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Journal of Investigative Medicine High Impact Case Reports

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https://read.qxmd.com/read/30739492/a-rare-case-of-advanced-urethral-diverticular-adenocarcinoma-and-a-review-of-treatment-modalities
#1
Fatai Oluyadi, Preethi Ramachandran, Vladmir Gotlieb
Female urethral diverticular cancer is a very rare entity with only around 100 cases reported so far in literature and accounts for <1% of all malignancies. In this article, we present a 47-year-old African American female with repeated hospital visits for urinary retention, hematuria, and urinary tract infections. Initial computed tomography imaging and cystoscopy was unremarkable except for a distended urinary bladder. Subsequent magnetic resonance imaging and corresponding cystoscopy eventually indicated the presence of a urethral diverticulum...
January 2019: Journal of Investigative Medicine High Impact Case Reports
https://read.qxmd.com/read/30764662/primary-esophageal-diffuse-large-b-cell-lymphoma-a-comparative-review-of-15-cases
#2
Faisal Inayat, Ahmed Munir, Ahsan Wahab, Fariha Younus, Fahad Zafar, Waqas Ullah
Primary esophageal diffuse large B-cell lymphoma (DLBCL) is an extremely rare clinicopathologic entity. We report one case from our clinical experience and undertake a review of the previously published cases. A systematic literature search of the medical databases PubMed and Google Scholar was conducted. A total of 15 cases fulfilled the inclusion criteria. The data on patients' characteristics, epidemiology, clinical features, HIV status, gross appearance of the lesion, esophageal location, treatment, and outcome were collected and analyzed...
January 2018: Journal of Investigative Medicine High Impact Case Reports
https://read.qxmd.com/read/30622993/vancomycin-induced-leukocytoclastic-vasculitis-a-rare-case-report
#3
Pratibha Sharma, Eliza Sharma, Sanjay P Neupane, Suyash Dahal, Sumit Dahal
Vancomycin causes different types of hypersensitivity reactions, ranging from localized skin reactions to generalized cardiovascular collapse. However, cases of vancomycin-induced leukocytoclastic vasculitis are rare. In this article, we present a case where the patient developed palpable purpura on his bilateral lower limbs following treatment with vancomycin. He was diagnosed with vancomycin-induced leukocytoclastic vasculitis that resolved without sequelae after withdrawal of vancomycin.
January 2018: Journal of Investigative Medicine High Impact Case Reports
https://read.qxmd.com/read/30622992/an-unusual-case-of-tertiary-syphilis-behaving-like-tongue-squamous-cell-carcinoma
#4
Roberto N Solis, Brooks T Kuhn, D Gregory Farwell
Syphilis may present with a myriad of oral manifestations in the primary, secondary, and tertiary stages, and may be confused with malignancy. Despite a rise in the incidence of syphilis, tertiary syphilis is exceedingly rare. Tertiary syphilis gummas usually affect the hard palate, while tongue involvement is very rare. A 55-year-old male with extensive smoking and alcohol use was referred for malignancy evaluation with an ulcerative mass creating a tongue cleft, and a positron emission tomography scan suggestive for malignancy...
January 2018: Journal of Investigative Medicine High Impact Case Reports
https://read.qxmd.com/read/30622991/patient-with-a-42-year-history-of-coccidioidal-meningitis
#5
Carlos D'Assumpcao, Arash Heidari, Royce H Johnson
This is a case of a 56-year-old man diagnosed with coccidioidal meningitis 42 years ago at the age of 14. He was treated with intrathecal amphotericin B deoxycholate by cisternal puncture for 15 years before switching to fluconazole once it became available in 1991. Over 42 years of treatment, he developed hearing loss due to auditory nerve neurotoxicity, hydrocephalus requiring ventriculoperitoneal shunting with associated malfunctions, lumbar arachnoiditis, and hypokalemic paralysis. Regular cerebrospinal fluid studies to this day do not show disease clearance...
