Indian Journal of Case Reports

Persistence of acute coronavirus disease 2019 infection: A rare case report

Anup Kumar Das — 2021-01-12

In late December 2019, the outbreak of coronavirus disease 2019 (COVID-19) caused by a novel coronavirus started in Wuhan, China, and has quickly spread globally. Clinical manifestations of COVID-19 have been shown to vary widely, from asymptomatic to acute respiratory distress syndrome, cardiovascular complications, and neurological symptoms such as acute inflammatory demyelinating polyneuropathy, gastrointestinal symptoms such as progression of compensated chronic liver disease to decompensated chronic liver disease. Here, we present the case of a 60-year-old symptomatic male who was tested COVID-19 positive on rapid antigen test (RAT) and reverse transcription-polymerase chain reaction (RT-PCR). The patient was given treatment as per protocol. The patient’s symptoms improved gradually but his RT-PCR and RAT were persistently positive till the 40th day of his hospital stay.

Griscelli syndrome type 2 with deletion of entire RAB27A gene

Ravi Shankar — 2021-01-12

Griscelli syndrome (GS) type 2 is a rare autosomal recessive disorder caused by mutation of RAS-associated protein RAB27A gene located on chromosome 15. It is a hyper-inflammatory disorder with partial albinism and immunological impairment and/or severe neurological impairment. We describe the case of a 2.5-month-old boy with classic features of GS type 2 with early-onset hemophagocytic lymphocytic histiocytosis (HLH) and multiple recurrences. Genetic testing found homozygous loss of 68 kbp of RAB27A gene at chromosome 15 at cytoregion q21.3, suggestive of deletion of exons 1–5. This genotype of large deletion correlated with the clinical severity. He was managed as per HLH 2004 protocol and was awaiting bone marrow transplantation when he succumbed to his illness. The case is being presented not only as the disease is rare but also the mutation identified is extremely rare and awareness of it will help clinicians to manage the case appropriately.

Broad ligament hernia as a rare cause of acute small bowel obstruction: A wolf in sheep’s clothing – A case report with review of the literature

Rafique Umer Harvitkar — 2021-01-12

Broad ligament hernia (BLH) is a rare clinical entity. It is a potentially life-threatening, yet often neglected and sometimes misdiagnosed surgical condition. We, herein report a case of acute small bowel obstruction in a 42-year-old female caused by internal herniation of the small bowel through a defect in the left broad ligament, which was successfully managed laparoscopically. We also reviewed the literature on BLH and present our recommendation on the diagnosis and management of BLH.

Eosinophilic gastroenteritis: A case report of a rare disease mimicking acute abdomen

Anoop James George — 2021-01-12

Eosinophilic gastroenteritis (EGE) is a rare disease that can present as acute abdomen and can be challenging for a clinician to differentiate amidst the numerous causes of abdominal pain. Due to the non-specificity of symptoms and scarcity of diagnostic guidelines, a high index of suspicion is required to diagnose EGE and thereby defer unnecessary surgical interventions. Herein, we present the case of a 17-year-old female who had presented to the emergency department (ED) with severe abdominal pain and peripheral eosinophilia mimicking an acute abdomen. The relevance of the case resides in highlighting the fact that such rare diseases are often missed in ED and a broader diagnostic spectrum should be considered while evaluating cases of undifferentiated acute abdomen.

Unilateral hemichorea and hemiballismus: Rare complications of non-ketotic hyperglycemia

Hardil Paresh Majmudar — 2021-01-12

Hemichorea-hemiballismus is an extremely rare and dramatic complication of non-ketotic hyperglycemia in patients with uncontrolled diabetes mellitus. Here, we present the case of a 65-year-old male, known hypertensive, diabetic with the left eye retinopathy who presented with the chief complaints of sudden onset hemichorea and hemiballismus on the right upper and lower limbs. Magnetic resonance imaging brain reported T1 hyperintense and T2 isointense/hypointense signal in the left putamen with no restricted diffusion – these signal changes. He was started on oral antihyperglycemics and a combination of tetrabenazine, clonazepam, and haloperidol. Mild resolution of symptoms was seen and the patient is on follow-up with advice to control sugar through diet and regular sugar monitoring.

