Clinics and Practice

397 KiB

Open AccessCase Report

Take a Second Look: It's Kikuchi’s Disease! A Case Report and Review of Literature

by Oana Joean, Thea Thiele, Mieke Raap, Reinhold E. Schmidt and Matthias Stoll

Clin. Pract. 2018, 8(4), 1095; https://doi.org/10.4081/cp.2018.1095 - 12 Dec 2018

Cited by 14 | Viewed by 730

Generalized lymphadenopathy is a common cause of concern for both patients and clinicians. Possible etiologies include infections, malignancies and autoimmune diseases. Kikuchi Fujimoto disease (KFD) is a hyperergic condition that presents with fever, lymphadenopathy and can include systemic involvement, thus being easily mistaken [...] Read more.

Generalized lymphadenopathy is a common cause of concern for both patients and clinicians. Possible etiologies include infections, malignancies and autoimmune diseases. Kikuchi Fujimoto disease (KFD) is a hyperergic condition that presents with fever, lymphadenopathy and can include systemic involvement, thus being easily mistaken for the above-mentioned entities. We report the case of a previously healthy 18-year-old male who presented with a selflimiting generalized lymphadenopathy, high fevers, skin vasculitis and polyserositis. The lymph-node biopsy revealed a histiocytotic necrotizing lymphadenitis, suggestive of Kikuchi’s disease. This case emphasizes the importance of KFD in the differential diagnosis of lymphadenopathy, especially in young adults. Full article

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Open AccessBrief Report

Surgical Outcome of Two-Flap Palatoplasty at King Fahad Medical City: A Tertiary Care Center Experience

by Alwaleed Khalid Alammar, Abdulsalam Aljabab and Gururaj Arakeri

Clin. Pract. 2018, 8(4), 1104; https://doi.org/10.4081/cp.2018.1104 - 4 Dec 2018

Cited by 4 | Viewed by 884

Abstract

The purpose of this study was to assess surgical outcomes of two-flap palatoplasty for management of cleft palate. Between January 2009 and January 2017, we recruited 29 nonsyndromic patients who underwent two-flap palatoplasty for cleft palate repair at the oral and maxillofacial department. [...] Read more.

The purpose of this study was to assess surgical outcomes of two-flap palatoplasty for management of cleft palate. Between January 2009 and January 2017, we recruited 29 nonsyndromic patients who underwent two-flap palatoplasty for cleft palate repair at the oral and maxillofacial department. Their medical records were procured, and surgical outcomes were assessed. Velopharyngeal insufficiency (VPI) was evaluated on the basis of speech assessment by a speech therapist. Speech abnormality (nasality, nasal emission, and articulation error) was assessed by a speech therapist using the GOSS-Pass test. Swallowing and regurgitation were assessed by a swallowing team. Fistula and wound dehiscence were clinically assessed by the primary investigator. Documented data were evaluated using statistical analysis. Among the study patients; 75.8 % had normal speech, 20.7 % developed VPI; 17.3% had hypernasality; 4.3% had hypernasality as well as nasal emission; 4.3% had hypernasality, nasal emission, and articulation errors; and 4.3% had articulation errors. Approximately 20% of the patients had fistulas (83.3% had oronasal fistulas and 16.7% had nasovestibular fistulas). Normal swallowing findings were noted in 93% of the patients. There were statistically significant relationships between age-repair and VPI (r=0.450, t=0.014), age-speech (r=0.525, t=0.003), and age-fistula development (r=0.414, t=0.026). Conversely, there were no significant relationships between age and dehiscence (r=0.127, t=0.512), age and swallowing (r=0.360, t=0.055), and age and regurgitation (r=0.306, t=0.106). Two-flap palatoplasty is a reliable technique with excellent surgical and speech outcomes. Early repair is associated with better speech outcome and less incidence of VPI. Full article

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Open AccessCase Report

Cutaneous Actinomycosis and Long-Term Management Through Using Oral and Topical Antibiotics: A Case Report

by Ali Hassan Najmi, Ibrahim Hassan Najmi, Mosa Mohmmed Hassan Tawhari, Khadija Hafed Sawadi, Khaled Ahamed Hassan Khbrani, Fawaz Hadi Tawhari, Mohammed Abdu Tawhari, Majed Hassan Mathkur and Khalid Mohammed Al-attas

