Journal of Clinical Case Reports

We report the case of a 27 year old woman who was diagnosed with an axonal type of Guillain-Barré syndromet 36 weeks’ gestation. The patient had severe motor loss but she was treated effectively with physiotherapy and eneral care in intensive care unit and she underwent cesarean delivery with general anesthesia at 38 weeks and gradual motor power recovered over a period of 3 months.

Subdural empyema (SDE) most frequently arises as a complication of paranasal sinusitis and is a serious intracranial infection. Parafalcine SDE, resulting from acute otitis media, is a rare phenomenon. Here, we report the case of 57 year old woman, with a history of nasopharyngeal carcinoma (NPC) with radiotherapy, 28 years ago and recent diagnosis of recurrent acute otitis media, who was admitted to the emergency department with a 2 days history of progressive right-sided limb weakness. Neurological examination revealed right-sided hemiparesis without meningeal signs. Non-enhanced computed tomography (CT) scans of the brain revealed a hypodense lesion in the left parafalcine region. Gadolinium-enhanced magnetic resonance imaging demonstrated layers of rim-enhancing subdural fluid collection and swelling of the surrounding brain, suggestive of empyema. The patient underwent surgical evacuation of empyema and was treated with intravenous antibiotics for 6 weeks. The patient recovered well without neurological deficits. Follow-up brain CT 6 weeks later showed complete resolution of previous lesions. Acute otitis media complicated by SDE is a rare clinical phenomenon that carries a high mortality rate. The complication risk may be higher in NPC patients following radiotherapy. Early diagnosis of SDE and prompt surgical evacuation of purulent material can result in a full recovery.

Central venous placement using ultrasound has significantly reduced the complications associated with blind puncture. The central venous catheter can still get misplaced if it follows an anomalous route after appropriate puncture of desired vessel. We report a case of misplaced dialysis catheter into the accessory hemiazygos vein which resulted in a large hemothorax and we recommend the routine use of fluoroscope for placement of dialysis catheters so as to avoid serious complication.

Perinatal Arterial Ischemic Stroke (AIS) is an important cause of neurological morbidity in infants. Some risk factors have been identified, but its pathogenesis remains unclear. We present a case of perinatal in which macroscopic examination of the placenta revealed the presence of a vasa praevia. We hypothesize that compression of the vasa praevia during labor could have determined the formation of thrombi, which were subsequently embolized into the fetal circulation causing perinatal AIS.

A 28 year old female with a long-standing rosacea presented for initiation of treatment of primarily erythematotelangiectatic rosacea with no prior treatment to date. The patient’s most significant concern was with the mildly erythematous appearance of her face at baseline, as well as frequent flushing.

Adult Onset Still’s Disease (AOSD) commonly affects young people. We observed an elderly woman with long standing seronegative rheumatoid arthritis and further transformation to systemic illness. A 74 year old woman was admitted to emergency room with multiple joints pain and rash, associated with a fever 40.5°C. The patient had a long standing rheumatoid arthritis presented as symmetric polyarthritis and treated with prednisone only. Multiple immunosuppressive and biological medications failed and she developed several severe bacteremia events. Her past ferritin levels were normal, except for a single elevation two years before.

Incidental findings of adrenal masses are increasingly found with the use of thoracic and abdominal imaging studies. It is standard practice to determine if these masses are hormonally active or nonfunctional, malignant or benign.

Churg Strauss Syndrome (CSS) is a rare systemic vasculitis associated with asthma, eosinophilia, sinusitis and pulmonary infiltrates. A 49 years old woman was admitted with migratory polyarthritis and Churg Strauss Syndrome. We will discuss the findings that lead to the diagnosis of CSS and we will raise the possibility that she might have a new syndrome that includes CSS with migratory polyarthritis. Until now there have no reports describing patients with CSS and arthritis. There have been some cases with arthrlagia, but our case represents the first case that was admitted with arthritis. This case is a novel case describing a new combination of migratory arthritis in a patient suffering from CSS.

Central venous catheters have a long and varied history of successful use. Integral to modern critical care, these vascular access devices serve as a means for the administration of dextrose and nutritional solutions, medications, colloid, and blood products. In addition, hemodynamic monitoring can be performed through larger Central venous catheters. Previously recommended for patient requiring long-term treatment, current literature supports the use of central venous catheters for short- to long-term treatment, for therapies that produce damage to the peripheral veins and tissue for patients with limited peripheral venous access.

Introduction: Ankle syndesmosis injuries typically occur when the foot is forced upward and outward. Syndesmosis of the ankle is the joint that connects the tibia and fibula and allows these two bones to work together to provide stability to the lower leg. Case: 24 year old active duty female service member presented to Womack Army Medical Center for left ankle pain approximately 12 weeks after incurring an injury while playing basketball. She reported increased pain with activity and no improvement when using a brace. Imaging studies performed on the weight bearing left leg, ankle, and foot revealed a healed proximal fibular fracture, syndesmosis widening with lateral shift and medial space widening, and decreased longitudinal arch height. A magnetic resonance imaging revealed a deltoid ligament tear and widening of the syndesmosis, but showed no tibialis posterior tendinopathy. The patient was taken to the operating room for open reduction internal fixation of the syndesmosis with a medial displacement calcaneal osteotomy, deltoid ligament repair, gastrocnemius recession, and medial cuneiform opening wedge osteotomy. Discussion: The coexistence of syndesmosis and deltoid ligament injuries modifies ankle joint motion and significantly destabilizes the ankle joint. Radiographs of the affected limb to rule out any fracture are important; however, stress radiographs may be needed to accurately determine stability of the ankle joint as clinical examination cannot assess or diagnose deltoid ligament injury.

Introduction: Giant Synovial osteochondromatosis of Hoffa’s body is very uncommon. Although described as a benign disease, it can be destructive and can cause severe osteoarthritis and pain.

Case report: We report an 18 year old female patient presented with a calcified mass inside the Hoffa’s body. Clinically, patient presented with eight-month history of progressively worsening left knee pain with associated swelling. The bony mass in the Hoffa’s body was evident on the X-ray. MRI showed synovial affectation. During the arthroscopy, all pathological synovial was removed and the bony mass was extirpated through a mini-arthrotomy. Diagnosis of a giant synovial osteochondromatosis was confirmed by histology and malignancy was ruled out. Five years after surgery the patient has been asymptomatic and motion range is complete.

Conclusion: This case of primary synovial chondromatosis is interesting because it was presented in an age, gender and unusual location. At 5 years of postoperative follow-up the patient has had no recurrence and has showed excellent performance of the knee joint.