Asian Journal of Case Reports in Medicine and Health
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Rare Case of Acute Myocarditis Complicating Macrophagic Activation Syndrome: A Complex Clinical Conundrum
No full textMacrophagic Activation Syndrome (MAS) and myocarditis individually pose significant challenges to healthcare providers due to their complex pathophysiology and diverse clinical presentations. However, when these two conditions intersect, the immune system's dysregulation amplifies the inflammatory response, posing unique diagnostic and therapeutic dilemmas. The clinical presentation is nonspecific, showing no pathognomonic signs, the patient may present chest pain, shortness of breath, fever and signs of systemic inflammation, which calls for heightened awareness and a comprehensive approach to make the diagnosis and for better management.
In the following paper, we report the case of a 23 years old man admitted to our hospital for dyspnea, and chest pain, associated to an altered general condition and fever, and in whom, a constellation of clinical features and laboratory findings, met the diagnostic criteria for MAS associated to a myocarditis. He was treated with high dose intravenous corticosteroid, and heart failure drugs, resulting in resolution of fever and dramatic clinical improvement
A Rare Case of Proliferative Glomerulonephritis with Monoclonal IgG Deposits in an Adolescent Female; Mimicking Immune Complex Glomerulonephritis
No full textProliferative glomerulonephritis with monoclonal IgG deposits (PGNMID) is a rare renal disease under the spectrum of monoclonal gammopathy of renal significance (MGRS). Majority of the cases have been diagnosed in adult population, especially after the age of 40 years. We report a rare case of PGNMID in a 16 years old female, presented with nephrotic syndrome and active urine sediment. She had normal serum creatinine, low C3 and negative infective and autoimmune markers. Renal biopsy revealed membranoproliferative glomerulonephritis (MPGN) with monoclonal IgG3 kappa deposits. Our adolescent patient was treated with standard antiproteinuric therapy and steroid. Though C3 became normal on follow up, but proteinuria was increased and rituximab was added. Our case emphasizes the awareness by nephrologist and renal pathologist about this rare disorder even in adolescent population for accurate diagnosis, prognostication and treatment
HIV Positive Client with Coronary Artery Disease and Tricuspid Valve Defect: A Case Report
No full textIn the modern world, coronary artery disease (CAD) is the leading cause of mortality, accounting for nearly 1 in 5 fatalities. The importance of this disease's morbidity, mortality, and socioeconomic impact makes quick accurate diagnosis and cost-effective care of CAD crucial. This in-depth analysis of the literature reveals crucial components in the diagnosis, risk assessment, and treatment plans for individuals with chronic CAD. Among cardiovascular illnesses, tricuspid valve disease (TVD) is typically little talked about while having a sizable morbidity and death rate. There aren't many research accessible in our nation that evaluate the many facets of TVD. Many of the clinical manifestations of the disease can be attributed to the severe immunological deficiency that occurs in HIV/AIDS patients. Opportunistic infections, autoimmune diseases, and cancer are more common because the virus damages the immune system. Additionally, clinical symptoms caused by the virus itself may show up. For instance, in at least 50% of patients, clinical symptoms appear during the primary illness, which begins a few weeks after the initial HIV encounter, often as a mononucleosis syndrome. HIV-related issues are rare in those who have kept their immunity. Here I present the scenario of 60 years old geriatric patient with complaint of having chest and epigastric pain, having positive complaints of Nausea and Constipation, while Auscultating the chest there was presence of murmur sound from the heart and there was also crackling sound from the lungs, there were abnormalities found in the ECG on that condition patient was diagnosed with the mentioned diseases. Supportive treatment was given for the management of mentioned case
Hemiagenesis of Right Hemithyroid with Left Lobe Multinodular Goitre
No full textAims: To present the case of a patient with an uncommon congenital abnormality and discuss it’s consequence and management.
Presentation of Case: We present the case of a 62 year old female patient with no thyroid function abnormalities and no previous neck surgery who was sent to our outpatient clinic for a left sided neck mass with associated discomfort. An ultrasound revealed a left sided multinodular goitre and the absence of the right lobe. A computed tomography scan confirmed these findings. A fine needle aspiration cytology excluded malignancy. A total thyroidectomy was performed and the patient prescribed levothyroxine. There were no intraoperative or postoperative adverse events and the patient remains asymptomatic four years later.
Discussion: Thyroid gland hemiagenesis is a rare congenital disorder consisting in the absence of a thyroid lobe. Left lobe agenesis is the most frequent and females are more commonly affected. Interestingly, thyroid-stimulating hormone and free T3 levels are higher in individuals with this condition and higher risk of thyroid disease has been suggested.
Conclusion: Thyroid gland hemiagenesis is rare. Patients are usually asymptomatic and the condition is found incidentally during screening tests or exams driven by other pathology. It’s existence should be recognized so that patients can be well studied and treated
A Beneficial Approach of Management for Delayed Diagnosis of Pemphigus Vulgaris: A Case Report
No full textThe most typical kind of pemphigus is pemphigus vulgaris, an uncommon chronic skin condition characterized by blisters. Desmosomes, which are skin-related elements that maintain some skin layers bonded to one another, are the target of this type II hypersensitivity reaction, in which antibodies are produced against them. In 2022, A 44-year-old female patient was admitted to the emergency department with complaints of skin lesions with burning sensation and irritation, fever and weakness of limbs. This case report highlights the treatment approach for pemphigus vulgaris during the worsened stage when immediate treatment is not initiated
An Anesthesiologist’s Perspective of Disseminated Cutaneous Rhinosporidiosis: ‘Block Resection’ of the Lesions!
