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Case Reports in Critical Care

Pierre Voizeux, Romain Lewandowski, Theresa Daily, Omar Ellouze, Olivier Bouchot, Belaïd Bouhemad, Pierre-Grégoire Guinot
Objective: To describe the case of a patient who developed a serotonin syndrome due to a 3,4-methylenedioxymethamphetamine ingestion with electrical storm and refractory cardiac arrest. Design: Case report. Study Selection: ICU of a university hospital. Patient: A 22-year-old man transferred to the emergency room with hyperthermia, tremors, and mydriasis presented a cardiac arrest due to ventricular fibrillation. Interventions: We implemented extra-corporeal life support combined with vasoactive drugs...
2019: Case Reports in Critical Care
Elise Godeau, David Debeaumont, Elise Artaud-Macari, Laurie Lagache, Gurvan Le Bouar, Jérémy Coquart
Case Presentation: This clinical case presents the history of a woman hospitalized for acute respiratory distress syndrome (ARDS). A 62-year-old woman, with regular physical activity and no history of respiratory disease or smoking, was hospitalized for moderate ARDS with bilateral pneumonitis. Fourteen days later, she was discharged from the intensive care unit and received respiratory physical therapy. One month later, she experienced exertional dyspnea. A regression of alveolar condensation with persistent sequelae at the pulmonary bases was noted...
2019: Case Reports in Critical Care
Charlène Couturier, Guillaume Dupont, François Vassal, Claire Boutet, Jérôme Morel
Background and Importance: Cerebral fat embolism (CFE) occurs mainly after long-bone fractures. Often reducing to minor neurological disorders as confusion, it can sometimes cause more severe consequences such as coma or even death. While CFE has been described for several years, there is no consensual treatment. Clinical Presentation: We report the case of a 15-year-old girl with a severe cerebral fat embolism secondary to a longboard fall with a femur fracture...
2019: Case Reports in Critical Care
Khuram Khan, Irwin White-Gittens, Saqib Saeed, Leaque Ahmed
Methemoglobinemia is a rare complication in clinical practice. It is most commonly seen in patients undergoing endoscopic procedures, including EGDs, laryngoscopies, bronchoscopies, and nasogastric tube insertions. This is thought to be a disease seen almost exclusively in patients with genetic predispositions to develop it; the increasing use of topical anesthetics during procedures has made methemoglobinemia a disease entity that every clinical provider should be able to recognize and treat. Clinically, patients become cyanotic with mild oxygen derangements on pulse oximetry, in the range of 84 to 90%...
2019: Case Reports in Critical Care
Geoffrey Newcomb, Peter Mariuz, Daniel Lachant
Cytomegalovirus (CMV) can cause severe disease including colitis, pneumonitis, and less commonly encephalitis, in profoundly immunocompromised individuals. CNS imaging findings are nonspecific and diagnosis is made by identifying CMV in cerebral spinal fluid through PCR testing or cell culture. Early initiation of antiviral therapy is key with an overall poor outcome. Here we present a patient with newly diagnosed AIDS and pneumocystis jiroveci pneumonia who was febrile and remained encephalopathic for the first 6 weeks of his admission despite treatment and extensive work up for encephalopathy...
2019: Case Reports in Critical Care
Colin Casault, Juan G Posadas-Calleja
Background: We describe a case of secondary Hemophagocytic Lymphohistiocytosis (HLH) from autoimmune hepatitis mimicking severe sepsis in a man admitted to the intensive care unit. Case Presentation: A 34-year-old Pakistani male with a prior history of biopsy-proven autoimmune hepatitis presented to a regional hospital with severe fever, cytopenias, hyperferritinemia, hypertriglyceridemia, splenomegaly, and a bone marrow biopsy showing hemophagocytosis. After ruling out mimicking conditions, a diagnosis of HLH was made using the HLH-2004 diagnostic criteria...
