20,726 results match your criteria BMJ Case Reports [Journal]


Spontaneous pneumomediastinum in COVID-19.

BMJ Case Rep 2020 May 25;13(5). Epub 2020 May 25.

Department of Medicine, St Francis Medical Center, Trenton, New Jersey, USA.

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http://dx.doi.org/10.1136/bcr-2020-236519DOI Listing

Customised three-dimensional printed revision acetabular implant for large defect after failed triflange revision cup.

BMJ Case Rep 2020 May 25;13(5). Epub 2020 May 25.

San Pier Damiano Hospital, Faenza, RA, Italy

Aseptic loosening is the most common cause for total hip arthroplasty revision. Acetabular cup revision is a significant challenge in the presence of a large bone defect. One of the options for cup revision in the presence of a large bone defect is the recently introduced customised three-dimensional (3D)-printed reconstruction. Read More

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http://dx.doi.org/10.1136/bcr-2019-233965DOI Listing

Distortion of dual energy X-ray images by faecal masses in a child with type 1 diabetes.

BMJ Case Rep 2020 May 21;13(5). Epub 2020 May 21.

Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, India

Dual energy X-ray absorptiometry (DXA) scanning is the most common investigating modality used to assess bone mineral density (BMD). Conditions causing tissue calcification and artefacts such as metallic objects may mislead the results of the DXA scan. We present here a case of a child with diabetes where the DXA images were distorted by faecal lumps, leading to falsely elevated BMD and an error in interpretation of the DXA scans. Read More

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http://dx.doi.org/10.1136/bcr-2020-235312DOI Listing

Teenager with a history of acute myeloid leukaemia with an isolated brain lesion.

BMJ Case Rep 2020 May 21;13(5). Epub 2020 May 21.

Division of Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.

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http://dx.doi.org/10.1136/bcr-2020-234857DOI Listing

Severe statin-induced autoimmune myopathy successfully treated with intravenous immunoglobulin.

BMJ Case Rep 2020 May 21;13(5). Epub 2020 May 21.

The Walton Centre for Neurology and Neurosurgery, Liverpool, UK

Statin-induced autoimmune necrotising myopathy causes a severe progressive muscle weakness even when the statins are discontinued. First-line treatment is usually with high dose steroids followed by immunosuppressants, but this is often ineffective and there is a high risk of side effects. We describe a diabetic patient who had a very severe statin-induced autoimmune myopathy. Read More

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http://dx.doi.org/10.1136/bcr-2020-234805DOI Listing

Surprise of Behcet's disease in a patient with bilateral disc oedema and the role of OCT.

BMJ Case Rep 2020 May 21;13(5). Epub 2020 May 21.

Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.

Behcet's disease is a multisystem vasculitis which can be associated with cerebral venous thrombosis (CVT) leading to increased intracranial tension and papilloedema. We report a case of a 17-year-old boy who presented to us with inward deviation of right eye with bilateral disc oedema and on further investigations was found to be Human Leukocyte Antigen (HLA) B5 positive, along with CVT on magnetic resonance venography which further led us to the diagnosis of non-parenchymal neuro-Behcet's. Read More

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http://dx.doi.org/10.1136/bcr-2020-234693DOI Listing

Fetal congenital midaortic syndrome with unilateral renal artery stenosis prenatally presenting with polyhydramnios and postpartum as hyponatremic hypertensive syndrome.

BMJ Case Rep 2020 May 21;13(5). Epub 2020 May 21.

Department of Obstetrics and Gynecology, Cantonal Hospital Lucerne, Lucerne, Switzerland.

The midaortic syndrome (MAS) is a rare anomaly, characterised by narrowing of the distal aorta and its major branches. The most common symptom is severe arterial hypertension. The combination of hyponatremia, polyuria and renovascular hypertension caused by a unilateral renal artery stenosis is described as hyponatremic hypertensive syndrome. Read More

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http://dx.doi.org/10.1136/bcr-2020-234459DOI Listing

Prolonged cholestasis after acute viral hepatitis: successfully treated with oral steroid.

