Seyed Farshad Allameh
Double inlet left ventricle (DILV) is a rare congenital cardiac malformation that is defined as an anomaly with univentricular atrioventricular (AV) connection, and single ventricular morphology. This variation can be associated with the inlet and outlet cardiac abnormalities. In the current report, we present a case of Holms heart, as a rare variant of double-inlet left ventricle.
Non-neoformans Cryptococcus species were formerly considered to be saprophytes and nonpathogenic to humans [1-2]. However, the incidence of Cryptococcus laurentii infections in immunocompromised and immunocompetent patients has been gradually increasing over the last decades [1-2]. During the COVID-19 pandemic, multiple cases of opportunistic bacterial and fungal infections have been reported in patients after a severe SARS-CoV-2 infection. The author reports the first case of opportunistic pulmonary cryptococcosis caused by Cryptococcus laurentii in a severely ill COVID-19 patient who received treatment with Tocilizumab and dexamethasone. This case contributes to the expanding knowledge of emergent secondary infectious complications including opportunistic pathogens after a SARS-COV-2 infection.
A syndrome of synovitis, acne, pustulosis, hyperostosis and osteitis (SAPHO) is a rare autoimmune disease. It occurs in genetically predisposed individuals by immune activation triggered by possible infectious agents. A 60-year-old man was presented with musculoskeletal and cutaneous manifestations. After exclusion of differential diagnoses, he was diagnosed with SAPHO and successfully treated with adalimumab. He had a typical image defined as a bull’s head sign in bone scintigraphy with 99mTc- methylene diphosphonate. Positron emission tomography also revealed increased inflammatory activity in related anterior chest joints and soft tissue. We want to emphasize diagnostic radiological images in patients with SAPHO to increase the awareness of clinicians.
With current SARS-CoV-2 pandemic, patients with respiratory symptoms are diagnosed with SARS-CoV-2 more readily, but we may oversee some prevalent infective diseases that may co-exist. We report a case of SARS-CoV-2/tuberculosis co-infection and the importance of considering tuberculosis amidst SARS-CoV-2 pandemic.
In the fifth’s SARS-CoV-2 infection peak, although extended vaccination, still there is some reports of neurologic complications of covid-19 in children like adult. Though often we expose to benign neurologic features but sometimes there is unusual clinicoradiologic presentation. Thus, report of uncommon neurologic manifestations can help us to better understand of main pathophysiology in pediatric brain involvement.In this report, we present a five-year- old previously healthy girl that arrive to our hospital with fever, vomiting and loss of consciousness, on lumbar puncture there was mild protein elevation without poleocytosis and nasopharyngeal swap PCR for COVID-19 was positive. Brain imaging 10 hours after admission, revealed findings suggestive of acute necrotizing encephalopa thy (ANE). In spite of extensive brain involvement, after prompt initiation of high dose methylprednisolone and IV immunoglobulin, there was dramatic improvement after 3 months’ follow-up. To our knowledge, this is the first Iranian report and the second report on the w orld.
Congenital absence of the vagina with variable uterine development known as Mullerian agenesis. We presented the case of a patient with distal vagina agenesis with presence of proximal vagina and functioning unicornoate uterus. A 13-year-old patient was referred to pelvic floor service due to primary amenorrhea and pelvic pain. She was diagnosed with the distal vaginal agenesis, functional unicornoate uterus and the ectopic right kidney.Rectoabdominal examination revealed segmental vaginal agenesis and a likely atretic cervix with a huge abdominopelvic mass of about 10 cm in size. On exploratory laparotomy, the bladder was completely dilated and the right kidney was ectopic and both kidneys had moderate hydronephrosis. On the left, a unicorn uterus containing blood and clot, and on the right, a non-functional rudimentary horn with a normal fallopian tube was seen. A neovagina was created by dissection of the space between the urethra hyatus and rectum in laparatomy. It is important to note that the patient may initially present with urinary symptoms and renal signs. Therefore, in the symptoms of urinary tract obstruction, mullerian anomalies should be considered.
