Asian Journal of Case Reports in Medicine and Health
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Interstitial Nephritis as the Initial Presentation of Sjogren’s Syndrome: A Case Report with Review of Literature
No full textPrimary Sjögren’s syndrome is a rare autoimmune condition affecting the exocrine glands. However, extra-glandular manifestations are not uncommon and may present as the initial symptoms of this disorder. Such cases offer a great challenge to clinicians. Here we present a case of primary Sjögren’s syndrome, which presented with incidentally detected renal dysfunction which on investigation revealed distal renal tubular acidosis and tubulointerstitial nephritis. The patient responded to combined therapy of steroid and rituximab and is currently having a stable renal function
Antiepileptic Drug-Induced Skin Rash Revealing a Cross-Reactivity between Antiepileptic Drugs in a Patient with Anticonvulsant Polypharmacy
No full textAims: The cross-reactivity of antiepileptic drugs (AEDs) in the occurrence of drug eruption makes intrinsic accountability difficult. We are reporting on a case of drug eruption that occurred in a patient treated with four AEDs who had previously developed rashes with two other AEDs.
Presentation of Case: A 17-year-old epileptic patient with a history of rashes induced by phenobarbital and carbamazepine three years ago, and since ceased. Two months before admission, levetiracetam was added. Lamotrigine and clobazam were then added for generalized seizures. Two weeks later, a rash appeared on the neck, trunk and face with extension to limbs associated with pruritus and fever. On admission, the patient was febrile with tachycardia. Skin examination revealed a maculo-papular exanthema on the limbs, trunk and puffy face with negative Nikolski's sign. Biological assessment: leukopenia, thrombocytopenia and elevated CRP. The skin biopsy was in favor of toxiderma. The patient received paracetamol; imputability scores of the 4 antiepileptic drugs were calculated; and incriminated latromigine (C3S2B4) which was stopped with progressive increase of levetiracetam. The evolution was marked by a clinical and biological improvement.
Discussion: The incidence of AED-induced drug eruption ranged from 1.7 to 8.8%. The AEDs most at risk are aromatic AEDs. A high initial dose and rapid dose escalation are risk factors, especially for lamotrigine when metabolism is inhibited by valproic acid.
Conclusion: During anticonvulsant polypharmacy, caution should be taken when administering some AEDs to ensure that clinicians safely prescribe appropriate anti-epileptic medications considering the history of previous AED-related skin reactions
Starvation Induced Euglycaemic Diabetic Ketoacidosis in a Postoperative Diabetic Patient
No full textPeri-operative euglycaemic diabetic ketoacidosis is under-recognized and difficult to diagnose due to variable triggers and absence of hyperglycaemia. We report a case of a 58 years old type -2 diabetic female who developed refractory post-operative metabolic acidosis caused by starvation and euglycaemic diabetic ketoacidosis. Recent surgery, major illness, carbohydrate restriction, and a relative insulin deficiency were the contributing factors leading to it. This report highlights the importance of nutrition and appropriate insulin usage in sick peri-operative diabetic patients presenting with unexplained keto acidosis
Spontaneous Spinal Epidural Hematoma Presenting as Acute Paraplegia
No full textBackground: Spontaneous spinal epidural hematoma is a rare condition which can have disabling neurological complications. Prompt timely surgical management may promote recovery even in severe cases. Timely recognition and diagnosis is essential for proper treatment.
Objective: To describe a case of spontaneous spinal epidural hematoma with acute presentation which was treated surgically with good outcomes.
Presentation of Case: We report a 66-year-old man with a four hour history of sudden severe upper back pain, followed by complete weakness and numbness over the bilateral lower limbs. A spinal magnetic resonance imaging scan was performed and revealed a posterior epidural hematoma of the cervicothoracic spine. He underwent an emergency decompressive laminectomy of the spine and hematoma evacuation. Just after surgery, his lower extremity movements improved. After 4 weeks, significant improvement in weakness and ambulation with assistance was resumed. The diagnosis of spontaneous spinal epidural hematoma must be considered in patients presenting with acute onset of back pain along with symptoms of compression of the spinal cord. Early recognition of the problem, proper investigations and diagnosis and prompt surgical treatment may result in significant improvement even in severe cases
A Rare De Novo Reciprocal Translocation 46,XX,rec(7;13)(p22;q32) Karyotype
No full textCarriers of structural chromosomal rearrangements such as Robertsonian or reciprocal translocations have an increased risk of spontaneous abortion and producing offspring with genetic abnormalities. We report an women with uncommon unbalanced Reciprocal translocation carrier 46,XX,rec(7;13)(q22; q32) chromosomal constitution. While her husband and her father showed normal 46,XY karyotype, her son and her mother showed same abnormal kartotype. Peripheral blood were taken from proband and family members, then performed with lymphocyte culture and stained by binded using Giemsa-banding method. According to the cytogenetic study results of first degree relatives of our proband, reciprocal translocation was maternally inherited in our case. Uniparental dysomia (UPD) is an abnormal condition in which a homologous chromosome pair is both from one parent and not from the other parent. The maternal inheritance of translocated chromosomes is same time compatible with UPD
Age and Papillary Thyroid Cancer; A Perspective with Case Report
No full textBackground: Papillary Thyroid Cancer (PTC), is a common encountered head and neck cancers, making the majority of cases among thyroid malignancies. It is unique since thyroid cancers are the only cancer that include age to predict the prognosis. The usage of age however is debatable albeit being still widely used in various staging systems.
Case Presentation: We report a case of a young 41years gentleman with aggressive features of PTC, presented with worsening progressive breathlessness. Clinically diffuse palpable right anterior neck swelling was noted upon examination.
