Case Reports in Internal Medicine

Journal Information
ISSN / EISSN : 2332-7243 / 2332-7251
Published by: Sciedu Press (10.5430)
Total articles ≅ 380
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Michael James Brockman, Anne Taylor, Farida Eid, Suranjana Dey;, Shawn Corcoran;
Case Reports in Internal Medicine, Volume 9; https://doi.org/10.5430/crim.v9n1p1

Abstract:
Antihistamine usage is commonplace for alleviating allergy symptoms, though they are not without side-effects. We present a case of antihistamine use precipitating upper and lower extremity ballismus in a patient. We also discuss other case reports which outline similar dopaminergic dysregulation secondary to antihistamine usage, as well as our recommendations for prevention of these symptoms.
Fahad A AlKaabba, Holman Li, Farrah Ibrahim
Case Reports in Internal Medicine, Volume 9; https://doi.org/10.5430/crim.v9n1p4

Abstract:
The SARS-CoV-2 pandemic has grown into a major global concern with huge efforts to combat the spread. Exaggerated inflammatory response plays a major role in which was the rationale to use corticosteroids as a treatment option. However, multiple studies showed an association between of opportunistic and bacterial infections in patients under corticosteroid therapy. We report a case of a 76-year old patient diagnosed with COVID-19 pneumonia, treated with 10 days Dexamethasone and Remdesivir who presented with abdominal symptoms with eosinophilia. Biopsy and stool studies revealed strongyloides stercoralis larvae. The patient was treated with 2 doses of Ivermectin with significant clinical resolution. Clinician should have high clinical suspicion for Strongloydiasis in patients who have lived or visited Strongyloides stercoralis endemic areas and for patients with unexplained eosinophilia. Prompt treatment with Ivermectin is crucial for confirmed cases and should be also implemented empirical in high risk groups, where obtaining a diagnosis is unfeasible.
Pouria Hosseini, Yogamaya Mantha, Shannon J Koh, Gebre K Tseggay, Jyothi K Baby, Rahul Gill, Mark Feldman
Published: 23 September 2021
Case Reports in Internal Medicine, Volume 8; https://doi.org/10.5430/crim.v8n2p5

Abstract:
A 29-year-old woman with known sickle cell disease (SCD) and iatrogenic iron overload presented to the emergency department with a recurrent pain crisis and fever. Blood cultures obtained at a recent prior admission for the same complaints grew M avium. Bone marrow biopsy revealed non-caseating granulomas, but stains for mycobacteria and fungi were negative. Disseminated non-tuberculous mycobacterial infections (NTMIs) occur almost exclusively in immunosuppressed patients. SCD is not considered a risk factor for the development of disseminated NTMIs, making diagnosis challenging in this population. However, a number of case reports describing disseminated NTMIs in patients with SCD have been published. This case adds to the current literature, suggesting SCD with iatrogenic iron overload is a possible risk factor for disseminated NTMIs. Potential mechanisms for this increased risk include 1) functional asplenia, 2) iatrogenic iron overload, 3) chronic indwelling central venous catheters, and 4) hydroxyurea use. Further investigation is required to describe the strength and mechanism of the relationship between SCD and disseminated NTMIs.
Christine Joy Licata, Sowmya Arja, Suzanne Teuber
Published: 23 September 2021
Case Reports in Internal Medicine, Volume 8; https://doi.org/10.5430/crim.v8n2p10

Abstract:
Hyperoeosinophilic syndrome (HES) is rare, and clinicians may not recognize its potential association with malignancy. Red flag signs of HES include steroid resistance, older age, and significant lymphadenopathy that can be indicative of malignancy. In this case, an elderly male presenting with right chest wall erythema and axillary lymphadenopathy was initially diagnosed with and treated for cellulitis. Labs were significant for hypereosinophilia. Evidence of end organ damage raised concern for HES. Over the course of three hospitalizations, he was found to have a rising eosinophil count despite high-dose corticosteroid treatment. Further investigation eventually revealed a diagnosis of Hodgkin’s Lymphoma. This case highlights steroid-resistant HES as a presenting sign of malignancy and allows for discussion of potential investigative approaches for HES therapy. Though corticosteroids are first-line treatment for hypereosinophilia and HES, they are well known to have many adverse effects. Biologics, such as mepolizumab and benralizumab, have more acceptable side effect profiles and are effective in treating non-myeloid HES. The use of biologics as first-line treatment for HES has yet to be investigated.
Quoc Bui, San Tran, Steven Pham, Vien Phan, Khiet Nguyen, Ngoc Mai, Thoai Nguyen, Lac Nguyen, Thanh Hoang, Chuong Le, et al.
Published: 23 September 2021
Case Reports in Internal Medicine, Volume 8; https://doi.org/10.5430/crim.v8n2p1

Abstract:
The surgical resection timing of left atrial (LA) myxoma is still controversial in concern for the risk of further embolic phenomena if delayed surgery versus hemorrhagic transformation during early surgery. We describe a case of 60-year-old man without significant past medical history admitted with two-day of double vision and found to have LA myxoma. Multiple factors including clinical aspects and comorbidities should be evaluated to decide the favorable management.
Liyan Yao, William Byas, Matthew Li, Merjona Saliaj
Published: 27 January 2021
Case Reports in Internal Medicine, Volume 8; https://doi.org/10.5430/crim.v8n1p9

