Asian Journal of Case Reports in Medicine and Health
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Case Report: Recurrent Calf Muscle Myositis in Pediatric Patient
No full textFocal myositis is a rare entity characterized by acute onset and localized skeletal muscle inflammation. A four-year-old boy presented with recurrent muscle myositis. He had a high level of muscle enzymes. Discharge after receiving fluid and analgesia
Spontaneous Rupture of a Huge Subserous Uterine Fibroid Vessel with Massive Hemoperitoneum: A Rare Case of Fibroid
No full textBackground: Spontaneous rupture is a potentially life-threatening acute complication of uterine fibroid. It is a very rare clinical diagnosis and hardly presents with massive hemoperitoneum. This is a case of spontaneous rupture of uterine fibroid vessels with massive hemoperitoneum, necessitating prompt surgical intervention and massive transfusion.
Case Report: Mrs A. I was a 35year-old Para 1 who presented to the accident and emergency department of the Rivers State University Teaching Hospital (RSUTH) on the 14th October 2021 with a three-month history of amenorrhoea, and 10 hours history of severe lower abdominal pains associated with dizziness. She was in shock and also had abdominal distension and tenderness. Ultrasonography showed massive hemoperitoneum, uterine fibroids and a left adnexal mass. She had an emergency exploratory laparotomy and the findings were massive hemoperitoneum, a left ovarian cyst and a huge subserous uterine fibroid with an actively bleeding surface vessel. Myomectomy and left ovarian cystectomy were done. She received 5 units of blood perioperatively and had an uneventful post-operative recovery.
Conclusion: Spontaneous rupture of uterine fibroid is a very rare clinical condition. It can lead to significant morbidity and mortality if not recognised and managed promptly. Therefore a high index of suspicion is necessary for women with huge uterine fibroids and hemoperitoneum
Risk Factors and Diagnositic Challenges of Abdominal Tuberculosis: A Case Report
No full textThis is a case of a 30 year old female who presented with a 4 month history of progressive abdominal swelling and mild abdominal discomfort. She had a past history of poorly treated pulmonary tuberculosis however during current symptoms the usual screening tests for tuberculosis such as the gene-xpert test, chest radiograph and acid-alcohol fast bacilli smear and culture were negative creating a diagnostic challenge and considerations for alternative diagnosis to abdominal tuberculosis. Other supportive evidence and risk factors for abdominal tuberculosis were sought for. The treatment was initiated when other likely diagnoses were excluded. Patient made remarkable improvement after starting anti-Koch’s therapy
Hemangioma of Tongue with Abrupt Growth Onset: A Rare Case Report
No full textHemangiomas of the oral cavity are uncommon but have a predilection for the tongue. Although the majority of lingual hemangomas are superficial, certain lesions can affect the deep tongue or even the entire tongue. They're called hamartomas rather than genuine neoplasms. Author presents a case of haemangioma of the anterior 2/3rd of the tongue involving both ventral and dorsal aspects, and ascertaining the diagnostic evaluation and emphasizing the role of color doppler ultrasonography and contrast enhanced magnetic resonance imaging in unrevealing the diagnostic dilemma of the lesion, and further helping in deciding the level of the management. This Study presents a relatively rare and unusual case of haemangioma of tongue with abrupt onset of growth
Childhood Cervical TB Lymphadenitis with Draining Sinuses: A Report from High TB Burden Resource Limited Setting
No full textThough tuberculous lymphadenitis is the most common form of extra-pulmonary Tuberculosis (TB) in children, it is usually overlooked as the main focus is on adult ‘sputum positive TB’. This is especially relevant in tribal communitities mostly living in inaccessible remote areas having poor access to health care facilities.
We are presenting here a case of bilateral cervical lymphadenitis with multiple draining sinuses – a fourteen-year-old girl belonging to the high TB burden Saharia tribe in Madhya Pradesh. She was detected through active TB case finding under the ongoing Intensified TB control project in the area and was suceessfully treated as per National Tuberculosis Elimination Program (NTEP) guidelines. The delay in treatment seeking in the present case is a matter of concern.
The findings highlight the importance of focussing on childhood TB especially in high TB burden communities from resource limited settings
Alkaline Diuresis and Pre-emptive Hemodialysis as Treatment for 2, 4-Dicholorophenoxy Acid Herbicide Intoxication
No full textIntroduction: Chlorophenoxy herbicides poisoning is very rare. It is used widely to control broad-leaved weeds. 2, 4-D is a Chlorphenoxy herbicide which has no antidote. The mission of this case report is to emphasize the role of accurate diagnosis and management of 2, 4-D herbicide intoxication.
Case Report: 19 year old male was admitted 6h after the deliberate ingestion of the contents of a half bottle (300 ml) of weedkiller named Dallas contents of which were 59% w/w 2,4-D acid tech, 30% w/w Di-methylamine. Soon after ingestion the patient gave history of vomiting, after which patient became unconscious.
On examination, RR was 35/min with a saturation of 90% on room air requiring 5-6L/min of oxygen. The pupils were small, 1.5 mm in diameter, reactive. Arterial blood analysis showed mild Metabolic acidosis. Gastric aspiration and lavage were performed. Patient was unresponsive to deep painful stimulus. He was sweating profusely with a temperature of 39 degree Celsius. Patient was electively intubated for airway protection.
