The SARS-CoV-2 pandemic has grown into a major global concern with huge efforts to combat the spread. Exaggerated inflammatory response plays a major role in which was the rationale to use corticosteroids as a treatment option. However, multiple studies showed an association between of opportunistic and bacterial infections in patients under corticosteroid therapy. We report a case of a 76-year old patient diagnosed with COVID-19 pneumonia, treated with 10 days Dexamethasone and Remdesivir who presented with abdominal symptoms with eosinophilia. Biopsy and stool studies revealed strongyloides stercoralis larvae. The patient was treated with 2 doses of Ivermectin with significant clinical resolution. Clinician should have high clinical suspicion for Strongloydiasis in patients who have lived or visited Strongyloides stercoralis endemic areas and for patients with unexplained eosinophilia. Prompt treatment with Ivermectin is crucial for confirmed cases and should be also implemented empirical in high risk groups, where obtaining a diagnosis is unfeasible.
{"title":"Activating Dormant Strongyloidiasis Secondary to COVID-19 Treatment","authors":"Fahad Alkaabba, Holman Li, F. Ibrahim","doi":"10.5430/crim.v9n1p4","DOIUrl":"https://doi.org/10.5430/crim.v9n1p4","url":null,"abstract":"The SARS-CoV-2 pandemic has grown into a major global concern with huge efforts to combat the spread. Exaggerated inflammatory response plays a major role in which was the rationale to use corticosteroids as a treatment option. However, multiple studies showed an association between of opportunistic and bacterial infections in patients under corticosteroid therapy. We report a case of a 76-year old patient diagnosed with COVID-19 pneumonia, treated with 10 days Dexamethasone and Remdesivir who presented with abdominal symptoms with eosinophilia. Biopsy and stool studies revealed strongyloides stercoralis larvae. The patient was treated with 2 doses of Ivermectin with significant clinical resolution. Clinician should have high clinical suspicion for Strongloydiasis in patients who have lived or visited Strongyloides stercoralis endemic areas and for patients with unexplained eosinophilia. Prompt treatment with Ivermectin is crucial for confirmed cases and should be also implemented empirical in high risk groups, where obtaining a diagnosis is unfeasible.","PeriodicalId":72533,"journal":{"name":"Case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44579094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. J. Brockman, A. Taylor, Farida Eid, Suranjana Dey; MD, Shawn Corcoran; MD
Antihistamine usage is commonplace for alleviating allergy symptoms, though they are not without side-effects. We present a case of antihistamine use precipitating upper and lower extremity ballismus in a patient. We also discuss other case reports which outline similar dopaminergic dysregulation secondary to antihistamine usage, as well as our recommendations for prevention of these symptoms.
{"title":"Ballismus Secondary to Antihistamine Use","authors":"M. J. Brockman, A. Taylor, Farida Eid, Suranjana Dey; MD, Shawn Corcoran; MD","doi":"10.5430/crim.v9n1p1","DOIUrl":"https://doi.org/10.5430/crim.v9n1p1","url":null,"abstract":"Antihistamine usage is commonplace for alleviating allergy symptoms, though they are not without side-effects. We present a case of antihistamine use precipitating upper and lower extremity ballismus in a patient. We also discuss other case reports which outline similar dopaminergic dysregulation secondary to antihistamine usage, as well as our recommendations for prevention of these symptoms.","PeriodicalId":72533,"journal":{"name":"Case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46086225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hyperoeosinophilic syndrome (HES) is rare, and clinicians may not recognize its potential association with malignancy. Red flag signs of HES include steroid resistance, older age, and significant lymphadenopathy that can be indicative of malignancy. In this case, an elderly male presenting with right chest wall erythema and axillary lymphadenopathy was initially diagnosed with and treated for cellulitis. Labs were significant for hypereosinophilia. Evidence of end organ damage raised concern for HES. Over the course of three hospitalizations, he was found to have a rising eosinophil count despite high-dose corticosteroid treatment. Further investigation eventually revealed a diagnosis of Hodgkin’s Lymphoma. This case highlights steroid-resistant HES as a presenting sign of malignancy and allows for discussion of potential investigative approaches for HES therapy. Though corticosteroids are first-line treatment for hypereosinophilia and HES, they are well known to have many adverse effects. Biologics, such as mepolizumab and benralizumab, have more acceptable side effect profiles and are effective in treating non-myeloid HES. The use of biologics as first-line treatment for HES has yet to be investigated.
