1
|
Phan AT, Buxton L, Choudhery MW, Ghantarchyan H, Converse C. A Rare Case of an Eosinophilic Pleural Effusion and Loculated Ascites Associated with Strongyloides stercoralis Hyperinfection Syndrome in California. Case Rep Pulmonol 2024; 2024:6652207. [PMID: 38628651 PMCID: PMC11019572 DOI: 10.1155/2024/6652207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 02/12/2024] [Accepted: 03/08/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction. Strongyloides stercoralis causes a helminthic infection that occurs via penetration of the skin with migration to the bloodstream, tracheobronchial tree, and gastrointestinal system. Pulmonary manifestations are rare and are typically seen in immunosuppressed patients who have Strongyloides stercoralis hyperinfection syndrome. Eosinophilic pleural effusions are rare in strongyloidiasis and only cited in a few case reports. Case Presentation. A 45-year-old male with a past medical history of diabetes mellitus, alcoholic cirrhosis, and end-stage renal disease presented to the emergency department with abdominal pain and dyspnea. Imaging studies demonstrated large bilateral pleural effusions, and he subsequently underwent an ultrasound-guided thoracentesis on the right hemithorax, yielding an exudative eosinophilic pleural effusion. An extensive hematology, gastroenterology, and infectious work-up was pursued. Strongyloides immunoglobulin G was positive, and he was successfully treated with ivermectin. Discussion. Eosinophilic pleural effusions related to strongyloidiasis are exceedingly rare. Clinicians should consider Strongyloides stercoralis infection as a part of the differential diagnosis when evaluating immunosuppressed patients with eosinophilic pleural effusions. Loculated abdominal fluid may also be a rare manifestation of Strongyloides stercoralis hyperinfection syndrome.
Collapse
Affiliation(s)
- Alexander T. Phan
- Department of Internal Medicine, Arrowhead Regional Medical Center, Colton, CA 92324, USA
| | - Luke Buxton
- Department of Pulmonary Medicine, Arrowhead Regional Medical Center, Colton, CA 92324, USA
| | | | - Henrik Ghantarchyan
- Department of Internal Medicine, Arrowhead Regional Medical Center, Colton, CA 92324, USA
| | - Curtis Converse
- Department of Pulmonary Medicine, Arrowhead Regional Medical Center, Colton, CA 92324, USA
| |
Collapse
|
2
|
Phan AT, Ghantarchyan H, Khosravi C, Maknouni B, Bhagat A, Chen J, Ibrahim A, Hasan M. Sclerosing epithelioid fibrosarcoma associated with WRN gene variant presenting as chronic dyspnea and pathologic cervical fracture: a case report and review of the literature. J Med Case Rep 2023; 17:517. [PMID: 38104125 PMCID: PMC10725598 DOI: 10.1186/s13256-023-04249-6] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 11/07/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Sclerosing epithelioid fibrosarcoma is an aggressive sarcoma subtype with poor prognosis and limited response to conventional chemotherapy regimens. Diagnosis can be difficult owing to its variable presentation, and cases of sclerosing epithelioid fibrosarcoma are rare. Sclerosing epithelioid fibrosarcoma typically affects middle-aged individuals, with studies inconsistently citing gender predominance. Sclerosing epithelioid fibrosarcoma typically arises from the bones and soft tissues and often has local recurrence after resection and late metastases. Immunohistochemical staining typically is positive for mucin-4. Werner syndrome is due to an autosomal recessive mutation in the WRN gene and predisposes patients to malignancy. CASE PRESENTATION A 37-year-old Caucasian female presented to the emergency department with 4 months of dyspnea and back pain. She had been treated for pneumonia but had persistent symptoms. A chest, abdomen, and pelvis computed tomography showed near-complete right upper lobe collapse and consolidation, mediastinal lymphadenopathy, lytic spinal lesions, and a single 15-mm hypodense liver nodule. The patient underwent a transthoracic right upper lobe biopsy, bronchoscopy, endobronchial ultrasound with transbronchial lymph node sampling, and bronchoalveolar lavage of the right upper lobe. The bronchoalveolar lavage cytology was positive for malignant cells compatible with poorly differentiated non-small cell carcinoma; however, the cell block materials were insufficient to run immunostains for further investigation of the bronchoalveolar lavage results. Consequently, the patient also underwent a liver biopsy of the liver nodule, which later confirmed a diagnosis of sclerosing epithelioid fibrosarcoma. Next-generation sequencing revealed a variant of unknown significance in the WRN gene. She was subsequently started on doxorubicin. CONCLUSION Sclerosing epithelioid fibrosarcoma is a very rare entity, only cited approximately 100 times in literature to date. Physicians should be aware of this disease entity and consider it in their differential diagnosis. Though pulmonary involvement has been described in the context of sclerosing epithelioid fibrosarcoma, this malignancy may affect many organ systems, warranting extensive investigation. Through our diagnostic workup, we suggest a possible link between sclerosing epithelioid fibrosarcoma and the WRN gene. Further study is needed to advance our understanding of sclerosing epithelioid fibrosarcoma and its clinical associations as it is an exceedingly rare diagnosis.
