Indian Journal of Case Reports

Case series of seven cases of urticaria, angioedema, and anaphylaxis (LTP syndrome) due to foods (nuts, lentils, and citrus foods) related to tree pollen (Prosopis juliflora and Holoptelea integrifolia) sensitization

P C Kathuria — 2021-09-15

Lipid transfer protein syndrome (LTPS) results from a primary sensitization to LTP belonging to the PR-14 family of pathogenesis-related PR-proteins which are plant food allergens, stable against heat and digestive enzymes, and can induce systemic reactions of urticaria, angioedema, and anaphylaxis. Here, we report a case series of seven patients with nsLTP syndrome. Our six cases of LTPS were significantly sensitized to Prosopis juliflora and Holoptelea integrifolia and one case was sensitized to H. integrifolia only. In our seven cases, we hypothesized that symptoms of hypersensitivity reaction to foods were due to cross-reactivity by IgE reactive protein of ns-LTP as a major allergenic protein in foods.

Correlation of HbF, HbA2, and HbS in sickle cell disease and its prevalence in Nigerian patients: A case series of 2 patients

Garima Agarwal — 2021-09-15

Sickle cell disease (SCD) is the most common inherited disorder of hemoglobin worldwide. In Nigeria, the prevalence of SCD is 20–30/1000 live births. The burden of the disease has reached a level where it contributes 9–16% of the under-five mortality in many West African countries. This case series evaluated the chromatographic patterns and red blood cell indices of sickle cell homozygous patients. Red cell indices, blood film, sickle solubility test, and chromatographic patterns using Bio-Rad HPLC D10 were evaluated for both patients. Both the patients were Nigerian and HPLC showed HbS window 81.7 and 81.6% and increased HbF, that is, 7.5 and 8.8%. HbA2 was normal in both the cases, that is, 2.2 and 2.6%. Our data suggest that homozygous sickle cell disease is very common among the Nigerian population with an increase in HbF along with HbS and HbA2 is normal.

Anesthetic management of a parturient with Eisenmenger’s syndrome: A case report

Anshul Singh — 2021-09-15

Eisenmenger’s syndrome results from certain uncorrected congenital abnormalities of the heart facilitating left to right shunt and chronic volume overload of the pulmonary vasculature, leading to irreversible changes in the pulmonary vasculature. Pregnancy in the patients of this syndrome is associated with a high risk of cardiovascular decompensation, thromboembolic complications, and sudden cardiac death. We present the case of a 25-year-old pregnant woman with Eisenmenger’s syndrome who delivered through the vaginal route at 37 weeks of gestation, under labor epidural anesthesia. A healthy male baby was delivered within 40 min of drug deposition in the epidural space. The postpartum period was essentially uneventful with successful maternal and neonatal outcomes.

Silent perforation and migration of IUCD: A diagnostic challenge in patients with pain abdomen: A case report

Annapurna Srirambhatla — 2021-09-15

Secondary perforations of intrauterine contraceptive devices (IUCD) may be clinically silent. The patient may not report the missing threads due to a lack of acute symptoms or under the impression that the device could have been expelled. We present a case of a 42-year-old lady treated for renal cell carcinoma and presenting with recurrent right lower quadrant abdominal pain for 2 years. Ultrasound scans did not reveal any abnormality. A plain computed tomography (CT) revealed a migrated IUCD embedded in the omentum with adjacent inflammation. Although CT is not the modality of choice in the diagnosis of migrated IUCD, it proved helpful in diagnosing this case as history was not forthcoming. This case highlights the diagnostic dilemma faced in cases of silent IUCD migration presenting with pain abdomen. It is important to counsel the patient at the time of IUCD insertion for the early recognition of missing devices and prompt diagnosis of complications.

Complicated COVID-19 pneumonia in an infant: A rare entity

Padmaja Biradar — 2021-09-15

In the era of the COVID-19 pandemic, children are spared from severe disease, accounting for 0.39–12.3%. According to a study in Wuhan China, only 2.7% of children are developed severe pneumonia. There are few cases reported with COVID-19 pneumonia in infants. We report the case of a 45-day-old infant who presented with respiratory distress with COVID-19 pneumonia required mechanical ventilation with an intercostal drainage tube for pyopneumothorax. The child was treated with intravenous antibiotics with supportive oxygen therapy. The fluid report of the pyopneumothorax was showing MRSA growth, so antibiotics were modified according to the sensitivity report. In this case report, COVID-19 pneumonia presented with complications in the form of pyopneumothorax with secondary bacterial infection and was successfully treated with a vigilant approach.

