A rare case of phlegmasia cerulea dolens complicated with iliac vein perforation
Venous thromboembolism (VTE) is a major healthcare problem in the world. It includes pulmonary embolism and deep vein thrombosis (DVT) that result in significant morbidity and mortality. Phlegmasia cerulea dolens (PCD) is a rare but potentially life-threatening severe form of acute DVT, which is characterized by marked swelling of the extremities with pain and cyanosis, and further leads to arterial ischemia due to venous hypertension and compartment syndrome, and ultimately cause gangrene with high amputation and mortality rates. However, there was rare case reported about PCD complicated with venous perforation. Herein, we report a scarce case of left iliofemoral DVT suffering from iliac vein perforation with extraperitoneal hematoma. Although this case treated by iliac vein stenting with cover stent and ultrasound-assisted thrombolysis (EKOS). Patient still finally received below the knee amputation due to reperfusion injury over distal foot despite great improved venous blood flow. Our case should be the first case of PCD complicated with venous perforation. This rare case reminds physicians that venous perforation is a possible complication of PCD and may lead to poor outcome. Early hemostasis by stenting and performing thrombectomy treatment as soon as possible is suggested to save the life and limb.
Polyneuropathy Of Unknown Etiology In An Adult Female With Anatomic Variants
One of the earliest descriptions of neuralgia dates back to John Fothergill in 1773.1 However, the concept of nerve pain can be traced to physicians like Rhazes (d. 925), Haly Abbas (d. 982), Avicenna (d. 1037), and Jorjani (d. 1137) who discussed multiple aspects of neuropathic pain including its classification, etiology, differentiating characteristics, qualities, and pharmacologic and nonpharmacologic treatments.2 Currently, neuropathy is a general term describing many signs and symptoms caused by dysfunction of the nervous system.3 Peripheral neuropathies are largely associated with pins and needles sensation, but can also include a range of symptoms from paresthesias to severe chronic dysesthesia. The burning pain of severe polyneuropathy can become so intense that it significantly impacts quality of life. In order to effectively treat neuropathy, it is essential to determine the underlying mechanism.3 According to Levine (2018), neuropathy can be caused by diabetes mellitus, impaired glucose tolerance, primary systemic amyloidosis, familial amyloidosis, Fabry disease, Lupus, vitamin B12 deficiency, celiac disease, Sjögren’s syndrome, sarcoidosis, paraproteinemia, HIV, or paraneoplastic syndrome. In addition, neuropathy can also be produced by various immune-mediated responses, inherited diseases, alcohol abuse, chemotherapy, medications, and trauma.4 Recently, SARS CoV-2 (COVID-19) has been reported to produce possible neuropathic pain in up to 2.3% of patients hospitalized with COVID-19, but this prevalence is probably underestimated because chronic neuropathic pain may develop months after injury to the nervous system.5 Prevalence of neuropathy ranges from 0.8 to 17.9%, with an estimated male-to-female ratio of 1:2; about 8% of adults over 65 report some degree of neuropathy.7,8
Using diabetic patients once daily fingerprick autologous blood eye drops for diabetic dry eye disease- A modified regimen to treat and prevent diabetic dry eye disease
Purpose: Diabetic patients tend to suffer from dry eye disease due to associated various reasons. Autologous blood is both safe and effective for treating Dry Eye Disease (DED) according to studies. Several papers demonstrated feasibility and effectiveness of four times Fingerprick Autologous Blood (FAB) eye drops to treat dry eye disease. As some diabetic patients perform daily finger pricking to monitor blood glucose level, the blood that remains can be used to apply to eyes to treat and prevent dry eye disease. This study intends to investigate if once daily fingerprick autologous blood eye drop in conjunction with blood glucose test is feasible and effective for diabetic patients who suffer from mild to moderate dry eye disease also to avoid four times fingerprick. This may be the first study on using diabetic patients once daily fingerprick autologous blood eye drops for mild to moderate diabetic’s dry eye disease. Design, setting and participants: This case series study enrolled 25 diabetics patients with mild to moderate DED who received ophthalmological care at a single clinic in Honolulu, Hawaii. All patients were performing once daily finger prick tests to monitor their blood glucose level. Participants were instructed to instill the remaining FAB after blood glucose tests into the medial inner canthus of each eye for one month. Patients remained on their daily dry eye treatment regimen throughout the study. Main outcomes and measures: The OSDI (Ocular Surface Disease Index) scores to categorize severity of DED were used for comparison before and after using FAB eye drop daily for one month. A questionnaire was used to evaluate the acceptability and compliance. Result: 52% of patients after one month of the trial demonstrated improvement in categorization of the severity in DED and willing to continue in the future. Conclusion and relevance: FAB that remained after…
