Journal of Clinical Case Reports

Background: Poly Arteritis Nodosa (PAN) is a rarely necrotizing vasculitis in childhood and is characterized by the inflammation of small and medium vessels affecting multiple organs. Although the presence of Anti Phosphor Lipid (APL) antibodies in PAN has been documented, there is limited data on the prevalence and understanding of pathogenesis and management for such co-incidence.

Case study: We herein reported that a 7-year-old boy without significant past medical history presented initially with high-grade fever, painful subcutaneous nodules, and ankle arthritis for 14 days prior to hospitalization. Biological findings revealed increased acute inflammatory biomarkers and no evidence of infection. The deep skin biopsy taken from the subcutaneous nodule proved leukocytoclastic medium-sized vasculitis suggestive of the PAN diagnosis. He eventually achieved a complete response with the use of intravenous corticosteroids (2 mg/kg/day) and subcutaneous methotrexate (15 mg/m2 body surface area (BSA)/week). However, the patient developed painfulness of bilateral proximal muscles and new-onset subcutaneous nodules of lower limbs after 1-week maintenance. Though the Creatine Phospho Kinase (CPK) level was normal, the Magnetic Resonant Imaging (MRI) showed multiple foci myositis of bilateral gluteal and femur regions. The serum level of D-dimer was remarkably elevated, and the lupus anticoagulant was positive. A combination of subcutaneous enoxaparin and pulsed cyclophosphamide (500 mg/m2 BSA) and threeday methylprednisolone (30 mg/kg/day) have contributed to a favourable outcome in this case. She further sustained remission on maintenance of gradually tapering doses of oral prednisolone and methotrexate.

Conclusions: We describe a case of PAN with the presence of APL antibody manifesting with multifocal myositis. It is recommended that general testing for APL antibodies should be undergone in patients with PAN, as well as other systemic vasculitis. Despite unusual co-incidence, APL antibodies might worsen systemic vasculitis through thrombotic events, which clinicians should consider adequate coagulant therapeutics besides immunosuppressors.

When all four Kocher Criteria are satisfied, the diagnosis of septic arthritis has a reported likelihood between 59-99%. However, when physical exam and imaging studies are inconsistent with septic arthritis, alternative diagnoses must be considered. We present to you the case of a 9-yearold female who satisfied all four Kocher Criteria and underwent an extensive workup. She was found to have an abscess along her pelvic sidewall that extended through the greater sciatic foramen into the piriformis muscle and inferiorly along the course of the sciatic nerve. Primary source control was achieved with operative irrigation and debridement, and long-term antibiotic therapy was used for eradication.

Background: We report a case of a patient with metastatic breast cancer that was treated with a novel magnetic nanoparticle hyperthermia approach for the treatment of solid tumors comprising of systemic administration of iron oxide multicore encapsulated nanoparticles, named Sarah Nanoparticles (SaNPs), and Alternating Magnetic Field (AMF) irradiation.

Case description: The patient participated in an ongoing open label feasibility ascending dose study designed to evaluate patients with stage IV solid tumors. The primary objective of the trial was to assess the safety profile of the approach. Eligibility criteria included patients with a life expectancy of at least 30 days, histologically confirmed advanced metastatic solid tumors that have progressed on or after standard therapy. Toxicity was evaluated using standard criteria for the grading of adverse events and tumor response was assessed after a follow-up period of 30 days by evaluating changes in the treated metastatic sites. The case, a 39-year-old female, was diagnosed with invasive lobular breast cancer with multifocal leptomeningeal dissemination and was enrolled to the trial in accordance with the eligibility criteria.

The patient received a SaNP dose of 10% followed by an AMF irradiation dose corresponding to two irradiation intervals of 5 minutes each, and successfully completed the treatment procedures in accordance with the study protocol, demonstrating feasibility and good tolerability. Although tumor response was not expected at these first dose levels, MRI and CT results showed a significant effect in a breast tumor without any concomitant toxicities observed.

Conclusion: The treatment was proven safe and induced necrosis of a tumor mass in a case of advanced breast cancer.

