International Journal of Medical and Pharmaceutical Case Reports

Colon Cancer with Complete Pathological Response to Only 1 Cycle of Capecitabine: Treatment Modification in the Perspective of COVID-19 Pandemic

Mussadique Ali Jhatial — 2021-11-22

Incidence of colorectal cancer has surged in the past few decades, currently it accounts for approximately 10% cancer related mortality. Upfront curative surgery is the main stay of treatment for localized disease followed by adjuvant chemotherapy for high-risk disease; however, neo adjuvant chemoradiation followed by surgery and chemotherapy is a standard treatment for rectal cancer. Here, we present a case of a young male aged 33 years with eight months’ history of per rectal bleeding, associated with fever and weight loss who was later diagnosed as sigmoid colon adenocarcinoma. The patient managed to have only one cycle of neoadjuvant capecitabine, as his definitive surgery was delayed due to the rife in pandemic situation of Covid-19. Notably, follow up laparoscopic LAR specimen showed no residual disease, nevertheless, there was an eosinophilic abscess with a giant cell reaction and Ova of Ascaris lumbricoides, which seemingly contributed in achieving pathological complete response with minimal therapy.

Bullous Hemorrhagic Dermatosis Induced By Heparin: An Indonesian Case Report

Syahfori Widiyani — 2021-11-26

Introduction: Bullous haemorrhagic dermatosis is a rare clinical disorder which is usually related to a treatment with unfractionated heparin (UFH) or low molecular weight heparin (LMWH), characterized by multiple intra-epidermal haemorrhages distant from the site of injection.

Presentation of Case: A 62-year-old male patient with coronary heart disease who received heparin treatment experienced several tense, haemorrhagic bullae located on the right arm area, close to the injection site, and followed by the formation of several hematomas on his back trunk 2 days after he had received UFH. The lesions regressed after discontinuation of heparin and supportive topical treatments.

Discussion: The lesions in this patient have similar characteristic with heparin-induced skin necrosis and demonstrate thrombocytopenia probably related to heparin. There are some proposed hypotheses of pathophysiology which include hypersensitivity reaction and idiosyncratic dose-related reaction. Given the clinically course, the discontinuation of heparin treatment was essential for lesion regression in addition other supportive measures.

Conclusion: Heparin-induced skin lesions may indicate the presence of life-threatening heparin-induced thrombocytopenia. An early diagnosis is crucial to enable discontinuation of heparin if required.

Symmetrical Polyarthropathy and Hepatosplenomegaly as a Manifestation of Parvovirus B-19: A Case Report

Mohamed Eltaieb Ali — 2021-11-30

This case was of a 35-years old Egyptian lady, who works as a primary school teacher, who presented to the OPD with complaints of persistent high fever for two days. Along with this fever, she also had severe pain in multiple joints of both hands, wrists, knees, and ankles. In addition, the woman also complained of having developed a rash on both her legs, which was so painful that she was unable to stand without pain. The pain was agonizing and it prevented her from performing her usual jobs as normal. But that was the extent of her symptoms. She did not complain of a cough, shortness of breath, chest pain, back pain, abdominal pain, or any other pain for that matter. In a summary, none of the factors and symptoms that could have pointed towards the patient suffering from a case of COVID19 were present. Moreover, there was no recent history of travel. She also had not contracted any gastrointestinal or genitourinary infections in the preceding few days. The clinical examination of the patient revealed no abnormalities at all. The only thing worth noting was remarkable swelling and tenderness over the metacarpophalangeal and proximal interphalangeal joints. The following series of events are discussed in detail in the subsequent section, and it was concluded that the woman might be suffering from the parvovirus B19 infection. She had several favorable causative factors that pointed toward this diagnosis, with the most important one being her in close contact with primary school children, who are most the likely age group, between five and twenty years, to carry this infection and also contract it. Adults can contract the infection from children, but the range of symptoms varies from person to person. In this case of the woman, further evaluations and investigations were needed to confirm the diagnosis, which was likely due to the obvious risk factors present in this case.

Hyperferritinemia in a Case of Soft Tissue Sarcoma

Tanya Pruthi — 2021-12-10

An elderly male presented with symptoms suggestive of anemia. During workup for the same he was found to have very high levels of serum Ferritin along with a normocytic, normochromic peripheral blood film and no other apparent cause for hyperferritinemia .A swelling which incidentally found on his shin was further investigated by FNAC confirmed presence of soft tissue sarcoma.