Castlemans Disease – Presenting with Recurrent Pleuropericardial Effusions- Mimicking Tuberculosis
Castleman disease (CD) is an uncommon heterogeneous group of lymphoproliferative disorders which can affect the lymph nodes of the neck, chest, abdomen and pelvis. It was first described by Castleman, in 1954, known as benign mediastinal lymph node hyperplasia, which was histologically similar to thymoma of unknown cause. [1] It is divided into unicentric (localized ) Castleman disease (UCD) and multicentric ( generalized) Castleman disease (MCD) based on the number of lymph nodes involved. Castleman disease has varied presentations. Clinically it can present as localized masses, or localized lymph node enlargement. Symptoms can result from compression effects of the enlarged lymph nodes and in asymptomatic patients it can be an incidental finding on radiological imaging. It can also present as diffuse lymphadenopathy with severe systemic symptoms . Rarely it presents with pleuro-pericardial effusions . We present a case of a; young gentleman presenting with anorexia, weight loss and night sweats . He had large exudative pleural effusion with pericardial effusion leading to constrictive pericarditis .He was started on ATT empirically, which was later stopped due to poor response . Extensive radiological work revealed multi loculated pleural effusion and multiple lymph nodes in the axillary and cervical area . Excisional Biopsy of the lymph nodes revealed Castleman disease .
Cutaneous Polyarteritis Nodosa: A Rare but Severely Debilitating Disease
Cutaneous polyarteritis nodosa is a rare cause of ulcerations of the lower extremities. Inflammation and occlusion of small and medium sized cutaneous vessels results in painful nodules and skin ulcerations. Mild cases can be treated with topical corticosteroids or oral nonsteroidal anti-inflammatory medications. Severe cases require corticosteroids and other immunosuppressive therapies. A 47-year-old female patient presented to the infectious diseases outpatient clinic with multiple skin lesions of her lower extremities that failed to respond to courses of oral antibiotics. A deep tissue biopsy confirmed findings of vasculitis and she was initiated on corticosteroids. She developed progressive necrotic lesions as soon as corticosteroids were tapered. Angiography of the lower extremities revealed extensive abnormalities of bilateral tibial arteries and she was advised amputation. The patient sought a second opinion and underwent limb salvage therapy with surgical debridement, skin grafting and hyperbaric oxygen therapy along with systemic corticosteroids. She continues experiencing slow healing and has successfully avoided limb amputations. This case highlights the need to have a high index of suspicion of this rare but highly debilitating form of cutaneous vasculitis. Corticosteroids or other immune-modulating agents along with expert care at a specialized wound center can help patients avoid limb amputation.
Catastrophic Upper Gastrointestinal Tract Complications Following Corrosive Ingestion
Ingestion of caustic substances, either acidic or alkali, is a well-known cause of significant mortality and morbidity in the pediatric and adult populations. According to the pH, physical form, amount, and rate of ingestion of these substances, a wide range of immediate as well as possible subsequent chronic complications can result. Some patients may have minimal to mild symptoms. However, others can present with moderate or even serious symptoms, in the form of dysphagia, odynophagia, hoarseness, and epigastric pain. Herein we present a case of a 26-year-old male patient with a history of Nitric acid ingestion. He initially complained of severe chest and abdominal pain, associated with hematemesis, dysphagia, odynophagia, hypersalivation, and inability to tolerate oral intake. Initial Esophagogastroduodenoscopy (EGD) showed diffuse mucosal ulceration reaching the second part of the duodenum. Multiple subsequent EGDs revealed more extensive damage and subsequent esophageal stricture and pyloric stenosis for which multiple dilatation attempts were done. The patient received extensive supportive management during his hospitalization course, but the damage was severe enough that he was referred for surgical management. Such catastrophic sequels of caustic ingestion are still encountered, especially in developing countries. We present this case looking forward to raising awareness about this dangerous phenomenon and highlighting the significance of immediate identification and grading of the injury.
