Journal of Clinical Case Reports

Background: Topical Corticosteroids have been ordered in Medical practice by many doctors for Various Skin diseases but prolong use of these Medication causes Systemic adverse effects including Cushing Syndrome. Iatrogenic Cushing Syndrome may occur with over use of potent topical steroids mostly due to Diaper dermatitis. Case report: We report a 3 month old female infant who developed Cushing Syndrome after diaper dermatitis treatment through misuse of Clobetasol without doctor’s Prescription. After diagnosis, the application of this topical corticosteroid was stopped and physiologic dose of prednisolon was prescribed to prevent an adrenal crisis for 2 months. Conclusions: Continuous use of moderate to high potency topical corticosteroids over several months can contribute to cushing’s syndrome. So parents must be informed by physicians about the adverse effect of steroids and they should be avoided in very young infant.

Sturge-Weber syndrome is a rare neurocutaneous syndrome characterized by port -wine stain, seizures and intracranial calcifications.The present case had bilateral port-wine nevus, generalised tonic-clonic seizures and right sided intracranial calcifications involving right temporo-parieto-occipital lobe regions with prominent choroid plexus.

50 year old male, diagnosed case of Chronic Obstructive Pulmonary Disease (COPD) was admitted to ICU as a case of cellulitis of left lower limb with septic shock and multi-organ dysfunction. On admission, he was managed with intravenous fluids, vasopressor (noradrenaline), broad spectrum antibiotics, nebulisation and mechanical ventilation. Gradually, he showed improvement clinically as well as in laboratory parameters. On fourth day, he became haemodynamically stable, maintaining oxygen saturation on minimal ventilatory support (Pressure Support mode) and was planned for extubation on the next day. But, he developed respiratory distress (respiratory rate 35/minute, use of accessory muscle present) while on Pressure Support Ventilation along with hypoxemia. He was immediately placed on control mode of mechanical ventilation with tidal volume of 350 ml (6 mls/kg) which showed high airway pressures (PIP>40 cm H2O) with every inspiratory effort. Suctioning of the endotracheal tube was done with a 12 Fr Gauge suction catheter by open method which could be negotiated up to the carina with minimal secretions being aspirated with poor cough reflex. Chest auscultation revealed diminished air entry on left side. The position of the tube was re-confirmed with direct laryngoscopy.

This case report concerns an 89-year-old woman who tolerated a urinary retention of 5000 ml due to longstanding asymptomatic bladder atony. It had a multifactorial origin because the patient had a lengthy history of benzodiazepine abuse for severe reactive depression. Furthermore, a large drugs assumption, cognitive impairment and low mobilization may have influenced the severity of her condition. She had never worried about her distended abdomen because her micturition was good cause of overflow incontinence. To our knowledge, this is the first report of an impaired elderly patient developing major urinary retention also as a result of using benzodiazepines that may have acquired a fundamental rule as trigger factor.

Sirenomelia is a rare congenital malformative disorder characterized by fusion of the lower limbs giving a characteristic mermaid-like appearance to the affected foetus. We report a case of sirenomelia occurring in a 19 year old Cameroonian woman following premature rupture of membranes and associated cord prolapse. This is the first documented case in this country. We highlight the some of the cultural myths associated with this disorder and discuss our findings relative to the present literature and related controversies on its etiopathogenesis.

Acute Intermittent Porphyria (AIP), the most common of acute porphyrias, is due to deficient activity of the enzyme porphobilinogen deaminase. Clinically presents with acute attacks, which comprise a variety of neuropsychiatric and visceral symptoms. The attacks may be precipitated by drugs, alcohol, smoking, reduced caloric intake, infection, surgery, psychological stress, or hormonal changes. Diagnosis is based on demonstration of markedly increased levels of precursors of porphyrins in blood or urine and deficient activity of the responsible enzyme in erythrocytes. Treatment consists of administering glucose and intravenous heme derivatives, and avoidance of precipitating factors. We report a patient with AIP, who presented with severe and protracted symptoms that led her to an impressive state of cachexia.

Pulmonary hemosiderosis is an uncommon disorder in pediatric population in developing countries. It may affect the lung in an isolated form of Idiopathic Pulmonary Hemosiderosis (IPH) or as a manifestation of systemic disorders. The present patient belonging to Mongolian race presented with history of fever, cough, respiratory distress and previous episode of hemoptysis. The child had anemia, negative tuberculin test and no acid-fast bacilli in sputum and presence of bilateral pulmonary infiltrates in X-ray chest. Sputum examination showed iron-laden macrophages and no secondary cause could be ascertained. The patient responded well to prednisolone treatment alone. Idiopathic pulmonary hemosiderosis can be diagnosed based on the clinical features and sputum examination. Lung biopsy and high resolution CT thorax may not be undertaken in setting where facilities are not available.

Complex regional pain syndrome most often follows peripheral soft tissue and nerve injury, fractures, and surgical procedures. The pain is out of proportion to the severity of the injury, spreads beyond a nerve or root territory and increases over time. In general, recommendations for anesthesia for these patients requiring surgery include sympathetic blockade or intravenous regional anesthesia as well as sympathetic blockade in conjunction with lidocaine. Quite often surgery for these patients seriously aggravates their condition. This is a retrospective evaluation of a case series of the use of ketamine as adjunctive anesthesia in twenty five refractory long standing complex regional pain syndrome patients. All patients met the International Association for the Study of Pain criteria for diagnosis. Ketamine was administered intravenously over four hours from the start of the procedure with midazolam and clonidine in addition to their standard anesthesia. At the end of the procedure, an additional dose of midazolam was administered. Lorazepam was used for restlessness if necessary for three nights after the procedure. All twenty five patients had no exacerbation of their symptoms and signs and no spread of their CRPS. This study supports the effective use of ketamine, midazolam and clonidine as adjunctive anesthesia in severe refractory CRPS patients undergoing a surgical procedure.