Journal of Medical Case Reports - Most accessed articles

Giant cutaneous horn in an African woman: a case report

Peter Nthumba — 2007-12-05T00:00:00Z

IntroductionA cutaneous horn is a conical projection of hyperkeratotic epidermis. Though grossly resembling an animal horn, it lacks a bony core. These lesions have been well described in Caucasian patients, as well as in a number of Arabic and Asian patients.Case presentationA young female presented with a large 'horn' of five-year duration, arising from a burn scar. Excision and scalp reconstruction were performed. Histology was reported as verrucoid epidermal hyperplasia with cutaneous horn. Conclusion: This may be the first documentation of this lesion in a black African. Although likely rare, it should be considered in the differential diagnosis of dermatologic lesions. Up to 40% of cutaneous horns occur as part of a premalignant or malignant lesion, and surgical extirpation with histological examination is thus more important than the curiosity surrounding these lesions.

Palpitations following regular ibuprofen dosing in a 13-year-old girl: a case report

Robert Douglas — 2010-03-02T00:00:00Z

IntroductionThe sensation of palpitations may either be the initial or the only symptom of cardiac arrhythmia. We describe a case of an apparent clear temporal relationship between standard ibuprofen dosing and palpitations. A review of the medical literature revealed this to be, to the best of our knowledge, the first reported case of this type.Case presentationA 13-year-old Caucasian girl initially presented to our clinic with hamstring tendinitis. She was commenced on a medication regimen of paracetamol and ibuprofen. After the third ibuprofen dose, she experienced palpitations. These were associated with lower chest and/or upper abdominal discomfort, and a feeling of being hot and sweaty. Her symptoms ceased upon the cessation of ibuprofen therapy. Conclusion: Cardiac arrhythmia is a potentially fatal disorder that may exhibit heart palpitations as its initial (or only) symptom. The prompt recognition of the cause of the symptom can reduce mortality and morbidity associated with any underlying pathological processes. There is a need to investigate cases of recurrent palpitations so as to exclude underlying structural cardiac pathology and/or abnormal cardiac rhythm.

Pica in iron deficiency: a case series

Yasir Khan — 2010-03-12T00:00:00Z

IntroductionPica is an unusual condition where patients develop cravings for non-nutritive substances that can cause significant health risks. We report three patients with pica, two of them showing evolutionary changes associated with pica and the third demonstrating a peculiar nature of pica, which has yet to be reported.Case presentationWe describe three patients who presented with symptoms of pica. The first patient is a 36-year-old Caucasian woman who had dysfunctional uterine bleeding due to daily ingestion of two super-sized cups of ice as iced tea. The second patient is a 62-year-old Caucasian man who presented with bleeding from colonic polyps after drinking partially frozen bottled water. Lastly, the third patient, a 37-year-old Hispanic woman, presented with dysfunctional uterine bleeding after chewing rubber bands. All three patients presented with hematological parameters diagnostic for iron deficiency anemia. Conclusion: Pica has been practiced for centuries without a clear etiology. We have noticed that the younger community of academic and community physicians are not aware of the importance of complaints related to pica. None of our patients we describe here, as well as their primary care physicians, was aware of the importance of their pica related symptoms.

Endoscopic management of biliary fascioliasis: a case report

Rajan Ezzat — 2010-03-06T00:00:00Z

IntroductionFasciola hepatica, an endemic parasite common in Iraq and its neighboring countries, is a very rare cause of cholestasis worldwide. Humans can become definitive hosts of this parasite through their ingestion of a contaminated water plant, for example, contaminated watercress. Symptoms of cholestasis may appear suddenly and, in some cases, are preceded by long periods of fever, eosinophilia, and vague gastrointestinal symptoms. Here we report the case of a woman with a sudden onset of symptoms of cholangitis. Her infection was proved by endoscopic retrograde cholangiography to be due to Fasciola hepatica infestation.Case presentationA 38-year-old Kurdish woman from the northern region of Iraq presented with fever, right upper quadrant abdominal pain, and jaundice. An examination of the patient revealed elevated total serum bilirubin and liver enzymes. An ultrasonography also showed a dilatation of her common bile duct. During endoscopic retrograde cholangiopancreatography, a filling defect was identified in her common bile duct. After sphincterotomy and balloon extraction, one live Fasiola hepatica was extracted and physically removed. Conclusion: Fasciola hepatica should be a part of the differential diagnosis of common bile duct obstruction. When endoscopic retrograde cholangiopancreatography is available, the disease can be easily diagnosed and treated.

Addison's disease presenting with idiopathic intracranial hypertension in a 24-year-old woman: a case report

Dushyant Sharma — 2010-02-19T00:00:00Z

IntroductionIdiopathic intracranial hypertension can rarely be associated with an underlying endocrine disorder such as Cushing's syndrome, hyperthyroidism, or with administration of thyroxine or growth hormone. Though cases of idiopathic intracranial hypertension associated with Addison's disease in children have been reported, there is only one documented case report of this association in adults. We describe a case of an acute adrenal insufficiency precipitated by idiopathic intracranial hypertension in a Caucasian female.Case presentationA 24-year-old Caucasian woman was acutely unwell with a background of several months of generalised fatigue and intermittent headaches. She had unremarkable neurological and systemic examination with a normal computerised tomography and magnetic resonance imaging of the brain. Normal cerebrospinal fluid but increased opening pressure at lumbar puncture suggested intracranial hypertension. A flat short synacthen test and raised level of adrenocorticotrophic hormone were consistent with primary adrenal failure. Conclusion: Addison's disease can remain unrecognised until precipitated by acute stress. This case suggests that idiopathic intracranial hypertension can rarely be associated with Addison's disease and present as an acute illness. Idiopathic intracranial hypertension is possibly related to an increase in the levels of arginine vasopressin peptide in serum and cerebrospinal fluid secondary to a glucocorticoid deficient state.

