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Clostridium difficile Enteritis after Total Abdominal Colectomy for Ulcerative Colitis
Authors: Hassan Nasser, Semeret Munie, Dania Shakaroun, Tommy Ivanics, Surya Nalamati, Keith Killu
Journal: Case Rep Crit Care (2019)
MeSH terms: Case Reports

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. Diagnostic workup revealed diffuse small bowel wall thickening on computed tomography scan as well as positive nucleic acid amplification test for C. difficile toxin B gene. Despite treatment with antibiotics and maximum attempts at resuscitation, the patient expired. Discussion. C. difficile infection most commonly affects the colon but rarely can involve the small bowel. The pathogenesis of C. difficile enteritis is unclear but is believed to mirror that of colitis. Surgical patients are susceptible for C. difficile infection, as they tend to be relatively immunosuppressed in the postoperative period. Radiologic findings of enteritis may mimic those of colitis and this includes small bowel dilation and thickening. Treatment for this condition has not been well established but it is approached similar to colitis.
Conclusion:
Despite an increase in the number of case reports of C. difficile enteritis, it continues to be a rare but potentially fatal infection. Clinicians should maintain a high index of suspicion especially in patients with inflammatory bowel disease who undergo colon resections.
Alere Determine-tuberculosis lipoarabinomannan positivity in disseminated non-tuberculous mycobacteria: An illustrative case series
Authors: Riana Greyling, Graeme Meintjes, Bianca Sossen
Journal: South Afr J HIV Med (2022)
Keywords: hiv, lipoarabinomannan, ambulatory, diagnostic, outpatient, point-of-care, tuberculosis, urine
MeSH terms: Case Reports

Introduction:
In outpatients, the World Health Organization recommends that the urine Alere Determine-tuberculosis lipoarabinomannan (AlereLAM) should be used to support the diagnosis of tuberculosis (TB) in people living with HIV (PLHIV) with CD4 counts ≤ 100 cells/µL or with signs of being 'seriously ill'. There is a risk of a false-positive AlereLAM in disseminated non-tuberculous mycobacterial (NTM) infections and it may be difficult to differentiate a single infection (either Mycobacterium tuberculosis or NTM) from dual infection.
Patient presentation:
We report three patients, enrolled in an operational study assessing AlereLAM use in an outpatient setting, who had advanced HIV (all CD4 < 20 cells/µL) and strongly positive (grade 4+) AlereLAM results in whom Mycobacterium avium or kansasii were later cultured from blood or urine and sputum.
Management and outcome:
Based on positive AlereLAM results, all three were initiated on TB treatment. One died before NTM infection was detected. Two were managed for dual infection (TB and NTM) but died within two years.
Conclusion:
Tuberculosis remains a leading cause of death and a disproportionate number of these deaths occur in PLHIV. Tuberculous treatment should be initiated based on a positive AlereLAM result, and this should be followed by additional testing to confirm the diagnosis of TB and to obtain drug susceptibility results. In those not responding to TB treatment where the only positive result was an AlereLAM, an alternative or additional diagnosis of NTM infection should be considered, particularly in patients with a very low CD4 count.
Fever, headache, and visual blurring in a 17-year-old woman
Authors: William Lynn, Sue Lightman
Journal: PLoS Med (2004)
MeSH terms: Fever / etiology, Headache / etiology, Meningoencephalitis / diagnosis, Uveomeningoencephalitic Syndrome / diagnosis, Case Reports, Adolescent, Diagnosis, Differential, Female, Humans, Immunosuppressive Agents / therapeutic use, Meningoencephalitis / complications, Uveomeningoencephalitic Syndrome / complications, Uveomeningoencephalitic Syndrome / drug therapy, Vision Disorders / etiology, Immunosuppressive Agents

A fascinating case, with much to learn about diagnosis and treatment of patients with abnormal CSF results. After learning from the case, take our online quiz
Late biliary endoclip migration after laparoscopic cholecystectomy: Case report and literature review
Authors: Hytham K S Hamid, Anna Fullard, Jamaleldin Sabahi, Sean M Johnston
Journal: Int J Surg Case Rep (2020)
Keywords: cholecystectomy, endoclip, laparoscopic, migration
MeSH terms: Case Reports

