bluuebunny/crossref_metadata_2025 huggingface dataset:
Scleroderma with Acro-Osteolysis and Papular Mucinosis Resembling Multicentric Reticulohistiocytosis
Authors: João Dantas  , Isabela S de Oliveira  , Emanuela P Fonseca  , Mittermayer Barreto Santiago
Published: May 2021

Objectives: We describe a case of systemic sclerosis (SS) with acro-osteolysis associated with cutaneous mucinosis, usually characterized by mucin deposition in the skin. The main differential diagnosis was multicentric reticulohistiocytosis due to the presentation of papulonodular skin lesions. Materials and methods: A physical examination, imaging studies and laboratory tests were performed. Results: Distal bone resorption was evident on plain radiographs, and skin biopsy confirmed mucinosis. The SS diagnosis was based on the clinical features, high levels of antinucleolar antibodies and typical nailfold capillaroscopy findings. Conclusion: To the best of our knowledge, this is the first description of cutaneous mucinosis accompanying SS with acro-osteolysis.
Very Late-Onset Systemic Lupus Erythematosus as Unusual Cause of Reversible Functional and Cognitive Impairments in an Octogenarian Patient
Authors: Stephanie de Montjoye  , Benoit Boland  , Jacqueline Van Raemdonck  , Frederic Houssiau
Published: May 2021

While functional decline is a common syndrome in geriatric medicine, the diagnosis of the underlying disease can be complex. We present a case of very late-onset systemic lupus erythematosus with fever, arthritis, lymphadenopathy, sicca syndrome, pleurisy, renal impairment and reversible functional and cognitive impairments. Prompt improvement was observed on prednisolone and hydroxychloroquine.
Recurring Asystole and Paradoxical Air Embolization in a Patient with a Patent Foramen Ovale Treated with Home Parenteral Nutrition
Authors: Laura Gombošová  , Jana Deptová  , Juraj Podracký  , Daniel Farkaš  , Ivica Lazúrová
Published: May 2021

Home parenteral nutrition is a therapeutic option for chronic intestinal failure. A tunnelled central venous catheter is commonly used for self-application of nutrition and hydration over a long period of time; that is, months or years. Air embolization within the venous circulation can be caused by inconsistent self-handling of the catheter in combination with air bubbles in the infusion set. Paradoxical air embolization within the brain and coronary arteries together with catheter perforation is a rare medical and technical complication. The authors report the case of a 63-year-old woman with type 3 chronic intestinal failure treated with home parenteral nutrition. During the first year of treatment and use of the catheter a fatal complication occurred. The patient experienced recurring asystolic episodes and strokes with monoplegia during flushing of the catheter. Although 2 resuscitations were successful, the third was not, and the patient died. The cause of these life-threatening complications was an unknown patent foramen ovale, with paradoxical air embolization within the coronary and brain arteries. The authors discuss the clinical consequences of arterial and venous air embolization, the differences between these and the therapeutic algorithm with a link to practice.
Not All Patients with Hemiplegia Need Alteplase: A Case of Hemiplegic Migraine
Authors: Sumeet Yadav  , Michelle Talukder  , Jacky Duong
Published: May 2021

Hemiplegic migraine (HM) is a rare type of migraine which presents with motor and sensory impairment like a cerebrovascular accident (CVA). We present a case of a 36-year-old female, with a prior CVA treated with alteplase, who presented to the emergency department with stroke-like symptoms with a duration of 1 hour. The NIH Stroke Scale score was 22 at presentation. The patient received alteplase under the supervision of a neurologist after head CT confirmed no bleed. Further work-up revealed no acute or remote ischaemia or infarction. This case demonstrates the importance of a thorough history, intercommunication between health systems and integrated Electronic Medical Records (EMR) for early diagnosis and management of HM.
A Severe Refractory Anaemia and Fever of Unknow Origin: Human Parvovirus B19 Reactivation
Authors: Joaquín Escobar-Sevilla  , Antonio Bustos Merlo  , Juan Diego Mediavilla Garcia  , Carmen Garcia Martínez
Published: May 2021

Reactivation of human parvovirus B19 is exceptional and characteristic of immunosuppression, with anaemia being the predominant manifestation although pancytopenia and thrombotic microangiopathy may also occur. We describe a patient with a history of diffuse large B-cell lymphoma with pure erythrocyte aplasia due to reactivation of parvovirus B19, who was treated with corticosteroids and immunoglobulins.
Bilateral Subdural Haematoma and CPAP Use: A Possible Association
Authors: Beatrice Khater  , Vicky Kassouf  , Georges Haddad  , Roula Hourany
Published: May 2021

Obstructive sleep apnoea (OSA) is a common condition usually treated with continuous positive airway pressure (CPAP). No reports have linked it to an acute subdural haematoma. A 54-year-old white man who had hypertension well controlled with an angiotensin II receptor blocker, presented with a 2-week history of occipital headache with no other focal neurological symptoms. The headache began 12 days after he had started using CPAP for OSA. A brain MRI performed 2 weeks later showed bilateral subdural haematomas which were chronic on the left and sub-acute/acute on the right. Since the patient was clinically stable with no focal neurological deficits, he received prednisone for 3 weeks and was followed up with consecutive CT scans demonstrating gradual regression of the haematomas. This is the first report showing that subdural haematomas could be linked to CPAP use.
Anosmia and Dysgeusia in the Absence of Other Respiratory Diseases: Should COVID-19 Infection Be Considered?
Authors: Noel Lorenzo Villalba  , Yasmine Maouche  , Maria Belen Alonso Ortiz  , Zaida Cordoba Sosa  , Jean Baptiste Chahbazian  , Aneska Syrovatkova  , Pierre Pertoldi  , Emmanuel Andres  , Abrar-Ahmad Zulfiqar
Published: May 2021

