Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 18 de 18
Filter
1.
BMJ Case Rep ; 15(6)2022 Jun 07.
Article in English | MEDLINE | ID: covidwho-1916381

ABSTRACT

Burning mouth syndrome (BMS) is a rare but serious medical condition with important psychiatric comorbidity and specific psychological correlates. Psychopathology related with BMS represents a real challenge for clinical decision-making. In this case, depression is the leading psychiatric diagnosis associated with patient's BMS somatic pain and is driven by anxiety and a dissociative functioning. Facing a complex psychosomatic symptomatology, we offer new clinical perspectives for the screening of psychological traits of BMS. Moreover, we highlight the need to foster interdisciplinarity to improve differential diagnosis and defining an optimal care path. This case report stimulates a reflection on management challenges for the consultation-liaison psychiatry and shows the importance of a person-centred approach when communicating the diagnosis.


Subject(s)
Burning Mouth Syndrome , Depressive Disorder, Major , Olfaction Disorders , Anxiety/complications , Burning Mouth Syndrome/complications , Burning Mouth Syndrome/diagnosis , Depression/psychology , Depressive Disorder, Major/complications , Humans , Olfaction Disorders/complications , Seizures/complications
2.
BMJ Case Rep ; 15(2)2022 Feb 28.
Article in English | MEDLINE | ID: covidwho-1714388

ABSTRACT

Embolic events causing stroke and intracranial haemorrhage are among the most catastrophic complications of infective endocarditis (IE).A female patient presented with acute unilateral weakness following a 3-month history of fever, for which she had multiple remote consultations with her general practitioner. A brain MRI confirmed a left sided infarct with haemorrhagic transformation. Blood cultures grew Streptococcus mitis and her cardiac imaging showed an aortic valve vegetation with severe aortic regurgitation. Following 2 weeks of antibiotics she developed a new cerebral haemorrhage associated with a mycotic aneurysm which was treated with two coils. After discussions within the multidisciplinary meeting, she underwent aortic valve replacement 3 weeks later. She made a remarkable recovery and was discharged.Our case highlights the importance of face-to-face clinical review in the post-COVID era. It stresses that the management of patients with infective endocarditis and neurological complications is challenging and requires a multidisciplinary approach.


Subject(s)
COVID-19 , Endocarditis, Bacterial , Endocarditis , Remote Consultation , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Delayed Diagnosis , Endocarditis/complications , Endocarditis/diagnosis , Endocarditis/surgery , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/drug therapy , Female , Humans , SARS-CoV-2
3.
BMJ Case Rep ; 15(1)2022 Jan 07.
Article in English | MEDLINE | ID: covidwho-1612961

ABSTRACT

Postoperative fevers are common in hospitalised patients and warrant workup beyond the early post-op period. A 50-year-old man was admitted after sustaining a tibial plateau fracture. Fevers began 3 days after external fixation and persisted through a second surgery despite initial negative workup. Careful review of medications revealed enoxaparin as the instigating agent of a febrile drug reaction, and the fevers resolved after discontinuing the drug. On further questioning, it was discovered the patient had an allergy to pork, from which the main components of enoxaparin are typically derived. To our knowledge, this is the first reported enoxaparin-induced fever in the setting of a pork allergy. Enoxaparin-induced fevers should be considered in patients with unexplained post-op fever. Our case demonstrates the importance of analysing newly administered medications. Simple detailed history may significantly reduce patient morbidity and help to broaden differentials during investigation.


Subject(s)
Fever of Unknown Origin , Hypersensitivity , Pork Meat , Red Meat , Animals , Anticoagulants/adverse effects , Enoxaparin/adverse effects , Humans , Male , Middle Aged , Postoperative Complications/chemically induced , Swine
4.
BMJ Case Rep ; 14(11)2021 Nov 19.
Article in English | MEDLINE | ID: covidwho-1526471

ABSTRACT

Alpha-gal syndrome (AGS) is a hypersensitivity reaction to mammalian meat that develops after tick bite exposure. AGS was first described in 2009 and testing for the allergy has become available in the last decade. We report the case of a 56-year-old farmer with a history of frequent lone star tick bites who presented with a 7-year history of diffuse urticaria occurring hours after eating red meat. AGS is likely underdiagnosed because of the unusual presentation of the allergy, historic lack of available testing, and deficiency of physician knowledge about the condition. Recognition of AGS is important both to help alleviate symptom burden and to avoid iatrogenesis. Patients with AGS should not receive products containing mammalian products, such as cat-gut suture, porcine-derived heart valves, and bovine-derived vaccines. Patients with AGS may present in a variety of clinical environments and physicians of all kinds should be able to recognise the symptoms.