Introduction:
Although formerly considered a rarity, biliary endoclip-related complications are being diagnosed with increasing frequencies. Among these, migration of endoclip into the common bile duct (CBD) is a rare encounter that usually presents in the first two years after surgery.
Presentation of case:
This case demonstrates a late biliary endoclip migration after laparoscopic cholecystectomy.
Discussion:
An 82-year-old male patient, with a history of laparoscopic cholecystectomy 22 years ago, presented with two-day history of severe upper abdominal pain. Routine hemogram and serum chemistry were remarkable for slightly raised alanine aminotransferase and C-reactive protein. A computed tomographic (CT) scan demonstrated a new metallic density within the CBD when compared to a previous CT scan 14 months earlier. An endoscopic retrograde cholangiography confirmed a metal endoclip within the mid-CBD contained within a choledochal stone. Balloon extraction of the endoclip and stone was successfully performed. The patient was discharged 2 days later, and remained symptom free for 1 year.
Conclusion:
To our knowledge, a latency of 22 years between cholecystectomy and clip migration has never been reported before. In cases of post-cholecystectomy abdominal pain the awareness of the surgeon should always be drawn to a clinical suspicion of endoclip migration into the CBD that can be easily remedied. Endoscopic biliary sphincterotomy with endoclip/stone removal is the therapeutic procedure of choice which usually circumvents the need for surgical extraction.
Government responses to gender-based violence during COVID-19
Authors: Rebecca Gordon, Nic Cheeseman, Sarah Rockowitz, Laura M Stevens, Heather D Flowe
Journal: Front Glob Womens Health (2022)
Keywords: covid-19, civil society, gender equality, gender-based violence, pandemic, policy

Gender-based violence (GBV) significantly and substantially threatens women's health. The COVID-19 pandemic has exacerbated existing risks and patterns of GBV. The impact of COVID-19 on GBV is not inevitable, however, and can be mediated by the policies of governments. In this study we developed the Government GBV Response Index to systematically examine how countries (N = 60) performed in response to the pandemic with respect to the government 1) enacting specific national-level GBV policy; 2) making dedicated COVID-19 specific funding available; and 3) adapting existing GBV responses to COVID-19 related restrictions and challenges. Most countries (N = 33) delivered fewer than two policy responses. We also performed rapid case study analyses to investigate what might contribute to countries having more comprehensive government policy. We find that civil society organizations played a key role in facilitating GBV policy during the pandemic, especially if they are well-funded and well-connected to the government, and if the country has a high-level government official responsible for gender issues.
Arterioureteral Fistula: Treatment of a Hemorrhagic Shock with Massive Hematuria by Placing a Balloon Catheter
Authors: Nicolas Merzeau, Hervé Riquet, Ioannis Nicolacopoulos, Abbas Alame, Stéphane Larré
Journal: Case Rep Urol (2017)
MeSH terms: Case Reports

Arterioureteral fistulas (AUF) are serious diseases with increasing incidence. This case report relates the management of AUF in a patient with a history of abdominal oncological surgery, pelvic radiotherapy, and a double J stent in place. The fistula was discovered during a hemorrhagic shock with massive hematuria. The bleeding was controlled by a balloon catheter which led to endovascular treatment consisting of a covered stent.
Hepatic hydatid disease: four case reports
Authors: Attef M Elshazly, Manar S Azab, Samar N Elbeshbishi, Hany M Elsheikha
Journal: Cases J (2009)

We report four cases who were referred to Mansoura University Teaching Hospital, Egypt suffering from abdominal pain and gastrointestinal manifestations. The patients' history was unremarkable, except that they had contact with dogs and live in rural communities. Laboratory findings showed peripheral blood eosinophilia, leucocytosis, and elevated liver enzymes. Serological tests were positive in three cases. Ultrasonography showed well-circumscribed cystic masses in the liver. Diagnosis of hydatid cysts was confirmed by computed tomography (CT). Surgical treatment along with chemotherapy was performed and all patients recovered well. The results of these cases support the notion that CT scan can led to increased clarity, regarding surgical management, because of discordance between radiographic and laboratory findings.
Calcified double J stent removed at 10 years: a case report
Authors: Ramzi Mejri, Kays Chaker, Mokhtar Bibi, Sami Ben Rhouma, Yassine Nouira
Journal: Pan Afr Med J (2022)
Keywords: double j stent, calcification, case report, incrustation stent
MeSH terms: Calcinosis / etiology, Calcinosis / surgery, Ureter / surgery, Case Reports, Cystotomy, Female, Humans, Hysterectomy, Middle Aged, Stents / adverse effects