BMJ Case Rep 2020 May 21;13(5). Epub 2020 May 21.

Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Cholestasis is a rare distinct complication of hepatitis A infection. Usually it runs a long indolent course with significant pruritus and malabsorption lasting for few months. A 9-year-old boy presented with yellowish discolouration of eye for 1 month. Read More

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http://dx.doi.org/10.1136/bcr-2020-234430DOI Listing

Incidental ectopic posterior pituitary in an adult.

BMJ Case Rep 2020 May 21;13(5). Epub 2020 May 21.

Nagoya City Hospital Management Department, Nagoya City, Nagoya, Japan.

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http://dx.doi.org/10.1136/bcr-2020-234415DOI Listing

Night-time confusion in an elderly woman post-stroke.

BMJ Case Rep 2020 May 21;13(5). Epub 2020 May 21.

Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.

For patients with acute ischaemic stroke, faster recanalisation improves the chances of a disability-free life and a quick discharge from the hospital. Hospital discharge, certainly after suffering a major life-changing event such as a stroke, is a complex and vulnerable phase in the patient's journey. Elderly are particularly vulnerable to the stressors caused by hospitalisation. Read More

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http://dx.doi.org/10.1136/bcr-2019-230693DOI Listing

Delayed diagnosis of an upper cervical epidural abscess masked due to crowned dens syndrome.

BMJ Case Rep 2020 May 20;13(5). Epub 2020 May 20.

Department of Respiratory Medicine, Kobe Red Cross Hospital, Kobe, Hyogo, Japan.

An 87-year-old Japanese man presented to our hospital with a 5-day history of fever and neck pain. On physical examination, his stiff neck indicated restricted movement, especially on rotation. CT of the head revealed calcification of the atlantoaxial joint consistent with crowned dens syndrome, and celecoxib was started. Read More

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http://dx.doi.org/10.1136/bcr-2020-235126DOI Listing

Acute ischaemic stroke following cisplatin-based chemotherapy for testicular cancer.

BMJ Case Rep 2020 May 20;13(5). Epub 2020 May 20.

Department of Medical Oncology, The Canberra Hospital, Canberra, Australian Capital Territory, Australia.

Cisplatin is a widely used chemotherapeutic agent for many cancer types. Its toxicity profile includes drug-induced vascular damage. Clinicians should be aware of its varied presentation, including acute and chronic vascular events involving the arterial and venous system. Read More

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http://dx.doi.org/10.1136/bcr-2020-235005DOI Listing

Severe hypothermia, bradycardia and cardiac arrest in association with risperidone.

BMJ Case Rep 2020 May 20;13(5). Epub 2020 May 20.

Pulmonary and Critical Care Medicine, Geisinger Community Medical Center, Scranton, Pennsylvania, USA.

Antipsychotic medications, including risperidone, are widely used in the treatment of psychiatric disorders, including schizophrenia. While hyperthermia is an establish adverse effect of these medications, less is known about the rare occurrence of hypothermia. We present two patients who developed hypothermia, bradycardia and cardiac arrest in association with risperidone. Read More

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http://dx.doi.org/10.1136/bcr-2020-234999DOI Listing

Previously undiagnosed neuroendocrine tumour mimicking breast cancer metastasis to the orbit.

BMJ Case Rep 2020 May 20;13(5). Epub 2020 May 20.

Department of Ophthalmology and Vision Science, University of California Davis Health Eye Center, Sacramento, California, USA

Metastatic neuroendocrine neoplasms to the breast are rare and histopathologic overlap with mammary carcinomas has led to misdiagnosis. We present a case of a middle-aged woman with diplopia and a right medial rectus mass. Metastatic breast cancer was initially suspected based on a history of invasive ductal carcinoma. Read More

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http://dx.doi.org/10.1136/bcr-2020-234629DOI Listing

Multiple concurrent atypical parathyroid adenomas: a rare occurrence.

