International Journal of Case Reports

  • From Colonoscope to Microscope: the Diagnosis of Trichuris Trichiura

    Soil Transmitted Helmenthiasis (STH) is a major public health problem in the developing countries. Trichuriasis is one of the common prevalent parasitic infestations in the tropical and sub-tropical countries across the globe incuding India. However, there has been a steady decline of STH in the last five years where there has been success of albendazole with Mass Drug Administration (MDA) in National Filariasis Control Program and Kerala state has been one of them. We report a case of whipworm infection that was incidentally diagnosed by colonoscopy where repeated stool microscopy was uncontributory. The worm can be overlooked, particularly if colon preparation is not good.

  • Acute Coronary syndrome in a patient newly diagnosed with Charcot-Marie-Tooth Neuropathy: a review of cardiovascular disease in this inherited neuropathy

    Whilst we suspect that there is no clear association between the two major diagnoses we made in this patient during this hospitalisation (i.e. coronary artery disease and CMT neuropathy), the literature from a series of published case reports does perhaps show an association between CMT and abnormalities of cardiac conduction. Brief Summary: This case reports follows the occurrence of an antero-lateral ST segment elevation myocardial infarction in a 34-year-old male newly diagnosed with an inherited neuropathy in the form of Charcot-Marie-Tooth type 1A.

  • The torsed intraabdominal testis presenting with a mechanical large intestinal obstruction – A maiden case report

    Torsion of an intraabdominal testis is a well-known complication and is usually associated with a testicular malignancy. Torsed intraabdominal testis compressing the large bowel leading to a mechanical gut obstruction is still an unreported entity. A 27 years old young patient presenting with nonspecific abdominal pain after 48 hours of delay. Due to features of gut obstruction, an emergency laparotomy was done. A large torsed intraabdominal testis was found with an empty right scrotum which was compressing the sigmoid colon leading to a complete gut obstruction. Interestingly, two of his siblings also were also suffering from undescended testicles.

  • Twins With Endogenous Tinea Versicolor

    Identical Twins with Endogenous Tinea Versicolor This case report was inspired by recent medical data consistent with the obser-vation that Tinea Versicolor caused by Malassezia Furfur species may be en-dogenous produced by human body. This case report involves a pair of identical twins –ages 71- who have had recur-rent Tinea Versicolor infections for over six decades. The author of this article twin A, a physician and his brother twin B have in summer months had skin lesions – on chest and upper extremities of round ap-proximately 1 inch wide – diagnosed as tinea versicolor by many doctors in di-verse medical settings in different countries since their adolescence. The infec-tions have been successfully treated by antifungal medications. Both twins were born in Istanbul Turkey. Twin A who lives in Houston Texas had lived in Los Angeles California and Dahran Saudi Arabia. Twin B who lives in Athens and spent the majority of his adult life in Washington DC. Neither twin reported any association between location and tinea versicolor infections yet they both observed that almost always infections emerged in warmer climates. Both twin A and twin B have been diagnosed with hypertension and hypercho-lesterolemia well controlled by amlodipine 10 mg and atorvastatin 20 mg respec-tively.

  • Acute soft head syndrome and a mini review of bone and neurologic complications in patients with sickle cell disease

    Introduction: Acute soft head syndrome is a rare complication in patients with sickle cell disease (SCD) that is characterized by progressive skull pain and swelling, it is usually related to skull bone infarction and full recovery is achieved with conservative management. This case represents a very rare association of sickle cell disease and acute soft head syndrome that necessitates to be differentiated from other bone and neurologic presentations occurring in this entity of patients. Case: We report a rare case of an 11 years old Saudi male patient with sickle cell disease who developed acute soft head syndrome that presented with severe headache. An underlying osteomyelitis of skull and lower limb bones couldn’t be excluded and the patient had full recovery after conservative treatment. Conclusion: Acute soft bone syndrome seldomly occurs in SCD, however, its presentations mimics those of bone and neurologic complications so differentiation is essential in order to set up a clear plan of management.