January 2018: Journal of Investigative Medicine High Impact Case Reports
https://read.qxmd.com/read/30574513/acquired-hemophilia-a-presenting-as-intramuscular-hematoma
#6
Ghassan Al-Shbool, Anusha Vakiti
Acquired hemophilia A poses a clinical and diagnostic challenge. Although rare, it is still the most common acquired factor deficiency. We present a case of acquired hemophilia A diagnosed in a 71-year-old female who presented with a right thigh hematoma of acute onset. The diagnosis was established based on the coagulation profile along with factor VIII levels, mixing studies, and inhibitor levels. The patient received multiple lines of therapy including steroids, factor VIIa, Obizur (porcine-derived recombinant factor VIII), followed by multiple cycles of chemotherapy including cyclophosphamide and rituximab...
January 2018: Journal of Investigative Medicine High Impact Case Reports
https://read.qxmd.com/read/30560138/resistant-hypertension-from-renal-artery-stenosis-leading-to-heart-failure-with-preserved-ejection-fraction
#7
Motasem Alyamani, Jissy Thomas, Miriam Shanks, Gavin Y Oudit
Resistant hypertension remains an important cause of heart failure. In this article, we describe a case of resistant hypertension in a 63-year-old woman leading to heart failure and marked morbidity. Her clinical course was characterized by chronic pleural effusions and recurrent hospitalizations with respiratory failure and flash pulmonary edema associated with heart failure with preserved ejection fraction. Her transthoracic echocardiogram showed severe concentric left hypertrophy and diastolic dysfunction...
January 2018: Journal of Investigative Medicine High Impact Case Reports
https://read.qxmd.com/read/30480005/crescendo-transient-ischemic-attacks-due-to-basilar-coccidioidal-meningitis-with-coccidioma
#8
Carlos D'Assumpcao, Arash Heidari, Katayoun Sabetian, Royce H Johnson
Coccidioidal meningitis typically presents with symptoms that may include headache, altered mental status including personality changes, fever, nausea, vomiting, gait abnormalities, and focal neurological deficits. This is a case of coccidioidal meningitis that initially presented as 4 consecutive crescendo cerebrovascular transient ischemic attacks with focal neurological deficits that resolved within minutes. Imaging showed a left basilar coccidioma. Follow-up at 4 months showed treatment response to conservative therapy of fluconazole 1000 mg with a dexamethasone taper...
January 2018: Journal of Investigative Medicine High Impact Case Reports
https://read.qxmd.com/read/30480004/iatrogenic-paradoxical-stroke-in-a-patient-with-catheter-associated-thrombosis-and-systemic-to-pulmonary-venous-shunt
#9
Lucas J Policastro, Kristaq Koci
Paradoxical embolism occurs when thrombotic material traverses a right-to-left shunt. We describe the first case of paradoxical stroke resulting from manipulation of a disused chemotherapy port. Contrast studies revealed that the mechanism was systemic-to-pulmonary venous shunt, in which systemic veins drain into the left atrium via collaterals. Chronically thrombosed central venous catheters may result in venous stenosis and shunt formation, exposing patients to risks of paradoxical stroke, acute coronary syndrome, hypoxemia, and other complications...
January 2018: Journal of Investigative Medicine High Impact Case Reports
https://read.qxmd.com/read/30480003/a-rare-case-of-macrophage-activation-syndrome-presenting-as-the-first-manifestation-of-systemic-lupus-erythematosus
#10
Pooja Poudel, Thein Swe, Sheetal Rayancha
Macrophage activation syndrome (MAS) itself is a rare, potentially life-threatening complication of a rheumatic disease, mostly seen in juvenile idiopathic arthritis. It infrequently occurs in systemic lupus erythematosus (SLE), and it is extremely rare to be the first presentation of SLE. In a study of 511 patients with SLE, 7 cases (1.4%) of MAS were identified. In all the cases, MAS was simultaneous to the presentation of SLE in this article, we report a case of a patient with MAS who presented with fever, rash, and high ferritin level up to 16911 ng/mL...