We describe two elderly patients evaluated at emergency departments for anosmia/dysgeusia in the absence of any other respiratory symptoms prior to or upon admission. In the current epidemiological context, clinical and biological work-up led to a diagnosis of COVID-19 infection. Unfortunately, one of the patients died during hospitalization, but the other recovered and was discharged.
Chylothorax with Transudate: An Unusual Presentation of Tuberculosis
Authors: Miguel Angel Zamora-López  , Iris Camelia Farias-Navarro  , Erick Joel Rendon-Ramirez
Published: May 2021

Introduction: Twenty-five per cent of tuberculosis patients have pleural tuberculosis, which is the third most common form of presentation. Most cases present as an exudative pleural effusion with just few cases reported as chylothorax in the literature. All pleural effusions from confirmed cases, including tuberculous chylothorax, had exudate features. Aim: To describe a patient with Mycobacterium tuberculosis affecting the lungs and pleura, which laboratory testing demonstrated had features of transudate chylothorax. Patient and methods: A 70-year-old man presented with constitutional symptoms, progressive exertional dyspnoea and right pleural effusion with fibrocavitary changes on chest imaging. Thoracentesis and pleural fluid analysis revealed chylous fluid with transudate features, high triglycerides, low cholesterol content and mononuclear cell predominance. Acid-fast sputum stains and pleural fluid were negative for Mycobacterium tuberculosis as was an adenosine deaminase test for pleural effusion. Tomography-directed lung biopsy sampling of a lung nodule revealed a chronic granulomatous inflammatory process associated with the presence of acid-fast bacilli. Discussion: Tuberculosis-associated chylothorax is an uncommon presentation of the disease. A recent review found only 37 cases of confirmed tuberculous chylothorax had been reported in the literature. All cases had exudate characteristics. The diagnosis of pleural tuberculosis was made through culture or testing of sputum, pleural fluid or biopsy samples in 72.2% of cases, with the rest identified by histopathology.
Acute Paraparesis after Epidural Corticosteroid Injection Revealing Spinal Dural Arteriovenous Fistula in a HIV Patient
Authors: Anouk Le Goueff  , Nicolas Mavroudakis  , Benjamin Mine  , Olivier De Witte  , Gauthier Remiche
Published: May 2021

Spinal dural arteriovenous fistulas (SDAVFs) are often misdiagnosed as their symptoms are non-specific, leading to treatment delay and a poor outcome. We describe the case of a 53-year-old man with a history of progressive paraparesis that worsened abruptly after an epidural corticosteroid injection. We highlight here the need for high diagnostic suspicion for an SDAVF in patients deteriorating after an epidural injection and an indication of repeated spine imaging in such cases. Finally, this is the first reported case of an SDAVF in a HIV-positive patient and it emphasizes the need for a broad differential diagnosis.
Abdominal Pain Relieved By A Warm Hot Water Bottle: An Atypical Presentation Of Eosinophilic Gastroenteritis
Authors: Ahmad Reza Shirazi-Nejad  , John M Hebden
Published: May 2021

A 26-year-old woman presented with a 3-month history of worsening episodic abdominal pain, which was associated with frequent passage of watery stools, nausea and dyspepsia. Her peripheral eosinophil count was markedly elevated. This responded well to a reducing regimen of corticosteroids. Her symptoms completely resolved with a corresponding fall in eosinophil count. The patient was diagnosed with eosinophilic gastroenteritis. We have not considered steroid-sparing agents at this point, but should she have future exacerbations then this will be considered.
Cerebral Venous Sinus Thrombosis as a Presentation of COVID-19
Authors: Christopher Hughes  , Tom Nichols  , Martin Pike  , Christian Subbe  , Salah Elghenzai
Published: May 2021

Coronavirus disease 19 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We describe the case of a 59-year-old man who presented with headache, hypertension and a single episode of fever with no other symptoms. He subsequently developed unilateral weakness. Computer tomography identified a cerebral venous sinus thrombosis (CVST). A subsequent test for COVID-19 was positive. This is the first report of CVST as a presenting symptom of COVID-19 infection.
Atypical Presenting Symptoms of Acute Onset Acquired Haemophilia with Eosinophilic Fasciitis
Authors: Yuto Nakakubo  , Kazuyo Yamamoto  , Masaaki Fujita
Published: May 2021

Acquired haemophilia is a bleeding disorder caused by antibodies against coagulation factors. Some cases are associated with autoimmune diseases. However, no cases of acquired haemophilia with eosinophilic fasciitis have been previously reported. Herein we describe the case of a patient with eosinophilic fasciitis associated with acquired haemophilia.
Angioimmunoblastic T-cell Lymphoma: A Mimic for Lupus
Authors: Hui Boon Tay  , Stanley Angkodjojo  , Zhi En Amos Tay  , Puay Hoon Tan  , Yan Denise Tan
Published: May 2021

New-onset systemic lupus erythematosus (SLE) is uncommon in elderly patients. We report the case of a 71-year-old woman who was diagnosed with SLE based on clinical manifestations of fever, alopecia, bicytopenia, hepatomegaly, lymphadenopathy, glomerulonephritis, positive antinuclear antibody (ANA) and anti-double stranded DNA (anti-dsDNA) antibody. Renal biopsy was consistent with lupus nephritis and excision biopsy of a right inguinal lymph node was initially reported as having features of reactive hyperplasia. However, a more careful review of the lymph node biopsy subsequently confirmed a concurrent angioimmunoblastic T-cell lymphoma. This case illustrates the importance of investigating secondary causes and possible alternative diagnoses in patients who present with atypical features of connective tissue disease, and the challenges in diagnosing a rare form of lymphoma.
Diaphragmatic Rupture and Gastric Perforation in a Patient with COVID-19 Pneumonia
Authors: Erika Poggiali  , Andrea Vercelli  , Elena Demichele  , Eva Ioannilli  , Andrea Magnacavallo
Published: May 2021

