Open Access Case Report

Intravenous Immunoglobulin in the Treatment of Patient with Acute Disseminated Encephalomyelitis: Case Report

Iryna Lobanova

International Journal of Medical and Pharmaceutical Case Reports, Page 1-10
DOI: 10.9734/IJMPCR/2015/19364

Background: Acute disseminated encephalomyelitis (ADEM) is a monophasic process nevertheless sometimes aggravated by relapses (so-called multiphase course of the disease). The treatment of ADEM must be targeted at reducing clinical manifestations of the disease and prevention of its relapses.

Case Presentation: We report a 42-year old woman with a diagnosis of acute disseminated encephalomyelitis. The patient received intravenous immunoglobulin in the dose of 0.4 g per 1 kg of body mass within 5 days 1 month after the hormonal pulse-therapy. The treatment was followed by monthly administration of human normal immunoglobulin – 0.4 g per 1 kg of body mass within 24 months as a method of ADEM monotherapy.

The positive dynamics of clinical symptoms was recorded 5 days after the beginning of the treatment (tendon anisoreflexia and swaying reduced). The treatment was followed by monthly administration of human normal immunoglobulin in the dose of 0.4 mg/kg. Three, nine and eighteen months after the beginning of the treatment the patient had two more MRI investigations of the brain that showed positive dynamics of the disease: reduction of demyelination foci and no accumulation of contrast agents. Her neurological deficits disappeared completely in 3 months. No relapses were observed over 24 months of observation.

Conclusion: This case report confirms a positive therapeutic efficacy of intravenous immunoglobulin in the treatment of patient with ADEM – reduction of clinical manifestations of the disease, in particular a decrease in neurological deficit level. Monthly intravenous immunoglobulin administration also helps to prevent the disease relapses (multiphase ADEM course).

Open Access Case Report

Cephalosporin Resistant Pneumococcal Meningitis in a Child-A Case Report

Appiah-Korang Labi, Joan Woode, Nicholas T. K. D Dayie, Eric S. Donkor

International Journal of Medical and Pharmaceutical Case Reports, Page 1-5
DOI: 10.9734/IJMPCR/2015/19873

Meningitis caused by Streptococcus pneumoniae is associated with severe morbidity and mortality. The occurrence of multi-drug resistant strains of S. pneumoniae is associated with treatment failure of pneumococcal infections. We present a case of multidrug resistant pneumococcal meningitis in a 10 month-old patient. The patient was admitted to the Department of Child Health of the Korle-Bu Teaching Hospital with high grade fever and irritability. She received an 8-day course of vancomycin after empirical treatment failure with ceftriaxone. Subsequently, she was discharged without complications on follow-up. Although resistance to ceftriaxone among Streptococcus pneumoniae in Ghana is rare, our report highlights an instance where an unusual ceftriaxone resistant isolate may be encountered as a cause of invasive disease leading to treatment failure.

Open Access Case Study

An Uncommon Case of Phenibut Toxicity in an Intensive Care Unit

Ching Kay Li, Krishnaswamy Sundararajan

International Journal of Medical and Pharmaceutical Case Reports, Page 1-6
DOI: 10.9734/IJMPCR/2015/21689

Gamma-aminobutyric acid (GABA) agonists are used as exogenous neuromodulators for patients with chronic pain and refractory mental illness. Phenibut is a controlled GABA-B agonist, with an extensive use in Russia for psychiatric and perioperative patients.In recent times, its anxiolytic and nootropic properties are commercially marketed with an increased risk for recreational abuse. We present a case of a complicated admission of phenibut overdose in a 44-year-old Caucasian man and subsequent management in an intensive care unit (ICU). The drug was accessed over the Internet. The patient previously had multiple ICU admissions due to overdosing on this particular substance, with a fluctuating conscious state and a threatened airway that required intubation, ventilation, haemodynamic monitoring and vasoactive supports. His ongoing agitation over a course of several days mandated sedatives and hypnotics, and his admission was complicated by hypertensive crises and aspiration pneumonia. The clinical dilemma is yet to be addressed including the implications of this toxidrome and multi-organ dysfunction. The laboratory diagnosis (i.e. plasma phenibut level) are still investigational and needs more research. This report highlights the role of phenibut as an emerging psychotropic substance with a significant disease burden on the public health system. There is neither a consensus-based approach nor an antidote for this toxidrome, and its diagnosis often relies on accurate history alone. Long-term neurological sequelae and outcomes remain uncertain and more clinical surveillance and governance is needed in this particular area of toxicology and the nexus between e-commerce and substance abuse.

Open Access Case Study

Sickle Cell Thalassemia: A Case Report and Review of Literature

Nashaat Elsayed Farara

International Journal of Medical and Pharmaceutical Case Reports, Page 1-4
DOI: 10.9734/IJMPCR/2015/20027

Sickle cell disease is a single gene disorder causing a debilitating systemic syndrome characterized by chronic anaemia, acute painful episodes, organ infarction and chronic organ damage and by a significant reduction in life expectancy. Combined sickle cell beta thalassemia disease is the most common form of sickle cell disease in people of Mediterranean descent, including people of Italian, Greek or Turkish heritage. We experienced a three years old girl who was admitted with bronchopneumonia and found to have anaemia which was proved to be sickle cell thalassemia.

Conclusion: Sickle cell disease should be considered in pneumonic child with severe anemia.

Open Access Case Study

Dilemma of Fetal Autosomal Dominant Polycystic Kidney Disease, a Disease Rare to Present in Fetal Life!

Namrata ., Mandakini Pradhan, Neeta Singh, Sangeeta Yadav

International Journal of Medical and Pharmaceutical Case Reports, Page 1-7
DOI: 10.9734/IJMPCR/2015/21790

Prenatal presentation of fetal ADPKD is rare, however the disease is seen to present in fetal life also. We realize that ADPKD has varied presentations. It can present as isolated enlarged echogenic kidneys with or without any cystic change in fetal life or any decline in renal function. Their presence in fetal life makes a difficult situation to explain the parents the uncertain risk of progression in utero, immediate postnatal or in later years of life. We report two cases each with different presentation and different outcome of similar disease in fetus. It is yet important to diagnose maternal ADPKD in females presenting with early onset hypertension so as to reach at an early diagnosis of fetal ADPKD and similarly screen the parents if the disease presents for the first time in fetus.