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Acute Necrotizing Pancreatitis with Cystic Lesion Concomitant with SARS-CoV-2
Get PDFSARS-CoV-2 causes severe acute respiratory distress and other clinical complications such as thromboembolic events and gastrointestinal tract disorders, which generally present with abdominal pain. In the case report, we describe a patient who had severe viral necrotizing pancreatitis associated with COVID-19 infection
Erythema Nodosum Revealing Metastatic Lung Cancer
Get PDFErythema nodosum (EN) is an inflammatory condition of the subcutaneous fat and has been reported in patients with haematological malignancies (lymphomas) or solid tumours. Lung cancer is the most common cause of paraneoplastic syndrome. We report a case of EN occurring as a paraneoplastic disease.A 48-year-old Tunisian woman, a non-smoker with no relevant medical history, presented with painful, erythematous, firm nodules on her legs with ankle swelling. The patient did not report any other symptoms. There were no abnormalities on examination except for moderate fever. An extensive infectious and immunological investigation was negative. Antistreptolysin antibodies were undetectable. Chest radiography showed a focal opacity in the right lung and a CT scan revealed a mass in the lower right pulmonary lobe with hilar and mediastinal lymphadenopathies, a nodule in the right adrenal gland, condensation in the iliac bone and multiple bilateral nodular cerebral expansive processes. Bronchial biopsies revealed a primitive and moderately differentiated adenocarcinoma. No argument for tuberculosis or sarcoidosis was foun
Sarcoidosis with Rare Extrapulmonary Involvement
Get PDFSarcoidosis is a systemic granulomatous disease in which medullary involvement is a rare extrapulmonary manifestation. We present the case of a 37-year-old man with right abdominal and dorso-lumbar pain lasting for months. Computerized tomography showed renal microlithiasis and retroperitoneal, hilar and mediastinal adenopathies. Laboratory results showed an elevated erythrocyte sedimentation rate, IgG, β2-microgobulin and angiotensin-conversion enzyme, serum calcium in the upper limit and hypercalciuria. There was a slight elevation of the CD4/CD8 ratio in bronchoalveolar lavage, without lymphocytic alveolitis. An endobronchial ganglion biopsy was inconclusive. A positron emission tomography scan demonstrated supra and infra-diaphragmatic, splenic and medullary involvement, suggesting lymphoproliferative disease (LPD). A bone marrow biopsy (BMB) revealed sarcoid-like epithelioid cell granulomas, excluding LPD. Sarcoidosis was assumed and corticosteroids were started. Although cytopenias were not present, the extensive ganglion, splenic and medullary involvement made LPD exclusion imperative, while BMB allowed for a definitive diagnosi
Reactive Thrombocytosis after Splenectomy in Hereditary Spherocytosis: Case Report and Literature Review
Get PDFReactive thrombocytosis after splenectomy is a feared cause of thrombosis throughout the arterial and venous system. There are many causes of splenomegaly, ranging from cirrhosis to lymphoma to hereditary spherocytosis. In this report, we will discuss a case of reactive thrombocytosis after splenectomy in a patient with hereditary spherocytosis. Splenomegaly is a relatively common finding in HD patients, causing extravascular haemolysis and thus leading to haemolytic anaemia. Splenectomy is usually considered when patients start to manifest severe symptoms such as abdominal pain, jaundice or worsening liver function tests. Our patient was a good surgical candidate and successfully underwent splenectomy but afterwards developed arterial and venous thrombosis due to reactive thrombocytosis. An extensive hypercoagulable work-up was unremarkable. The patient was started on hydroxyurea and anticoagulation with eventual improvement of platelet levels
Severe Haemolytic Anaemia Resulting from a Malpositioned Haemodialysis Catheter
Get PDFSevere haemolytic anaemia is a rare complication of haemodialysis that is often difficult to recognize, especially when there are other potential differential diagnoses. Here, we present the case of 19-year-old man on haemodialysis who developed severe haemolytic anaemia while recovering from acute renal failure secondary to rhabdomyolysis. Other causes of haemolytic anaemia such as thrombotic thrombocytopenic purpura and haemolytic uraemic syndrome were ruled out. As his blood counts were dropping on days following haemodialysis, haemolysis secondary to the mechanical sheering effect of the catheter was considered and his haemodialysis catheter was exchanged, which led to the resolution of anaemia
