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Asfeen U, Raj R, Ezeafulukwe CJ, Hassan OA, Francis DT, Dhillon SS, Khan A. Amiodarone-Induced Leukocytoclastic Vasculitis in a Decompensated Heart Failure Patient: A Case Report. Cureus 2024; 16:e51817. [PMID: 38327906 PMCID: PMC10847063 DOI: 10.7759/cureus.51817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/09/2024] Open
Abstract
Leukocytoclastic vasculitis (LCV) is a small-vessel vasculitis characterized by inflammation and damage to the walls of small blood vessels. It typically presents with palpable purpura and can be associated with various systemic conditions. Although its etiology is diverse, LCV has been associated with systemic diseases, infections, medications, and autoimmune disorders. Here, we present a case of LCV in a patient with decompensated heart failure. A 58-year-old man presented with progressively deteriorating swelling in both his lower limbs and scrotum, a persistent dry cough associated with minor ulcerative lesions on his shins, and a patchy rash with pustules and flat reddish spots. He was hospitalized three days prior due to atrial fibrillation and rapid ventricular rate, for which he was commenced on amiodarone. This rash persisted for three days, yet he denied experiencing any discomfort or itchiness along with it. Based on his clinical picture, laboratory evaluations, and imaging findings, he was diagnosed with LCV induced by amiodarone.
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Affiliation(s)
- Ummul Asfeen
- Internal Medicine, New York Medical College, Saint Michael's Medical Center, Newark, USA
| | - Rohan Raj
- Internal Medicine, Nalanda Medical College and Hospital, Patna, IND
| | | | - Omar A Hassan
- General Practice, Ondokuz Mayis University, Samsun, TUR
| | | | - Sukhmeet S Dhillon
- Internal Medicine, Baba Farid University of Health Sciences, Patiala, IND
| | - Aadil Khan
- Trauma Surgery, OSF Saint Francis Medical Center, University of Illinois Chicago, Peoria, USA
- Cardiology, University of Illinois Chicago, Illinois, USA
- Internal Medicine, Lala Lajpat Rai Hospital, Kanpur, IND
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Francis S, Francis DT, Thassu I, Anwaar MA, Kothari J, Chima R, Jayan M. Management of a Unique Subcarinal Bronchogenic Cyst with Robotic-Assisted Thoracic Surgery. Cureus 2024; 16:e51814. [PMID: 38327959 PMCID: PMC10847006 DOI: 10.7759/cureus.51814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/09/2024] Open
Abstract
A bronchogenic cyst (BC), although a rare congenital abnormality, represents the most common cystic lesion in the mediastinum and can present with chest pain and shortness of breath, especially due to compression of adjacent vital structures. The most common diagnostic modalities used are computed tomography (CT) and magnetic resonance imaging (MRI). These cysts may elude even a seasoned clinician unless they become symptomatic. For clinicians attempting to give optimum and prompt management for these cysts, robotic-assisted surgical resection is the recommended treatment of choice. Robotic-assisted thoracic surgery (RATS) offers precision and enhanced visualization, making it a safe and accurate approach for the removal of posterior mediastinal BCs. Our patient is a 65-year-old female who presented with symptomatic posterior mediastinal subcarinal BCs and underwent complete surgical resection with RATS. The diagnosis was confirmed with histopathology. Advancements and the clinical impact of RATS for mediastinal BCs including the Da Vinci robotic surgeries have been demonstrated to be minimally invasive, safe, and feasible especially when in difficult-to-reach areas. RATS has also proven to be advantageous in reducing disease burden and improving patient outcomes.
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Affiliation(s)
- Sandra Francis
- Internal Medicine, Windsor University School of Medicine, Basseterre, KNA
| | | | - Ishaan Thassu
- College of Medicine, Calcutta National Medical College, Kolkata, IND
| | - Mohammad Ahsan Anwaar
- Internal Medicine, Combined Military Hospital (CMH) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Jhanvi Kothari
- Internal Medicine, Gujarat Medical Education and Research Society (GMERS) Medical College, Gandhinagar, IND
| | - Rupert Chima
- Internal Medicine, CardioCare Multispecialty Hospital, Abuja, NGA
| | - Malavika Jayan
- Internal Medicine, Bangalore Medical College and Research Institute, Bangalore, IND
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Chenna VSH, Palle LRA, Emmanuel S, Gupta A, Francis DT, Hussain A, Dahal R, Carredo CKC, Francis SM, Garg T, Akuma O, Khan AM. A rare case of perforating chest wall including pericardial sac with penetrating trivial injury: A case report and literature review. Trauma Case Rep 2023; 48:100962. [PMID: 37964982 PMCID: PMC10641277 DOI: 10.1016/j.tcr.2023.100962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 11/16/2023] Open
Abstract
Perforating chest wall injuries involving the pericardial sac in pediatric patients are exceedingly rare and pose a unique clinical challenge. Thoracic trauma in the pediatric population remains a significant cause of morbidity and mortality. We present a case of an 8-year-old boy with an acute history of a sharp injection needle embedded in his chest wall presented with severe chest pain and diaphoresis. Diagnostic evaluations included computed tomography revealed a hyperdense focus with a metallic artefact seen impacted in the interventricular septa and perforating the heart. He underwent a thoracotomy and cardioplegic arrest for needle retrieval and subsequent cardiac repair. Our case underscores the importance of a multidisciplinary approach, meticulous monitoring, and a profound understanding of the unique anatomical considerations in pediatric chest injuries. Summary This article presents a rare and challenging case of an 8-year-old male who arrived at the emergency department with a sharp injection needle embedded in his chest wall. Despite being relatively rare in children, thoracic injuries can be severe and potentially life-threatening. A fast and accurate diagnostic approach is crucial to prevent fatal complications. Thoracic trauma in the pediatric population remains a significant cause of morbidity and mortality. Timely diagnosis and appropriate interventions are critical in improving patient outcomes. The presented case highlights the need for caution and a well-planned approach in managing such rare and complex injuries in children.