Adenocarcinoma jejunum: A rare cause of acute onset vomiting

Manju Kumari — 2021-01-12

Small intestine malignancies are very rare and account for <5% of gastrointestinal malignancies. Of these, around 64% occur in the duodenum, 13% in the jejunum, and 13% in the ileum. They mostly present as non-specific symptoms due to which the diagnosis is often delayed. We present the case of a 57-year-old female who presented with a short vague history of pain abdomen and vomiting. The abdominal ultrasound was normal which further delayed the diagnosis. The computed tomography scan was done which revealed circumferential thickening of the jejunal wall. On histopathology, the final diagnosis of adenocarcinoma was made.

Myelopathy: A rare presentation of initial systemic lupus erythematous manifestation in a young male

Ritu Gupta — 2021-01-12

Acute transverse myelitis (ATM) is a consequence of inflammation of various etiologies resulting in damage to the nerve tracts. Regardless of the etiology, the prevalence of ATM is estimated at 1–4 new cases per million a year. Among connective tissue disorder, systemic lupus erythematous (SLE) is the most common cause of ATM. SLE is complicated by neurological manifestation in 25–80% of the patients. ATM may be a complication in 1–3% of SLE patients, but in some patients, it may be the first manifestation of SLE. We describe the case of a 20-year-old male where longitudinal extensive transverse myelitis was the initial manifestation of SLE involving almost the whole length of the spine. Early diagnosis and aggressive treatment may prevent long-term permanent damage and may have a favorable outcome

Foreign body in gallbladder: A case report

Ashwani Kumar Malhotra — 2021-01-12

Foreign bodies in the gall bladder are a rare event, and they being asymptomatic is even rarer. The rarity of such a clinical entity makes the following worthwhile of recording. We report the case of a 51-year-old male who was incidentally found to have gallstones on abdominal ultrasound. The patient himself was asymptomatic. Blood investigations were unremarkable. The patient underwent a laparoscopic cholecystectomy which was later converted to an open procedure. Intraoperatively, he was found to have a cholecystoduodenal fistula for which cholecystectomy, resection of fistula, and repair of the duodenum were done. On bisecting the gallbladder specimen, it was found to contain a wooden toothpick. To the best of our knowledge, this is the first report in the medical literature of a toothpick inside the gallbladder.

Cryptococcal meningitis: A delineating presentation peeping toward HIV status

Manoj U Vedpathak — 2021-01-12

Cryptococcal meningitis is an ominous presentation of the most common opportunistic fungal infection in patients affected by the Human immunodeficiency virus (HIV). Cryptococcus neoformans is the commonly associated species in immunocompromised patients. It is the first AIDS-defining illness in 6–10% of patients. Cryptococcosis is reported as a major opportunistic infection in India. The case of cryptococcal meningitis presented here is of a young, chronic alcoholic 28-year-old male patient with non-specific symptoms having the only significant history that he was sexually active with a woman whose husband died of unknown cause which draws attention to look for HIV status of the patient which was found to be reactive confirming it as one of the AIDS-defining illness.

Neonatal cardiac hypertrophy: A rare case of clinically suspected and genetically confirmed mitochondrial disorder presenting as hypertrophic cardiomyopathy

Sushil Azad — 2021-01-12

Infants presenting with ventricular hypertrophy in the absence of structural heart disease causes can be either genetic, metabolic, or storage disorders. Familial hypertrophic cardiomyopathy is very rare in the neonate. We present a rare case of infantile cardiomyopathy with clinical suspicion of mitochondrial disorder confirmed genetically to have a disorder of mitochondrial oxidative phosphorylation with both parents as a carrier of the recessive gene to highlight the importance of detail genetic evaluation of all neonates presenting with ventricular hypertrophy.

