Journal of Clinical Case Reports

Introduction: This work represents a preliminary study of the treatment of systemic lupus erythematosus with a commercially available intravenous immunoglobulin. The aim of this study was to assess the efficacy of this product in three patients aged 16, 34 and 49 diagnosed with systemic lupus erythematosus at the Internal Medicine Service of “Freire de Andrade” Hospital, Cuba. Case report summary: The patients had a history of treatment with several drugs, including immunesuppressants. However recurrent respiratory tract infections, skin rash as well as several immunological abnormalities were present. Intravenous immunoglobulin (5-10 g/day) was given intravenously during five consecutive days, in the absence of other types of immunotherapy. An immunological profile before and after the intravenous immunoglobulin therapy was performed. In addition the patients were clinically evaluated using the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) score. The intravenous immunoglobulin therapy was highly effective in all patients due to its immunosuppressive, anti-inflammatory, immunomodulating and antimicrobial properties. It also prevented some of the frequent complications associated with the traditional immunotherapy in systemic lupus erythematosus. Conclusion: We recommend new clinical studies on large group of patients to establish the efficacy and side effects of intravenous immunoglobulin as a first line therapy in systemic lupus erythematosus.

Despite improved legislation in most countries, child abuse in sport continues to exist but is a problem which is often under reported or ignored. In elite sport ‘suffering’ is not uncommon and hence sometimes child abuse is sometimes unrecognised, de-emphasised or easily dismissed as part of a collective experience that is perceived to be necessary to ‘create’ elite athletes. However, even swearing, anger, raised voices and negative comments directed at child athletes by coaches is considered abuse and can, when regular and routine, cause long term wellbeing and health issues. Self-harm can be a consequence and here self-harm in the form of trichotillomania, self hair-pulling, is reported for the first time as a secondary consequence of abuse. The 12 year old female gymnast, subject of this case study, presented with this impulse control disorder as defined by the American Psychiatric Association and was successfully treated using cognitive behavioural therapy. However, the training environment, including coach behaviour, did not change and so the gymnast remained at risk of recurrence of self-harm. Such environments in sport have many characteristics in common with and reminiscent of religious cults; sacrifice, isolation, shared obsession, a charismatic leader, and often in the presence of severe calorie restriction. As a consequence of ageing, growth, injury and an unchanging abusive environment, a year later the gymnast retired from the sport.

Acute onset of tetraplegia is a medical emergency. Hyperkalemia has been described as a very uncommon cause of tetraplegia. A 79 year old male presented with an acute onset of tetraplegia. His past medical history was significant for stage III follicular lymphoma diagnosed 4 years ago that 1 month prior to the admission progressed with biopsy-proven transformation to a diffuse large B-cell lymphoma. Recent CT and PET scans revealed multiple active lesions including a large paravertebral mass measuring 29 cm×12 cm×7 cm starting in the axial level of the diaphragm involving left psoas, the left renal vein and encasing the aorta. Multiple skeletal lesions, as well as numerous lymph nodes were found. The liver and spleen were also compromised. His surgical history was remarkable for radical prostatectomy for localized prostate cancer. The patient did not have previous history of renal failure and his blood urea nitrogen and creatinine were within normal range (15 mg/dL and 0.8 mg/dL, respectively).

In December 2010, a 43 year old South Asian woman presented to the acute medical unit with a 7 day history of coryzal symptoms, a nonproductive cough and 5 days of leg weakness and muscular aches. She presented due to the worsening of symptoms and confusion. She also noted that she was passing less urine than usual.

Background: Histopathologically similar to small cell carcinoma of lung, small cell neuroendocrine carcinoma of the cervix is a rare malignancy with an aggressive behavior, due to an early lymphatic involvement and hematogenous dissemination. Pelvic recurrence and distant metastasis are very common. In literature, the best treatment modality remains controversial. Cases: From a series of 3 cases and a literature review, we focus on screening, prognostic factors and treatment of this cancer. Conclusion: Human Papilloma Virus (HPV) 18 infection seems to be specifically related to small cell neuroendocrine carcinoma. Screening with HPV genotyping, and a multimodal therapy could improve the prognosis of these patients.

Adenoviral keratoconjunctivitis (AK) has a wide spectrum of duration and clinical manifestations. Conjunctival infection with adenovirus is the most common external ocular infection worldwide and is highly contagious, sometimes appearing in epidemics. After an incubation period of 2 to 14 days, symptoms of tearing and itching along with findings of conjunctival edema and hyperemia with or without conjunctival pseudomembranes can appear in 1 eye, and then in the fellow eye a few days later.

A 3-year-old male child presented as delay in development of speech, a rare single presenting feature with tuberous sclerosis. Clinical history and examination were consistent with tuberous sclerosis including major features like Ash-leaf spots and Adenoma sebaceum. The clinical manifestations and evaluation of tuberous sclerosis are discussed.