Indian Journal of Case Reports

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https://imsear.searo.who.int/handle/123456789/162465

Chief-Editor: Dr. Amit Agarwal
ISSN:(Print) 2454-129X (Online) 2454-1303

Frequency: Quarterly

Language: English

Open Access Peer-reviewed journal

Web site: https://atharvapub.net/index.php/IJCR/index

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Now showing 1 - 20 of 638

Hepatitis B induced fulminant liver failure: A call for prevention
(Mansa STM Publishers, 2023-07) Singh, Bhupinder; Singh, Jugraj; Bansal, Kabir; Verma, Sakshi; Bali, Kusum; Kaur, Navjot
Acute fulminant hepatic failure is a condition in which a healthy liver deteriorates rapidly following an insult, resulting in the impairment of its synthetic functions. This condition is rare and is associated with high fatality rates. We report the case of a 19-year-old male who was brought to the emergency room in an unconscious state with jaundice and persistent fever for 2–3 weeks after recently commencing intravenous use of morphine. He was found to be hepatitis B surface antigen reactive, and his laboratory tests indicated severe liver dysfunction with elevated levels of serum bilirubin, aspartate transaminase, alanine transaminase, gamma-glutamyl transferase, and International normalized ratio. The patient was diagnosed with fulminant liver failure with coagulopathy and hepatic encephalopathy. The patient’s family was addressed and counseled regarding the urgent need for liver transplantation. However, due to a lack of funds and insurance, supportive treatment was the only option left. Despite all supportive measures, the patient expired within 48 h. This case highlights the importance of various socioeconomic issues involved with liver transplantation, as in a resource-limited setting, urgent transplantation seems nearly impossible. In addition, this case report raises certain ethical issues that need consideration, particularly in an injection drug use scenario. It also highlights the importance of addressing the rising issue of injection drug use among youth, particularly in the regions of Punjab.
A rare case of post-ictal diffuse alveolar hemorrhage due to seizures
(Mansa STM Publishers, 2023-01) Akhil, Aramandla; Varshitha, Bandi Venkata
Diffuse alveolar hemorrhage is persistent or recurrent pulmonary hemorrhage that occurs due to a variety of causes. Here, we present the case of a 15-year-old male child who presented with chief complaints of involuntary jerking movements of the entire body in the morning followed by coughing out a massive amount of blood. At presentation, the patient’s blood glucose level was high. Bronchoscopy revealed bleeding in the middle and lower lobes of both lungs. Computed tomography (CT) brain was suggestive of cerebral edema and the CT chest was suggestive of diffuse opacities in bilateral lung fields. The patient was started on corticosteroids, antiplatelet drugs, antiepileptics, insulin, and oxygen inhalation which helped the patient to recover and was discharged in a week’s time.
Spontaneous pneumothorax in a young male athlete: A case report with review of literature
(Mansa STM Publishers, 2023-01) Maglica, Mirko; Jur?evi?, Ante; Jur?evi?, Branimira; Miškovi?, Josip
Spontaneous pneumothorax (SP) is a serious and life-threatening condition often caused by ruptured apical lung bulla in young male individuals. It is commonly associated with different syndromes but also occurs in healthy individuals. In this case report, we aim to discuss the etiology, clinical course, and surgical treatment of a 21-year-old male kickboxer with a right-sided pneumothorax that occurred during a sparring session. A chest tube with negative suction was inserted to resolve the pneumothorax. Because there was no visible resolution, video-assisted thoracoscopic surgery (VATS) was performed. During VATS, a large, apically placed, ruptured lung bulla, was revealed and removed. One month after surgery, the patient is in great clinical condition. There are no signs of a recurrence of SP.
Wilms tumour in a two day old neonate: A rare and challenging case
(Mansa STM Publishers, 2023-01) Ravel, Naveen; Rajan, Teena; Mohankumar, K; Vadivelu, Gomathy; Sathiyamoorthy, P N; Ramanan, Arun; Vijayaraghavan, P; Joel, Sam M; Chodavarapu, Dheeraj; Konduri, Meena; Pothala, Vijayalakshmi
