Asian Journal of Case Reports in Medicine and Health
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Ataxia and Seizure as a Manifestation in a Pediatric Case of SARS-CoV-2
No full textBackground: SARS-CoV-2 infection is an ongoing pandemic with more than seven million cases worldwide and a wide range of presenting symptoms in various ages. Neurological symptoms as mildly as a light headache and as severe as an acute encephalitis are reported.
Objective: We aim to report the clinical course of pediatric patient infected with SARS-CoV-2 whom also presented ataxia and seizures as her neurological manifestation.
Case: Patient was a 16 month old baby girl with clinical presentations of ataxia, focal myoclonic seizures, fever and diarrhea and no significant medical history. Her seizures were controlled with sodium valproate along with carnitine. She developed respiratory symptoms after her RT-PCR test from her nasopharyngeal sample swap returned with positive results. We ruled out a wide range of disease such as paraneoplastic and metabolic disorders. Patient was discharged with full recovery after receiving IVIG.
Discussion: We believe there is a post infectious mechanism involved that has lead the patient to have such neurological manifestations because of a significant response to IVIG while she also presented typical finds in children infected with SARS-CoV-2. Patients with SARS-CoV-2 infection can have neurological manifestations despite their negative RT-PCR test for SARS-CoV-2 in their cerebrospinal fluid.
Conclusion: During the pandemic, every practitioner should have SARS-CoV-2 infection in mind when it comes to neurological manifestations without a strongly-associated explanation
Atypical Presentation of Novel COVID 19 Disease: A Case Report and our Experience
No full textIntroduction: COVID 19 virus infection commonly presents with respiratory symptoms which has posed a serious public health concern due to its mode of transmission from direct contact. A different mode of presentation was noticed in our establishment which appeared atypical.
The Aim: The aim of this report is to show this atypical presentation of the novel corona virus disease, its impact in our environment and possible solution.
Presentation of Case: This is a male 60 year old, who presented with anterior neck wound and unconsciousness of 2 weeks duration associated with fever, which was unremitting despite high dose antibiotics. He tested positive to COVID 19 virus disease, exposing all the managing team to risk of the infection.
Discussion: All the exposed health workers tested negative, but the spouse of the patient was COVID 19 positive, this shows the importance of use of protective gadgets against COVID 19 virus infection.
Conclusion: COVID 19 infection presentation can be atypical. All patients should be regarded as carriers until proven otherwise.
The solution to reduce exposure of many staff to this disease is screening of every patient at presentation
A Case of Protracted Alcohol Withdrawal Syndrome: Resistant Lilliputian Hallucinations with Tremor
No full textIn Sri Lanka WHO estimates 3.1% of the population to have alcohol used disorder and predicts that nearly 50% of them can present with alcohol withdrawal syndrome.
We describe a 51 year old male with the back ground history of alcohol abuse for 20 years duration and series of adverse life events facilitating him to develop severe alcohol used disorder and depression. When he presented to us, he exhibited features of major depression with suicidal thoughts and evidence of alcohol withdrawal syndrome according to DSM V criteria. He also had minor cognitive impairment according to MMSE.
After two months of inward treatments, he continued to have disturbing Lilliputian hallucinations, tremors and sleep disturbances which made us to diagnose him having protracted alcohol withdrawal syndrome after considering the other possibilities like major depression with psychotic symptoms, lewy body dementia and psychotic disorder with mood symptoms. His cognitive impairment can be explained by reduced attention and concentration together with low literacy, therefore the diagnosis of pseudo dementia secondary to depression was made.
