Open Access Case Study

An Alleged Sepsis Syndrome turned out to be Aortic Dissection

Rozita Khodashahi, Hamid Reza Naderi

International Journal of Medical and Pharmaceutical Case Reports, Page 1-5
DOI: 10.9734/IJMPCR/2016/22829

Aortic dissection is an emergency condition in which there is a tear in the wall of the major artery carrying blood from the heart. As the tear extends along the wall of the aorta, blood flows within the layers of the vessel, and leads to aortic rupture or decreases perfusion in other vital organs. Acute aortic dissection might be associated with higher mortality rates and usually represents a medical emergency. In this case we described aortic dissection in a 68 year old man, with clinical presentation of high grade fever, confusion, dyspnea and hypertension and initially misdiagnosed as sepsis syndrome.

Notably, a high index of suspicion is required to diagnose aortic dissection and it is more challenging in elderly patients, referred to atypical symptoms and various underlying organ dysfunctions.

Open Access Case Study

False Positive Test or Phantom hCG: A Case Report

Oguz Eroglu, Yuksel Isik, Zeynep Dag, Ozlem Banu Tulmac

International Journal of Medical and Pharmaceutical Case Reports, Page 1-4
DOI: 10.9734/IJMPCR/2016/22467

A 45-year-old  female patient,gravida3,para3 was admitted to the emergency room because of pelvic pain and irregular menstruation. An human chorionic gonadotropin level ordered as part of the routine test was 210 IU/L. A pelvic ultrasound was negative for intrauterine pregnancy and the lower right lateral  uterine tube measuring 1,5×2 cm. The patient was admitted to the gynecology clinic and following β -hCG levels remained between 250-300IU/L. She received methotrexate (MTX) 50 mg/m2 for a presumed ectopic pregnancy. Surgical management a diagnostic laparoscopy, which was negative for tubal and ovarian pregnancy. A diagnosis of chronic pelvic pain and with high β -hCG levels (where systemic methotrexate and laparascopic management is fail) was made and an abdominal hysterectomy was thus planned. Total abdominal hysterectomy with bilateral salpingooophorectomy was done. The patient was plateau in serum human chorionic gonadotropin after operation.

Open Access Case Study

An Unusual Presentation of Multiple Myeloma with High Grade Fever and Loss of Consciousness

Hamid Reza Naderi, Fereshte Sheybani, Rozita Khodashahi, Sareh Sajjadi, Mahdi Miradi

International Journal of Medical and Pharmaceutical Case Reports, Page 1-7
DOI: 10.9734/IJMPCR/2016/22934

Patients with multiple myeloma (MM) are susceptible to bacterial infections, particularly those caused by encapsulated pyogenic bacteria such as Streptococcus pneumoniae. Significant morbidity and mortality attributable to these infections has been reported in patients with MM. Insufficient synthesis of polyclonal immunoglobulins reflected in marked hypogammaglobulinemia is an important underlying mechanism responsible for the compromised immune system in patients with MM. Despite the fact that patients with MM are prone to develop sepsis caused by encapsulated bacteria, an acute bacterial infection is rarely reported as the first manifestation of underlying MM. Here, we report a rare presentation of MM with hyperacute bacterial meningitis.

Open Access Case Study

Anidulafungin-induced Hepatotoxicity and Dose Reduction: A Case Report

L. W. Loo, Jocelyn Teo, Tan Thuan Tong, Winnie Lee, Andrea L. Kwa

International Journal of Medical and Pharmaceutical Case Reports, Page 1-5
DOI: 10.9734/IJMPCR/2016/22272

Anidulafungin, the newest echinocandin antifungal recently approved by the U.S. FDA, is unique among echinocandins as it undergoes biotransformation rather than being metabolized. In general, patients who received anidulafungin demonstrated low rates of adverse events. Hepatotoxicity is uncommon with anidulafungin and to date; there is no information on hepatic dose adjustments and it is also unknown if the adverse events are dose-related. We describe a patient who developed raised alkaline phosphatase (ALP) upon exposure to a high maintenance dose of anidulafungin at 200 mg every morning. Our patient has a persistent active mitral valve Candida endocarditis, complicated with recurrent candidemia. Patient received multiple courses of anti-fungal agents but breakthrough while on oral anti-fungal suppressive therapy. Prior to the initiation of high dose anidulafungin therapy, patient’s liver function tests were all normal. One month after the initiation of high dose anidulafungin, repeat blood tests revealed a raised ALP level to 3 times the upper normal limit. As prolonged anti-fungal therapy is necessary, the maintenance dose of anidulafungin was reduced to 100 mg every morning, even though patient remained well. Three months after dose reduction, patient’s serum ALP levels showed a steady decrease to 1 time the upper normal limit. In this patient that we have reported – taking into consideration of the temporal relationship of events, coupled with the probability scoring using the Naranjo Algorithm, it is probable that anidulafungin may exhibit dose-related hepatotoxicity resulting in elevated serum ALP levels and such adverse events may be mitigated with dose reduction. 

Open Access Case Study

A Case of Secondary Syphilis Presenting with a Vaginal Mass: A Case Report

Ozlem B. Tulmac, Mukadder Kocak, Zeynep O. Dag, Yuksel Isik

International Journal of Medical and Pharmaceutical Case Reports, Page 1-3
DOI: 10.9734/IJMPCR/2016/23067

Syphilis is an infectious venereal disease caused by the Treponema pallidum that presents with variable clinical manifestations. Herein we present an atypical case of secondary syphilis presenting with vaginal mass as the main complaint. Syphilis should be kept in mind as one of the diseases in differential diagnosis checklist in management of nonspecific genital masses which do not address any disease initially.