BMJ Case Rep 2020 May 20;13(5). Epub 2020 May 20.

Otolaryngology, Surrey and Sussex Healthcare NHS Trust, Redhill, UK.

We present a case of an 80-year-old patient with three concurrent multiple atypical parathyroid adenomas. The patient was managed with bilateral parathyroid exploration and concurrent parathyroidectomy. Postoperative recovery was uneventful. Read More

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http://dx.doi.org/10.1136/bcr-2020-234421DOI Listing

Fatal febrile neutropenia during adjuvant chemotherapy for early breast cancer.

BMJ Case Rep 2020 May 20;13(5). Epub 2020 May 20.

Department of Surgery, Hospital Beatriz Ângelo, Loures, Portugal.

We report the case of a 76-year-old female patient with early breast cancer (hormone receptor-positive erbb2 amplified) that had started adjuvant chemotherapy with docetaxel, carboplatin and trastuzumab (TCH). Eight days after the first cycle of TCH chemotherapy, the patient was diagnosed with grade 1 oral mucositis, treated conservatively. The next day she started with nausea, vomiting, chills and fever, followed by a generalised tonicoclonic seizure. Read More

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http://dx.doi.org/10.1136/bcr-2019-233778DOI Listing

Benefits of effective multidisciplinary teamwork: catheter ablation of premature ventricular ectopics.

BMJ Case Rep 2020 May 20;13(5). Epub 2020 May 20.

Guy's and St Thomas' NHS Foundation Trust, London, UK.

The case concerns a difficult but successful right ventricular outflow tract ectopy catheter ablation in a fit and well 33-year-old man with a 16-year history of symptomatic premature ventricular contractions (PVCs). Beta blockade medication had become ineffective in suppressing the PVCs, and a 24-hour Holter monitor revealed a high burden of ectopy (10%). An echocardiogram and cardiac MRI showed a structurally normal heart. Read More

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http://dx.doi.org/10.1136/bcr-2019-233411DOI Listing

Extra-skeletal Ewing's sarcoma of the frontal sinus: a rare disorder in pediatric age.

BMJ Case Rep 2020 May 20;13(5). Epub 2020 May 20.

Department of Otorhinolaryngology and Head & Neck Surgery, Hospital de Braga, Braga, Portugal.

Paediatric sinonasal tumours comprise numerous aetiologies. Ewing's sarcoma (ES) consists of a malignancy of neuroectodermal origin. This type of sarcoma affects mainly children and adolescents and can assume the skeletal or extra-skeletal form. Read More

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http://dx.doi.org/10.1136/bcr-2019-232460DOI Listing

Seropositive anti-MOG antibody-associated acute disseminated encephalomyelitis (ADEM): a sequelae of infection.

BMJ Case Rep 2020 May 19;13(5). Epub 2020 May 19.

Department of Pediatric Infectious Disease, Kaiser Permanente Oakland Medical Center, Oakland, California, USA.

Acute disseminated encephalomyelitis (ADEM) is a demyelinating, autoimmune disease of the central nervous system (CNS). It causes motor and sensory deficits, altered mental status and other neurological symptoms. Though rarely fatal, it has been associated with residual motor and neurocognitive deficits. Read More

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http://dx.doi.org/10.1136/bcr-2020-234565DOI Listing

Chronic thromboembolic pulmonary hypertension secondary to implantable cardioverter defibrillator lead thrombus in a patient with Brugada syndrome: a rare complication requiring a multidisciplinary approach.

BMJ Case Rep 2020 May 19;13(5). Epub 2020 May 19.

Pulmonary Hypertension Unit, Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal.