We describe the case of a young female patient admitted to our emergency department during the Italian COVID-19 epidemic, for fever and dry cough associated with symptoms of gastric reflux over the previous 5 days. Lung ultrasound showed diffuse bilateral B lines with irregular pleural thickening, and consolidation with air bronchogram and slight pleural effusion in the lower left lobe. Chest HRCT and abdominal CT scanning with contrast revealed diaphragmatic rupture with gastric perforation, and atelectasis of the left pulmonary lobe with unilateral pleural effusion, diffuse ground-glass opacities and multiple small consolidations in both lobes. A nasopharyngeal swab for 2019-nCoV was positive. A diagnosis of diaphragmatic rupture and gastric perforation in COVID-19 pneumonia was made. The patient was immediately hospitalized and surgically treated. Treatment for COVID-19 and empiric antibiotic therapy were promptly started.
Late Pulmonary Embolism after COVID-19 Pneumonia despite Adequate Rivaroxaban Treatment
Authors: Giuseppe Di Tano  , Luigi Moschini  , Marco Loffi  , Gianluca Galeazzi  , Sophie Testa  , Gian Battista Danzi
Published: May 2021

Introduction: SARS-CoV-2 infection may predispose patients to thrombotic disease. Patients with COVID-19 pneumonia who are receiving non-vitamin K antagonists or direct oral anticoagulants for chronic disease are usually switched to heparin treatment during hospitalization. However, information about the most appropriate antithrombotic therapy after the acute infection phase is lacking. Case Description: We report the case of a patient with chronic atrial fibrillation who was recently hospitalized for severe COVID-19 pneumonia. Four weeks after discharge he experienced an episode of an acute pulmonary embolism while on rivaroxaban therapy with adequate drug plasma levels, and in the absence of strong predisposing risk factors. Conclusion: This case highlights the risk of thrombotic complications after COVID-19 infection, raises some concern about their underlying mechanisms, and supports the use of effective anti-thrombotic therapy.
Isolated Non-Resolving Vulvar Lesion as a Presentation of Disseminated Histoplasmosis in a Woman with HIV
Authors: Moni Roy  , Ashish Kumar Roy  , Jan Nalinee Upalakalin  , Sharjeel Ahmad
Published: May 2021

Disseminated histoplasmosis is most commonly caused by Histoplasma capsulatum and is a known opportunistic infection in immunocompromised patients. The clinical presentation of histoplasmosis varies from asymptomatic to a progressive disseminated form. Pulmonary and CNS involvement is common in disseminated histoplasmosis. Rarely, disseminated disease can present as vulvar lesion in the absence of pulmonary symptoms, causing a delay in diagnosis. As per our PubMed literature search, there have only been two reported cases where vulvar lesion was the only presenting symptom of disseminated disease. In our patient, a histopathological diagnosis was made with staining showing budding yeast forms of histoplasma.
Menstrual Cup-Associated Toxic Shock Syndrome
Authors: Christian Neumann  , Rene Kaiser  , Judith Bauer
Published: May 2021

Toxic shock syndrome (TSS) is a rare inflammatory response syndrome associated with an infection by toxigenic strains of Staphylococcus aureus or group A ?-haemolytic Streptococcus. We report a rare case of menstrual TSS associated with usage of a menstrual cup. The diagnosis was established through case definition criteria and supported by vaginal cultural growth of Staphylococcus aureus with evidence of TSS toxin 1 (TSST-1). The patient received prophylactic intravaginal clindamycin in an individual approach to reduce the risk of recurrence. No relapse was reported in the 12 months following discharge.
Infectious Mononucleosis Resulting in Acute Necrotizing Mediastinitis: A Case Report and Literature Review
Authors: Héloïse Van Noten  , Samuel Markowicz  , Serge Cappeliez  , Soraya Cherifi
Published: May 2021

The serological prevalence of Epstein-Barr virus (EBV) among young adults exceeds 90% worldwide. Even though EBV primary infection is usually benign, severe complications can occur in adolescents and young adults and so the disease must be promptly diagnosed. The development of an oropharyngeal abscess leading to a descending necrotizing mediastinitis (DNM) is exceptional and potentially lethal, so early diagnosis with a CT scan, appropriate antibiotics and surgery are essential.  The authors present a case where DNM was associated with reactive hemophagocytic syndrome as a result of infectious mononucleosis, as well as a review of similar cases in the English literature.
Defining the Cause of Postpartum Myocardial Infarction – Another Use for Optical Coherence Tomography
Authors: Abdullah Alenezi  , Jadan Alsaddah  , Ossama Maadarani
Published: May 2021

Chest pain in a young postpartum female can have many causes; however, when associated with ST elevation on ECG, spontaneous coronary artery dissection (SCAD) should be high on the list. Coronary angiography remains the first step in delineating the coronary lesion in suspected cases of SCAD and optical coherence tomography (OCT) can be crucial when the angiographic appearance remains uncertain. We present a case of a young postpartum female with ST elevation myocardial infarction (STEMI). Coronary angiography revealed a dilated part of the middle segment of the left anterior descending (LAD) artery while intramural haematoma (IMH) of the coronary artery wall was found on OCT, which confirmed the clinically suspected diagnosis of SCAD.
Kawasaki-like Syndrome as an Emerging Complication of SARS-CoV-2 Infection in Young Adults
Authors: César Burgi Vieira  , Ana Teresa Ferreira  , Filipa Botelho Cardoso  , Jorge Pelicano Paulos  , Nuno Germano
Published: May 2021