2019: Case Reports in Critical Care
Hassan Nasser, Semeret Munie, Dania Shakaroun, Tommy Ivanics, Surya Nalamati, Keith Killu
Introduction: Isolated Clostridium difficile small bowel enteritis is a rare condition with significant morbidity and mortality. Presentation of Case: An 83-year-old female with refractory ulcerative colitis underwent a total proctocolectomy and end ileostomy. Her postoperative course was complicated with return to the operating room for repair of an incarcerated port site hernia. Subsequently, she developed septic shock and multiorgan failure requiring intubation and mechanical ventilation, renal replacement therapy, and high dose vasopressors...
2019: Case Reports in Critical Care
C Laivier, M-O Bleuze, P Hantson, J Devos
A 53-year-old man developed a Legionella pneumophila pneumonia complicated by rhabdomyolysis, acute kidney injury, and protracted ileus. Risk factors were smoking and chronic alcoholism, but the patient had no history of previous abdominal surgery. Hemodialysis was required for a period of 5 weeks with a full renal recovery. Pneumonia required respiratory support but for a limited period of 6 days. The protracted course of the ileus led to explorative laparotomy despite negative computed tomography findings...
2019: Case Reports in Critical Care
Niclas Lundström, Gert Henriksson, Ola Börjesson, Malin Jonsson Fagerlund, Johan Petersson
We present a case of repeated cardiac arrests derived from dynamic hyperinflation in a patient with severe tracheobronchomalacia. Mechanical ventilation led to auto-PEEP with hemodynamic impairment and pulseless electric activity. Adjusted ventilation settings, deep sedation, and muscle paralysis followed by acute stenting of the affected collapsing airways restored ventilation and prevented recurrent circulatory collapse. We briefly review the pathophysiology and treatment options in patients with dynamic hyperinflation...
2019: Case Reports in Critical Care
Ronni Andrea Muñoz Tovar, Luis Carlos Alvarez Perdomo, Sandra Milena Rojas Molina, Silvana Jimenez Salazar
Venous thromboembolic disease is an important cause of mortality worldwide. A widely recognized risk factor is active neoplasia, mainly hematological tumors, in which associated thrombocytopenia can be a frequent complication. We present the case of a patient with submassive pulmonary thromboembolism associated with severe thrombocytopenia with signs of right heart failure and a requirement for systemic thrombolysis and anticoagulation, however with absolute contraindication for them. The case establishes a therapeutic challenge for the treating group, leading us to carry out an extensive search of the literature and propose a management algorithm in this complex situation...
2019: Case Reports in Critical Care
L C Napp, C Moelgen, F Wegner, P Heitland, H D Koester, M Klintschar, M Hiss, A Schaper, B Schieffer, J Bauersachs, A Schäfer, J Tongers
We here report on a case of massive organic mercury intoxication in a 40-year-old man that resulted in progressive multiorgan failure. We treated the patient intravenously and enterally with the chelating agent (RS)-2,3-bis(sulfanyl) propane-1-sulfonic acid (DMPS) in addition to hemodialysis. The patient was treated for 6 weeks and could successfully be weaned from mechanical ventilation and hemodialysis. He awoke and was sent to rehabilitation, but unfortunately died 7 months later from refractory status epilepticus...
2019: Case Reports in Critical Care
Anusha Ganapati Bhat, Armand Golchin, Deepak Kumar Pasupula, Jaime A Hernandez-Montfort
Veno-Arterial Extracorporeal Membrane Oxygenation is a common technology of the modern era used as a bridge in severe refractory cardiac and respiratory failure until definitive management is planned. However, early recognition and management of one of the most challenging complications, intracardiac thrombus, continue to remain a conundrum. The incidence of the clinical scenario is very rare. Therefore, due to the lack of literature, there are no guidelines for risk stratification, prevention, or management of intracardiac thrombus...
2019: Case Reports in Critical Care
Linle Hou, Jonathan Stoll, Lauren Pioppo, Jack Xu, Wajahat Khan
Background: To describe an unusual presentation of acquired hypoventilation syndrome treated successfully with noninvasive positive pressure ventilation. Case Presentation: We report a case report of a 48-year-old male who presented to the emergency room for recurrent syncope. He was found to have a ventricular colloid cyst causing uncal herniation. The patient was noted to be intermittently apneic and bradypnic. Transient hypoventilation was successfully treated with noninvasive positive pressure ventilation and the patient made a full neurological recovery following transcallosal resection of the colloid cyst...