We report the case of a 57-year-old male patient with prior syncope associated with sustained ventricular tachycardia in the setting of Brugada syndrome, who was submitted to implantation of a cardioverter defibrillator for secondary prevention. During follow-up, he presented a significant increase in lead impedance, and a transthoracic echocardiogram showed a mass attached to the lead. He was started on oral anticoagulation after infective endocarditis was excluded but nevertheless suffered repeated episodes of pulmonary embolism that led to severe chronic thromboembolic pulmonary hypertension. Read More

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http://dx.doi.org/10.1136/bcr-2020-234549DOI Listing

Duplication of the oral cavity and mandible: a rare congenital craniofacial anomaly.

BMJ Case Rep 2020 May 19;13(5). Epub 2020 May 19.

Otolaryngology - Head & Neck Surgery, MUSC, Charleston, South Carolina, USA.

A newborn girl was referred to the otolaryngology service after prenatal imaging showed a right mandibular mass. Physical examination revealed a 1-2 cm mass along the right mandible with the appearance of a vestigial oral cavity. Tissue resembling the vermillion and primitive tongue appeared innervated and moved in conjunction with oral movements. Read More

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http://dx.doi.org/10.1136/bcr-2019-233799DOI Listing

CMV coinfection in treatment refractory immune checkpoint inhibitor colitis.

BMJ Case Rep 2020 May 19;13(5). Epub 2020 May 19.

Department of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.

As immune checkpoint inhibitors (ICIs) are increasingly used, clinicians are more frequently encountering the side effects of these therapies. ICIs have been implicated in numerous adverse effects against healthy tissues. We present a case of a patient who developed treatment refractory checkpoint inhibitor colitis. Read More

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http://dx.doi.org/10.1136/bcr-2019-233519DOI Listing

Curious case of reversible left ventricular dysfunction in a young woman.

BMJ Case Rep 2020 May 19;13(5). Epub 2020 May 19.

Cardiology, All India Institute of Medical Sciences, New Delhi, Delhi, India

A 27-year-old woman presented with breathlessness on exertion of 3 months duration and was treated as dilated cardiomyopathy elsewhere. On evaluation, she was found to have left ventricular hypertrophy with ventricular dysfunction. CT angiogram revealed a peripheral-enhancing mass with central necrosis in the aortocaval region. Read More

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http://dx.doi.org/10.1136/bcr-2020-234978DOI Listing

Delayed-onset progressive pseudorheumatoid dysplasia with secondary synovial chondromatosis.

BMJ Case Rep 2020 May 18;13(5). Epub 2020 May 18.

Radiology, PGIMER, Chandigarh, India.

A 25-year-old man presented to us with progressive multiple joint pain, enlargement, and restricted movements. X-rays showed platyspondyly, multiple epiphyseal widening, synovial chondromatosis, and decreased bone stock and cortical thickness. Genetic testing showed biallelic pathogenic variants in CCN6 which confirmed the diagnosis of progressive pseudorheumatoid dysplasia. Read More

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http://dx.doi.org/10.1136/bcr-2020-234461DOI Listing

Romiplostim for management of refractory immune thrombocytopenic purpura in the immediate postpartum period.

BMJ Case Rep 2020 May 18;13(5). Epub 2020 May 18.

Department of OB/GYN, Trinity Health of New England, Hartford, Connecticut, USA

We present a case of a pregnant woman with chronic immune thrombocytopenic purpura and chronic hypertension who developed pre-eclampsia with severe features warranting delivery. Her overall clinical picture and liver enzymes improved in the immediate postpartum period, however, aggressively progressing thrombocytopenia posed a diagnostic dilemma to the interdisciplinary care team. After failing to respond to first-line therapies including high-dose corticosteroids and intravenous immunoglobulin, she was successfully managed with a trial of the thrombopoietin receptor agonist, Romiplostim. Read More

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http://dx.doi.org/10.1136/bcr-2020-234335DOI Listing

Immune checkpoint inhibitor induced large vessel vasculitis.