Background: Kawasaki-like syndrome occurring in children during the COVID-19 pandemic has been labelled multisystem inflammatory syndrome in children (MIS-C) by the CDC and paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS) by the ECDC.  Case report: We report the case of an 18-year-old male patient presenting with a 72-hour history of abdominal pain, fever, erythematous skin rash, vomiting and diarrhoea. Examination showed he also had shock and he was first thought to have oedematous cholecystitis. SARS-CoV-2 infection was also diagnosed. He was admitted to the ICU, and echocardiography showed cardiac dysfunction, with a low ejection fraction and low cardiac index. High-sensitivity troponin serum levels were elevated. The patient received inotropic and vasopressor support. As he fulfilled several criteria for MIS-C/PIMS-TS, he was administered acetylsalicylic acid, corticosteroids and immunoglobulin, with a good clinical response.
 Conclusion: This case emphasizes how this severe presentation of COVID-19 can easily be misdiagnosed if the clinician is less aware of this syndrome in younger patients.
Disseminated Nocardia beijingensis Infection in an Immunocompetent Patient
Authors: Moni Roy  , Annia Martial  , Sharjeel Ahmad
Published: May 2021

Nocardia is a genus of aerobic, non-motile and non-spore-forming filamentous branching bacteria with fragmentation into bacillary or coccoid forms. Infections caused by Nocardia often occur in immunocompromised hosts and are potentially life-threatening. Nocardia beijingensis has rarely been reported to cause infection in immunocompetent hosts. We present a case of disseminated infection due to Nocardia beijingensis in a patient with no known medical comorbidities, who presented with new-onset seizure. Another interesting finding in our case is that our patient did not have any pulmonary symptoms despite chest CT showing the pulmonary system as the likely primary site of infection. As per our literature review, this is the seventh reported case of infection due to Nocardia beijingensis in an immunocompetent host.
Treatment of Mobile Right Heart Thrombi
Authors: Xenofon M Sakellariou  , Andreas Efstathopoulos  , Konstantinos V Stamatis  , Dimitrios N Nikas  , Theofilos M Kolettis
Published: May 2021

Right heart thrombi are detected in approximately 4% of patients with pulmonary embolism. The associated mortality is high, but the optimal strategy remains controversial. We report a case of a large mobile right heart thrombus, complicated by embolism of the right pulmonary artery, which was successfully treated with half-dose alteplase. We briefly review the literature and discuss the therapeutic options, focusing on the advantages of thrombolysis.
Hyperemesis Gravidarum: A Benign Condition of Pregnancy or a Challenging Metabolic Disorder?
Authors: Matilda Florentin  , Ioannis Parthymos  , Aris Agouridis  , George Liamis
Published: May 2021

Hyperemesis gravidarum (HG) is a complication mainly of the first trimester of pregnancy, which sometimes leads to metabolic disorders such as hypovolemia and acute kidney injury (AKI). Herein, we present the case of a 25-year-old woman at week 10 of gestation who exhibited a constellation ofsevere abnormalities, namely AKI (serum creatinine 6.15 mg/dl), transaminasemia (serum aminotransferases >1,000 IU/l), alkalemia (arterial pH7.667), hyponatremia (serum sodium 117 mEq/l), hypochloremia (serum chloride 54 mEq/l),hypokalemia (serum potassium 2.2 mEq/l) and hyperuricemia (serum uric acid 20 mg/dl). Despite a thorough work-up, no other disorder was found apart from HG. All symptoms and metabolic abnormalities resolved with targeted administration of intravenous fluids. The differential diagnosis of these disorders and therapeutic challenges are discussed.
Late-Onset Lipid Storage Myopathy with Fatal Hepatosteatosis
Authors: Arda Yavuz  , Gökçen Ünverengil  , Ayşe Nur Toksöz Yıldırım  , Hatice Şeyma Maraşlı  , İlyas Tuncer
Published: May 2021

Hepatosteatosis, a common condition, is increasing in prevalence. It is typically associated with diet, alcohol consumption and obesity. In some cases, a rare genetic disease may be the underlying defect. Lipid storage myopathy (LSM) is a genetic disease caused by lipid metabolism defects. LSM often affects the muscles, heart and liver. Coenzyme Q, riboflavin or carnitine replacement can be beneficial in some cases. We describe a patient who presented with liver failure and was unresponsive to treatment.
Meralgia Paraesthetica after Prone Position Ventilation in a Patient with COVID-19
Authors: Lucio Marinelli  , Laura Mori  , Chiara Avanti  , Filippo Cotellessa  , Sabrina Fabbri  , Cristina Schenone  , Carlo Trompetto
Published: May 2021

Background and objectives: One of the most feared complications of COVID-19 is respiratory failure caused by acute respiratory distress syndrome. In order to improve oxygenation and survival, patients admitted to intensive care units and intubated may undergo prone position mechanical ventilation. Prolonged prone positioning may cause meralgia paraesthetica due to lateral femoral cutaneous nerve entrapment between the inguinal ligament and the anterior superior iliac spine. Reports of the first two cases have been recently published. Case presentation: We describe the case of a 52-year-old man with respiratory failure during COVID-19 infection, who underwent prone position ventilation for 16 hours a day over 19 days and developed persistent burning pain and dysaesthesia on the lateral surface of the thigh bilaterally, diagnosed as meralgia paraesthetica. Conclusion: This is the second report describing meralgia paraesthetica following prone position ventilation in COVID-19. Given the ongoing pandemic and the inevitability of more patients with severe respiratory distress requiring prone position ventilation, this disabling entrapment condition should be considered and possibly prevented.
Foix-Alajouanine Syndrome Mimicking Longitudinally Extensive Transverse Myelitis
Authors: Anirudha S Rathnam  , Anza B Memon
Published: May 2021

