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Abu-Hilal LH, Njoum Y, Barghouthi DI, Khatib H, Mtour S, Adwan B. An Undiagnosed Shone Complex in a 52-Year-Old Female: A Case Report. J Investig Med High Impact Case Rep 2024; 12:23247096231218636. [PMID: 38288715 PMCID: PMC10829487 DOI: 10.1177/23247096231218636] [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: 09/03/2023] [Revised: 11/08/2023] [Accepted: 11/18/2023] [Indexed: 02/01/2024] Open
Abstract
Shone complex (SC) is a rare congenital heart disease characterized by four obstructive anomalies, including parachute mitral valve (PMV), left atrial supra-valvular ring, subaortic stenosis, and coarctation of the aorta. Typically, SC manifests early in life. However, we encountered a 52-year-old female with a history of hypertension diagnosed at 26 years and left-sided weakness poststroke. She presented with worsening dyspnea and palpitations, prompting a thorough investigation. Echocardiography revealed a heavily calcified bicuspid aortic valve with severe aortic stenosis and parachute mitral valve with severe mitral stenosis and preserved ejection fraction, raising suspicions regarding the presence of SC. Cardiac catheterization, aortic-angiography, and noncontrast chest computed tomography (CT) revealed abrupt occlusion of the postductal aorta, giving a picture of aortic coarctation with well-established collateral vessels including prominent right and left internal mammary arteries. So, she was diagnosed with an incomplete SC at the age of 52. Shone complex is a rare congenital heart disease that typically presents in early childhood, but late presentations due to misdiagnosis or incomplete work up are possible. This case emphasizes the rarity of late presentations of SC and highlights the importance of early diagnosis and intervention to improve outcomes. An incomplete SC should be considered in adult patients presenting with left-sided obstructive lesions.
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Affiliation(s)
| | | | | | - Hasan Khatib
- Al-Makassed Charitable Hospital, Jerusalem, Palestine
| | - Sameer Mtour
- Al-Makassed Charitable Hospital, Jerusalem, Palestine
| | - Bilal Adwan
- Al-Makassed Charitable Hospital, Jerusalem, Palestine
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Abu-Hilal LH, Njoum Y, Jabbarin FM, Barghouthi DI, Hamamdah A, Bourini M, Mtour S. Gonococcal endocarditis in a 32-year-old male: a rare presentation of an underrecognized disease - case report. Ann Med Surg (Lond) 2023; 85:5096-5099. [PMID: 37811029 PMCID: PMC10553011 DOI: 10.1097/ms9.0000000000001125] [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] [Received: 05/31/2023] [Accepted: 07/20/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction and importance Disseminated gonococcal infection (DGI) is an infrequent but serious complication of gonorrhea that can exhibit atypical symptoms. While rare, it can lead to infective endocarditis (IE), a condition that affects the heart valves and can result in severe and potentially life-threatening outcomes. Case presentation We present a case of Neisseria gonorrhoeae-caused IE confirmed by blood culture and direct isolation from the aortic valve vegetation. Our patient experienced complications, including glomerulonephritis, respiratory failure, and positive troponin. Urgent surgery successfully removed a large vegetation, replaced the aortic valve, and improved cardiac function. Follow-up showed symptom resolution. Clinical discussion DGI can present atypically with a triad of tenosynovitis, polyarthralgia, and rash, even without genitourinary symptoms. However, it can also present with nonspecific symptoms, leading to a later diagnosis of IE, as observed in our patient, who developed an aortic valve abscess and aortic regurgitation. Conclusion This case provides important insights into the diagnosis and management of gonococcal endocarditis, emphasizing the significance of early recognition, timely intervention, and multidisciplinary collaboration in improving patient outcomes. It is imperative to have a high level of suspicion for this rare entity, given its high virulence and potential for severe complications.