Wilms tumor or nephroblastoma is the second most common renal tumor occurring in the neonatal age group next to congenital mesoblastic nephroma. The most common age group of presentation of Wilms tumor is between 3 and 4 years of age. Here, we report a case of right-sided Wilms tumor in a 2-day-old neonate. A term-born female baby presented on day 2 of birth with abdominal distension and physical examination revealed a large palpable mass in the right lumbar region crossing the midline. Imaging features were suggestive of a retroperitoneal mass of probable right renal origin. The patient was taken up for right radical nephroureterectomy and Per-operatively, there was anticipated tumor spillage. Post-operative histopathological examination was suggestive of a triphasic Wilms tumor with no anaplasia and favorable histology. The patient was diagnosed with Wilms tumor of the right kidney, COG stage III, SIOP (“International Society of Pediatric Oncology”) intermediate risk. Loss of heterozygosity testing for 1p and 16q was negative. She was started on chemotherapy with a DDA4 regimen. She completed whole abdominal radiotherapy and tolerated treatment well. The child is disease free and is under regular follow-up. This case of neonatal Wilms tumor was indeed a challenge to the pediatric surgeons and the oncologists but the final results were worth the challenge that was faced
Headache as the sole manifestation of Wilson’s disease
(Mansa STM Publishers, 2023-07) Verma, Nikhil; Pathania, Kanika; Sharma, Milap; Katoch, Nandita; Yadav, Meenu
Wilson’s disease (WD) is an inborn error of copper metabolism caused by a mutation to the copper-transporting gene ATP7B. In the first decade of life, hepatic involvement predominates but neurological manifestations occur in the third or fourth decades. Studies showed Indian children with neuro WD present with behavior abnormality, speech and cognitive impairment, sub-clinical affection of visual pathway, and autonomic function. As a treatable disease, WD should be detected early in the course of the disease by any health professional at any care level, but the rare prevalence of the disease explains the lack of awareness of this disease. Even a high index of suspicion about this entity gets more difficult when the rare and atypical symptom is the only presentation of the disease. Here, we present the case of a 15-year-old girl with worsening headache for the past 3 months as the only neurological manifestation of WD, and that also without any evidence of hepatic involvement.
Spontaneous bilateral pneumothorax in a previously healthy COVID-19 patient: A case report
(Mansa STM Publishers, 2023-07) Haryati, Haryati; Nurrasyidah, Ira; Kusumawardhani, Erna
Coronavirus disease 2019 (COVID-19) is commonly linked with mild cough, fever, and shortness of breath symptoms. However, there have been reports of pneumothorax, which particularly occurred at least 1 week following symptom onset in elderly COVID-19 patients. Spontaneous pneumothorax (SP) is an uncommon but possibly fatal complication of COVID-19 pneumonia and is rarely reported in non-intubated patients. We report a case of a healthy, non-smoker 35-year-old young woman who presented with a 7-day cough, fever, and sudden shortness of breath. She was diagnosed with severe COVID-19 pneumonia, experienced a right SP, and developed a second pneumothorax on the contralateral side. She improved gradually following chest tube insertion in the right lung and conservative management for the left pneumothorax.
A rare case of avascular necrosis of the hip joint secondary to ochronosis
(Mansa STM Publishers, 2023-06) Kolwalkar, Ravish; Pereira, Jessica
This is a case report of a 53-year-old female patient who presented with long-standing hip pain secondary to avascular necrosis of the hip joint. She underwent total hip replacement and her intraoperative findings raised suspicion of ochronosis and was retrospectively evaluated for alkaptonuria both clinically and through biochemical investigations to confirm the diagnosis
Epidermoid cyst of the brain: A common cystic lesion in rare location
(Mansa STM Publishers, 2023-06) Kuppusamy, Thilagarani; Prasad, Sowmya Devi Ajith