Foix-Alajouanine syndrome is an arteriovenous malformation causing subacute congestive myelopathy that can lead to progressive paraplegia. It typically affects the lower thoracic and lumbosacral levels. Arteriovenous fistula (AVF) leads to increased venous pressure, decreasing the arteriovenous pressure gradient and leading to a decrease in spinal cord perfusion, oedema and necrosis. Early recognition and surgical intervention can result in a good prognosis.
Takotsubo Cardiomyopathy in a Healthcare Worker During the COVID-19 Pandemic: Caused by the Virus or the Demands of the Many Being Placed on the Few?
Authors: Mustafa Mohammed  , Samer Zakhour  , Jasneet Devgun  , James Lee  , Thomas Keimig  , Dee Dee Wang
Published: May 2021

We present a case of Takotsubo (stress-induced) cardiomyopathy (TCM) in a healthcare worker that occurred during the COVID-19 pandemic. TCM, or broken-heart syndrome, has various presentations. This case sheds light on how stress due to the COVID-19 pandemic may cause cardiac illness in healthcare workers.
The Dangers of Immediately Performing a Sensitive and Specific Investigation versus the Dangers of Delaying It: A Cautionary Case of Hodgkin’s Lymphoma
Authors: Takahiro Ito  , Hiroshi Sawachika  , Yukinori Harada  , Taro Shimizu
Published: May 2021

A 60-year-old man was admitted with a 1-month history of fever and weight loss. Multiple lymphadenopathies and haemophagocytic lymphohistiocytosis were noted from the beginning, suggesting lymphoma. However, lymph node biopsy was deferred because lymph node biopsy was regarded as being invasive and requires general anaesthesia, and because other possible differential diagnoses including gastrointestinal malignancies and TAFRO syndrome were being considered. Instead, investigations including gastrointestinal endoscopy and bone marrow biopsy were prioritized. The patient was eventually diagnosed with Hodgkin’s lymphoma based on lymph node biopsy but died during chemotherapy. Physicians should prioritize the tests that are most directly related to the diagnostic outcome, even if they are invasive.
Pulmonary Hypertension in COVID-19 Pneumoniae: It Is Not Always as It Seems
Authors: Maria Cristina Pasqualetto  , Maria Domenica Sorbo  , Maria Vitiello  , Chiara Ferrara  , Moreno Scevola  , Fabio Pantalone  , Fabio Gelain  , Claudio Aloi  , Manuele Nizzetto  , Fausto Rigo
Published: May 2021

A patient affected by COVID-19 pneumonia may develop pulmonary hypertension (PH) and secondary right ventricular (RV) involvement, due to lung parenchymal and interstitial damage and altered pulmonary haemodynamics, even in non-advanced phases of the disease. This is a consequence of hypoxic vasoconstriction of the pulmonary circulation, the use of positive end-expiratory pressure (PEEP) in mechanical ventilation, pulmonary endothelial injury, and local inflammatory thrombotic and/or thromboembolic processes. We report the case of a young man admitted with a diagnosis of COVID-19 pneumoniae with PH unrelated to viral infection and in whom partial anomalous pulmonary venous drainage (PAPVD) was eventually diagnosed.
Late Erosion of Percutaneous ASD Occlusion Device
Authors: Ronan William Cusack  , Gearoid Fitzgerald  , Mark Kennedy
Published: May 2021

Percutaneous closure of atrial septal defects (ASDs) is an ever more common treatment modality in selected patients. Device erosion is a rare but often fatal complication of this therapy, which usually presents early in the post-procedure course. We describe the case of a patient presenting with chest pain and shock in whom early recognition and intervention prevented a negative outcome. Awareness of this potentially lethal complication is important as the population of patients undergoing percutaneous procedures for structural heart disease continues to grow.
Ceftriaxone-induced Agranulocytosis
Authors: Lénio Couto  , André Goulart  , Ivone Valadão  , Magda Garça  , Maria Beatriz Santos  , Pedro Cota  , Carolina Teixeira
Published: May 2021

Ceftriaxone is a widely used antibiotic regarded as safe and effective. Drug-induced agranulocytosis is a life-threatening adverse reaction and few reports related to ceftriaxone were found in a review of the literature. The authors present a case of ceftriaxone-induced agranulocytosis, in which a brain abscess was diagnosed and ceftriaxone was commenced. Neutropenic fever occurred on the 29th day of therapy with a cumulative dose of 116 g ceftriaxone and a neutrophil nadir of 0.1×109/l. Ceftriaxone was withheld, filgrastim was administered for 3 days and neutrophil normalization was achieved. Although rare, ceftriaxone-induced agranulocytosis may occur in patients on a long course of ceftriaxone therapy. Prompt recognition and drug withdrawal are required.
Abdominal Splenosis Mimicking a Colon Tumour
Authors: Joana Braga  , Francesca Pereira  , Cristiana Fernandes  , Marinha Silva  , Teresa Boncoraglio  , Carlos Oliveira
Published: May 2021

Splenosis is a benign condition which results from the self-implantation of splenic tissue on intra or extraperitoneal surfaces, after splenic trauma or splenectomy. Patients are usually asymptomatic but may present with varied symptoms related to the implantation site. The diagnosis is a challenge because abdominal splenosis can mimic several diseases, including neoplasm. The gold standard examination for its diagnosis is scintigraphy with 99mTc-labelled heat-denatured erythrocyte. When splenosis is found in an asymptomatic patient, surgical removal is not indicated. A 57-year-old male patient presented with sporadic epigastric pain and a suspected mass in the recto-sigmoid transition. Abdominal ultrasound, CT and MRI identified this mass, its characteristics and location, but failed to distinguish its nature. However, given the patient’s past history of splenectomy and because the mass showed a similar sign to that of the splenic parenchyma, a hypothesis of abdominal splenosis was raised, which was confirmed by scintigraphy with 99mTc-labelled heat-denatured erythrocyte. In this case, the diagnosis was obtained before the patient was subjected to more invasive procedures, which are associated with high morbidity, and, as in most cases, no targeted intervention was necessary.
Clear Cell Carcinoma of the Thymus: An Improbable Enemy
Authors: Fábio Rêgo Salgueiro  , Paulo Cunha  , Diana Miranda  , Tatiana Pereira  , Filipa Pontes  , Ana Caetano  , Joana Monteiro
Published: May 2021

