Clinical characteristics and literature review of chronic active Epstein-Barr virus-associated enteritisYaJie Meng1+, RenDong Li2+, JieWen Ding1, Bo Xiang1,Qin Wang1,Min Wang1 *and KeJiang Tang1**Correspondence:KeJiang Tang :firstname.lastname@example.org and Min Wang+Equal contributors.1Department of Gastroenterology, The People’s Hospital of Nanchuan, No. 16South Street, Nanchuan District, Chongqing 408400, China2The People’s Hospital of Nanchuan, No. 16 South Street, Nanchuan District, Chongqing 408400, China
Heart Failure due to Peripartum Cardiomyopathy Presenting in the First Week of Puerperium - A Case Series from NepalAbstract: Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure associated with pregnancy without any other known cause. Most of the clinical presentation is similar to symptoms of advanced pregnancy making the diagnosis difficult. Reported are three patients who developed dyspnea, orthopnea, and dry cough during the first week of puerperium. On examination, bilateral lower limb edema and bilateral basal lung crepitation were present in all patients. Chest radiograph showed pulmonary edema in cases two and three, and pleural effusion in case one. All patients had reduced left ventricular ejection fraction and raised N-terminal pro-b-type natriuretic peptide (NT-proBNP) levels. Case two developed PPCM in the background of left pyelonephritis. Case three was complicated by acute kidney injury. All patients were managed with bromocriptine, diuretics, beta-blockers, ACE inhibitors, and fluid restriction. Hence, PPCM though rare should be considered as a differential in women presenting with features of heart failure in later months of pregnancy or within five months of delivery.Keywords: heart failure, bromocriptine, peripartum dilated cardiomyopathy, pregnancy, peripartum cardiomyopathy.Introduction-Peripartum cardiomyopathy (PPCM) is a rare cause of heart failure affecting women in the later months of pregnancy or within five months of delivery. PPCM often presents when peak volume load, reached just before delivery is greatly reduced after delivery.1,2PPCM affects women from all ethnicities globally with wide variation in incidence from 1:20,000 live births in Japan to 1:100 in Zaria, Nigeria.3,4 With a prognosis that can vary from the complete recovery of left ventricular function to maternal mortality as well as recurrence with subsequent pregnancies, the study of PPCM has been done sparsely in Nepal.2,5 This case series attempts to increase awareness of disease, diagnosis, and treatment in Nepal.CASE PRESENTATIONCase 1A 33-years lady, G2A1 at 38+6 weeks of gestation, with no significant medical history underwent emergency LSCS for non-progression of labor secondary to arrest of descent. On the 4th day of puerperium, she developed dyspnea on exertion, orthopnea, bilateral lower limb edema, and dry cough. On examination, she had increased blood pressure (160/110 mmHg) and bilateral lower limb pitting edema with bilateral basal crepitation on chest auscultation. Chest radiograph showed bilateral minimal pleural effusion. Transthoracic echocardiography (TTE) showed severe left ventricular systolic dysfunction, dilated left atrium (LA), moderate to severe mitral regurgitation (MR), severe tricuspid regurgitation (TR), moderate pulmonary artery hypertension (PAH) and reduced ejection fraction i.e< 25%. ECG showed T wave inversion in leads V1-V4 and aVL (figure 1). Serum N-terminal pro-b-type natriuretic peptide (NT-proBNP) was 10897 pg/ml (Normal <300). With the diagnosis of PPCM, she was managed with fluid restriction, diuretics, beta blockers, angiotensin receptor blockers (ARB), bromocriptine, and antibiotics. Repeat TTE done on the 12th day of puerperium showed EF of 30%. However, she had 3 episodes of syncopal attack on the 19th puerperal day which was probably due to orthostatic hypotension. She was discharged on the 22nd puerperal day with oral ARB and bromocriptine and with close follow-up with cardiology and obstetrics and gynecology clinic.
IntroductionEndoscopic removal of colorectal polyps is used as first-line treatment for reducing incidence of colorectal cancer and cancer-related mortality.(1) Colonoscopy is a safe procedure in general but there is a chance of complication. Complications are more likely to happen in colonoscopy with cautery. As the procedure gets more complex, the higher rate of complications is reported.(2) Perforation and post-colonoscopy hemorrhage are the most common complications.Local infection is one of colonoscopy complications; however, it is rare indeed. Perianal abscess and Fournier’s gangrene have been described after colonoscopy. The mechanism is local mechanical trauma.(3) Intraperitoneal and retroperitoneal abscess formation are also described in a few case reports as a result of colonoscopy.(4, 5) As far as we know, there is no report of rectus abdominis muscle abscess after colonoscopy. In this article, we want to present a case of rectus abdominis muscle abscess after colonoscopy completed with applying abdominal pressure techniques.
