2023: Vol 10 No 8

2023: Vol 10 No 8
  • Xin Ya See, Omer Ahmed, Nikita Nand, Waleed Quwatli
    Views: 400 HTML: 79 PDF: 349

    Legionnaire's disease can cause rare and severe complications such as rhabdomyolysis and acute kidney injury. This case report details a 45-year-old male patient who presented with features of Legionnaire's disease. Laboratory results showed a significantly elevated serum creatinine kinase level and an increased creatinine level. Imaging showed right lower lobe consolidation, and a positive urine antigen test confirmed Legionnaire's disease. The patient was administered azithromycin and underwent fluid repletion to manage the rhabdomyolysis and acute kidney injury, resulting in improved creatinine kinase levels and kidney function. He was discharged and continued on azithromycin for 10 days. His outpatient follow-up showed that creatinine kinase levels had further decreased. This case report emphasises the importance of early recognition and management of Legionnaire's disease and its rare but severe complications.

  • Pierre Rossignon, Kenza El Alaoui, Alain Soupart
    Views: 283 PDF: 308 HTML: 83

    Spontaneous periodic hypothermia (SPH) is an exceptionally rare condition characterised by paroxysmal episodes of spontaneous hypothermia. While commonly associated with Shapiro syndrome, which includes SPH, hyperhidrosis and agenesis of the corpus callosum, there are also cases of SPH that do not exhibit these defining characteristics, known as ‘Shapiro syndrome variant'. These variants may present with diverse brain imaging findings but no agenesis of the corpus callosum, suggesting different potential aetiologies. Notably, the association of SPH with epilepsy has only been reported in a few cases, and confirming epileptic activity in the context of SPH remains a challenge.
    In line with this, our report presents two exceptional cases of SPH without significant brain malformation, where we successfully confirmed the presence of epilepsy. The confirmation of epilepsy in these cases is particularly noteworthy, as it adds to the limited documentation of SPH cases with confirmed epilepsy. These findings contribute valuable insights into the association between SPH and epilepsy, enhancing our understanding of this rare condition.
    Our report also addresses the broader clinical presentations and the physiopathological mechanisms of SPH. By providing comprehensive insights into these aspects, we aim to advance the existing literature and improve our understanding of SPH and its association with epilepsy.

  • Maysoun Kudsi , Tasneem Drie , Ghina Haidar, Safaa Al-Sayed, Enas Roumieh
    Views: 605 PDF: 325 HTML: 98

    Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease that affects many organs. In this report, we discuss the case of a patient with SLE who presented to an out-hospital clinic, complaining of fever and pain with genital ulcers. Negative evaluations for other causes of genital ulcers, indicated these ulcers as related to SLE. This case highlights the importance of including SLE ulcers in the differential diagnosis of genital ulcers.


  • Tiago Valente, Gisela Gonçalves, Valter Duarte, Gorete Jesus
    Views: 484 PDF: 380 HTML: 134

    Anti-N-methyl-D-aspartate receptor (Anti-NMDAR) encephalitis is a rare autoimmune disease, characterized by the presence of neuropsychiatric symptoms. It is sometimes mistaken for a psychiatric disorder and other times not considered in the differential diagnosis of an encephalitic process. Correct identification of this disease and prompt treatment are key for optimal recovery, which might take weeks to months. Many patients manifest severe symptoms, with depressed level of consciousness, breathing dysfunction and dysautonomia requiring admission to the Intensive Care Unit (ICU). We report the case a young male patient with anti-NMDA encephalitis who presented typical neuropsychiatric symptoms. Despite being diagnosed and treated in a timely manner, he did not respond well to first-line immunotherapy and was admitted to the ICU with neurological, respiratory, and cardiovascular dysfunction. This resulted in prolonged hospital admission and many infectious complications. Despite the severity of the disease, the patient managed to recover in the months following discharge from hospital.