January 2018: Journal of Investigative Medicine High Impact Case Reports
https://read.qxmd.com/read/30480002/a-perplexing-case-of-pituitary-apoplexy-masquerading-as-recurrent-meningitis
#11
Madhura Myla, Jeremy Lewis, Alan Beach, Gresa Sylejmani, Mark R Burge
In this article, we present an exceptional case of pituitary apoplexy in which a patient presented with meningeal symptoms of headache, stiff neck, and nausea rather than the classical findings of ophthalmoplegia and/or vision loss. The patient has had 2 similar presentations with cerebrospinal fluid showing neutrophilic pleocytosis, as well as a computed tomography scan showing a prominent pituitary gland. On current presentation, the patient's vital signs were stable and the physical examination was remarkable for nuchal rigidity...
January 2018: Journal of Investigative Medicine High Impact Case Reports
https://read.qxmd.com/read/30397618/vertebral-osteomyelitis-discitis-and-epidural-abscess-a-rare-complication-of-cardiobacterium-endocarditis
#12
Sanjay K Yadava, Ambika Eranki
In this article, we report the case of a 75-year-old man who was presented with new low back pain for 2 weeks. His past history was significant for severe aortic stenosis necessitating bioprosthetic aortic valve placement 4 years ago, hypertension, and coronary artery disease. His physical examination was positive for point tenderness over the lower lumbar spine. He was found to be bacteremic with Cardiobacterium hominis . Magnetic resonance imaging of the spine showed lumbar (L4-L5) epidural abscess and vertebral osteomyelitis, discitis...
January 2018: Journal of Investigative Medicine High Impact Case Reports
https://read.qxmd.com/read/30349836/malignant-peritoneal-mesothelioma-a-rare-cause-of-ascites
#13
Abdisamad M Ibrahim, Mohammad Al-Akchar, Zainab Obaidi, Hamid Al-Johany
Malignant peritoneal mesothelioma (MPM) is a rare diagnosis that presents with difficulties in diagnosis and management. This article reports a case of an 88-year-old male who presented with a 2-week history of abdominal distention and bloating. He worked at an insulation production factory between the ages of 23 and 25 years with presumed asbestos exposure. On the computed tomography scan of the abdomen/pelvis, the patient was found to have diffuse omental, peritoneal, and mesenteric nodularity with moderate to large ascites...
January 2018: Journal of Investigative Medicine High Impact Case Reports
https://read.qxmd.com/read/30349835/identification-and-management-of-the-hypervirulent-invasive-klebsiella-pneumoniae-syndrome-a-unique-and-distinct-clinical-entity
#14
Mithu Maheswaranathan, Tue Ngo, Don C Rockey
In this article, we describe the case of a 61-year-old woman who presented with altered mental status and was found to have Klebsiella pneumoniae meningitis, bacteremia, and hepatic abscess. Despite intravenous antibiotic therapy and percutaneous drainage of the hepatic abscess, the patient developed worsening meningitis with ventriculitis, which led to her death. This invasive Klebsiella syndrome is characterized by metastatic infections with a hypervirulent strain and a poor clinical prognosis. Important elements of this patient's case-including the widespread and highly aggressive course-and of those reported in the literature are reviewed...
January 2018: Journal of Investigative Medicine High Impact Case Reports
https://read.qxmd.com/read/30349834/non-muscle-invasive-papillary-urothelial-carcinoma-metastatic-to-the-mandible
#15
Noah Frydenlund, Yousef Zakharia, Rohan Garje, Laila Dahmoush, Michael A O'Donnell
Urothelial carcinoma, the most common histologic subtype of bladder cancer in the United States, most frequently presents as non-muscle invasive disease. Initially, therapy involves transurethral endoscopic resection and subsequent intravesical therapies with extended surveillance for high-risk disease. Even with the best treatments, recurrence and progression can occur. However, metastasis of non-muscle invasive bladder cancer to distant sites without evidence of progression or regional metastasis is rare...