Subject(s)
Food Hypersensitivity , Red Meat , Tick Bites , Urticaria , Animals , Cattle , Food Hypersensitivity/diagnosis , Food Hypersensitivity/etiology , Humans , Meat
5.
BMJ Case Rep ; 14(10)2021 Oct 07.
Article in English | MEDLINE | ID: covidwho-1462938

ABSTRACT

With increasing presentations of headaches following COVID-19 vaccination, we present one of the UK's earliest proven cases of vaccine-induced thrombotic thrombocytopaenia (VITT), with the aim of giving colleagues a case to compare other patients against. Our patient was a 48-year-old man who presented with frank haematuria, a widespread petechial rash, and headaches, 2 weeks after receiving the first dose of the Oxford AstraZeneca ChAdOx1 nCoV-19 vaccine. He had a platelet count of 14×109/L and an extensive cerebral venous sinus thrombosis (CVST) with subarachnoid haemorrhage on imaging. He developed localising neurological signs and experienced a cardiopulmonary arrest. He was successfully resuscitated and transferred to a tertiary care centre for urgent thrombectomy. This case illustrates how the diagnosis of VITT should be based on the platelet count and imaging-and how patients with VITT should be cared for in centres with urgent neurosurgical and interventional radiology services.


Subject(s)
COVID-19 , Exanthema , Sinus Thrombosis, Intracranial , COVID-19 Vaccines , Headache , Hematuria , Humans , Male , Middle Aged , SARS-CoV-2 , Vaccination
7.
BMJ Case Rep ; 14(6)2021 Jun 10.
Article in English | MEDLINE | ID: covidwho-1266371

ABSTRACT

A healthy, active woman in her 70s reported intermittent exertional dyspnoea for 2 months, notable during frequent open-water swimming. Symptoms were similar to an episode of travel-provoked pulmonary embolism 3 years prior. She denied chest pain, cough, fever, extremity complaints and symptoms at rest. Due to the COVID-19 pandemic, her healthcare system was using secure telemedicine to evaluate non-critical complaints. During the initial video visit, she appeared well, conversing normally without laboured breathing. An elevated serum D-dimer prompted CT pulmonary angiography, which identified acute lobar pulmonary embolism. After haematology consultation and telephone conversation with the patient, her physician prescribed rivaroxaban. Her symptoms rapidly improved. She had an uneventful course and is continuing anticoagulation indefinitely. The pandemic has increased the application of telemedicine for acute care complaints. This case illustrates its safe and effective use for comprehensive management of acute pulmonary embolism in the primary care setting.


Subject(s)
COVID-19 , Pulmonary Embolism , Telemedicine , Female , Humans , Pandemics , Primary Health Care , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/drug therapy , SARS-CoV-2
8.
BMJ Case Rep ; 14(5)2021 May 11.
Article in English | MEDLINE | ID: covidwho-1226742

ABSTRACT

Creutzfeldt-Jakob disease (CJD) is a rapidly progressive, fatal neurodegenerative disorder belonging to the family of transmissible spongiform encephalopathies. The disease is believed to be caused by an abnormal isoform of a cellular glycoprotein known as the prion protein. Our patient is an 84-year-old Caucasian man who presented to the geriatric clinic for evaluation of short-term memory loss and decreased concentration which started 3 months prior to initial evaluation. Rapid progression of dementia demonstrated by severe impairment in tasks with a predominantly visual component, including visual scanning, perceptual reasoning and visual spatial processing. Diagnosis of CJD was determined by characteristic ribboning on brain MRI as well as notable real-time quaking-induced conversion on cerebrospinal fluid.