2018: Case Reports in Critical Care
Aristide Ntahe
[This corrects the article DOI: 10.1155/2018/1208401.].
2018: Case Reports in Critical Care
Jan-Thorben Sieweke, Jens Vogel-Claussen, Andreas Martens, Jörn Tongers, Andreas Schäfer, Johann Bauersachs, L Christian Napp
A 66-year-old patient was admitted under continuous resuscitation for pulseless electrical activity. After return of spontaneous circulation ECG showed signs of acute inferior ST-elevation myocardial infarction, and echocardiography showed acute right ventricular failure with a dilated right ventricle. Carotid pulses were present in the absence of femoral pulses. Subsequent computed tomography demonstrated inferior myocardial infarction with ventricular septal rupture and thrombotic occlusion of the thoracic aorta, resulting in a heart-brain-circulation with loss of perfusion downstream of the aortic arch...
2018: Case Reports in Critical Care
Ester Ilyayeva, Khaled Nada, Roxane Farahi Far, Kamal Albright, Manmeet Kaur Gujral, Menachem Gold
Moyamoya disease is a rare condition affecting the circle of Willis and its branching arteries. While the pathogenesis is unclear, it causes progressive occlusion of multiple cerebral vessels leading to severe strokes. We report a case of a 47-year-old Hispanic woman with HTN presented with altered mental status and bilateral upper and lower extremity weakness with dystonic-like upper extremity movement. Serial brain CTs and angiography were performed which showed massive frontal and parietal cerebral infarcts with radiological evidence of moyamoya disease...
2018: Case Reports in Critical Care
Paula J Watts, Natasha Fazel, Dmitriy Scherbak
Neisseria meningitidis is a cause of bacterial meningitis and meningococcemia worldwide. Rarely, it causes invasive disease with significant lifelong sequela if survived. Early clinical recognition is key as meningococcemia is an easily treatable disease, yet mortality is 50% if it is left untreated. In this case review, we present a classic case of meningococcemia, with an atypical presentation.
2018: Case Reports in Critical Care
Mabrouk Bahloul, Basma Souissi, Olfa Turki, Mariem Dlela, Khaireddine Ben Mahfoudh, Mounir Bouaziz
Background: Severe scorpion envenomation can lead to severe neurological manifestations, which are an indicator of the severity of the scorpion sting. The direct action of scorpion venom on the central nervous system can explain partly these neurological disorders. Methods and Findings: We report a case of severe scorpion envenomation in 16-month-old boy with no pathological history admitted in ICU for severe scorpion envenomation. The result of cerebral MRI agrees with the hypothesis of direct action of scorpion venom on the central nervous system...
2018: Case Reports in Critical Care
Motohiro Asaki, Takamitsu Masuda, Yasuo Miki
A 57-year-old man presented to the emergency department with fever and progressive altered level of consciousness of 5 days' duration. Three days before admission, influenza A was diagnosed at a clinic. On admission, his vital signs were unstable. Pneumonia was diagnosed through chest computed tomography, and urinary Legionella antigen test was positive. A diagnosis of septic shock due to Legionella and influenza pneumonia was made, and critical care management was initiated, including mechanical ventilation and vasopressors...
2018: Case Reports in Critical Care
Naoki Kawakami, Ho Namkoong, Takanori Ohata, Shinji Sakaguchi, Fumitake Saito, Hideki Yuki
Introduction: The prognosis of mycoplasma pneumonia in adults is generally favorable, but a few patients show progression to acute respiratory distress syndrome (ARDS). We have described the management of a patient who showed progression of mycoplasma pneumonia to ARDS. Presentation of Case: A 26-year-old male patient with no significant past medical or social history presented with a 5-day history of fever. Following this, he was diagnosed with bacterial pneumonia and treated with tazobactam/piperacillin; however, he showed little clinical improvement with this treatment approach...
2018: Case Reports in Critical Care
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