BMJ Case Rep 2020 May 18;13(5). Epub 2020 May 18.

Department of Medical Oncology, Guy's and St Thomas' NHS Foundation Trust, London, UK.

This is a case report of a 67-year-old patient with castration resistant metastatic prostate cancer who developed an immune-mediated large vessel vasculitis following treatment with ipilimumab (anti-CTLA-4) and nivolumab (anti-PD-1). Read More

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http://dx.doi.org/10.1136/bcr-2019-233496DOI Listing

Subclavian steal syndrome treated by kissing stenting of the subclavian and vertebral arteries.

BMJ Case Rep 2020 May 18;13(5). Epub 2020 May 18.

Department of Interventional Radiology, Toronto General Hospital, Toronto, Ontario, Canada

The prevalence of subclavian artery (SA) stenosis is approximately 2%. The exact prevalence of extracranial vertebral artery (VA) stenosis is undetermined, with estimates ranging from 7% to 40%. Nearly 25% of ischaemic strokes involve the vertebrobasilar circulation, and arteriosclerotic disease and narrowing of the proximal VA may be the cause for up to one-fifth of these incidents. Read More

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http://dx.doi.org/10.1136/bcr-2019-233153DOI Listing

Postintravenous immunoglobulin stroke in a toddler with Down syndrome: a diagnostic challenge.

BMJ Case Rep 2020 May 18;13(5). Epub 2020 May 18.

Department of Paediatrics, Penang General Hospital, Georgetown, Pulau Pinang, Malaysia.

Children with Down syndrome have a higher risk of stroke. Similarly, intravenous immunoglobulin (IV Ig) is also known to cause a stroke. We reported a 3-year-old boy with Down syndrome who presented with severe pneumonia and received IV Ig. Read More

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http://dx.doi.org/10.1136/bcr-2019-233149DOI Listing

Tension pneumothorax in a patient with COVID-19.

BMJ Case Rep 2020 May 17;13(5). Epub 2020 May 17.

Emergency Department, University College London Hospitals NHS Foundation Trust, London, UK.

A 36-year-old man was brought to the emergency department with suspected COVID-19, following a 3-week history of cough, fevers and shortness of breath, worsening suddenly in the preceding 4 hours. On presentation he was hypoxaemic, with an SpO of 88% on 15 L/min oxygen, tachycardic and had no audible breath sounds on auscultation of the left hemithorax. Local guidelines recommended that the patient should be initiated on continuous positive airway pressure while investigations were awaited, however given the examination findings an emergency portable chest radiograph was performed. Read More

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http://dx.doi.org/10.1136/bcr-2020-235861DOI Listing

Acral vascular syndrome during an immune checkpoint inhibitor.

BMJ Case Rep 2020 May 17;13(5). Epub 2020 May 17.

Department of Medical Oncology, University of Kansas Medical Center, Kansas City, Kansas, USA.

Immune checkpoint inhibitors, including antiprogrammed death cell protein 1 (anti-PD-1) and anti cytotoxic T-lymphocyte-associated protein 4 (anti-CTLA-4), have been associated with a range of autoimmune-related side effects since their introduction in cancer treatment. Small vessel digital necrosis, referred to as the acral vascular syndrome, is a rare but serious complication that can result in loss of digits. Here we present a case report of acral vascular syndrome and review possible aetiologies. Read More

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http://dx.doi.org/10.1136/bcr-2019-233463DOI Listing

Midgut volvulus secondary to congenital malrotation in pregnancy.

BMJ Case Rep 2020 May 14;13(5). Epub 2020 May 14.

Department of General Surgery, The Northern Hospital, Epping, Victoria, Australia.

