Open Access Case Study

Meningococcal Septic Shock with Polyarticular Arthritis and Hemorrhagic Skin Lesions in a 70-Year-Old Immunocompetent Woman

Gerasimos Eleftheriotis, Sofia Kalantzi, Marina Gkeka, Asimina Protogerou, Constantinos Christopoulos, Chariclia Loupa

International Journal of Medical and Pharmaceutical Case Reports, Page 1-6
DOI: 10.9734/IJMPCR/2017/39054

Aim: To describe a case of meningococcal polyarthritis and hemorrhagic skin lesions in an immunocompetent woman with meningococcal septic shock.

Case Presentation: Α 70-year-old woman was presented to the emergency room with fever, chest pain, and purpura. Vital signs: 98 bpm, 26 breaths/min, blood pressure: not measurable. She had no photophobia or neurologic-meningeal signs. Chest radiograph showed bilateral bronchopneumonia infiltrates and 6th left rib fracture, which was attributed to a fall at home due to hypotension. Blood tests showed acute kidney injury and disseminated intravascular coagulation, while inflammatory markers were markedly elevated. Due to hemorrhagic lesions and the unresponsiveness to vasopressors, brain and adrenal CT was performed, which revealed subarachnoid haemorrhage, while it excluded Waterhouse-Friderichsen syndrome. Aggressive hydration with crystalloids and ceftriaxone plus vancomycin was initiated as empirical treatment of sepsis due to primary bacteremia. Blood cultures revealed penicillin-sensitive N.meningitidis (MIC: 0,094 μg/mL). The patient was afebrile on the 3rd hospital day. On the 4thday she presented new fever along with arthritis of left proximal mesophalangic and carpal joints, and afterwards of the left elbow and right metacarpophalangeal joints. Lornoxicam was added to therapy. Fever resolved after 1 week. The patient continued NSAID treatment for 1 month until CRP and ESR values returned to normal.

Conclusion: Meningococcal arthritis is found in up to 12% of patients with invasive meningococcal disease and is presenting 3 days to 2 weeks after disease onset when the patient’s status is otherwise improving. Clinicians should be aware of this complication because fever and inflammatory markers’ rebound can lead to the unnecessary initiation of nosocomial antibiotics.

Open Access Case Study

Tarlov Cyst Causing Sacral One Nerve Compression, a Rare Presentation: Case Report and Literature Review

Emmanuel Murwanashyaka, Alex M. Buteera, Emmanuel Bukara, Lynnette Kyokunda-Tumwine, Emmanuel Rudakemwa

International Journal of Medical and Pharmaceutical Case Reports, Page 1-7
DOI: 10.9734/IJMPCR/2017/39033

Aims: We describe the clinical, radiological and pathological characteristics of a symptomatic Tarlov cyst in a female adult patient who presented with severe low back pain of prolonged duration from Kigali, Rwanda.

Presentation of Case: We report a 48-year-old Rwandan female patient who presented with a history of progressive low back pain and numbness of S1 and S2 distributions for the last 15 years. A magnetic resonance imaging (MRI) was carried out to evaluate for disc degenerative disease, however, we found an incidental symptomatic Tarlov cyst in front of the first sacral vertebra. The symptomatic cyst was surgically excised and the excision site after repair covered with durafoam. The patient reported a remarkable improvement in her symptoms in the post-operative period and follow up of up to 8 months duration.

Discussion: Tarlov cyst (TC) or sacral perineurial cyst is a cystic lesion of the nerve root that is common in the sacrum. TCs are typically located at the junction of the dorsal ganglion and the posterior nerve root and usually develop between the endoneurium and perineurium of the nerve root. Perineural cysts are commonly detected as incidental findings during magnetic resonance imaging of the lumbosacral spine in the imaging of suspected disc degenerative disease.

Conclusion: Tarlov cysts very rarely occur and when they do they are commonly asymptomatic. They cause sacral radiculopathy and sacral pain syndrome, particularly in women. To our knowledge, this is the first case of asymptomatic Tarlov cyst causing unbearable pain in Rwanda.

Open Access Case Study

A Case of Sporadic Bilateral Polythelia with High-Grade Myopia

Mehmet Emre Yegin

International Journal of Medical and Pharmaceutical Case Reports, Page 1-3
DOI: 10.9734/IJMPCR/2017/39378

Aim: Polythelia is a rare condition. It ıs known to be associated with urogenital anomalies. Also, there are other types of rare anomalies like hand or mandible anomalies related with this anomaly. However, our case presents the first case of polythelia with ophthalmic abnormalities.

Presentation of Case: A 22-year-old male with congenital bilateral nodular inframammarian macules with aesthetic complaints and high-grade myopia. Lesions were excised and concluded as polythelia. Ultrasonic examinations revealed no structural abnormalities in urogenital system.

Discussion: Polythelia is a rare condition with several accompanying abnormalities. Mostly, it is associated with urogenital anomalies. Our case showed no signs of urogenital deformities. Only deformity he had was high-grade myopia which began at infancy.

Conclusion: Our report is the only article that reports the possible association of polythelia with ophthalmic deformities.

Open Access Case Study

Hydrangea arborescence and Berbaris vulgaris Ease Ureteric Calculi Emission: Single Case Report

Nazmul Hasan, Md. Emrul Kayes, Md. Jahangir Alom, Md. Kamrul Kayes

International Journal of Medical and Pharmaceutical Case Reports, Page 1-5
DOI: 10.9734/IJMPCR/2017/39743

Renal calculi or nephrolithiasis refers stone in the kidney-ureter-bladder (KUB) region. Calcium oxalate is the chief ingredient to form most of the calculi and kidney stone is one of the most common health problems in Bangladesh as well as in the world. Multiple risk factors play important role in the formation of stone including fatty foods, increased intake of NSAID, sedentary life and few chronic clinical conditions. Recurrent infection in the urinary tract and dull aching pain in the flank is a most common symptom along with difficulties in urine output and may lead to sudden obstruction of urine flow if not treated properly. Conventionally surgery is the most prescribed solution however, there are few tangles of this including fear to surgery, expenses, and recurrence. Therefore, finding an alternative, more beneficial and less expensive for patients is essential. The current case study involves a single case of ureteric calculi complicated with enlarged prostate, increased creatinine and previously diagnosed diabetes mellitus, where Hydrangea arborescence and Berbaris vulgaris used with a positive outcome. The detailed mechanism of these two could be determined with extensive study along with new verge of research get opened.

Open Access Case Study

De Garengeot Hernia: A Rare Cause of Acute Abdomen

Jurij Janež

International Journal of Medical and Pharmaceutical Case Reports, Page 1-3
DOI: 10.9734/IJMPCR/2017/39735

De Garengeot hernia is a femoral hernia with an appendix vermiformis within the hernia sac. It is named after a French surgeon Rene Jacques Croissant de Garengeot, who first described the appendix in the femoral hernia sac in the 18th century. De Garengeot hernia is a relatively rare clinical entity and only a few surgeons are aware of it. This case described an older female patient, who presented to the emergency department with an incarcerated right sided femoral hernia, which could not be reduced. An emergency surgery revealed incarcerated appendix vermiformis inside the femoral hernia sac – the so called »De Garengeot hernia«.