{"title":"Steroid resistant hypereosinophilic syndrome found to be Hodgkin’s Lymphoma","authors":"Christine J. Licata, Sowmya Arja, S. Teuber","doi":"10.5430/crim.v8n2p10","DOIUrl":"https://doi.org/10.5430/crim.v8n2p10","url":null,"abstract":"Hyperoeosinophilic syndrome (HES) is rare, and clinicians may not recognize its potential association with malignancy. Red flag signs of HES include steroid resistance, older age, and significant lymphadenopathy that can be indicative of malignancy. In this case, an elderly male presenting with right chest wall erythema and axillary lymphadenopathy was initially diagnosed with and treated for cellulitis. Labs were significant for hypereosinophilia. Evidence of end organ damage raised concern for HES. Over the course of three hospitalizations, he was found to have a rising eosinophil count despite high-dose corticosteroid treatment. Further investigation eventually revealed a diagnosis of Hodgkin’s Lymphoma. This case highlights steroid-resistant HES as a presenting sign of malignancy and allows for discussion of potential investigative approaches for HES therapy. Though corticosteroids are first-line treatment for hypereosinophilia and HES, they are well known to have many adverse effects. Biologics, such as mepolizumab and benralizumab, have more acceptable side effect profiles and are effective in treating non-myeloid HES. The use of biologics as first-line treatment for HES has yet to be investigated.","PeriodicalId":72533,"journal":{"name":"Case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49654292","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hepatosplenic T cell lymphoma (HSTCL) is an exceedingly uncommon, aggressive peripheral T cell lymphoma comprising < 1% non-Hodgkin’s lymphomas (NHL). Despite treatments including allogeneic stem cell transplantation, median survival is < 2 years. In the majority of patients, the etiology of HSTCL is undetermined; although it has been associated with chronic immunosuppression which accounts for 20% of cases. HSTCL presents as a systemic illness, and sometimes in association with hemophagocytic lymphohistiocytosis syndrome (HLH). Our patient is a young male with a long-standing history of Crohn’s disease on immunosuppressive medications, who presented with progressive bicytopenia. He was diagnosed with HSTCL on a bone marrow biopsy and met clinical diagnostic criteria for HLH. He was started on chemotherapy and dexamethasone per HLH treatment protocol and underwent allogeneic hematopoietic stem cell transplantation (HSCT).
{"title":"Hepatosplenic T cell lymphoma and hemophagocytic lymphohistiocytosis in an adult patient with Crohn’s disease on immunosuppressive therapy","authors":"Nahid Suleman, J. Woodroof, Eyad Reda","doi":"10.5430/crim.v8n1p22","DOIUrl":"https://doi.org/10.5430/crim.v8n1p22","url":null,"abstract":"Hepatosplenic T cell lymphoma (HSTCL) is an exceedingly uncommon, aggressive peripheral T cell lymphoma comprising < 1% non-Hodgkin’s lymphomas (NHL). Despite treatments including allogeneic stem cell transplantation, median survival is < 2 years. In the majority of patients, the etiology of HSTCL is undetermined; although it has been associated with chronic immunosuppression which accounts for 20% of cases. HSTCL presents as a systemic illness, and sometimes in association with hemophagocytic lymphohistiocytosis syndrome (HLH). Our patient is a young male with a long-standing history of Crohn’s disease on immunosuppressive medications, who presented with progressive bicytopenia. He was diagnosed with HSTCL on a bone marrow biopsy and met clinical diagnostic criteria for HLH. He was started on chemotherapy and dexamethasone per HLH treatment protocol and underwent allogeneic hematopoietic stem cell transplantation (HSCT).","PeriodicalId":72533,"journal":{"name":"Case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47981485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Q. Bui, S. Tran, S. Pham, V. Phan, Khiet Nguyen, Ngoc Mai, T. Nguyen, L. Nguyen, Thanh D. Hoang, C. Le, Hashim Chaudhry, A. Goyal, Duc H. Nguyen, Phillip Tran, Dat Q Ha, Doi Huynh
The surgical resection timing of left atrial (LA) myxoma is still controversial in concern for the risk of further embolic phenomena if delayed surgery versus hemorrhagic transformation during early surgery. We describe a case of 60-year-old man without significant past medical history admitted with two-day of double vision and found to have LA myxoma. Multiple factors including clinical aspects and comorbidities should be evaluated to decide the favorable management.