Midgut volvulus complicating congenital malrotation is a rare but life-threatening condition that can occur in pregnancy. We present a case of intestinal infarction resulting from midgut volvulus in a healthy 32-week pregnant woman who underwent emergency laparotomy and small bowel resection in the setting of fetal death in utero. This case highlights several challenging issues in diagnosing and managing this uncommon condition which leads to increased adverse perinatal outcomes. Read More

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http://dx.doi.org/10.1136/bcr-2020-234664DOI Listing

infection presenting as pyelonephritis and perinephric abscess in an immunocompromised patient.

BMJ Case Rep 2020 May 14;13(5). Epub 2020 May 14.

Department of Urology, Mater Hospital Brisbane, Brisbane, Queensland, Australia.

We report a case of an immunosuppressed 67-year-old woman who presented with fever of unknown origin. Further investigation revealed multiple left renal and perinephric abscesses. These were managed with percutaneous drainage and broad-spectrum antibiotics; however, no clinical improvement resulted. Read More

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http://dx.doi.org/10.1136/bcr-2020-234538DOI Listing

Intralipid and haemodialysis in caffeine overdose.

BMJ Case Rep 2020 May 14;13(5). Epub 2020 May 14.

Critical Care, Queen Elizabeth Woolwich, London, UK.

A 26-year-old woman presented after an intentional ingestion of 20 g of caffeine. She suffered a profound respiratory alkalosis with metabolic acidosis, hypokalaemia and sustained polymorphic ventricular tachycardia. She was treated with intravenous intralipid and haemodialysis, and her arrhythmia was controlled using magnesium sulphate. Read More

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http://dx.doi.org/10.1136/bcr-2020-234256DOI Listing

Multidrug-resistant tuberculosis of lumbosacral spine producing extensive destruction with lumbosacral kyphosis.

BMJ Case Rep 2020 May 14;13(5). Epub 2020 May 14.

Department of Orthopedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.

It is uncommon to get lumbosacral junction deformity due to tuberculosis. Lumbosacral junction alignment is of paramount importance in maintaining global sagittal balance. In this case report, we present a case of a 42-year-old woman with multidrug-resistant tuberculosis of lumbosacral spine with complete destruction of L3, L4 and L5 vertebra with partial destruction of L2 and S1 vertebra leading to significant shortening and lumbosacral kyphosis. Read More

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http://dx.doi.org/10.1136/bcr-2020-234246DOI Listing

Cerebellitis as a rare manifestation of scrub typhus fever.

BMJ Case Rep 2020 May 14;13(5). Epub 2020 May 14.

Department of General Medicine, Government Medical College and Hospital, Chandigarh, India.

Scrub typhus is a mite-borne rickettsial disease caused by a gram-negative coccobacilli transmitted through the bite of chigger mite. Scrub typhus has diverse clinical manifestations, often presenting either as a simple febrile illness or as a complicated multi-organ dysfunction. Neurological complications in scrub typhus are diverse but their exact incidence is unknown. Read More

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http://dx.doi.org/10.1136/bcr-2019-233993DOI Listing

Pituitary hyperplasia with Sertoli cell-only and 47,XYY syndromes: an uncommon triad.

BMJ Case Rep 2020 May 14;13(5). Epub 2020 May 14.

Arrowe Park Hospital, Wirral, UK.

We report the case history of a 32-year-old man with no phenotypical abnormalities who presented with infertility. Semen analysis revealed azoospermia and testicular biopsy confirmed Sertoli cell-only (SCO) syndrome. Karyotyping revealed 47,XYY and pituitary hyperplasia was found on MRI pituitary. Read More

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http://dx.doi.org/10.1136/bcr-2019-233100DOI Listing

Anaphylaxis and other allergic reactions to food: a global challenge.

BMJ Case Rep 2020 May 14;13(5). Epub 2020 May 14.

Department of Medicine, San Fernando Teaching Hospital, San Fernando, Trinidad and Tobago.