Collapse
Affiliation(s)
- Alexander T Phan
- Department of Internal Medicine, Arrowhead Regional Medical Center, 400 N. Pepper Avenue, Colton, CA, 92324, USA.
- California University of Science and Medicine, Colton, CA, 92324, USA.
| | - Henrik Ghantarchyan
- Department of Internal Medicine, Arrowhead Regional Medical Center, 400 N. Pepper Avenue, Colton, CA, 92324, USA
- California University of Science and Medicine, Colton, CA, 92324, USA
| | - Chayanne Khosravi
- Department of Pulmonary and Critical Care Medicine, Arrowhead Regional Medical Center, Colton, CA, 92324, USA
- California University of Science and Medicine, Colton, CA, 92324, USA
| | - Bahareh Maknouni
- Department of Pulmonary and Critical Care Medicine, Arrowhead Regional Medical Center, Colton, CA, 92324, USA
- California University of Science and Medicine, Colton, CA, 92324, USA
| | - Ankur Bhagat
- Department of Internal Medicine, Arrowhead Regional Medical Center, 400 N. Pepper Avenue, Colton, CA, 92324, USA
- California University of Science and Medicine, Colton, CA, 92324, USA
| | - Jeff Chen
- California University of Science and Medicine, Colton, CA, 92324, USA
| | - Ahmad Ibrahim
- Department of Pathology, Arrowhead Regional Medical Center, Colton, CA, 92324, USA
| | - Mufadda Hasan
- Department of Pulmonary and Critical Care Medicine, Arrowhead Regional Medical Center, Colton, CA, 92324, USA
- California University of Science and Medicine, Colton, CA, 92324, USA
| |
Collapse
|
3
|
Chen J, Cano-Besquet S, Ghantarchyan H, Neeki MM. The Incidence of Alopecia Areata in a COVID-19-Vaccinated Population: A Single-Center Review. Cureus 2023; 15:e50133. [PMID: 38186412 PMCID: PMC10771325 DOI: 10.7759/cureus.50133] [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: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
Background Cases of alopecia areata (AA) attributed to the coronavirus disease 2019 (COVID-19) vaccination have been reported in recent literature. However, these reports are reflective of specific geographic areas, and whether this phenomenon is observed in other regions remains to be investigated. This study focused on the association between AA and COVID-19 vaccination among patients from a large single-center safety net hospital in California. Methodology In this study, using electronic health records of patients and publicly available vaccination data, the demographics of patients including age group, sex, and race along with the vaccination status were carefully reviewed. Results A total of 73 cases of AA in the period from the release of the COVID-19 vaccination on December 17, 2020, to February 10, 2023, were identified. The odds ratios (ORs) for developing AA among the vaccinated and unvaccinated for each demographic level were calculated. Among all vaccinated individuals, the OR for developing AA was 0.58 (95% confidence interval (CI) = 0.35-0.94, p-value = 0.02). Conclusions This investigation noted no apparent increase in the incidence of AA among the vaccinated population compared to the unvaccinated population.