{"title":"Acute ischemic stroke on the setting of left atrial myxoma: optimal time for cardiac surgery","authors":"Q. Bui, S. Tran, S. Pham, V. Phan, Khiet Nguyen, Ngoc Mai, T. Nguyen, L. Nguyen, Thanh D. Hoang, C. Le, Hashim Chaudhry, A. Goyal, Duc H. Nguyen, Phillip Tran, Dat Q Ha, Doi Huynh","doi":"10.5430/crim.v8n2p1","DOIUrl":"https://doi.org/10.5430/crim.v8n2p1","url":null,"abstract":"The surgical resection timing of left atrial (LA) myxoma is still controversial in concern for the risk of further embolic phenomena if delayed surgery versus hemorrhagic transformation during early surgery. We describe a case of 60-year-old man without significant past medical history admitted with two-day of double vision and found to have LA myxoma. Multiple factors including clinical aspects and comorbidities should be evaluated to decide the favorable management.","PeriodicalId":72533,"journal":{"name":"Case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41307653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
L. Nguyen, C. Le, S. Pham, S. Tran, Thanh D. Hoang, Khiet Nguyen, T. Nguyen, Hashim Chaudhry, Nghi Tran, Ngoc Mai, M. Brockman, V. Phan, A. Goyal, Phillip Tran
Cardiovascular manifestations of COVID-19 infection remain an ongoing study. We present a case of significant bradycardia in the patient with COVID-19 sepsis. We discuss about the possible mechanism, pathophysiology, and management in this pathology.
{"title":"Significant bradycardia in patient with COVID-19 sepsis: Full management review","authors":"L. Nguyen, C. Le, S. Pham, S. Tran, Thanh D. Hoang, Khiet Nguyen, T. Nguyen, Hashim Chaudhry, Nghi Tran, Ngoc Mai, M. Brockman, V. Phan, A. Goyal, Phillip Tran","doi":"10.5430/crim.v8n1p17","DOIUrl":"https://doi.org/10.5430/crim.v8n1p17","url":null,"abstract":"Cardiovascular manifestations of COVID-19 infection remain an ongoing study. We present a case of significant bradycardia in the patient with COVID-19 sepsis. We discuss about the possible mechanism, pathophysiology, and management in this pathology.","PeriodicalId":72533,"journal":{"name":"Case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49628741","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pei Xue, Danielle M. Nogoy, Konstantinos Damiris, S. Ahlawat
Adenosquamous carcinoma (ASC) of the esophagus is a rare malignancy of the esophagus with histopathologic features of both adenocarcinoma and squamous cell carcinoma. Given the rarity of this disease, there is scant literature on ASC. We report a unique case of a 29-year-old African American female with advanced ASC manifesting as a pathologic fracture. Magnetic resonance imaging (MRI) confirmed femoral fracture, and femoral biopsy demonstrated metastatic ASC. Upper endoscopy revealed a distal esophageal stricture, and histopathology confirmed ASC. To our knowledge this is the youngest case of ASC to be reported. We discuss ASC epidemiology, clinical findings, diagnosis, and current treatments.
{"title":"Discovery of esophageal stricture following femoral neck fracture: a case of adenosquamous carcinoma of the esophagus in a young female","authors":"Pei Xue, Danielle M. Nogoy, Konstantinos Damiris, S. Ahlawat","doi":"10.5430/CRIM.V8N1P13","DOIUrl":"https://doi.org/10.5430/CRIM.V8N1P13","url":null,"abstract":"Adenosquamous carcinoma (ASC) of the esophagus is a rare malignancy of the esophagus with histopathologic features of both adenocarcinoma and squamous cell carcinoma. Given the rarity of this disease, there is scant literature on ASC. We report a unique case of a 29-year-old African American female with advanced ASC manifesting as a pathologic fracture. Magnetic resonance imaging (MRI) confirmed femoral fracture, and femoral biopsy demonstrated metastatic ASC. Upper endoscopy revealed a distal esophageal stricture, and histopathology confirmed ASC. To our knowledge this is the youngest case of ASC to be reported. We discuss ASC epidemiology, clinical findings, diagnosis, and current treatments.","PeriodicalId":72533,"journal":{"name":"Case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43403900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Spur cells are reportedly linked to advanced end-stage liver diseases and may lead to accelerated hemolysis. In this case report, we discuss one of these rare instances when a 45-year-old female with decompensated cirrhosis was admitted for severe anemia. Extensive workup revealed non-immune hemolysis secondary to spur cell formation. Orthotopic liver transplantation remains the only treatment of choice for reversal of spur cell anemia. Alternatively, multidrug therapy has also been explored, including usage of bile acid sequestrants; however, success is rare.