CT neck showed that the mass arising from right inferior lobe of thyroid gland with regional lymphadenopathy and retrosternal extension. Total thyroidectomy and neck dissections and tracheostomy was performed, complicated with intraoperative iatrogenic injury to the subclavian vessel due to the aggressiveness of the tumour, which was ultimately secured by the assist from vascular surgeon.
Conclusions: Adopting age as a sole factor is not sufficient for preliminary prognosis and outcome for the patients.
Objective: To share our experience in managing a case of an aggressive Papillary Thyroid Cancer in a young 42-year-old patient.
Article Design and Setting: Case Report & Tertiary General Medical Centre
Bilateral Sudden Sensorineural Hearing Loss Post-COVID-19 “A Case Report”
No full textBackground: Sudden sensorineural hearing loss (SSNHL) is an otolaryngological emergency that requires early diagnosis and management. In most cases, the cause is unknown; however, viral infection is the most likely causative factor. The early start of steroids is a cornerstone of treatment and good prognosis. Despite the extensive study about the presentations of COVID-19, there are few case reports about hearing loss after coronavirus infection.
Case Presentation: This case report presents the first case of SSNHL following COVID-19 in Saudi Arabia for which other causes of hearing loss were excluded by physical examination and imaging. Course of steroid given to the patient without improvement in the hearing.
Conclusions: It is important to pay more attention to hearing status following COVID-19. This will result in early diagnosis, management and improved prognosis
Telescopic Removal of a Subglottic Foreign Body in a Child: A Case Report
No full textThe foreign body ranges from metallic to non-metallic household materials of different shapes and sizes. Foreign body aspiration in the airway is not an uncommon problem and is one of the causes of morbidity and mortality affecting children which requires prompt diagnosis and management. A child presenting in severe respiratory distress with upper airway obstruction may require urgent relief of the upper airway obstruction. A 6 years old male child presented to the Children Emergency Ward (CHEW) on account of aspiration of trunking nail of one hour duration prior to presentation while playing with it in his mouth. There was associated noisy breathing, respiratory distress and cough. At presentation, he was restless and stridulous. The respiratory rate was 60 cycles per minute, Peripheral oxygen saturation (SPO2) was 85%, reduced air entry in both lung fields and no crepitation on chest examination. A diagnosis of foreign body (trunking nail) in the larynx was made. Patient was worked up for emergency tracheostomy. Intraoperative finding showed a metallic trunking nail, with plastic component. The foreign body was grasped with the attached forceps of the telescope with the tip facing upwards and carefully extracted without injury to the surrounding structures .No intraoperative complication was noted, patient was admitted into the ward, given medications and observed for a few days. He was later weaned off the tracheostomy tube and discharged home in a stable clinical condition
Sewing Needle in the Kidney after Being Ingested 13 Years Before
No full textForeign body ingestion occurs, especially in childhood. But we saw it among adults. most foreign bodies pass through the gastrointestinal tract, causing no damage. Migration of an ingested needle to the kidney is very rare. We report a case of a 30-year-old female who was admitted to the urology department for right lumbar pain which appeared three months later. The interrogation found a notion of accidental ingestion of a sewing needle 13 years ago. On physical examination, there was lumbar pain caused by the shock. Radiography of the abdomen showed a needle in the right hypochondrium.
Computed tomography (CT) was performed. CT showed a linear density in the right kidney, lower pole. At follow-up, stabbing pain in the right upper abdominal quadrant was noted. Surgical exploration was planned; We then performed surgical removal; we easily removed the needle in this fashion. The postoperative period was uneventful, and the patient was discharged on the second day following the operation.
The presence of an ingested foreign body in the renal parenchyma remains exceptional. It follows negligence or inability to remove the foreign body immediately after its ingestion. The clinical symptomatology is not specific, it can range from abdominal pain to infection and up to renal failure. It is the conventional imagery or even the uro-tomo-densitometry which localizes the exact seat of the foreign body, its relationship with the urinary excretory tract, and the consequences of its presence. The extraction strategy depends on imaging or and endoscopic data, and the means and skill of the surgical teams. Minimally invasive surgery is desirable when it is workable; otherwise open surgery is still the order of the day. The importance of preventing this type of accident in children and adults is indisputable. In case of an occurrence, urgent medical care is necessary before reaching the stage of complications
A Case of Megaloblastic Anaemia Complicated with Extra-Pulmonary Tuberculosis
No full textMegaloblastic anaemia is known to cause elevated lactate dehydrogenase (LDH) levels due to increased cell turn over with ineffective erythropoiesis in the bone marrow, a laboratory parameter which can help in the diagnosis and monitoring the response to treatment with vitamin B12 and folate as well. Serum LDH level can get significantly elevated in many other non- neoplastic and neoplastic conditions as well, such as metastatic cancers, infections, haematological malignancies including lymphomas and conditions with haemolysis. Elevated LDH is considered as an independent predictor of mortality and a marker of major complications in hospitalized patients [1].
This case is about a young man, a vegan who presented with features of megaloblastic anaemia,generalized lymphadenopathy, constitutional symptoms and a very high LDH level mimicking a diagnostic possibility of a high grade lymphoma, ultimately confirmed to have megaloblastic anaemia and tuberculous lymphadenitis, the latter was an unexpected finding of the lymph node biopsy done to exclude a lymphoma.
His significantly high LDH level at diagnosis which declined dramatically in response to vitamin B12 replacement therapy, can be used as a supportive diagnostic tool and also to monitor the response to therapy in megaloblastic anaemia