International Journal of Case Reports

  • Acute soft head syndrome and a mini review of bone and neurologic complications in patients with sickle cell disease

    Introduction: Acute soft head syndrome is a rare complication in patients with sickle cell disease (SCD) that is characterized by progressive skull pain and swelling, it is usually related to skull bone infarction and full recovery is achieved with conservative management. This case represents a very rare association of sickle cell disease and acute soft head syndrome that necessitates to be differentiated from other bone and neurologic presentations occurring in this entity of patients. Case: We report a rare case of an 11 years old Saudi male patient with sickle cell disease who developed acute soft head syndrome that presented with severe headache. An underlying osteomyelitis of skull and lower limb bones couldn’t be excluded and the patient had full recovery after conservative treatment. Conclusion: Acute soft bone syndrome seldomly occurs in SCD, however, its presentations mimics those of bone and neurologic complications so differentiation is essential in order to set up a clear plan of management.

  • Probable Transient Anterior Bulging Fontanelle after Measles Vaccination

    Transient anterior bulging fontanelle is a rare but serious medical condition, which can be classified as definite and probable transient bulging fontanelle. Conducting case surveillance, diagnosis and on time reporting during vaccination is of paramount importance in managing the adverse events following immunization. We diagnosed probable transient bulging fontanelle in a 9 month infant weighing 7.8Kg with ultrasound in Arba Minch General Hospital after 12 hours of measles vaccination. A physical examination was conducted to confirm probable transient bulging fontanel. Treated with her mother’s breast milk at her home and visiting was done after three and five days. We used a measles vaccine adverse effect case report, to find potential transient bulging fontanelle (TBF) and to describe the characteristics of probable cases of TBF on admitted infant to Arba Minch General Hospital. The Infant was alert; a febrile to touch whose temperature measured at the left auxiliarysitewas37.8oc with non-tender, bulging and tense swelling that includes non-pulsatile anterior fontanelle size of 3cm.The infant was found with no fever, vomiting, bleeding and no problem of feeding and respiratory difficulties except a history of fallen down accident from bed on her head 15 days back of the swelling. The swelling was decreased gradually and the fontanel started pulsation and the swelling returned back to the normal after the three and five day of visits without any medication. Despite this rare side effect, vaccination against the preventable disease, measles need to be sustained since transient bulging fontanelle is a self-limited case and immunization balances the impact of adverse events following immunization. Adequate case surveillance, diagnosis and reporting are very essential up to the management.

  • Rare Anomaly Of Aberrant Right Subclavian Artery Associated With Right Common Carotid Artery In The Pre Tracheal Position –A Case Report

    Congenital variations of the aortic arch and great vessels are often encountered in clinical practice. This is a case report of a 60 year old lady diagnosed with carcinoma thyroid and during the procedure, incidentally diagnosed to have right common carotid artery crossing the trachea anteriorly. Post operative computed tomographic angiographic study confirmed the common carotid artery in the pretracheal position and aberrant right subclavian artery (ARSA) was discovered. This is a rare anamoly of the common carotid artery and to be kept in mind during the procedures done in the pretracheal position and other associated anomalies are to be evaluated.

  • Endodontic Management Of C-shaped Root Canal Followed By a Post Less Core and Crown-a Case Report

    C-shaped canal is one of the most difficult situations with which the dentist is confronted during endodontic treatment of teeth. Recognition of unusual variation in the canal configuration is critical because it has been established that the root with a single tapering canal and apical foramen is the exception rather than rule. The early recognition of these configurations facilitates cleaning, shaping and obturation of the root canal system. “C” configuration, which is an important anatomic variation, presents a thin fin connecting the root canals. In this case report we have discussed the successful management of C-shaped canal (Melton’s category II) in mandibular second molar diagnosed by using cone-beam computed tomography and operating microscope and also used self-adjusting file (SAF), sonic irrigation and thermoplasticized gutta percha obturating technique. Endocrown-type restorations are single prostheses fabricated from reinforced ceramics that can be acid etched, indicated for endodontically treated molar teeth that have significant loss of coronal structure. Endocrowns are formed from a monoblock containing the coronal portion integrated into the apical projection that fills the pulp chamber space, and possibly the root canal entrances. A endocrown-type restoration was fabricated from lithium disilicate ceramic (IPS e.Max) in a mandibular second molar with extensive lingual destruction.

  • Emergency surgery for a Morgagni hernia causing respiratory failure

    Reports of emergency surgical repair of a retrosternal hernia causing respiratory failure in an adult are rare. We treated an 82-year-old man who had been suffering breathlessness upon exertion, some speech difficulty, and, most recently, visual hallucinations. He had consulted a physician who ordered an arterial blood gas test, which revealed hypoxemia, and thoracoabdominal computed tomography (CT), which revealed a hernia that was compressing the pulmonary parenchyma. Over the next 30 days, the hernia worsened, acute respiratory failure developed, and the patient was transferred to our hospital by ambulance. The patient presented to us not only with respiratory failure but also a decreased level of consciousness. CT performed upon admission revealed prolapse of the transverse colon from the posterior surface of the sternum to the right thoracic cavity, left deviation of the mediastinum, and compression of the pulmonary parenchyma, which we believed to be the cause of the hypoxemia. With the hernial orifice appearing to be on the right, a Morgagni hernia was diagnosed. Emergency surgery was deemed necessary. An epigastric midline laparotomy incision was placed, and we observed a retrosternal hernia, with an enlarged foramen of Morgagni measuring 70mm × 50 mm as the hernial orifice. The hernia contained portions of the greater omentum and transverse colon. We returned the contents to the peritoneal cavity manually closed the hernia orifice by simple suturing and reinforced the repair with a mesh patch. With signs of cardiac failure developing, temporary noninvasive positive-pressure ventilation was instituted from postoperative day 5 to postoperative day 11, but the patient’s general condition improved thereafter, and he was discharged on postoperative day 29.