Epidermoid cysts are common benign tumors comprising around 1% and 2% of all intracranial tumors. Their usual locations include the parasellar region and cerebellopontine angle, and less commonly, the Sylvian fissure, suprasellar region, cerebral, and cerebellar hemispheres. Epidermoid cysts located in the brain stem are rare. These epidermoid cysts are similar to epidermoids arising in the skin which contain cheesy and flaky-white soft pultaceous material. Epidermoid cysts are very slow-growing tumors having a similar growth pattern of the epidermal cells of the skin and develop from the remnants of epidermal elements during the closure of the neural groove and disjunction of the surface ectoderm with neural ectoderm between the 3rd and 5th weeks of embryonic life. The ideal treatment of choice is the removal of cystic components with the complete resection of the capsule. We are presenting an interesting case of an epidermoid cyst in the frontal lobe in a 42-year-old male along with radiological investigations.
Rehabilitation using neurodevelopmental and sensory integration therapy approaches in an 8-month-old infant with self-gratification behavior: A case report
(Mansa STM Publishers, 2023-07) Ghadge, Tejal; Deshpande, Snehal; Hegde, Anaita
Self-gratification behavior is a normal behavior in infants or children and is usually misdiagnosed with dystonic development delays, repeated movement disorders, or even epilepsy. This case report aims to share our clinical experience in managing a child with self-gratification disorder through physical therapy techniques. An 8-month-old female infant presents with concerns related to poor social interaction, reduced play, irritable behavior, frequent crossing, and stiffness in the legs which she started showing at 3 months of age. She was earlier diagnosed with dystonic developmental delay and referred for a thorough development and sensory assessment. Rehabilitation with sensory integration and neurodevelopmental techniques was delivered to the child. Ages and Stages Questionnaire, Denver’s score, and Sensory profile were assessed at 8–9 months, 9–10 months, and 10–11 months to monitor prognosis. There was a significant improvement in self-gratification habits and improved attention in the child. Self-gratification behavior is a normal behavior in infants or children and is usually misdiagnosed. Treatment mainly constitutes neurodevelopment, sensory integration techniques, and parent education.
Cystinuria: A rare cause of bladder stone
(Mansa STM Publishers, 2023-06) Babu, Amalu Marutholil; Radhakrishnan, Radhika Chemmangattu; Uthup, Susan; Vasudevan, Beena Sushamma
VCystinuria is an inherited metabolic disorder progressing with recurrent kidney stones due to impaired reabsorption of dibasic amino acids and arises from mutations in the SLC3A1 and SLC7A9 on chromosome 2. Here, we present the case of a 1-year 10-month-old male child with recurrent episodes of urinary tract infections. On evaluation, duplex kidneys and a large bladder calculus were found which was surgically managed. Stone analysis and the genetic study were suggestive of cystinuria.
A rare presentation of Mycoplasma pneumoniae with splenic nodules
(Mansa STM Publishers, 2023-01) Rodda, Alekhya; Reddy, Avinash; Dekate, Parag Shankarrao; Banothu, Kiran Kumar
Mycoplasma pneumoniae is a common respiratory pathogen that can cause a wide spectrum of extrapulmonary manifestations with neurological manifestations being the most common. Here, we report a rare case of splenic nodules in a 7-year-old girl with M. pneumoniae infection which responded well to macrolides. M. pneumoniae infection should be considered in children with extrapulmonary manifestations including splenic lesions
Intensive care management of Gitelman syndrome: A rare case
(Mansa STM Publishers, 2023-06) Das, Subhankar; Kumari, Silky; Kumari, Sudha; Kataria, Yuvika; Sahanawaz, Mohammad
Gitelman syndrome (GS) is an autosomal-recessive disorder distinguished by hypokalemia, hypomagnesemia, and hypocalciuria. Elderly people and women of childbearing age are highly affected by GC. Not much evidence is known about its effects on maternal and fetal outcomes. GS is caused by mutations in the thiazide-sensitive Na-Cl cotransporter gene. Due to its rarity and lack of knowledge, it is susceptible to misdiagnosis or being overlooked. In our case, the patient suffered from recurrent hypokalemia, hypomagnesemia, hypochloraemia, and hypocalciuria with hypotension. After taking proper medication, the patient recovered slowly, and during counseling, the patient was provided a diet chart by nutritionists to avoid recurrent electrolyte imbalances.
Are breath-holding spells always innocuous: A case report
(Mansa STM Publishers, 2023-07) Paranjpe, Mugdha; Sane, Sudhir; Sharma, Ratna
