Year 2023, Volume 7 - Issue 5

Open access Case Report | June 07, 2023
Decrease in aorto-mesenteric angle and distance diagnosis and treatment: case report
Hiwa Mohammed Hassan Karkhani , Oleg Vladimorovich Galimov , Khanov Olegovich Vladislav , Bhawna Sharma
Year: 2023 | Pages: 96 - 99
Background: Wilkie syndrome (WS) is a pathological manifestation caused by an abnormal disorder of the superior mesenteric artery (SMA). It is a branch of the abdominal part of the aorta. As a result, the distal part of the duodenum is compressed between the abdominal aorta, spine, and SMA, which creates a hindrance for the passage of chyme in the duodenum, creating a mechanical obstruction, and thus, gives rise to the WS. It is commonly due to the loss of fatty tissue. Case Presentation: We hereby discuss the case report of a 28-year-old patient diagnosed with the same at the initial stage of WS. The patient had been suffering from the symptoms of WS since 2018 but wasn't able to identify the disease when he came to our department. Based on the results of abdominal sonography, Computed tomography (CT)-scan with contrast, and angiography, we confirmed the diagnosis of WS. The patient was treated with the duodenojejunostomy (laparoscopic Strong's operation), and after the surgery, the patient was treated symptomatically. Conclusion: WS is a rare and fatal manifestation that if delayed can cause severe life-threatening complications and even death, but diagnosis in the initial stages, especially with contrast CT/magnetic resonance imaging angiography, and timely management can save the life and prevent fatal complications. WS can be a fatal manifestation if not diagnosed on time, but early and accurate diagnosis can unleash the diseased state of WS, and treatment on time can avoid severe and deadly complications.

Open access Case Report | May 18, 2023
Cecal adenocarcinoma with extension into terminal ileum presenting as terminal ileitis and abscess formation
Gordon S. Wong , Ashley Thompson , Keely Parisian , Aaron Huber , Aameera Khan
Year: 2023 | Pages: 100 - 103
Background: While terminal ileitis is most often associated with Crohn's disease, it has a broad differential, including malignancy. Case Presentation: We report an 83-year-old female with fever and right lower quadrant abdominal pain. An imaging study revealed an abscess located at a thickened terminal ileum. The etiology of terminal ileitis was unclear, but symptoms subsided with antibiotics and cessation of naproxen. Two years later, the patient presented with similar symptoms and imaging findings. Colonoscopy revealed a submucosal mass, which was found to be adenocarcinoma, located in the cecum and terminal ileum. Conclusion: This case highlights that differential for cecal adenocarcinoma with extension into the terminal ileum should be considered in those presenting with terminal ileitis and abscess formation.

Open access Case Report | May 01, 2023
Myositis-myasthenic overlap syndrome triggered by pembrolizumab in a melanoma patient: a case report and brief review of the literature
Margarida Carrolo , Sara Machado , Paulo Gomes , Andreia Chaves , Antonio Quintela
Year: 2023 | Pages: 104 - 109
Background: In the era of precision medicine, immune checkpoint inhibitors (ICIs) have dramatically changed the therapeutic approach toward advanced cancers. Despite an undeniably therapeutic benefit, ICIs have unique and uncharted toxicities known as immune-related adverse events (irAEs). Case Presentation: We report a rare overlap syndrome of inflammatory and necrotizing myopathy with a superimposed myasthenia-like syndrome in a melanoma patient who had received the first dose of pembrolizumab 22 days before symptoms onset. The patient initially presented with muscle weakness and ptosis and rapidly progressed to tetraparesis, extrinsic ophthalmoplegia, dysarthria, dysphagia, and respiratory difficulty with a short-term need for non-invasive ventilation and nasogastric intubation. Transitory myocarditis was also diagnosed. One month after hospital discharge, the patient still exhibits mild dysarthria, dysphagia, and ptosis and needs walking assistance. Conclusion: Although rare, neuromuscular irAEs impose a notable burden on morbidity and even mortality. Early recognition of symptoms and prompt intervention are crucial for the management of immunotherapy-related toxicity.

Open access Case Series | August 01, 2023
A case series of euglycemic starvation ketoacidosis in pregnant women with COVID-19 infection: atypical presentations
Nida' Ul-Huda Adznan , Carolina Shalini Singarayar , Foo Siew Hui
Year: 2023 | Pages: 110 - 114
Background: We present a case series of euglycemic starvation ketoacidosis in pregnant women with coronavirus disease 2019 (COVID-19) infection. Our patients presented with fever and typical respiratory symptoms secondary to COVID-19 infection in the third trimester. It was complicated by severe metabolic ketoacidosis, likely contributed by the hypermetabolic state of pregnancy, maternal starvation, and increased metabolic demand due to COVID-19 infection. Case Presentation: Among most of the cases, there was a swift resolution of ketoacidosis, through timely fluid resuscitation, dextrose, and insulin. But despite those measures, most of the patients had to undergo emergency cesarean section due to maternal deterioration, preterm delivery, and fetal distress. All the mothers recovered well and were discharged home, but there was one case of neonatal death after preterm delivery. Conclusion: These cases illustrate the importance of early diagnosis of euglycemic ketoacidosis, prompt management, and close monitoring to obviate adverse materno-fetal outcomes in pregnant women with COVID-19 infection.

Open access Case Report | August 01, 2023
Severe acute myxedematous psychosis; rare complication of hypothyroidism
Hasnae Guerrouj , Ghizlane Ennibi
Year: 2023 | Pages: 115 - 117
Background: Severe acute myxedematous psychosis, or myxedema madness, is a rare and serious psychiatric complication of hypothyroidism. It is most often misdiagnosed, but it remains reversible after treatment with thyroid hormones. Case Presentation: We report a case of a patient without a known past medical history who underwent total thyroidectomy for papillary thyroid carcinoma. During her withdrawal from thyroid hormone therapy to perform a diagnostic radioiodine wholebody scintigraphy, she presented with anxiety, delirium, and hallucinations, culminating in a suicide attempt. Laboratory testing revealed a high sensible-thyroid stimulating hormone (TSH) value of 35 µIU/ml. The patient was hospitalized in a psychiatric unit, where she received antipsychotic medication and was started on thyroid hormones. After a week, there was a dramatic improvement. Psychiatric symptoms were completely gone a month later justifying the discontinuation of antipsychotics. Recombinant human TSH (rh-TSH) was necessary injected before radioiodine therapy to avoid thyroid hormone therapy suppression and to prevent a second episode of acute psychosis. Conclusion: rh-TSH interest is both in the pre Ira therapy stimulation and for the post-treatment monitoring of patients with thyroid cancer, and helps avoiding hormonal treatment suppression.