January 2018: Journal of Investigative Medicine High Impact Case Reports
https://read.qxmd.com/read/30306095/human-botfly-a-case-report-and-overview-of-differential-diagnosis
#16
Mina Shenouda, Garrett Enten, Thanh Nguyen, Devanand Mangar, Enrico Camporesi
Dermatobia hominis , commonly known as the human botfly, is native to Tropical America. As such, cutaneous infestation by its developing larvae, or myiasis, is quite common in this region. The distinct dermatological presentation of D hominis myiasis allows for its early recognition and noninvasive treatment by locals. However, it can prove quite perplexing for those unfamiliar with the lesion's unique appearance. Common erroneous diagnoses include the following: folliculitis, benign dermatocyst, and embedded foreign body with localized infection...
January 2018: Journal of Investigative Medicine High Impact Case Reports
https://read.qxmd.com/read/30302346/an-esophagogram-or-tracheobronchogram-a-review-of-barium-sulfate-aspiration
#17
Mohsin Hamid, Waqas Ullah, Mamoon Ur Rashid, Waseem Amjad, Maryam Mukhtar, Abu Hurairah
The barium swallow is an important radiological investigation used for the diagnosis of upper gastrointestinal anatomical disorders like esophageal cancer, diverticulum, achalasia, foreign body, among others. Generally, it is believed to be a safe technique with rare complications, but few cases of barium sulfate aspiration have been reported in the literature with multiple complications. We are reporting a case of an elderly male who underwent esophagogram for the workup of chronic dysphagia, aspirated barium sulfate, and went into respiratory failure and circulatory shock several hours later...
January 2018: Journal of Investigative Medicine High Impact Case Reports
https://read.qxmd.com/read/30283808/chilaiditi-syndrome-complicated-by-cecal-perforation-in-the-setting-of-scleroderma
#18
Tagore Sunkara, Prashanth Rawla, Krishna Sowjanya Yarlagadda, Gerald A Baltazar, Vinaya Gaduputi
Chilaiditi syndrome is a very rare disorder characterized by abdominal pain due to the entrapment of the colon between the liver and the diaphragm. However, it is rare to have bowel perforation as a complication of this syndrome with only 2 cases reported to date. In this article, we present the case of a 56-year-old woman with medical history of scleroderma who presents with abdominal pain and was found to have colonic perforation from Chilaiditi syndrome. She was also incidentally found to have cecal adenocarcinoma...
January 2018: Journal of Investigative Medicine High Impact Case Reports
https://read.qxmd.com/read/30283807/embolizing-massive-right-atrial-thrombus-in-a-hiv-infected-patient
#19
Piruthiviraj Natarajan, Fowrooz Joolhar, Sudhagar Thangarasu, Ayham Aboeed, Theingi Tiffany Win, Everardo Cobos
The risk of thromboembolism is increased when associated with the human immunodeficiency viral (HIV) infection. Various factors are involved in promoting thrombosis, and the presence of a patent foramen ovale augments the potential for a paradoxical embolism. We describe the case of a 56-year-old man receiving antiretroviral therapy with features of right heart failure and pulmonary embolism. Due to the high incidence of life-threatening thromboembolism in the HIV-infected group, the need for long-term anticoagulation has to be evaluated...
January 2018: Journal of Investigative Medicine High Impact Case Reports
https://read.qxmd.com/read/30283806/atrial-fibrillation-in-a-patient-with-an-accessory-pathway
#20
Andrew Silverman, Sonia Taneja, Liliya Benchetrit, Peter Makusha, Robert L McNamara, Alexander B Pine
A 24-year-old man with history of unspecified arrhythmia presented with palpitations and chest pain. Initial electrocardiogram (ECG) revealed irregular tachycardia with varying QRS width: 150 to 200 beats per minute for narrow complexes and 300 beats per minute for wide complexes. Following cardioversion, ECG revealed sinus tachycardia with a preexcitation pattern of positive delta waves in the anterolateral leads and negative delta waves in inferior leads. The patient remained in sinus rhythm and underwent successful ablation of a right posteroseptal accessory pathway...
January 2018: Journal of Investigative Medicine High Impact Case Reports
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