This case illustrated us the multi-faceted presentations of alcohol used disorder which ultimately posing significant burden to the patient, family, society and also to the free health care system in the country
A Genetically Transmitted, Benign Habit: A Case Report and Review
No full textHabits are defined as acquired, repetitive, involuntary and body focused, stereotyped motor acts. Tics have the same attributes, but are characterised by muscle spasm additionally. So far, the emphasis in the literature is that the habits are acquired. There is no reference in the literature as to the habits being transmitted genetically. Whereas in the case of tics, some like, Tourette Syndrome (TS), are accepted to have genetic basis Habits are harmless. But some are self - destructive Out of the group of the four destructive habits, like trichotillomania (TTM), bruxism, scabiomania or skin pulling (SP) and onychophagia, TTM, along with chronic persistent motor tics, persistent vocal tics and combined motor and vocal tics like TS, are grouped together, as habit disorders by the American Psychiatry Association (APA) Statistical Manual of Mental Disorders classification, 4th edition (DMS 4). Virginia Commission recommends inclusion of SP also under habit disorders. Other authors include all the four destructive habits under the habit disorders. It is also accepted that habits are related to behavioural patterns and that the behavioural patterns are genetically determined. Thus an indirect link is established between the habits and heredity, through behaviours. The author presents in this article, a benign, ‘nose rubbing habit’ being transmitted through 6 generations in a family tree. Unique to the pattern of inheritance, 100 % desendents in some generations (generations 1,2 and 3) with involvement of both males and females, without any skip generations, is seen .Very early onset is recorded at the age as low as 2 years and as high as 6 years belonging to the in the 6th generation. This is the first of it’s kind reported in literature that a benign habit is shown to run in a family, across 6 generations. This is contrary to the popular belief, that habits are always acquired. If it is so, what is it that irrefutably transmitted through 6 generations in this case? Mitochondrial gene (mtDNA) transmission, involving recombinant maternal and paternal mtDNA, is suggested, by inference and after eliminating the other Mendalean and non Mendalean types of inheritance. Of course, the main intended focus of the article is to highlight the transmission of a habit- trait (?) genetically. As a possible explanation of this observed phenomena only, the tentative inheritance pattern is suggested. The matter is open for discussion by the concerned fraternity
The Aicardi Syndrome: Case Report about a 3-month-old Infant
No full textAicardi syndrome, exclusively occurring female patient, was originally characterized by triad: agenesis of the corpus callosum, distinctive chorioretinal lacunae, and infantile spasms. Besides the triad, several other findings are present in patients with this condition. We here shortly report the case of a 3-month-old female infant with Aicardi syndrome, who had non-consanguineous parents. Triad was seen: infantile spasm with abnormal EEG, agenesis of corpus callosum revealed by MRI, and chorioretinal lacunae of the posterior pole. We diagnosed this condition as Aicardi syndrome. After treatment with vigabatrin and psychomotor sessions at the age of 3 months, it is noted that the attacks were reduced and psychomotor development was normal at the age of 5 months. We summarized the clinical characteristics of this syndrome based on the literature survey
Hemorrhagic Posterior Reversible Encephalopathy – A Case Report and Literature Review
No full textWe aim to review the etiological investigation and differential diagnosis of PRES, including viral infectious diseases, considering the current Coronavirus disease 2019 (COVID-19) pandemic. Our case report showed a critical patient with hemorrhagic PRES associated with nephropathy. Posterior reversible encephalopathy syndrome (PRES) is an acute neurological syndrome that can be presented as a variety of symptoms and it is usually associated with hypertension status, sepsis, eclampsia, autoimmune diseases, immunosuppressive therapy, or infectious diseases. Recently, an association between that hemorrhagic PRES and COVID-19 was reported. The mechanism of posterior reversible encephalopathy syndrome (PRES) is unknown, but there are two main theories to explain the vasogenic brain edema. The typical imaging pattern includes brain vasogenic edema located in the subcortical white matter and the cerebral cortex of the parieto-occipital lobes. There is no specific treatment for PRES and it can be reversible if the predisposing cause is identified and controlled
Pressure Ulcer on Wrist Post Synthetic Fracture Cast: A Case Report
No full textWith evolution of technology and materials, new synthetic substances like fiberglass are now available and used for the casting of fractures. Though these offer advantages for both patient and physician, the possibility of developing a pressure ulcer needs to be kept in mind, which should be treated timely and effectively. The family physician can play an important role in imparting such awareness, as well as in treating, and regularly monitoring such cases, with the support of telephonic and video digital health platforms
A Lipomatous Axillary Mass Revealing an Eosinophilic Granulomatosis with Polyangiitis
No full textEosinophilic granulomatosis with polyangiitis (EGPA), formerly called Churg-Strauss syndrome, is a condition characterized by asthma, high levels of eosinophils and vasculitis. It is characterized during its prodromal phase by an asthma of increasing severity. Vasculitis affects the lungs, the heart, the skin and the peripheral nerves. Skin involvement is common but may not be very suggestive.
