Metastasis to the anterior cranial fossa from solid tumors is very unusual. We describe a 72-year-old male with history of locally advanced prostate cancer who presented with sequential bilateral vision loss, initially misdiagnosed and mistreated as giant cell arteritis. Neuroimaging eventually revealed an extra-axial soft tissue mass in the planum sphenoidale exerting a pressure effect on the cisternal segments of the optic nerves. He underwent surgical excision of the mass to try to improve his vision. Biopsy results confirmed high grade metastatic adenocarcinoma of the prostate. He was started on high dose glucocorticoids and radiation therapy and his visual symptoms improved. Patients with metastatic prostate cancer can develop cranial nerve deficits secondary to metastatic involvement of the skull base. Early recognition and appropriate therapy is essential to prevent permanent neurological impairment.
{"title":"Prostate cancer metastatic to the planum sphenoidale presenting as sequential bilateral vision loss","authors":"B. Yohannan, M. Feldman","doi":"10.5430/CRIM.V5N4P5","DOIUrl":"https://doi.org/10.5430/CRIM.V5N4P5","url":null,"abstract":"Metastasis to the anterior cranial fossa from solid tumors is very unusual. We describe a 72-year-old male with history of locally advanced prostate cancer who presented with sequential bilateral vision loss, initially misdiagnosed and mistreated as giant cell arteritis. Neuroimaging eventually revealed an extra-axial soft tissue mass in the planum sphenoidale exerting a pressure effect on the cisternal segments of the optic nerves. He underwent surgical excision of the mass to try to improve his vision. Biopsy results confirmed high grade metastatic adenocarcinoma of the prostate. He was started on high dose glucocorticoids and radiation therapy and his visual symptoms improved. Patients with metastatic prostate cancer can develop cranial nerve deficits secondary to metastatic involvement of the skull base. Early recognition and appropriate therapy is essential to prevent permanent neurological impairment.","PeriodicalId":72533,"journal":{"name":"Case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-08-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5430/CRIM.V5N4P5","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44288388","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}
Systemic lupus erythematosus (SLE) is a common rheumatologic condition with known GI involvement. Acute pancreatitis (AP) is a rare GI complication of SLE and is typically associated with increased disease activity. Macrophage activation syndrome (MAS) is an unusual, hyper-inflammatory response to a rheumatologic stimulus characterized by hyperferritinemia, pancytopenia, thermal dysregulation and multi-organ dysfunction. MAS, more commonly seen in children, has been reported to complicate both adult onset SLE and AP. We present a case of necrotizing AP secondary to an SLE flare complicated by MAS in an adult patient successfully treated with anakinra.
{"title":"UnMASking the diagnosis: Acute severe necrotizing pancreatitis in the setting of systemic lupus erythematosus complicated by macrophage activation syndrome","authors":"C. Askin, J. Edelson, G. Dooley, A. Stratton","doi":"10.5430/crim.v5n4p1","DOIUrl":"https://doi.org/10.5430/crim.v5n4p1","url":null,"abstract":"Systemic lupus erythematosus (SLE) is a common rheumatologic condition with known GI involvement. Acute pancreatitis (AP) is a rare GI complication of SLE and is typically associated with increased disease activity. Macrophage activation syndrome (MAS) is an unusual, hyper-inflammatory response to a rheumatologic stimulus characterized by hyperferritinemia, pancytopenia, thermal dysregulation and multi-organ dysfunction. MAS, more commonly seen in children, has been reported to complicate both adult onset SLE and AP. We present a case of necrotizing AP secondary to an SLE flare complicated by MAS in an adult patient successfully treated with anakinra.","PeriodicalId":72533,"journal":{"name":"Case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5430/crim.v5n4p1","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47877444","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}
Ludwig’s angina is a deep neck infection of the supramylohyoid and inframylohyoid spaces. Without prompt recognition and intervention, it can progress to airway compromise with significant morbidity and mortality. Although otolaryngologists and oral surgeons are well-versed in this condition, it is vital that physicians across all specialties are knowledgeable about the presentation and basic treatment of this potentially fatal condition. Here we report a case of Ludwig’s angina in a 29-year-old male that was successfully managed with both medical and surgical intervention. We also aim to describe the presentation and treatment of Ludwig’s angina in order to increase awareness in non-surgical fields.
