Case Reports

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Case Report: Four Extremity Compartment Syndrome Fasciotomy Resulting From Influenza A Viral Myositis; a Rare Complication

Eric Chen, Arion Lochner, and Robert Cesaro

Influenza A and B commonly cause benign respiratory disease in humans but can cause more severe illness in higher risk populations. From 2009-2015 there was only one reported case in the English literature with the formal diagnosis of compartment syndrome as a complication from influenza. We report an unusual case of a previously healthy adult patient who presented with myocarditis and severe rhabdomyolysis secondary to influenza A infection, which... Read More
A case of portal hypertension due to a superior mesenteric arteriovenous fistula

Ivan M. Columbus Morales, Taha Ashraf, and Humberto C. Gonzalez

Introduction: Superior mesenteric arteriovenous fistula (SMAVF) is an infrequent vascular disorder characterized by abnormal communication between high-pressure superior mesenteric artery and low-pressure superior mesenteric vein. This allows blood to bypass the intestinal capillary bed and produces portal hypertension leading to ascites and gastro-esophageal variceal bleeding. Although SMAVF can be congenital, most reported cases have been due to abdominal trauma or iatrogenic causes. Here, we report a case of SMAVF... Read More
Hepatic Epithelioid Hemangioendothelioma: A Rare Malignant Lesion

Peter Cormier, Omar Kaddurah, and Ronela Hanson

Hepatic Epithelioid Hemangioendothelioma (HEHE) is a rare, low to intermediate grade malignant lesion of vascular origin which has an incidence of less than 0.1 cases per 100,000 people. Given its rarity, this lesion is often misdiagnosed. We present a case of a patient diagnosed with HEHE who was initially thought to have NASH cirrhosis and hepatocellular carcinoma. Our case demonstrates the characteristic imaging features of this lesion and a... Read More
Case Study: Infectious Mononucleosis, A Rare Cause of Transient Mydriasis

Joseph Cox and John Bauer

Anisocaria is a condition characterized by unequal pupil size. The potential causes of anisocaria range from benign to potentially life threatening processes. Therefore, determining the etiology is of great importance. Mydriasis, more specifically, is when anisocaria is caused by an abnormally dilated pupil. There are several well-known causes of this phenomenon, however the objective of this clinical case study is to present an unusual cause of mydriasis to help... Read More
RIPE Treatment Failure in a Patient with Mycobacterium tuberculosis sepsis

Mohamad Dabaja and Erica Herc

Case: A 36-year old Guatemalan male with diabetes mellitus presented with night sweats, productive cough, worsening dyspnea, and chills for the past 3 weeks. The patient had a remote history of being incarcerated and moved to the United States from Guatemala 12 years ago, with his last visit being one year prior to current presentation. At presentation, patient was febrile, hypotensive, tachycardic, tachypneic, and was found to have acute... Read More
IVIG Induced Hemolytic Anemia

Nicholas J. Daering, Zachary Demertzis, and Peter Luyeho

Intravenous immunoglobulin (IVIG) is derived from donated plasma used to treat immune deficiency, autoimmune, and inflammatory disorders. Adverse effects occur in 5-15% of patients with hemolytic anemia being a delayed reaction. Risk factors for hemolysis are high-dose infusions (1-2g/kg/day or >100g/day), female sex, and non-O blood group. Our case involves a 69-year old male presetting with bilateral lower extremity weakness for 1 year after sustaining a fall, affecting his... Read More
Quadricuspid aortic valve with aortic insufficiency: a rare echocardiographic finding

Zachary Demertzis, Paul Nona, and Bryan Zweig

Introduction: Quadriscupidaortic valve (QAV) is a rare congenital heart defect typically found incidentally without any associated cardiac defects. The functional status of QAV is pure aortic insufficiency (AI), however, clinical manifestations are dependent on the functional status of the valve, presenting in the fifth or sixth decade of life due to progressive degeneration of the leaflets. In our case, we present a 37-year-old female who developed post-partum dyspnea with... Read More
PRIMARY GALLBLADDER PARAGANGLIOMA: A CASE REPORT AND REVIEW OF LITERATURE

Megan D'John and Furrukh Jabbar

BACKGROUND: Paragangliomas are tumors arising from paraganglia of the autonomic nervous system. They are rare tumors and occurrence inside the gallbladder is exceptionally rare. Biliary paragangliomas are thought to be associated with the parasymphathetic fibers and are therefore non-functioning and benign. There are less than 10 cases reported in literature and majority are found incidentally upon cholecystectomy. There is no specific treatment for these tumors and resection is considered... Read More
A Rare Case of Sotalol-Induced Respiratory Failure

Anh P. Do and Zachary Demertzis

Introduction: Beta-blockers (BB), a class II antiarrhythmic, are usually associated with respiratory adverse event such as exacerbations of obstructive lung disease, hypersensitivity pneumonitis etc. Sotalol, a BB that has both class II and III antiarrhythmic activities, is commonly used in the treatment and maintenance of atrial fibrillation or atrial flutter. It is generally thought to associate with significantly lower pulmonary side effects. The lower respiratory side effect profile does... Read More
Case Study: Was that a bedside hysterectomy in the Emergency Department?