Collapse
Affiliation(s)
- Jeff Chen
- Internal Medicine, California University of Science and Medicine, Colton, USA
| | | | | | - Michael M Neeki
- Emergency Medicine, Arrowhead Regional Medical Center, Colton, USA
| |
Collapse
|
4
|
Ghantarchyan H, Abbas N, Lewis A, Chamanadjian C, Kambiz R. A Rare Presentation of Metastatic Breast Cancer Manifesting As Diffuse Nodular Skin Lesions. Cureus 2023; 15:e49633. [PMID: 38161904 PMCID: PMC10755805 DOI: 10.7759/cureus.49633] [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: 11/28/2023] [Indexed: 01/03/2024] Open
Abstract
We present a 63-year-old African American female with a prior medical history of gastroesophageal reflux disease (GERD) and uterine fibroids whose primary concern was vaginal bleeding. She had no prior medical care established, and the last mammogram was conducted 10 years prior with normal results. She has had multiple ED visits for symptoms of reflux and vaginal bleeding and has been discharged with a primary care follow-up referral each time. On physical exam, there was evidence of nodular skin lesions, tightening of the skin on her face, neck, and back, as well as nodular skin lesions on her neck, back, chest, and abdomen, notably progressing in number, not in size, in a caudal fashion. Further exam findings included telangiectasias predominantly on her right hand. On initial laboratory studies, she was hypercalcemic with an elevated calcium level of 13 mg/dL. Initial imaging included a CT scan of her chest, abdomen, and pelvis, which revealed pulmonary embolism and uterine fibroids, with the largest measuring 5.9 x 4.3 x 5.3 cm, as well as bilateral breast masses noted to be a BI-RADS 3 on ultrasound. A skin biopsy completed early on in the hospitalization revealed metastatic breast cancer, specifically high-grade, poorly differentiated infiltrating mammary carcinoma of the lobular type. Similarly, a right breast mass biopsy illustrated resemblant findings, specifically invasive mammary carcinoma with mixed ductal and lobular features. She was ultimately treated with ribociclib and fulvestrant (KR1) and discharged from the hospital with oncology and primary care follow-up.
Collapse
Affiliation(s)
| | - Nia Abbas
- Internal Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - Azaria Lewis
- Internal Medicine, Arrowhead Regional Medical Center, Colton, USA
| | | | - Raoufi Kambiz
- Internal Medicine, Arrowhead Regional Medical Center, Colton, USA
| |
Collapse
|
5
|
Phan AT, Ghantarchyan H, Nguyen VT, Hasan M. Acute Respiratory Distress Syndrome: A Rare Manifestation of Rhinovirus Infection. Cureus 2023; 15:e43484. [PMID: 37711941 PMCID: PMC10499462 DOI: 10.7759/cureus.43484] [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: 08/14/2023] [Indexed: 09/16/2023] Open
Abstract
Human rhinovirus (HRV) is a common cause of respiratory infections. HRV-related lower respiratory tract infections, including community-acquired pneumonia, are seldom seen in the clinical setting, and progression to acute respiratory distress syndrome (ARDS) is even rarer. We report on a case of a young immunosuppressed host who presented to the hospital for respiratory distress. She was diagnosed with HRV-related pneumonia, which rapidly progressed to ARDS based on clinical examination. After orotracheal intubation and mechanical ventilation with a low tidal volume strategy, she made a rapid recovery. This case highlights the importance of understanding that HRV may be an etiology of community-acquired pneumonia in immunosuppressed hosts and that ARDS may be a complication of this infection. Rapid recognition and clinical suspicion are important to the care of these patients, as ARDS has a high mortality rate.
