Open Access Case Report

Granulomatosis with Polyangiitis (GPA), an Important Differential Diagnosis in Sepsis

Delme Luff, Priyakam Chowdhury, Sancho Rodríguez-Villar

International Journal of Medical and Pharmaceutical Case Reports, Page 1-5
DOI: 10.9734/IJMPCR/2016/25223

Introduction: Sepsis is a well-recognised medical emergency requiring aggressive medical management, often in a critical care setting. Granulomatosis with Polyangiitis (GPA) (previously named Wegener’s Granulomatosis) is a type of primary systemic antineutrophil cytoplasmic antibodies (ANCA) associated vasculitis (AAV) [2-4]. AAV can present with a variety of symptoms including those which mimic infective disease. Differentiation between these two diseases is extremely important because their respective treatments differ significantly and delays in commencing therapy can be fatal.

Case Presentation: A 70 year old Caucasian gentleman presented with symptoms suggestive of severe sepsis who failed to respond to standard treatment. However an autoimmune screen revealed that he was in fact suffering from severe generalised GPA. Despite aggressive treatment his disease progressed rapidly and he passed away on day 20 of his admission.

Conclusion: This case report describes a rare and potentially fatal disease which can present with a variety of non specific symptoms. It highlights the importance of differentiating between AAV and syndromes that may mimic AAV, particularly infection (including meningitis) in the ICU settings.

Open Access Case Report

Impacted Urethral Stone in a Female: Case Report

Isaac Olusayo Amole, Stephen Adesope Adesina, Adepeju Olatayo Adegoke, Adewumi Ojeniyi Durodola, Adenike Adeniran, David Akintayo OlaOlorun, Olufemi Timothy Awotunde

International Journal of Medical and Pharmaceutical Case Reports, Page 1-4
DOI: 10.9734/IJMPCR/2016/25639

Aims: To present a case of impacted urethral stone in a female.

Presentation of Case: A 32-year-old female presented at the Family Medicine clinic with a history of external urethral meatal pain and a foreign body in her external meatus of one hour duration. She noticed that the stream of her urine was poor and she developed severe pain in her external urethral meatus after micturition. On physical examination at the clinic, general and abdominal examinations were normal but it was discovered that she had an impacted stone in her external urethral meatus. The stone was extracted with the aid of a curved hemostat after copious lubrication with 2% lidocaine jelly.

Discussion: Urethral calculi are uncommon and they account for approximately 1% of all urinary tract stones. Urethral calculi are rarely seen in females but do occur in males. Majority of urethral calculi migrate down into the urethra from the upper urinary tract and bladder and are rarely formed primarily in the urethra except those that occur secondary to abnormalities in the urethra.

Conclusion: Urethral calculi are extremely rare in female patients with no associated genitourinary abnormality. Urethral calculi must be kept in mind in female patients who complain of a poor stream of urine, urinary retention, severe pain in the external urethral meatus and palpable mass around the urethra.

Open Access Case Study

Allergic Contact Dermatitis Caused by Both Eucalyptus Oil and Spruce Oil

Demet Kartal, Levent Kartal, Salih L. Çınar, Murat Borlu

International Journal of Medical and Pharmaceutical Case Reports, Page 1-3
DOI: 10.9734/IJMPCR/2016/25115

Infantum cold® (Sedomed İlaç Pazarlama-Konya-Turkey) is an inhalant ointment that helps to relieve nasal congestion due to upper respiratory tract infections. It contains only eucalyptus oil and spruce oil. Although many reports present allergic contact dermatitis (ACD) due to eucalyptus oil and spruce oil separately there are no cases caused by both oil. We present a case of a pediatric patient who developed an ACD secondary to application of Infantum cold®. We believe that ACD due to eucalyptus oil and spruce oil might be more common than currently described in the literature. We encourage others to test with eucalyptus oil and spruce oil if there is clinical indication.

Open Access Case Study

Clinical Course of a Case with Sarcomatoid Renal Cell Carcinoma

Özkan Onuk, Burak Arslan, Aydın İsmet Hazar, Arif Özkan, Nusret Can Çilesiz, Barış Nuhoğlu

International Journal of Medical and Pharmaceutical Case Reports, Page 1-5
DOI: 10.9734/IJMPCR/2016/25900

Introduction: Renal cell carcinoma (RCC) is the most frequently observed malign neoplasm of the kidney. Its sarcomatoid variant (SRCC) is rare but aggressive. Our aim is to present the clinical course of a 51 year-old patient with SRCC, in the light of the literature.

Methods: A patient applied to our clinic reporting weight loss, fatigue, flank pain, and abdominal mass. Magnetic resonance imaging revealed a hypointense mass that has a heterogenic T2-weighted outlook with a size of 95x110x147 millimeters. Patient underwent left radical nephrectomy, as well as colon resection and ileostomy due to invasion.

Results: Pathological diagnosis was reported as colon-invasive SRCC with a tumor sized 20x10x7.5 centimeters.

Conclusion: First resection has a key role because complete resections are the biggest chance of most patients for long-term survival.

Open Access Case Study

N-chlorotaurine and N-bromotaurine Combination Regimen for the Cure of Valacyclovir-unresponsive Herpes Zoster Comorbidity in a Multiple Sclerosis Patient

Anthony M. Kyriakopoulos, Stella Logotheti, Janusz Marcinkiewicz, Markus Nagl

International Journal of Medical and Pharmaceutical Case Reports, Page 1-6
DOI: 10.9734/IJMPCR/2016/25476

Aims: Skin herpes zoster frequently affects immunocompromised patients including multiple sclerosis patients that belong to a distinct category of autoimmunity. Although considered a manageable condition, non-immunocompetent patients are suboptimally targeted by the gold standard valacyclovir treatment. In the case presented here, a new endogenous antiseptic treatment was applied.

Presentation of Case: We describe a recurrent multiple sclerosis patient with herpes zoster skin infection, who was unresponsive to cotreatment with valacyclovir. Topical application of 0.8% N-chlorotaurine twice daily for four days resulted in immediate symptom resolution including loss of pain. Alternating application of 0.8% N-chlorotaurine and 1.0% N-bromotaurine in the next three days led to rapid healing.

Discussion and Conclusion: This is the first case where natural taurine haloamines (N-chlorotaurine and N-bromotaurine), which are involved in innate immunity, were applied in reactivated, painful herpes zoster. The rapid clinical healing observed suggests specific investigations of the therapeutic effect of these compounds in this indication.