The authors report the case of a 39-year-old man, with a medical history of asthma and sinusitis, who consulted in the ER for abdominal pain and partial occlusion syndrome. Diagnostic laparoscopy showed images of digestive vasculitis. Skin biopsy of an axillary subcutaneous mass which had lipomatous aspect was compatible with vasculitis associated with a perivascular infiltrate rich in eosinophils. Biology showed a persistent hyper eosinophilia in the blood. Antineutrophil cytoplasmic antibodies were negative. There was no evidence of pulmonary infiltrate or sinus opacity. The other cardiac, neurological and renal explorations were normal. The diagnosis of EGPA was suspected based on clinical and biological arguments. It was confirmed by skin biopsy of an atypical axillary mass. Treatment with corticosteroid therapy and immunosuppressants resulted in spectacular clinical improvement with a 3-year follow-up.
The cutaneous manifestations can have an essential contribution for the diagnosis of vasculitis. Early recognition of these lesions is essential for proper treatment and prevention of serious visceral complications.
Our observation is unique due to the atypical cutaneous manifestation which contributed to the early positive diagnosis of EGPA
Plasmablastic Lymphoma: A Challenging Diagnosis
No full textIntroduction: Plasmablastic lymphoma (PBL) is an aggressive lymphoma characterized by early relapses and subsequent chemotherapy resistance representing therefore diagnostic and therapeutic challenge with a very poor outcome.
Case Presentation: A 53-year-old- female patient presented with dyspnea and general status alteration due to anemia; diagnosed as hemolytic anemia and treated by corticotherapy without amelioration. The most recent hospitalization revealed worsening of her symptoms with weight loss of 5 kilos in one week, anorexia and lumbar pain. Physical examination showed isolated splenomegaly with no signs of bleeding, adenopathy nor a palpable breast mass. Extended laboratory tests were normal, except normocytic anemia with hemoglobin =8.76 g/dl; hct=26.6%; MCV=89.2 fl and a low haptoglobin concentration level <0.04 g/l with a high value of LDH 1165 UI/litre. Hypercalcemia of 12 mg/dl was also noted with low PTH. To complete the workup: imaging showed a total body CT scanner with absence of adenopathy, a magnetic resonance imaging (MRI) with no metastatic bone lesions confirming the diagnosis and a full body PET CT scanner revealing diffuse hyperactivity of the bone marrow with hypermetabolic splenomegaly, hepatomegaly and bone lytic lesion of some cervical vertebras. Bone marrow aspirate, biopsy and flow cytometry were done and in favor of lymphoma. An immunohistochemical profile shows positivity and correlates with morphology. It was compatible with Plasmablastic lymphoma (PBL). Patient received three cycles of chemotherapy (lenalidomide and CHOP) and immunomodulatory agents. But she passed away three months later.
Conclusion: Despite the recent advances in therapy of aggressive lymphomas, patients with PBL have the poorest outcome. Moreover, due to its challenging diagnosis and related complications, management of PBL remains to discuss on a case by case basis
Isolated Leg Monoparesis in a Patient with Atrial Fibrillation and Acute Ischemic Small Vessel Disease
No full textMonoparesis is most commonly caused by dysfunction of the lower motor neurons (LMNs) which innervates the affected limb. This includes lesion affecting the anterior nuclei, ventral nerve roots, lumbosacral plexus, or peripheral nerve. Nevertheless, it can also be due to upper motor neuron lesion, typically seen in lesions of the spinal cord. In general, many conditions that cause hemiplegia, paraplegia or quadriplegia may begin as monoplegia. We illustrate an elderly patient with hypertension, diabetes mellitus, dyslipidemia and atrial fibrillation, who presented with acute monoparesis and radiological evidence suggestive of recent infarct and small vessel disease