The diverse clinical manifestations of Langerhans cell histiocytosis (LCH) present a dilemma to clinicians and pediatricians play an important role in its diagnosis and multidisciplinary approach. LCH, previously known as histiocytosis X, is an uncommon hematological disorder characterized by uncontrolled stimulation and proliferation of normal antigen-presenting cells, Langerhans cells. The purpose of this report is to describe the case of a 7-month-old female child with multisystem involvement who presented with breath-holding spells and to discuss the clinical, radiological, and histopathological features of LCH.
Emphysematous pyelonephritis in patient with hemophagocytic lymphohistiocytosis: A case report
(Mansa STM Publishers, 2023-06) Singgih, Nicholas Andrian; Oktaviani, Jacinda Risha; Secodiningrat, Raden Honggo Pranowo Sampurno; Manuputty, Egi Edward
Emphysematous pyelonephritis (EPN) and hemophagocytic lymphohistiocytosis (HLH) are rare, fatal illnesses. The presence of both at once in a patient is extremely rare. The number of reported cases of EPN is <800 cases worldwide to date. Contrarily, the prevalence of adults with HLH is estimated to be 1 in every 2000 adults admitted to a tertiary health center. This case report aims to present the case of a 45-year-old woman who was diagnosed with EPN with a history of HLH and was successfully treated with medication alone. In conclusion, the clinical manifestations of EPN are non-specific and need imaging modalities like computed tomography (CT) scans. Treating EPN is based on CT scan classification. Medical treatment was an option for these patients. There is no direct association between EPN and HLH; it is a challenging decision to treat patients with both.
Pediatric Charcot-Marie-Tooth disease: A case report and diagnostic challenges
(Mansa STM Publishers, 2023-07) Babu, Sarath; Francis, Johny Vakayil; George, Ditty
Charcot-Marie-Tooth (CMT) disease is a hereditary motor sensory neuropathy affecting about one in 2500 individuals that is characterized by progressive weakness and loss of touch sensation affecting different parts of the body. Despite its significant genetic heterogeneity, CMT is rarely reported in the Indian literature. We report a 10-year-old boy with CMT presented with severe calf pain, bilateral pes cavus deformity, and areflexia. His mother also had similar symptoms, and the diagnosis was confirmed by neuroimaging and nerve conduction studies. This highlights the importance of considering CMT disease in patients with progressive muscle weakness and deformities, especially with a family history of similar symptoms.
Infantile tremor syndrome: Case report
(Mansa STM Publishers, 2023-06) Sarpangala, Murali Keshava; Jain, Rishabh
Infantile tremor syndrome (ITS) is a very rare disease with an incidence of <0.2% in India. Affecting children are around 1 year of age and characterized by developmental delay, skin pigmentation, and coarse tremors. Studies since 1990 conclude that ITS is caused by nutritional deficiencies, most prominently of Vitamin B12. Since lactating mothers from a poor socioeconomic background in regions where vegetarianism is prevalent because of cultural reasons are most likely to be deficient in Vitamin B12, the syndrome is most likely to affect this segment. The case described herein is unique because it is from Mangalore in India which is a coastal town with very low levels of vegetarianism. A 14-month-old girl presented with fever, vomiting, and loose stools coupled with abnormal movements of eyes, tongue, and hands which were coarse, rhythmic, continuous of low amplitude, present throughout the day, and absent during sleep. Although initial suspicions were of seizures and the patient was administered anti-epileptics, there was no improvement in the condition of the patient. On suspicions of symptoms being of ITS, an MRI-brain was done which showed diffuse mild loss of white matter. Consequently, blood investigations showed macro-to-microcytic hypochromic anemia. Thereafter, the child was started on injectable B12 supplementation and propanolol at 0.5 mg/kg/day for tremors. The child responded well clinically.
Challenges of managing HIV cytomegalovirus co-infection in the presence of pancytopenia
(Mansa STM Publishers, 2023-06) Vupmandla, Niveditha; Shivaswamy, Rajendra Prasad; B J, Subhash Chandra; K C, Shashidhara
