Open Access Case Study

Use of Gabapentin during ECT for Myalgia and Anxiety: Effects on Seizure Activity

Stephanie L. Peglow, William H. Lemley, Kathleen P. Decker

International Journal of Medical and Pharmaceutical Case Reports, Page 30-34
DOI: 10.9734/IJMPCR/2015/16531

Aim: The goal was to determine if use of gabapentin could assist with management of myalgia and anxiety in a patient treated with Electroconvulsive therapy (ECT) for depression, without interfering with seizure activity during ECT.
Methods: A patient was scheduled for ECT but was reluctant to continue after completing the first session, due to myalgia and anxiety. Medical history and clinical data were noted. He had comorbid alcohol use disorder, so benzodiazepines were avoided. His response to ECT was followed while taking gabapentin for myalgia, anxiety and alcohol cravings.
Results: Gabapentin did not interfere with seizure intensity and did not reduce seizure duration. The patient experienced complete relief of myalgia within 24 hours and reduced anxiety and alcohol cravings while taking gabapentin. He experienced relief of depression through a course of seven ECT sessions.
Conclusion: Gabapentin appears to be a promising adjunct during ECT to manage anxiety and myalgia as it did not interfere with seizure duration or clinical effect on depression. Although randomized, controlled trials must be performed; this case supports its use during ECT for these symptoms.

Open Access Case Study

Treatment of Fibroepitheial Hyperplasia with PRF: An Interesting Outcome

Veenadharini Gundapaneni, P. Anuroopa, R. Vinaya Kumar, S. Savita, Pulivarthi Sushma

International Journal of Medical and Pharmaceutical Case Reports, Page 35-41
DOI: 10.9734/IJMPCR/2015/17151

Introduction: Gingival overgrowths in the oral cavity not only cause functional and esthetic problems but also increase the risk for the development of caries and periodontal disorders when left untreated. This article focuses on a case of gingival overgrowth which was positively dealt with appropriate periodontal therapy and platelet rich fibrin (PRF), a biological bandage.
Presentation of Case: A 38 year old female patient reported to the department with a chief complaint of a long standing gingival overgrowth and tooth displacement in the left front region of the lower jaw since 6 months which was positively managed with appropriate periodontal therapy that included excision followed by the use of a biological bandage, platelet rich fibrin (PRF). Histopathological report revealed a diagnosis of fibroepithelial hyperplasia, a rare self-limiting proliferative fibrous lesion of gingiva.
Conclusion: A good esthetic result was obtained after implementing the treatment plan with no recurrence during the 6 months follow up period.

Open Access Case Study

Catastrophic Parasitic Meningoencephalitis Due to Halicephalobiasis: Case Report

Kee Fong Loo, Krishnaswamy Sundararajan, Marek Litwin, Lara Hughes

International Journal of Medical and Pharmaceutical Case Reports, Page 42-49
DOI: 10.9734/IJMPCR/2015/17015

Halicephalobus gingivalis is a free-living nematode and facultative parasite, rarely known to affect the central nervous system (CNS). We report the 6th case of Halicephalobiasis in humans worldwide and the first case of catastrophic meningoencephalitis caused by Halicephalobus gingivalis in Australasia, in a 73-year-old woman on long-term immunosuppressive drugs for rheumatoid arthritis. Her initial presentation and normal blood profile did not lead to a clinical suspicion of meningitis. A rapid deterioration in her neurological state to a GCS score of 6 was noted within 48 hours. Broad-spectrum antimicrobials and antivirals were commenced to treat possible severe meningoencephalitis, with the addition of an anti-helminthic therapy at a later stage. Due to medical futility and poor prognosis, multisystem organ supports were withdrawn and focus was changed to comfort care and she died on day 8 of admission. All human cases have reportedly led to death within ten days. Diagnosis through detection of parasites in the CSF is difficult as nematodes tend to be invasive and there is no immunoassay or polymerase chain reaction (PCR) test readily available. All cases have been diagnosed post-mortem and it is paramount that further research is conducted in this area of clinical parasitology for earlier detection and institution of therapy to achieve clinically meaningful outcomes.

Open Access Case Study

Using Pazopanib and Radiotherapy to Treat Metastatic Renal Cell Carcinoma with Acrometastases

Cigdem Usul Afsar, Semra Paydas

International Journal of Medical and Pharmaceutical Case Reports, Page 50-53
DOI: 10.9734/IJMPCR/2015/17236

Introduction: Renal cell carcinoma (RCC) is the third most common urological cancer. Skeletal metastases from renal cell carcinoma are common, but metastatic tumors involving the hand and foot are rare. This is known as acrometastases and is usually a late manifestation ofdisseminated disease.
Case: We present a metastatic case of RCC with acrometastases. Pazopanib treatment was started and there was a quick but short-term response. The patient refused to have surgery for hand lesions so radiotherapy was given. The patient is in good health and under pazopanib treatment.
Conclusion: RCC patients with acral metastases have a short median survival and a choice of treatment should be made considering this poor prognosis. Surgery is the usual choice for treatment. However, if there are multiple digital metastases the quality of life of the patient should be taken into account. Palliative radiotherapy and pazopanib helped our patient and improved his quality of life.

Open Access Case Study

Kikuchi - Fujimoto Disease Presenting with Abnormal Liver Function Test Results: Case Report

Yoo Mi Lee, You Jin Choi, Ah Young Kwon, Jun Ho Lee, Su Jin Jeong

International Journal of Medical and Pharmaceutical Case Reports, Page 54-58
DOI: 10.9734/IJMPCR/2015/17472

Kikuchi - Fujimoto disease (KFD) also called histiocytic necrotizing lymphadenitis, characterized by lymphadenopathy (0.5-4 cm) and pain for 1-3 weeks. It mainly occurs in the posterior cervical triangle of the neck. The cause of KFD is unknown. Although viral or autoimmune causes have been suggested, none have been confirmed. Accurate differential diagnosis to rule out other conditions such Kawasaki disease, tuberculosis, lymphoma or infectious mononucleosis must be performed. Thus, histological analysis is essential to accurately diagnose KFD. Although an increase in liver enzyme levels is rarely associated with KFD, it has been associated with systemic lupus erythematosus, which in turn is typically associated with abnormal liver function test results. Here, we report a case of KFD with elevated liver enzyme levels, and positive antinuclear antibody results in an 11-year-old girl with a 1-month history of a palpable lump on the left side of the neck.