  • Emergency surgery for a Morgagni hernia causing respiratory failure

    Reports of emergency surgical repair of a retrosternal hernia causing respiratory failure in an adult are rare. We treated an 82-year-old man who had been suffering breathlessness upon exertion, some speech difficulty, and, most recently, visual hallucinations. He had consulted a physician who ordered an arterial blood gas test, which revealed hypoxemia, and thoracoabdominal computed tomography (CT), which revealed a hernia that was compressing the pulmonary parenchyma. Over the next 30 days, the hernia worsened, acute respiratory failure developed, and the patient was transferred to our hospital by ambulance. The patient presented to us not only with respiratory failure but also a decreased level of consciousness. CT performed upon admission revealed prolapse of the transverse colon from the posterior surface of the sternum to the right thoracic cavity, left deviation of the mediastinum, and compression of the pulmonary parenchyma, which we believed to be the cause of the hypoxemia. With the hernial orifice appearing to be on the right, a Morgagni hernia was diagnosed. Emergency surgery was deemed necessary. An epigastric midline laparotomy incision was placed, and we observed a retrosternal hernia, with an enlarged foramen of Morgagni measuring 70mm × 50 mm as the hernial orifice. The hernia contained portions of the greater omentum and transverse colon. We returned the contents to the peritoneal cavity manually closed the hernia orifice by simple suturing and reinforced the repair with a mesh patch. With signs of cardiac failure developing, temporary noninvasive positive-pressure ventilation was instituted from postoperative day 5 to postoperative day 11, but the patient’s general condition improved thereafter, and he was discharged on postoperative day 29.

  • Serious Staphylococcus Aureus Infection in a Patient with Diabetes Mellitus

    The immune system and metabolism are closely related and it is recognized that diabetes mellitus (DM) and its complications have a compromising impact on the degree of immunosuppression. The authors present the case of a 65-year-old man with a history of type 2 DM and ulcers of the lower limbs who went to the emergency departament with odynophagia, dysphagia, fever and cervicalgia. He had a painful cervical and supraclavicular region and highly infectious parameters in blood samples. The cervical radiography suggested vertebral fusion and cervical computed tomography with soft tissue thickening, hypopharyngeal deviation and gaseous foci suggestive of abscess. He started empiric antibiotic therapy and was performed an abscess drainage where Staphylococcus aureus oxacillin susceptible was isolated. S. aureus bacteremias have a higher prevalence in diabetics, being essential the rapid orientation in situations of bacteremia to clarify the infectious focus and immediate onset of antibiotic therapy which decreases mortality.

  • Oral pyridostigmine for treatment of postoperative ileus associated with elevated catecholamine levels: A case report

    The etiology of post-operative ileus is usually multifactorial, but increased catecholamines have been implicated as an important cause. We present a case of catecholamine-induced prolonged post-operative ileus treated successfully with Pyridostigmine. A 70-year-old male underwent a low-anterior resection and diverting loop ileostomy for rectal cancer. Immediately post-operatively he developed refractory hypertensive urgency and a small bowel ileus. Biochemical testing revealed markedly elevated 24-hour urinary metanephrines and normetanephrines. However, radiologic studies failed to identify a pheochromocytoma. The ileus persisted despite employing a multimodal regimen consisting of avoidance of narcotic pain medications, gastric decompression via a nasogastric tube, maintenance of normal levels of electrolytes, parenteral nutritional support, and early mobilization. Two weeks after the surgery the patient was treated with oral Pyridostigmine with appropriate return of bowel function. Excessive circulating catecholamines play an important role in the etiology of refractory post-operative ileus, and cholinesterase inhibitors such as Pyridostigmine could be used as an effective treatment in such cases.

  • Pulmonary metastasis of a Dermatofibrosarcoma of Darier and Ferrand treated by IMATINIB: a case report

    Dermatofibrosarcoma (DFS) described by Darier and Ferrand represents less than 5% of soft tissue sarcomas and metastases only very rarely. We report the case of a 51-year-old patient followed for six years for a DFS of the right thigh root recurrent several times after non-optimal surgical resections. The occurrence of thoracic pain associated with a cough with dyspnea, motivated the realization of a thoracic computed tomography (CT) showing a right basal pulmonary mass with pulmonary nodules. CT biopsy of one of the pulmonary nodules confirmed the metastatic nature of these lesions. The search for translocation t (17,22) could not be performed. A treatment based on imatinib has been started. The evolution was marked by the disappearance of the respiratory symptomatology and a good radiological response. The advent of targeted therapy with imatinib transformed the prognosis for this disease, which was considered incurable at the metastatic stage.

  • Inadvertent epidural administration of remifentanil (Ultiva®) during labour analgesia

    The use of remifentanil patient-controlled analgesia for labour analgesia remains controversial. The high potency of the drug, the fear of serious adverse drug reactions and drug administration errors are all legitimate concerns. We report the case of a woman in labour who inadvertently received a remifentanil solution via epidural route. In addition to the risk of respiratory depression, the epidural administration of remifentanil contains glycine in its solution and is therefore contraindicated due to potential neurological injury. The patient received a total of 2 mg of remifentanil and 15 mg of glycine in her epidural over a long period before the error was identified. Interestingly the patient was mostly comfortable during labour and fortunately no maternal or neonatal adverse events occurred.