scholarly journals An Interesting Case of Rhino-Orbito-Cerebral Mucormycosis: A Case Report

2020 ◽  
Author(s):  
R Minnu Lekshmi ◽  
Stephen Sudhakar ◽  
S Rajasekharan
Keyword(s):  
Fungal Infections ◽  
Neurological Complications ◽  
Acute Onset ◽  
Interesting Case ◽  
Rapid Progression ◽  
Uncontrolled Diabetes ◽  
Immunocompromised Individual ◽  
Life Threatening ◽  
History Of ◽  
The Right

Fungal infections are the most challenging problems in an immunocompromised individual. Mucormycosis is a life-threatening fungal infection with rapid progression and high mortality in immunocompromised individuals. A case of 58-year-old female, with uncontrolled diabetes is with five days history of headache, fever, and acute onset drooping of the eyelid. The initial vision was normal which dropped to PL in the following days, with ophthalmoplegia and dilated nonreactive pupil in the right eye. Fundus and IOP were normal on presentation. MRI and MRV brain showed subtle ethmoidal cysts. CT-PNS showed mild ethmoidal thickening and cyst. Diagnostic nasal endoscopy showed unhealthy mucosa with no lesion suggesting eschar. A provisional diagnosis of orbital mucormycosis was made. The patient was started on antibiotics and IV Amphotericin B but she went on to further neurological complications. Despite treatment, she developed necrotising eschars in eyelid for which debridement was done. Further, exenteration was advised and patient developed septicaemia, however he died. The culture from debrided tissue showed growth of mucor. The objective of presenting this particular case is to emphasise the importance of considering mucormycosis as diagnosis despite subtle radiological and endoscopic findings in symptomatic immunocompromised patients. Early diagnosis and aggressive management improve better chances for survival.

scholarly journals Unilateral asterixis, thalamic astasia and vertical one and half syndrome in a unilateral posterior thalamo‑subthalamic paramedian infarct: An interesting case report

2013 ◽  
Vol 04 (02) ◽  
pp. 220-223 ◽  
Author(s):  
Subasree Ramakrishnan ◽  
Veera Rajkumar Narayanaswamy
Keyword(s):  
Past History ◽  
Clinical Findings ◽  
Acute Onset ◽  
Interesting Case ◽  
Third Nerve Palsy ◽  
Uncontrolled Diabetes ◽  
History Of ◽  
Left Thalamus ◽  
Intense Signal ◽  
Skew Deviation

ABSTRACTA 42-year-old young lady presented with acute onset of dizziness, drooping of left eye with binocular diplopia and inability to walk unassisted. She had past history of uncontrolled diabetes mellitus and hypertension. On examination, she had left fascicular type of third nerve palsy, vertical one and half syndrome (VOHS), left internuclear ophthalmoplegia and skew deviation with ipsilesional hypertropia. She also had thalamic astasia and right unilateral asterixis. Her MRI revealed T2 and Flair hyper intense signal changes with restricted diffusion in the left thalamus, subthalamus and left midbrain. MR Angiography was normal. Thalamic‑subthalamic paramedian territory infarct is relatively uncommon. It can present with oculomotor abnormalities including vertical one and half syndrome, skew deviation, thalamic astasia and asterixis. This case is reported for the rarity of the presenting clinical findings in unilateral thalamo‑mesencephalic infarcts.

Omental Infarction: A Case Treated with Laparoscopic Surgery

2019 ◽  
pp. 1-3
Author(s):  
Bertrand Ng ◽  
Arafat Yasser
Keyword(s):  
Diabetes Mellitus ◽  
Laparoscopic Surgery ◽  
Hospital Stay ◽  
Acute Cholecystitis ◽  
Inflammatory Markers ◽  
Acute Onset ◽  
Laparoscopy Surgery ◽  
History Of ◽  
Background History ◽  
The Right

Omental infarct is a rare cause of an acute abdomen that arises from an interruption of blood supply to the omentum. Here, we present a case of omental infarct in a 67-year-old gentleman with background history of diabetes mellitus who present unusually with a severe acute onset right hypochondrium pain. Examination revealed that he was tender to touch at the right and was having localized guarding. His inflammatory markers were normal. He was successfully treated with laparoscopy surgery and he was subsequently discharged the following day. Omental infarct cases with right hypochondrium pain can sometimes mimicked acute cholecystitis and management includes laparoscopic surgery which can hasten symptoms resolution and reduces hospital stay, however recommendation for surgery has to be balanced with anesthetics risk and complication of the surgery itself.

