International Journal of Case Reports

  • A Rare Reason of Ileus: Atypical Hemolytic Uremic Syndrome

    Hemolytic uremic syndrome (HUS) is a thrombotic microangiopathy that is characterized by intravascular hemolytic anemia, thrombocytopenia and acute renal failure. Typical form occurred with the shiga-like toxin produced by Escherichia coli bacterium or Shigella dysenteriae bacterium while atypical HUS is sporadic or familial form of the disease which develops due to uncontrolled activation in alternative complement pathway. It may present with recurrent attacks and it has a potential of poor prognosis. In this case report we presented a 36-year-old woman in her 22nd week pregnancy without any history of chronic disease or medication whom admitted to hospital with abdominal pain, bloody diarrhea, oliguria and diagnosed with atypical HUS. She was diagnosed with ileus at the first month of Eculizumab treatment and a polyploid lesion obstructing the lumen of the colon was detected. Pathologic examination of the mass revealed a chronic active inflammatory lesion.

  • Cardiovascular Disease Associated with the Chronic Use of Ergotamine: A Case Report

    Ergotamine and its derivatives were used for multiple diseases; in the nineties, its use in association with caffeine was considered a standard treatment for migraines, although it has been in decline, due to the evidenced toxic effects related to its chronic use including vascular, cardiovascular and central nervous system manifestations. In this article is reported a case of a 59-year-old female with chronic use of caffeine plus ergotamine for more than 20 years; afterwards she develops peripheral artery disease, severe mitral and tricuspid valve regurgitation with requirement of valve replacement. In the absence of past cardiovascular history and rheumatic fever, its clinical evolution and pathology results are associated with ergotism.

  • Paraparesis following commencement of Anti Tuberculosis drugs for latent Tuberculosis. Case report and review of literature

    A 43 year old female Patient, with recently diagnosed latent Tuberculosis (TB), started On anti – TB drugs (Isoniazid, Rifampicin), came with symptoms of Motor and sensory polyneuropathy only 4 weeks after starting the drugs. Extensive investigations were pursued. Nerve conduction study showed Features of Guillain – Barre syndrome (GBS). After stopping the Anti TB medications, patient symptoms Improved. This gives us an idea that Anti TB medications can itself trigger GBS. The Association of TB and GBS will be reviewed in Literature as well as the differentials and management.

  • Dasatinib-Induced Colitis in a Patient with Chronic Myeloid Leukemia (Chronic Phase)

    Chronic myeloid leukemia (CML) is a Philadelphia (Ph) chromosome-positive myeloproliferative neoplasm. The molecular consequence of reciprocal translocation t(9;22)(q34;q11) is the generation of the BCR–ABL fusion gene, which encodes a constitutively active tyrosine kinase signaling protein. The tyrosine kinase is responsible for the leukemia phenotype through the constitutive activation of multiple signaling pathways involved in the cell cycle and in adhesion and apoptosis. Dasatinib is an oral BCR-ABL tyrosine kinase inhibitor (TKI) which is mainly used for treating CML patients with resistance or intolerance to Imatinib. Dasatinib has several significant adverse reactions and gastrointestinal side effects including colitis. We report a case of a 33-year-old male, diagnosed with CML (Chronic Phase) who received Dasatinib as second-line therapy and developed chronic diarrhea and colitis attributed to Dasatinib and improved after stopping it.

  • Ovarian Mucinous Cystadenoma Complicating Pregnancy- A Case Report

    Diagnosis of ovarian tumor during pregnancy presents a management dilemma. We herein report a case of huge ovarian cyst adenoma complicating pregnancy in a 25 years old gravida 3, previous two caesarian, presenting at 13 wks. pregnancy. She was referred from periphery for uterine size more than the period of gestation and ultrasound (USG) showing 25×12 cm ovarian cyst. USG was inconclusive of benign or borderline ovarian tumor. Neoadjuvent chemotherapy followed by cytoreductive surgery was planned. USG guided fine needle aspiration cytology (FNAC) was done before starting chemotherapy which suggested benign etiology. Management plan was changed to continuation of pregnancy and conservative surgery at 20 wks of pregnancy. Planned exploratory laparotomy with left sided salpingoophorectomy was done under general anesthesia at 22 wks. of gestation. Post-operative period was uneventful. Patient was delivered by LSCS at 38 wks. of gestation.

  • Anomalous Right Coronary Artery with LV Non-compaction having Malignant Course, A Rare but Lethal Combination

    Anomalous Right coronary Artery origin from contralateral sinus is a rare but lethal variant that may mimic like acute coronary syndrome and is a potential cause of sudden cardiac death. This needs early diagnosis with prompt treatment which may be conservative or interventional depending upon the clinical presentation, exact anatomy and route of the vessel. Here we present a unique case of combination of anomalous right coronary artery origin from opposite sinus causing ischemia, with LV non-compaction ending in non-hemorrhagic stroke.

