Open Access Case Report

Hemorrhagic Posterior Reversible Encephalopathy – A Case Report and Literature Review

Isabela dos Santos Alves, Cristyano Bismark Ferreira Leite, Cairo Thome Roca, Daniel de Souza Delgado, Maria da Graça Morais Martin, Ana Patricia Ferreira Vieira, Claudia da Costa Leite, Marcos Fernando de Lima Docema

Asian Journal of Case Reports in Medicine and Health, Page 1-8

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.

Open Access Case Report

A Case of Ventilator Associated Pneumonia Caused by Pannonibacter phragmitetus

Dooshanveer C. Nuckchady

Asian Journal of Case Reports in Medicine and Health, Page 20-22

Pannonibacter phragmitetus is an environmental pathogen that can occasionally cause serious infections in humans. While positive cultures for this organism in an otherwise asymptomatic person likely represent contamination, this microbe should not be ignored in patients who show signs of sepsis. This is the first report of a ventilator associated pneumonia caused by this organism.

Open Access Case Study

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

Mobassir Ali Akbar, Arzoo Shahid, Madiha Ariff

Asian Journal of Case Reports in Medicine and Health, Page 9-12

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.

Open Access Case Study

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

H. T. D. W. Ariyarathna, S. R. Hulathduwa

Asian Journal of Case Reports in Medicine and Health, Page 13-19

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.

Open Access Case Study

Restrictive Cardiomyopathy or Hypertensive Heart Disease?: A Case Report

B. P. Wijesinghe, S. R. Hulathduwa

Asian Journal of Case Reports in Medicine and Health, Page 23-27

Cardiomyopathies include a spectrum of intrinsic myocardial diseases without significant inflammation. Out of these, restrictive cardiomyopathy is considered a rare form compared to Hypertrophic and Dilated types. A 67-year-old male with a history of hypertension and diabetes for more than 10 years and a previous echo-cardiographic diagnosis of restrictive cardiomyopathy was admitted with bilateral lower limb swelling, severe dyspnoea and other features of cardiovascular compromise. Despite resuscitative attempts, he died shortly after admission. During the post mortem examination, pink frothy discharge from the mouth and icteric sclerae were noted. Gross pulmonary oedema, gross ascites with 3 liters of straw-colored fluid, nutmeg liver and oedematous kidneys were noted. The spleen was shrunken. Heart was grossly enlarged with a weight of 700 g and increased epicardial fat. Right and Left ventricular thicknesses were 0.8 cm and 2.2 cm respectively showing marked bi-ventricular hypertrophy. All major branches of coronary circulation showed over 60% atherosclerotic narrowing. An organized clot at right auricle was noted with dilated atria. Histological examination revealed pulmonary oedema and congestion, centri-lobular hepatic necrosis, patchy renal tubular necrosis and relatively hypertrophic cardiac myocytes with diffuse interstitial hyaline material. Gross myocyte disarray was not noted specially in sections from the inter-ventricular septum and apex. Special stains did not show evidence of amyloid deposition.  Although the clinical picture might have been compatible with diastolic dysfunction due to a restrictive element restricting the diastolic filling, the primary disease/pathology was confirmed at autopsy as hypertrophy with scarring due to hypertensive heart disease. An infiltrative condition leading to restrictive cardiomyopathy had been excluded. Functional restriction to diastolic filling could be attributed to gross ventricular hypertrophy.