scholarly journals Exclusive Phlebosclerosis of Submucosal Veins Leading to Ischemic Necrosis and Perforation of the Large Bowel: First European Case

2018 ◽  
Vol 12 (1) ◽  
pp. 137-142 ◽  
Author(s):  
Sebastian Klein ◽  
Denise Buchner ◽  
De-hua Chang ◽  
Reinhard Büttner ◽  
Uta Drebber ◽  
...  
Keyword(s):  
Wall Thickening ◽  
Caucasian Woman ◽  
Ischemic Necrosis ◽  
Colonic Wall ◽  
Asian Patients ◽  
Life Threatening ◽  
History Of ◽  
Mesenteric Vessels ◽  
The Right ◽  
European Woman

Phlebosclerotic colitis (PC) is a rare, potentially life-threatening disease of unclear pathogenesis almost exclusively reported in Asian patients of both genders. A fibrous degeneration of venous walls leads to threadlike calcifications along mesenteric vessels and colonic wall thickening, detectable by CT. This causes disturbed blood drainage and hemorrhagic infarction of the right-sided colonic wall. This is a report of PC in a Caucasian woman in Europe without Asian background and no history of herbal medications, a suspected cause in Asian patients. CT revealed no calcification of the mesenteric vein or its tributaries. Instead, submucosal veins of the left-sided colonic wall were calcified, leading to subsequent transmural necrosis. Clinically, the patient developed a paralytic ileus and sigmoidal perforation during a 2-week hospitalization due to a bleeding cerebral vascular aneurysm. This case of a European woman with PC is unique in its course as well as its radiologic, clinical, and pathologic presentation.

scholarly journals Otitis with Aspergillus niger in a patient with SARS-CoV-2 and multiple comorbidities

2021 ◽  
Vol 24 (3) ◽  
pp. 137-140
Author(s):  
Andreea Florentina Stoenescu ◽  
◽  
Geta Vancea ◽  
Dana Ispas ◽  
Nicoleta Voicu-Pârvu ◽  
...  
Keyword(s):  
Aspergillus Niger ◽  
Antiviral Treatment ◽  
Clinical Signs ◽  
Acute Onset ◽  
Suppurative Otitis Media ◽  
Vein Thrombosis ◽  
Significant Incidence ◽  
Lower Lung ◽  
History Of ◽  
The Right

Introduction. COVID-19 is associated with a significant incidence of bacterial and fungal superinfections and with the exacerbation of pre-existing infections, representing a diagnostic and therapeutic challenge. Case presentation. A 64-year-old woman, confirmed with COVID-19 by the SARS-CoV-2 antigen test, is hospitalized accusing fatigue, nausea, watery stools, cough and vertigo started 10 days ago, aggravated 4 days before the presentation. It also reports recurrent episodes of otalgia and otorrheic pluriantibiotic treatment in the last 2 months. From the personal pathological antecedents we remember: hypothyroidism, dyslipidemia, hypertension, ischemic heart disease, history of deep vein thrombosis (DVT) and secondary pulmonary thromboembolism, in chronic anticoagulant treatment. Pathological clinical signs at admission: bilateral basal crackling rales. Biologically, inflammatory syndrome is detected, and radiologically, interstitial-alveolar infiltrates in the lower lung fields. On day 3 of hospitalization, the patient shows purulent secretion in the right external auditory canal and the ENT consultation confirms chronic suppurative otitis media in acute onset. Bacteriological examination of otic secretion reveals Aspergillus niger. Antiviral treatment with Remdesivir is initiated, antibiotic therapy initiated at home with Azithromycin is continued for one day, then escalated to Ceftriaxone i.v. (in the context of clinical-paraclinical aggravation), systemic corticotherapy, anticoagulation with Dalteparin in the prophylactic regime of DVT, systemic treatment with Voriconazole p.o. (according to the antifungal program) and topical (local) with a slow favorable evolution. Conclusions. The association of COVID-19 with otitis with Aspergillus is a rare and particular clinical picture.

