JournalTOCs

Case Reports in Acute Medicine
Number of Followers: 4

This is an Open Access Journal

Open Access journal
ISSN (Online) 2504-5288
Published by Karger

[120 journals]

Acute Esophageal Necrosis as an Unusual Cause of Epigastric Pain in the
Emergency Department
- Abstract: Epigastric pain is a common complaint in the emergency department (ED). Clinicians require skills to differentiate the epigastric pain in the ED. Here, we report a case of acute esophageal necrosis (AEN) as a cause of epigastric pain in the ED. An 83-year-old woman with diabetes mellitus visited the ED because of worsening subacute epigastric pain, nausea, and anorexia. The patient’s vital signs and general condition did not seem serious at first in the ED. Esophagogastroduodenoscopy revealed circumferential inflammation and necrosis of the esophageal mucosa. The patient was diagnosed with AEN and admitted. The patient’s condition suddenly worsened on the sixth day. Citrobacter koseri was detected in blood culture, and although the patient was treated with antibiotics, she died on the twelfth day. In our case, epigastric pain, a common complaint in the ED in elderly women, was caused by AEN, an uncommon disease. The patient was seemingly stable at first but rapidly developed sepsis and died. In this case, we identified two important clinical issues: (1) AEN is an uncommon cause of epigastric pain in the ED, but it is worth considering. (2) Once AEN is diagnosed, the clinician should engage in further investigations such as esophageal and blood culture tests and close follow-up of the clinical course, even if patients’ condition does not appear to be serious.
  Case Rep Acute Med 2022;5:6–11
  PubDate: Fri, 11 Nov 2022 08:20:21 +010
Giant Colonic Diverticulum of the Sigmoid with an Unusual Localization
- Abstract: Diverticular disease is a common disorder of the colon. A rare complication of diverticulosis is a giant colonic diverticulum (GCD) defined as a diverticulum measuring #x3e;4 cm. It most often affects the sigmoid colon. We report a case of a 68-year-old male presenting at the emergency department with a giant diverticulum of the sigmoid with an unusual size and migration to the right hemi-abdomen. Segmental colectomy with en-bloc diverticular resection and primary anastomosis seems to be the best treatment according to the available current literature.
  Case Rep Acute Med 2022;5:1–5
  PubDate: Mon, 31 Jan 2022 09:22:21 +010
Erratum
- Abstract:
  Case Rep Acute Med 2021;4:95–96
  PubDate: Thu, 09 Dec 2021 07:24:19 +010
Bell’s Palsy Caused by SARS-CoV-2
- Abstract: The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has led to major healthcare and everyday life challenges. Every day, new disease associations and systemic manifestations are being explored and reported. Peripheral facial nerve paralysis or Bell’s palsy has been reported to be caused mainly by viral infections. This case represents a COVID-19-positive patient with Bell’s palsy making SARS-CoV-2 as the most likely culprit of his condition.
  Case Rep Acute Med 2021;4:91–94
  PubDate: Mon, 15 Nov 2021 11:30:25 +010
Recurrent Generalized Seizures with Postictal Todd’s Paralysis Caused by
Medication-Associated Severe Hypomagnesemia: A Case Report
- Abstract: Hypomagnesemia is one of the electrolyte disturbances that can cause seizures. It is common in the hospitalized patients and can be induced by long-term usage of many medications. A 68-year-old male known to have hypertension and gastroesophageal reflux presented to the Emergency Department with an unprovoked first seizure at home followed by a temporary right-sided hemiparesis, dysphasia, and facial asymmetry. The hemiparesis, dysphasia, and facial asymmetry resolved within less than an hour after the seizure. His serum potassium was low with prolonged QT interval in the electrocardiogram (serum magnesium was not checked in the Emergency Department). He received intravenous IV potassium chloride infusion, and his serum potassium level was corrected, but he had a recurrent seizure after 10 h. At that time, his serum magnesium was found to be very low, he received IV magnesium sulfate infusion, and his indapamide, omeprazole, and metformin medications were stopped. He had no further seizures, the rest of his blood tests were normal, and his CT brain was unremarkable. He was treated for aspiration pneumonia, and his outpatient MRI brain and EEG came to be normal too.
  Case Rep Acute Med 2021;4:85–90
  PubDate: Mon, 15 Nov 2021 11:26:05 +010
Traumatic Refractory Ventricular Fibrillation Successfully Treated with
Intra-Arrest Esmolol
- Abstract: Here, we describe a case of refractory ventricular fibrillation (RVF) in an undifferentiated trauma patient that responded to intra-arrest esmolol. To our knowledge, this is the first case of RVF in an undifferentiated trauma patient that responded to intra-arrest esmolol. This case continues to support the growing evidence for use of esmolol as a treatment of refractory fibrillation and should be considered even in undifferentiated traumatic arrest patients prior to the cessation of resuscitation efforts.