Detecting jellyfish sign in a patient with systemic lupus erythematosus: An added value of the echocardiography

Marha M. Menaisy — 2021-09-15

Systemic lupus erythematosus (SLE) is an autoimmune disease that affects nearly every organ of the body. Cardiopulmonary manifestations are common in SLE, almost in the form of serositis, and include pleural and pericardial effusions. In these patients, echocardiography is an excellent non-invasive tool for detecting pericardial effusion and may provide a hint about pleural effusion. We report the case of a 20-year-old woman with SLE who had been experiencing dyspnea for 1 month and had no prior history of cardiovascular or pulmonary disease. A rheumatologist referred her to our echocardiography lab for a cardiac evaluation. In the echocardiographic examination, pleural mass depended from the left visceral pleura was discovered, surrounded by massive pleural effusion that induced left lung atelectasis (Jellyfish sign, and complete atelectasis of a lung lobe floats above a massive pleural effusion).

Autosomal dominant polycystic kidney disease: A case report

Jean V. Varghese — 2021-09-15

Autosomal dominant polycystic kidney disease (ADPKD) is an inherited condition that causes small fluid-filled sacs called cysts to develop in the kidneys. ADPKD affects 1 in 500–1000 people. We report the case of a 70-year-old male patient with complaints of difficulty in passing urine, lower abdominal pain, fever with chills, and hematuria. The ultrasonography report of the abdomen and pelvis showed bilaterally mildly enlarged kidneys with multiple variable simple cysts slightly distorting the normal renal architecture and mildly increased residual visualized cortical echoes concerning adult polycystic kidney changes. The therapeutic regimen was targeted to treat the symptoms of the patient. In India, there is a need for epidemiological studies on ADPKD since insignificant data are present that could rationally reflect its prevalence and incidence, for which this case report could be utilized.

A case of guillain-barré syndrome associated with post-covid infection during 2nd wave of coronavirus in india

Anil Kumar Behera — 2021-09-15

The novel coronavirus-COVID-19 was detected in Wuhan city of Hubei Province in China on December 31, 2019. Coronaviruses are known to infect multiple organ systems, with respiratory complications being the most obvious symptoms. Although, neurological manifestations are quite rarely reported in cases of COVID-19. In this report, we present the case of a 57-year-old male patient reported with complaints of acute progressive symmetric quadriparesis and recently recovered from COVID-19. Two weeks prior to hospitalization, the patient suffered from cough and fever. The reverse transcriptase-polymerase chain reaction test for COVID-19 infection was positive. Electrodiagnostic tests showed that the patient had acute motor and sensory axonal neuropathy variant of Guillain-Barré Syndrome (GBS). COVID-19 virus stimulates the inflammatory cells and as a result, creates immune-mediated processes. GBS is an immune-mediated disorder. It is not clear whether COVID-19 infection induces the production of antibodies against specific gangliosides. Further investigations should be conducted in regards to the mechanism of GBS in patients with COVID-19 in the future.

Unusual pericuff leak around proseal-laryngeal mask airway corrected by clamping gastric drain port: A case report

Mohd. Mustahsin — 2021-09-15

ProSealTM-Laryngeal Mask Airway (PLMA) (Laryngeal Mask Company, Henley-on Thames, UK) is commonly used for securing the airway with an added advantage over classic LMA as its gastric drain tube allows the insertion of Ryle’s tube and suctioning of gastric contents. The ProSeal LMA is designed in such a way that it allows controlled mechanical ventilation. During controlled mechanical ventilation, air leaks can occur because of positive airway pressures. Air leaks from the gastric drain port are almost always due to the malposition of PLMA. Here, we report a case of air leak from gastric drain port despite correctly placed PLMA and its successful management without removing the device.

Fournier’s gangrene in females: A rare entity

A Prem Kumar — 2021-09-15

Fournier’s gangrene is a form of necrotizing fascitis with abrupt onset of rapidly fulminating genital gangrene of idiopathic origin and gangrene up to deep fascia. It occurs usually in patients with urogenital infections and comorbidities such as diabetes, immunosuppression, or even trauma. Here, we present one such case of an 86-year-old female presenting with a history of pain and purulent discharge from the perianal region for 5 days. On examination, a wound of 20 × 15 cm perineal region extending up to the gluteal region posteriorly and labia majora anteriorly. The patient was planned for debridement under spinal anesthesia on an emergency basis followed by regular dressing and antibiotic therapy. The peri-operative period was uneventful. Along with surgical management, the patient was managed medically by control of sugars, treating sepsis with appropriate antibiotics. The patient recovered from sepsis, and the wound showed granulation tissue after 1 week of serial debridement. The wound was closed with a skin graft at a later date. Fournier’s gangrene should be kept as a differential diagnosis in females with perineal abscesses or necrotizing fascitis in females.