Subject(s)
Creutzfeldt-Jakob Syndrome , Prion Diseases , Aged , Aged, 80 and over , Creutzfeldt-Jakob Syndrome/complications , Creutzfeldt-Jakob Syndrome/diagnosis , Humans , Magnetic Resonance Imaging , Male
9.
BMJ Case Rep ; 14(4)2021 Apr 21.
Article in English | MEDLINE | ID: covidwho-1197246

ABSTRACT

A previously fit and well 72-year-old man was referred to the acute medical unit with acute shortness of breath and confusion. He had presented 6 months earlier to his General Practitioner with a 6-month history of weight loss and lethargy. Despite CT imaging and extensive blood tests, no cause was found. He was having ongoing outpatient investigations, including a respiratory review leading up to his admission; the deterioration in his condition also coincided with the implementation of the COVID-19 lockdown. On admission, he was found to be in acute-on-chronic type 2 respiratory failure; examination revealed scattered fasciculations. Further inpatient electromyography (EMG) and nerve conduction study (NCS) confirmed motor neuron disease (MND). This case highlighted the importance of considering neuromuscular causes for acute respiratory failure in acute presentations and demonstrated the challenges in the diagnosis of MND in those presenting atypically with non-specific symptoms and the limitations of remote consultations in complex cases.


Subject(s)
Motor Neuron Disease , Respiratory Insufficiency , Weight Loss , Aged , COVID-19 , Humans , Male , Motor Neuron Disease/complications , Motor Neuron Disease/diagnosis , Respiratory Insufficiency/etiology
10.
BMJ Case Rep ; 13(9)2020 Sep 14.
Article in English | MEDLINE | ID: covidwho-1186232

ABSTRACT

Nasal granuloma gravidarum usually presents as a small vascular lesion on the septum or turbinates during pregnancy. We present a case of a giant nasal granuloma gravidarum and its management.


Subject(s)
Granuloma/surgery , Nasal Cavity/abnormalities , Adult , Female , Granuloma/pathology , Humans , Nasal Cavity/pathology , Nasal Cavity/physiopathology , Pregnancy
11.
BMJ Case Rep ; 14(4)2021 Apr 07.
Article in English | MEDLINE | ID: covidwho-1172744

ABSTRACT

Serratia marcescens, time and again, has demonstrated its ability to easily adhere and infect vascular access catheters, making them a bona fide source of hospital outbreaks and contributing to adverse patient outcomes. We present a unique case of a severe recurrent Serratia infection, leading to persistent bacteria in the blood, haematogenous dissemination and subsequent development of abscesses, to a degree not reported in the literature before. These infections are exceedingly challenging to eradicate, owing to multiple virulence mechanisms and the deep seeding ability of this microorganism. Serratia infections require a multifaceted approach with intricacies in identification, therapeutics and surveillance, all of which are sparsely reported in the literature and reviewed in this report.


Subject(s)
Cross Infection , Serratia Infections , Catheters , Disease Outbreaks , Humans , Serratia Infections/diagnosis , Serratia Infections/drug therapy , Serratia marcescens
12.
BMJ Case Rep ; 14(2)2021 Feb 04.
Article in English | MEDLINE | ID: covidwho-1066845

ABSTRACT

COVID-19 is a biphasic illness with an initial viraemia phase and later effective adaptive immune phase, except in a minority of people who develop severe disease. Immune regulation is the key target to treat COVID illness. In anticipation, an elderly man self-medicated himself with dexamethasone on the day of symptom onset of a flu-like illness, took other symptomatic measures and was tested positive for SARS-CoV-2. His condition deteriorated with each passing day resulting in hospitalisation. He demanded oxygen and declared as severe COVID. With supportive treatment, he recovered after the 20th day of illness. Immunosuppression and anti-inflammation are likely to benefit when the immune response is dysregulated and turning into a cytokine storm. A medication that has saved many could be the one predisposing to severity if taken as a preventive measure, too early in the disease course, especially the viraemia phase.