A Case of Budd-Chiari Syndrome Associated with Erythrocytosis and Homozygous MTHFR C677T Mutation

Leilane Bentes de Sousa — 2021-12-14

An erythrocytosis describes an increased erythrocyte, subclassified into relative due to hemoconcentration or absolute by an increase in erythrocyte mass, defined as an increase in hemoglobin concentration and/or hematocrit in the peripheral blood above the sex-specific normal range. Budd-Chiari Syndrome (BCS) is related to an obstruction of the hepatic venous flow leading to occlusion of hepatic veins and their tributaries. Genetic and environmental factors can interact for risk determination of venous thromboembolism. The risk associated with SNP 677C>T and 1298A>C of the methylenetetrahydrofolate reductase (MTHFR), 1691G>A of the Factor V Leiden (FVL) and 20210G>A of the prothrombin (FII) genes were investigated in many studies involving thrombosis. This case report describes the clinical, hematological and biochemistry data about a 48-year-old woman diagnosed with PV and a BCS associated, also carrying 677C>T SNP in homozygosity. The patient started therapy with phlebotomy, hydroxyurea and oral anticoagulant. Currently, she presents a better clinical and laboratory condition with normalized values of hematological and platelet indices. This case report aims to contribute with evidence of related comorbidities and makes it possible to report that genetic factors are involved since the patient's mother had already been diagnosed with absolute erythrocytosis in 2016 at 78 years old. For this main result, we understand that it is clear that a family genetic study can reveal clinical modifying factors in these patients, as there are different clinical severities in the family. Furthermore, we believe in the need for a greater number of randomized clinical trials to add better evidence to complement an ideal therapeutic approach in these patients.

Association between Antidiabtic Medications and Worsening of Parkinson’s Symptoms: A Case Report

Ghaida Aldajani — 2021-12-21

Introduction: Parkinson's disease (PD) is one of the most prevalent neurologic disorders, leading to progressive disability; it is characterized by tremors, slow movements, stiffness in arms and legs, and balance impairment; PD symptoms can be slowed but not stopped by treatment such as a combination of Carbidopa/ Levodopa. Although it's widely used for PD, it risks dyskinesia, orthostatic hypotension, and dizziness. The prevalence of PD in Saudi Arabia has been estimated to be 27 per 100,000 populations, and the occurrence of PD in the U.S. is approximately 20 cases per 100,000 people per year.

Case presentation: A 61 years old male presented with worsening PD symptoms, especially dysarthria symptom; he had a history of diabetes with A1C of 8.5%, on metformin, insulin glargine, liraglutide, and linagliptin, with good adherence, and he had a history of Parkinson on levodopa/carbidopa. Even there are no known drug-drug interactions between antidiabetic medication and levodopa/ carbidopa, he reported that coadministration of antidiabetic medications with levodopa/carbidopa cause PD symptoms worsening, especially dysarthria worsening. This drug-drug interaction was noticed when the patient tried to stop all of his antidiabetic medication except insulin mixtard, when he noticed dysarthria symptoms improved. He is currently on insulin mixtard for diabetes with an A1C of 6.7%.

Conclusion: Unintentional drug-drug interaction poses a challenge to the healthcare provider, so this report highlights the importance of adverse drug-drug interaction of antidiabetic with levodopa/carbidopa, its presentation, and management.

A Rare Case of Adult-onset Still's Disease Revealed by Acute Myopericarditis

A. El-Adaoui — 2021-12-21

Background: Still's disease in adults is a systemic inflammatory pathology of unknown aetiology, characterized by clinical manifestations associating feverish peaks, arthritis or arthtralgia, transient rashes and hyperferritinemia.

Currently, this disease remains a multisystemic disease with generally poor outcome, poorly described in the literature with very few studies unlike other rheumatic diseases, probably underdiagnosed due to its clinical polymorphism.

Cardiac forms are quite rare and among the manifestations described, pericarditis remains the most reported entity, myocardial involvement is exceptional.

The aim of our observation is to report an exceptional case of discovery of stille disease following a myo-pericarditis mimicking a coronary Sd initially.