International Journal of Case Reports

  • A Case Report of Warfarin Induced Coagulopathy and Upper Gastro Intestinal Bleeding

    Warfarin is an oral vitamin k antagonist prescribed to those patients for the treatment and prevention of venous thromboembolism. The major challenges to be faced during the therapy were a greater risk for both major well as minor bleeding, which makes the regular monitoring of INR (international normalized ratio) mandatory. Here we report a case study of 76 year old male who presented to institution with the complaints of bleeding from oral cavity due to consumption of conventional anticoagulant therapy. Patient was on anticoagulation therapy for paroxysmal atrial fibrillation since 2011. The blood investigation revealed anemia (Hemoglobin: 6.1g/dl). He was immediately transfused with packed RBC and fresh frozen plasma to replenish the body reserves. Prothrombin time (PT)/INR was reported undetectable and warfarin was withheld from the past medications and was restarted at INR therapeutic range. Furthermore this case highlights the need for a better communication by providing counselling regarding all aspects of medications as well as lifestyle modifications and also by giving patient information leaflets.

  • Regional Anaesthesia for Lumbar Laminectomy- Case Series

    The use of central neuraxial anaesthesia for lumbar laminectomy is evolving in our centre with its attendant advantages like decrease in intraoperative blood loss, peri-operative cardiac ischemic incidents, postoperative hypoxic episodes, arterial and venous thrombosis, and it provides longer/ adequate postoperative pain control. Nonetheless, blindness a possible complication under general anaesthesia is preventable with regional anaesthesia, this is because patient is awake and there is no restriction in neck movement. This case series helps to provide feasibility of lumbar laminectomy under central neuraxial anaesthesia (spinal, epidural and combined spinal epidural anaesthesia).

  • Temozolamide-Associated Pancytopenia in a Patient with Glioblastoma Multiforme

    Glioblastoma multiforme (GBM) is the most common primary malignant brain tumor. GBM treatment is a combined modality approach involving maximum surgical resection, adjuvant postoperative radiation and adjuvant chemotherapy treatment.There is a greater risk of hematological toxicity in concurrent temozolomide and radiation therapy. We reported that pancytopenia has been developed on a 54-year old female patient with GBM after concurrently used temozolomide and radiotherapy treatment. It should be kept in mind that this side effect may develop because the risk of morbidity and mortality may be elevated. Therefore, supportive therapies should be started immediately in patients where this toxicity developed.

  • The Rare Case of Thromboangiitis Obliterans in a Patient Previously Diagnosed with a Stroke

    Thromboangiitis obliterans (Buerger’s disease) is a disease of small and medium-sized vasculature, mainly involving the distal upper and lower extremities in male patients under the age of 45. Smoking tobacco is considered to be a predisposing and triggering agent. This presentation discusses the case of JS, a 35-year old male patient who initially presented with a stroke, followed by pain and swelling in the upper extremity, and finally with pain, absent peripheral pulses, and necrosis of the left lower extremity requiring below knee amputation. This case is of interest due to the rarity of this disease in the developed world, the presentation of a stroke in a young patient later diagnosed with thromboangiitis obliterans, and the use of a prostaglandin analog in treatment. This case highlights the difficulty of making the diagnosis of vasculitis and the time consuming, multispecialty approach that is required. The availability of subspecialists, medical record integration, communication between community hospitals, and the drug Iloprost could have positively affected the patient’s outcomes and prognosis.

  • Case Report on Port Site Sinus

    Port site infection (PSI) is an infection which is seen at port site after any laparoscopic surgery or at the site where any other medical devices are inserted into the body. It is one of the rare but preventable complications of successful laparoscopic surgeries due to improper sterilization of instruments. PSI is already known to be a rare complication but if it is occurring because of mycobacterium then it is considered to be the rarest. One of the commonest causative organisms is Staphylococcus and mycobacterial species also. Antibiotics are prescribed based on culture sensitivity reports. If mycobacterium is seen to be the cause, then second line anti-tubercular drugs (ATT drugs) like Macrolide (Clarithromycin), Quinolones (Ciprofloxacin), Tetracyclines (doxycycline) and aminoglycosides (amikacin and tobramycin) are prescribed. A case of male patient is reported who underwent laparoscopic surgery (TAPP) and developed pus discharge from supraumbilical port site. Sinus tract excision for port site infection was tried two times but every time recurrence was seen. Anti-tubercular drugs was started by patient after collecting excision biopsy reports showing Langerhans cells which are associated with TB and progress was seen in patient.