  • Yasaman Navari, Amirbehzad Bagheri, Justine Chinnappan, Su Khine, Huda Marcus, Ghassan Bachuwa
    Views: 395 HTML: 97 PDF: 307

    Endoscopic retrograde cholangiopancreatography (ERCP) is a diagnostic and therapeutic tool for pancreaticobiliary diseases. Like every other procedure, ERCP can lead to complications that include pancreatitis, cholecystitis, perforation, and rarely, retroperitoneal hematoma. We present a case of post-ERCP acute hemorrhagic pancreatitis resulting in retroperitoneal hematoma and sequelae of unilateral hydronephrosis and ileus. The patient was treated supportively and had good clinical improvement with resolution of hydronephrosis, ileus and more importantly tolerating oral diet without further episodes of abdominal pain.

  • Michel Pescia, Marco Conti, Romina Contratto
    Views: 260 PDF: 328 HTML: 29

    Nerium oleander is a plant containing cardiac glycosides, and intoxication with its leaves is a medical emergency. We report the case of a 73-year-old man who took a decoction of oleander leaves for a reckless purpose. Upon arrival in the emergency room, he presented an altered state of consciousness, drooling and vomiting. He was bradycardic with intermittent third- degree atrioventricular block and typical downsloping ST-segment depression related to glycosides toxicity. Despite initial treatment with atropine, isoprenaline and repeated bolus of digoxin-specific antibody (Fab) fragments, symptoms were persistent 12 hours after admission. Suspecting that the patient not only drank the decoction but also ingested the leaves and had slow gastric emptying, we performed gastric lavage without benefit. We subsequently performed a gastroscopy that showed an oleander phytobezoar, and its removal permitted a rapid clinical improvement.

    Treatment with digoxin-specific antibodies for intoxication is well described and dosage should be adapted to the plasmatic level. Such an examination is useless in oleander intoxication because it does not represent the real quantity of toxin. The dosage of antibodies is empiric and should be guided by the clinical severity.
    In such intoxication, the presence of a phytobezoar from oleander leaves cannot be excluded so we believe that a gastroscopy for its mechanical removal should always be considered to avoid persistent release of toxin.

  • Rebecca Zurbuchen, Mirjam de Roche, Aikaterini Galimanis, Kerstin Narr, Olivier Dubuis, Christiane Resch, Mairi Ziaka
    Views: 529 HTML: 115 PDF: 383

    Purpose: Flavobacterium lindanitolerans is an environmental Gram-negative, non-spore-forming rod which is usually not considered to be a human pathogen. Isolation from human clinical samples has been described only once. We report the first case of meningoencephalitis and bacteraemia with Flavobacterium lindanitolerans.
    Case description: A 76-year-old female presented with fever, headache, alteration of mental status, marked meningism and dysarthria. A lumbar puncture demonstrated cerebrospinal fluid findings consistent with bacterial meningitis, and a broad-spectrum antibiotic therapy was initiated. Blood and cerebrospinal fluid cultures revealed a growth of Flavobacterium lindanitolerans. Based on antimicrobial susceptibilities testing, antibiotic treatment was changed to levofloxacin, resulting in a remission of the clinical symptoms after 21 days of treatment.
    Conclusion: Flavobacterium species are extremely rare human pathogens. However, some of them have been reported to cause opportunistic infections. We describe the first case of meningoencephalitis and bacteraemia caused by Flavobacterium lindanitolerans which was effectively treated with levofloxacin for 21 days.

  • Rami Al-Handola, Justine Chinnappan, Mohammad Bakeer, Danielle Osterholzer
    Views: 439 HTML: 48 PDF: 405

    Long-acting (LA) cabotegravir/rilpivirine (CAB/RPV) is a complete regimen for the management of human immunodeficiency virus type 1 (HIV-1) infection to replace their oral antiretroviral therapy (ART) when they have been virologically suppressed. We present a case of successful achievement of undetectable HIV RNA viral load levels in an acquired immunodeficiency syndrome (AIDS) patient with long-standing virologic failure within two months of CAB/RPV LA initiation. This was later complicated by immune reconstitution inflammatory syndrome (IRIS) due to Mycobacterium avium-intracellulare (MAI) infection and hepatitis B virus (HBV) reactivation.

