Asian Journal of Case Reports in Medicine and Health
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Gastrointestinal Stromal Tumor Presenting Uncommonly as an Intra-lesional Bleed after Antiplatelet Therapy: A Case Report
No full textBackground: Gastrointestinal stromal tumors (GISTs) are rare but the most common mesenchymal tumors of the gastrointestinal tract. It has a variable clinical presentation, making early diagnosis difficult. We report a rare case of intra-lesional bleed as the initial presentation of gastric GIST.
Case Presentation: A middle-aged male patient, presented with the diagnosis of ST-elevation Myocardial Infarction. Angioplasty was done and he was kept on multiple blood thinners. Post-procedure, he became unstable and dropped hemoglobin level. Gastroscopy revealed submucosal gastric mass but no source of active bleeding was found. CT angiogram revealed intra-tumoral bleed within the mass. Hence, CT-guided empiric arterial embolization was done before mass would have ruptured. Later, the mass biopsy revealed GIST. Patient was thereafter managed with surgical resection and chemotherapy.
Conclusion: This is an unusual initial presentation of GIST. Life-threatening complications of GIST rupture can be prevented if diagnosed early
Pontine-bulbar Hemorrhage in a Complicated form of Preeclampsia with Eclampsia and HELLP Syndrome “Case Report”
No full textThe mortality rate from stroke in pregnant women is 1.4 per 100,000 births. Vascular malformations are the most common cause of hemorrhagic stroke in this population; preeclampsia and other risk factors have been identified. However, the cause of almost one in four strokes is unknown. Spontaneous intracranial hemorrhage (ICH) is less common but causes significant morbidity. Pontine-bulbar hemorrhage in the absence of trauma or dislocation of the vessels is an uncommon complication during pregnancy. Hypertension is the typical cause, Less frequently, these hemorrhages accompany a hemorrhagic diathesis or vascular malformation. We report the case of pontine-bulbar hemorrhage following an eclampsia attack. This case report aims to shed light on this complex medical situation, highlighting the need for careful consideration of the potential risks and benefits of treatment options
A Case Report of Neuromyelitis Optica: An Effective Combination of Immunosuppressants, Corticosteroids and Plasmapheresis
No full textA girl in her teens presented with decreased sensation in the right half of the face and right half of the tongue associated with dysphagia, vomiting, and aphasia for 2 weeks with sudden onset flaccid quadriparesis for 7 days with diminished vision in both eyes and double vision for 5 days, with no history of fever, convulsions, diarrhoea, headache, palpitations, shortness of breath, loss of consciousness or features suggestive of bladder and bowel involvement with no history of trauma or similar episodes in the past.
MRI Brain revealed features favouring a demyelinating condition. MRI Spine, autoimmune encephalitis panel, ANA profile, and VEP were normal. NMOSD Screen (IIFD-EUROIMMUN) MOG & AQP-4 analysis showed a positive titre of Anti-NMO antibodies. She was treated with intravenous Methylprednisolone, oral prednisolone, and mycophenolate mofetil with 5 rounds of plasmapheresis. In subsequent follow-up, there was an improvement in power and gait with an improvement in vision.
A patient presenting with optic neuritis usually has a differential diagnosis of multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD) and Myelin oligodendrocyte glycoprotein (MOG) antibody disease (MOG-AD). MS, the commonest entity, should be ruled out first. The other two diagnoses have less favourable prognosis and the clinician should be vigilant about the possibilities, complications, and different treatment modalities. NMOSD can present without ocular symptoms and this significantly expands the presentation and differential of NMOSD when the patient does not have ocular involvement
Hemophagocytic Lymphohistiocytosis and CMV: Case Management
No full textAim: Hemophagocytic Lymphohistiocytosis is often confused with a septic shock. Hemophagocytic Lymphohistiocytosis is a life-threatening condition in which the immune system overreacts. It causes the release of high levels of inflammatory cytokines, leading to fever, cytopenias, hyperferritinemia, and hypertriglyceridemia. HLH can be primary or secondary to an underlying condition such as infection, malignancy, or autoimmune disease.
Presentation: The article describes a case report of a 65-year-old woman who was admitted to the hospital with bloody diarrhea and a fever. The patient had a medical history of diffuse large B-cell lymphoma, coronary artery disease, heart failure, and diabetes mellitus. On admission, the patient had low hemoglobin, a low platelet count, and leukopenia. The laboratory investigations showed elevated AST and CRP levels, positive CMV PCR, and high levels of ferritin, fibrinogen, and soluble CD25. The patient was treated with dexamethasone and ganciclovir IV. A subsequent lymph node biopsy showed CMV-related lymphadenitis. The article also explain the pathophysiology of the disease and the possibilities of treatment.