A 60-year-old male patient who presented with generalized weakness and low-grade fever was diagnosed to be human immunodeficiency virus (HIV) positive with a CD4 count of 17. Routine laboratory investigations revealed pancytopenia. Serum cytomegalovirus (CMV) DNA polymerase chain reaction (PCR) was positive and fundoscopy showed CMV retinitis in the right eye. The patient was started on tablet valganciclovir. After 2 weeks, the patient was brought back in an altered sensorium. He was found to have hyponatremia which was corrected. He was started on antiretroviral therapy and tablet valganciclovir was continued. The patient came back again after one and a half months with a urinary tract infection and fissure-in-ano. He was found to have severe neutropenia. Valganciclovir was stopped. He was started on injection granulocyte colony-stimulating factor. The patient clinically improved and his hematological parameters became normal. Patients having HIV and CMV co-infection with pre-existing pancytopenia have to be closely monitored as the medicines used for treatment can exacerbate the existing conditions.
The B-cell non-Hodgkin’s lymphoma: An enigma to diagnose
(Mansa STM Publishers, 2023-07) Iyer, Shruti Suryanarayan; Narayanan, Vivek; Ramakrishnan, Karthik; Gurram, Prashanthi; Subramanian, Abinaya
Non-Hodgkin’s lymphoma is a heterogeneous group of malignancies characterized by an abnormal clonal proliferation of T-cells, B-cells, or both. Sometimes, tuberculosis and lymphoma presentation can share common symptoms and features. In this case report, we present the case of a 28-year-old female patient who came with a chief complaint of swelling on the right side of the face for the past 6 months. Initially, it was not associated with pain but gradually developed severe pain over the region and reduced salivary flow. The patient was planned for surgery with a differential diagnosis of salivary gland pathology. Post-operatively, the histopathological report showed atypical cells which were diffusely positive for cluster of differentiation (CD)20. Focally positive for CD45 and CD3 which was positive in reactive T lymphocytes. Immunohistochemistry pattern favors the diagnosis of B-cell type NHL. Through this case report, we want to share our experience in treating an aggressive tumor that mimics salivary gland pathology.
Leukemic gingival enlargement- A case report and review
(Mansa STM Publishers, 2023-07) Manoharan, Murali Gopika; Senthilkumar, Eyakshara
Oral signs are an early indicator for a variety of systemic diseases. Gingival enlargement can be due to local factors, certain medications, hormonal changes, and malignant diseases. Leukemia is a malignancy characterized by the proliferation of abnormal white blood cells within the bone marrow; oral changes may be the first and only presenting feature in these patients, making it imperative for dental surgeons to make accurate diagnosis and timely referral to prevent a fatal situation. This article aims to discuss a case of acute myeloid leukemia (AML) that came with the chief complaint of swollen gums for 2-month duration. The case was provisionally diagnosed as a leukemic gingival enlargement on the basis of oral manifestation and lymph node examination. Accurate diagnosis and early initiation of chemotherapy for leukemic gingival enlargement can improve the prognosis of the patient and also helps in avoiding complications. Around 50–80% of patients with AML achieve complete remission, more often in children and patients under the age of 60. This paper aims at emphasizing the importance of thorough oral examination and careful investigations to identify the underlying life-threatening condition.
Mucormycosis of left maxilla: A case report and review
(Mansa STM Publishers, 2023-07) Jayachandran, Poovaraghavan; Narayanan, Vivek; Ramakrishnan, Karthik; Gurram, Prashanthi; Rathan, A C Lakshmi
Mucormycosis is an angioinvasive infection caused by fungi of the Zygomycetes order. Rhizopus is the main pathogen responsible for 90% of cases of cerebral mucormycosis. The term rhinocerebral mucormycosis should be used only in the face, palatal, orbital, paranasal sinus, or brain area. Here, we present the case of a 42-year-old man who presented with complaints of pain and swelling in relation to the left upper back tooth region for the past 20 days. In this case, the patient was immunocompromised due to type II diabetes, as well as COVID hospitalization. This case enlightens the investigation, as well as the management protocol followed by post-operative rehabilitation. Early diagnosis and prompt treatment can significantly reduce the morbidity and mortality of these deadly fungal infections.

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