old infant with a timely diagnosis

POCUS Journal ◽

10.24908/pocus.v2i2.13278 ◽

2017 ◽

Vol 2 (2) ◽

pp. 13-14

Author(s):

Victor Istasy MD, FRCPC ◽

Tim Lynch MD, FRCPC ◽

Rodrick Lim, MD, FRCPC

Keyword(s):

Emergency Department ◽

Case Report ◽

Female Infant ◽

Telephone Consultation ◽

Timely Diagnosis ◽

Bilious Vomiting ◽

History Of ◽

Local Emergency Department

A healthy, four month-old female infant presented to a local emergency department with a 12-hour history of decreased activity, non-bilious vomiting and one episode of dark red blood in the stools. There was no history of fever. Telephone consultation was completed and the patient was transferred to a tertiary, pediatric centre for further evaluation. On arrival, the infant appeared pale and was lethargic during the exam.

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Case Report: Creutzfeld- Jakob disease, onset with ataxia and absence of dementia

10.5327/1516-3180.614 ◽

2021 ◽

Author(s):

Lucas de Oliveira Pinto Bertoldi ◽

Beatriz Cassarotti ◽

Isabela Silva Souza ◽

Alana Strucker Barbosa ◽

Eduardo Silveira Marques Branco ◽

...

Keyword(s):

Case Report ◽

Cognitive Deficit ◽

Disease Onset ◽

Abdominal Distension ◽

Initial Assessment ◽

Progressive Dementia ◽

Mri Scan ◽

History Of ◽

Jakob Disease ◽

Low Incidence

Context: Creutzfeld Jakob disease, a rare prion disease that leads to rapidly progressive dementia and movement disorders, through its pathophysiology will determine brain damage. Regardless of the cause, the course of the disease will be rapid and will invariably lead to death. Objective: The reason why the case is described is due to the low incidence of this disease and its unusual course in the case described. Case report: A 67-year-old male, had a personal history of smoking and obesity . Referred to our service due to sudden ataxia, in the presence of an unchanged MRI scan. The first sympton started when he woke up with a dizzying and inability to walk due to imbalance. In the initial assessment, the patient had appendicular ataxia in all 4 limbs, with an examination of his mental status without changes. New head MRI exam showing alterations compatible with CJD. Interned with hipotheses diagnoses of Wilson’s disease, encephalitis or CJD, he developed abdominal distension with surgical need and immediately after the procedure he already presented a comatose, spastic, and myoclonic condition compatible with the final phase of CJD, later protein 14-3-3 was found in the CSF. Conclusions: CJD, usually presents with rapidly progressive cognitive deficit associated with movement disorder. In the case presented, initially there was no change in cognition and after an urgent surgical procedure, there was an important advance in a shorter than expected period for the disease.

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Futile Sexual Homicide in Nepal: A Case Report

Journal of Nepal Medical Association ◽

10.31729/jnma.6057 ◽

2021 ◽

Vol 59 (243) ◽

pp. 1174-1176

Author(s):

Alok Atreya ◽

Shiva Pandit ◽

Samata Nepal ◽

Jun Bajracharya ◽

Deepak Shrestha

Keyword(s):

Emergency Department ◽

Sexual Abuse ◽

Case Report ◽

Sexual Intercourse ◽

Sexual Homicide ◽

Sexual Offenses ◽

History Of ◽

Uncommon Case

Although cases of sexual offenses are not uncommon in children, they present to the Emergency Department seeking treatment for a medical cause. Sometimes the history of abuse is missed by the treating clinicians who are only focused upon the presenting complaint and not upon the underlying cause. Furthermore, the lack of reporting of sexual abuse in medical literatures makes them a rarity in the Nepalese scenario. We present an uncommon case of a child where the perpetrator who tried to silence her during the sexual intercourse made a futile attempt to kill her cutting her throat with a sickle.

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Gemcitabine-induced pseudocellulitis: a case report and review of the literature

Current Oncology ◽

10.3747/co.26.5007 ◽

2019 ◽

Vol 26 (5) ◽

Cited By ~ 1

Author(s):

H. Bami ◽

C. Goodman ◽

G. Boldt ◽

M. Vincent

Keyword(s):

Emergency Department ◽

Case Report ◽

Side Effects ◽

Chemotherapeutic Agent ◽

Whipple Procedure ◽

Venous Stasis ◽

Past Medical History ◽

Review Of The Literature ◽

Peripheral Vascular ◽

History Of

Gemcitabine is a chemotherapeutic agent used in a wide variety of solid tumours. Known side effects include a dose-limiting myelosuppressive toxicity, mild rash, and radiation-dependent dermatitis. Rarely, localized inflammation in the form of pseudocellulitis has also been observed. We present the case of a 77-year-old woman with a history of a Whipple procedure for pancreatic adenocarcinoma who presented to the emergency department after the start of gemcitabine therapy with increased erythema, swelling, and tenderness in her lower legs. Relevant past medical history included peripheral vascular disease, dyslipidemia, and hypertension. A diagnosis of gemcitabine-induced pseudocellulitis aggravated by venous stasis was confirmed after an extensive workup. This case report and the literature review describe this rare reaction, highlighting the need for increased recognition to avoid unnecessary therapeutic intervention.

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