{"title":"“Air” on the side of caution: The importance of early recognition and intervention in Ludwig’s angina","authors":"Sallie M Long, Talha Demirci, S. Kruse","doi":"10.5430/CRIM.V5N3P40","DOIUrl":"https://doi.org/10.5430/CRIM.V5N3P40","url":null,"abstract":"Ludwig’s angina is a deep neck infection of the supramylohyoid and inframylohyoid spaces. Without prompt recognition and intervention, it can progress to airway compromise with significant morbidity and mortality. Although otolaryngologists and oral surgeons are well-versed in this condition, it is vital that physicians across all specialties are knowledgeable about the presentation and basic treatment of this potentially fatal condition. Here we report a case of Ludwig’s angina in a 29-year-old male that was successfully managed with both medical and surgical intervention. We also aim to describe the presentation and treatment of Ludwig’s angina in order to increase awareness in non-surgical fields.","PeriodicalId":72533,"journal":{"name":"Case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5430/CRIM.V5N3P40","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41456413","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}
We report a case of a 55-year-old woman who developed hyponatremia after the initiation of exogenous vasopressin to treat vasodilatory shock. Discontinuation of exogenous vasopressin therapy, without any other changes in medical therapy or the patient’s condition, led to a rapid correction in the serum sodium level along with a marked increase in urine output. Increased free water retention due to exogenous vasopressin administration may have contributed to hyponatremia in this patient. This case illustrates the potential for vasopressin to have potent and unintended renal and electrolyte effects in patients treated for vasodilatory shock.
{"title":"Vasopressin-induced hyponatremia in a patient with pulmonary hypertension and right heart failure treated for septic shock","authors":"A. Peters, Y. Brailovsky, V. Lakhter, P. Forfia","doi":"10.5430/CRIM.V5N3P36","DOIUrl":"https://doi.org/10.5430/CRIM.V5N3P36","url":null,"abstract":"We report a case of a 55-year-old woman who developed hyponatremia after the initiation of exogenous vasopressin to treat vasodilatory shock. Discontinuation of exogenous vasopressin therapy, without any other changes in medical therapy or the patient’s condition, led to a rapid correction in the serum sodium level along with a marked increase in urine output. Increased free water retention due to exogenous vasopressin administration may have contributed to hyponatremia in this patient. This case illustrates the potential for vasopressin to have potent and unintended renal and electrolyte effects in patients treated for vasodilatory shock.","PeriodicalId":72533,"journal":{"name":"Case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5430/CRIM.V5N3P36","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49302342","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}
Marta Valentim, I. Velez, C. Neto, S. Almeida, A. Gameiro, I. Fernandes
Background: Psychiatric disorders are often difficult to evaluate and sometimes have negative connotations associated. That could be a reason to ignore the correct diagnosis of underlying neurological diseases.Case report: We present a case report of a patient with psychiatric symptomatology, where during the study in the Emergency Department an acute hydrocephalus secondary to a massive meningioma was evidenced.Conclusions: This case exemplifies how psychiatric symptoms, often devalued by the physician, may be the first manifestation of serious neurological disorders, as well as being associated with a medical emergency, as in this case was the acute hydrocephalus.
{"title":"Acute hydrocephalus secondary to meningioma with psychiatric symptoms as initial manifestation","authors":"Marta Valentim, I. Velez, C. Neto, S. Almeida, A. Gameiro, I. Fernandes","doi":"10.5430/crim.v5n3p32","DOIUrl":"https://doi.org/10.5430/crim.v5n3p32","url":null,"abstract":"Background: Psychiatric disorders are often difficult to evaluate and sometimes have negative connotations associated. That could be a reason to ignore the correct diagnosis of underlying neurological diseases.Case report: We present a case report of a patient with psychiatric symptomatology, where during the study in the Emergency Department an acute hydrocephalus secondary to a massive meningioma was evidenced.Conclusions: This case exemplifies how psychiatric symptoms, often devalued by the physician, may be the first manifestation of serious neurological disorders, as well as being associated with a medical emergency, as in this case was the acute hydrocephalus.","PeriodicalId":72533,"journal":{"name":"Case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5430/crim.v5n3p32","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42299543","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}
Esophageal varices develop in half of cirrhotic patients. Endoscopic variceal band ligation is the current treatment for acute bleeding and applicable for primary and secondary prophylaxis. However, there is a risk of complications, including ligationinduced ulcer bleeding. The aim of this study is to review the current diagnosis, management and prophylaxis of bleeding related to post-esophageal variceal band-ligation ulcers in cirrhotic patients. PubMed and Google Scholar were searched for English language articles about the theme. The main findings were that Child-Pugh class C, higher model of end-stage liver disease, emergency ligation, presence of hepatocellular carcinoma, peptic esophagitis and bacterial infection were reported as the most important risk factors for post-banding ulcer hemorrhage. There are few studies with proton pump inhibitors and sucralfate showing size reduction of post-banding ulcers. Many treatment modalities have been used to control post band ulcer bleeding, such as band local injection of epinephrine or cyanoacrylate, balloon tamponade, stent placement and ligation of the ulcerated bleeding site. However, the optimal management remains uncertain. The principal conclusions of the study were that post-banding ulcer bleeding is potentially life-threatening and must be suspected in the presence of hematemesis, melena or anemia after endoscopic variceal band ligation (EVL). Predictors of rebleeding must be assessed and controlled as much as possible before band ligation. The post-banding treatment with proton pump inhibitors or sucralfate seems advisable, in particular for high-risk patients. Further investigation and new approaches are still required to achieve optimal management of this complication.
