International Journal of Case Reports

  • Psychosis Due to Hypothyroidism: Are Antipsychotics Indicated?

    Objective: To present a case of thyroid-related psychosis and review the literature to assess evidence regarding the use of antipsychotic medications in patients who develop this condition. Data Sources: The OVID database was utilized to search for the terms “myxedema madness” and the combination of the terms “psychosis” and “thyroid.” The database was searched from 1946 until July 2018 and was limited to English language articles. Study Selection: A total of 25 articles were included in this study. These included 27 distinct case reports. Data Extraction: The abstracts of identified articles were reviewed. If an abstract was unavailable or inconclusive, the full article was reviewed. If there was no case report, or if the case was not clearly related to hypothyroidism, it was excluded. Authors assessed and identified cases included. Studies were excluded if recovery time was unreported; if cases included patients with pre-existing, chronic mental illness or intellectual disability, or if thyroid replacement medication was not initially administered. Results: Data suggested that there may be no benefit to treating thyroid-related psychosis with scheduled dosing of antipsychotics in addition to thyroid replacement. The review also suggested that male patients with thyroid-related psychosis seemed to respond more rapidly to thyroid replacement than female patients. Conclusions: Scheduled dose antipsychotic therapy was not observed to hasten recovery. Males with thyroid-related psychosis were observed to respond more quickly to thyroid replacement than females among the identified cases identified. Consideration should be given to initial trials of thyroid replacement alone in cases of thyroid-related psychosis.

  • Levothyroxine malabsorption induced by gastroparesis in type one diabetic patient: effect of intravenous levothyroxine therapy case report

    19 year old female known case of primary hypothyroidism on levothyroxine replacement, type one diabetes on insulin pump with good glycemic control and stable thyroid function, developed diabetic gastroparesis with worsening response to oral levothyroxine therapy. Her symptoms of hypothyroidism and her thyroid function improved dramatically by intravenous levothyroxine three times weekly for 4 weeks then she restarted on her usual dose of oral levothyroxine. Intravenous levothyroxine three times weekly for 4 weeks followed by oral levothyroxine therapy maintained her euthyroid, improved hypothyroidism and gastroparesis symptoms till the date of editing of this report (more than 15 months.).

  • Foreign Body Aspiration in Adult, What Would You Expect? Case Report

    Foreign body (FB) aspiration is an uncommon but potentially life-threatening event, while the majority of accidental aspiration events occur in children, adults represent up to 25% of cases. When the diagnosis is not established immediately, retained FBs may lead to recurrent pneumonias, bronchiectasis, recurrent hemoptysis, pneumothorax, lung abscesses, pneumo-mediastinum, or other complications. Extraction of aspirated FBs should be undertaken as soon as possible to alleviate acute symptoms and prevent long term complications. FB aspiration is slightly more common in males. The vast majority of adult patients with FB aspiration have obvious risk factors for aspiration including neurological deficits with swallowing difficulties or altered mental status, neuromuscular disease, intoxication, or have an iatrogenic cause. Still, 10% of adult patients with FB aspiration have no known risk factors. Our case is 35 y old male patient who was brought to Accident and Emergency department after being found unresponsive in the street, on arrival to hospital his GCS was 9/15 with pin points pupils , spontaneous breathing and hemodynamic stable . CT brain was unremarkable Patient failed to respond to repeated doses of naloxone and his GCS dropped with episode of apnea so was intubated and mechanically ventilated. Follow up chest x-ray show opacification of the right lung, and ABG reveled hypoxia with respiratory acidosis in spite high ventilator settings, So CT chest was the best option which reveled bronchial obstruction mostly due to foreign body. Urgent bronchoscopy was done and unexpectedly obstruction was due to chewing gum pieces, aspiration of four large pieces of chewing gum, following that patient remained in the ICU for 2 days where chest x-ray show significant improvement and he was weaned and extubated successfully.

  • Transfer Factor Revisited: Treatment of Candida Prosthetic Valve Endocarditis

    Candida prosthetic valve endocarditis (CPVE) is most commonly seen in persons who inject drugs intravenously or have indwelling catheters, pacemakers, or prosthetic joints that can serve as a nidus for candida suprainfection and seed the valve. Current treatment guidelines for CPVE include valve replacement and long-term antifungal therapy with intravenously administered Amphotericin B and parenteral or oral therapy with 5-fluorocytosine. Despite treatment, CPVE is characterized by a high recurrence rate (up to 36%) and a 5-year survival of less than 50%. I review my past experience in treating recalcitrant CPVE with transfer factor (TF) immunotherapy and conclude that TF can be a valuable adjuvant in the treatment of CPVE that does not respond to conventional interventions.