  • Sierra Sullivan, Blayne Fenner, Hannah McCool, Jesus Davalos, Neha Mittal
    Views: 320 PDF: 318 HTML: 48

    Glucocorticoid intramuscular injections are a quick, routine procedure done in an outpatient setting to relieve musculoskeletal pain quickly. However, despite being a low-risk procedure it can lead to local infections, including abscess and skin necrosis, and even more rarely, bacteraemia and multi-organ failure. In this case, we present a healthy, immunocompetent woman in her 40s diagnosed with a retroperitoneal abscess due to methicillin-resistant Staphylococcus aureus after an intramuscular injection of triamcinolone.

  • Floyd A. Pirtle, Dylan Maldonado , Pitchaporn Yingchoncharoen, Jerapas Thongpiya, Natnicha Leelaviwat, Annia Cavazos, Cloyce L. Stetson
    Views: 580 HTML: 248 PDF: 311

    Rumpel-Leede phenomenon is a rarely diagnosed entity that can be seen in patients following the application of tourniquet-like forces to the extremities. This phenomenon describes petechiae and purpura secondary to venous compression and congestion, with its underlying aetiology involving the fragility of capillary vessels within the dermis. This condition is associated with chronic medical conditions such as diabetes mellitus, hypertension, dyslipidemia, peripheral vascular disease and systemic inflammatory diseases, including infections. In addition, patients with coagulopathy including thrombocytopenia or platelet dysfunction from antiplatelet use, or those with thrombotic thrombocytopenic purpura and idiopathic thrombocytopenic purpura, are predisposed to capillary haemorrhage and petechiae formation. In this report, we present a case of a patient who developed Rumpel-Leede phenomenon following catheterisation of the right radial artery with spontaneous resolution – where only five cases have been reported to date – with the aim to make clinicians aware of this condition and to avoid unnecessary interventions.

  • Teresa Medeiros, Sofia Sequeira, Manuela Mendes, Fátima Hierro, Sara Duarte
    Views: 347 HTML: 47 PDF: 327

    Central nervous system (CNS) lymphoma is a rare and aggressive primary neoplasm that comprises a small proportion of brain tumours and non-Hodgkin lymphomas. We present a case report of a 64-year-old woman with CNS lymphoma, who exhibited cognitive changes, weight loss and neurological symptoms. Imaging scans revealed multiple lesions in the brain and thrombosis in the venous sinuses. A diagnosis of diffuse large B-cell lymphoma of the CNS was confirmed through histological examination. The patient underwent treatment with corticosteroids and chemotherapy, but experienced clinical deterioration with thrombocytopenia and disease progression. Despite efforts to manage complications and provide targeted therapy, the patient passed away. Primary CNS lymphoma typically responds well to chemotherapy, and prognostic factors such as age and functional status play a significant role in patient outcomes. However, complications such as thromboembolism pose challenges during treatment due to the hypercoagulable state induced by chemotherapy agents. The pathophysiology of thromboembolic events in the context of malignancy remains uncertain but may involve direct tumour compression, vascular invasion and alterations in coagulation factors. The diagnostic process for CNS lymphoma can be complex, and the information obtained from cerebrospinal fluid analysis, including flow cytometry, may be limited in cases with low cell counts. Ongoing research exploring genetic tests and biomarkers shows promise for improving diagnostic accuracy in such cases. This case underscores the need for comprehensive management strategies that address both the neoplasm and its associated complications, to optimise patient outcomes.

  • Aastha Bharwad, Chelsea Wuthnow, Mahmoud Mahdi, Kyle Rowe
    Views: 283 PDF: 272 HTML: 38

    Angiotensin-converting enzyme inhibitors (ACEI) are frequently prescribed for cardiovascular and renal diseases. However, ACEI-induced visceral angioedema is a rare occurrence that often goes unnoticed and poses a diagnostic challenge due to its non-specific and diverse symptoms. Key diagnostic indicators on a CT scan include the ‘target’ sign, elongation of bowel loops, enlarged mesenteric vessels, mesenteric edema with or without ascites, thickened omentum, and the absence of vascular compromise or adenopathy. Discontinuation of ACEI usually results in symptom resolution within 48 hours. While this phenomenon is more commonly observed in females and African Americans, we present a case of a Caucasian male who underwent an extensive diagnostic evaluation, including exploratory surgery, before ACEI-induced angioedema was considered.