Spinal cord stimulation as a treatment for refractory neuropathic pain in tethered cord syndrome: a case report

Maarten Moens — 2010-02-25T00:00:00Z

IntroductionThe spinal cord is a target for many neurosurgical procedures used to treat chronic severe pain. Neuromodulation and neuroablation are surgical techniques based on well known specific anatomical structures. However, anatomical and electrophysical changes related to the tethered spinal cord make it more difficult to use these procedures.Case presentationWe report a 37-year-old Caucasian female patient who had several surgical interventions for a tethered cord syndrome, resulting in severe neuropathic pain in the lower back and right leg. This pain had been treated by spinal cord stimulation, using intra-operative sensory mapping, allowing the optimal placement in a more caudal position. Conclusion: The little more caudally-placed electrodes with low voltage use are specific remarks for this treatment in tethered cord syndrome.

Statin-associated weakness in myasthenia gravis: a case report

Michael Keogh — 2010-02-20T00:00:00Z

IntroductionMyasthenia gravis is a commonly undiagnosed condition in the elderly. Statin medications can cause weakness and are linked to the development and deterioration of several autoimmune conditions, including myasthenia gravis.Case presentationWe report the case of a 60-year-old Caucasian man who presented with acute onset of dysarthria and dysphagia initially attributed to a brain stem stroke. Oculobulbar and limb weakness progressed until myasthenia gravis was diagnosed and treated, and until statin therapy was finally withdrawn. Conclusion: Myasthenia gravis may be underappreciated as a cause of acute bulbar weakness among the elderly. Statin therapy appeared to have contributed to the weakness in our patient who was diagnosed with myasthenia gravis.

Nocardia farcinica lung infection in a patient with cystic fibrosis: a case report

Fadi Bittar — 2010-03-08T00:00:00Z

IntroductionRespiratory tract infections are the major causes of morbidity and mortality in patients with cystic fibrosis. Nocardia are rarely implicated in these infections and few reports of the involvement of this species are found in the literature.Case presentationWe describe a case of lung infection followed by chronic colonization of trimethoprim and sulfamethoxazole resistant Nocardia farcinica in a patient with cystic fibrosis. The chronic colonization of this uncommon bacterium in patients with cystic fibrosis was proved using a newly developed real-time polymerase chain reaction assay, which indicates that this bacterium, despite treatment, is difficult to eradicate. Conclusion: Our case report confirms that this organism can be recovered in persons with cystic fibrosis. Its eradication is necessary especially if the patient is to undergo lung transplantation.

Mycosis fungoides bullosa: a case report and review of the literature

Hermann Kneitz — 2010-03-03T00:00:00Z

IntroductionMycosis fungoides, the most common type of cutaneous T-cell lymphoma, can manifest in a variety of clinical and histological forms. Bulla formation is an uncommon finding in mycosis fungoides and only approximately 20 cases have been reported in the literature.Case presentationWe present a case of rapidly progressive mycosis fungoides in a 68-year-old Caucasian man who initially presented with erythematous plaques characterised by blister formation. Conclusion: Although mycosis fungoides bullosa is extremely rare, it has to be regarded as an important clinical subtype of cutaneous T-cell lymphoma. Mycosis fungoides bullosa represents a particularly aggressive form of mycosis fungoides and is associated with a poor prognosis. The rapid disease progression in our patient confirms bulla formation as an adverse prognostic sign in cutaneous T-cell lymphoma.

Primary treatment of acromegaly with high-dose lanreotide: a case series

Christian Wuster — 2010-03-08T00:00:00Z

IntroductionThe first-line treatment for acromegaly is transsphenoidal surgery. In approximately 50% of patients, however, a cure is not possible with surgery and alternatives are needed. Somatostatin analog therapy is the recommended first-line treatment in patients with such cases. Here we provide the first report of a high-dose lanreotide primary therapy in patients with acromegaly.Case presentationSix patients who were not suitable for surgery were given 60mg of lanreotide (Autogel(R)) every four weeks. All patients were German nationals and Caucasian.When the response of our patients was unsatisfactory, the dose was increased sequentially to 90mg every four weeks, 120mg every four weeks, 120mg every three weeks and 180mg every three weeks. Treatment duration was 12 to 24 months. In all cases, the lanreotide dose was 120mg every 4 weeks or higher. In five of our patients, growth hormone (GH) levels were successfully reduced (in three patients GH <2.5ng/ml was achieved). Insulin-like growth factor 1 levels were normalized in three patients and decreased in two patients. One patient failed to show a biochemical response to lanreotide therapy or pegvisomant therapy.Tumor shrinkage or degeneration was observed in the five responding patients. No drug-related adverse events were noted. Conclusions: These results suggest that lanreotide at high doses of 120mg every four weeks or more is an effective first-line therapy for patients with acromegaly that surgery alone cannot treat.