Abstract:
Treatments for COVID-19 infection have varied widely within the past year. Remdesivir is the only direct-acting antiviral approved by the Food and Drug Administration with demonstrated efficacy in the management of patients with COVID-19.[1] Commonly reported adverse effects include hepatotoxicity and gastrointestinal symptoms such as nausea and diarrhea. Less common adverse effects include respiratory toxicity, cardiovascular toxicity and nephrotoxicity.[2] We report a case of international normalized ratio (INR) prolongation in a COVID-19 patient receiving concomitant warfarin and remdesivir therapy.
Aditi Singh, Morgan M Bailey, Neha J Patel, Danae Hamouda
Published: 27 January 2021
Case Reports in Internal Medicine, Volume 8; https://doi.org/10.5430/crim.v8n1p5

Abstract:
Objective: To report a case of leukocytosis (LCT) and hyperleukocytosis (HLCT) episodes post Pegfilgrastim (Neulasta) administration.Case Summary: A 74-year-old female presented with several episodes of LCT and HLCT following administration of Pegfilgrastim while undergoing adjunct dose dependent chemotherapy for adenocarcinoma of the gallbladder. The patient had completed cycle 6, day 8 of chemotherapy and subsequently received Neulasta 48 hours later. Two days later, she presented to the ER with white blood cell (WBC) count of 110K. Prior to Neulasta administration, her WBC counts were within normal range and after each episode of leukocytosis, the patient’s WBC count trended downward. Upon consultation, hematology considered Pegfilgrastim as a likely cause for this patient’s WBC cycling and HLCT.Discussion: Pegfilgrastim-induced HLCT occurs in less than 1% of patient cases. Dose-dependent chemotherapy combined with Pegfilgrastim treatment is an optimal treatment option to reduce the length of chemotherapy schedules and risk of febrile neutropenia. Following the dosing of Pegfilgrastim, the drug clearance is mediated by neutrophil receptors which results in a reduction of ANC values.Conclusions: Further studies are needed to determine the optimum timing and dosage of Pegfilgrastim to offer maximum myeloprotective benefit while also minimizing the risks of adverse events such as leukocytosis and hyperleukocytosis experienced by our patient.
Yoshihiro Miyashita, Miyuki Kobayashi, Yumiko Kakizaki, Toshiharu Tsutsui, Takashi Kumagai, Hiroaki Kobayashi, Haruna Yamaki, Chisa Ohmori, Toshio Oyama
Published: 27 January 2021
Case Reports in Internal Medicine, Volume 8; https://doi.org/10.5430/crim.v8n1p1

Abstract:
A 67-year-old patient visited the hospital for the evaluation of pulmonary nodular lesions detected in his chest radiograph duringan annual screening. He was asymptomatic and transbronchial tumor biopsy of the nodule in the right upper lobe revealed features of pulmonary sarcoma, which did not resemble any of the histolopathological categories of primary lung cancer. A positive immunological staining for both HMB-45 and Melan-A resulted in the final diagnosis of melanoma. It is important for a respiratory clinician to remind the possibility of a melanoma, when tumors cannot be histopathologically classified under any of the categories of primary lung cancer.
Nahid Suleman, Janet Woodroof, Eyad Reda
Published: 27 January 2021
Case Reports in Internal Medicine, Volume 8; https://doi.org/10.5430/crim.v8n1p22

Abstract:
Hepatosplenic T cell lymphoma (HSTCL) is an exceedingly uncommon, aggressive peripheral T cell lymphoma comprising < 1% non-Hodgkin’s lymphomas (NHL). Despite treatments including allogeneic stem cell transplantation, median survival is < 2 years. In the majority of patients, the etiology of HSTCL is undetermined; although it has been associated with chronic immunosuppression which accounts for 20% of cases. HSTCL presents as a systemic illness, and sometimes in association with hemophagocytic lymphohistiocytosis syndrome (HLH). Our patient is a young male with a long-standing history of Crohn’s disease on immunosuppressive medications, who presented with progressive bicytopenia. He was diagnosed with HSTCL on a bone marrow biopsy and met clinical diagnostic criteria for HLH. He was started on chemotherapy and dexamethasone per HLH treatment protocol and underwent allogeneic hematopoietic stem cell transplantation (HSCT).
Lac Nguyen, Chuong Le, Steven Pham, San Tran, Thanh Hoang, Khiet Nguyen, Thoai Nguyen, Hashim Chaudhry, Nghi Tran, Ngoc Mai, et al.
Published: 27 January 2021
Case Reports in Internal Medicine, Volume 8; https://doi.org/10.5430/crim.v8n1p17

Abstract:
Cardiovascular manifestations of COVID-19 infection remain an ongoing study. We present a case of significant bradycardia in the patient with COVID-19 sepsis. We discuss about the possible mechanism, pathophysiology, and management in this pathology.
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