Use of resting state-functional magnetic resonance imaging to assess the utility of focused meditation in post-coronavirus disease cognitive dysfunction

Atul Kapoor — 2021-09-15

Post-coronavirus disease (COVID-19) syndrome is a well-recognized entity in which cognitive brain dysfunction is the most common presentation. Diagnosis and management of such patients are challenging. We describe an important brain finding of post-COVID-19 syndrome on resting (rs)-functional magnetic resonance imaging by mapping the default mode network of the brain which becomes dysfunctional thus causing patient symptoms and its correction by the technique of focused meditation.

Complete resolution of juvenile neuropsychiatric lupus with low dose rituximab

Chanchal Gera — 2021-09-15

Nervous system involvement leads to high mortality in juvenile systemic lupus erythematosus. We present the case of a 12-year-old girl who was admitted with a history of recurrence of fever, cervical swellings, seizure, and delirium. Approximately 6 months back, she was started on antitubercular therapy (ATT) for fever and granulomatous lymphadenitis. She developed a recurrence of fever, new cervical swellings, seizures, and delirium while she was continuing ATT. Magnetic Resonance Imaging brain revealed multiple hyperintensities in bilateral basal ganglia, temporal, and hippocampal regions. The patient was diagnosed to have lupus based on clinical features, positive antinuclear antibody, positive double-stranded DNA antibody, and hypocomplementemia. To avoid cyclophosphamide-related gonadotoxicity in this young girl, Rituximab was given. She was treated with two doses of Rituximab and there was complete resolution of her neuropsychiatric SLE. Rituximab can be considered over cyclophosphamide in children to avoid gonadotoxicity.

Neonatal infective endocarditis in a cardiac rhabdomyoma case: A rare presentation

Manifa Afrin — 2021-09-15

Neonatal infective endocarditis (IE) is an exceedingly rare disease and usually not associated with cardiac rhabdomyomas or any underlying structural cardiac anomalies. Cardiac rhabdomyoma is also the most common benign primary cardiac tumor. The prognosis depends on the size, location of tumors, and outflow tract obstruction but can regress within 2 months of age and reduces the necessity of surgery. Due to the variable clinical features and course, we need to evaluate cardiac vegetation as soon as possible for better outcomes. A combination of these two conditions was not reported before. Here, we presented a case of IE with cardiac rhabdomyoma in a male baby which is first reported from Bangladesh previously.

Accidental intralenticular sustained-release dexamethasone (Ozurdex) implantation: A case report

Chaitali Basu — 2021-09-15

Intravitreal implantation of Ozurdex (Allergan Inc., Irvine, CA, USA), a sustained-release dexamethasone implant, is a common practice in ophthalmology. Inadvertent intralenticular implantation of Ozurdex is a very rare complication. Herein, we report a case of accidental intralenticular Ozurdex implantation. During the intravitreal procedure, the patient moved his head vigorously which resulted in the said complication. He was followed up periodically with monitoring of intraocular pressure (IOP), best-corrected visual acuity, lens status, fundus, and macular edema status. He developed a posterior subcapsular cataract after about 5 months of the procedure. The cataract was removed around 6 months follow-up by phacoemulsification with anterior vitrectomy and implantation of a 3-piece posterior chamber intraocular lens in the ciliary sulcus. Macular edema had resolved by 3 months of Ozurdex implantation and the patient did not require a second intravitreal dose. He was well at 3 months follow up after cataract surgery.

A case report on a rare disorder: Moyamoya

Saikrishna Mandhala — 2021-09-15

Moyamoya is a rare disease characterized by progressive endpoint stenosis of the internal carotid arteries of the internal intracranial portions due to smooth muscle hypertrophy in the vessel walls. Here, we present the case of a 17-year-old boy who has been admitted to a tertiary care hospital in India with complaints of major headache, multiple vomiting episodes, and difficulty in seeing the right half of things from the past 20 days. The computed tomography (CT) brain, magnetic resonance imaging, and cerebral angiogram were examined for the patient. He has been diagnosed with moyamoya disease based on the evaluation. The patient was, therefore, recommended for cerebral revascularization and performed successfully then discharged with stable condition.

An unusual presentation of giant pancreatic pseudocyst in the parietal wall

Ishita Laha — 2021-09-15

A true cyst is a localized fluid collection covered by a capsule lined by epithelium, whereas, a pseudocyst does not consist specific lining of cells. We report one such case of a 37-year-old gentleman with giant pancreatic pseudocyst in the anterior abdominal wall which had developed secondary to acute necrotizing pancreatitis. A contrast-enhanced computed tomography scan showed a pseudocyst in the lesser sac and left pre-renal fossa. He was planned for exploration but within a month, he was at the emergency with yet another episode of gastric outlet obstruction with a huge hypogastric swelling compressing the stomach. The patient was resuscitated and immediately posted for exploratory laparotomy. To the surprise of surgeons, the lump was just below the umbilicus with whatsoever no relation with the pancreas. However, the expert opinion of the histopathologists suggested it to be a pseudocyst.