Collapse
Affiliation(s)
- Alexander T Phan
- Internal Medicine, Arrowhead Regional Medical Center, Colton, USA
| | | | - Viet-Tien Nguyen
- Internal Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - Mufadda Hasan
- Pulmonary and Critical Care Medicine, Arrowhead Regional Medical Center, Colton, USA
| |
Collapse
|
6
|
Ghantarchyan H, Fischer N, Karp D, Hamidi A. Methamphetamine-Induced Hypoglycemia: A Case Report and Literature Review. Cureus 2023; 15:e39158. [PMID: 37332469 PMCID: PMC10275691 DOI: 10.7759/cureus.39158] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2023] [Indexed: 06/20/2023] Open
Abstract
We present a rare case of a 34-year-old male patient with a history of schizophrenia who was found to be persistently hypoglycemic after a positive toxicology screen for methamphetamine. The patient has had multiple admissions to the hospital for persistent hypoglycemia and was then transferred to our in-patient behavioral health unit (BHU). At this time, his toxicology screen was negative for methamphetamines. During his stay in the BHU, he was compliant with his psychiatric medications and was euglycemic despite having a poor appetite until he was discharged home. This patient was shortly readmitted to the hospital and found to be severely hypoglycemic and methamphetamine positive. Here, we present this rare case of methamphetamine-induced hypoglycemia. We emphasize our work-up, treatment, and our suggested theory of why methamphetamines are the likely cause of hypoglycemia.
Collapse
Affiliation(s)
| | - Nina Fischer
- Internal Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - David Karp
- Internal Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - Afshin Hamidi
- Endocrinology and Diabetes, Arrowhead Regional Medical Center, Colton, USA
| |
Collapse
|
7
|
Johnson K, Ghantarchyan H, Johnston B, Sond V, Vo D. A Mysterious Case of Left Shoulder Pain in AIDS: A Case Report and Literature Review. Cureus 2023; 15:e38884. [PMID: 37303361 PMCID: PMC10257405 DOI: 10.7759/cureus.38884] [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: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
Neisseria (N.) gonorrhea is a gram-negative diplococcus and one of the most commonly reported sexually transmitted infections (STIs) in the United States. Disseminated gonococcal infection is a rare but serious complication of N. gonorrhoeae infection that can result in arthritis-dermatitis syndrome or purulent gonococcal arthritis. Co-infection with human immunodeficiency virus (HIV) has been shown to reduce the efficacy of complement recruitment, which may lead to an increased risk of disseminated gonococcal spread. We present a case of a 41-year-old male with concomitant HIV-gonorrhea infection complicated by rare chronic subacute septic arthritis localized to the left shoulder. The patient had a history of HIV, hypertension, and diabetes, and presented with symptoms, including diarrhea, oral thrush, body aches, and fevers. During his hospitalization, the patient developed increasing left shoulder pain, and imaging and joint aspiration revealed N. gonorrhoeae as the causative agent. The patient was treated with appropriate antibiotics and showed improvement. This case highlights the importance of considering disseminated gonococcal infection as a potential complication of N. gonorrhoeae infection, particularly in patients with concomitant HIV infection, and the need for prompt diagnosis and appropriate treatment to prevent complications.
Collapse
Affiliation(s)
- Kendall Johnson
- Internal Medicine, California University of Science and Medicine, Colton, USA
| | | | - Brandon Johnston
- Internal Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - Veerpal Sond
- Internal Medicine, Arrowhead Regional Medical Center, Colton, USA
| | - Dan Vo
- Internal Medicine, Arrowhead Regional Medical Center, Colton, USA
| |
Collapse
|
8
|
Ghantarchyan H, Bholat Y, Patel A, Bourbeau K, Vo D. Correction: Disseminated Histoplasmosis Found in Bone Marrow in a Newly Diagnosed AIDS Patient: A Literature Review and Report of a Rare Case. Cureus 2023; 15:c107. [PMID: 37038377 PMCID: PMC10082221 DOI: 10.7759/cureus.c107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
[This corrects the article DOI: 10.7759/cureus.35417.].