  • Serious Staphylococcus Aureus Infection in a Patient with Diabetes Mellitus

    The immune system and metabolism are closely related and it is recognized that diabetes mellitus (DM) and its complications have a compromising impact on the degree of immunosuppression. The authors present the case of a 65-year-old man with a history of type 2 DM and ulcers of the lower limbs who went to the emergency departament with odynophagia, dysphagia, fever and cervicalgia. He had a painful cervical and supraclavicular region and highly infectious parameters in blood samples. The cervical radiography suggested vertebral fusion and cervical computed tomography with soft tissue thickening, hypopharyngeal deviation and gaseous foci suggestive of abscess. He started empiric antibiotic therapy and was performed an abscess drainage where Staphylococcus aureus oxacillin susceptible was isolated. S. aureus bacteremias have a higher prevalence in diabetics, being essential the rapid orientation in situations of bacteremia to clarify the infectious focus and immediate onset of antibiotic therapy which decreases mortality.

  • Oral pyridostigmine for treatment of postoperative ileus associated with elevated catecholamine levels: A case report

    The etiology of post-operative ileus is usually multifactorial, but increased catecholamines have been implicated as an important cause. We present a case of catecholamine-induced prolonged post-operative ileus treated successfully with Pyridostigmine. A 70-year-old male underwent a low-anterior resection and diverting loop ileostomy for rectal cancer. Immediately post-operatively he developed refractory hypertensive urgency and a small bowel ileus. Biochemical testing revealed markedly elevated 24-hour urinary metanephrines and normetanephrines. However, radiologic studies failed to identify a pheochromocytoma. The ileus persisted despite employing a multimodal regimen consisting of avoidance of narcotic pain medications, gastric decompression via a nasogastric tube, maintenance of normal levels of electrolytes, parenteral nutritional support, and early mobilization. Two weeks after the surgery the patient was treated with oral Pyridostigmine with appropriate return of bowel function. Excessive circulating catecholamines play an important role in the etiology of refractory post-operative ileus, and cholinesterase inhibitors such as Pyridostigmine could be used as an effective treatment in such cases.

  • Pulmonary metastasis of a Dermatofibrosarcoma of Darier and Ferrand treated by IMATINIB: a case report

    Dermatofibrosarcoma (DFS) described by Darier and Ferrand represents less than 5% of soft tissue sarcomas and metastases only very rarely. We report the case of a 51-year-old patient followed for six years for a DFS of the right thigh root recurrent several times after non-optimal surgical resections. The occurrence of thoracic pain associated with a cough with dyspnea, motivated the realization of a thoracic computed tomography (CT) showing a right basal pulmonary mass with pulmonary nodules. CT biopsy of one of the pulmonary nodules confirmed the metastatic nature of these lesions. The search for translocation t (17,22) could not be performed. A treatment based on imatinib has been started. The evolution was marked by the disappearance of the respiratory symptomatology and a good radiological response. The advent of targeted therapy with imatinib transformed the prognosis for this disease, which was considered incurable at the metastatic stage.

  • Inadvertent epidural administration of remifentanil (Ultiva®) during labour analgesia

    The use of remifentanil patient-controlled analgesia for labour analgesia remains controversial. The high potency of the drug, the fear of serious adverse drug reactions and drug administration errors are all legitimate concerns. We report the case of a woman in labour who inadvertently received a remifentanil solution via epidural route. In addition to the risk of respiratory depression, the epidural administration of remifentanil contains glycine in its solution and is therefore contraindicated due to potential neurological injury. The patient received a total of 2 mg of remifentanil and 15 mg of glycine in her epidural over a long period before the error was identified. Interestingly the patient was mostly comfortable during labour and fortunately no maternal or neonatal adverse events occurred.

  • A Case Report of Warfarin Induced Coagulopathy and Upper Gastro Intestinal Bleeding

    Warfarin is an oral vitamin k antagonist prescribed to those patients for the treatment and prevention of venous thromboembolism. The major challenges to be faced during the therapy were a greater risk for both major well as minor bleeding, which makes the regular monitoring of INR (international normalized ratio) mandatory. Here we report a case study of 76 year old male who presented to institution with the complaints of bleeding from oral cavity due to consumption of conventional anticoagulant therapy. Patient was on anticoagulation therapy for paroxysmal atrial fibrillation since 2011. The blood investigation revealed anemia (Hemoglobin: 6.1g/dl). He was immediately transfused with packed RBC and fresh frozen plasma to replenish the body reserves. Prothrombin time (PT)/INR was reported undetectable and warfarin was withheld from the past medications and was restarted at INR therapeutic range. Furthermore this case highlights the need for a better communication by providing counselling regarding all aspects of medications as well as lifestyle modifications and also by giving patient information leaflets.