Subject(s)
Anti-Inflammatory Agents/adverse effects , COVID-19/drug therapy , Dexamethasone/adverse effects , Viremia/drug therapy , Aged , Anti-Infective Agents/therapeutic use , Anti-Inflammatory Agents/therapeutic use , COVID-19/complications , Dexamethasone/therapeutic use , Hospitalization , Humans , Hydroxychloroquine/therapeutic use , Male , Pneumonia, Viral/complications , Pneumonia, Viral/drug therapy , SARS-CoV-2/isolation & purification , Self Medication/methods , Steroids/adverse effects , Steroids/therapeutic use , Treatment Outcome , Viremia/complications
14.
BMJ Case Rep ; 14(1)2021 Jan 18.
Article in English | MEDLINE | ID: covidwho-1066840

ABSTRACT

The ongoing SARS-CoV-2 (COVID-19) pandemic has presented many difficult and unique challenges to the medical community. We describe a case of a middle-aged COVID-19-positive man who presented with pulmonary oedema and acute respiratory failure. He was initially diagnosed with acute respiratory distress syndrome. Later in the hospital course, his pulmonary oedema and respiratory failure worsened as result of severe acute mitral valve regurgitation secondary to direct valvular damage from COVID-19 infection. The patient underwent emergent surgical mitral valve replacement. Pathological evaluation of the damaged valve was confirmed to be secondary to COVID-19 infection. The histopathological findings were consistent with prior cardiopulmonary autopsy sections of patients with COVID-19 described in the literature as well as proposed theories regarding ACE2 receptor activity. This case highlights the potential of SARS-CoV-2 causing direct mitral valve damage resulting in severe mitral valve insufficiency with subsequent pulmonary oedema and respiratory failure.


Subject(s)
COVID-19/complications , Mitral Valve Insufficiency/etiology , Acute Disease , Atrial Fibrillation/complications , Atrial Fibrillation/physiopathology , COVID-19/therapy , Chordae Tendineae/diagnostic imaging , Echocardiography , Electrocardiography , Heart Valve Prosthesis Implantation , Humans , Male , Middle Aged , Mitral Valve Insufficiency/diagnostic imaging , Mitral Valve Insufficiency/physiopathology , Mitral Valve Insufficiency/surgery , Pulmonary Edema/etiology , Pulmonary Edema/physiopathology , Pulmonary Edema/therapy , Respiratory Insufficiency/etiology , Respiratory Insufficiency/physiopathology , Respiratory Insufficiency/therapy , SARS-CoV-2 , Severity of Illness Index , Shock, Cardiogenic/etiology , Shock, Cardiogenic/physiopathology
15.
BMJ Case Rep ; 13(12)2020 Dec 17.
Article in English | MEDLINE | ID: covidwho-1020885

ABSTRACT

A 67-year-old man presented to his general practitioner with intermittent episodes of unilateral sciatica over a 2-month period for which he was referred for an outpatient MRI of his spine. This evidenced a significant lumbar vertebral mass that showed tight canal stenosis and compression of the cauda equina. The patient was sent to the emergency department for management by orthopaedic surgeons. He was mobilising independently, pain free on arrival and without neurological deficit on assessment. Clinically, this patient presented with no red flag symptoms of cauda equina syndrome or reason to suspect malignancy. In these circumstances, National Institute for Health and Care Excellence guidelines do not support radiological investigation of the spine outside of specialist services. However, in this case, investigation helped deliver urgent care for cancer that otherwise may have been delayed. This leads to the question, do the current guidelines meet clinical requirements?


Subject(s)
Adenocarcinoma/diagnosis , Cauda Equina Syndrome/diagnosis , Prostatic Neoplasms/diagnosis , Spinal Neoplasms/complications , Spinal Stenosis/diagnosis , Adenocarcinoma/complications , Adenocarcinoma/secondary , Adenocarcinoma/therapy , Aged , Cauda Equina/diagnostic imaging , Cauda Equina Syndrome/blood , Cauda Equina Syndrome/etiology , Cauda Equina Syndrome/therapy , Chemoradiotherapy/methods , Humans , Image-Guided Biopsy , Kallikreins/blood , Lumbar Vertebrae/diagnostic imaging , Lumbar Vertebrae/pathology , Magnetic Resonance Imaging , Male , Palliative Care/methods , Prostate/diagnostic imaging , Prostate/pathology , Prostate-Specific Antigen/blood , Prostatic Neoplasms/blood , Prostatic Neoplasms/pathology , Prostatic Neoplasms/therapy , Spinal Neoplasms/blood , Spinal Neoplasms/diagnosis , Spinal Neoplasms/secondary , Spinal Stenosis/etiology , Spinal Stenosis/therapy , Ultrasonography, Interventional
16.
BMJ Case Rep ; 13(8)2020 Aug 24.
Article in English | MEDLINE | ID: covidwho-827667