Tiffani Doan and Omar Francis

Introduction: Abnormal non-pregnant uterine bleeding is a common gynecological complaint encountered in the emergency department. Emergency physicians must be able to differentiate life threatening bleeding from non-life threatening bleeding. The differential diagnosis can include endometriosis, sexually transmitted disease, fibroids. The differential becomes even more narrow when your exam shows an expelled uterus shaped mass. Uterine or decidual casts are a rare clinical finding, and diagnosis. The decidua forms because... Read More
Hypercoagulability in COVID-19: A rare case of DIC in SARS-CoV2 in the Emergency Department

Naureen Farook and Stephanie Stokes-Buzzelli

Although SARS-CoV2 is increasingly being considered a systemic disease, there have been very few case reports documenting DIC as a rare but fatal consequence of the SARS-CoV2 syndrome. We present our patient scenario as an example of severe COVID sepsis in the ED and DIC. 67-year old nursing home resident with CAD, DM, HTN, and seizures presents to our ED resus room with altered mental status and hypoxia after... Read More
Terson’s Syndrome: An Underdiagnosed Complication of Subarachnoid Hemorrhage

Danielle Gabe, Hisham Alhajala, Mariam Hamid, and Bradley Howell

Background: Terson Syndrome refers to an intraocular hemorrhage in patients with severe subarachnoid hemorrhage (SAH), traumatic brain injury or intracerebal hemorrhage. The mechanism of injury is due to increased intracranial pressure which transmits into the optic nerve sheath and causes rupture of the retinal vessels. Despite its relatively common incidence, the syndrome remains under diagnosed or delayed because it usually occurs in severely ill patients with depressed level of... Read More
RARE PRESENTATION OF LUPUS: SLE PRESENTING AS SEPTIC SHOCK

Nitesh Gandhi and Yaser Alkhatib

Introduction: Infections are common in patients with SLE because of the immune impairments, but there are only very few cases that present as infection as the initial manifestation of SLE. Here we present the case of a patient whose initial presentation of SLE was septic shock secondary to Pseudomonas UTI complicated by Pseudomonas bacteremia.

Case presentation: The patient is an 18-year-old female with no significant past medical history presented... Read More
Corticosteroid Use in Traumatic Optic Neuropathy

Sachin Gandhi, Shawn Gandhi, Daniel A. Brill, and Candice Yousif

Traumatic optic neuropathy is a potentially visual devastating event caused by acute injury to the optic nerve from direct or indirect trauma. It usually presents with decreased vision and a relative afferent pupillary defect. Oddly, the dilated fundus exam is usually unremarkable. Treatment at this time is controversial with options including observation, corticosteroids, or surgery. A 47 year old male presented with decreased vision of left eye after falling... Read More
Advanced systolic heart failure in undiagnosed cardiac amyloidosis

David Gelovani, Zachary Demertzis, and Gillian Grafton

Introduction: Transthyretin (TTR) amyloidosis is a life-threatening disease characterized by extracellular deposition of hepatocyte derived TTR with hereditary and acquired variants. Although there are over 120 genetic mutations in the (TTR) gene, only a few are responsible for hereditary TTR amyloidosis. The most common mutation in African-Americans is Val142Ile substitution, occurring with a frequency of 3.5%. Accumulation of misfolded TTR within the myocardium results in cardiac restriction and dysfunction,... Read More
Hypertriglyceridemia induced pancreatitis: a cost-effective management approach

Sonika Gill

Hypertriglyceridemia (HTG) induced pancreatitis causes up to 15% of cases of acute pancreatitis, typically occurring in patients with triglyceride levels >1,000 mg/dL. HTG occurs in primary(genetic) and secondary disorders of lipoprotein metabolism. Secondary causes include diabetes, pregnancy, medication, alcoholism, and thyroid disorders. Our case involves a 45-year old male former alcohol user who presented with acute epigastric abdominal pain and bilious emesis. On exam, he severe epigastric tenderness with... Read More
Fusobacterium nucleatum: A Rare Presentation of Hepatic Abscesses

Meghan Gwinn and Erica Herc

Fusobacterium nucleatum is a facultative anaerobic gram-negative bacillus found in the oral cavity, gastrointestinal tract, and genitourinary tract. Fusobacterium nucleatum is a rare cause of hepatic abscesses and empyema. We describe a case of Fusobacterium liver abscess and empyema, resulting in extensive thrombophlebitis in intraabdominal and extremity veins. A 78-year-old female with past medical history significant for bicytopenia and tooth repair 8 months prior presented with mild diarrhea and... Read More
$Splenic Artery Embolization for Idiopathic Warm Autoimmune Hemolytic Anemia Refractory to Medical Therapy by Mohamad O. Hadied, Riyad Y. Kherallah, Mariam Salman, Khalid Eteer, and Scott Schwartz$
Splenic Artery Embolization for Idiopathic Warm Autoimmune Hemolytic Anemia Refractory to Medical Therapy

