Journal of Case Reports in Practice
Volume:3 Issue: 3, Jul 2015

Myeloid sarcoma is a rare disease with poor prognosis. It is characterized by tumor masses composed of myeloblastic cells and usually occurs in association with acute myeloid leukemia. A 71 year old female with past medical history of essential thrombocytosis for 15 years. She was asymptomatic at diagnosis, but began experiencing early satiety 1 year prior and was found to have splenomegaly and was started on hydroxyurea without improvement of her symptoms. This time, she presents to the emergency department with severe painless vaginal bleeding for 2 days. A complete blood count revealed severe thrombocytopenia (14,000/µL). Patient reported she was started on ruxolitinib for four months prior but denied any prior bleeding episodes. CT scan was obtained due to concern for a gynecologic malignancy; which revealed a para-spinous soft tissue mass around L4 level protruding into the psoas muscle. CT-guided biopsy of the sacrum was subsequently performed. Histology reported myeloid myeloperoxidase-positive elements. Immunohistochemical stains showed CD34-positive myeloblasts and CD-117-positive immature myeloid elements accounted for 20% of nucleated elements, compatible with the diagnosis of myeloid sarcoma. Bone marrow biopsy showed extensive fibrosis with no significant hematopoiesis and only 1% of myeloblasts. Bleeding resolved after several platelets transfusions and she was discharged with plans to start chemotherapy as outpatient. Her clinical course was complicated with septic shock during chemotherapy; she expired four months after her initial visit to the ED.

Ankylosing spondylarthritis and Takayasu’s arteritis are two inflammatory diseases with a not yet elucidated pathogenic mechanism. Only a few cases with this association (15 cases) have been published in the literature. We report here a new case of a 20-year-old, HLA-B27 positive male patient, who was the known case of ankylosing spondylitis. He was treated with Diclofenac and Sulfasalazin and the result was acceptable. One year after the first visit he presented with palpitation, dyspnea, nightly cough, absence of pulsation in the right radial artery, anemia and an increase in erythrocyte sedimentation rate (ESR). By performing colour doppler ultrasonography and neck and abdomen magnetic resonance angiography (MRA), Takayasu disease (TA), which led to stenosis of the common carotid, subclavian artery, celiac and renal arteries, was diagnosed. This occured two years after the initiation of ankylosing spondylitis. Treatment was begun with 40 mg prednisolone per day, Methotrexate 7.5 mg per week, Amilodipin 7.5 mg per day, Atrovastatin 20 mg per day and Aspirin, which were successfully tolerated. Now, two years after the diagnosis, he is in remission and all of the drugs have been stopped.

Colchicine is an old well-known drug commonly used in treatment of gout and familial mediterranean fever. Fatal colchicine intoxication has been reported in accidental or intentional accidents. Multiorgan failure or subsequent sepsis due to myelosuppression, are the main cause of death in these cases. The wide lethal dose of 7-90 mg has been reported in previous studies. We reported colchicine intoxication in 18 year-old-female who ingested 30 mg of her brother who was treated for FMF. Heart failure, renal failure and hepatic failure resulting in disseminated intravenous coagulopathy caused unresponsive cardiopulmonary arrest after 65 hours post ingestion. Precise control of number of tablets prescribed for patients especially drugs with narrow therapeutic index like colchicine should be considered. Great burden of chronic disease in families should draw attention to psychological health of patients’ family.

A fourteen year old girl presented to the outpatient ENT department of a tertiary care centre with complaints of sudden onset of swelling over the neck and upper chest associated with pain and mild breathlessness, following an episode of violent coughing. Examination revealed surgical emphysema over the entire neck and upper chest with absent laryngeal crepitus. Patient was also found to have signs suggestive of chronic pharyngotonsillitis. Auscultation of the chest revealed bilateral wheeze. Plain X-ray soft tissue neck (anteroposterior and lateral views) showed evidence of air in the pre-sternal region, pre-vertebral region and soft tissues of neck, suggestive of subcutaneous emphysema. As the patient’s condition was stable and the patient was maintaining oxygen saturation at room air, the patient was managed conservatively with intravenous broad spectrum antibiotics, oral corticosteroids, bed rest and other supportive therapy. The patient improved within a week, with complete relief of all symptoms and full clinical resolution of the surgical emphysema. A review of the possible mechanism is presented. This case is being reported due to its rarity, as spontaneous tracheal rupture is extremely uncommon and has only very rarely been reported in the pediatric population.

