Asian Journal of Case Reports in Medicine and Health

Hemorrhagic Posterior Reversible Encephalopathy – A Case Report and Literature Review

Isabela dos Santos Alves — 2020-11-17

We aim to review the etiological investigation and differential diagnosis of PRES, including viral infectious diseases, considering the current Coronavirus disease 2019 (COVID-19) pandemic. Our case report showed a critical patient with hemorrhagic PRES associated with nephropathy. Posterior reversible encephalopathy syndrome (PRES) is an acute neurological syndrome that can be presented as a variety of symptoms and it is usually associated with hypertension status, sepsis, eclampsia, autoimmune diseases, immunosuppressive therapy, or infectious diseases. Recently, an association between that hemorrhagic PRES and COVID-19 was reported. The mechanism of posterior reversible encephalopathy syndrome (PRES) is unknown, but there are two main theories to explain the vasogenic brain edema. The typical imaging pattern includes brain vasogenic edema located in the subcortical white matter and the cerebral cortex of the parieto-occipital lobes. There is no specific treatment for PRES and it can be reversible if the predisposing cause is identified and controlled.

Persistent Pruritic Plaque Like Rash in Adult-Onset Still’s Disease: A Case Report

Mobassir Ali Akbar — 2020-11-23

Adult-onset Still’s disease (AOSD) is a multi-system, inflammatory disease that presents with acute fevers, arthritis or arthralgia, and a evanescent maculopapular rash, mostly occurring with myalgia, sore throat, splenomegaly, lymphadenopathy, raised C-reactive protein (CRP), serum ferritin, and neutrophilic leukocytosis. This is a case report of a 51-year-old female who came with pruritic plaques on her neck, chest, shoulders, upper arms, thighs, and lower back along with fever and arthritis. Her initial lab work showed borderline low C4, positive antinuclear antibody (ANA), and a CRP of 14 mg/dl (that was later increased to 281 mg/dl), microscopic hematuria with +1 protein on urinalysis with a creatinine of 1.3 mg/dl, WBC of 23.5x109/L mildly elevated liver function tests, brain natriuretic peptide (BNP) of 480 mg/dl, and high troponin of 0.130. In this case, we are highlighting the atypical presentation of rash in Adult-onset Still’s disease.

Orbital Emphysema: Is it Due to Primary Blast Injury or Nose Blowing? A Case Report

H. T. D. W. Ariyarathna — 2020-11-28

The authors wish to discuss the possibilities and pathophysiology of orbital emphysema of a live victim of high-explosive blast attack. A 35-year-old male suffered a terrorist blast resulting in shrapnel injuries, flash-burns and bilateral ear drum perforation. Throughout in a conscious and rational state, he was taken to the nearest tertiary-care hospital. Two shrapnels were surgically removed and all external injuries cleaned and dressed. Swollen left eye was examined by the ophthalmologist to reveal unilateral subcutaneous emphysaema and diplopia but no orbital wall fracture was detected. Specialized ENT referral revealed bilateral central eardrum perforation with impaired hearing. Treating clinicians have already attributed all injuries to the effects of the blast, by the time the Forensic Specialists examined the patient for medico-legal purposes. The forensic specialists were reluctant to attribute orbital emphysema to the effects of the initial blast. Detailed history from the examinee revealed an incident of forceful and violent nose-blowing immediately after the blast to relieve the abnormal sensation he felt within his ears. We discuss here the pathophysiology of orbital emphysema and possible mechanisms of its causation. In conclusion, we emphasize the need for careful interpretation of injuries specially in complex situations such as bomb blasts to prevent attribution of erroneous aetiological factors.