Title: Charcot knee mimicking erysipelas A 85-year-old diabetic man presented to the emergency department for a 2-week history of a limb pain associated with right leg edema. Physical examination revealed a temperature of 37.5°C, a marked swelling in the right limb with an erythematous overlying skin. The patient had limitation of both passive and active range of motion of right knee. Laboratory tests showed inflammation (C-reactive protein (CRP) 179 mg/l). Blood cell counts were normal. The diagnosis of erysipelas was made and antibiotic therapy (amoxicillin–clavulanate) was started. Four days later, fever appeared and we noted an increase in the oedema and the CRP was 218mg/l. A leg abscess was suspected. The surgical flattening of the abscess was indicated. Per-operative examination showed a fracture of the fibular head associated with excessive bone loss at the medial plateau of the tibia.X-ray showed destructive femoral condyle and signs of knee subluxation and bone fragmentation (figure 1A). Computer tomography scanning of the right knee confirmed the femorotibial dislocation and the bony fragmentation, with formation of debris seen as intra-articular loose bodies (figure B). Considering these aspects, the most likely diagnosis was Charcot Knee. The patient underwent a trial of conservative treatment and then we suggested a custom-made hinged knee brace for daily use.Neuropathic arthropathy, or Charcot joint is a systemic disease that generates pathological changes in the musculoskeletal system, causing instability, dislocations, and deformities . The literature on CK remains sparse, with most publications being case reports . Diabetes mellitus is the most common etiology and feet and ankles are the most commonly involved joints . Charcot knee is rare, and observed in 6% of patients with diabetes , physicians should be aware of this complication. Any patient with peripheral neuropathy, presenting with a red and erythematous knee should be reviewed for CK.
Secretory carcinoma of salivary gland is a recently-recognized tumor resulting in pathognomic ETV6-NTRK3 gene fusion, identification of which is gold standard for diagnosis. In resource-limited settings unable to perform molecular analysis, histology and immunohistochemistry are quintessential for diagnosis. We present an illustrative case, discussing typical presentation of this rare entity.
PULMONARY TUBERCULOSIS IN AN ADULT PRESENTING WITH SEVERE HYPONATREMIA: A CASE REPORT AND REVIEW OF LITERATUREShailes Paudel1,2 , Maulik Dhanani 2,3, Krish Hitesh Patel2,4, Naga Praneeth Vakkalagadda2,5, Vivek Sanker2,6, Abhiram Rao Damera2,7, Umang Gupta2,8, Prakriti Bhandari1,21Patan Academy of Health Sciences, Lalitpur, Nepal2 Team Erevnites, India3Southwestern University School of Medicine, Cebu City, Philippines4Government Medical College, Surat, India5Guntur Medical College, Andhra Pradesh, India6Noorul Islam Institute of Medical Sciences, Kerala, India7Mediciti Institute of Medical Sciences, Ghanpur, Telangana, India8 Nepalgunj medical college, BP Chowk-12, Nepalgunj Banke, Nepal
Introduction Osteonecrosis of bone, a complex process of bone resorption and formation, is characterized by necrosis of bone cells1. There are numerous etiologies and risk factors nominated for this situation. Vascular interruption, thrombotic occlusion, and extravascular compression lead to decreased blood flow, and the reason will be avascular necrosis (AVN) of bone1. Intracapsular or extracapsular hip fractures, hip dislocations, sickle cell anemia, coagulation factor anomalies, corticosteroids, alcohol, pregnancy, radiation, bone marrow transplant, Hyperlipidemia, hyperuricemia, pancreatitis, leukemia or lymphoma, hypertriglyceridemia, and dysbaric situation are the risk factors of AVN1–6. The incidence of AVN in the general population is uncertain and was not assessed well in risk groups7.Although osteonecrosis of the femoral head (ONFH) has been studied, the literature is so far sparse on osteonecrosis of the acetabulum (ONA). Here, we aim to report on a case of ONA.
Introduction: Systemic Mastocytosis (SM) is a rare disorder in which mast cells pathologically accumulate within tissue. The mast cells can be limited to the skin, or they can be systemic and involve extracutaneous tissues. One subtype of systemic mastocytosis (SM) is called indolent systemic mastocytosis, which is considered a less aggressive form of the disease, compared to advanced systemic mastocytosis which is considered to have organ impairment due to mast cell infiltration. Multi-kinase inhibitors such as Midostaurin and Imatinib are often used in the treatment of advanced SM or indolent SM that is refractory to conservative symptomatic treatment, but currently Avapritinib is reserved for treatment of advanced SM. Here is a case of an indolent SM responding to treatment with lower dose Avapritinib.