Open Access Case Report

Isoniazid-Induced Psychosis in 2 Children Treated for Tuberculosis: Case Reports and Literature Review

Samuel O. Oninla, Gabriel A. Oyedeji, Olumayowa A. Oninla, Julia O. Gbadebo-Aina

International Journal of Medical and Pharmaceutical Case Reports, Page 1-6
DOI: 10.9734/IJMPCR/2016/23675

Aims: To report isoniazid-induced psychosis in 2 children treated for Tuberculosis (TB) as a reminder or an alert to clinicians and other health workers.

Presentation of Cases: Isonicotinic acid hydrazide (INH) is commonly used drug to treat and prevent TB, and because of HIV pandemic, its uses have increased tremendously. This report describes two children aged 14 years and 5 years, who exhibited psychotic features about 9 days and two weeks, respectively after the commencement of anti-TB combination drugs containing INH. These two patients were severely under-nourished, with no past medical or family history of mental illness. The psychiatric signs and symptoms resolved completely about 33 days (14-year-old) and 42 days (5 year old) from the time the symptoms started, and 29 days and 28 days, respectively after INH withdrawal and commencement of pyridoxine and haloperidol treatment.

Discussion: Isoniazid-induced psychosis can occur in patients on INH. The time of onset of the symptoms, clinical features, and the drug dosage at which symptoms occur can vary widely. The dose relationship appears to be less significant with psychosis than with peripheral neuritis. The time of onset of symptoms after the institution of INH therapy varies roughly with the dosage, with high doses symptoms appear early, but later with conventional low-dose. The duration of the symptoms and the predisposing factors also differ. Malnutrition, debilitating diseases and past medical or family history of mental illness may act as predisposing factors.

Conclusion: Isoniazid-induced psychosis does occur in children and may present with broad clinical features, even in a patient who may not have past or family history of psychiatric disorders. It can be treated with INH withdrawal, pyridoxine and haloperidol. The severe malnutrition suffered by these two reported cases might have predisposed the patients to INH-induced psychosis.

Open Access Case Study

A Case of Alkaptonuria Diagnosed in Late Adulthood

Nayyereh Saadati, Mandana Khodashahi, Bahram Naghibzadeh

International Journal of Medical and Pharmaceutical Case Reports, Page 1-5
DOI: 10.9734/IJMPCR/2016/22710

Background: Alkaptonuria (AKU), also known as black urine disease, ochronosis as well,  is a rare Mendelian autosomal recessive disorder,  located on chromosome 3q21-q23, caused by deficiency of the homogentisate 1,2 dioxygenase (HGO), an enzyme which normally catalyses the conversion of homogentisic acid (HGA) into maleylacetoacetic acid, in the tyrosine degradation pathway. It results in accumulation and deposition of homogentisic acid in cartilage, eyelids, forehead, hand, axillae, genital regions, nail beds, buccal mucosa, larynx, tympanic eardrum, and the tendons. This condition leads to a severe and crippling arthropathy. We present a case of AKU in a 53 year old woman in Mashhad, Iran.

Case Presentation: In this paper, we report a case of 53-year-old woman who presented with AKU and ochronotic pigment deposited in articular cartilage, sclera, cartilage of the ear, hands and degenerative arthropathy in Ghaem Hospital, in Mashhad, Iran. The features include arthritis of the spine and in larger peripheral joints. The problem began about 9 years ago with a history of darkening of urine and discoloration of sclera, ears and hands. In imaging studies, there were degenerative changes in spine. She also underwent hand biopsy which showed Ochronotic pigmentation.      

Conclusion: This case report that shows AKU must be considered in the evaluation of low back pain of patients’ bluish discoloration, ochronotic pigment deposited in cartilage tissues, sclera and hands. Therapeutic options include protein restriction, administration of high dose vitamin C.

Open Access Case Study

Mind the Drain: Inadvertent Colonic Puncture after Mediastinal Drain Insertion in a High-risk Cardiac Surgical Patient

Krishnaswamy Sundararajan, Ching Kay Li

International Journal of Medical and Pharmaceutical Case Reports, Page 1-4
DOI: 10.9734/IJMPCR/2016/23902

Cardiothoracic surgeries are known to cause gastrointestinal complications due to its proximity to the peritoneal cavity. Such complications in susceptible patients are associated with adverse post-operative outcomes. While the majority of cases reported in the literature were related to intrinsic GI complications as consequences of physiological disturbance, e.g. stress ulcers and mesenteric ischaemia, complications originating from extrinsic factors, e.g. instrumentation and drain insertion, are infrequently discussed and the potential risks can be equally great if not higher. Relevant to this, we present a case of colonic perforation secondary to a misplaced mediastinal drain in a patient who underwent a high risk redo surgery for mitral valve replacement.

Open Access Case Study

Bracket Assisted Treatment of Multiple Gingival Recession Using Placental Membrane- A One Year Follow up Case Series

Rupali Mahajan, Paramjit Kaur Khinda, Amarjit Singh Gill, Akhilesh Shewale, S. P. Maj Saravanan, Nidhi Bhatia

International Journal of Medical and Pharmaceutical Case Reports, Page 1-8
DOI: 10.9734/IJMPCR/2016/23319

Gingival recession is the apical migration of the junctional epithelium with exposure of the root surface. The treatment of buccal gingival recession is a common requirement due to esthetic concern or root sensitivity. Several surgical techniques have been proposed to treat gingival recession. The literature has documented that gingival recession can be successfully treated by means of several mucogingival surgical approaches irrespective of the technique utilized, provided that the biologic conditions for accomplishing root coverage are satisfied with no loss of soft and hard tissue height interdentally. The treatment of multiple adjacent recession type defect (MARTD) show some differences when compared with a single type of recession. The following is a case series of  three patients for evaluating the efficacy of modified approach of the coronally advanced flap with guided tissue regeneration membrane (GTR) (Amnion, Tata Memorial, Mumbai) for treating multiple adjacent gingival recession type defect assisted by orthodontic brackets.

Open Access Case Study

Urinary Obstruction Due to Fungal Infection in Two Preterm Siblings

Vlad Laurentiu David, Ramona Stroescu, Calin Marius Popoiu, Marioara Boia, Simona Cerbu, Alexandra L. Scarlett, Aniko Manea, Corina Maria Stanciulescu, Teofana Bizerea, Eugen Sorin Boia, Otilia Marginean

International Journal of Medical and Pharmaceutical Case Reports, Page 1-5
DOI: 10.9734/IJMPCR/2016/24214

Extravasation of urine and formation of urinoma is rare in the absence of either trauma or congenital anomalies. Fungal ball formation in urinary tract can cause obstruction leading to extravasation. We present two such cases in siblings. Case One: Triplet II referred from the Neonatal unit with clinical picture of acute abdomen. Imaging was inconclusive therefore he proceeded to an exploratory laparotomy, where a diagnosis of urinary ascites was made. Candida albicans infection was confirmed on urine culture. He was treated with antifungals and made a full recovery. No structural anomalies were demonstrated on renal tract imaging. Case Two: Triplet I presented to ED one month later with symptoms of respiratory infection. Commenced on empirical antibiotic medications but clinically deteriorated. Urine culture was positive for fungal infection so antifungal medication was commenced as well. USS demonstrated a right perinephric urinoma.  This was drained percutaneously. He made a good recovery and no structural anomalies were demonstrated on renal tract imaging. Although there is no other direct link between the two cases, that the patients are siblings may suggest a congenital factor. Anyhow, early recognition is vital in managing these complicated patients. Further study is required to explore the concept of a potential familial predisposition for the condition.