ABSTRACT

Methaemoglobinaemia is a rare disease that is typically caused by a medication or other exogenous agent, with dapsone being the most common. It occurs when the concentration of methaemoglobin rises via ferrous haeme irons becoming oxidised to the ferric state, which shifts the oxygen dissociation curve to the left. The net result of an elevated methaemoglobin concentration is functional anaemia and impaired oxygen delivery to tissues. At lower blood levels, this can cause symptoms such as cyanosis, lethargy, headache and fatigue, whereas at higher levels it can be fatal. Here we discuss a subtle case of dapsone-induced methaemoglobinaemia presenting as subacute mental status changes and apparent hypoxia, thus highlighting the association between methaemoglobinaemia and dapsone. This case demonstrates the importance of thorough medication reconciliation and maintaining a broad differential diagnosis, while also recognising the significance of conflicting data and their implications for the workup.


Subject(s)
Anti-Infective Agents/adverse effects , Dapsone/adverse effects , Methemoglobinemia , Aged , Confusion/chemically induced , Female , Humans , Memory Disorders/chemically induced , Methemoglobin/analysis , Methemoglobinemia/chemically induced , Methemoglobinemia/diagnosis , Oxygen/blood
17.
BMJ Case Rep ; 13(8)2020 Aug 27.
Article in English | MEDLINE | ID: covidwho-733175

ABSTRACT

During the previous months, we have seen the rapid pandemic spread of SARS-CoV-2. Despite being considered a respiratory virus, it has become clear that other clinical presentations are possible and some of these are quite frequent. In this paper, a case of a man in his late 70s showing atypical symptoms in general practice is presented. Apart from fever, the patient complained of diarrhoea, borborygmus, loss of appetite and nausea. He developed no respiratory symptoms during his disease. Due to his symptoms, malignant disease was suspected, and he was referred for further testing which revealed typical COVID-19 findings on a chest CT scan. The occurrence of atypical symptoms is discussed, including the importance of recognising these in an ongoing pandemic.


Subject(s)
Anorexia/physiopathology , Coronavirus Infections/physiopathology , Diarrhea/physiopathology , Hypoxia/physiopathology , Lung/diagnostic imaging , Nausea/physiopathology , Pneumonia, Viral/physiopathology , Aged , Betacoronavirus , C-Reactive Protein/metabolism , COVID-19 , Coronavirus Infections/diagnosis , General Practice , Humans , Male , Pandemics , Pneumonia, Viral/diagnosis , SARS-CoV-2 , Tomography, X-Ray Computed
18.
BMJ Case Rep ; 13(8)2020 Aug 11.
Article in English | MEDLINE | ID: covidwho-713638

ABSTRACT

Since the beginning of the COVID-19 pandemic, healthcare providers worldwide have faced many obstacles in the diagnostic evaluation of patients for severe acute respiratory syndrome coronavirus 2, the causative virus. Even with the application of statistical inference by Bayes' theorem to estimate the probability of a diagnosis, with and without testing capabilities, some cases may still carry a degree of uncertainty. This has important implications for limiting the spread of disease. The basis for isolation and quarantine is a known diagnosis. This case is an example of a diagnostic conundrum that required more thorough use of testing methods, particularly serological testing, to guide the isolation recommendations for a patient with COVID-19. This will be helpful to other diagnosticians by providing an example of how serological findings may be effectively applied in the course of individual COVID-19 management.


Subject(s)
Betacoronavirus , Coronavirus Infections/blood , Coronavirus Infections/diagnosis , Pneumonia, Viral/blood , Pneumonia, Viral/diagnosis , Serologic Tests/methods , Bayes Theorem , COVID-19 , Diagnosis, Differential , Female , Humans , Middle Aged , Pandemics , Polymerase Chain Reaction , Reproducibility of Results , SARS-CoV-2
SELECTION OF CITATIONS
SEARCH DETAIL