Introduction: Thymic clear cell carcinoma is the most uncommon subtype of thymic carcinoma, with 20 cases reported worldwide. Case Description: We present the case of a 61-year-old female with dyspnoea and chest pain for 2 days. Computed tomography (CT) angiography showed pulmonary thromboembolism and the existence of mediastinal and bilateral hilar lymphadenopathy, the largest infracarinal with an inferior axis of 25 mm, and also, micronodules on the left pulmonary parenchyma. The patient was admitted for aetiological assessment and underwent anticoagulant therapy. After a month, she had an ischaemic stroke, the sequelae of which proved to be fatal. The autopsy showed a mass in the superior-anterior mediastinum, with dimensions of 11×8×6 cm, corresponding to a thymus signet ring cell primary carcinoma. The immunohistochemistry study revealed that this mass was positive for AE1/AE3, CK5/6 and CK7. Conclusion: The clinical, morphological and immunophenotypic diversity of this tumour makes its diagnosis a difficult multidisciplinary challenge, which requires a high level of clinical knowledge and accurate imaging and histological investigation.
A Rare Case of Exocrine Pancreatic Insufficiency
Authors: Labied Mohamed , Tabakh Houria , Guezri Hamza , Siwane Abdellatif , Touil Najwa , Kacimi Omar , Chikhaoui Nabil
Published: May 2021

Lipomatous pseudohypertrophy (LPH) of the pancreas is an uncommon affection of exocrine pancreatic insufficiency. It is defined as substitution of the pancreatic exocrine gland by a large fat component. We report the case of a young patient with malabsorption syndrome (chronic diarrhoea and steatorrhoea), abnormal laboratory results and normal fibroscopy. Computed tomography revealed characteristic diffuse pancreatic abnormalities.
Strategy for Removing an Impacted Enterolith using Double-Balloon Enteroscopy in Crohn’s Disease
Authors: Tatsuya Kikuchi  , Yasushi Yamasaki  , Tsuyoshi Fujimoto  , Shoichi Tanaka
Published: May 2021

An enterolith in Crohn’s disease is an uncommon but serious condition because it can cause intestinal obstruction. Endoscopic treatment to remove the enterolith is attempted first, but is sometimes difficult owing to poor accessibility of the endoscope. In such cases, surgical treatment is inevitable. We successfully overcame poor accessibility and removed an enterolith using double-balloon enteroscopy. We describe our method below and suggest several helpful techniques.
Transplant-associated Thrombotic Microangiopathy Treated with Eculizumab and Romiplostim
Authors: Muhammad Awidi  , Meenu Jain  , Russell Baur
Published: May 2021

Transplant-associated thrombotic microangiopathy (TA-TMA) can occur after solid organ transplantation. It results in thrombocytopenia, haemolytic anaemia and microvascular occlusion. TA-TMA is not fully understood and treatment has not been clearly established. However, there is increasing evidence to suggest an immune-complement mediated component to its development. Eculizumab is a monoclonal antibody that inhibits the cleavage of C5 into pro-inflammatory, prothrombotic terminal complement elements and has been utilized in the treatment of atypical haemolytic uremic syndrome. We report a case of TA-TMA successfully treated with eculizumab and romiplostim. This case adds to the evidence that TA-TMA is triggered by complement dysregulation and suggests possible interventions for refractory cases.
COVID-19-Induced Hyperleucocytosis in Chronic Lymphocytic Leukaemia
Authors: Balraj Singh  , Sarah Ayad  , Parminder Kaur  , Ro-Jay Reid  , Sachin Gupta  , Michael Maroules
Published: May 2021

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel coronavirus responsible for the current global pandemic, coronavirus disease 2019 (COVID-19). COVID-19 usually presents with respiratory symptoms but can affect multiple organ systems. A wide spectrum of complications can occur depending upon the comorbidities of patients. There is limited literature available regarding the presentation and outcome of COVID-19 in chronic lymphocytic leukaemia (CLL) patients. We report 2 cases of COVID-19-induced hyperleucocytosis (WBC count >100,000/?l) in CLL patients.
Drug-induced Liver Injury Due to a Horse Chestnut Dietary Supplement
Authors: Diogo Costa Santos  , Graça Lérias  , Isabel Madruga
Published: May 2021

Drug-induced liver injury (DILI) is the most common cause of acute liver failure in the Western world. In recent years, natural herbal and dietary supplements have become widely available to the general public and have increased in popularity. Reports of idiosyncratic liver injury caused by such supplements have also increased over the last decade. Horse chestnut is a herb used in dietary supplements primarily for complications of venous insufficiency. Clinically significant acute liver injury has been very rarely associated with its use. We present the case of a 70-year-old man with idiosyncratic horse chestnut-induced liver injury.
What are the Clinical Implications of a Positive RT-PCR Test 6 Months after a Mild SARS-CoV-2 Infection?
Authors: Joao Gabriel De Carvalho  , Kateryna Hvozdara
Published: May 2021

