International Journal of Case Reports

  • Miller Fisher syndrome associated with respiratory failure

    Miller Fischer syndrome (MFS) is a rare clinical variant of Guillain-Barre syndrome. The diagnosis suspected primarily on clinical trial of areflexia, ophtalmoplegia and ataxia, is confirmed by the mandatory presence of antiganglioside antibodies (anti GQ1b). An acute onset is typical of MFS, beginning with neurological symptoms following a respiratory or digestive infectious illness. The therapeutic options are either the plasmapheresis or the administration of intravenous immunoglobulin (IVIG). Although rare, in certain cases the patients present with respiratory symptoms needing intensive care. We report the case report of a patient which presented with the classical triad of MFS but also with rapid progressive respiratory failure due to bilateral vocal cords palsy and general muscle weakness. He needed respiratory mechanical support. The patient received a treatment by IVIG without any improvement in symptomatology. Eventually he completely recovered and he was discharged from the hospital 3 month later.

  • Tuberculosis Mimicking a Testicular Tumor

    Genitourinary tuberculosis is a challenging clinical entity which can affect the entire male genital tract. Seventy-five- year old male presented with a testicular lump masquerading a testicular malignancy. Histological and microbiological examination of testicular biopsy specimens established the diagnosis of tuberculosis. Isolated testicular tuberculosis is rarely reported. High degree of clinical suspicion and histological sampling are paramount important in the process of diagnostic evaluation.

  • Conditional Dysosmia: a Very Unpleasant Symptom Causing Severe Anorexia and Breathing Problems in Covid-19: a Case Report

    The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new coronavirus that is highly contagious and responsible for the ongoing pandemic disease; coronavirus disease (COVID-19). The disease was first identified in December 2019, and the World Health Organization declared the pandemic on the 11th of March 2020. Although individuals infected with SARS-CoV-2 may be asymptomatic, the disease can present as an upper respiratory tract illness. In the majority of the cases, it is of a mild type, however, some patients experience severe viral pneumonia that leads to respiratory failure, and, in some cases to death. A COVID-19 diagnosis is confirmed by viral RNA detection in nasopharyngeal swab specimens; nonetheless, in some countries, COVID-19 tests are not available for screening and are only used to diagnose severe cases. Since 31 December 2019 and as of 17 October 2020 and in accordance with the applied case definitions and testing strategies in the affected countries 39 400 032 cases of COVID-19 have been reported, including 1 105 353 deaths [1]. The main way to control the spread of COVID-19 is to prevent human-to-human transmission, which can be achieved through a combination of public health measures, including the rapid identification and isolation of infected people [1]. Diagnostic suspicion is based on nonspecific symptoms, such as fever, odynophagia, head- ache, and dry cough which are present in almost all acute respiratory virus cases [2]. Anosmia, which may be associated with the loss of taste, has been initially observed in European cases and seems to be a more specific symptom of COVID-19. Thus, during the pandemic, individuals with these symptoms should be tested for COVID-19; when tests are not available, isolation of the patient is indicated [3]. It should also be noted that olfactory dysfunction significantly influences the physical well-being, quality of life, safety, and…

  • Fatal diffuse pleural calcification due to Tuberculosis- An unexplained entity

    Diffuse pleural thickening has many causes and often need to be diagnosed early as delay in treatment can be lethal. Diffuse pleural thickening can be due to calcifications and may occur as a result of chronic infections including Tuberculous effusion. Primary pleural calcification due to Tuberculosis is extremely rare. A 28 year old patient was presented with exertional dyspnea, chronic cough and pleuritic type chest pain for a period of 4 months. CXR showed left sided diffuse pleural calcifications and ultrasonography showed calcified pleura with thick echogenic material suggestive of an empyema. Further evaluation with a CECT showed left sided diffusely calcified, septated pleura with empyema and contralateral early pleural and peritoneal calcification. Pleural aspiration showed a hemorrhagic exudative lymphocytic effusion with high ADA titer. Cytology did not reveal malignant cells. His serum calcium level was normal. He was diagnosed to have extra-pulmonary tuberculosis and was treated with standard anti TB treatment with an intercostal tube drainage. Despite TB treatment he passed away due to respiratory distress caused by pleural thickening. This case highlights the importance of timely initiation of anti TB treatment and the capacity of Tuberculosis to cause diffuse pleural calcification which can be fatal in an untreated setting.