Gorham-Stout Disease with Clinical Response to Sirolimus Treatment
Get PDFGorham-Stout disease (GSD) is a rare clinical entity of unknown aetiology, with osseous resorption, vascular structure proliferation and inflammation of adjacent soft tissues. The clinical spectrum varies from asymptomatic patients to patients with pain, functional limitation or deformity. GSD may affect 1 or multiple bones in any location; however, predilection for the maxillofacial area and upper limbs has been described. We present the case report of a 33-year-old male patient with facial pain and loss of dental pieces; imaging showed extensive lytic involvement of the mandible and cranial bones. After exclusion of malignant, metabolic, infectious, or autoimmune disease, a diagnosis of GSD was made. Treatment with sirolimus was prescribed, achieving a symptomatic improvement and stability of imaging findings. The importance of the knowledge of this orphan disease is highlighted, to achieve a prompt diagnosis and medical treatment
Intoxication by Hand-Sanitizers and other Toxic Alcohols in a Low-Resource Setting: Two Case Reports
Get PDFToxic alcohol poisoning can be lethal if not identified early and treated appropriately. Toxic alcohol assays are often unavailable in low-resource setting, so clinicians have to infer a diagnosis based on suspicion, repeated evaluation and biochemical course. We report a case of toxic alcohol poisoning concealed by auto-intoxication with in-hospital hand sanitizer. The eventual appearance of a concurrent high anion gap prompted dialysis. In another case, a comatose patient presented with a high osmolal gap and a high anion gap. Incorrect a priori opinions caused us to defer dialysis and the patient died shortly afterwards. Clinicians should be aware that toxic alcohol poisoning can produce a confusing diagnostic picture with an insidious course, and that doctor delay can prove fatal
Management of Spasticity in a Frail Multiple Sclerosis Patient During the COVID-19 Pandemic
Get PDFSpasticity is a common symptom in patients with multiple sclerosis, and it is associated with fatigue, anxiety, depression, pain and mobility and bladder dysfunction, negatively affecting patient quality of life. During the COVID-19 pandemic, several patients were not able to continue treatment for multiple sclerosis. Here, we present a case of a 45-year-old man who experienced symptoms that worsened after discontinuing nabiximols treatment during the lockdown. Within 2 months of treatment restoration, the patient showed a strong improvement in his overall clinical condition
Multiple Sclerosis, Spasticity and Nabiximols: A User Experience
Get PDFThis clinical case concerns a 54-year-old woman with onset of multiple sclerosis at the age of 21 years, a long remission for 12 years and a subsequent resumption of disease activity partially contained by therapies. Not surprisingly, the increased burden of disability and impairment of quality of life is related not so much to the severity of the neurological damage as to the spasticity associated with the disease, which is responsible for severe alterations to posture control and trunk instability. A complex therapeutic strategy pathway started combining physical and pharmacological treatment, which reached a delicate balance with the introduction of nabiximols
Gli effetti della pandemia Covid-19 sulla criminalità: uno sguardo d’insieme
Get PDFIl presente lavoro si propone di dare uno sguardo d’insieme all’impatto sulla criminalità determinato dalla pandemia Covid 19. Partendo dall’analisi dei dati a livello internazionale particolare attenzione viene prestata alla situazione italiana relativamente al periodo marzo-giugno 2020, da cui emerge una generale diminuzione dei reati relativi a rapine, furti, lesioni personali e omicidi, a fronte di un incremento dei casi di Intimate Partner Violence (IVP) e di criminalità minorile. Dopo aver analizzato le caratteristiche e i fattori determinanti di questo trend criminologico viene posta attenzione al fatto che anche a questo livello l’attuale crisi pandemica si è connotata come una vera e propria sindemia, capace cioè di aggravare ulteriormente le disuguaglianze a discapito delle fasce di popolazione più deboli, tale per cui appare centrale la necessità, da parte di tutti gli organismi regolatori coinvolti, di potenziare i propri interventi prendendo in maggiore considerazione, tra gli altri parametri, i profili sociodemografici delle popolazioni interessate, con una attenzione particolare alla salvaguardia delle fasce più deboli della società