International Journal of Medical and Pharmaceutical Case Reports

Non-union of Intertrochanteric Fracture Right Femur with Limb Shortening

Htay Lwin — 2020-04-21

Nonunion of intertrochanteric fracture is uncommon because there are excellent blood supply and good cancellous bone in the intertrochanteric region of the femur. A diagnosis of primary intertrochanteric nonunion is made when at least 15 weeks after the fracture there is radiological evidence of a fracture line, with either no callus (atrophic) or with callus that does not bridge the fracture site (hypertrophic). The patient was subsequently treated successfully with an open reduction procedure. Open reduction and internal fixation with right DHS (Dynamic Hip Screw) with 8 screw holes plate inserted first and then 6 screws inserted under the guidance of Image Intensifier (C Arm). We would like to report a case of right intertrochanteric fracture with non-union. A 60 years old patient presented with the history of pain in the right hip, off and on for many years after the operation. The pain was associated with stiffness of the right hip joint. This case is selected for reporting because it’s a relatively rare incidence.

Management of Severe Beta-Blockers Toxicity with High Dose Insulin Euglycemic Therapy: A Case Report

K. Hussein — 2020-07-13

Aims: Highlighting the efficacy of early initiation of high dose insulin therapy in Beta-blockers overdose over conventional therapy.

Presentation of Case: Authors describe the successful treatment of severe bisoprolol-induced cardiogenic shock in a 74-year-old man using high dose insulin euglycemic therapy. He received intravenous bolus of 1IU/kg of actarapid insulin followed by intravenous infusion of 0.5 IU/kg/hour. The patient hemodynamic parameters improved dramatically within few hours after starting the insulin therapy.

Discussion: Beta-blockers overdose can lead to significant morbidity and mortality due to the often-associated vasopressor-resistant shock. high dose insulin euglycemic therapy is a potential emerging therapy for beta-blockers toxicity with support in the literature from several animal studies, case reports and expert opinion.

Conclusion: High dose insulin euglycemic therapy is a safe and effective method in reversing the hemodynamic consequences induced by beta-blockers overdose and should be used early in the treatment.

Persistent Cutaneous Metastatic Tubercular Abscesses Revealing Multifocal Tuberculosis in an Immunocompetent Patient

Anis Hariz — 2020-04-20

Tuberculosis remains one of the infections with high mortality rate. Multifocal tuberculosis usually affects immune compromised patients such as Human Immunodeficiency virus carriers. However, patients with no underlying immunodeficiency may still present an extensive and atypical form of tuberculosis. We hereby report the case of a 16-year-old female patient presenting persistent and multiple cutaneous lesions associated with fatigue and loss of appetite which led to the diagnosis of disseminated, multifocal tuberculosis with neurological, musculoskeletal, genital, pulmonary, peritoneal and lymph nodes involvement. Screening for potential underlying immunodeficiency yielded no results. Clinical and radiological outcome was favorable on anti-tuberculosis drugs with complete regression of identified lesions. This case serves as a reminder that tuberculosis remains a challenging diagnosis that encompasses a variety of clinical presentation ranging from cutaneous abscesses to life-threatening conditions such as cerebral tuberculomas even in immune competent patient.

Immunophenotyping for Diagnosis of Oral Lesions: Is It an Important Tool?

Alessandra Rodrigues de Camargo — 2020-06-30

Aims: To report two cases of onco-hematologic diseases diagnosed by oral biopsy and subsequent flow cytometry immunophenotyping.

Presentation of Case: Case 1: A 36-year-old woman, HIV +, referred to the Hospital Dentistry Center presenting an extensive, ulcerated and painless lesion in the left maxilla involving teeth #24, #25, #26 and #27. A fine needle aspiration and incisional biopsy were performed and one sample was sent to anatomopathological analysis and other to immunophenotyping. Immunophenotyping revealed 31.2% of aberrant plasma cells with phenotype suggestive of plasmablastic lymphoma.

Case 2: 62-year-old male patient attended Hospital Emergency presenting extra and intraoral swelling on the left side of maxilla. Fine needle aspiration and incisional biopsy were performed, followed by pathological analysis and immunophenotyping. Immunophenotyping revealed 40.7% of large mature B cells with phenotype suggestive of diffuse large B-cell lymphoma. Both patients presented histopathological and immunophenotyping results leading to the same diagnosis. After definitive diagnosis, both patients underwent antineoplastic treatment through cycle of chemotherapy.

Conclusion: Immunophenotyping is a well-established method for the diagnosis of onco-hematologic diseases and has been shown to be effective for the rapid diagnosis of oral tumors.

Cryptococcal Lymphadenopathy in an 18-year-old Male HIV-infected Patient: A Case Report

Patrick Kavabushi — 2020-07-31

Introduction: Cryptoccocus neoformans is an encapsulated fungal pathogen which is contracted through inhalation of the infectious organisms which cause primarily pulmonary disease. The infection remains latent until the host becomes immunocompromised. The disease may disseminate to different sites; however most patients essentially present with brain and lung disease (meningitis and pneumonia, respectively). Cryptococcal lymphadenitis is therefore an uncommon occurrence of this infection.

Objective: We describe the clinico-pathological features of an 18-year-old male with vertically transmitted HIV/AIDS infection who presented to our hospital with features of disseminated cryptococcal infection and notable lymph node involvement.

Case Presentation: An 18-year-old secondary school adolescent boy presented to our hospital with a 3-week history of fever, headache, body weakness and marked loss of body weight. He had been recently diagnosed with HIV infection and initiated on antiretroviral therapy (ART). On examination, he was weak, dehydrated and had multiple enlarged lymph nodes and facial skin papules. Notably, laboratory investigations revealed positive India ink test on cerebrospinal fluid (CSF) microscopy examination and culture, positive PAS stain for yeasts on lymph node histopathology and markedly prominent chest lymph nodes on the chest X-ray. A diagnosis of disseminated Cryptococcosis with lymph node involvement was made. He improved on Amphotericin B and oral fluconazole and a repeat CSF culture two weeks later was negative for Cryptococcus neoformans.

Conclusion: Cryptococcal lymphadenitis is a rare manifestation of Cryptococcal disease.