In our current practice, the use of JJ probes has become extremely frequent. However, incrustation and fragmentation of JJ leads are still relatively common and sometimes complicate removal. A 61-year-old woman with a history of hysterectomy ten years ago, she had a double J endo-ureteral stent for preoperative identification of the right ureter. The patient has forgotten the double J stent. She currently has right lower back pain and urinary tract symptoms of urinary. Uroscan revealed a very important right hydronephrosis, a fully calcified right double J stent with a calcification of 6 cm at the level of the lower loop. She had, at first, a cystotomy allowing the extraction of the lower part of the calcified stent and secondly a pyelotomy to extract the rest of the double J stent. The operative follow-up was simple. The use of a double J probe to divert the urinary tract is an effective and generally well tolerated technique. Regular monitoring prevents complications.
A case of recurrent renal aluminum hydroxide stone
Authors: Basri Cakıroglu, Akif Nuri Dogan, Tuncay Tas, Ramazan Gozukucuk, Bekir Sami Uyanik
Journal: Case Rep Urol (2014)

Renal stone disease is characterized by the differences depending on the age, gender, and the geographic location of the patients. Seventy-five percent of the renal stone components is the calcium (Ca). The most common type of the stones is the Ca oxalate stones, while Ca phosphate, uric acid, struvite, and sistine stones are more rarely reported. Other than these types, triamterene, adenosine, silica, indinavir, and ephedrine stones are also reported in the literature as case reports. However, to the best of our knowledge, aluminum hydroxide stones was not reported reported before. Herein we will report a 38-years-old woman with the history of recurrent renal colic disease whose renal stone was determined as aluminum hydroxide stone in type. Aluminum mineral may be considered in the formation of kidney stones as it is widely used in the field of healthcare and cosmetics.
Acute blastocystis-associated appendicular peritonitis in a child, Casablanca, Morocco
Authors: Emilie Fréalle, Dima El Safadi, Amandine Cian, Estelle Aubry, Gabriela Certad, Marwan Osman, Agnès Wacrenier, Emmanuel Dutoit, Colette Creusy, François Dubos, Eric Viscogliosi
Journal: Emerg Infect Dis (2015)
MeSH terms: Appendix / parasitology, Blastocystis Infections / diagnosis, Peritonitis / diagnosis, Case Reports, Research Support, Non-U.S. Gov't, Adolescent, Adult, Aged, Aged, 80 and over, Blastocystis / isolation & purification, Blastocystis Infections / epidemiology, Child, Child, Preschool, Disease Outbreaks, Feces / parasitology, Female, Humans, Infant, Male, Middle Aged, Morocco, Peritonitis / parasitology, Young Adult

Despite increasing reports that Blastocystis infection is associated with digestive symptoms, its pathogenicity remains controversial. We report appendicular peritonitis in a 9-year-old girl returning to France from Morocco. Only Blastocystis parasites were detected in stools, appendix, peritoneal liquid, and recto-uterine pouch. Simultaneous gastroenteritis in 26 members of the child's family suggested an outbreak.
Mesalamine-induced myocarditis and coronary vasculitis in a pediatric ulcerative colitis patient: a case report
Authors: Elimarys Perez-Colon, Gul H Dadlani, Ivan Wilmot, Michelle Miller
Journal: Case Rep Pediatr (2011)
MeSH terms: Case Reports

Mesalamine-containing products are often a first-line treatment for ulcerative colitis. Severe adverse reactions to these products, including cardiovascular toxicity, are rarely seen in pediatric patients. We present a case of a 16-year-old boy with ulcerative colitis treated with Asacol, a mesalamine-containing product, who developed sudden onset chest pain after four weeks on therapy. Serial electrocardiograms showed nonspecific ST segment changes, an echocardiogram showed mildly decreased left ventricular systolic function with mild to moderate left ventricular dilation and coronary ectasia, and his troponins were elevated. Following Asacol discontinuation, his chest pain resolved, troponins were trending towards normal, left ventricular systolic function normalized, and coronary ectasia improved within 24 hours suggesting an Asacol-associated severe drug reaction. Mesalamine-induced cardiovascular toxicity, although rare, may represent a life-threatening disorder. Therefore, every patient presenting with acute chest pain should receive a workup to rule out this rare drug-induced disorder.
Telerehabilitation in the Treatment of Frozen Shoulder: A Case Report
Authors: Ji Hui Neo, Siao Ting Teo, Chiew Lan Lee, Cong Cong Cai
Journal: Int J Telerehabil (2019)
Keywords: case report, frozen shoulder, telerehabilitation
MeSH terms: Case Reports

