Open Access Case Report

Hypernatraemic Dehydration Ensuing Death Following Ingestion of an Unknown Laxative used in Alternative Medicine: A Case Report

H. T. D. W. Ariyarathna

Asian Journal of Case Reports in Medicine and Health, Page 20-25

This is the first reported death from brain damage resulting from hypernatraemic dehydration caused by a laxative administered by a non-medical therapist to a patient. In this case study, the author describes the clinical features, post-mortem features of death due to hypernatraemic dehydration.  The legal aspects pertaining to the case in the context of the mens rea and the actus reus and the manner of death are also discussed. The deceased experienced increased thirst, irritability, loss of consciousness, generalised seizures, and brain death before succumbing to death. The component of mens rea was impossible to determine in this case when attempting to establish criminal responsibility and culpable homicide. Instead, a negligent act was deemed plausible. In Sri Lanka, social and cultural beliefs about alternative medicinal practises exist, but there are no laws regulating the therapists' abilities or the substances they offer to patients. Additionally, such therapists lack the medical knowledge necessary to recognise patients' imminent dangers.

Open Access Case Study

Unusual Neurological Manifestation of Dengue Fever

Mandip Singh Bhatia, Suraj Agrawal, Saurabh Sharda, Ritu Attri

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

Background: Neurological manifestations are considered to be a rare part of dengue fever. The frequency of neurological involvement is not exactly known. Only few cases have been reported in literature from South Asia and Africa. Dengue fever is an arboviral infection with systemic involvement. Neurological complications can occur in the form of encephalitis, seizures, encephalopathy, aseptic meningitis, intracranial haemorrhage, polyneuropathies and Guillain barre syndrome, transverse myelitis etc. These features can be associated with other comorbidities and complications like prolonged shock.

Case Presentation: We are present a case of 50 years female resident of Punjab India, who presented to us with fever of 4 days duration, myalgias, altered mental status, followed by sudden onset paraparesis with urinary incontinence. On examination, there was flaccid paraparesis, areflexia with patchy area of sensory loss without any definite level, neck rigidity and no other significant finding. Routine investigations showed thrombocytopenia, with normal liver and renal functions, tropical fever serology was positive for dengue IgM. After recovery of thrombocytopenia, cerebrospinal fluid examination was done which showed 40 cells predominantly lymphocytes, high protein and normal sugars, fluid was also positive for dengue IgM and dengue PCR. Nerve conduction studies showed acute sensory motor axonal neuropathy. Thus, finally a diagnosis of dengue encephalitis with Guillain barre syndrome was made and patient was started on Immunoglobulin therapy. Patient did respond to the treatment and has now recovered completely over 3 months. 

Conclusion: Neurological complications which occurs after dengue infection due to physiological response of body to dengue virus, can affect body in different forms and systems. Usually the central nervous system involvement and peripheral nervous system involvement and local complication due to  direct viral effect like myositis and  periodic paralysis occur at different time, but rarely both CNS (encephalitis) and PNS (GBS) complication can occur in same patient at the same time.

Open Access Case Study

Tuberculosis of the Oral Cavity Revealing Pulmonary Tuberculosis: About an Observation

A. Raihane, Y. Oukessou, S. Rouadi, R. Abada, M. Roubal, M. Mahtar

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

Tuberculosis of the oral cavity is a rare entity, often secondary to pulmonary localization. This article reports a case of palatine tonsil tuberculosis, indicative of miliary pulmonary tuberculosis, in a 40-year-old patient who has as history of an actif smoking, alcoholism, without any notion of previous tuberculosis infection. The clinical manifestations of oral tuberculosis are not very specific. It most often results in a chronic oral ulceration that evokes many other etiologies among which a malignant tumor, a bacterial, viral or mycotic infection, a systemic disease, a foot-and-mouth ulcer or traumatic. Any chronic oral ulceration whose etiology does not appear obvious, one must think of tuberculosis of the oral cavity. To confirm this diagnosis, histopathological examination, direct bacteriological examination and culture from fresh tissue as well as search for pulmonary tuberculosis are necessary.

Open Access Case Study

Hematohidrosis: A Rare and Mysterious Case

Shrawan Kumar, K. K. Bhoi, Gajanan Yelme

Asian Journal of Case Reports in Medicine and Health, Page 10-13

Aim: To report a rare case of hematohidrosis 13 years old female child.

Presentation of Case: A 13 years old female child was presented at the department of general medicine, Shri Balaji Institute of Medical Science, Raipur. The patient was found to be bleeding from intact skin of the face. The patient had no history of trauma or associated bleeding due to infection and was alert and had no abnormality in general examination. Biochemical and microscopic examinations suggested the presence blood and blood components. The patient was advised 10 mg of propranolol and no recurrent hematohidrosis was observed.

Discussion: Previous literature suggests effective usage of propranolol and lorazepam as anxiolytic. We found significant and effective role of propranolol against the disease and remission was achieved.

Conclusion: Propranolol was used as an efficient beta blocker against the condition and stress was declared as one of the contributory factor for hematohidrosis.

Open Access Case Study

Fatal Undiagnosed Adult Idiopathic Hypertrophic Pyloric Stenosis: An Autopsy Case Report

Sebastian A. Omenai, Friday E. Ogbetere, Ojevwe H. Egbo

Asian Journal of Case Reports in Medicine and Health, Page 14-19

Primary adult hypertrophic pyloric stenosis is an uncommon cause of gastric outlet obstruction in adults [1]. It is a benign condition caused by hypertrophy of the muscularis propria and resembles the congenital pyloric stenosis seen in infants.

We report a case of a middle-aged woman who presented in extremis at our facility with eye witness account of sudden collapse and loss of consciousness. She had adult hypertrophic pyloric stenosis complicated by acute lung injury following aspiration of gastric contents that was diagnosed at post mortem examination following a coroner inquest.

Adult idiopathic hypertrophic stenosis true incidence is not known as the clinical presentation is non-specific and thus diagnosis is difficult and could be missed. Depending on the severity a missed case can present with severe life-threatening complications such as aspiration pneumonitis.