Imaging findings in diastematomyelia: A rare type of spinal dysraphism

Ramakrishna Narra — 2021-01-04

Diastematomyelia, also termed as split cord malformation (SCM), is a rare congenital spinal dysraphism in which there is an abnormal sagittal clefting of the spinal canal that causes the cord to split into two hemicords by a fibrous, osseous, or cartilaginous septum. Various vertebral segmental anomalies such as hemivertebrae, butterfly vertebrae, and scoliosis are seen in association with diastematomyelia. Most of the diagnosed cases of diastematomyelia are children under the age of 7 years. Such a spinal anomaly is less frequently diagnosed in adults with female preponderance. We reported a case of diastematomyelia that was diagnosed by magnetic resonance imaging (MRI) in a 23-year-old woman who presented with chronic back pain for 7 years. MRI is the imaging modality of choice for establishing the diagnosis and exploring any associated malformations.

A case series on post-COVID pulmonary rehabilitation: Early experiences from Kerala, South India

Akhilesh Kunoor — 2021-01-12

Patients who were contracted with COVID-19 are reported to have a variety of symptoms affecting neuromuscular, psychological, cardiac, and respiratory systems. A significant proportion of patients present with prolonged symptoms even weeks to months including minor illness. The lung is the most common and important organ affected in COVID-19 and sequela can result in exertional breathlessness, cough, hypoxia, or pulmonary fibrosis. Along with medical and supportive therapy, a multidisciplinary pulmonary rehabilitation program is essential to improve the quality of life and reduce symptoms in post-COVID-19 patients. We report a case series of three cases who presented with diverse manifestations after COVID-19 recovery, who were treated with a multidisciplinary pulmonary rehabilitation program. This case series, with early experiences from Kerala which had its peak of COVID-19 pandemic in late October 2020, shows a substantial improvement of symptoms in patients even with initial rehabilitation sessions itself, which shows promising hope in post-COVID-19 management.

Acute Hemorrhagic Edema of Infancy: A Case Series of Three Cases

Gabriela Roncada Haddad — 2021-01-12

Acute hemorrhagic edema of infancy (AHEI) is a poorly known benign vasculitis. With a rapid course, self-limited evolution, and without specific diagnostic tests, it is poorly diagnosed. It has differential diagnosis with Henoch–Schönlein’s purpura, multiform erythema, Kawasaki’s incomplete disease, or urticaria. We present a case series of three cases of children with a clinical diagnosis of AHEI, and in two of them, a biopsy was performed which confirmed the diagnosis. The three children have a maculopapular purpuric eruption, fever, and edema at the extremities. They were treated with symptomatic medications and showed improvement in a few days. AHEI is a rare vasculitis, sometimes underdiagnosed, due to the similarity with other differential diagnoses, much more prevalent. As it is not frequently described, and due to the exuberance of symptoms, it is a disease susceptible to diagnostic errors and iatrogenic treatments.

A series of four cases on plasmablastic lymphoma: A rare Epstein–Barr virus-positive lymphoma in immunocompetent patients with varied presentation

Gaurav Sharma — 2021-01-12

Plasmablastic lymphoma (PBL) is a rare and aggressive type of non-Hodgkin lymphoma (NHL) which is typically seen in the setting of an immunocompromised state, classically associated with human immunodeficiency virus infection. It is often also associated with Epstein–Barr virus infection. It has an immunophenotype of a terminally differentiated B lymphocyte. The diagnosis of PBL is challenging due to complex overlap with myeloma and other B-cell NHL having a plasmablastic morphology. In the past few years, there are an increasing number of cases being identified in patients with no known immunocompromised state. We hereby report a case series of four such cases in immunocompetent patients with different sites of involvement and varied presentation to add to the literature.