Indian Journal of Case Reports

Post-COVID-19 Guillain-Barre syndrome with good response to intravenous immunoglobulin

Gopala Krishnan Ravi — 2022-08-10

A case series of Covid-19-associated fungal infections: The gruesome twosome

Sunayana Jangla — 2022-08-10

Severe Acute Respiratory Syndrome Coronavirus-2(SARS-CoV-2) is the novel coronavirus responsible for causing Coronavirus disease (COVID-19). The pandemic has seen many ebbs and flows since its detection, particularly regarding various manifestations coupled with it. Secondary fungal infections, especially COVID-19-associated mucormycosis, have seen a summit, especially during the second wave of the pandemic. However, we reported a series of three cases of mucormycosis in association with another fungal mould from the sample received from patients infected with this virus that presented to our hospital during this pandemic. Our report is about the novelty of dual fungal infection caused by a Zygomycete group along with Aspergillus isolated from pulmonary as well as extra-pulmonary sites, all of which were confirmed on culture. Timely and multidisciplinary management of these patients helped patient survival.

Pinpoint size port d’Entrée as a predictor for better clinical outcome in pediatric endophthalmitis: A case series

Andi Arus Victor — 2022-08-10

Endophthalmitis is an intraocular inflammation involving both posterior and anterior segments, caused by bacterial or fungal infections. Here, we present a case series of five cases presented to the National Referral Hospital from January to December 2017. Five eyes were identified, including exogenous and endogenous odontogenic causes. All eyes were managed with vitrectomy, intravitreal antibiotics, and systemic antibiotics. Documented final best VA were 20/40 (20%), 1/300 (40%), and no light perception with phthisis bulbi (40%). Despite aggressive timely treatments, visual prognosis are poor in both endogenous and exogenous endophthalmitis. The best final VA 6/12 was found in the smallest port d’entrée size (pinpoint). Other characteristics did not show any significant clinical difference. Pinpoint size or smaller port d’entrée suggests better visual outcomes in pediatric endophthalmitis.

A case series on bullous pemphigoid like scabies: A diagnostic challenge

Dooha hamdi — 2022-08-10

Scabies is an ectoparasitic infection caused by Sarcoptes scabiei var. hominis in humans. Accurate figures of the prevalence of scabies are difficult to obtain, it seems to affect around 100–300 million people worldwide. Scabies is usually transmitted by close intimate physical contacts, such as the sharing of a bed or prolonged hand-holding. Scabies mites survive for 24–36 h outside of human bodies. Itching is the most obvious manifestation of scabies, which is usually sparing the face in adult classic scabies. The onset occurs 3–4 weeks after acquiring the infection. Bullous pemphigoid-like scabies is one of the atypical and rare forms of scabies that may be overlooked and mismanaged, where only 44 cases worldwide with this mode of presentation were reported. Here, we reported a series of three cases of bullous pemphigoid-like scabies, which presented with nocturnal itching and vesiculobullous lesions that are to the best of our knowledge the first cases reported in our country

Peripheral odontogenic fibroma an uncommonly overviewed benign neoplasm: A case report and review of literature

Lavanya Pasalkar — 2022-08-10

Peripheral odontogenic tumors (POTs) are one of the rare neoplasms to occur on the gingiva. Peripheral odontogenic fibroma (POdF) is the most common POT constituting a prevalence of 1.2%. A plethora of lesions sharing similar clinical features makes the diagnosis difficult. Histopathological examination plays a key role in these types of cases. Here, we present a rare case of POdF in a 36-year-old female patient with a lobulated pebbled-like exophytic growth on the right gingiva. Histopathological investigation showed the presence of odontogenic epithelium and dystrophic calcification which are the pathognomonic features of POdF. After surgical removal, POdF is seen to recur, but the exact recurrence rate cannot be estimated due to the scarcity of reported cases. In this case, follow-up of the patient showed no recurrence at 6, 12, and 18 months post-surgery.

Early to recognize and Early to recover: A case series on Thyrotoxic periodic paralysis

Raja Poovarasan — 2022-08-10

Thyrotoxic periodic paralysis (TPP) is a rare disease of muscle, presenting with sudden onset weakness of muscles with or without features of hyperthyroidism. The disease most commonly occurs in the Asian population representing about 1.9% of thyrotoxic patients. It involves a predominantly male population with no family history, with or without hypokalemia. Pathophysiology is still not clearly understood. We are describing, a case series of two different patients of TPP presented to our emergency department (ED). One patient presented with classical episodic weakness of both lower limbs specifically during the night times with spontaneous reversal of weakness early in the morning. Another patient presented with complete weakness of both lower limbs for the past 1 day. Both of them had a history of weight loss and intermittent palpitations. They were promptly diagnosed in the ED and successfully treated. We recommend evaluating thyroid function status in the emergency room with the aforementioned clinical features, as early recognition and correction of thyrotoxic state are the definitive treatment helping in a complete reversal of weakness. Potassium supplements, beta-blockers, and antithyroid medications are used in treating acute attacks and preventing recurrence.