Elastofibroma dorsi is an infrequent benign, slow growing, soft tissue tumour that is usually located in the scapular zone. A 60-year-old male patient with no particular past medical history, presented with pain in the right scapular region of 8 months duration, which was exacerbated by physical activity. On examination, a hard and painless mass in the right subscapular region measuring approximately 7 cm in diameter was found. Computed tomography scan showed an unencapsulated mass with density similar to muscle, mixed with adipose tissue bands in the right infrascapular region. The patient underwent total excision of the tumour. Histologically, the tumour was poorly circumscribed and was composed of hypocellular fibrous collagenous strands admixed with a large number of coarse, densely eosinophilic elastic fibers and entrapped mature fat cells. The elastic structures sometimes formed discs or globules. These findings were consistent with elastofibroma. Postoperative course was uneventful, but the patient was lost to follow-up.

Giant left atrium is a rare condition normally resulting from mitral valve disease, especially Rheumatic heart disease. Several definitions have been presented for giant left atrium, but this condition is usually termed giant left atrium when the left atrial diameter exceeds 80 or and 65 mm. Giant left atrium is the end product of severe and prolonged pressure and volume overload, occurring mainly during mitral insufficiency, stenosis, and rarely in mitral valve prolapse alone4This condition may predispose the patient to atrial arrhythmia, atrial thrombosis and systemic embolization. It may also compress adjacent structures or mimic pleural effusion. It is defined left atria larger than 6 cm in diameter as giant left atrium. In this case report, we present a 75-year-old woman with giant left atrium, which was mistaken for right pleural effusion.

A 38-year-old woman with 2 sons after the second childbirth bleeding (uterine inertia) rejected her husband «s sexual demands. Then, she began to sexually abuse her children. The patient did not have any problem before the second child» s birth. There was no history of child abuse in her childhood. However, she had a family history of schizophrenia. After receiving diagnosis of schizophrenia, she was treated with daily antipsychotic. After being discharged from hospital the problems with her children decreased gradually and after almost 6 months, did not apply for sexual abuse of children.

Hypertrophic (Obstructive) Cardiomyopathy is typically well tolerated in pregnancy but patients may become symptomatic if given epidural anesthesia. Therefore it is very important to collect to do a through history and physical prior to any anesthetic procedure. We will discuss a patient who was 34 weeks pregnant and received epidural anesthesia which resulted in sudden drop in her blood pressure and development of chest pain. Learning Objective The learning objective of this case report is the importance of through history and physical before any and all procedures. We are physician should not simple rely on the history and physical of other because what if the pervious person failed to get important details. So each medical provider should get their own information from the patients as a way of confirming detailed medical history.

In general, outcomes after cardiac arrest remain poor, especially in patients with risk factors such as unwitnessed arrest, unfavorable initial rhythm, older age, and prolonged resuscitation without return of spontaneous circulation (ROSC). Nonetheless, successful resuscitation and good recovery after prolonged arrest have been documented.As the field of cardiopulmonary resuscitative medicine evolves, new techniques are being implemented to improve outcomes in patients who are in cardiac arrest. We present an example of how recent research findings in resuscitative medicine improved chances of survival of one patient. This case demonstrates that seemingly desparate long term resuscitation may sometimes be successful. Our case went home with no residual cognitive deficit or neurologic sequelae after one hour of cardiopulmonary resuscitation (CPR).

Here we present a pregnant woman diagnosed with Rhupus (SLE and RA overlap syndrome) and CREST syndrome (calcinosis cutis, Raynaud«s phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia) using ultrasonography for the diagnosis of calcinosis cutis while investigating the etiology of proteinuria. Since our case was pregnant, arthritis and hardness in her fingers were assessed by USG as a radiological imaging. The USG examination detected tenosynovitis, nodular calcification, and erosions in all PIP levels and the patient»s treatment was arranged. USG can be successfully used in the assessment of the involvement of musculoskeletal system in the ligaments diseases especially to avoid harmful effects of X-rays on the pregnancy, just as we did in our own case.

A 50-year-female with denied pain during swallowing, retrosternal pain, drooling of saliva, nasal regurgitation, cough, breathlessness, hoarseness of voice, abdominal pain, vomiting, loss of weight or loss of appetite. Upper GI endoscopy revealed a web at 17cms from incisors. Complete blood picture suggestive of neutrophilic leukocytosis. Other parameters shows normal. Thin barium study showed pseudo lumen in esophagus and confirmed the diagnosis of esophageal web with esophageal dissection. Patient was treated conservatively with nil per oral and parenteral fluids and antibiotics. Web was dilated after 2 weeks with SG dilator and procedure was uneventful and oral feeding was initiated..