  • Successful non-operative management of extensive pneumomedia- stinum and pneumoperitoneum

    Background: A 70 year old male presented with acute left flank pain and was found to have extensive free air in both the mediastinal and peritoneal cavities. He was managed successfully without surgery. Case: A 70 year old male presented with left flank pain that began an hour prior to arrival. He had a history of obstructive sleep apnea that had been treated with continuous positive airway pressure therapy (CPAP) at home for many years. His vital signs, physical exam, and laboratory testing were all unremarkable. However, imaging findings were impressive for massive pneumoperitoneum and pneumomediastinum. Given his clinical stability, operative exploration was deferred, and he was admitted for observation and bowel rest. He was discharged less than 48 hours after admission without incident. His history of home CPAP therapy was the only attributable cause for the ominous findings seen on his imaging. Recognizing that this was a case of benign free air saved this patient from the morbidity and potential for death that comes with an unnecessary operative exploration. Conclusion: Continuous positive airway pressure therapy can result in benign free air within the mediastinal and peritoneal cavities. Evaluating the complete clinical scenario will allow for recognition of similar cases in which these grim findings are not indicative of surgical disease, thus avoiding the iatrogenesis of unnecessary surgery.

  • Shewanella, not just found in the marine environment. A rare case of Shewanella algae bacteremia

    A 63 year old Caucasian female with ampullary pancreatic cancer s/p pancreaticoduodenectomy in 2016 was admitted to our cancer center with complaints of fever (temperature 103° F) and abdominal pain. She was found to have multiple liver abscesses. Her blood culture grew out Shewanella algae. We herein report on this rare human bacterial infection.

  • A suspected insulinoma with the unexpected histopathological finding of a nesidioblastosis – A case report and literature review

    Introduction: Nesidioblastosis is a hyperplasia of the beta cells that causes persistent hyperinsulinemic hypoglycemia, unfortunately, it is difficult to diagnose through imaging studies. Case presentation: A 68-year-old woman with palpitations, diaphoresis, dizziness and alterations in the level of consciousness that improve with food intake. Laboratories: glucose 35.0 mg/dl, insulin 12.5 mUI/ml, proinsulin 14.1 pmol/L and peptide C 2.55 ng/ml. Octreoscan reveals an abnormal epigastric uptake area and the tomography shows a focal hypervascular lesion in pancreatic body of 12×11 mm. A distal pancreatectomy was performed without palpating the tumor in transoperative period, and a diffuse nesiodioblastosis was reported in the histopathological study. The patient persists with hypoglycemia and an additional pancreatic resection was performed, resecting 90% of the organ. Although an insulinoma was not located in the piece, an area surrounded by connective tissue was observed where islet hyperplasia was more accentuated. Discussion: The pathophysiology of nesidioblastosis is unknown, its main differential diagnosis is insulinoma and this should be suspected when the tumor can not be identified. Most agree that a pancreatectomy that involves 60-80% of the total organ can control glucose levels with low risk of diabetes and pancreatic insufficiency. Conclusion: The nesidioblastosis should be suspected when a hyperinsulinemic hypoglycemia is difficult to control and when a tumor can not be identified. The extension of the pancreatectomy should be individualized and if an insulinoma is not localized and a nesidioblastosis is suspected, an intraoperative histopathological examination with frozen section evaluation for the margins could determine the extent of pancreatectomy.

  • Rare case of ectopic pleomorphic adenoma on the plane of the cheek

    Pleomorphic adenoma is a benign tumor of the salivary gland with the highest incidence rate among all salivary gland tumors in the general population. Even though it’s common, ectopic presentation of the same is rare. When it happens, it presents in the head and neck region. We discuss in this paper a rare case of ectopic pleomorphic adenoma on the plane of the cheek.

  • Phosphate Enema Causing Life-Threatening Rectal Perforation

    We report a near fatal rectal perforation due to a phosphate enema in an elderly male. The presentation in septic shock within 4 hours of the enema is quite rare. Early recognition and prompt management are essential for a good outcome. A defunctioning colostomy is standard for these cases but we recommend a distal rectal washout since intraluminal faeces in a loaded rectum could be a cause of ongoing sepsis. Although enemas are commonly used for constipation in the elderly, suppositories and oral preparations should be used preferentially where appropriate.

  • Methemoglobinemia – A review and recommendation for management – Acute methemoglobinemia with hemolytic anemia following suicidal use of aniline based substance

    Methemoglobinemia is a rare disease classification related with congenital or acquired (usually iatrogenic) hemoglobin oxygenation disorder. Despite the fact that number of potentially methemoglobin forming agents is very long, methemoglobinemia is still a case-report of patients admitting to the Emergency Departments. The patient was brought after consuming resin hardener for suicidal purposes from the Center of lower reference to the hospital Emergency Department with suspected burns of the gastrointestinal tract. The patient presented cyanosis, dyspnoea and brown-colored urine on admission.