Open Access Case Report

COVID-19 Patient Associated with Rare Pneumatocele Finding: CT Features and Case Report

Edwin Adhi Darmawan Batubara, Christy Amanda, Paralam Sinambela, Ricky Triweda, Jerry Indra Setiawan

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

Background and Aim: Coronavirus disease-2019 (COVID-19) has become pandemic across the world, especially in Indonesia. One of the rare complications reported due to COVID-19 is pulmonary pneumatocele. We aim to describe the COVID-19 patient case report with pneumatocele in CT-Scan findings.

Case Report: A 41-year-old man referred to our hospital with fever, dyspnea and a productive cough for seven days before admission. His chest X-ray and CT-Scan showed possible bilateral bronchopneumonia due to COVID-19 and confirmed with Polymerase Chain Reaction (PCR) test. In the next two weeks, the second CT-Scan showed the development of pneumothorax dextra and pneumatocele dextra with a diameter of 7,8 cm. On the third follow up, CT-Scan revealed increasing diameter into 9,5 cm and air-fluid levels in pneumatocele. He was diagnosed with infected pneumatocele, and we gave antibiotics. The patient recovered after the twenty-third-day post-admission, then discharged from hospital after twice a negative of nasopharynx swab result and resolution of symptoms.

Conclusion: Pneumatocele is one of the rare abnormality findings in COVID-19 patients. If the clinician suspect pneumatocele finding, the progressivity of disease should be monitored due to the possibility of complicated pneumatocele.

Open Access Case Report

Bilateral Osgood-Schlatter Disease in an Adolescent Nigerian Male: A Case Report

Airenakho Emorinken, Folasade Ojuolape Agbebaku, Oluwaseun Remi Agbadaola, Asuwemhe Johnson Ugheoke

Asian Journal of Case Reports in Medicine and Health, Page 6-9

Osgood-Schlatter disease is a frequent but uncommon cause of knee pain in active adolescent children aged 10-15 years. The incidence is generally unknown. Affected children usually present with a history of pain below the patella at the insertion of the patellar tendon which is usually aggravated by sporting or other activity. Despite its frequent occurrence, late sequelae are rarely observed. We report a 13-year-old male adolescent who presented to the rheumatology clinic with a 1-year history of recurrent bilateral knee joint pain. There was no associated fever, swelling, or limitation of ambulation. The diagnosis was initially missed at first contact at the referring clinic. Plain radiograph of both knees revealed an irregularity of tibial tuberosity; patella tendon edema; osseous density anterior to the tuberosity which suggests Osgood-Schlatter disease. Clinicians need to have a high index of suspicion for prompt diagnosis of Osgood-Schlatter disease especially in adolescents with chronic knee pain.

Open Access Case Report

Corticosteroid Treatment for Recurrent Henoch- Schönlein Purpura with Gastrointestinal Manifestation: A Case Report

Elizabeth Melina, Felix Nathan Trisnadi

Asian Journal of Case Reports in Medicine and Health, Page 17-21

Aims: Henoch-Schönlein Purpura (HSP) is the most common vasculitis during childhood yet sometimes is misdiagnosed. Gastrointestinal symptom in HSP is a frequent finding which causes patient to seek medical care. Recurrent episode of HSP occurs in 2.7–30% cases, most of which has predisposing factors. HSP is usually a self-limiting disease which is managed with supportive treatment. Limited evidence has been reported about the use of corticosteroid for HSP.

Presentation of Case: A 10-year-old girl came with chief complaints of abdominal pain, nausea and vomiting, and palpable purpura in lower extremities a day prior to admission, preceded by upper respiratory tract infection. Patient had history of similar symptoms before, she was diagnosed with recurrent HSP with skin and gastrointestinal manifestations. She was treated with corticosteroid for two weeks and showed clinical improvement during follow-up.

Discussion: Recurrent episode of HSP occurs more frequently in patients with predisposing factors. Although there is no specific recommendation about the use of corticosteroid for HSP, several studies reported benefits of corticosteroid for patients with organ involvement such as gastrointestinal to relieve the pain. We considered giving short-term corticosteroid and observed clinical improvement in our patient.

Conclusion: Identifying predisposing factors for HSP in each patient may help to prevent the recurrence. Despite limited evidence regarding the use of corticosteroid, short-term use of corticosteroid could be considered in HSP with gastrointestinal involvements to relieve the symptoms.

Open Access Case Study

Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency Co-incident with Autoimune Haemolytic Anemia in an Adolescent Female: A Case Report

Chizoma I. Eneh, Chukwunonso C. Iheji

Asian Journal of Case Reports in Medicine and Health, Page 10-16

Background: Glucose-6-Phosphate Dehydrogenase (G6PD) deficiency is a genetic disorder with a deficiency or absence of G6PD, an enzyme required for the proper function of red blood cells. The pattern of inheritance for G6PD gene mutation is sex-linked recessive. It thus affects males and either homozygous or heterozygous females whose unaffected X chromosome is inactivated (lyonized females). Autoimmune hemolytic anemia (AIHA) is a disorder characterized by premature destruction of red blood cells (RBC) by autologous RBC autoantibodies whose presence is demonstrated by a positive direct antiglobulin (Coombs) test (DAT). AIHA is classified into primary or idiopathic and secondary types based on the absence or presence of an underlying disease. In Nigeria AIHA is rare in children but secondary forms are common in teenagers. Chronic granulomatous disease (CGD) is a rare, genetic, immune disorder characterized by neutrophil dysfunction and deficiency or absence of G6PD in both neutrophils and RBC. CGD has both sex-linked recessive and autosomal recessive pattern of inheritance. Therefore CGD with G6PD could occur in a female with X chromosome anomaly in whom co-existence of an immune disorder and G6PD deficiency could worsen hemolysis.

Aim: To highlight the possible existence of the rare chronic granulomatous disease.

Case: To describe a case of acute hemolytic anaemia on a background of G6PD deficiency, positive direct Coombs test and a seeming neutrophil dysfunction in an adolescent female.

Case Report: We report a case of a G6PD deficient 14 year-old female with systemic inflammatory response syndrome, marked neutrophillia yet mild toxic granulation, steroid-responsive hemolytic anemia and positive direct Coombs test.

Conclusion: C6PD deficiency and AIHA may co-exist in an adolescent female possibly as part of CGD but a definitive diagnosis of CGD is required.

Open Access Case Study

Pressure Ulcer on Wrist Post Synthetic Fracture Cast: A Case Report

Varsha Narayanan

Asian Journal of Case Reports in Medicine and Health, Page 22-25

With evolution of technology and materials, new synthetic substances like fiberglass are now available and used for the casting of fractures. Though these offer advantages for both patient and physician, the possibility of developing a pressure ulcer needs to be kept in mind, which should be treated timely and effectively. The family physician can play an important role in imparting such awareness, as well as in treating, and regularly monitoring such cases, with the support of telephonic and video digital health platforms.