  • ISOLATED ORBITAL CYSTICERCOSIS… CAUSE OF PTOSIS IN CABBAGE EATERS

    PURPOSE: To report case of isolated orbital cysticercosis METHODS: Patients with drooping of eyelid were referred to our hospital. Patients were evaluated and investigated to find the cause of ptosis. RESULTS: Two patients with acute unilateral ptosis were referred to our hospital. Patients were investigated, blood test, stool tests and MRI were done to rule out the causes. In both the patients ptosis was due to involvement of LPS muscle by cysticercus larva. All the patients gave history of excessive consumption of cabbage and pork. The mainstay of treatment included oral albendazole (15 mg/kg/day) and oral prednisolone (1mg/kg/day) for 4 weeks. After 4 weeks, oral albendazole was stopped and oral prednisolone was slowly tapered over the next one month. The effect of above treatment was seen after few days with regression of swelling and improvement of signs and symptoms. CONCLUSION: Orbital cysticercus stands as one of the major causes of ptosis in the lower socioeconomic status people who are consuming mainly unhygienic leafy vegetables such as cabbage, burgers and undercooked pork. Therefore, these patients should be vigorously evaluated on scans (MRI and CT) so that early diagnosis can be made and treatment can be given to prevent the permanent visual loss or dissemination to brain.

  • The intriguing post –caesarean sinus : A case report

    The post caesarean fistula and sinus can take place due to tuberculosis , Crohn’s disease , deep pelvic infections or non absorbable sutures and even gauzes. A thirty year old woman ( P1 ,L1 ) who presented with multiple discharging sinuses at left lower abdomen since five months . She underwent lower segment caesarean section 10 months ago. On local examination , there were three linear scars two cm below the previous horizontal scar . The Ultrasound of local site revealed irregular loculated collections of size 3 × 2 cm in subcutaneous plane. We excised the sinus tracts ,but after two month came with reccurence . We did re- exploration and the sinus tract of size 9 cm was excised. Sinuses reccur even without retained foreign body or chronic disease. The management does not differ with the size of sinus.

  • Osseous metaplasia in thyroid nodule: A case report and review of literature

    Objective: To present a case of osseous metaplasia in thyroid nodule. Introduction: Long standing thyroid nodules undergo changes. Sometimes they degenerate, may lead to hemorrhage or fibrosis and sometimes ectopic bone formation. Case report: 41 years old Yemeni married lady, presented to our surgical clinic with left thyroid nodule for 3 years duration. She had right thyroid lobectomy 6 years ago. She presented with left neck swelling and was taken to OR for thyroidectomy. histopathology came as extensive fibrosis and osseous metaplasia with small remnant of thyroid tissue. Discussion; Most thyroid stay longer with no complications but some undergo calcification or hemorrhage, fibrosis and sometimes osseous metaplasia. It may occur in benign or malignant thyroid swellings.

  • Tracheal rupture after endotracheal intubation – a case report

    Tracheal rupture is a rare condition associated with high morbidity and mortality. Iatrogenic tracheal injury is also very rare and can occur as a serious complication after endotracheal intubation. We report a case study of tracheal rupture of patient with a history of rheumatoid arthritis and corticosteroid treatment during surgical procedure with orotracheal intubation in a supine position. Lesions were healed after conservative treatment without stenosis, signs of mediastinitis or local infection. Patient was able to undergo three other surgical procedures during the next 8 month without any other complications connected to endotracheal intubation.

  • A Rare Case of Glandular Odontogenic Cyst With a Breif Review Of Literature

    Glandular odontogenic cyst (GOC) is an extremely rare cyst of jaw bone with only 182 cases documented so far in the English literature. GOC is considered to be a locally aggressive lesion with high rate of recurrence. Anterior mandible is the most common site of involvement for GOC, involvement of the maxillary bone which is a rare occurrence. The clinical and radiographic finding of GOC are varied & often pathognomic. As clinical & radiographic findings are overlapping with those of other odontogenic cyst, a careful histopathological examination is needed to arrive at a definite diagnosis of GOC. In the present paper we reported a rare case of GOC in a 23yrs old male involving maxillary bone along with a review of literature focussing on clinical & radiological presentation and treatment outcome.

  • Idiopathic Spontaneous Pneumoperitoneum: When Not to Operate

    Pneumoperitoneum is often a surgical emergency related to gastrointestinal tract perforation. On rare occasions, free intraperitoneal air can be present without any discernible cause and is considered Idiopathic Spontaneous Pneumoperitoneum (ISP). Deciding which patients with ISP can be managed conservatively would help prevent some patients from undergoing unnecessary surgery. We describe here two cases of successful management of ISP and the review of literature of ISP management for the past 29 years. In the first case, a patient with ISP with no significant abdominal symptoms was successfully managed nonoperatively. In the second case, a patient with ISP and symptoms of small bowel obstruction was successfully treated surgically with exploratory laparotomy and small bowel resection. We recommend conservative management for the subset of ISP patients with no sign of peritonitis or sepsis.