  • A Case Report Highlighting Some of the Difficulties Faced Diagnosing Appendicitis in Children

    Introduction: In England 12,000 children are diagnosed with appendicitis each year. The diagnosis of appendicitis is difficult especially in children. There are many other diagnoses which mimic appendicitis including Meckel’s diverticulum, intussusception, gastroenteritis and mesenteric adenitis. Unfortunately there is no gold standard in the diagnosis of appendicitis and often clinicians are hesitant to submit a child to radiological investigations. Presentation of the case: An eleven year old boy, of Bangladeshi origin, presented to the Royal Gwent Hospital, South Wales, with an acute onset of centralised abdominal pain and vomiting. Following a period of observation and re-examination his pain had localised to the right iliac fossa and it was decided on clinical grounds to perform a laparoscopy for suspected appendicitis. Intra-operative findings showed an intussusception of the small bowel secondary to a mucosal lesion. Histology showed high grade non-Hodgkin’s lymphoma with a pattern suggestive of Burkitt’s lymphoma. Conclusion: The case highlights the importance of accurate diagnosis of appendicitis and the difficulties of managing abdominal pain in children. More needs to be done to develop a better criterion and judicial use of imaging to guide surgical intervention.

  • Intraventricular Tuberculoma : Single Case Report from Tertiary Care Centre in Eastern India

    Intraventricular tuberculomas as a manifestation of CNS tuberculosis is a rare finding.Suspicion for tuberculosis in these lesions is by the constitutional symptoms like low grade fever, weight loss, presence of tuberculosis elsewhere, contact with a TB patient, low socioeconomic status, occurrence in an endemic region, raised ESR, abnormal Chest X Ray findings, positive mantoux test. It is difficult to make a differential diagnosis from lesions if no systemic tuberculosis is present. Medical treatment is the preferred management method of this disease, and surgical intervention should be considered in certain situations. We report a case of an intraventricular tuberculoma in a 15- year-old girl and we discuss the pathogenesis and the radiological findings according this location.

  • Loading Doses of Bevacizumab in Branch Retinal Vein Occlusion (BRVO): a Case Report

    Background: Branch retinal vein occlusion (BRVO) is a sight threatening condition which may result well when promptly diagnosed and treated. Current trend of BRVO therapy uses anti-vascular endothelial growth factor (anti-VEGF) such as bevacizumab, ranibizumab and aflibercept as agents of choice. Previous studies have proven effectiveness of six monthly injections of anti-VEGF as loading doses before switching to pro-renata regimen in BRVO. We would like to report a case with lower frequency of bevacizumab injection as anti-VEGF in a case of BRVO with satisfactory outcome. Case presentation: A 52-year old male presented with sudden painless vision loss on right eye since 2 months prior to examination. Patient had been taking medications regularly for hypertension and dyslipidemia. Patient had also been previously diagnosed with peripheral artery disease. Patient came with BCVA of 0.1 and negative pinhole on right eye while BCVA for left eye was 1.0. Relative afferent pupillary defect was positive on the right eye. Intraocular pressure and anterior segment were within normal limits for both eyes. Upon fundus examination of the right eye, findings included 0.3 CDR, dilated and tortuous retinal veins, multiple scattered preretinal hemorrhages, and macular edema. Upon posterior segment evaluation of the left eye, no abnormalities was found. Patient was then diagnosed with BRVO of the right eye and received three monthly injections of bevacizumab. Patient’s BCVA and anatomic condition improved with final BCVA of 0.5 on the right eye. Patient was monitored monthly for the next six months and there was no deterioration on the anatomical and functional outcomes. Conclusion: Lower frequency of monthly bevacizumab injection could be beneficial in some cases of BRVO. Monthly monitoring is essential to maintain anatomical and functional outcomes.

  • Broncho-Oesophageal Fistula Complicating Carcinoma of the Oesophagus

    Broncho-oesophageal fistula refers to an abnormal communication between a bronchus and the oesophagus. Broncho-oesophageal fistula is rare and can be either congenital or acquired. Congenital fistulas are usually diagnosed in the neonatal period as they present with respiratory distress and cyanosis during feeding. Whereas developmental anomaly is the commonest cause in infancy and childhood, the aetiology in adults is most frequently secondary to an oesophageal malignancy1. Non-malignant causes of fistulae are rare. Diagnosis of a broncho-oesophageal fistula may sometimes be difficult because of an insidious and non-specific clinical course2. A rare case of broncho-oesophageal fistula due to carcinoma of the oesophagus, which was discovered incidentally during a barium swallow study is presented. SUMMARY A 68-year-old man with dysphagia who was diagnosed to have carcinoma of the oesophagus, which was complicated by broncho-oesophageal fistula is presented. The role of radiology in the management of this condition is discussed.