Журнал клинических случаев

Vitamin k Antagosnist Oral Anticoagulants (VKA) are effective in the primary and secondary prevention of venous thromboembolism, in the prevention of systemic embolism and stroke in patients with prosthetic heart valves or atrial fibrillation. In patients with thromboembolic disease Low Molecular Weight Heparin (LMWH) and oral VKA are started at diagnosis.

Gupta et al. reported an excellent case report of an acute myocardial infarction caused by thyrotoxicosis in a 23-year old man with a normal coronary angiogram [1]. Acute myocardial infarction may occur in patients with hyperthyroidism and normal coronary arteries due to major coronary artery occlusion by coronary vasospasm induced by a hyperadrenergic state with stimulation of adrenergic receptors on coronary arteries and increased myocardial oxygen demand.

Mutations in the MYO15A gene located on chromosome 17 p11.2, are responsible for non-syndromic autosomal recessive profound hearing loss (DFNB3). Direct sequencing of 96 Japanese families with profound congenital hearing loss revealed one family with a novel homozygous mutation in MYO15A, a T to A transition at the nucleotide of 9413 (c.9413T>A) that encodes the MyTh4 domain of the protein (p. L3138Q). This is the first report of an East Asian hearing loss patient with a MYO15A mutation.

Sub Acute Thyroiditis is believed to be a viral associated non-immunological disease. A viral etiology has been suspected as the etiological cause of this disease, even though there is only one histological proof. We would like to describe a 70 years old woman who was admitted for investigation of Fever of Unknown Origin (FUO). She had a known goiter without any functional abnormality and after a long work-up we found that the only possible cause for her FUO is an acute infection with West Nile Virus.

Paclitaxel is an antimicrotubule agent used for the treatment of metastatic breast cancer. The development of scleroderma-like skin changes is an exceptional adverse effect. We report two patients with metastatic breast cancer treated by paclitaxel who presented an unexplained unilateral lymphedema of the upper limb. Medical work-up did not demonstrate any mechanical or tumor obstruction of the lymphatic vessels. Dermatologic examination revealed cutaneous and subcutaneous indurations and hardening of certain areas of the involved arm. The clinical suspicion of scleroderma was confirmed by histology and immunohistology. Treatment was initiated with methotrexate and methylprednisolone, resulting in a clear reduction of the lymphedema and a regression of the scleroderma. These two cases suggest a pathogenic role of paclitaxel-induced scleroderma in the subsequent development of severe localized lymphedema.

One of the reported complications of totally implantable venous access ports is the spontaneous migration of the catheter tip which can lead to serious complications. We report an early catheter tip migration into the ipsilateral internal jugular vein after initial correct placement of the port using the subclavian approach. Through this case and based on data from literature, we attempt to determine the factors predisposing to this mechanical complication and the means to avoid it.

Neurocysticercosis (NCC) is the commonest parasitosis of the Central Nervous System (CNS), endemic in developing countries and also seen in developed nations. The parasite usually invades the brain parenchyma and the patients present with a variety of neurological manifestations, mostly seizures and neural deficits. But we present a case of a 16 years old boy who presented with occipital headache, vomiting and difficulty in walking. CT scan and MRI showed a cystic mass lesion in the 4th ventricle causing obstructive hydrocephalus. Histopathological examination confirmed it to be neurocysticercosis. We present this case due to its rare site and unusual presentation. This case highlights the importance of careful interpretation of head CT scans in context of presentations of headache and other nurological deficit in a susceptible population.

We present a case of contra-lateral haemopneumothorax and pneumopericardium following a dual chamber ICD implantation using the cephalic vein. The explanation lies in the use of an active fixation atrial (screw-in) lead and not the route of venous access. One should inspect for pneumopericardium when a pneumothorax is present on the CXR and look for right sided pneumothorax even when the cephalic vein was used for access.

Rosai-Dorfman disease, also known as sinus histiocytosis with massive lymphadenopathy, is a benign disorder of histiocyte proliferation that usually affects the lymph nodes. Purely Cutaneous Rosai-Dorfman Disease (CRDD) is a rare extranodal variant that is strictly limited to the skin. We report a patient with of cutaneous rosai-dorfman of the abdominal wall with a past medical history of autism spectrum disorders. Autism is surely a complex disease and the most prevailing opinion is that it is a neuro-immune disorder. Both the diseases are considered strictly correlated to the immune disorders and the immunodeficiency might play an important pathogenetic role. A brief review of the literature of CRDD is also provided.