Publications by authors named "M Ammar Kalas"

31 Publications

A Rare Culprit of Methemoglobinemia.

J Investig Med High Impact Case Rep 2022 Jan-Dec;10:23247096221117919

Texas Tech University Health Sciences Center, El Paso, USA.

Methemoglobinemia is a rare cause of hypoxia and can be a diagnostic challenge early in the disease course. The incidence of medication-induced methemoglobinemia is more common than congenital-related methemoglobinemia. The most common cause of methemoglobinemia is exposure to household detergents, illicit drugs, or medications with nitrate or sulfonamide chemical groups. The 2 main medications accounting for up to 45% of medication-induced cases are dapsone and benzocaine. We report a case of hypoxia and diarrhea with an arterial blood gas (ABG) showing methemoglobinemia at 26%. Infectious and autoimmune workup were negative. Methemoglobinemia level returned to normal level within 2 weeks of hydrochlorothiazide discontinuation, suggesting medication-induced methemoglobinemia at appropriate hypertension dosage. In this case, there was an acute rise in methemoglobin levels following initiation of an hydrochlorothiazide-losartan combination, which improved following the discontinuation of hydrochlorothiazide. Extensive workup ruled out cytochrome b5 reductase (Cb5R) and Glucose-6-phosphate dehydrogenase (G6PD) deficiency, which raised the suspicion of hydrochlorothiazide-induced methemoglobinemia, as it is part of the sulfa drug family.
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http://dx.doi.org/10.1177/23247096221117919DOI Listing
August 2022

A Perfect Storm: Abdominal Pain and Ileus Explained by Acute Intermittent Porphyria Caused by Prehospitalization and Intrahospitalization Factors.

J Investig Med High Impact Case Rep 2022 Jan-Dec;10:23247096221109206

Texas Tech University Health Sciences Center El Paso, USA.

Acute intermittent porphyria (AIP) is a rare autosomal dominant inherited disease, predominantly seen in female patients, caused by mutations in the hydroxymethylbilane synthase gene. When impaired, elevated heme biosynthesis precursor levels accumulate in the liver, resulting in neurological symptoms, psychiatric disturbances, darkened urine color, abdominal pain, nausea, vomiting, and ileus. We present a 22-year-old Hispanic female with diffuse abdominal pain and no bowel movements for 8 days. She reported recent antibiotic and oral contraceptive pill use. Computerized tomography of her abdomen revealed a dilated small bowel and marked colonic distension. A colonoscopy found mild nonspecific inflammation in the rectosigmoid and terminal ileum. Her abdominal pain persisted despite interventions and improvements in appetite, bowel movements, abdominal imaging, and treatment of an identified infection. A random urine porphobilinogen was then obtained and found to be elevated. Fractionation of plasma and urine porphyrins was suggestive of AIP. Her symptoms improved with 3 days of intravenous (IV) hematin and IV dextrose. This is a unique case of a rare disease due to her clinical presentation with ileus, unremarkable past medical history, family history, and the prehospitalization and intrahospitalization factors that likely exacerbated the patient AIP.
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http://dx.doi.org/10.1177/23247096221109206DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9243374PMC
June 2022

Colorectal Carcinoma in the Background of Pelvic Inflammatory Disease.

J Investig Med High Impact Case Rep 2022 Jan-Dec;10:23247096221106755

Texas Tech University Health Sciences Center El Paso, TX, USA.

Colorectal carcinoma (CRC) is a common malignancy with steadily declining incidence rates and mortality, secondary to improved screening and lifestyle changes (eg, decreased smoking rates). The association between pelvic inflammatory disease (PID) and CRC has been unclear in the past. However, multiple studies showed a positive association between PID and underlying malignancy (gynecologic and pelvic primarily). Several studies evaluated the relation between PID and CRC, but the results were conflicting. We describe a case of a 33-year-old female patient, with a history of PID and recurrent pelvic abscesses, who was found to have CRC. Of note, the patient's diagnosis was based on abnormal computed tomography findings, which were further investigated (by colonoscopy and biopsy), rather than on symptoms suggestive of CRC, such as rectal bleeding, constipation, symptomatic anemia, or abdominal pain.
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http://dx.doi.org/10.1177/23247096221106755DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9235299PMC
June 2022

Post-cholecystectomy Mirizzi Syndrome.

Cureus 2022 Apr 22;14(4):e24379. Epub 2022 Apr 22.

Gastroenterology and Hepatology, Cleveland Clinic Abu Dhabi, Abu Dhabi, ARE.

Post-cholecystectomy Mirizzi syndrome (PCMS) is characterized by symptoms of recurrent abdominal pain, jaundice, and fever in patients who underwent cholecystectomy. Imaging is crucial in the diagnosis of PCMS and Mirizzi syndrome. Imaging modalities have evolved over the years with abdominal ultrasonography, computed tomography of the abdomen, and magnetic resonance cholangiopancreatography being used in the diagnosis of PCMS and Mirizzi syndrome. The imaging findings show obstruction of the common hepatic duct due to impingement by a stone in the cystic duct or gallbladder infundibulum. PCMS management has evolved over the years with the current first-line management being endoscopic intervention. This case describes a 61-year-old male presenting with recurrent right upper quadrant pain two years after undergoing cholecystectomy due to cholelithiasis. The patient was later diagnosed with PCMS, and endoscopic management was performed with complete resolution of the symptoms.
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http://dx.doi.org/10.7759/cureus.24379DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9124549PMC
April 2022

Medical Management of Septic Arthritis of the Sternoclavicular Joint With Extended-Spectrum Beta-Lactamase-Producing Escherichia coli: A Case Report.

Cureus 2022 Apr 9;14(4):e23969. Epub 2022 Apr 9.

Internal Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, USA.

The sternoclavicular joint (SCJ) is an uncommon location for septic arthritis to occur in. Due to the rarity of the condition and the nonspecific symptoms, SCJ septic arthritis can be missed or mislabeled as osteoarthritis or muscle strain. Accurate history and physical examination is crucial for recognizing this condition. With the potential life-threatening complications that may ensue, SCJ septic arthritis has traditionally been managed surgically. This ranges from simple incision and drainage to resection of the joint. However, in cases where there is not enough fluid for incision and drainage, a trial of medical management with antibiotics can be attempted. We herein describe a case of a 58-year-old male who presented with nonspecific anterior chest wall and neck pain. Chest X-ray and ultrasound of the anterior chest wall was normal; however, magnetic resonance imaging (MRI) of the chest showed a small effusion without other complications. His blood cultures grew extended-spectrum beta-lactamase (ESBL)-producing rendering this as his hematogenous source of septic arthritis. The ESBL was from a left-sided obstructing kidney stone that resulted in pyelonephritis, which was confirmed via computed tomography of the abdomen. His effusion was too minimal to drain; therefore, he was managed medically with intravenous (IV) antibiotics along with a left ureteral stent placement, and he had a full recovery. This case represents the ability for SCJ septic arthritis to be managed medically with IV antibiotics, especially when the diagnosis is caught early without complications. The role of MRI is indispensable for coming to the diagnosis, as it is capable of detecting complications that ultimately dictate management. Additionally, this case highlights the unique microorganism, ESBL-producing  causing the SCJ septic arthritisa finding that has been rarely reported in the literature as the majority of microorganisms that have been previously documented are either or 
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http://dx.doi.org/10.7759/cureus.23969DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9088884PMC
April 2022
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