{"title":"Diagnosis, management and prophylaxis of bleeding related to post-esophageal variceal band ligation ulcer in cirrhotic patients","authors":"T. Lima, G. Silva, F. Romeiro","doi":"10.5430/CRIM.V5N3P23","DOIUrl":"https://doi.org/10.5430/CRIM.V5N3P23","url":null,"abstract":"Esophageal varices develop in half of cirrhotic patients. Endoscopic variceal band ligation is the current treatment for acute bleeding and applicable for primary and secondary prophylaxis. However, there is a risk of complications, including ligationinduced ulcer bleeding. The aim of this study is to review the current diagnosis, management and prophylaxis of bleeding related to post-esophageal variceal band-ligation ulcers in cirrhotic patients. PubMed and Google Scholar were searched for English language articles about the theme. The main findings were that Child-Pugh class C, higher model of end-stage liver disease, emergency ligation, presence of hepatocellular carcinoma, peptic esophagitis and bacterial infection were reported as the most important risk factors for post-banding ulcer hemorrhage. There are few studies with proton pump inhibitors and sucralfate showing size reduction of post-banding ulcers. Many treatment modalities have been used to control post band ulcer bleeding, such as band local injection of epinephrine or cyanoacrylate, balloon tamponade, stent placement and ligation of the ulcerated bleeding site. However, the optimal management remains uncertain. The principal conclusions of the study were that post-banding ulcer bleeding is potentially life-threatening and must be suspected in the presence of hematemesis, melena or anemia after endoscopic variceal band ligation (EVL). Predictors of rebleeding must be assessed and controlled as much as possible before band ligation. The post-banding treatment with proton pump inhibitors or sucralfate seems advisable, in particular for high-risk patients. Further investigation and new approaches are still required to achieve optimal management of this complication.","PeriodicalId":72533,"journal":{"name":"Case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5430/CRIM.V5N3P23","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42168061","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. Amaradio, E. Mascheroni, L. Luca, R. Sbrojavacca
Introduction: Acute aortic syndromes (AAS) are emergency conditions with a common pathway but various clinical manifestations. In order to reduce the extremely poor prognosis, these syndromes require a rapid diagnosis and decision making.Case report: We report the case of a young black woman with recurrent aortic dissection (RAD), presenting to the Emergency Department (ED) with an atypical symptom: ankle soreness. After the surgical treatment, several exams were performed in order to investigate underlying conditions for recurrence: after a first suspicion of tuberculous aortitis, the final diagnosis was Takayasu’s arteritis.Discussion: The aim of this article is to underline the extremely heterogeneous presentation of AAS that worsens the already complicated process in diagnosing the syndromes. Despite uncommon signs and symptoms, identifying patients with a high pre-test likelihood for the disease is crucial to promptly get a correct diagnosis. Once the diagnosis has been confirmed, since AAS may be a spy for important systemic diseases, conditions such as congenital disease, autoimmune and infectious aortitis need to be excluded and treated to prevent any recurrence or systemic implications.