  • A Case of Klinefelter Syndrome Presenting with Infertility and Gynaecomastia

    The term Klinefelters syndrome refers to a group of chromosomal disorders in which the normal male karyotype 46XY has at least one extra X chromosome. The 47XXY aneuploidy is the most common human male sex chromosomal disorder associated with infertility and hypogonadism .It has prevalence of 1 in 500 to 1 in 800 live births independent of race. The aim of this case report is to document the rare case in the literature with the view of raising awareness about its existence in our environment and beyond. The Case: We present a case of a 31 year old black male patient with a 7 years history of progressive bilateral painless breast swelling that has rapidly increased in size over the past 3 years. He has no associated breast discharge. He also complained of associated infertility since he married his wife about 7 years ago despite regular unprotected intercourse within the same period. Hormonal assays done showed elevated gonadotropins( Leuteinising hormone and follicle stimulating hormone) , low levels of testosterone and elevated estradiol. Karyotype done revealed 47XXY karyotype.he was counseled on the need for assisted reproductive therapy, which he accepted. Subsequently, his wife was delivered of a baby boy following a successful assisted reproductive therapy by an obstetrician. Conclusion: Klinefelter syndrome is a rare clinical syndrome but a common chromosomal cause of male infertility. The introduction of assisted reproductive therapy has greatly improved infertility outcomes in terms of achieving pregnancy and live births.

  • Late Presentation of Posterior Urethral Valve in a 24-Year-old Man

    Posterior urethral valve (PUV) is the most common cause of lower urinary tract obstruction in male neonates, with an incidence of one case per 8,000 to 25,000 live births1. The diagnosis is usually made prenatally or at birth, when male newborns are evaluated for prenatal hydronephrosis, or during early childhood, but rarely during adolescence or adulthood. Late presentation of PUV is rare and it has been estimated to account for 10% of cases2. Presentation in adulthood may occur due to the presence of a mild form of the disease devoid of the life threatening complications seen in children with the severe form3. A rare case of PUV which manifested in adulthood with lower urinary symptoms is presented to create awareness of the likelihood of the disease outside the paediatric age group.

  • Traumatic Tooth Aspiration: Case Report and Review of the Literature

    In the setting of polytrauma, several foreign bodies could be aspirated, including avulsed teeth. Because a minimally responsive polytrauma patient could be at risk of airway compromise, emergency intubation is performed which can by itself lead to aspirated tooth. A complete dental examination is required to check for any fracture. A CT scan is the most sensitive modality for diagnosis. A rigid or flexible bronchoscopy is indicated for removal of the foreign bodies.

  • Evaluation of Macular Circulation in Patient with Sudden Visual Loss Secondary to Behcets Perifoveal Vasculitis by Using (Retinal Flow) Swept Source Optical Coherence Tomography Angiography Map

    Objective: To evaluate macular vascular circulation in patient with perifoveal vasculitis secondary to Behcet’s disease by using (Retinal Flow) swept source optical coherence tomography angiography map. Methods: We retrospectively review a 39-y old female patient, with history of Behcet’s disease, presented with history of sudden unexplained central loss of vision which was more significant on the right eye with best corrected vision (BCVA=0.1) and less on the left eye with best corrected visual acuity (BCVA=0.7). The clinical ophthalmic examination of both anterior and posterior segments for the both eyes were normal with no any signs of uveitis. Imaging with DRI Triton Swept Source (SS- OCTA) (Topcon, Japan) was performed for evaluation of both superficial and deep capillary plexus of macular area. Fluorescein angiography (FA) was used also for assessing foveal avascular zone features. Results: The SS-OCTA Retinal Flow map was more sensitive than FA in marking out hypoperfusion in both superficial capillary plexus (SCP), and deep capillary plexus (DCP), especially in the right eye which had the positive correlation with visual acuity. SS-OCTA Retinal Flow map was also sensitive in showing improvement of macular hypoperfusion after treatment of Behcet’s Perifoveal Vasculitis. Conclusion: OCTA is a noninvasive imaging modality that can be used to evaluate macular vascular changes in Bechet’s perifoveal vasculitis and can explain acute visual loss in Behcet.

  • Pseudo-Ortner Syndrome

    Ortner syndrome is vocal cord paralysis secondary to left recurrent laryngeal nerve palsy from atrial dilation. We present the case of a 28 year old woman with metastatic appendicular cancer to the peritoneum and pleura who experienced chest pain, progressive dyspnea and change in vocal quality secondary to esophageal impingement on the recurrent laryngeal nerve. This novel case of “Pseudo-Ortner Syndrome” further demonstrates the susceptibility of the laryngeal nerve to palsy secondary to mechanical impingement stemming from an unlikely distal non cardiac source.