Open Access Case Report

Ataxia and Seizure as a Manifestation in a Pediatric Case of SARS-CoV-2

Farzad Ahmadabadi, Amirmohammad Abdolmohammadzadeh, Negin Nahanmoghaddam, Faramarz Ajri

Asian Journal of Case Reports in Medicine and Health, Page 6-11

Background: SARS-CoV-2 infection is an ongoing pandemic with more than seven million cases worldwide and a wide range of presenting symptoms in various ages. Neurological symptoms as mildly as a light headache and as severe as an acute encephalitis are reported.

Objective: We aim to report the clinical course of pediatric patient infected with SARS-CoV-2 whom also presented ataxia and seizures as her neurological manifestation.

Case: Patient was a 16 month old baby girl with clinical presentations of ataxia, focal myoclonic seizures, fever and diarrhea and no significant medical history. Her seizures were controlled with sodium valproate along with carnitine.  She developed respiratory symptoms after her RT-PCR test from her nasopharyngeal sample swap returned with positive results. We ruled out a wide range of disease such as paraneoplastic and metabolic disorders. Patient was discharged with full recovery after receiving IVIG.

Discussion: We believe there is a post infectious mechanism involved that has lead the patient to have such neurological manifestations because of a significant response to IVIG while she also presented typical finds in children infected with SARS-CoV-2. Patients with SARS-CoV-2 infection can have neurological manifestations despite their negative RT-PCR test for SARS-CoV-2 in their cerebrospinal fluid.

Conclusion: During the pandemic, every practitioner should have SARS-CoV-2 infection in mind when it comes to neurological manifestations without a strongly-associated explanation.

Open Access Case Study

A Lipomatous Axillary Mass Revealing an Eosinophilic Granulomatosis with Polyangiitis

Raja Amri, Rami Triki, Haifa Tounsi, Imen Chaabene, Emna Chelbi, Hassen Touinsi, Mohamed Ali Sbai

Asian Journal of Case Reports in Medicine and Health, Page 1-5

Eosinophilic granulomatosis with polyangiitis (EGPA), formerly called Churg-Strauss syndrome, is a condition characterized by asthma, high levels of eosinophils and vasculitis. It is characterized during its prodromal phase by an asthma of increasing severity. Vasculitis affects the lungs, the heart, the skin and the peripheral nerves. Skin involvement is common but may not be very suggestive.

The authors report the case of a 39-year-old man, with a medical history of asthma and sinusitis, who consulted in the ER for abdominal pain and partial occlusion syndrome. Diagnostic laparoscopy showed images of digestive vasculitis. Skin biopsy of an axillary subcutaneous mass which had lipomatous aspect was compatible with vasculitis associated with a perivascular infiltrate rich in eosinophils. Biology showed a persistent hyper eosinophilia in the blood. Antineutrophil cytoplasmic antibodies were negative. There was no evidence of pulmonary infiltrate or sinus opacity. The other cardiac, neurological and renal explorations were normal. The diagnosis of EGPA was suspected based on clinical and biological arguments. It was confirmed by skin biopsy of an atypical axillary mass. Treatment with corticosteroid therapy and immunosuppressants resulted in spectacular clinical improvement with a 3-year follow-up.

The cutaneous manifestations can have an essential contribution for the diagnosis of vasculitis. Early recognition of these lesions is essential for proper treatment and prevention of serious visceral complications.

Our observation is unique due to the atypical cutaneous manifestation which contributed to the early positive diagnosis of EGPA.

Open Access Case Study

Povidone-iodine Induced Fixed Bullous Eruption: A Case Report

Zaruhi G. Kalikyan, Sona S. Harutyunyan, Tatevik G. Aloyan

Asian Journal of Case Reports in Medicine and Health, Page 12-16

Fixed drug skin eruption to the iodine especially manifesting by bullous lesions is very rare. We present a case of a 73-year-old female who developed multiple blisters on the fingers of both hands with serous or serous-hemorrhagic content after a week of postoperative topical use of Povidone-iodine. Clinically diagnosed bullous eruption resolved in 12 days on the background of offending drug discontinuation and systemic steroid treatment but then it was reappeared at the same site after re-treatment of inflamed wound with the same antiseptic drug. Three months later after the complete resolution of the symptoms, diagnostic examinations such as patch-test and provocation were performed. On the basis of these test results, the diagnosis of a fixed bullous eruption caused by Povidone-iodine was confirmed.

Open Access Case Study

Atypical Presentation of Novel COVID 19 Disease: A Case Report and our Experience

I. O. Akpalaba, T. O. Olarinoye

Asian Journal of Case Reports in Medicine and Health, Page 17-22

Introduction: COVID 19 virus infection commonly presents with respiratory symptoms which has posed a serious public health concern due to its mode of transmission from direct contact. A different mode of presentation was noticed in our establishment which appeared atypical.

The Aim: The aim of this report is to show this atypical presentation of the novel corona virus disease, its impact in our environment and possible solution.

Presentation of Case: This is a male 60 year old, who presented with anterior neck wound and unconsciousness of 2 weeks duration associated with fever, which was unremitting despite high dose antibiotics. He tested positive to COVID 19 virus disease, exposing all the managing team to risk of the infection.

Discussion: All the exposed health workers tested negative, but the spouse of the patient was COVID 19 positive, this shows the importance of use of protective gadgets against COVID 19 virus infection.

Conclusion: COVID 19 infection presentation can be atypical. All patients should be regarded as carriers until proven otherwise.

The solution to reduce exposure of many staff to this disease is screening of every patient at presentation.

Open Access Case Study

Plasmablastic Lymphoma: A Challenging Diagnosis

Ephrem Christelle, Elias Edouard, Khoueiry Paul, Matta Clemence

Asian Journal of Case Reports in Medicine and Health, Page 23-26

Introduction: Plasmablastic lymphoma (PBL) is an aggressive lymphoma characterized by early relapses and subsequent chemotherapy resistance representing therefore diagnostic and therapeutic challenge with a very poor outcome.

Case Presentation: A 53-year-old- female patient presented with dyspnea and general status alteration due to anemia; diagnosed as hemolytic anemia and treated by corticotherapy without amelioration. The most recent hospitalization revealed worsening of her symptoms with weight loss of 5 kilos in one week, anorexia and lumbar pain. Physical examination showed isolated splenomegaly with no signs of bleeding, adenopathy nor a palpable breast mass. Extended laboratory tests were normal, except normocytic anemia with hemoglobin =8.76 g/dl; hct=26.6%; MCV=89.2 fl and a low haptoglobin concentration level <0.04 g/l with a high value of LDH 1165 UI/litre. Hypercalcemia of 12 mg/dl was also noted with low PTH. To complete the workup: imaging showed a total body CT scanner with absence of adenopathy, a magnetic resonance imaging (MRI) with no metastatic bone lesions confirming the diagnosis and a full body PET CT scanner revealing diffuse hyperactivity of the bone marrow with hypermetabolic splenomegaly, hepatomegaly and bone lytic lesion of some cervical vertebras. Bone marrow aspirate, biopsy and flow cytometry were done and in favor of lymphoma. An immunohistochemical profile shows positivity and correlates with morphology. It was compatible with Plasmablastic lymphoma (PBL). Patient received three cycles of chemotherapy (lenalidomide and CHOP) and immunomodulatory agents. But she passed away three months later.

Conclusion: Despite the recent advances in therapy of aggressive lymphomas, patients with PBL have the poorest outcome. Moreover, due to its challenging diagnosis and related complications, management of PBL remains to discuss on a case by case basis.