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Affiliation(s)
| | - Yumna Njoum
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | | | | | - Mohammad Bourini
- Nephrology Department, Al-Makassed Hospital, Jerusalem, Palestine
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Njoum Y, Barqawi AD, Maree M. Spontaneous rupture of a splenic artery aneurysm causing acute abdomen in a 19-year-old male patient: a case report. Front Surg 2023; 10:1223271. [PMID: 37790992 PMCID: PMC10544323 DOI: 10.3389/fsurg.2023.1223271] [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] [Received: 05/15/2023] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
Introduction A splenic artery aneurysm is considered an abnormal dilatation of the splenic artery layers greater than 1 cm in diameter. First described by Beaussier in 1770, it affects 1% of the population but carries a major risk for life-threatening complications of rupture in 3%-10% of cases regardless of its congenital or acquired etiology. The presentation is highly variable, from asymptomatic incidental discovery during routine imaging to aneurysmal rupture causing acute abdomen, massive gastrointestinal bleeding, and hemorrhagic shock. Case presentation Herein, we present a 19-year-old male patient who presented with epigastric pain and abdominal rigidity associated with a moderate amount of free peritoneal fluid that was found to be a ruptured SAA after immediate laparoscopy, which was successfully managed with splenectomy. Conclusion SAAs are a rare etiology of acute abdomen and hemorrhagic shock but have a very high risk of mortality even upon immediate intervention, requiring a very high level of vigilance and a low threshold for surgical intervention in unstable patients presenting with abdominal pain.
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Affiliation(s)
- Yumna Njoum
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | - Mohammed Maree
- Department of Surgery, Al-Makassed Hospital, Jerusalem, Palestine
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Mtour S, Abu-Hilal LH, Barghouthi DI, Njoum Y, Jabbarin F, Adwan B, Abu Asbeh I, Mtour A, Alsallamin I. Takotsubo cardiomyopathy prevalence and associated factors in patients presenting with a clinical picture of acute myocardial infarction in Palestine. Egypt Heart J 2023; 75:71. [PMID: 37578674 PMCID: PMC10425303 DOI: 10.1186/s43044-023-00399-6] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/09/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Takotsubo cardiomyopathy (TC) is a transient cardiac syndrome that manifests with symptoms resembling acute myocardial infarction (MI). It is characterized by temporary wall-motion abnormalities predominantly affecting the apical and mid-portions of the left ventricle, despite the absence of significant obstructive coronary disease. TC poses diagnostic challenges due to its resemblance to ST-segment elevation myocardial infarction. Our study aimed to determine the prevalence of TC and identify the factors associated with its occurrence in patients presenting with acute MI in Palestine. RESULTS A retrospective analysis was conducted on a cohort of patients diagnosed with TC at Al-Makassed hospital. Women accounted for 90.7% of TC cases (95% CI 88.2-93.2%). The mean age of affected individuals ranged from 62 to 76 years. The most common presenting symptoms were chest pain (83.4%, 95% CI 80.0-86.7%) and dyspnea (20.4%, 95% CI 16.3-24.5%), often following an emotionally or physically stressful event. Electrocardiography (ECG) on admission indicated ST-segment elevations in 71.1% of cases (95% CI 67.2-75.1%), accompanied by mild elevations of Troponins in 85.0% of cases (95% CI 80.8-89.1%). Despite the initial severity, left ventricular ejection fraction (LVEF) improved from 20-49.9 to 59-76% within a mean time of 7-37 days. The in-hospital mortality rate was 1.7% (95% CI 0.5-2.8%), with complete recovery observed in 95.9% of cases (95% CI 93.8-98.1%) and rare recurrence. The underlying etiology is believed to involve exaggerated sympathetic stimulation. CONCLUSIONS TC should be considered as a significant differential diagnosis in acute coronary syndrome (ACS) cases, particularly among postmenopausal women with a preceding stressful event. Our study provides insights into the prevalence and characteristics of TC in the Palestinian population. While stress has been recognized as a potential trigger for TC, further research is needed to explore if there are specific associations between occupation and other unique stressors in the Palestinian context and the prevalence of TC. The study's results can raise awareness among healthcare professionals in Palestine about the prevalence and characteristics of TC in their patient population.