We present the case of an 84-year-old female patient hospitalized for surgical treatment of a hip fracture who re-tested positive for SARS-CoV-2 with an RT-PCR nasopharyngeal swab approximately 6 months after presenting mild respiratory symptoms with confirmed COVID-19 in April 2020. We discuss the possibility of reinfection, long-term viral shedding and residual positivity, the limitations of RT-PCR swab tests, and the necessity for new testing methods as the COVID-19 pandemic spreads and long-lasting immunity is uncertain.
Cardiac Abnormalities in COVID-19 Patients: Should a Cardiac Echocardiogram be Routine?
Authors: Ramalho Carina , Almeida Mariana , Gomes Francisco , Silva Magda , Rodrigues Silvia
Published: May 2021

Current scientific evidence shows that SARS-CoV-2 infection is associated with an increased risk of thromboembolic events. In patients with ischaemic heart disease and heart failure, thrombi of the left ventricle can increase patient mortality, mainly due to the risk of systemic embolization. Given the hypercoagulable state associated with COVID-19, such events may be more likely. We describe a patient hospitalized for congestive heart failure and SARS-CoV-2 infection who was diagnosed with a thrombus in the left ventricle. After the thrombus was identified on echocardiography and treated with anticoagulation, it completely resolved and cardiac function improved.
Rheumatoid Vasculitis as an Initial Presentation of Rheumatoid Arthritis
Authors: Sravani Lokineni  , Amr Mohamed  , Leela Krishna Teja Boppana  , Megha Garg
Published: May 2021

Rheumatoid vasculitis is a rare, extra-articular manifestation that can be seen in long-standing rheumatoid arthritis. Here we present the case of a 51-year-old man who presented with arthralgias, skin rash, dyspnoea and generalized leg swelling and who was diagnosed with rheumatoid arthritis flare.
Diagnostic Bias in the COVID-19 Pandemic: A Series of Short Cases
Authors: Zieda Anete , Sbardella Silvia , Patel Malika , Smith Richard
Published: May 2021

During the COVID-19 pandemic, healthcare systems have faced unprecedented pressures. One challenge has been to promptly recognise non-COVID-19 conditions. Cognitive bias due to the availability heuristic may cause difficulties in reaching the correct diagnosis. Confirmation bias may also affect imaging interpretation. We report three cases with an alternative final diagnosis in whom COVID-19 was initially suspected: (a) Pneumocystis jirovecii pneumonia with unrecognised HIV infection; (b) pulmonary lymphangitis carcinomatosis; and (c) ST elevation myocardial infarction causing acute pulmonary oedema. To help mitigate bias, there is no substitute for thoughtful clinical assessment and critical appraisal when evaluating new information and formulating the differential diagnosis
Blood culture-negative endocarditis caused by Tropheryma whipplei: a case report of Whipple’s endocarditis
Authors: Knol Silke , Nijhuis Rogier L , Geeraedts Felix , Linssen Gerard
Published: May 2021

Case description: A 67-year-old man was admitted with progressive heart failure, due to blood culture-negative endocarditis of the aortic valve. In early course, urgent aortic valve replacement was needed. A polymerase chain reaction test (PCR) on samples of the explanted aortic valve revealed Tropheryma whipplei. He received ceftriaxone, followed by long-term co-trimoxazole. Recent arthralgia may have been a diagnostic clue. Conclusion: Whipple’s endocarditis should be assessed in patients with arthralgia and blood culture-negative endocarditis (BCNIE).
A Rare Case of Hypophosphataemic Osteomalacia in von Recklinghausen Neurofibromatosis
Authors: Makhlouf Yasmine , Boussaid Soumaya , Ajlani Houda , Jemmali Samia , Rekik Sonia , Sehli Hela , Eleuch Mouhamed
Published: May 2021

Background: Neurofibromatosis type 1 (NF1), also known as von Recklinghausen disease, is a one of the more common hereditary autosomal disorders. However, osteomalacia in neurofibromatosis type 1 is very rare tumour-induced osteomalacia; fibroblast growth factor-23 is usually implicated. Patients and methods: We report the case of a patient with a history of von Recklinghausen neurofibromatosis who presented with hypophosphataemic osteomalacia. Results: The patient was treated with high-dose calcitriol and oral phosphate with clinical improvement. Conclusion: Even though it is a rare entity, we must consider the diagnosis of hypophosphataemic osteomalacia in patients with neurofibromatosis in order to deliver appropriate treatment.
Unequal Infrastructure Development (Case Study in Banjarnegara District)
Authors: Prihatin Wiwik , Gravitiani Evi
Published: May 2021

This study will discuss the inequality of infrastructure development in terms of various aspects such as road conditions, clean water, solid waste, education, worship, and health. The purpose of this research is to determine the condition of infrastructure development that is not evenly distributed in the Banjarnegara district so that a strategy can be formulated to overcome this problem. The method used is descriptive qualitative using primary data obtained directly through a survey to show how the state of the existing infrastructure and secondary data. The results of this study indicate that inequality in infrastructure development occurs in almost all aspects. Three important and main aspects that must be addressed immediately are related to the construction or repair of road infrastructure because it is the mobility for all community movements to carry out their activities to make it smooth and easy, so that the development of an area is also easy to do. The second is increasing the number of clean water connection service coverage, and the third is handling solid waste management. If this is not done immediately, it will lead to even wider inequality in infrastructure development in the Banjarnegara district considering that infrastructure is also the key to driving economic growth and improving the quality of people's welfare.
The Analysis of Property Loans Development in Indonesia
Authors: Nurpita Anisa , Oktavia Rina
Published: May 2021

