Case Reports in Clinical Medicine

Journal Information
ISSN / EISSN : 2325-7075 / 2325-7083
Published by: Scientific Research Publishing, Inc. (10.4236)
Total articles ≅ 694
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Omar Sow, Nicolas Sorbane Fetche, Alice Anusca, Lionel Perrot
Case Reports in Clinical Medicine, Volume 11, pp 133-137; https://doi.org/10.4236/crcm.2022.114020

Abstract:
Meckel’s diverticulum is a common pathology in children and rare in adults. We present a case of a 79-year-old patient in which a significant gastrointestinal bleeding, whose paraclinical explorations confirmed a fatty tumor of the terminal ileum. The exploratory coelioscopy revealed a tumor of the Meckel diverticulum complicated of intestinal invagination, resected at the same time with resection and extracorporeal anastomosis by mini coelio-guided laparotomy. Histology confirmed the presence of heterotopical tissue of the duodenal mucosa with Brunner cells and a carcinoid tumor. In conclusion, this clinical case shows that coelioscopy can be considered a very important diagnostic and therapeutic tool in this pathology especially in the elderly.
S. S. Subramanian
Case Reports in Clinical Medicine, Volume 11, pp 94-100; https://doi.org/10.4236/crcm.2022.113015

Abstract:
Low back pain remains a most common clinical entity among musculoskeletal disorders. Pain reducing modalities, Manual therapy various specific techniques were widely used physiotherapeutic means as part of treatment for subjects with low back pain. An emerging trend with Independent physiotherapy practice, knowing red flags, conditions requiring investigations and experts treatment were to be recognized and adhered for maximizing patients care and benefits. Prostate cancer among men above 50 years were more found to be linked with Low back pain. This original research presentation where a subject having chronic low back pain found to have prostate cancer were analyzed and discussed with scientific evidence on clinical manifestations, investigations and medical management. Underlines the importance of recognizing, directing and getting treated of the root cause of subjects suffering with Low back pain due to prostate cancer and not just keep treating the symptoms alone were major purpose of this study.
Steven Hardy, Ryan King, Stephen Scholand
Case Reports in Clinical Medicine, Volume 11, pp 101-105; https://doi.org/10.4236/crcm.2022.114016

Abstract:
Background: Yellow urticaria is a rarely reported phenomena that occurs in patients with hyperbilirubinemia that suffer an episode of urticarial rash. A variety of insidious etiologies of hyperbilirubinemia have been reported in cases of yellow urticaria making it an opportunity to catch serious liver or biliary disease early in its course. Case Report: We report a case of yellow urticaria that occurred in a 67-year-old male suffering from end-stage liver disease after he had received a transfusion of fresh frozen plasma. Physical examination and thorough history collection allowed the determination of the proper diagnosis and guided further clinical care. Conclusion: An occurrence of yellow urticaria necessitates that the clinician finds two diagnoses: the cause of hyperbilirubinemia, and the cause of urticaria. While striking in appearance, yellow urticaria may be most clinically significant when it prompts recognition of previously unknown hepatic or biliary pathology.
Mohamed Elbayomi, Timo Seitz, Michael Weyand
Case Reports in Clinical Medicine, Volume 11, pp 25-30; https://doi.org/10.4236/crcm.2022.111005

Abstract:
A troponin in serum of more than one Million in vivo is rare insult. We report a case of 85-year-old woman who was transferred to our institution because of acute ST elevated myocardial infarction and the troponin level reached a peak of 1,032,904.2 pg/ml. She was discharged with highly reduced left ventricular function, however in the three months follow up after a coronary bypass operation she completely was free from heart failure symptoms and echocardiography showed a totally normal function of both ventricles. This case study highlights that the initial serum troponin in acute settings can mislead the long-term prognosis and gives prominence to the expeditious myocardial revascularization.
Malarkodi Suppamutharwyam, Tiong Ing Khieng
Case Reports in Clinical Medicine, Volume 11, pp 106-115; https://doi.org/10.4236/crcm.2022.114017

Abstract:
Coronavirus disease 2019 (COVID-19) often has multifaceted presentations, even in young adults, which poses a significant challenge to clinicians who are caring for older adults. Older patients often present with subtle atypical manifestations, and failure to recognize these may lead to a cascade of negative events. Age-related immune system changes, comorbidities, and atypical presentations often make early diagnosis of COVID-19 difficult. Here, we report a case of an 82-year-old moderately frail male patient who presented with generalized body weakness and tested positive for COVID-19. On the second day of admission, he developed unilateral body weakness and aphasia, and computed tomography of the brain revealed acute right frontal spontaneous intracerebral hemorrhage with no vascular anomaly. He did not have any traditional risk factors for intracerebral hemorrhage and was not on any anticoagulants. The course of this case illustrates the delicate balance between the atypical presentations of COVID-19, the importance of a comprehensive geriatric assessment, and the management of older adults during the COVID-19 pandemic.
Ronald Lagoe, Shelly Littau
Case Reports in Clinical Medicine, Volume 11, pp 1-7; https://doi.org/10.4236/crcm.2022.111001

Abstract:
Hospitals in the United States are being challenged to provide the capacity for adult medicine and surgery care. The study suggested that the hospitals of Syracuse, New York have generated additional inpatient capacity through a number of efforts. One program involved moving some low severity of illness inpatient procedures to ambulatory care. A different approach has also avoided inpatient utilization by diverting incoming ambulances to different providers. The third program evaluated in the study, length of stay reduction, was a different type of initiative. It has generated additional inpatient capacity by reducing the amount of inpatient care provided. In effect, it has increased inpatient capacity by addressing the efficiency of care. These programs illustrate the potential for improving hospital capacity at the community level. Each of them was developed by acute care providers using local services.
Deanna Ingrassia Miano, Gilbert Xue, Erika White, Faisal Ridha Al-Timimi
Case Reports in Clinical Medicine, Volume 11, pp 152-159; https://doi.org/10.4236/crcm.2022.115023