Clin. Pract. 2018, 8(4), 1102; https://doi.org/10.4081/cp.2018.1102 - 4 Dec 2018

Cited by 4 | Viewed by 570

Abstract

Actinomycosis is a subacute or chronic suppurative bacterial infection which caused because of filamentous gram-positive, anaerobic to microaerophilic nonacid fast bacilli primarily of the genus Actinomyces that normally colonize the mouth, colon, and vagina. Primary cutaneous actinomycosis is a rare entity and is [...] Read more.

Actinomycosis is a subacute or chronic suppurative bacterial infection which caused because of filamentous gram-positive, anaerobic to microaerophilic nonacid fast bacilli primarily of the genus Actinomyces that normally colonize the mouth, colon, and vagina. Primary cutaneous actinomycosis is a rare entity and is generally associated with trauma. A 61- year-old Yemeni male firstly presented to the surgical department in King Fahd Central Hospital with multiple swelling, petted lesions and boring of sensation in the right foot. Local examination showed multiple erythematous nodules and plaques with discharge in the right leg, and active sinus was not determined. Full article

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Open AccessCase Report

Rapidly Progressive Neurologic Decline and Morbilliform Rash Presenting in a Patient with Lymphoma

by Dean Ehrlich, Jennifer Phan, Gavin Hui and Alexandra Drakaki

Clin. Pract. 2018, 8(4), 1097; https://doi.org/10.4081/cp.2018.1097 - 4 Dec 2018

Viewed by 456

Abstract

A 67-year-old male with past medical history of mantle cell lymphoma and atrial fibrillation presented with a truncal rash, bilateral lower extremity weakness, and confusion. Within three days of presentation, his condition rapidly deteriorated with the onset of diffuse flaccid paralysis, aphasia, and [...] Read more.

A 67-year-old male with past medical history of mantle cell lymphoma and atrial fibrillation presented with a truncal rash, bilateral lower extremity weakness, and confusion. Within three days of presentation, his condition rapidly deteriorated with the onset of diffuse flaccid paralysis, aphasia, and severe alteration in mental status. Initial results from serum studies, lumbar puncture, magnetic resonance imaging, and electroencephalogram were not diagnostic. However, on the ninth day after initial presentation, the West Nile Virus (WNV) immunoglobulin M antibody returned positive from the cerebrospinal fluid. West Nile Virus encephalitis is endemic worldwide, and is the most common viral encephalitis in the United States. WNV presents in a variety of ways, and the recognition by physicians is crucial due to the estimated 2- 12% mortality rate and significant longterm morbidity of neuroinvasive disease. The initial management and long term prognosis are points of ongoing research. This case represents a particularly profound example of neuroinvasive WNV. Our patient made a significant recovery after his initial presentation with aggressive supportive care, however still suffers from bilateral lower extremity weakness more than a year later. Full article

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Open AccessCase Report

Suspected Oseltamivir-Induced Bradycardia in a Pediatric Patient: A Case Report from King Abdullah Specialist Children’s Hospital, Riyadh, Saudi Arabia

by Hisham Arabi, Ahmed Abou Zaid, Mohammed Alreefi and Salman Alahmed

Clin. Pract. 2018, 8(4), 1094; https://doi.org/10.4081/cp.2018.1094 - 28 Nov 2018

Cited by 8 | Viewed by 1066

Abstract

In recent years, influenza infection in the pediatric population has been a widescale issue that physicians face during the winter season. Medications used to treat and prevent such infections include Oseltamivir, an anti-viral neuraminidase inhibitor developed for both influenzas A and B. The [...] Read more.

