ABSTRACT
INTRODUCTION: Chlorpromazine is a commonly used drug in several medical conditions associated with a wide range of side effects. Few cases of hemostatic disorder have been reported in the literature. CASE REPORT: A 39-year-old man had previously been diagnosed with a cavernous malformation of the medulla oblongata. Chlorpromazine was started to treat persistent hiccups. Twenty days later, the patient presented hepatitis and a pruritic rash. Haemostasis tests revealed a prolonged partial thromboplastin time associated with isolated decrease of factor VIII level and anti-factor VIII antibodies. Magnetic resonance imaging revealed recent asymptomatic bleeding. Introduction of eptacog alfa and prednisone allowed clinical and biological improvement as well as a prolonged remission after 12 months of follow-up.
Subject(s)
Hemophilia A , Male , Humans , Adult , Hemophilia A/chemically induced , Hemophilia A/diagnosis , Hemophilia A/drug therapy , Chlorpromazine/adverse effects , Hemorrhage , Medulla OblongataABSTRACT
OBJECTIVE: Comment on spinal damage in Charcot's disease. OBSERVATION: We report on a paraplegic patient with T9 spinal cord injury who developed destructive arthropathy of the lumbosacral joint. DISCUSSION: Charcot's disease occurs sporadically during the progression of certain chronic neurological diseases. It affects the limbs and the spine, where it causes major disc and vertebral damage. In cases of spinal cord injury, Charcot's disease must be considered when faced with the appearance of spinal deformity or the aggravation of neurological symptoms. Treatment of Charcot's disease requires spinal osteosynthesis for the relief of neurological compression and the re-establishment of spinal stability.
Subject(s)
Arthropathy, Neurogenic/diagnosis , Diagnostic Errors , Lumbar Vertebrae , Paraplegia/complications , Sacrum , Spinal Cord Injuries/complications , Accidents, Traffic , Adult , Arthropathy, Neurogenic/etiology , Arthropathy, Neurogenic/surgery , Bacteremia/complications , Discitis/diagnosis , Epidural Abscess/complications , Humans , Joint Instability/etiology , Joint Instability/surgery , Male , Ofloxacin/therapeutic use , Osteolysis/etiology , Oxacillin/therapeutic use , Spinal Fractures/complications , Spinal Fusion , Spondylitis/diagnosis , Staphylococcal Infections/complications , Staphylococcal Infections/drug therapy , Thoracic Vertebrae/injuries , Thoracic Vertebrae/surgery , Wound Infection/complications , Wound Infection/drug therapy , Wound Infection/microbiologyABSTRACT
INTRODUCTION: Tuberculous lesions of the oral cavity are uncommon. Most of cases are secondary to pulmonary disease and the primary form is rare. EXEGESIS: We report the case of a 64 year-old man, smoker, presenting a chronic ulcer of the tongue, with anorexia and important weight loss. The biopsy of this ulcer showed granulomatous inflammation and Langhans type giant cells, without necrosis. Ziehl-Nielsen stain was negative. Pulmonary lesions were subsequently detected (chest X-ray, CT-scan) and the disseminated tuberculosis was confirmed by a positive culture with acid-fast bacilli in urine, blood, and pulmonary sample. Antituberculosis treatment resulted in the complete resolution of the oral lesion. CONCLUSION: Biopsy for histopathological diagnosis, acid-fast stains and culture, is essential to determine the exact nature of chronic oral ulceration to distinguish between oral malignancy, infectious (syphilis), traumatic, or aphthous ulcers. Tuberculosis of the tongue is a difficult diagnosis. However it should be searched for because treatment usually results in a rapid recovery.
Subject(s)
Tongue Diseases/microbiology , Tuberculosis, Oral/microbiology , Tuberculosis, Pulmonary/complications , Ulcer/microbiology , Antitubercular Agents/therapeutic use , Humans , Male , Middle Aged , Tongue Diseases/diagnosis , Tongue Diseases/drug therapy , Treatment Outcome , Tuberculosis, Oral/diagnosis , Tuberculosis, Oral/drug therapy , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/drug therapy , Ulcer/diagnosis , Ulcer/drug therapyABSTRACT
INTRODUCTION: Pancreatic involvement in the course of wegener's granulomatosis is rarely reported. EXEGESIS: We report a case presenting as a pancreatic tumorlike lesion. We also discuss six further cases from the medical literature. Two of them had a tumorlike lesion, three had acute pancreatitis and the last had exocrine pancreatic insufficiency. CONCLUSION: Treatment, association of corticoid and cyclophosphamide, is efficient if it is started quickly. So we think that this unusual manifestation of Wegener's granulomatosis should be recognized.
Subject(s)
Granulomatosis with Polyangiitis/complications , Pancreatic Diseases/etiology , Aged , Diagnosis, Differential , Humans , Male , Pancreatic Diseases/diagnosis , Pancreatic Neoplasms/diagnosisABSTRACT
An infarctus of medulla oblongata was discovered in a 44-year old man with an intractable hiccup and 10, 11th and 12th right cranial nerves palsies. Systemic lupus erythematosus (SLE) with antiphospholipid syndrome was subsequently diagnosed. Hiccup has withdrew with corticosteroid therapy and low-dose aspirin. The other cases of literature and pathophysiologic hypotheses are briefly reported.