We describe a case of a biphasic anaphylactic reaction that occurred in a young woman soon after the ingestion of soy milk that led to her hospitalisation. Early recognition and appropriate treatment led to a successful outcome of this life-threatening condition. Challenges encountered in the care of this common illness are highlighted. Read More

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http://dx.doi.org/10.1136/bcr-2019-231425DOI Listing

Hypogeusia as the initial presenting symptom of COVID-19.

BMJ Case Rep 2020 May 13;13(5). Epub 2020 May 13.

Department of Internal Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA.

COVID-19 is the disease caused by the novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which first arose in Wuhan, China, in December 2019 and has since been declared a pandemic. The clinical sequelae vary from mild, self-limiting upper respiratory infection symptoms to severe respiratory distress, acute cardiopulmonary arrest and death. Otolaryngologists around the globe have reported a significant number of mild or otherwise asymptomatic patients with COVID-19 presenting with olfactory dysfunction. Read More

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http://dx.doi.org/10.1136/bcr-2020-236080DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228456PMC

Incomplete primary hypertrophic osteoarthropathy.

BMJ Case Rep 2020 May 13;13(5). Epub 2020 May 13.

Department of Orthopaedics, University College of Medical Sciences, New Delhi, Delhi, India.

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http://dx.doi.org/10.1136/bcr-2020-236034DOI Listing

Pemphigus vulgaris.

BMJ Case Rep 2020 May 13;13(5). Epub 2020 May 13.

Department of Oral Medicine and Radilogy, AJ Institute of Dental Sciences, Mangalore, Karnataka, India.

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http://dx.doi.org/10.1136/bcr-2020-235410DOI Listing

Spontaneous transethmoidal meningoencephalocele presenting in the form of recurrent unilateral nasal discharge: discussion of the diagnosis and endoscopic surgical management.

BMJ Case Rep 2020 May 13;13(5). Epub 2020 May 13.

Otorhinolaryngology, Hospital of Sion, Sion, Switzerland.

Meningoencephaloceles of the skull base most commonly occur as a sequela of head trauma or they can more rarely be congenital malformations. Several types of encephalocele exist depending on anatomic features and localisation. Clinical presentation and symptoms can vary. Read More

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http://dx.doi.org/10.1136/bcr-2020-234703DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228147PMC

Blebophthalmos: proptosis due to a massive bleb following implant surgery in refractory paediatric glaucoma.

BMJ Case Rep 2020 May 13;13(5). Epub 2020 May 13.

VST Center for Glaucoma Care, LV Prasad Eye Institute, Hyderabad, India

A 5-year-old boy with failed combined trabeculotomy and trabeculectomy underwent Ahmed glaucoma valve (AGV) implantation and presented 5 weeks postoperatively, with sudden onset proptosis downward displacement of the globe, limited extraocular movements and displacement of tube from anterior chamber. CT scan of the orbits showed a large cystic bleb with posterior dislocation of the implant and was explanted. In vitro testing of implant for fluid flow characteristics revealed a dysfunctional valve with anterior leak, which could have possibly lead to anterior and inferior fluid accumulation resulting in displacement of implant, a probable cause for this rare complication. Read More

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http://dx.doi.org/10.1136/bcr-2020-234454DOI Listing

Immune checkpoint inhibitor-mediated myasthenia gravis with focal subclinical myocarditis progressing to symptomatic cardiac disease.

BMJ Case Rep 2020 May 13;13(5). Epub 2020 May 13.

Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, New South Wales, Australia.

The advent of immune checkpoint inhibitors (ICIs) for cancer therapy has heralded increasing frequency of immune-related adverse events including endocrinopathies, hepatitis, colitis and rarely myocarditis and myasthenia gravis (MG). The heterogeneity in clinical presentations regardless of organ-specific involvement can lead to delayed recognition and management of these events and adverse health outcomes. We describe a case of ICI-induced subclinical focal myocarditis that was recognised and treated in the broader context of MG. Read More

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http://dx.doi.org/10.1136/bcr-2019-232920DOI Listing

A rare case of biventricular non-compaction.

