International Journal of Medical and Pharmaceutical Case Reports

Cleidocranial Dysostosis, known also as Cleidocranial dysplasia, Mutational Dysostosis, Scheuthauer Marie-Sainton syndrome, is a rare condition which is characterized by delayed ossification of midline structures. Case study of the phenomenon has been reported here. Reports revealed that the classical association of a spectacular dental anarchy, with non-closure of cranial sutures, retention of deciduous teeth and delayed eruption of permanent denture and typical facies of underdevelopment raise strong suspicion of autosomal syndrome. The reviewed patient as a classic demonstration of cleidocranial dysostosis, succinctly represented the condition.

Aim: To show how the surgery helped to eliminate the fear of the stigma associated with Hansen’s disease.

Presentation of Cases: We present a case series of two patients with right ulnar nerve paralysis and one patient with left foot drop. They all underwent surgery for correction of their deformities with excellent outcome.

Discussion: From the cases presented it was clear that though all of them were treated with multi-drug therapy for one year but they were still living under the fear of stigmatization until they had their deformities corrected through surgery. There was a great transformation in the lives of these affected individuals when they had their deformities corrected through surgery. They all overcame their fear of stigmatization after the successful surgery.

Conclusion: Correction of deformities is one of the ways of eliminating fear of stigmatization among the patients who have residual deformities after completing their treatment for Hansen’s disease. The government and non-governmental agencies could do more to make the service readily available and accessible to these individuals. This will help in reintegrating the treated individual back into the community and it will eventually lead to the closure of Leprosy camps.

Aim: To discuss two patient cases of Serratia marcescens endocarditis and the paucity of literature regarding treatment options.

Presentation of Case: Patient 1 was a 29-year old male who presented with native mitral valve Serratia marcescens endocarditis presumed secondary to intravenous drug use. He was empirically treated with vancomycin and piperacillin/tazobactam then transitioned to meropenem and gentamicin 1 mg/kg every 8 hours. He was maintained on vancomycin monotherapy for days 4-14. Gentamicin was restarted on hospital day 14 at 7 mg/kg every 36 hours for 6 weeks. He underwent mitral valve replacement on hospital day 20. He was readmitted on day 42 with splenic lesions and enlarging mycotic aneurysms. Patient 2 was a 38-year old male with native aortic valve Serratia marcescens endocarditis with septic emboli presumed secondary to intravenous drug use. He was treated with vancomycin and cefepime then was transitioned to ceftriaxone and levofloxacin. The patient underwent aortic valve replacement on hospital day 3 and was transitioned to meropenem and levofloxacin for 6 weeks.

Discussion: The treatment strategies for both patients demonstrates that the optimal treatment strategy for Serratia marcescens endocarditis remains unclear. The gentamicin dosing for patient 1 demonstrates “synergy” and extended-interval dosing. Despite both dosing strategies being used, the patient continued to exhibit complications of the infection. Patient 2 demonstrates successful treatment of the infection with surgical intervention and a carbapenem/fluoroquinolone regimen.

Conclusion: These cases demonstrates that much remains unclear in the treatment of Serratia marcescens endocarditis and more studies and case reports are needed.

Aims: We aim to share our experience in the successful use of tedizolid for the treatment of Staphylococcus aureus bacteremia in two of our patients.

Presentation of Cases: Our first patient had methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. The MRSA isolated was sensitive to linezolid and vancomycin (MIC=2), resistant to daptomycin (MIC=2). In view of the documented drug allergy to ceftriaxone and drug interaction with daptomycin, the patient was initially initiated on intravenous vancomycin but developed a breakthrough fever with rising inflammatory markers. However, upon initiation of tedizolid, fever lysed and the patient improved clinically.

Our second patient has end–stage renal failure on hemodialysis. The patient has methicillin-susceptible Staphylococcus aureus (MSSA) catheter-related bloodstream infection. The MSSA isolated was sensitive to vancomycin (MIC=2) and ceftaroline (MIC=0.50), but resistant to daptomycin (MIC=2). Vancomycin was initiated in view of documented drug allergy to ceftriaxone but repeated blood cultures showed the persistence of MSSA. Antibiotics were switched to linezolid for 3 days before switching to tedizolid due to previous neutropenia with linezolid. Blood cultures had documented clearance with tedizolid.

Discussion and Conclusion: In both our patients, tedizolid was introduced after a few days of vancomycin therapy. Hence, the efficacy of tedizolid as the first-line therapy for the treatment of staphylococcus bacteremia remains unknown. Nevertheless, in both patients, there was no relapse of staphylococcus bacteremia when tedizolid was used to complete the antibiotic therapy. The optimal treatment duration of staphylococcus bacteremia with tedizolid also remains unknown.

Aims: We report a rare case of therapy-related AML with t(8;21)(q22;q22.1) that occurred after treatment for mantle cell lymphoma (MCL) and oral squamous cell carcinoma (OSCC).

Presentation of Case: A 52 years-old male patient was diagnosed with MCL in leukemic phase. The treatment consisted in R-CHOP rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone, then patient experienced remission. Three months later, he presented a lump that was diagnosed as OSCC, which was surgically removed and treated with cisplatin and radiotherapy. Then, the patient’s hemogram presented 35.0% of blasts and, after morphologic, phenotypic and molecular analysis, it was classified as AML with t(8;21)(q22;q22.1). However, due to the previous historic of chemotherapy and radiotherapy, the final diagnosis was t-AML.

Discussion: The correct diagnosis of therapy related malignancies is important due to its severity as they are very aggressive and, usually, considered incurable. t-AMLs with t(8;21)(q22;q22.1) is considered as favorable karyotype, still, it has a poorer outcome compared with its de novo counterpart.

Conclusion: t-AML with t(8;21)(q22;q22.1) is rare and few cases are described in the literature. More reports are necessary to better elucidate the mechanisms involved in this disease to define better treatment strategies to prevent these events and to improve the poor outcomes.