Background and objectives:
Frozen shoulder is a common musculoskeletal condition. Telerehabilitation has seen emerging use in a variety of conditions. This case report aims to investigate the feasibility of adopting telerehabilitation in treating frozen shoulder.
Case presentation:
A 43-year old female presented with frozen shoulder of insidious onset. She underwent four sessions of physiotherapy. Sessions two and three were telerehabilitation sessions; the initial and final sessions were conducted in-person.
Results:
The subject was compliant with all exercises prescribed during her rehabilitation and achieved all rehabilitation goals in four sessions. She was then discharged from physiotherapy.
Conclusion:
Telerehabilitation is feasible in treating frozen shoulder. One barrier to implementation of telerehabilitation includes the lack of technical skills and knowledge despite the high prevalence of technology in today's society. Telerehabilitation increases accessibility and ease of rehabilitation. Telerehabilitation can be considered for segments of the population that are most inclined to use technology.
Treatment of phantom limb pain (PLP) based on augmented reality and gaming controlled by myoelectric pattern recognition: a case study of a chronic PLP patient
Authors: Max Ortiz-Catalan, Nichlas Sander, Morten B Kristoffersen, Bo Håkansson, Rickard Brånemark
Journal: Front Neurosci (2014)
Keywords: augmented reality, electromyography, myoelectric control, neurorehabilitation, pattern recognition, phantom limb pain, virtual reality

A variety of treatments have been historically used to alleviate phantom limb pain (PLP) with varying efficacy. Recently, virtual reality (VR) has been employed as a more sophisticated mirror therapy. Despite the advantages of VR over a conventional mirror, this approach has retained the use of the contralateral limb and is therefore restricted to unilateral amputees. Moreover, this strategy disregards the actual effort made by the patient to produce phantom motions. In this work, we investigate a treatment in which the virtual limb responds directly to myoelectric activity at the stump, while the illusion of a restored limb is enhanced through augmented reality (AR). Further, phantom motions are facilitated and encouraged through gaming. The proposed set of technologies was administered to a chronic PLP patient who has shown resistance to a variety of treatments (including mirror therapy) for 48 years. Individual and simultaneous phantom movements were predicted using myoelectric pattern recognition and were then used as input for VR and AR environments, as well as for a racing game. The sustained level of pain reported by the patient was gradually reduced to complete pain-free periods. The phantom posture initially reported as a strongly closed fist was gradually relaxed, interestingly resembling the neutral posture displayed by the virtual limb. The patient acquired the ability to freely move his phantom limb, and a telescopic effect was observed where the position of the phantom hand was restored to the anatomically correct distance. More importantly, the effect of the interventions was positively and noticeably perceived by the patient and his relatives. Despite the limitation of a single case study, the successful results of the proposed system in a patient for whom other medical and non-medical treatments have been ineffective justifies and motivates further investigation in a wider study.
Congenital midline spinal hamartoma in an infant with DICER1 syndrome: A case report
Authors: Rawan Hammad, Winnie Lo, Haiying Chen, Manohar Shroff, David Malkin, Anita Villani, Avram Denburg
Journal: Front Oncol (2022)
Keywords: dicer1, cancer predisposition, case report, congenital midline spinal hamartoma, infant
MeSH terms: Case Reports

Congenital spinal hamartomas are rare benign tumors. They are mostly seen in infants and are typically asymptomatic at presentation. Spinal hamartomas have not been associated with any known cancer predisposition syndrome. DICER1 syndrome is a well-characterized cancer predisposition syndrome caused by a germline mutation in the DICER1 gene, which shows variable expressivity. To our knowledge, spinal hamartoma has never been described in individuals with DICER1 syndrome. Here, we describe a rare association of congenital spinal hamartoma and DICER1 syndrome in a 5-week-old infant, with molecular findings suggestive of the implication of DICER1 in the pathogenesis of this tumor.
Pleural FDG Uptake More Than a Decade after Talc Pleurodesis
Authors: Hilke Peek, Wouter van der Bruggen, Gijs Limonard
Journal: Case Rep Med (2009)
MeSH terms: Case Reports