  Case Rep Acute Med 2021;4:80–84
  PubDate: Tue, 05 Oct 2021 13:14:22 +020
Veno-Arterial Extracorporeal Membrane Oxygenation for Severe Heatstroke
with Refractory Hemodynamic Failure
- Abstract: A 68-year-old male was found unconscious in a hot bathtub on a cold winter’s day and was brought to our hospital. On arrival, the patient’s systolic blood pressure was 65 mm hg, heart rate was 134 beats per min, and rectal temperature was 40.5°C. A large volume infusion of acetated Ringer’s solution and vasopressors were administered as an immediate treatment for circulatory failure due to heatstroke. Although the circulatory failure temporarily improved, the blood pressure dropped almost to the point of cardiac arrest. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was implemented and the hemodynamics were soon stabilized. Subsequently, VA-ECMO was withdrawn on the third hospital day. The patient recovered enough to feed normally on the 40th hospital day and was transferred to another hospital on the 116th hospital day. Based on this case study, we consider that VA-ECMO implementation before cardiac arrest might be a suitable strategy.
  Case Rep Acute Med 2021;4:76–79
  PubDate: Mon, 19 Jul 2021 15:29:32 +020
Administration of Tranexamic Acid as Treatment for Angiotensin Converting
Enzyme Inhibitor-Induced Angioedema: A Case Report
- Abstract: Background Angiotensin converting enzyme inhibitor-induced angioedema is a major cause of angioedema-related hospitalizations each year. Common swelling predilection sites include the face, periorbital skin, lips, pharynx, larynx, and tongue. Involvement of airway structures could lead to airway obstruction and ultimately death if not treated promptly. A 62-year-old man presented to a rural clinic with a massively swollen tongue that obscured visualization of the retropharynx and mildly swollen lips. The patient stated that he had been taking lisinopril for many years and never had a swelling episode similar to this. The patient was initially administered epinephrine, antihistamine, steroids, and Tranexamic acid. A second dose of Tranexamic acid was administered 30 min later followed by close monitoring. Seven hours after the first administration, the patient had near-complete resolution of tongue swelling and was later discharged. Angioedema treatment is still variable and hospitals in different settings may be able to take advantage of available resources for treatment. Tranexamic acid is a cheap and widely available antifibrinolytic that may be used to treat angiotensin converting enzyme inhibitor-induced angioedema, especially if more specific therapeutics are unavailable.
  Case Rep Acute Med 2021;4:71–75
  PubDate: Mon, 19 Jul 2021 09:27:09 +020
Case Report: De Quervain’s Thyroiditis as a Long-Term Sequelae
Complication to SARS-CoV-2 Infection
- Abstract: A 44-year-old man presented with an enlarged painful lower anterior neck lump with elevated serum concentrations of free thyroxine (T4) and tri-iodothyronine (T3), alongside the presence of antithyroid peroxidase antibodies. Prior to presentation, the patient was demonstrating recovery from a SARS-CoV-2 infection that required sedation, intubation, and invasive ventilation in the intensive care unit (ICU) for 11 days. Ultrasound examination of the thyroid demonstrated features of De Quervain’s (subacute) thyroiditis. This corresponded to the clinical picture, and continuous thyroid function tests were arranged. Emerging evidence throughout the SARS-CoV-2 pandemic describes the long-term sequelae of the infection, including developing atypical effects on the thyroid gland. This case report emphasises the association of painful subacute thyroiditis with post-viral infection and its manifestation during recovery from severe SARS-CoV-2, suggesting that follow-up thyroid function testing should be considered in patients discharged from the ICU who develop neck discomfort.
  Case Rep Acute Med 2021;4:64–70
  PubDate: Fri, 09 Jul 2021 10:57:21 +020
Fatal lymphocytic myocarditis masquerading as thoracic aortic dissection
- Abstract: Acute myocarditis usually presents with a broad spectrum of symptoms and has variable clinical outcomes. A proportion of acute myocarditides may develop into fulminant myocarditis resulting in significant mortality if left untreated. This case report describes an unusual presentation of fatal lymphocytic myocarditis mimicking a thoracic aortic dissection in a previously healthy 45-year-old male. Fulminant myocarditis should be considered as part of the differential diagnosis in an acutely unwell young adult presenting to the Emergency Department with non-specific symptoms.
  Case Rep Acute Med 2021;4:58–63
  PubDate: Thu, 08 Jul 2021 11:18:17 +020