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Mondor’s Disease: A Rare Cause of Chest Pain
Get PDFIntroduction: Chest pain is a very frequent reason for seeking medical care. When there is no obvious cause, patients are sometimes subjected to tests and treatments that may be unnecessary and potentially harmful. Mondor's disease is a rare but usually benign and self-limited entity characterized by thrombophlebitis in a specific region. Case report: We report the clinical case of a 51-year-old man admitted to the emergency department with a 24-hour history of left chest pain with no other symptoms. Physical examination revealed a palpable subcutaneous cord-like structure that ultrasound confirmed to be thrombophlebitis of a superficial vein in the mammary region. Secondary causes were ruled out, and the condition resolved with ibuprofen and the application of local ice.Discussion: Mondor’s disease can be associated with neoplasms, trauma or hyperviscosity states, but it is mostly idiopathic. Usually, it resolves completely in 4–8 weeks without specific treatment. Because this infrequent diagnosis mainly relies on clinical findings, it is important that clinicians can recognize the syndrome
Diabetic Ketoacidosis, Hypertriglyceridemia and Abdominal Pain due to Acute Pancreatitis Complicated by Non-immune Haemolytic Anaemia
Get PDFThe triad of diabetic ketoacidosis, acute pancreatitis and hypertriglyceridemia is a rare phenomenon, with mortality rates of up to 80%. A unique characteristic of the described case is the co-occurrence of non-immune haemolytic anaemia (NIHA) with the complex triad. It is suggested that this presentation is secondary to hyperlipidemia which leads to increased fragility of erythrocytes due to destabilization of red cell membranes. Supportive treatment with intravenous insulin and blood transfusions is the cornerstone of treatment
Cryptogenic Stroke and Valvular Strands
Get PDFBackground: Ischaemic stroke can be classified according to its aetiology. In cryptogenic stroke, Lambl’s excrescences should be considered since they can only be detected through transesophageal echocardiography (TEE), which is not routinely performed.Case description: The authors report the case of a 63-year-old Caucasian man with two ischaemic cerebral events associated with the presence of Lambl’s excrescences in the aortic valve detected with TEE. Switching antiaggregant therapy to anticoagulant therapy allowed the patient to remain asymptomatic throughout a 3-year follow-up.Conclusion: The lack of protocols for the management of cryptogenic stroke results in a delay in the identification of less frequent causes of stroke, leading to recurrent vascular events, morbidity and loss of functionality. The authors describe a patient who experienced multiple cerebral ischaemic events until the correct diagnosis was made
Methicillin-Resistant Staphylococcus aureus and Candida albicans Secondary Bloodstream Co-Infection in a Patient with Tubular Oesophageal Duplication
Get PDFGastrointestinal duplications are rare congenital anomalies usually found incidentally in asymptomatic adult patients. We report a case of methicillin-resistant Staphylococcus aureus and Candida albicans secondary bloodstream co-infection in a 57-year-old male patient with a communicating tubular oesophageal duplication. The patient completed 21 days of medical treatment with vancomycin and anidulafungin and remained well without any complications, over 2 years of follow-up
Keep an Eye Out for Crohn’s Disease: Orbital Myositis as the Initial Sign before Gastrointestinal Manifestations
Get PDFExtraintestinal manifestations of Crohn's disease sometimes occur and can present prior to intestinal symptoms. Ocular manifestations of Crohn's disease are considered rare, with orbital myositis an even rarer manifestation with only a handful of cases reported in the literature. We present the case of a young woman who was diagnosed with orbital myositis, which was initially attributed to pseudotumor cerebri after an extensive negative work-up. Months later, the patient presented with haematochezia, and was subsequently diagnosed with Crohn's disease
Simultaneous VZV and HSV-1 Reactivation after Minor Head Injury