BMJ Case Rep 2020 May 13;13(5). Epub 2020 May 13.

Department of Cardiology, Saint Vincent Hospital, Worcester, Massachusetts, USA.

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http://dx.doi.org/10.1136/bcr-2019-231154DOI Listing

Bilateral adrenal histoplasmosis presenting as adrenal insufficiency in an immunocompetent host in the Philippines.

BMJ Case Rep 2020 May 12;13(5). Epub 2020 May 12.

Department of Medicine, Division of Infectious Disease, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.

Disseminated histoplasmosis, with the adrenal glands as being the only site of demonstrable disease in an immunocompetent adult, is a rare infection leading to adrenal insufficiency. This disease carries high mortality when unrecognised. We describe the first reported case of adrenal histoplasmosis in the Philippines in a 72-year-old immunocompetent, Filipino man who presented with a 3-month history of intermittent flank pain, weight loss and generalised weakness. Read More

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http://dx.doi.org/10.1136/bcr-2020-234935DOI Listing

Phantom radiculopathy: a rare postoperative phenomenon.

BMJ Case Rep 2020 May 12;13(5). Epub 2020 May 12.

Trauma & Orthopaedics, James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, UK

Limb amputations are carried out for a number of reasons, which include trauma, vascular disorders, infection, oncology and congenital abnormalities. These patients can develop multiple complications postoperatively with phantom limb pain being a well-recognised issue. That being said, phantom radiculopathy is far less encountered and can therefore be easily overlooked. Read More

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http://dx.doi.org/10.1136/bcr-2020-234433DOI Listing

Surgery despite multiple non-interventional images of a porcelain aorta.

BMJ Case Rep 2020 May 12;13(5). Epub 2020 May 12.

Cardiology, Whipps Cross University Hospital NHS Trust, London, UK.

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http://dx.doi.org/10.1136/bcr-2019-234042DOI Listing

Optimal management of acute kidney injury in critically ill patients with invasive fungal infections being treated with liposomal amphotericin B.

BMJ Case Rep 2020 May 12;13(5). Epub 2020 May 12.

Department of Nephrology, Queen Elizabeth Hospital Birmingham, Birmingham, UK

Critically ill patients are at risk of developing both acute kidney injury (AKI) and invasive fungal infections (IFIs). Prompt and efficient treatment of the IFI is essential for the survival of the patient. This article examines three distinct clinical situations where liposomal amphotericin B, a broad-spectrum antifungal agent, was successfully used in the setting of AKI. Read More

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http://dx.doi.org/10.1136/bcr-2019-233072DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228453PMC

Ovarian torsion and laparoscopy in the paediatric and adolescent population.

BMJ Case Rep 2020 May 12;13(5). Epub 2020 May 12.

Obstetrics and Gynaecology, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK.

A 9-year-old girl attended the emergency department with right-sided abdominal pain and vomiting. Due to history and following examination, an ultrasound was requested which demonstrated a large complex midline mass. The most likely diagnosis was ovarian torsion, for which the patient underwent laparoscopy, detorsion and ovarian cystectomy. Read More

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http://dx.doi.org/10.1136/bcr-2019-232610DOI Listing

Lipotransfer provides effective soft tissue replacement for acquired partial lipodystrophy.

BMJ Case Rep 2020 May 12;13(5). Epub 2020 May 12.

Division of Surgery & Interventional Science, University College London, London, UK.

We present a 48-year-old female patient who presented with features consistent with acquired partial lipodystrophy (APL) also known as 'Barraquer-Simons syndrome'. It is a rare disease characterised by a gradual and progressive onset of lipoatrophy limited to the face, neck, upper limbs, thorax and abdomen and sparing the lower extremities. The resultant physical appearance can have significant psychosocial sequelae, further compounded by misdiagnosis and delay in recognition and management. Read More

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http://dx.doi.org/10.1136/bcr-2019-232601DOI Listing