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Affiliation(s)
| | | | | | | | - Deepa Treesa Francis
- Department of Internal Medicine, Windsor University School of Medicine, Cayon, Saint Kitts and Nevis
| | | | - Rojaj Dahal
- Department of Internal Medicine, Manipal College of Medical Sciences (MCOMS), Pokhara, Nepal
| | | | - Sandra Mary Francis
- Department of Internal Medicine, Windsor University School of Medicine, Cayon, Saint Kitts and Nevis
| | - Tulika Garg
- Government Medical College and Hospital, Chandigarh, India
| | | | - Aadil M. Khan
- Department of Trauma Surgery, OSF St Francis Medical Center, Peoria, USA
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Francis MA, Nerella R, Francis DT, Raj R, Zain A, Augustine S, Jamil NA. Acute Appendicitis with Appendicolith and its Complication and Management: A Case Report. Cureus 2023; 15:e45715. [PMID: 37868373 PMCID: PMC10590198 DOI: 10.7759/cureus.45715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Acute appendicitis is a common cause of acute abdominal pain requiring urgent surgery. Despite characteristic clinical signs, diagnosis can be challenging, leading to unnecessary appendectomies. This case report focuses on a 34-year-old male with escalating right lower quadrant abdominal pain. Imaging revealed acute appendicitis with a substantial appendicolith. Surgical intervention involved a open appendectomy with possible ileocecal resection due to cecal inflamation. Surgical findings indicated successful resection, and the patient recovered without complications. While urgent appendectomy is the norm, conservative approaches are gaining traction for peri-appendiceal abscesses. Interval appendectomy post-conservative treatment is a debated strategy. Management decisions are influenced by patient factors and disease severity. Future research is needed to establish standardized treatment protocols for complicated appendicitis. The case illustrates the evolving landscape of acute appendicitis management.
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Affiliation(s)
- Maya Ann Francis
- Internal Medicine, Windsor University School of Medicine, Cayon, KNA
| | - Resheek Nerella
- Trauma Surgery, University of Illinois College of Medicine Peoria (UICOMP), Peoria, USA
| | | | - Rohan Raj
- Internal Medicine, Nalanda Medical College and Hospital, Patna, IND
| | - Ahmer Zain
- General Medicine, Kempegowda Institute of Medical Sciences, Bangalore, IND
| | - Sana Augustine
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Niyaz A Jamil
- Trauma Surgery, University of Illinois/OSF St Francis Medical Center, Peoria, USA
- Surgery, Windsor University School of Medicine, Cayon, KNA
- Surgery, Combined Military Hospital, Nowshera, PAK
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Raj R, Francis MA, Francis DT, Kaur P, Chima R, Jamil NA. A Rare Case of Small Bowel Intussusception in an Elderly: A Case Report and Literature Review. Cureus 2023; 15:e44204. [PMID: 37767247 PMCID: PMC10521763 DOI: 10.7759/cureus.44204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 09/29/2023] Open
Abstract
Intussusception, a rare cause of bowel obstruction in adults, is even less common in the elderly population. Unlike pediatric cases, adult intussusception is primarily associated with pathologic diseases acting as lead points, often requiring surgical intervention. We present a case of an 84-year-old male with a medical history significant for multiple comorbidities, who was diagnosed with a large segment jejunojejunal intussusception resulting in small bowel obstruction. Surgical management was recommended, and an exploratory laparotomy with bowel resection was performed, including the excision of the leading point. This case highlights the challenges in diagnosing adult intussusception and the importance of surgical intervention due to the high incidence of associated pathologic diseases.
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Affiliation(s)
- Rohan Raj
- Internal Medicine, Nalanda Medical College and Hospital, Patna, IND
| | - Maya Ann Francis
- Internal Medicine, Windsor University School of Medicine - St Kitts and Nevis, Cayon, KNA
| | - Deepa Treesa Francis
- Internal Medicine, Windsor University School of Medicine - St Kitts and Nevis, Cayon, KNA
| | - Parvinder Kaur
- Internal Medicine, Crimean State Medical University, Simferopol, UKR
| | - Rupert Chima
- Internal Medicine, Cardiocare Multispeciality Hospital Abuja, Abuja, NGA
| | - Niyaz A Jamil
- Surgery, Windsor University School of Medicine, Cayon, KNA
- Surgery, Combined Military Hospital, Nowshera, PAK
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Lord GP, Hiebert C, Francis DT. Postoperative hypoxia. N Engl J Med 1969; 280:1300-1. [PMID: 5770060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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