Journal of Clinical Case Reports

Pasteurella multocida is the causative agent of numerous economically relevant diseases worldwide. Pasteurella multocida has been known to cause infections in humans, the most familiar being soft tissue infection after animal bites. Systemic infections are rare and endocarditis is exceptionally rare. We report about a 72 year old woman with prosthetic biologic aortic valve was admitted to West Galilee Naharia Hospital because of 10 days long fever after a domestic cat scratch in her left palm. During her stay the patient continued to have spiking fever accompanied by shivering despite the antibiotic therapy, she had worsening dyspnea, tachypnea, feet edema and cough. Due to the findings listed above another trans thorathic echocardiography was performed on the 11th day of her hospitalization, which showed endocarditis of the prosthetic aortic. On the 42nd day an MRI exam was done that showed an inflammatory process that involved the l5-s1 vertebras and the intervertebral disc. We believe our report is the second documented case of Pasteurella multocida endocarditis that was complicated by osteomyelitis, and we contemplate upon this rare occurrence and its implications.

A 62-year-old male with a history of type 2 diabetes mellitus and alcoholic liver disease presented with dysphagia, heartburn, and appetite loss. He had lost 10 kg weight within 1 month. The patient gave a history of excessive alcohol intake and a smoking habit of 60 cigarettes per day for 40 years. Upper gastroenteroscopy revealed a wartlike, whitish, protruding mass with circumferential stricture at a point 35 cm from the incisor down to the cardia. Although esophageal cancer was suspected, repeated biopsies of the mass revealed no malignant findings. Concurrent esophageal candidiasis was treated with an antifungal drug. Increased esophageal stricture made food intake impossible; therefore, total parenteral nutrition was initiated. Endoscopic mucosal resection revealed highly keratinized, well-differentiated squamous cell carcinoma with invasion into the submucosa. A diagnosis of verrucous squamous carcinoma was confirmed. Subtotal esophageal resection and esophagostomy was performed with video assistance. Postoperative pathological findings were compatible with the diagnosis of verrucous squamous carcinoma, which is known to be a slow-growing tumor that rarely metastasizes to lymph nodes or distant organs. However, verrucous squamous carcinoma is rarely diagnosed by endoscopic biopsy. Moreover, endoscopic mucosal resection or surgery should be considered in cases when endoscopic examination fails to confirm the diagnosis of carcinoma and if the lesion presents some characteristics of verrucous squamous carcinoma.

Lung cancer is the commonest cause of acrometastatic disease to the fingers. Treatment of acrometastasis is palliative with radiation or amputation and the prognosis is poor. The authors report a case of phalangeal metastasis in a man aged 72 years old, diagnosed as a painful swelling of the thumb, revealing a bronchial adenocarcinoma. An amputation of the thumb was performed. Histology confirmed a metastasis from the lung adenocarcinoma. The patient died one month after discovery of the primary tumor.

Case of heterotopic quadruplet pregnancy with coexistence of tubal and intrauterine twins. Objective (s): To present the case heterotopic quadruplet pregnancy with coexistence of tubal and intrauterine twins and its successful surgical management with brief literature review. Design: A case report supplemented with brief literature review and discussion. Setting: City clinical university hospital. Patient (s): Heterotopic quadruplet pregnancy with tubal and intrauterine twins in a 31-year-old woman after natural conception. Intervention (s): Laparoscopy, adhesiolisys, aspiration of tubal embryos through tubotomy and cervical dilatation and vacuum aspiration of intrauterine embryos as well as vaginal and intraoperative laparoscopic ultrasound examination. Main outcome measure (s): Physical examination, laparoscopy and postsurgical hCG serum assay, as well as preintra- and postoperative vaginal ultrasound and intraoperative laparoscopic sonography. Result (s): Successful diagnosis and treatment of a case of heterotopic quadruplet pregnancy with coexistence of tubal and intrauterine twins in a 31-year-old woman with 6 artificial abortions, pelvic inflammatory diseases and periadnexal adhesions, after natural conception was described. An intraoperative laparoscopic sonography was applied to complete diagnosis of heterotopic pregnancy with coexistence of tubal and intrauterine twins after control of bleeding and stabilization of patient condition due to necessity to perform an emergency surgery. The case was supplemented with a brief review of literature and discussion. Conclusion (s): A unique case of heterotopic quadruplet pregnancy with coexistence of tubal and intrauterine twins after natural conception was presented in the first time.

Malignant peripheral nerve sheath tumor accounts for about <10% of all sarcomas. It’s incidence in the parotid gland is even rarer. A 49 year old male presented to the ENT department with a history of parotid swelling of 1 year duration. The mass was rapidly increasing in size. We received the gross specimen comprising of irregular, grayish white tissue in pieces, as the tumor was infiltrating into the deeper structures and couldn’t be removed in toto. Histomorphological features showed a spindle cell neoplasm with features of malignant peripheral nerve sheath tumour. Neural origin of the tumor was confirmed by immunohistochemistry. The patient is now receiving radiotherapy and doing well. We report this case due to its rarity and also to aware the surgical pathologists to keep this as a differential diagnosis in the evaluation of all spindle cell parotid tumours.

Background: Genetic linkages with psychiatric disorders have been documented. In our clinical practice, we noticed a high propensity for blood disorders in female patients with certain neuropsychiatric phenomenon, specifically Tourette Syndrome (TS) or Trichotillomania (TTM). With this clinical observation, we hoped to better understand a possible genetic correlation, namely the role of chromosome 11 which encodes for both the B globulin gene and human dopamine receptor D4 (DRD4) gene. Method: This is a retrospective case series of six children found to have a blood disorder and neuropsychiatric diagnosis in our clinic. We used family interview, lab results, and the patient’s medical chart for data collection Results: Our case series reveals six children with a repetitive neuropsychiatric disorder and a blood disorder. Conclusions: Currently, there are no definitive susceptibility genes that have been identified to date for TS or TTM. We postulate that blood disorders found on chromosome 11 may play a role as a susceptibility factor, particularly in females, for repetitive neuropsychiatric disorders.

One third of the world’s human population has been infected with Tuberculosis (TB), the prevalence being the highest in developing countries. With world travel becoming increasingly more common, disease can readily spread from endemic areas to areas not otherwise affected. TB is thought of as a pulmonary disease but, in fact, it can affect the entire organism. We present an unusual case of an intestinal perforation due to abdominal tuberculosis.

We read the case series of Bilgili et al. on prolonged apnea and sedation in 3 former preterm babies after administration of oral tramadol (2 mg.kg-1) with great interest. Although there may have been additional risks associated with the apnea and sedation events in these specific cases (e.g. low hematocrit, former preterm neonates), we confirm that these side effects were clinically significant and serious. We reported on a similar, unanticipated side effect profile following low dose oral chloral hydrate administration in former preterm neonates for procedural sedation. At least, such observations confirm that prospective studies are urgently needed to improve the effect/side effect balance of analgesic treatment in neonates. Consequently, the authors need to be congratulated for both their effort to perform the study and report the unanticipated side effects. As a neonatologist and clinical pharmacologist with clinical and research experience with this compound in neonates, I would like to draw the attention of the readers and authors to a likely pathogenetic explanation of these events since this likely relates to tramadol metabolism and its routes of elimination.