Collapse
Affiliation(s)
| | - Yousuf Bholat
- Internal Medicine, St. George's University School of Medicine, St. George's, GRD
| | - Amir Patel
- Internal Medicine, Arrowhead Regional Medical Center, Colton, USA
| | | | - Dan Vo
- Internal Medicine, Arrowhead Regional Medical Center, Colton, USA
| |
Collapse
|
9
|
Ghantarchyan H, Oganesian B, Gayed MM, Maknouni B, Hasan M. A Rare Case of Coccidioidomycosis Meningitis. J Med Cases 2023; 14:81-87. [PMID: 37032742 PMCID: PMC10079362 DOI: 10.14740/jmc4040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 01/11/2023] [Indexed: 04/05/2023] Open
Abstract
Disseminated coccidioidomycosis is a fungal disease endemic to the Southwest United States as well as South and Central America. This dimorphic fungus typically manifests as pulmonary infection; however, there are very rare instances of extrapulmonary disseminated disease especially in immunocompromised hosts. Here, we present a 46-year-old immunocompromised patient with a recent diagnosis of pulmonary coccidioidomycosis that initially presented with acute respiratory failure and was found to have coccidioidomycosis meningitis. This case highlights that despite early and adequate treatment of a known pulmonary coccidioidomycosis infection, dissemination of the disease can still ensue and should be considered in cases of acute encephalopathy.
Collapse
Affiliation(s)
- Henrik Ghantarchyan
- Department of Internal Medicine, Arrowhead Regional Medical Center, Colton, CA 92324, USA
- Corresponding Author: Henrik Ghantarchyan, Department of Internal Medicine, Arrowhead Regional Medical Center, Colton, CA 92324, USA.
| | - Buzand Oganesian
- Department of Internal Medicine, Arrowhead Regional Medical Center, Colton, CA 92324, USA
| | - Monica M. Gayed
- Department of Internal Medicine, Arrowhead Regional Medical Center, Colton, CA 92324, USA
| | - Bahareh Maknouni
- Department of Internal Medicine, Arrowhead Regional Medical Center, Colton, CA 92324, USA
- Department of Pulmonary and Critical Care, Arrowhead Regional Medical Center, Colton, CA 92324, USA
| | - Mufadda Hasan
- Department of Internal Medicine, Arrowhead Regional Medical Center, Colton, CA 92324, USA
- Department of Pulmonary and Critical Care, Arrowhead Regional Medical Center, Colton, CA 92324, USA
| |
Collapse
|
10
|
Ghantarchyan H, Bholat Y, Patel A, Bourbeau K, Vo D. Disseminated Histoplasmosis Found in Bone Marrow in a Newly Diagnosed AIDS Patient: A Literature Review and Report of a Rare Case. Cureus 2023; 15:e35417. [PMID: 36987462 PMCID: PMC10040219 DOI: 10.7759/cureus.35417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2023] [Indexed: 02/26/2023] Open
Abstract
Histoplasmosis is a rare fungal infection caused by the dimorphic species Histoplasma (H.) capsulatum, found in the Midwest and Central United States. Infection with H. capsulatum is observed in other regions beyond the Ohio and Mississippi River valley, including Mexico and Central and South America. There have been increasing reports of the disease occurring in Latin America in immunocompromised patients with human immunodeficiency virus (HIV). This case report details clinical findings of disseminated histoplasmosis in an immunocompromised patient, newly diagnosed with acquired immunodeficiency syndrome (AIDS) and initially presenting with sepsis of unclear source. The focus of this case report is the significance of detailed history-taking guiding for an appropriate investigation and recognition of the infectious source and giving insight into the management of disseminated histoplasmosis in the outpatient and inpatient settings.
Collapse
|
11
|
Ghantarchyan H, Win S, Nagori EK, Arabian S. Breast to Brain: A Case Report and Literature Review of Leptomeningeal Carcinomatosis. J Med Cases 2023; 14:13-18. [PMID: 36756000 PMCID: PMC9881483 DOI: 10.14740/jmc4024] [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] [Received: 11/08/2022] [Accepted: 11/25/2022] [Indexed: 01/20/2023] Open
Abstract
Breast cancer is widely known as the most common cancer in women in the United States. If left untreated, it can have detrimental effects. If the breast cancer is aggressive in nature, it can metastasize to the lymph nodes, bones, liver, lungs, and brain. A rare location of metastasis is the leptomeninges, specifically the pia and arachnoid matter. This term is coined as leptomeningeal carcinomatosis. Its diagnosis can be challenging to make as patients can present with non-specific symptoms. We present the case of an elderly female with a prior history of breast cancer that was treated with 12 cycles of chemotherapy with paclitaxel, radiation to her left axilla, and daily anastrozole for 3 years who came into the emergency department for worsening confusion, urinary incontinence, and difficulty ambulating. Cerebral spinal fluid obtained from a lumbar puncture supported a diagnosis of leptomeningeal carcinomatosis.