Mohamad O. Hadied, Riyad Y. Kherallah, Mariam Salman, Khalid Eteer, and Scott Schwartz

Purpose: While Partial Splenic Artery Embolization (PSAE) is a useful procedure that has been performed for a variety of indications including trauma and hypersplenism, it has been rarely described as a treatment for Idiopathic warm Autoimmune Hemolytic Anemia (AIHA). Previous reports in the literature are limited to case reports in situations that include the patient being a poor surgical candidate, the inability to transfuse blood during surgery because of... Read More
Inflamed Non-Limbal Scleral Dermoid Masquerading as Nodular Scleritis

Mariam Hamid, Daniel W. Steen, Adrian H. Ormsby, and Kim Le

Background: Dermoid cysts are one of the most common orbital lesions in childhood. They typically present as a palpable subcutaneous mass in the superotemporal region along the frontozygomatic suture. When involving the eye, ocular dermoids typically present as visible lesions at the limbus.

Clinical Case Report: A five-year-old male presented with focal injection of the left nasal conjunctiva sparing the limbus that progressed to a non-mobile scleral nodule with... Read More
E-cigarette or Vaping Product Use Associated Lung Injury

Charles Hammond and Alexis C. Haftka-George

With the increased popularity of vaping and the recognition of e-cigarette or vaping product use associated lung injury (EVALI), it is important to understand the potential harms and treatment options. A 25 year old female with acute-onset chest pain and shortness of breath. Initial workup reveals tachycardia to 140bpm but she is afebrile. Laboratory and imaging workup reveals leukocytosis and CT scan of the chest reveals a multifocal pneumonia.... Read More
Rasburicase-induced Reds and Blues

Zakaa Hassan, Tanya Belle, and Gina Hurst

Introduction: G6PD deficiency (G6PDD) is a genetic disorder resulting in low levels of the G6PD enzyme which plays a key role in preventing cellular damage from oxidative stress. We report a case of newly diagnosed G6PDD manifesting as methemoglobinemia (MetHb) and non-autoimmune hemolytic anemia (NIHA) following Rasburicase administration in an elderly male.

Case: A 78-year-old male with a history of untreated chronic lymphocytic leukemia (CLL), congestive heart failure and... Read More
COVID-19 Presenting with Neurological Symptoms

Matthew Henry, Raef Fadel, Joseph B. Miller MD, Geehan Suleyman, Odaliz Abreu-Lanfranco, and Indira Brar

Introduction: Healthcare officials of Wuhan City in China became aware of several pneumonia cases with an unknown etiology in December 2019. A novel coronavirus, SARS-CoV-2, was identified as cause of the disease named Coronavirus disease-19 (COVID-19). SARS-CoV-2 enters cells through a receptor found on pneumocytes, and there is also evidence this receptor is located on neurons and glial cells. Recently, the neurological manifestations of COVID-19 have been described. However,... Read More
SINAM: A Rare Case Leading to Respiratory Failure

D. Christine Hermiz and Patrick Bradley

Introduction: Statins are commonly prescribed in primary care offices daily; however, they are not exempt from adverse effects. Statin-induced myopathies are best described on a continuum, as patients can range widely in presentation. The most extreme of cases displaying respiratory distress, quadriparesis, dysphagia, and rhabdomyolysis. Cases on the severe end of the spectrum with respiratory failure are exceedingly rare and should be shared with the medical community in order... Read More
Retinal Detachment with Vitreous Hemorrhage Causing Acute Angle Closure Glaucoma

Michael B. Holbrook, Daniel Kaitis, Lily Van Laere, Jeffrey Van Laere, and Christopher R. Clark

A 90-year-old female with past medical history of trigeminal neuralgia presented with a four-day history of a left-sided headache, nausea, vomiting, and vision loss in her left eye and one month of intermittent flashes of light in her left eye. Her left eye was diffusely injected with a cloudy cornea and fixed, mid-dilated, and non-reactive pupil. The vision in her, right eye was 20/200 with an intraocular pressure (IOP)... Read More
A Case of Uveitis-Hyphema-Glaucoma Syndrome due to ExPRESS Miniature Implantation

Andrew Hou, Madeline Hasbrook, and David A. Crandall

Purpose: To report a case of a 69-year-old patient who developed uveitis-glaucoma-hyphema syndrome after an uneventful EX-PRESS (Optonol, Ltd. Neve Ilan, Israel) mini shunt surgery for advanced primary open angle glaucoma and to discuss management options and clinical implications. Uveitis-glaucoma-hyphema syndrome is a rare but serious complication usually described after cataract surgery. It is often described in anterior chamber intraocular lenses, sulcus lenses, as well as malpositioned or subluxed... Read More