Conclusion: Hemophagocytic Lymphohistiocytosis, which has the same symptoms of a septic shock, should be suspected if the patient does not respond quickly to treatment. Also, if Hemophagocytic Lymphohistiocytosis flares again, it seems not enough to give the same immunosuppressive treatment, but a stronger one is needed
Miller Fischer Syndrome: A Case Report and Review
No full textGuillain–Barre syndrome (GBS) is a rapid-onset weakness caused by the immune syste damaging the peripheral nervous system. Miller Fisher syndrome (MFS) is a variant of GBS characterized by weakness of the eye muscles, abnormalities in coordination, and absent reflexes. The symptoms may develop over the course of hours to a few weeks. Although rare, it has a tendency to recur, mostly affects younger age groups and may have a long duration of course resulting in significant psychological and economical impact. However, it remains a less reported and studied entity. There is a need for a detailed study to provide recommendations for proper diagnosis and management to reduce the morbidity as well as the adverse psychological, social, and economic impact
Isolated Left Sided Hydrothorax in a Newly Diagnosed Hepatocellular Carcinoma: A Case Report
No full textUsually hepatic hydrothorax is a common presentation noticed with Hepatocellular carcinoma but we present a case report with left sided hydrothorax which is a rare association with Hepatocellular carcinoma
Aseptic Meningitis with Acute Urinary Retention
No full textAim: The clinical importance of acute urinary retention in aseptic meningitis.
Case Presentation: A 19-year-old male presented to us with signs and symptoms suggestive of meningitis. He later developed urinary retention. MRI of the brain with contrast was normal. Cerebrospinal fluid (CSF) analysis was consistent with aseptic meningitis. However, the meningoencephalitis panel was reported as negative. Urinary retention in the context of meningitis is known as Meningitis retention syndrome (MRS). MRS is a rare but important complication of meningitis. Early treatment with antiviral therapy resulted in a favorable outcome for our patient.
Conclusion: MRS is a rare self-limiting unique neuro-urological condition. The awareness of MRS and its clinical course is important for both neurologists and urologists in preventing unnecessary investigation and treatment, thereby reducing patients' anxiety
Spontaneous Peripartum Cardiomyopathy Relapse
No full textPeripartum cardiomyopathy (PPCM) is heart failure occurring without any determinable heart disease during the last month of pregnancy or the first six months postpartum. PPCM may be underappreciated, as many patients stop follow-up as soon as they achieve a normal EF. We contribute with an unusual case of short-lived cardiomyopathy in a 36-year-old female, while in this hospitalization was experiencing stressful circumstances, in the absence of pregnancy and other apparent causes of cardiomyopathy, yet to recover two days later. We believe with a history of PPCM in a prior pregnancy; this could be a PPCM relapse after excluding viral and connective tissue etiology. It is unclear when a patient with PPCM may be considered fully recovered and heart failure medications safely discontinued. Restoration of ejection fraction (EF) may not represent complete recovery. The lessons learned here are that there are no PPCM guidelines, limited conflicting data exist regarding the long-term management of PPCM patients with recovered LV function, and relapse of PPCM may be misdiagnosed with Takotsubo syndrome
Case Study of COVID-19 Vaccine-Associated Myocarditis
No full textCOVID-19 mRNA vaccines have serious side effects, including myocarditis; it’s an uncommon but dangerous side effect following mRNA-based COVID-19 immunization. Herein we report a 45-year-old female presenting with myocarditis seven days after the second dose of Pfizer-BioNTech vaccine, yet to recover three months later with guideline-directed medical treatment. COVID-19-associated myocarditis was evaluated and treated similarly to typical myocarditis with reduced ejection fraction heart failure, after exhausting other possible different etiologies. Here we illustrate various causes of myocarditis, contrasting diagnostic approaches, prognosis, and solidating management guidelines
Recurrent Kounis Syndrome Due to Amoxicillin Induced Anaphylaxis: A Case Report
No full textKounis syndrome is the occurrence of acute coronary syndrome during an allergic, anaphylactoid or anaphylactic reaction. It is thought to be due to the mast cells activation and degranulation. Patients can present with features of Acute coronary syndrome during or after a hypersensitivity reaction. Here we report a case of a 60-year-old gentleman presenting with fascial swelling, rash, shortness of breath associated with severe tightening left sided chest pain and dizziness which occurred 5 minutes after taking Amoxicillin. Serial ECGs taken showed dynamic ischemic changes with a rising Troponin I titer. He was subsequently managed for both the anaphylaxis and the non-ST elevation myocardial infarction. Subsequent history revealed that he had a similar episode following amoxicillin four years ago. This case report highlights the importance identifying Kounis syndrome as an important differential diagnosis amongst patients presenting with chest pain. This syndrome which can be easily diagnosed clinically if missed can lead to mismanagement of a relatively easily treatable cause of acute coronary syndrome