Patient was admitted in the ICU. The total leukocyte counts were 17000/cmm. Liver function and kidney function tests were within normal limits. CPK total was 3150. Over the next 7 hours, patient’s condition worsened and the blood pressure started dropping to 80/50 mmHg. Patient was started on vasopressor support. Alkaline diuresis was started by giving 1 meq/kg sodium bicarbonate in 0.9% normal saline, 100 ml iv within the next 30 minutes and then added with 75meq of sodium bicarbonate and 25 meq of potassium in 500 ml 5% dextrose within 8 hours. Inj Furosemide 20 mg was given every 12hours intravenously. On the second day, patient’s laboratory investigations showed a rising trend in TLC, creatinine rose to 2.4 mg/dl from 1.1mg/dl on the day of admission. Patient’s metabolic acidosis also worsened. Patient’s output dropped to 5-10 ml/hr. Patient was then taken on Haemodialysis. Patient’s urine output improved and GCS also improved. Three cycles of haemodialysis were done, the TLC showed a falling trend with normalising creatinine, metabolic acidosis also improved; pH normalised and patient was extubated on the fourth day. Patient was then shifted to ward and discharged subsequently on clinical improvement.
Conclusion: 2,4-Dimethylamine intoxication is uncommon, doesn’t have an antidote with very high morbidity and mortality. Alkaline diuresis as a life-saving treatment and must be supplemented by other therapies including decontamination of the gastrointestinal system, initial emergency resuscitation and supportive treatment with haemodialysis as and when required
Acute Myocardial Infarction Fallowing Blunt Chest Trauma-the Need for Third-Line Investigations in Medico-Legal Practice
No full textAcute myocardial infarction is relatively uncommon among the young adults. Blunt trauma to chest is one rare mechanism of acute myocardial infarction specially among young adults. A 35-year-old male had sustained among other injuries, a blunt impact on the left side of his front chest and abdomen when his motor bike collided with a van from behind. ECG on admission to the accident and emergency unit showed ST segment elevations from V2-V6 together with elevated CPK and periodic changes of Troponin T. He was managed as for acute myocardial infarction. Streptokinase was not given due to high risk of bleeding following trauma. He had an uneventful recovery. Myocardial infarction could be precipitated by damage to coronary arteries due to non-penetrating blunt impact on the chest, the possible mechanisms being coronary artery dissection, intimal tears, sub-intimal hemorrhages, intra-luminal thrombosis and spasm. CT/MRI guided coronary angiography is considered the best investigation to exactly identify the aetiology. Blunt impact may also cause myocardial contusions which can also lead to an outcome similar to a myocardial infarction. The objective of this case report is to highlight that trauma and infarction (specially in a person with pre-existing ischaemia) will pose a wide array of medico-legal issues some of which are difficult to be answered by the clinician or the pathologist with certainty
Hypernatraemic Dehydration Ensuing Death Following Ingestion of an Unknown Laxative used in Alternative Medicine: A Case Report
No full textThis is the first reported death from brain damage resulting from hypernatraemic dehydration caused by a laxative administered by a non-medical therapist to a patient. In this case study, the author describes the clinical features, post-mortem features of death due to hypernatraemic dehydration. The legal aspects pertaining to the case in the context of the mens rea and the actus reus and the manner of death are also discussed. The deceased experienced increased thirst, irritability, loss of consciousness, generalised seizures, and brain death before succumbing to death. The component of mens rea was impossible to determine in this case when attempting to establish criminal responsibility and culpable homicide. Instead, a negligent act was deemed plausible. In Sri Lanka, social and cultural beliefs about alternative medicinal practises exist, but there are no laws regulating the therapists' abilities or the substances they offer to patients. Additionally, such therapists lack the medical knowledge necessary to recognise patients' imminent dangers
Tuberculosis of the Oral Cavity Revealing Pulmonary Tuberculosis: About an Observation
No full textTuberculosis of the oral cavity is a rare entity, often secondary to pulmonary localization. This article reports a case of palatine tonsil tuberculosis, indicative of miliary pulmonary tuberculosis, in a 40-year-old patient who has as history of an actif smoking, alcoholism, without any notion of previous tuberculosis infection. The clinical manifestations of oral tuberculosis are not very specific. It most often results in a chronic oral ulceration that evokes many other etiologies among which a malignant tumor, a bacterial, viral or mycotic infection, a systemic disease, a foot-and-mouth ulcer or traumatic. Any chronic oral ulceration whose etiology does not appear obvious, one must think of tuberculosis of the oral cavity. To confirm this diagnosis, histopathological examination, direct bacteriological examination and culture from fresh tissue as well as search for pulmonary tuberculosis are necessary
COVID-19 Reinfection in a Nurse Working in Emergency Hospital in Duhok City, Kurdistan Region of Iraq
No full textNovel coronavirus disease (COVID-19) or SARS-CoV-2 infection was discovered in December 2019 in Wuhan City, China. The infection became a global pandemic over a period of few months. Post-infection immunity and susceptibility for reinfection is still under investigation. In this report, we present a case of a COVID-19 reinfection in patient who had recovered from an initial infection.
Case Report: 41-year-old male, nurse working in emergency hospital, presented in August 2020 with two days history of fever, sore throat, myalgia, lower back pain, shortness of breath. Then, his oxygen saturation dropped to 80%. COVID-19 infection was proved by a positive RT-PCR for SARS-CoV-2 and CT scan of the chest demonstrated bilateral ground glass opacities. After clinical improvement, the patient was discharged from hospital. On 26th of October, he developed fever, and fatiguability. RT-PCR for SARS-CoV-2 resulted as positive twice. The infection was mild and no specific treatment was administered to the patient during the second infection. On 6th of November, the patient was asymptomatic. On 7-8th of November, he consecutively tested negative for SARS-CoV-2 twice.
Conclusions: Mild SARS-CoV-2 reinfection may occur rarely due to repeated exposed to the virus in hospital setting. If the occurrence of reinfections is demonstrated to be true, it may change the strategy of infection prevention. Further studies are needed to confirm the possibility of COVID-19 reinfection