Abstract:
Treatment of central retinal artery occlusion (CRAO) has been an ambiguous entity in the medical community. Many interventions have been explored; however, a standard of care has yet to be defined. Recent studies have suggested localized intra-arterial fibrinolysis as a promising method; however, a timeframe for optimal treatment initiation continues to be investigated. This case demonstrates an instance of CRAO treated with local fibrinolysis, however, what could be due to delayed time-to-treat, final visual outcomes were unfavorable. In conjunction with supporting literature, we believe optimization of thrombolytic protocols should be sought after to facilitate successful treatment outcomes. In addition, we encourage community awareness of the signs and symptoms of CRAO in hopes that earlier patient presentations will lead to swifter interventions and overall preservation of ocular function.
Dana Criṣan, Andreea Ardelean, Mihaela Coman, Laurenţiu Stoicescu, Ioana Rusu, Nadim Al Hajjar, Tudor Pop, Sorin Criṣan, Constantin Bodolea, Lucreţia Avram
Case Reports in Clinical Medicine, Volume 11, pp 63-71; https://doi.org/10.4236/crcm.2022.113010

Abstract:
The small bowel represents one of the main sites for cutaneous melanoma metastasis; however, numerous cases of primary intestinal melanoma have recently been described. In view of this, we present the case of a 39-year-old woman admitted for nausea, heartburn, abdominal pain, change in bowel habits and weight loss. Contrast-enhanced CT revealed a small bowel mass. Surgical resection of a 6 cm ileal tumour with regional mesenteric lymphadenectomy and end-to-end anastomosis was performed. Histopathological findings indicated the presence of an ileal melanoma metastasis. Subsequent dermatological examination identified a cutaneous lesion on the right forearm, however no malignant cells were found at the histopathological exam. Whole body PET CT with FDG identified multiple frontal and parietal lesions. Genetic testing was positive for BRAF gene V600 E mutation. The patient underwent multiple neurosurgical procedures for the resection of cerebral metastases. Palliative external radiation and chemotherapy was also attempted. After approximately 2 years after the diagnosis, the patient died following multiple episodes of intracranial hypertension.
Khalid Al-Quliti, Rakan Maher Alhujeily
Case Reports in Clinical Medicine, Volume 11, pp 48-54; https://doi.org/10.4236/crcm.2022.113008

Abstract:
Epilepsy is a common neurological disorder in neurology clinic. Levetiracetam is considered as one of common antiepileptic drugs used to manage epilepsy with good efficacy and tolerability profile. It is renally excreted and not depending on the cytochrome p450. It has adverse effects reported as somnolence, headaches, dizziness, depression and anxiety. Also, it was reported that levetiracetam can cause Acute kidney injury (AKI), renal profile disturbance, that may be related to its way of excretion and possible nephrotoxicity especially with high loading dose. We are reporting a young female patient with epilepsy presented to hospital with status epileptcus and started on loading dose of levetiracetam 3 grams and then maintenance dose of 1 gram twice daily seizure were controlled but she developed acute kidney injury that improved after discontinue leveriracetam and medical management without renal dialysis and discharged home in stable condition. Physician and health care providers should be aware of such rare adverse reaction and available management options for better patient care and outcome.
Wadi Bnouhanna, Taho Oulounao Adlaide, Chaima EL Jemili, Mounia Rahamani, Maria Benabdeljlil, Saadia Aidi
Case Reports in Clinical Medicine, Volume 11, pp 13-18; https://doi.org/10.4236/crcm.2022.111003

Abstract:
Introduction: Ischemic strokes represent a classic complication of infective endocarditis (IE) and are most often related to the fragmentation of valvular vegetation. In most cases, they occur in the Sylvian territory and are related to Staphylococcus aureus. MRI can demonstrate, in addition to the AVCI image, cerebral microbleeds (CMBs) that are very suggestive of the diagnosis. We present the case of a patient who presented an ischemic stroke occurring in the context of infective endocarditis. Observation: A 32-year-old woman with no previous medical history initially presented with acute febrile headache, two weeks later she developed right hemiplegia with aphasia in the context of fever. Her general examination revealed lesions on the soles of her feet, in the form of nodules, infected in places, suggestive of Janeway nodules (characteristic of IE). The brain MRI showed an ischemic stroke in the Sylvian territory, with the presence of multiple microbleeds on the magnetic susceptibility sequences. The biological examination showed a severe inflammatory syndrome; the transthoracic echocardiography (TTE) confirmed the presence of vegetation on the aortic valve; and the blood cultures showed a Staphylococcus aureus. Antibiotic therapy was started, and the patient was transferred to the cardiology department. Discussion: Our observation has a double interest. The first is clinical due to the presence of plantar nodules (Janeway’s nodules) that are characteristic of IE which should orientate the diagnosis before the installation of the stroke, and the second is radiological and linked to the discovery of microbleeds. Their presence is increasingly reported in the literature, but their pathophysiology is not yet very clear. Conclusion: Stroke is the most frequent extracardiac complication during IE. The presence of microbleeds contributes to early diagnosis, especially in asymptomatic forms.
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