Journal of Clinical Case Reports

Introduction: There is a lot of interest and spirited debate about the adverse effects of anti-SARS CoV2 vaccines in the global pandemic context of the SARS Co-V2 infection.

Aim of the study: the purpose of this article is to demonstrate a link between vaccine inoculation and the development of some unusual clinical symptoms.

Methods: We describe the case of a 21-year-old young woman who developed symptoms of fever, chest and limb discomfort in her left upper arm around 10 days after receiving her first dose of Moderna vaccine, necessitating a trip to the emergency room and hospitalization 14 days later. Septic arthritis of the left sternoclavicular joint, mediastinitis, deep vein thrombosis of the left upper limb, and pulmonary embolism were diagnosed as a result of the instrumental tests performed during the hospital stay, particularly the angio TC of the chest and left upper limb; the growth of Staphylococcus aureus on a blood culture. The patient receives bacterial and anticoagulant therapy and recovers clinically and radiologically, allowing him to be discharged 10 days following hospitalization.

Results: Given the chronological sequence, the vaccination's causative role in the formation of the clinical picture is extremely likely in this case, but with a plausible non-specific mechanism including vaccine injection at the venular or arteriolar level and adherence to asepsis.

Conclusion: Although cases of septic arthritis following vaccines have been reported in recent years for influenza and pneumococcal vaccines, as well as more recently for SARS CoV2 vaccines (in particular with involvement of the shoulder joint), the novelty of our finding stems from the fact that it would be the first case of septic arthritis with a sternoclavicular localization, which is unusual in and of itself.

Background: The purposes of this case series was to identify clinical characteristics of patients with restrictive eating disorders who have experienced pneumothorax or pneumomediastinum and elucidate possible risk factors for the development of pneumothorax or pneumomediastinum in this patient population through literature review. The scope of the case series is limited to patients admitted for medical stabilization from severe restrictive Eating Disorders (EDs).

Methods: We compiled a series of adult patients with severe EDs who were diagnosed with a pneumothorax or pneumomediastinum while admitted to the ACUTE Center for Eating Disorders at Denver Health between April 2016 and January 2021. Additionally, a series of adult patients who reported a history of pneumothorax on admission to the same institution, during the same time period, were identified and characteristics of their pneumothorax were obtained using outside records provided by the patient at time of their admission. A literature review of cases of pneumothorax and pneumomediastinum in patients with EDs was completed.

Results: Twenty-five cases of pneumothorax were identified in patients with anorexia nervosa (AN) or avoidant/restrictive food intake disorder (ARFID), all of whom were below normal body weight, between cases at our institution and literature review. Additionally, 5 patients at our institution, and 21 patients with EDs from the literature with below normal body weight with spontaneous pneumomediastinum were identified.

Conclusions and limitations: The relationship of spontaneous pneumomediastinum in patients with AN and ARFID and low body weights is well established and can be managed conservatively with good outcomes. It is currently unclear if the starved state, and the lung changes it induces in these patients increases patients’ risk for spontaneous pneumothorax. Patients with AN and ARFID may be at higher risk for iatrogenic pneumothorax with certain invasive procedures. There is direct connection between patients’ eating disorder and occurrence of traumatic pneumothorax. Patients at expected body weights, or in larger bodies with restrictive Eds, were not included in this study and therefore, their risk of pneumothorax and pneumomediastinum in relation to their eating disorder behaviours is unknown.

Client Z.I was 36 years old man with presenting complaints of sleep disturbance, difficulty in concentration, restlessness, fatigue, lack of interest in anything, suicidal ideation and history of suicide attempt. In Forma assessment; Siddique Shah Depression Inventory (SSDI), Suicidal Ideation Scale (SIS) were used and in informal assessment observations, clinical interview, mental status examination, Dysfunctional Thought Record chart (DTR) used for diagnosis. Client was diagnosed with major depression disorder. Management plan was devised based on cognitive behaviour therapy techniques such as identifying distortions, ABC model, distraction techniques, motivational interviewing and hope box/survival kit, moreover no harm contract, art therapy, social therapy were used. Total 14 sessions were conducted.

Bone Marrow Edema Syndrome (BMES) is a clinical syndrome of unknown etiology characterized by the acute onset of pain gradually worsening over several weeks to months. Radiographic changes occur, but laboratory studies are generally unremarkable. It can primarily affect the foot and ankle and should be considered in the differential diagnosis of patients with acute foot and ankle pain, particularly in middle age men, and women in the third trimester of pregnancy. I here present 2 case reports of BMES of the ankle. Appropriate conservative treatment resulted in resolution of symptoms. Bone marrow edema syndrome can present a diagnostic challenge, but awareness of the typical presenting features and investigation findings can makes the diagnosis more accessible.