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Affiliation(s)
- Sameer Mtour
- Cardiology Department, Al-Makassed Hospital, Jerusalem, Palestine
| | | | | | - Yumna Njoum
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Farah Jabbarin
- Cardiology Department, Al-Makassed Hospital, Jerusalem, Palestine
| | - Bilal Adwan
- Cardiology Department, Al-Makassed Hospital, Jerusalem, Palestine
| | | | - Ali Mtour
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Isaac Alsallamin
- Cardiology Department, Al-Makassed Hospital, Jerusalem, Palestine
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Batta R, Njoum Y, Deek R, Awad F, Bakri IA, Maree M. Follicular thyroid carcinoma with sternal metastasis: A case report. Int J Surg Case Rep 2023; 109:108625. [PMID: 37566985 PMCID: PMC10425392 DOI: 10.1016/j.ijscr.2023.108625] [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] [Received: 07/09/2023] [Revised: 07/29/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Sternal metastasis of follicular thyroid cancer (FTC) is rare as only 15 cases have been reported in the literature in which most cases of sternal metastasis occurs form breast and lung cancer. Surgical excision of the metastatic mass provides the best option due to its curative benefit, symptomatic palliation, and better response to radioactive iodine. CASE PRESENTATION Herein, we present a 77-year-old female patient with a known history of follicular thyroid carcinoma with isolated sternal metastasis treated with total thyroidectomy and en-bloc resection of the metastasis, followed by chest wall reconstruction using pectoralis major muscle flap. CLINICAL DISCUSSION Surgical excision of metastatic FTC to sternum with chest wall reconstruction was seldom reported as the treatment of choice. In most cases in the literature, mesh was used. However, in our patient mesh was not used taking into consideration the drastic consequences of wound infection and the possible need for mesh retrieval in such a dangerous area in proximity to the mediastinum. We believe that myo-adipo-facial flap is a more reasonable and safe option. CONCLUSION In patients with FTC, large tumors and bone metastases are factors that indicate poor prognostic factors, both of which were present in our patient. However, surgical excision provides hope for a better quality of life as it enhances subsequent Radioactive Iodine (RAI) therapy.
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Affiliation(s)
- Rita Batta
- General surgery department, Al-Makassed Hospital, Jerusalem, Palestine.
| | - Yumna Njoum
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Rahmeh Deek
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Fadi Awad
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Izzeddin A Bakri
- Pathology department, Al-Makassed Hospital, Jerusalem, Palestine
| | - Mohammed Maree
- General surgery department, Al-Makassed Hospital, Jerusalem, Palestine
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Njoum Y, Abu-Hilal LH, Barghouthi D, Alshawwa K, AbuKeshek T, Maree M. Unveiling follicular thyroid carcinoma by solitary spinal metastasis causing severe neurological deficit in a 67-year-old female: A case report. Int J Surg Case Rep 2023; 109:108541. [PMID: 37481973 PMCID: PMC10369476 DOI: 10.1016/j.ijscr.2023.108541] [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] [Received: 06/20/2023] [Revised: 07/06/2023] [Accepted: 07/15/2023] [Indexed: 07/25/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Follicular thyroid carcinoma (FTC) exhibits the ability to metastasize hematogenously to distant organs. Spinal metastasis is an unusual site for metastasis that even when it does, spinal metastasis manifests late in the course of the disease and is frequently linked to advanced disease and a bad prognosis. Until 2019, the literature only showed 29 cases of FTC with spinal metastasis as the first presenting feature. CASE PRESENTATION We present a case of a 67-year-old female who presented with an acute onset of severe neurological deficit that ended up bedridden. Magnetic resonance imaging of the spine revealed a spinal lesion causing severe spinal cord compression. Urgent surgical decompression was performed, and the histopathology confirmed metastatic FTC. Subsequent comprehensive evaluation, unveiled a primary thyroid tumor. CLINICAL DISCUSSION FTC accounts for 1 % of all malignancies, Therefore, regardless of how irrelevant symptoms may appear at first, it is important to understand all risk factors, screening recommendations, diagnostic techniques, treatment, and the vast range of potential presenting symptoms. Just like our patient, who had incontinence and abrupt loss of motor and sensory function in her lower limbs to be diagnosed with spinal cord compression by metastatic FTC. CONCLUSION This instance emphasizes how crucial it is to consider FTC as a possible differential diagnosis in cases with spinal metastasis, even when there is no known primary thyroid cancer. Prompt diagnosis, comprehensive staging, and multidisciplinary management are crucial in optimizing outcomes.