In recent years, influenza infection in the pediatric population has been a widescale issue that physicians face during the winter season. Medications used to treat and prevent such infections include Oseltamivir, an anti-viral neuraminidase inhibitor developed for both influenzas A and B. The most commonly well-known and manifesting adverse effects are nausea, vomiting and gastrointestinal upset. There is paucity of reports on other potential serious side effects of Oseltamivir in the pediatric population. One of the rarely reported adverse reactions in adult population is sinus bradycardia. This case reports the development of sinus bradycardia in a pediatric patient after administration of Oseltamivir. The previously healthy five-year-old patient was started on Oseltamivir after a positive polymerase chain reaction for influenza. The patient developed sinus bradycardia but remained hemodynamically stable. This finding led to consultations and investigations to determine the cause of bradycardia. It is pivotal to increase the awareness of the potential link between Oseltamivir and bradycardia in pediatric and adult populations to avoid unnecessary clinical investigations and to enhance physician decisionmaking. A prospective cohort study on Oseltamivir is needed for better understanding of its adverse effects in the pediatric population. Full article

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Open AccessCase Report

Acute Tubulointerstitial Nephritis and Polyclonal Hypergammaglobulinaemia: Which Is the Culprit?

by Ana E. Sirvent, Ricardo Enríquez, Tania Muci, Francisco Javier Ardoy-Ibañez, Isabel Millán, Amadeo Almiñana, Rosalía Ruiz-Ferrús and Luis Jiménez del Cerro

Clin. Pract. 2018, 8(4), 1065; https://doi.org/10.4081/cp.2018.1065 - 7 Nov 2018

Cited by 1 | Viewed by 545

Abstract

Proton pump inhibitors (PPIs) are among the most frequent implicated drugs in acute tubulointerstitial nephritis (ATIN), nevertheless it is important to report cases with atypical profiles. A 80-year-old female, exposed during 34 months to omeprazole, presented with polyclonal hypergammaglobulinaemia and renal failure. After [...] Read more.

Proton pump inhibitors (PPIs) are among the most frequent implicated drugs in acute tubulointerstitial nephritis (ATIN), nevertheless it is important to report cases with atypical profiles. A 80-year-old female, exposed during 34 months to omeprazole, presented with polyclonal hypergammaglobulinaemia and renal failure. After stopping omeprazole there was a partial improvement in serum creatinine and IgG. Renal biopsy revealed ATIN; immunohistochemistry for IgG4 was negative. Treatment with steroids and mycophenolate sodium improved renal function and normalized immunoglobulins. The lack of data of other entities and the patient’s evolution strongly point omeprazole as the culprit. After 27 months of follow-up, she remains clinical and analytically stable. ATIN caused by PPIs may appear after a long period of exposure and may be accompanied by analytical anomalies that simulate a systemic disease. Full article

616 KiB

Open AccessCase Report

Rare Case of a Kidney and Inferior Vena Cava Abnormalities with Extensive Lower Extremity Deep Vein Thrombosis in a Young Healthy Male

by Muhammad Khalid, Manisha Nukavarapu, Rupal Shah and Timir K. Paul

Clin. Pract. 2018, 8(4), 1079; https://doi.org/10.4081/cp.2018.1079 - 26 Oct 2018

Cited by 5 | Viewed by 557

Abstract

Kidney and inferior vena cava (IVC) abnormalities with extensive deep vein thrombosis (DVT) is a very rare cause of DVT and has a diverse clinical presentation. Computed tomography (CT) angiography is the gold standard for diagnosis and treatment including thrombectomy, thrombolysis and systemic [...] Read more.

Kidney and inferior vena cava (IVC) abnormalities with extensive deep vein thrombosis (DVT) is a very rare cause of DVT and has a diverse clinical presentation. Computed tomography (CT) angiography is the gold standard for diagnosis and treatment including thrombectomy, thrombolysis and systemic anticoagulation. We present a rare case of active young healthy male admitted with acute onset of right lower extremity pain and swelling who was found to have extensive DVT on doppler ultrasound. CT abdomen showed extensive clot burden involving right common femoral vein extending into internal and external iliac veins associated with IVC hypoplasia and hypoplastic left kidney. Patient underwent urgent thrombectomy, catheter directed thrombolysis and was discharged home in stable condition on oral anticoagulation. Full article

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Clin. Pract., Volume 8, Issue 4 (October 2018) – 7 articles

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