Esophageal-pleural (E-P) fistula is introduced to be an uncommon clinical finding maybe due to non-specific clinical pointers and vague radiologic clues. In this regard, the main drivers are esophageal traumatization, endoscopic dilation, irradiation and corrosive agent ingestion as well as major underlying esophageal diseases like carcinomas and tuberculosis. The presented case is a 51-year-old man with medical record of recurrent pneumonias resulted in right lobectomy who admitted to the medical institution with a significant empyema leading to chest tube insertion. It should be noted that the presence of food particles in the chest bottle in addition to the history of previous surgery raised suspicion of a post-surgical E-P fistula formation. Attempts were made to find fistula tract and insert an esophageal stent bypassing the fistula opening. However, investigations argued against E-P fistula as an ensuing event after surgery and arose the question that whether E-P fistula would be the cause or effect of pneumonia in the presented case?
The present case report describes a patient who had presented with resistant trigeminal neuralgia and was later discovered to suffer from idiopathic increased intracranial pressure. The related symptoms were resolved by decreasing the intracranial pressure. As in our case, symptom relief can predict a good prognosis in these cases, resulting in an improved quality of life. Although it is not frequently reported, this potential association can be significant as resolving intracranial hypertension can easily improve the symptoms in those suffering from this condition.To our knowledge, no relationship between increased intracranial pressure and trigeminal neuralgia had yet been reported in the literature.
The Fontan operation is a palliative procedure for patients with several forms of congenital heart disease unsuitable for biventricular circulation, especially tricuspid valve atresia. In this procedure, the vena cava flow is directed to the pulmonary arteries bypassing the ventricle. Pregnant patients with Fontan surgery in their post-surgical history have more maternal risks. We should counsel patients with saturations <85%, depressed ventricular function, refractory arrhythmia, or protein-losing enteropathy against pregnancy (mWHO; IV). In this study, we review a pregnant case that has successful pregnancy and Fontan palliation and lv systolic heart failure (LVEF: 35%) in her pas t medical history.
There are limited reports of oculomotor nerve palsy following vaccination. Herein, we aimed to report a case of acute oculomotor nerve palsy following the first dose of the Sinopharm vaccine. A 17-year-old woman presented with a history of acute painful diplopia and right ptosis within a week after receiving the first dosage of the Sinopharm vaccine. The neurological examination was compatible with acute right third nerve palsy sparing pupils. All the para-clinical tests were unremarkable. With a diagnosis of possible oculomotor nerve palsy as an adverse event of the COVID-19 vaccine, she was treated with steroids leading to a significant recovery. We reported the first case of acute oculomotor nerve palsy associated with the Sinopharm vaccine. However, our findings dose not conclude a causal association between oculomotor nerve palsy and COVID-19 vaccination.
Chest tube insertion is one of the common and critical procedures in emergency room. The most common tool for chest tube position confirmation is chest x-ray. The aim of this case report is to explain one of pitfalls of this tool in confirmation of chest tube position.The patient was a 36-year-old man who had been transferred to ED by EMS due to blunt chest trauma in a motor vehicle collision. After detecting pneumothorax in chest CT scan, chest tube has been inserted and chest x ray has been done for chest tube`s place confirmation. X-ray ascertains that the tube is in the right place but lung does not expand and dyspnea does not improve completely. In chest CT scan which will be done after 2 days, it reveals that chest tube was in subcutaneous tissue. Although chest x-ray is a useful modality to confirm chest tube placement, chest tube function can define important information and imaging should be interpreted beside clinical coarse. It should be noted that in the case of current report, the physical examination is used.
Subacute thyroiditis is an uncommon thyroid disease which usually occurs after a viral infection. During COVID-19 pandemics, several subacute thyroiditis cases were identified during or after COVID-19. Due to their similar manifestations and high prevalence of COVID-19, subacute thyroiditis might be neglected if the clinicians do not keep it in mind. In this care report, we present a missing patient with SARS-COV-2 infection and subacute thyroiditis which was not suspected until the latent phase of the disease.The patient report can be a re-emphasis on the importance of clinical examination and especially paying attention to palpation of the thyroid gland.
Seyed Farshad Allameh
|All the work in this journal are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.|