The property sector in Indonesia has an essential role in driving the national economy. The bank lending development to the property sector in April 2019 did not show significant growth and stagnant. This study analyzes the growth trend of property loans in Indonesia and estimates the factors that affect the number of housing loans (KPR) and apartment ownership loans (KPA) in Indonesia. The data used in this study are secondary data and time series. The analytical tools used in this research are trend and regression. The results showed that from 2020 to 2025, the property loan growth in Indonesia will still be sluggish. The condition is identified by construction loan which is expected to grow even though the increase is not too significant, real estate loan is still fluctuating, this is because in 2019 there was a decline in real estate loan growth of almost 50 percent from the previous year, and KPA and KPR are estimated to decline even though in nominal terms the number of KPR and KPA increases. The population number variable has a positive and significant effect on the number of KPR and KPA in Indonesia. The more the population, the more the number of KPR and KPA will increase. Meanwhile, the variables of economic growth and inflation in this study did not significantly affect the number of KPR and KPA.
Ondina: sobre as relações entre verdade, imagem e natureza
Authors: Sarinho Rafaela Travassos , Portugal Daniel B. , Da Costa Carlos Eduardo Félix
Published: May 2021

Este trabalho explora a obra Ondina (2005), do artista visual Walmor Corrêa. Partindo de uma perspectiva arqueológica, tal como o termo é definido por Foucault, seu objetivo é investigar como a obra mencionada se relaciona com a episteme atual ao representar, a partir de componentes típicos do universo científico, seres do imaginário popular.
Jaikoa regua
Authors: De Araújo Inês , Queiroz Tania , Karai Mirim Laércio
Published: May 2021

Kova´e nhembopara ma ijayu ha´e ombopara Xadalu Tupã Jekupe pe omboyau ague kova´emba´eapo ojapo va´e kue kuery, omombe´u mba´eixa pa guembiapo arte regua re ha´e oiko oikoa tetã re ha´e tekoa rupi ha´e maba´eixa vy pa omovaen rã o arte amboae kuery pe, ha´e javive pe oupity aguã rami ojepy´a py rei he´yn re, ha´e javive pe omovaen aguã rami.
Acupotomy for Osteoarthritis of the Knee; A Systematic Review and Meta-Analysis
Authors: Lee Seung Min , Lee Cham Kyul , Kim Kyung Ho , Kim Eun Jung , Jung Chan Yung , Seo Byung-Kwan , Goo Bon Hyuk , Baek Yong Hyeon , Lee Eun Yong
Published: May 2021

The purpose of this study was to evaluate the effectiveness and safety of acupotomy for the treatment of patients with knee osteoarthritis. There were 9 databases searched to retrieve randomized controlled trials until August 3, 2019 regarding acupotomy versus conventional Western medicine, conventional Western medicine treatment with and without acupotomy, and Korean medicine treatment with and without acupotomy, and meta-analysis was performed. Of 303 potentially relevant studies retrieved, 43 were systematically reviewed. All studies were conducted in China. Effective rate, visual analogue scale, and Western Ontario and McMaster Universities Osteoarthritis index were used as the evaluation scales. The Ashi point was selected most frequently. In all studies, the intervention group was more effective than the control group. Meta-analysis revealed that acupotomy showed statistically significant beneficial results. Although acupotomy had a beneficial effect on knee osteoarthritis, the risk of bias of the included studies was not low. The majority of the results from the evaluation scales used were highly heterogeneous (> 50%) which reduced confidence in the estimation of effect, or had a small sample size. Further clinical research and development is required in the future.
Deep neural network for designing near- and far-field properties in plasmonic antennas
Authors: Wu Qingxin , Li Xiaozhong , Jiang Li , Xu Xiao , Fang Dong , Zhang Jingjing , Song Chunyuan , Yu Zongfu , Wang Lianhui , Gao Li
Published: May 2021

The electromagnetic response of plasmonic nanostructures is highly sensitive to their geometric parameters. In multi-dimensional parameter space, conventional full-wave simulation and numerical optimization can consume significant computation time and resources. It is also highly challenging to find the globally optimized result and perform inverse design for a highly nonlinear data structure. In this work, we demonstrate that a simple multi-layer perceptron deep neural network can capture the highly nonlinear, complex relationship between plasmonic geometry and its near- and far-field properties. Our deep learning approach proves accurate inverse design of near-field enhancement and far-field spectrum simultaneously, which can enable the design of dual-functional optical sensors. Such implementation is helpful for exploring subtle, complex multifunctional nanophotonics for sensing and energy conversion applications.
Wellenreiten im Gesundheitsamt – Digitaler Wandel im Corona-Containment
Authors: Zimmermann Roland , Zimmermann Ina , Bornschlegl Philipp , Günther Katja
Published: May 2021

Das „Brechen von Infektionsketten“ ist das Ziel für den Öffentlichen Gesundheitsdienst (ÖGD) in der Pandemiebekämpfung. Diese komplexe Aufgabe benötigt digitale Unterstützung in den Gesundheitsämtern. Entgegen der landläufigen Meinung ist in den meisten Fällen dafür geeignete Software schon seit Sommer 2020 verfügbar – allerdings als nicht-standardisierte, lokale Lösungen. Viel entscheidender für die Zielerreichung ist es, die richtige Arbeitsteilung und die dazu passenden Prozesse zu definieren sowie ein enges Controlling des Kontaktmanagements zu realisieren. Erst dadurch können in kurzer Zeit viele Unterstützer in den Ämtern entsprechend der Pandemiesituation zusätzlich produktiv eingesetzt werden. In dem vorliegenden Erfahrungsbericht wird anhand eines Fallbeispiels des Gesundheitsamtes der Stadt Nürnberg aufgezeigt, wie Prozessorganisation, IT und Controlling aufeinander abgestimmt werden sollten. Diese Erkenntnisse helfen auch bei der anstehenden Vernetzung der föderal strukturierten Gesundheitsämter in Deutschland über eine zentrale Lösung (SORMAS). Denn es zeigt sich, dass lediglich die politische Vorgabe zentraler Lösungen noch lange nicht zu ihrer effektiven Nutzbarkeit führt und wiederum der Zusammenhang aus Software und Organisation berücksichtigt werden muss, um nicht Schiffbruch zu erleiden.