Postcoital hemoperitoneum is a rare but potentially life threatening condition characterized by accumulation of blood in the peritoneal cavity following sexual intercourse. We present a case of 23 years old female patient who presented with diffuse abdominal pain, right shoulder pain and chest discomfort following sexual intercourse. Physical examination and imaging studies confirmed the presence of moderate to large hemoperitoneum, leading to the suspicion of a ruptured corpus luteal cyst. An emergent exploratory laparotomy was done. Bleeding site was identified over the ovary and ruptured tiny friable cyst was noted, same excised and send for histopathological examination. Hemostasis secured with series of sutures over the ovary. Patient received transfusion of packed red cells and discharged in stable condition. Histopathological examination confirmed the diagnosis. This case report emphasizes the importance of early recognition, prompt intervention and highlights the potential life threatening complications associated with ruptured corpus luteal cysts.

Milwaukee shoulder syndrome is a rare orthopaedic entity. Affected individuals usually have significant functional impairment at presentation. Few cases of this condition are documented in the literature making it a hard condition to treat. However, for the affected shoulder joint viable surgical options are between a reverse shoulder arthroplasty or shoulder arthrodesis as salvage procedures. Both procedures leave the shoulder relatively functional and therefore effort she’ll be on early diagnosis and treatment of precursor stages of the disease. We also highlight our case of a 56 years old African female with Milwaukee shoulder of the left shoulder as well as precursor rotator cuff arthropathy of the contralateral shoulder sparking a review of recent literature.

The male patient was 51 years old. He was admitted to hospital on March 29, 2019, due to "fever, cough, jaundice and 5 days of poor appetite". He developed a fever (no body temperature) at 5 days prior to the absence of an obvious cause, no chills, with slight cough, a little white sticky sputum, no blood in the sputum, no rust colored sputum, no chest pain, no nasal congestion or runny nose, no sore throat and had been treated at the local hospital and intends to be diagnosed as "upper respiratory infection".

The incidence of EBV positive mucocutaneous ulcer is likely highly underestimated, given its self-limiting course, in addition to its rarity amongst the spectrum of EBV positive lymphoproliferative disorders with only a limited number of reported cases in the literature. It was first identified in 2010 and is associated with immunosuppression, iatrogenic, primary and age related. A slight female predominance has been reported with a median patient age of 66.4 years. Disruptions in the balance of this interaction are believed to result in the lymph proliferation of various cell derivatives. EBV positive Mucocutaneous Ulcer (EBVMCU) is an indolent condition on this spectrum of LPDs, which localizes to the skin and mucosal surfaces. It is a rare lymph proliferation that gained recognition as a new entity in the 2016 revisions to the World Health Organization classifications.

First cases of COVID-19 appeared in Kazakhstan at the end of March 2020, which was significantly later than in other countries of Asia and Europe. We report on one of the first Kazakhstani patients with severe COVID-19. A 60-year old Caucasian man was hospitalized to the infectious department of Semey city hospital with the symptoms of fever up to 38.5°C, sore throat, general fatigue, scanty cough. The disease started abruptly and the patient was on self-administered antibiotics and aspirin within 4 days with no improvement.

In our case report, we discuss a patient, who underwent a dual antiplatelet therapy as a secondary prevention of stroke. To our knowledge, there are no other cases in the literature reviews about pituitary haemorrhage on dual antiplatetelet therapy. The 7^th most common reason for intrapituitary haemorrhage is aspirin. However, the risk for bleeding was not considered when a dual therapy was administered.

The patients, who have suffered a stroke, need a suitable secondary stroke prophylaxis. The dual therapy has shown advantages over the monotherapy with aspirin or with clopidogrel. The personal approach to every patient, who has suffered a stroke, has to be taken. The pituitary adenoma can increase the risk for intracranial bleeding, when a dual therapy is used as a second stroke prophylaxis.

Background: The COVID-19 pandemic can lead to severe respiratory failure and hypoxia. Extracorporeal life support or ECMO, has been successful in treating patients with respiratory disease from a variety of causes but its’ use in COVID-19 is controversial. While it may be helpful, concern over heavy resource use when personnel and equipment may be limited raises caution. Concurrent obesity and secondary organ failure have also been cited as poor prognostic indicators.

Case summary: We present our first COVID-19 patient with both obesity and acute kidney injury who received ECMO support at a large, experienced ECMO center and survived to discharge.

Conclusion: ECMO can provide life-saving support for patients with severe respiratory failure, concurrent obesity and renal failure in selected patients.