Get PDFAn 81-year-old patient presented to the emergency department with a dark lesion on his forehead and swelling of his left eye, 3 days after a minor forehead injury and skin laceration. He also showed singular papules on his chin, upper chest, upper arms and back, later evolving into vesicles. Polymerase-chain reaction testing of vesicle content was positive for VZV and HSV-1, confirming a diagnosis of disseminated cutaneous herpes virus infection and concomitant HSV-1 reactivation. Antiviral and antibiotic treatment was initiated for 1 week with an immediate response. This case report highlights the association of head trauma and subsequent reactivation of VZV in patients at risk. Simultaneous reactivation of HSV-1 and VZV is rare in immunocompetent patients
Miliary Brain Tuberculomas and Meningitis: Tuberculosis Beyond the Lungs
Get PDFTuberculosis remains one of the most common infectious diseases. Miliary presentation is a rare and possibly lethal form, resulting from massive lymphohaematogenous dissemination of Mycobacterium tuberculosis bacilli. The authors describe the case of a 47-year-old immunocompetent woman, diagnosed with miliary tuberculosis, with both lung and central nervous system involvement, who showed total recovery after starting anti-tuberculous drugs. The atypical neutrophilic-predominant pleocytosis and negative cerebrospinal fluid microbiological results made the diagnosis even more challenging. Since prognosis largely depends on timely treatment, recognition and prompt diagnosis is important. Thus, clinicians should be aware and treatment should be initiated as soon as the diagnosis is suspected
Ulisse e il lockdown. Razionalità limitata ed etica della sostenibilità
Get PDFQuesto articolo tenta di formulare una lettura della pandemia da Covid-19 utilizzando sia testi classici come “Fuga dalla Libertà” di Erich Fromm, “I limiti della Libertà” di James Buchanan, “Ulisse e le Sirene di Jon Elster, “La ragione nelle vicende umane” di Herbert A. Simon, “Il futuro della democrazia” di Norberto Bobbio, con contributi più recenti come “Il quarto shock” di Sebastiano Maffettone, congiuntamente al dibattito sulla sostenibilità,
in particolare riferimento ad Agenda 2030 per lo Sviluppo Sostenibile, che necessita un’idea comune di etica pubblica. Contro i ‘battitori liberi’, alla base delle misure di chiusura (lockdown) vi è l’espediente di farsi legare, che è un fondamentale principio della razionalità imperfetta che
caratterizza la maggior parte delle attività umane e che non implica l’isolamento dei cittadini col rischio quindi di una ‘fuga dalla libertà’
Società, politica, scienza: l’importanza della fiducia
Get PDFQuesto articolo intende presentare, a partire da alcuni dei contributi più interessanti reperibili in letteratura,
i principali temi all’ordine del giorno rispetto alla fiducia nella ricerca scientifica (in particolare di ambito
biomedico), e alcune delle possibili vie di miglioramento del rapporto tra scienza e società con riferimento all’obiettivo della promozione del benessere. È noto, infatti, come le strategie e la decisionalità politica siano fortemente influenzate dal clima culturale che fa da sfondo al dibattito politico, e che condiziona il consenso e la fiducia) nei confronti delle idee e delle istituzioni che le rappresentano, in modo particolare nei confronti della
scienza e dei risultati della ricerca scientifica. Il tema è oggetto di rinnovato interesse in ragione della recente situazione di emergenza sanitaria, che ha richiamato l'importanza di riflessioni volte ad indagare come sia possibile migliorare il rapporto tra scienza, società e politica; come fare un migliore uso della ricerca scientifica e dei suoi risultati ai fini del benessere e della giustizia sociale; come aumentare il livello di fiducia dei cittadini nelle indicazioni scientifiche attraverso interventi di tipo informativo e formativo
Cardiac Involvement in Leptospirosis – An Unusual Manifestation
Get PDFCardiovascular involvement by Leptospira is unusual. We report a case of a 29-year-old male sanitation worker who was diagnosed with leptospirosis (PCR testing for Leptospira spp. was positive in blood and urine). He had no classical clinical findings, and the presence of shock was the main worrisome finding. Within 24 hours of admission, the emergence of chest pain led us to consider cardiac involvement, which was demonstrated by diffuse supra-ST segment elevation, elevated troponin and NT-proBNP and an echocardiogram showing mildly left ventricular ejection fraction (LVEF 48–50%). There are several reports of cardiovascular involvement in severe leptospirosis but most patients are asymptomatic. In this case, the main key to diagnosis of perimyocarditis was the new onset of chest pain