No full textRhinosporidiosis is a chronic granulomatous disease caused by a fungus-like organism, Rhinosporidium seeberi, which is endemic in India and Sri Lanka. Polypoidal nasal mass is the most common clinical manifestation, with scattered case reports of lesions in the nasopharynx, eye (nasolacrimal duct) and lower aerodigestive tract. Isolated disseminated cutaneous lesions, though reported, are very rare.
Purpose: This case report aims to throw light on the path less travelled - management of such a rare and challenging patient through the eyes of an anesthesiologist.
Case: 36 year old ASA I male with disseminated cutaneous rhonosporidiosis for surgical excision of upper and lower limb lesions. Intravenous access was secured by central line. Anesthetic coverage for upper and lower limbs was provided with interscalene + supraclavicular block and subarachnoid block respectively.
Conclusion: Chronic recurrent disseminated cutaneous rhinosporidiosis poses novel challenges for the anaesthesiologist in the perioperative period, right from simple issues such as intravenous access to the more pressing concern of choosing an anaesthetic technique tailored to the wide variety of clinical presentations and hence planned surgical interventions
A Case Report on Amniotic Band Disease
No full textAmniotic band disease (ABD) is a complex and relatively rare set of birth defects. These malformations mainly concern the limbs, the craniofacial region and the thoracoabdominal axis. The severity of these malformations is highly variable, starting from isolated skin furrows to visceral malformations that are often incompatible with life. The prognosis of ABD in the presence of craniofacial and visceral polymalformations is known and bleak. The situation is quite different in the case of superficial and isolated constriction of a limb. A medical termination of pregnancy is generally advised in the presence of severe craniofacial and visceral malformations, while isolated malformations of the limbs are accessible to surgical treatment at birth. We reported 1 case of ABD
Intradural Spinal Metastasis from Renal Cell Carcinoma: A Rare Entity
No full textRenal cell carcinoma constitutes about 2% of all malignant neoplasms. It is known to metastasize to lung, bone and lymph nodes; intradural spinal metastases (IDSM) are relatively uncommon, only 5% as per literature. Keeping in mind the curative, functional, and palliative aspects; the management should be tailored for each patient. Surgery represents the gold standard of treatment for spinal metastases.
However Radiation therapy offers a less invasive means of tumor control, and can be utilized as the initial treatment or as an adjunct in the postoperative setting. The decision to use radiation therapy largely depends on factors, namely neurologic compromise, overall performance, and systemic tumor burden.
Here we present a case of 66 year old male, diagnosed as renal cell carcinoma - clear cell histology. Patient was subjected to radical nephrectomy & subsequently put on ‘pazopanib. While on pazopanib patient developed low back pain, evaluation revealed spinal cord lesion adjacent to L2&3 lumbar vertebrae suggestive of intradural metastasis. Patient was treated with external beam radiotherapy (EBRT) after he refused surgery & subsequent evaluation revealed complete disappearance of spinal lesion. Patient is alive & still on follow up
Pancreatic Pseudocyst Masquerading as a Serous Cyst Adenoma: A Case Report
No full textA pancreatic pseudocyst (PP) is a post-inflammatory collection of pancreatic enzymes and inflammatory exudates surrounded by a fibrous tissue wall. PPs are mainly formed in the pancreatic bed. It is seen more commonly after an episode of chronic pancreatitis and less commonly after acute pancreatitis. The main differential diagnoses in such cases include pancreatic cystic neoplasms such as mucinous cyst adenoma of the pancreas, serous cyst adenoma of the pancreas, pancreatic retention cyst, and other benign congenital lesions such as gastric duplication cysts. The incidence PPs is 0.5 to 1 in 100,000 hospital admission due to pancreatitis. Complications may include bleeding, rupture, infection, gastric outlet or biliary obstruction, and thrombus formation. These lesions are typically unilocular but can be thinly septated.
Here we report a case of PP mimicking a benign cystic neoplasm, which is not typically confused with a PP. PP’s can be misdiagnosed on radiological imaging but correct diagnosis can be made through aspiration and microscopic examination of the fluid via EUS
Synthetic Antimalarial Maculopathy: A Case Series
No full textSynthetic antimalarials (SAM) are drugs originally used for the prevention and treatment of malaria but, because of anti-inflammatory and immuno-modulatory activities, they have been since used to treat many other pathologies. Many side effects have been attributed to them, in particular ocular toxicity represented essentially by retinopathy or chloroquine maculopathy.
This maculopathy is reversible if diagnosed at an early stage, hence the importance of early detection in patients on long-term SAM.
Our study consists of a retrospective study about fifteen patients followed for various pathologies and under long-term SAM .The study highlighted the modalities of monitoring patients, the need of the long term ophthalmological follow-up in order to detect a beginning retinal toxicity and reduce the dosage or even discontinue treatment depending on the risk-benefit ratio and possible therapeutic alternatives. An initial ophthalmologic clinical and paraclinical review must be performed before initiating treatment