Collapse
Affiliation(s)
- Henrik Ghantarchyan
- Department of Internal Medicine, Arrowhead Regional Medical Center, Colton, CA 92324, USA,California University of Science and Medicine, Colton, CA 92324, USA,Corresponding Author: Henrik Ghantarchyan, Department of Internal Medicine, Colton, CA 92324, USA.
| | - Suyee Win
- California University of Science and Medicine, Colton, CA 92324, USA
| | - Essam K. Nagori
- Department of Internal Medicine, Arrowhead Regional Medical Center, Colton, CA 92324, USA,Department of Pulmonary and Critical Care Medicine, Arrowhead Regional Medical Center, Colton, CA 92324, USA
| | - Sarkis Arabian
- Department of Internal Medicine, Arrowhead Regional Medical Center, Colton, CA 92324, USA,California University of Science and Medicine, Colton, CA 92324, USA,Department of Pulmonary and Critical Care Medicine, Arrowhead Regional Medical Center, Colton, CA 92324, USA
| |
Collapse
|
12
|
Ibrahim AE, Ghantarchyan H, Le T, Bhagat A, Maknouni B, Arabian S. A Rare Presentation of Severe Organophosphate Poisoning: A Case Report and Review of Literature. Cureus 2022; 14:e31497. [DOI: 10.7759/cureus.31497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 11/16/2022] Open
|
13
|
Nagori EK, Ghantarchyan H, Qadir A, Arabian S. COVID-19-Induced Thrombocytopenia: A Brief Literature Review and Case Report. Cureus 2022; 14:e30993. [DOI: 10.7759/cureus.30993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/01/2022] [Indexed: 11/07/2022] Open
|
14
|
Ghantarchyan H, Phan AT, Hu J, Thaker K, Dombrovsky I, Roloff K, Arabian S. Wound Botulism in the Setting of Pregnancy: A Literature Review and Case Report. Cureus 2022; 14:e29273. [PMID: 36277593 PMCID: PMC9576342 DOI: 10.7759/cureus.29273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2022] [Indexed: 11/05/2022] Open
Abstract
Botulism is a rare neuroparalytic illness caused by Clostridium botulinum that can manifest as a descending flaccid paralysis, progressing from cranial neuropathies to respiratory failure. Wound botulism, constituting a minority of cases, is majorly associated with the injection of black tar heroin (BTH) in the western United States. A patient population of particular concern is pregnant women, who may experience a more severe course due to the physiological changes that occur in pregnancy. Because botulism in pregnancy lacks pathognomic features, physicians should maintain a high clinical suspicion when faced with a pregnant patient with neurological symptoms and a history of BTH use. Here, we report the case of a 25-year-old G3P1A1 female with a history of BTH use who presented with cranial neuropathies and respiratory insufficiency.
Collapse
|
15
|
Ghantarchyan H, Daniel T, Guerrero MA, Perrone J, Hanna P, Zuberi J, Christian DJ. Decreasing the burden: An unusual GIST presentation, a case report. Int J Surg Case Rep 2020; 74:243-246. [PMID: 32896685 PMCID: PMC7484535 DOI: 10.1016/j.ijscr.2020.08.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Received: 06/03/2020] [Revised: 07/24/2020] [Accepted: 08/24/2020] [Indexed: 01/17/2023] Open
Abstract
GIST may be refractory to treatment with only Imatinib and Sunitinib. Surgical debulking in addition to molecular therapy for patients with severely extensive GISTs. Debulking promotes an improved response to chemotherapy, decreases symptoms of obstruction and improves pain, and increases the patient’s ability in activities of daily living. Debulking this large mass significantly reduced tumor burden and thus promoted to an overall increase in chemotherapy effectivity.