Talc pleurodesis induces a strong local inflammatory reaction which can be detected by PET scan for years after the procedure. When patients undergo PET scanning in the workup of a suspected malignancy later in life, pleural FDG uptake may unnecessarily lead to an additional invasive diagnostic workup. We present two cases of positive pleural PET findings more than 10 years after talc pleurodesis, where we adopted a watchful waiting approach. Positive pleural PET findings as a result of prior talc pleurodesis should always be included in the differential diagnosis of pleural abnormalities.
Isoniazid-Induced Acute Psychosis in a Patient with Pleural Tuberculosis
Authors: Joana Gomes, Diana Durães, André Sousa, Hugo Afonso
Journal: Case Rep Psychiatry (2019)
MeSH terms: Case Reports

Tuberculosis is one of the top 10 causes of death and the leading cause from a single infectious agent (above HIV/AIDS). Isoniazid is highly bactericidal against replicating tubercle bacilli and is a component of all antituberculous chemotherapeutic regimens currently recommended by the World Health Organization (WHO). Several neuropsychiatric adverse effects, following both therapeutic and overdose use of isoniazid, have been described and isoniazid-induced psychosis, although uncommon, has been reported in the literature. We describe the case of a 21-year-old black woman, with no prior psychiatric history, who developed a psychotic episode four days after she was started on isoniazid. This case highlights psychosis arising as a possible adverse effect of isoniazid and the importance of remaining vigilant when antituberculous therapy is started.
Diagnosis of Leiomyosarcoma after Uterine Artery Embolization for Multiple Leiomyomas
Authors: Maako Tsuji, Tomoko Kihara, Shuko Hushimi, Yukari Nishino, Tomoko Kanayama, Mitsuhiro Nishijima
Journal: Case Rep Obstet Gynecol (2020)
MeSH terms: Case Reports

Uterine sarcoma is significantly rarer than leiomyoma and has poor prognosis. Moreover, the diagnosis of leiomyosarcoma is difficult because its symptoms, including pelvic pain, uterine mass, and/or uterine bleeding, are very similar to those of leiomyoma. There are a few cases of leiomyosarcoma wherein leiomyoma was treated with uterine artery embolization (UAE); these reports revealed that the symptoms of hypermenorrhea or/and pelvic pain persisted even after UAE. Symptoms persisting even after UAE treatment for leiomyomas, especially multiple leiomyomas, should be investigated to rule out leiomyosarcoma. Therefore, long-term follow-up is needed. Here, we describe a case of a 39-year-old woman diagnosed with leiomyosarcoma 3 years after undergoing UAE for multiple leiomyomas.
Mutant BCL11B in a Patient With a Neurodevelopmental Disorder and T-Cell Abnormalities
Authors: Sai Yang, Qingyun Kang, Yanqi Hou, Lili Wang, Liping Li, Shulei Liu, Hongmei Liao, Zhenhua Cao, Liming Yang, Zhenghui Xiao
Journal: Front Pediatr (2020)
Keywords: bcl11b, developmental disorder, immune system abnormalities, immunodeficiency, neurodevelopmental disease
MeSH terms: Case Reports

Background: BCL11B encodes B-cell lymphoma/leukemia 11B, a transcription factor that participates in the differentiation and migration of neurons and lymphocyte cells. De novo mutations of BCL11B have been associated with neurodevelopmental disorder and immunodeficiency, such as immunodeficiency 49 (IMD49) and intellectual developmental disorder with speech delay, dysmorphic facies, and T-cell abnormalities (IDDSFTA). However, the pathogenesis of the neurodevelopmental disorder and T-cell deficiency is still mysterious. The strategy to distinguish these two diseases in detail is also unclear. Methods: A patient with unique clinical features was identified. Multiple examinations were applied for evaluation. Whole-exome sequencing (WES) and Sanger sequencing were also performed for the identification of the disease-causing mutation. Results: We reported a 17-month-old girl with intellectual disability, speech impairment, and delay in motor development. She presented with mild dysmorphic facial features and weak functional movement. MRI indicated the abnormal myelination of the white matter. Immunological analysis showed normal levels of RTEs and γδT cells but a deficiency of naive T cells. Genetic sequencing identified a de novo heterozygous frameshift mutation c.1192_1196delAGCCC in BCL11B. Conclusions: An IDDSFTA patient of East Asian origin was reported. The unreported neurological display, immunophenotype, and a novel disease-causing mutation of the patient extended the spectrum of clinical features and genotypes of IDDSFTA.