{"title":"A case of recurrent acute aortic syndrome: Beyond emergency diagnosis and treatment","authors":"M. Amaradio, E. Mascheroni, L. Luca, R. Sbrojavacca","doi":"10.5430/CRIM.V5N3P18","DOIUrl":"https://doi.org/10.5430/CRIM.V5N3P18","url":null,"abstract":"Introduction: Acute aortic syndromes (AAS) are emergency conditions with a common pathway but various clinical manifestations. In order to reduce the extremely poor prognosis, these syndromes require a rapid diagnosis and decision making.Case report: We report the case of a young black woman with recurrent aortic dissection (RAD), presenting to the Emergency Department (ED) with an atypical symptom: ankle soreness. After the surgical treatment, several exams were performed in order to investigate underlying conditions for recurrence: after a first suspicion of tuberculous aortitis, the final diagnosis was Takayasu’s arteritis.Discussion: The aim of this article is to underline the extremely heterogeneous presentation of AAS that worsens the already complicated process in diagnosing the syndromes. Despite uncommon signs and symptoms, identifying patients with a high pre-test likelihood for the disease is crucial to promptly get a correct diagnosis. Once the diagnosis has been confirmed, since AAS may be a spy for important systemic diseases, conditions such as congenital disease, autoimmune and infectious aortitis need to be excluded and treated to prevent any recurrence or systemic implications.","PeriodicalId":72533,"journal":{"name":"Case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5430/CRIM.V5N3P18","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46090991","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}
B. Osorio, Linle Hou, Jack Xu, E. Pagan, Michael Piscopiello
Background: Lambl’s excrescences (LEx) are thin, filiform structures that arise on the lines of closure of heart valves. Although rare, we have come across various case reports in the literature describing thromboembolic events associated with LEx. We report the case of a 63-year-old female who presented with TIA-like symptoms and was found to have a LEx on the aortic side of native aortic valve. We conducted a comprehensive literature review with emphasis on different therapeutic strategies utilized to provide insight for future encounters.Case presentation: A 63-year-old female with a past medical history significant for hypertension and hyperlipidemia presented to the emergency room with symptoms of dysarthria and unsteady gait. While in the hospital, the patient returned to her baseline gait and speech without intervention. Work-up for including computed tomography of the head, magnetic resonance imaging, and carotid doppler, as well as prolonged telemetry monitoring was negative. A transthoracic echocardiogram showed a 0.81 cm linear echodensity attached to the aortic side of the aortic valve, highly suggestive of LEx that was later confirmed on transesophageal echocardiogram. Patient was placed on clopidogrel alone for antiplatelet therapy due to an aspirin allergy and she was subsequently discharged home.Discussion: No standard management for LEx currently exists. We aim to add to the evidence of effective management and explore the literature of patients who have experienced TIA/CVA symptoms secondary to LEx.
{"title":"Lambl’s excrescences and a review of therapeutic strategies","authors":"B. Osorio, Linle Hou, Jack Xu, E. Pagan, Michael Piscopiello","doi":"10.5430/CRIM.V5N3P13","DOIUrl":"https://doi.org/10.5430/CRIM.V5N3P13","url":null,"abstract":"Background: Lambl’s excrescences (LEx) are thin, filiform structures that arise on the lines of closure of heart valves. Although rare, we have come across various case reports in the literature describing thromboembolic events associated with LEx. We report the case of a 63-year-old female who presented with TIA-like symptoms and was found to have a LEx on the aortic side of native aortic valve. We conducted a comprehensive literature review with emphasis on different therapeutic strategies utilized to provide insight for future encounters.Case presentation: A 63-year-old female with a past medical history significant for hypertension and hyperlipidemia presented to the emergency room with symptoms of dysarthria and unsteady gait. While in the hospital, the patient returned to her baseline gait and speech without intervention. Work-up for including computed tomography of the head, magnetic resonance imaging, and carotid doppler, as well as prolonged telemetry monitoring was negative. A transthoracic echocardiogram showed a 0.81 cm linear echodensity attached to the aortic side of the aortic valve, highly suggestive of LEx that was later confirmed on transesophageal echocardiogram. Patient was placed on clopidogrel alone for antiplatelet therapy due to an aspirin allergy and she was subsequently discharged home.Discussion: No standard management for LEx currently exists. We aim to add to the evidence of effective management and explore the literature of patients who have experienced TIA/CVA symptoms secondary to LEx.","PeriodicalId":72533,"journal":{"name":"Case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5430/CRIM.V5N3P13","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48374699","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}
A 63-year-old male was referred to the cardiology team with a one month history of progressive chest pain and shortness of breath. This was associated with general decline, weight loss and new heart failure. Emergency Department ECG showed ST elevation throughout the chest leads and blood tests confirmed an elevated troponin. Clinical examination revealed a precordial mass. Bedside echocardiography showed an akinetic anterior wall with infiltration from a mediastinal mass. CT scan demonstrated a large mediastinal mass invading the sternum, ribs and myocardium. Biopsy showed a high grade neuroendocrine tumour of uncertain origin. Despite the need for rapid treatment of ST-Elevation Myocardial Infarction (STEMI), due care needs to be taken to ensure accurate diagnosis.