Introduction Gastrointestinal stromal tumours (GIST) are notoriously one of the most common mesenchymal tumours of the alimentary canal. Most commonly originating from the gastric stroma, they are recognized by their mass effects on the abdominal cavity. Recurrence frequently occurs with GIST and these tumours may become refractory to tyrosine kinase inhibitors (TKIs). Therefore, resection may be indicated for improved outcomes. Presentation of case We present a 52-year-old African American male with a surgical history of GIST resection with recurrence that came to the emergency room with worsening diffuse abdominal pain. The tumour was refractory to two TKIs, Imatinib and Sunitinib. Computed tomography (CT) of the abdomen and pelvis was done which showed severe metastatic disease with carcinomatosis, multiple dilated loops of small bowel in the left hemiabdomen without discrete transition point. After seventeen days on nasogastric tube, antiemetics, the patient worsened, and it was decided to go to surgery. In this report, attention is focused on the surgical approach of tumour debulking with subsequent Regorafenib therapy for decreased obstructive symptoms and improved quality of life. Conclusion This case serves as an example of the importance of surgical debulking in addition to molecular therapy for patients with severely extensive GISTs. Tumour debulking is important to decrease tumour burden, improve chemotherapeutic response and improve quality of life especially in persons refractory to pharmacological therapy.
Collapse
Affiliation(s)
- Henrik Ghantarchyan
- St. Joseph's University Medical Center, 703 Main St., Paterson, NJ, 07503, United States; St. George's University, School of Medicine, Grenada.
| | - Tyrell Daniel
- St. Joseph's University Medical Center, 703 Main St., Paterson, NJ, 07503, United States; St. George's University, School of Medicine, Grenada.
| | - Manrique A Guerrero
- Department of Surgery, St. Joseph's University Medical Center, 703 Main St., Paterson, NJ, 07503, United States.
| | - John Perrone
- Department of Surgery, St. Joseph's University Medical Center, 703 Main St., Paterson, NJ, 07503, United States.
| | - Paul Hanna
- Department of Surgery, St. Joseph's University Medical Center, 703 Main St., Paterson, NJ, 07503, United States.
| | - Jamshed Zuberi
- Department of Surgery, St. Joseph's University Medical Center, 703 Main St., Paterson, NJ, 07503, United States.
| | - Derick J Christian
- Department of Surgery, St. Joseph's University Medical Center, 703 Main St., Paterson, NJ, 07503, United States.
| |
Collapse
|
16
|
Ghantarchyan H, Philip S, Dunn K, Suh JS. A Rare Case of Vertebral Osteomyelitis and Bilateral Psoas Abscess From an Unknown Source. J Med Cases 2020; 11:345-347. [PMID: 34434344 PMCID: PMC8383498 DOI: 10.14740/jmc3565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/18/2020] [Indexed: 11/11/2022] Open
Abstract
We present a case of a 31-year-old Filipino man with vertebral osteomyelitis and bilateral psoas abscesses. Vertebral osteomyelitis is a rare infection of the bone and bone marrow that affects the vertebral column. The patient’s initial presentation included a 1-week history of cough, fatigue, diarrhea, fevers, and a 40-pound weight loss. An extensive workup including a computed tomography (CT) scan of the abdomen and pelvis demonstrated bilateral psoas abscesses with subcutaneous air tracking into the right flank. Blood cultures revealed Escherichia coli, Streptococcus anginosus, and Bacteroides. However, with an unclear primary source of infection, the most likely causative factor we believed to be due to immobility.
Collapse
Affiliation(s)
- Henrik Ghantarchyan
- St. Joseph’s University Medical Center, 703 Main St., Paterson, NJ 07503, USA
- St. George's University, School of Medicine, Grenada, West Indies, USA
- Corresponding Author: Henrik Ghantarchyan, St. Joseph’s University Medical Center, 703 Main St., Paterson, NJ 07503, USA.
| | - Simi Philip
- Department of Infectious Disease, St. Joseph’s University Medical Center, 703 Main St., Paterson, NJ 07503, USA
| | - Kathleen Dunn
- Department of Infectious Disease, St. Joseph’s University Medical Center, 703 Main St., Paterson, NJ 07503, USA
| | - Jin S. Suh
- Department of Infectious Disease, St. Joseph’s University Medical Center, 703 Main St., Paterson, NJ 07503, USA
| |
Collapse
|