scholarly journals Broken metallic tracheostomy tube migrating into the tracheobronchial tree

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Nilam U. Sathe ◽  
Ratna Priya ◽  
Sheetal Shelke ◽  
Kartik Krishnan
Keyword(s):  
Foreign Body ◽  
Tracheostomy Tube ◽  
Main Bronchus ◽  
Tracheobronchial Tree ◽  
Life Saving ◽  
Wear And Tear ◽  
Life Threatening ◽  
History Of ◽  
The Right ◽  
Periodic Replacement

Foreign body aspiration can be a life-threatening emergency. Broken tracheostomy tube in tracheobronchial tree is one of the rarest types of foreign body reported. Here we report two cases of fracture of metallic tracheostomy tube, leading to foreign body in tracheobronchial tree. A 14-year-old girl presented to our Emergency Department with history of respiratory distress and violent bouts of cough since 2 days. Chest X-ray showed that the broken part of the tube was lodged in the right main bronchus. The presence of Parkinson’s disease in the patient and restricted neck flexion offered a challenge both for the anaesthetist and the surgeon. We were successful in removing the broken tube in 13 small pieces. Check bronchoscopy was clear and the procedure went uneventful. We would like to conclude that broken tracheostomy tube presenting as foreign body bronchus is infrequent but it is a preventable complication of tarcheostomy. The patient must be kept on regular follow up to check for signs of wear and tear. Timely and periodic replacement of tracehostomy tube should also be done, otherwise such life-saving surgery can become lifethreatening.

Remitting seronegative symmetric synovitis with pitting edema (RS3PE) with painful erythematous nodules

2020 ◽  
Vol 13 (4) ◽  
pp. e234197
Author(s):  
Nicholas Kevin Laidler ◽  
Thomas Delaney
Keyword(s):  
Tertiary Hospital ◽  
Acute Onset ◽  
General Malaise ◽  
Metastatic Adenocarcinoma ◽  
Cutaneous Manifestations ◽  
Hands On ◽  
History Of ◽  
Recent Diagnosis ◽  
The Right ◽  
Pitting Edema

Remitting seronegative symmetric synovitis with pitting edema (RS3PE) is an uncommon syndrome characterised by acute onset severe synovitis of the radiocarpal and small joints of the hands, with associated pitting edema. Discussed here is the case of a 69-year-old man who presented to the emergency department of a tertiary hospital with acute bilateral hand swelling. This was on a background of a recent diagnosis of metastatic adenocarcinoma of the caecum and subsequent hemicolectomy. There was a history of general malaise, fever and lethargy for 5 days prior to the swelling of the hands. On examination, the upper limbs were swollen to the elbow bilaterally. Painful erythematous nodules were noted on the dorsal and palmar aspects of the hands and violaceous periungual discolouration was observed on the right fourth and fifth fingers. Prednisolone was commenced resulting in a dramatic resolution of the articular and cutaneous manifestations within 3 weeks.

The Sweating Anomaly in Cluster Headache: Further Observations on the Underlying Mechanism

Cephalalgia ◽  
1987 ◽  
Vol 7 (1) ◽  
pp. 77-81 ◽  
Author(s):  
Ottar Sjaastad ◽  
Rolf Salvesen ◽  
F Antonaci
Keyword(s):  
Cluster Headache ◽  
Underlying Mechanism ◽  
Interesting Case ◽  
Test Results ◽  
Sympathetic Dysfunction ◽  
Typical History ◽  
History Of ◽  
Heating Test ◽  
The Right ◽  
Autonomic Test

We describe a patient with a typical history of cluster headache for more than 18 years. During the first approximately 10 years of his disease, the pain was right-sided, and pupillometric and evaporimetric measurements indicated a sympathetic deficiency on this same side. However, for the next >6 years, his pain was consistently left-sided, although the signs of sympathetic dysfunction still were more marked on the right side. This was also true for the findings obtained during the interictal period and for the heating test performed within an attack. The implications of this interesting case are discussed. The view that two separate lines of symptom production lead to the pain and the autonomic phenomena seems to be supported by this case history. The cluster headache syndrome may also be a bilateral disorder, with only the weight of balance pointing one way or the other. Finally, the autonomic test results of this patient could reflect an autonomic “scar” in the previous headache side.