{"title":"Rare cause of non-immune hemolytic anemia in end-stage liver disease","authors":"Maheep Sangha, A. Aggarwal, J. Sandhu","doi":"10.5430/crim.v7n2p7","DOIUrl":"https://doi.org/10.5430/crim.v7n2p7","url":null,"abstract":"Spur cells are reportedly linked to advanced end-stage liver diseases and may lead to accelerated hemolysis. In this case report, we discuss one of these rare instances when a 45-year-old female with decompensated cirrhosis was admitted for severe anemia. Extensive workup revealed non-immune hemolysis secondary to spur cell formation. Orthotopic liver transplantation remains the only treatment of choice for reversal of spur cell anemia. Alternatively, multidrug therapy has also been explored, including usage of bile acid sequestrants; however, success is rare.","PeriodicalId":72533,"journal":{"name":"Case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43554134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nuno Zarcos Palma, M. Cruz, L. Santos, Margarida Cruz, Filipe Cunha, Vítor Fagundes, L. Pires, M. Mesquita
Autoimmune Polyendocrine Syndromes (APS) are rare autoimmune endocrinopathies, characterized by the association of two or more organ-specific disorders. Type II Autoimmune Polyendocrine Syndromes (APS II) comprises the association of Addison’s disease with thyroid autoimmune disease and/or type 1 diabetes mellitus. Although the classic presentation is symptomatic hypotension, it can manifest as an adrenal crisis - a life-threatening condition. We report a case of a 41-year-old woman with prolonged asthenia, cutaneous hyperpigmentation and symptomatic hypotension refractory to intravenous fluids. APS II was diagnosed with a presentation of an Addisonian crisis, resolved after the onset of hydrocortisone.
{"title":"Autoimmune polyendocrine syndrome type II: After adrenal crisis","authors":"Nuno Zarcos Palma, M. Cruz, L. Santos, Margarida Cruz, Filipe Cunha, Vítor Fagundes, L. Pires, M. Mesquita","doi":"10.5430/crim.v7n2p3","DOIUrl":"https://doi.org/10.5430/crim.v7n2p3","url":null,"abstract":"Autoimmune Polyendocrine Syndromes (APS) are rare autoimmune endocrinopathies, characterized by the association of two or more organ-specific disorders. Type II Autoimmune Polyendocrine Syndromes (APS II) comprises the association of Addison’s disease with thyroid autoimmune disease and/or type 1 diabetes mellitus. Although the classic presentation is symptomatic hypotension, it can manifest as an adrenal crisis - a life-threatening condition. We report a case of a 41-year-old woman with prolonged asthenia, cutaneous hyperpigmentation and symptomatic hypotension refractory to intravenous fluids. APS II was diagnosed with a presentation of an Addisonian crisis, resolved after the onset of hydrocortisone.","PeriodicalId":72533,"journal":{"name":"Case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-06-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5430/crim.v7n2p3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42241062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Natalie E Hassell, Ewa Grzeszczak, Ryan C Adams, Wonder P Drake
Pulmonary sarcoidosis is unlikely to resolve if it persists for greater than five years. A growing body of literature supports the involvement of the microbiome in sarcoidosis and a role for sex hormones in pulmonary fibrosis. Additionally, obesity is a risk factor for the development of sarcoidosis. Bariatric surgery is an effective treatment for obesity and can lead to microbial and endocrine changes. Here, we report the clinical improvement of longstanding pulmonary sarcoidosis following sleeve gastrectomy.
{"title":"Improvement of pulmonary sarcoidosis following sleeve gastrectomy.","authors":"Natalie E Hassell, Ewa Grzeszczak, Ryan C Adams, Wonder P Drake","doi":"10.5430/crim.v7n1p1","DOIUrl":"https://doi.org/10.5430/crim.v7n1p1","url":null,"abstract":"<p><p>Pulmonary sarcoidosis is unlikely to resolve if it persists for greater than five years. A growing body of literature supports the involvement of the microbiome in sarcoidosis and a role for sex hormones in pulmonary fibrosis. Additionally, obesity is a risk factor for the development of sarcoidosis. Bariatric surgery is an effective treatment for obesity and can lead to microbial and endocrine changes. Here, we report the clinical improvement of longstanding pulmonary sarcoidosis following sleeve gastrectomy.</p>","PeriodicalId":72533,"journal":{"name":"Case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5430/crim.v7n1p1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9713009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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