European Journal of Case Reports in Internal Medicine

SCLERODERMA SPECTRUM DISEASES: GENERALIZED MORPHEA

2020-10-28T18:47:30+00:00

We present a clinical case of an 82-year-old man who developed progressive thickening of the skin (thighs, abdominal wall, trunk and limbs) and thoraco-abdominal discomfort due to the extrinsic compression. At physical examination we noted the presence of morpheaform plaques – confluent, non-symmetrical, some sclerotic and others atrophic, with poorly defined erythematous border areas, involving more than 80% of the body surface. Immunological markers, other than Antinuclear Antibodies (ANA), and systemic involvement were negative. Clinical findings favored Generalized Morphea and the skin biopsy confirmed it. Patient started Prednisolone (PDN) 1mg/kg/day at weaning, with symptomatic improvement.

Morphea is a connective tissue disorder of unknown etiology and poorly understood pathogenesis. Despite the cutaneous involvement with sclerosis, morphea must be distinguished from Systemic Sclerosis (SSc) wich has frequent internal organ involvement. Raynaud’s phenomenon, gastrointestinal disease (early signs of SSc), sclerodactyly, telangiectasia, digital ulcers, puffy fingers, and facial sclerosis are usually absent in Morphea.

Nail sarcoidosis presenting with onychorrhexis and longitudinal erythronychia

2020-10-28T09:31:16+00:00

Sarcoidosis is a granulomatous disease characterized by the presence of noncaseating granulomas in organs and tissue affecting multiple systems, and cutaneous involvement is seen in 10–35% of cases. Involvement of the nail is rare, and occurs usually in patients with chronic sarcoidosis. We present a rare case of a 17-year-old patient with cutaneous and nail sarcoidosis with longitudinal erythronychia and onychorrhexis.

Generalized lichen planus-like eruption related to trimebutine

2020-10-27T17:56:38+00:00

Trimebutine is a spasmolytic agent with antimuscarinic effects that is used for the treatment of irritable bowel syndrome (IBS) and lower gastrointestinal tract motility disorders. Lichenoid drug eruptions(LDE), to trimebutine maleate have not previously been reported. Here we present the case of a 50-year-old male patient who developed and extensive lichenoid eruption on his upper and lower extremities and trunk four weeks after starting treatment with trimebutine maleate 300mg once daily for IBS. Two months after discontinuation of the drug and topical tretament with emollients and corticosteroids, the LDE cleared completely with no recurrence. The diagnosis of LDE due to trimebutine was made, based upon the clinical features resembling lichen planus, the histologic findings of interface dermatitis, the evidence of temporal relationship between drug intake and development of skin lesions and resolution upon discontinuation fo the drug. To the best of the authors’ knowledge lichenoid drug eruption (LDE) following trimebutine maleate intake has never been reported. Management of trimebutine-induced lichenoid drug eruptions includes withdrawal of the causative agent and treatment with potent topical corticosteroids.

First experimental clinical case of an automated detection platform for situations at risk of geriatric decompensation

2020-10-27T11:10:55+00:00

Introduction : We experimented with the e-platform MyPredi - dedicated to the automated, intelligent detection of situations at risk of decompensation of geriatric syndromes.

Objective: the goal was to validate the technological choices, to consolidate the system and to test the robustness of the MyPredi platform, through its daily use.

Results: The telemedicine solution made 3,552 measurements for the patient throughout her hospitalization, with an average of 237 measurements per day. The telemedicine solution issued 32 alerts for the patient during her stay, with an average of 2 alerts per day. Heart failure was the main geriatric risk that generated the most alerts (n=13). In terms of sensitivity, the results are 100% for all geriatric risks, and very satisfactory in terms of positive and negative predictive value.

Conclusion: The present experiment shows through its realization the relevance of the technological choices, the tools and the solutions developed.

Ulcerative necrotic skin changes of the penis similar to Fournier's gangrene after homosexual oral sex with a two-hour use of a throttling rubber ring to maintain an erection and after an interval of four days with repeated intense self-masturbation.

2020-10-27T09:16:28+00:00

We present a patient with ulcerative necrotic skin changes after oral homosexual sex. To maintain the erection he used a vasoconstrictive, commercially available rubber ring that was applied to the penis and scrotum for more than two hours. The ring caused ischemia and thrombosis of small and medium-sized veins, later ulcerative necrotizing and inflammatory changes of the skin of the penis with infection as in acute balanoposthitis. The condition initially resembled Fournier's gangrene without involvement of the fascia or deeper structures of the penis. After the wound healed, a permanent defect of the skin with a scar remained.