scholarly journals Localized Asymmetry in Human Dental Crown Form—an Interesting Case

2018 ◽  
Vol 17 (1) ◽  
pp. 18-23 ◽  
Author(s):  
John Wetherell ◽  
Tracey Winning ◽  
Grant Townsend
Keyword(s):  
Root Formation ◽  
Interesting Case ◽  
Normal Range ◽  
History Of ◽  
Tooth Germs ◽  
The Right ◽  
Range Of Variation ◽  
Lower Molar ◽  
Or History ◽  
Crown Form

A case of a 20-year-old female is described in which the premolars and molars on the right side of the arch display altered crown proportions and altered occlusal morphology. There is no evidence of an orofacial congenital disorder or history of trauma. It is argued that the asymmetrical expression of crown form does not fall within the normal range of variation but has resulted from a localized disruption in cellular function within the developing tooth germs, probably upsetting the folding of the internal enamel epithelia. This has produced crowns that have rounded cuspal outlines and reduced intercuspal distances. Superimposed space constraints in the mandible may have also led to compression of the lower molar crowns mesiodistally and affected their root formation.

scholarly journals Localized Aortic Dissection in a Patient with Polycystic Kidney Disease: A Case Report

2021 ◽  
Vol 6 (04) ◽  
pp. 285-287
Author(s):  
Sarah A. Alkuraydis ◽  
Abdulaziz S. Allihimy ◽  
Osama Smettei ◽  
Rami M Abazid
Keyword(s):  
Chest Pain ◽  
Aortic Dissection ◽  
Acute Chest Pain ◽  
Uncontrolled Hypertension ◽  
Polycystic Kidney ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
The Right ◽  
Multiple Cysts

Aortic dissection (AD) is the most frequent life-threatening aortic disorder. It is commonly associated with hypertension; however, aortic dissection occasionally represents a complication of more complex syndromes. In this article we aim to report. A 40-year-old male patient, with a known case of ADPKD and a strong family history of ADPKD. He presented to the emergency department with prolonged sharp retrosternal chest pain radiating to the back and uncontrolled hypertension. Computed tomography angiography showed a localized dissection flap at the aortic root and multiple cysts in the right kidney. AD is a life-threatening condition and should be suspected in patients presenting with acute chest pain with history of ADPKD.

scholarly journals COVID-19–Associated Acute Asymmetric Hemorrhagic Necrotizing Encephalopathy: A Case Report

2022 ◽  
pp. 194187442110553
Author(s):  
Najo Jomaa ◽  
Tarek El Halabi ◽  
Jawad Melhem ◽  
Georgette Dib ◽  
Youssef Ghosn ◽  
...  
Keyword(s):  
Neurological Complications ◽  
Parahippocampal Gyrus ◽  
Biological Drugs ◽  
Acute Necrotizing Encephalopathy ◽  
Immune Mediated ◽  
Acute Necrotizing ◽  
History Of ◽  
The Central Nervous System ◽  
Magnetic Resonance Imaging Mri ◽  
The Right

Background: Coronavirus disease 2019 (COVID-19) has been associated with many neurological complications affecting the central nervous system. Purpose: Our aim was to describe a case of COVID-19 associated with a probable variant of acute necrotizing encephalopathy (ANE). Results: A 60-year-old man who presented with a 3-day history of dyspnea, fever, and cough tested positive for severe acute respiratory syndrome–coronavirus 2 (SARS-CoV-2). Five days following his admission, the patient was intubated secondary to respiratory failure. Following his extubation 16 days later, he was found to have a left-sided weakness. Magnetic resonance imaging (MRI) of the brain showed hemorrhagic rim-enhancing lesions involving the right thalamus, left hippocampus, and left parahippocampal gyrus. These lesions showed decreased relative cerebral blood flow on MR perfusion and restricted on diffusion-weighted imaging. These neuroimaging findings were consistent with ANE. The left-sided weakness gradually improved over the subsequent weeks. Conclusions: We concluded that COVID-19 can be associated with ANE, a condition believed to be the result of an immune-mediated process with activation of the innate immune system. Future studies must address whether biological drugs targeting the pro-inflammatory cytokines could prevent the development of this condition.

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