{"title":"Mediastinal neuroendocrine tumour presenting with ECG changes: An unusual ST-Elevation Myocardial Infarction mimic","authors":"A. Borrie, T. Pegg","doi":"10.5430/CRIM.V5N3P10","DOIUrl":"https://doi.org/10.5430/CRIM.V5N3P10","url":null,"abstract":"A 63-year-old male was referred to the cardiology team with a one month history of progressive chest pain and shortness of breath. This was associated with general decline, weight loss and new heart failure. Emergency Department ECG showed ST elevation throughout the chest leads and blood tests confirmed an elevated troponin. Clinical examination revealed a precordial mass. Bedside echocardiography showed an akinetic anterior wall with infiltration from a mediastinal mass. CT scan demonstrated a large mediastinal mass invading the sternum, ribs and myocardium. Biopsy showed a high grade neuroendocrine tumour of uncertain origin. Despite the need for rapid treatment of ST-Elevation Myocardial Infarction (STEMI), due care needs to be taken to ensure accurate diagnosis.","PeriodicalId":72533,"journal":{"name":"Case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5430/CRIM.V5N3P10","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42811368","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}
Linle Hou, Seung Eun Lee, F. DeMichele, B. Osorio, N. Nagella
Background: Posterior reversible encephalopathy syndrome (PRES) is characterized by altered mental status, visual perception abnormalities and seizures. Systemic lupus erythematosus (SLE) is a rare etiology of PRES and affects less than 1% of SLE patients. We present a unique case of a new-onset SLE patient presenting with borderline cardiac tamponade requiring emergent pericardiocentesis and hospital course complicated by intractable seizures found to have PRES on imaging.Case presentation: A 21-year-old female underwent outpatient evaluation for new-onset SLE presenting to the emergency room with dyspnea. She was found to have a large circumferential pericardial effusion with borderline tamponade features requiring emergent pericardiocentesis. On her fifth hospital day, she developed generalized motor seizure (tonic-clonic) with magnetic resonance imaging (MRI) revealing bilateral parieto-occipital edema consistent with a radiographic diagnosis of PRES. Induction therapy with mycophenolate was started and follow-up studies showed improvement in the cortical and subcortical regions on MRI with no evidence of recurrent pericardial effusion.Conclusions: PRES is a rare complication of lupus and has been infrequently described in literature. It is thought that the association is secondary to the effect of SLE on endothelial dysfunction and the effect of cytotoxic medication on the loss of autoregulation of systemic hypertension. It is important to recognize this condition and its significant associations as early detection and intervention often lead to favorable outcomes. To our knowledge, this is the first case report of SLE with associations of both PRES and circumferential pericardial effusion with tamponade physiology, both of which are rare in the SLE patient population.
{"title":"Life threatening pericardial and neurologic presentations in systemic lupus erythematosus","authors":"Linle Hou, Seung Eun Lee, F. DeMichele, B. Osorio, N. Nagella","doi":"10.5430/CRIM.V5N3P6","DOIUrl":"https://doi.org/10.5430/CRIM.V5N3P6","url":null,"abstract":"Background: Posterior reversible encephalopathy syndrome (PRES) is characterized by altered mental status, visual perception abnormalities and seizures. Systemic lupus erythematosus (SLE) is a rare etiology of PRES and affects less than 1% of SLE patients. We present a unique case of a new-onset SLE patient presenting with borderline cardiac tamponade requiring emergent pericardiocentesis and hospital course complicated by intractable seizures found to have PRES on imaging.Case presentation: A 21-year-old female underwent outpatient evaluation for new-onset SLE presenting to the emergency room with dyspnea. She was found to have a large circumferential pericardial effusion with borderline tamponade features requiring emergent pericardiocentesis. On her fifth hospital day, she developed generalized motor seizure (tonic-clonic) with magnetic resonance imaging (MRI) revealing bilateral parieto-occipital edema consistent with a radiographic diagnosis of PRES. Induction therapy with mycophenolate was started and follow-up studies showed improvement in the cortical and subcortical regions on MRI with no evidence of recurrent pericardial effusion.Conclusions: PRES is a rare complication of lupus and has been infrequently described in literature. It is thought that the association is secondary to the effect of SLE on endothelial dysfunction and the effect of cytotoxic medication on the loss of autoregulation of systemic hypertension. It is important to recognize this condition and its significant associations as early detection and intervention often lead to favorable outcomes. To our knowledge, this is the first case report of SLE with associations of both PRES and circumferential pericardial effusion with tamponade physiology, both of which are rare in the SLE patient population.","PeriodicalId":72533,"journal":{"name":"Case reports in internal medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.5430/CRIM.V5N3P6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48375788","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}
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