Self-Expandable Transcatheter Aortic Valve Frame Infolding: An Increasingly Recognized Complication

2020-10-25T23:27:45+00:00

Transcatheter aortic valve replacement (TAVR) with either balloon-expandable or self-expandable transcatheter heart valve (THV) is an approved therapy for patients with symptomatic severe aortic stenosis and high or intermediate surgical risk. We present here a case of severe valve frame infolding of a CoreValve Evolut PRO^® self-expandable THV (Medtronic Inc.), which was restored to optimal geometry with balloon post dilation.

THE USE OF THALIDOMIDE IN SEVERE REFRACTORY ANEMIA DUE TO GASTRIC ANTRAL VASCULAR ECTASIA (GAVE) IN CIRRHOSIS

2020-10-25T01:49:39+00:00

Gastric antral vascular ectasia (GAVE) is a rare cause of upper gastrointestinal bleeding associated with cirrhosis. The first-line treatment is endoscopic therapy with argon plasma coagulation (APC). Because of the high recurrence rate, some evidence suggest that thalidomide could play an important role in controlling refractory anaemia due to GAVE. The authors present the case of a cirrhotic patient with recent diagnosis of GAVE, submitted to multiple endoscopic treatments and blood transfusions due to hematemesis. The patient started thalidomide and 6 months after, there was no recurrence of hematemesis and haemoglobin levels were stable, with no reported adverse effects.

A case of stridor after SARS-CoV-2 pneumonia

2020-10-24T14:00:50+00:00

SARS-CoV-2, the novel coronavirus, is the causative agent of a major outbreak. The known severity of COVID-19 disease ranges from mild symptoms of upper respiratory tract infection to severe pneumonia. Much is left to understand about the natural course of the disease as well as about the complications that may arise, even after there are criteria for cure.

We present the case of a patient who developed severe airway edema after SARS-CoV-2 infection, simulating a bilateral paralysis of the vocal folds, needing orotracheal intubation for airway protection and after that a tracheotomy.

The authors believe that the persistence of severe cough after COVID-19 disease may have been responsible for the severe edema, leading to upper respiratory distress requiring tracheotomy.

Tension pneumomediastinum complicating Pneumocystis jirovecii pneumonia

2020-10-22T12:02:27+00:00

Pneumomediastinum is a rare complication of Pneumocystis jirovecii pneumonia. It can evolve into a tension pneumomediastinum, which is a potential life-threatening complication.

We report the case of a 40-year-old man admitted in the emergency department with a 15-day history of fever, dyspnea and dry cough. Arterial blood gas analysis revealed significant hypoxemia and the chest radiograph showed diffuse interstitial bilateral lung infiltrates. He tested positive for human immunodeficiency virus 1 and after bronchoalveolar lavage analysis a diagnosis of Pneumocystis jirovecii pneumonia was established. On day-14 of treatment the patient complained of chest tightness and had an acute deterioration in his oxygen saturation. Physical examination revealed swelling and crepitus of the neck and thorax and computed tomography showed an exuberant pneumomediastinum. The patient’s clinical condition deteriorated and required mechanical ventilation, which in turn worsened the pneumomediastinum with progression into a tension pneumomediastinum with hemodynamic instability, requiring emergent mediastinal drainage. Despite medical treatment and extensive ventilatory support the patient died on the 30^th day of hospitalization.

Isolated TET2 Positive in Triple Negative Essential Thrombocytosis - Case Report and Literature Review.

2020-10-21T16:01:43+00:00

Essential Thrombocytosis (ET) is one of the famous diseases under the category of myeloproliferative disorder (1). It is an end result of a genetic mutation of one or more of the most frequent oncogenes such as (Janos kinase 2) JAK2, MPL & CALR. However, negative genetic markers, so called (triple negative disease), can happen and this requires further screening for other infrequently affected genes. TET2 (Ten-eleven translocation 2) positive as isolated genetic marker in triple negative Essential Thrombocytosis is uncommon genetic presentation (2). For that, we are reporting a 22 years old lady who presented with feature of dyspepsia and accidentally found to have persistently high platelet count, even after treating her mild iron deficiency anemia with no other secondary causes. Further investigations and bone marrow biopsy supported the diagnosis of isolated TET2 positive in triple negative Essential Thrombocytosis. we treated her conservatively with good hydration and low dose of aspirin. In conclusion, isolated TET 2 positive in triple negative Essential Thrombocytosis at presentation is un common and there is no clear guidance for how to categorize and risk stratifcation of patients with such presentation. Moreover, no guidelines in how to manage this group of patients and whether cytoreduction agent is indicated or not. Further study and guidelines required in this area.