Peculiar association of pulmonary embolism with evolved inferior wall myocardial infarction

Nandha kumar Selvam — 2022-08-10

Inferior wall myocardial infarction (MI) is one of the common straightforward cardiac conditions in the emergency department (ED) but inferior wall MI masquerading pulmonary embolism (PE) is extremely rare and can be missed if not evaluated promptly in ED. Misdiagnosis of PE is associated with high mortality. Here, we report a case of a 67-year-old male who was admitted to the ED and has been diagnosed with evolved inferior wall MI based on his clinical presentation and electrocardiogram. Later, he developed syncope following which he was reassessed and evaluated for the other possible conditions. Bedside echocardiography findings raised suspicion for PE, which was further confirmed by computed tomography pulmonary angiogram (CTPA). The patient underwent successful thrombolysis and was scheduled for an elective coronary angiogram. This case report highlights the importance of clinical presentation and the benefits of bedside echocardiography that helped in suspecting the association of PE with evolved inferior wall MI.

CT myocardial perfusion imaging complementing coronary CT angiography in a patient with a history of unstable angina: A case report

Christian Rendy Chandra — 2022-08-10

Coronary computed tomography angiography (CCTA) could show the morphological status of coronary stenosis. Moreover, computed tomography (CT) myocardial perfusion (CTP) could provide additional information to identify hypoattenuating areas that might complement the limitation of CCTA in terms of evaluating the functional status, adding to the diagnostic performance of CCTA. We reported the imaging features of coronary artery disease in a female patient with a history of unstable angina by evaluating the anatomic and functional information through CCTA and CT myocardial perfusion in one stop modality.

A case report on leptospirosis with pseudohepatorenal syndrome

Nishant Johri — 2022-08-10

The spirochete Leptospira interrogans causes leptospirosis, a zoonosis. There are numerous clinical symptoms of leptospirosis. Clinical manifestations might range from a subclinical infection with a mild fever to severe clinical symptoms with jaundice and renal failure. Here, a case of leptospirosis with acute renal failure, thrombocytopenia, and hyperbilirubinemia is presented. A 51-year-old man presented with fever, body aches, muscle aches, colored urine, and jaundice for 2 days. On serology report, L. interrogans AB IGM-CARD was weekly positive. In the Renal function test, urea and creatinine values were high as well as the liver function test was abnormal. The patient was given 1 g of ceftriaxone intravenously and 100 mg of doxycycline orally. Hepatorenal treatment was supportive and the outcome was positive. It may have been overlooked when the diagnosis of leptospirosis was confirmed.

Japanese encephalitis presenting as transverse myelitis: An uncommon presentation

Leema Pauline Cornelius — 2022-08-10

Japanese Encephalitis Virus (JEV) is the main cause of viral encephalitis in South East Asia. Commonly, it presents as an acute encephalitic syndrome with fever, headache, seizures, and altered sensorium as clinical manifestations. However, there can be atypical presentations such as acute transverse myelitis (ATM) as the initial manifestation. Clinicians should be aware of such possibilities and myelitis due to the JE virus should be considered as a differential in children presenting with encephalomyelitis.

A case of significant weight loss and severe malnutrition caused by achalasia

Reeju Maharjan — 2022-08-10

Achalasia is caused by chronic degeneration of ganglionic cells in the myenteric plexus that leads to failure of relaxation of the lower esophageal sphincter (LES). This leads to aperistalsis of the digital esophagus and eventually led to dilation of the lower esophagus. We present the case of a 37-year-old man who initially presented with dysphagia for solid food and then slowly developed dysphagia for liquid over the past 6 months. He had significant weight loss, and his esophagogastroduodenoscopy (EGD) showed esophagitis and gastritis. The imaging of computed tomography (CT) with oral contrast showed dilation of the distal esophagus and mild circumferential thickening at the gastroesophageal junction. After the failure of response to BoTox-infiltration in the LES, the patient was taken for Heller’s myotomy. He showed immediate improvement in dysphagia after surgical intervention. This case study includes findings from CT scan, X-ray, and EGD with biopsies in this patient. This paper also summarizes the therapeutic options of BoTox-injection and surgical myotomy

Pregnancy with COVID-19-related severe ARDS: A case report from rural critical care unit in India

Harish Handyal — 2022-08-10

Acute Respiratory Distress Syndrome (ARDS) can frequently occur as a complication of Coronavirus Disease 19 (COVID-19). As a result of the increasing number of COVID-19 cases around the world, it is inevitable that ARDS will complicate some pregnancies with COVID-19. At present, there are scarce data to guide decision-making on the timing of delivery for these patients. We present a case of a pregnant woman at 30 weeks gestation with COVID-19-related ARDS, who was successfully managed with lung protective strategies for mechanical ventilation and early delivery by cesarean section in the rural critical care setting.