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Affiliation(s)
- Yumna Njoum
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | | | - Duha Barghouthi
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Khaled Alshawwa
- Department of Surgery, Al-Makassed Hospital, Jerusalem, Palestine
| | - Tawfiq AbuKeshek
- Department of Radiology, Al-Makassed Hospital, Jerusalem, Palestine
| | - Mohammed Maree
- Department of Surgery, Al-Makassed Hospital, Jerusalem, Palestine
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Njoum Y, Abu-Hilal LH, Jabbarin F, Bannoura S, Mtour S, Itmaizeh M. Rosai-Dorfman disease presenting as autoimmune hemolytic anemia in a male child in Palestine: a case report. Oxf Med Case Reports 2023; 2023:omad078. [PMID: 37484548 PMCID: PMC10359060 DOI: 10.1093/omcr/omad078] [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: 04/29/2023] [Revised: 06/19/2023] [Accepted: 06/22/2023] [Indexed: 07/25/2023] Open
Abstract
Rosai-Dorfman disease (RDD) is a rare, benign non-Langerhans cell histiocytosis predominantly affects lymph nodes and skin. Despite its benign nature, RDD can cause serious hematological complications. A 14-year-old male, presented with 3-month history of hemolytic anemia, lymphadenopathy, hepatosplenomegaly and rash. After thorough investigation, RDD was diagnosed by mediastinal lymph node biopsy that revealed presence of S100 and CD68-positive cells with absence of CD1a confirming the diagnosis of RDD. Treatment involved combination of steroids and Rituximab, which proved to be highly effective. The patient had dramatic improvement and entered remission, with follow-up period of 2 years. It is important to note that although RDD is a rare disease, it causes severe complications, as evidenced by the patient's parameters. Thus, prompt diagnosis and treatment are paramount. Histological diagnosis is of great value, as it helps confirming and guiding treatment decisions. With the right treatment, patients can experience great recovery and quality of life.
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Affiliation(s)
- Yumna Njoum
- Correspondence address. Faculty of Medicine, Al-Quds University, West Bank, PO: P583, Palestine. Tel: +972592130424; E-mail:
| | | | - Farah Jabbarin
- Department of Cardiology, Al-Makassed Hospital, Jerusalem, Palestine
| | - Sami Bannoura
- Department of Pathology, Al-Makassed Hospital, Jerusalem, Palestine
| | - Sameer Mtour
- Department of Cardiology, Al-Makassed Hospital, Jerusalem, Palestine
| | - Muaath Itmaizeh
- Department of Rheumatology, Al-Makassed Hospital, Jerusalem, Palestine
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Njoum Y, Obeid A, AbuKeshek T, Maree M. The first reported case of clicking larynx syndrome complicating thyroidectomy due to papillary thyroid cancer. Int J Surg Case Rep 2023; 108:108443. [PMID: 37421769 PMCID: PMC10382800 DOI: 10.1016/j.ijscr.2023.108443] [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] [Received: 05/26/2023] [Revised: 06/24/2023] [Accepted: 06/27/2023] [Indexed: 07/10/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE When the superior cornu or the top edge of the thyroid cartilage rubs against the hyoid, or when these structures come to rub against the cervical spine, Clicking Larynx Syndrome (CLS) occurs. Which is a very rare disorder in that only less than 20 cases are reported in the literature. Patients seldom ever mention past laryngeal injuries. The cause of the accompanying pain when present is yet unknown. Gold standard management appears to be thyroplastic surgery in which the structures responsible for the clicking sounds are removed or reduction of the size of the large horn of the hyoid bone. CASE PRESENTATION Herein, we present a 42-year-old male patient with a history of papillary thyroid microcarcinoma treated with left thyroidectomy presented with a spontaneous continuous painless clicking noise and abnormal clicking movement of the larynx. CLINICAL DISCUSSION CLS is a very rare condition with a very limited number of cases reported worldwide, most reported cases revealed abnormal laryngeal structural anatomy. However, our patient had normal laryngeal structures where multiple diagnostic tools (i.e.: Computed tomography, laryngoscopy) failed to disclose causative abnormality to explain his symptoms, nor literature could reveal any previously reported similar causes or explain the causative relationship between our patient's history of thyroid malignancy or thyroidectomy with his condition. CONCLUSION It is crucial to explain to patients with mild CLS that these clicking noises are safe and to provide them with information on the best possible case-dependent treatments to avoid the usually associated anxiety and psychological stress. Further observations and research are needed to analyze the association between thyroid malignancy, thyroidectomy and CLS.
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Affiliation(s)
- Yumna Njoum
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine.
| | - Amal Obeid
- Department of Surgery, Al-Makassed Hospital, Jerusalem, Palestine
| | - Tawfiq AbuKeshek
- Department of Radiology, Al-Makassed Hospital, Jerusalem, Palestine
| | - Mohammed Maree
- Department of Surgery, Al-Makassed Hospital, Jerusalem, Palestine
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Njoum Y, Alshawwa K, Jaber B, Abu-Zaydeh O. Inferior mesenteric arteriovenous malformation extending to splenic flexure colonic wall presenting with massive lower gastrointestinal bleeding, a case report. Int J Surg Case Rep 2023; 107:108322. [PMID: 37244107 DOI: 10.1016/j.ijscr.2023.108322] [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] [Received: 04/03/2023] [Revised: 05/06/2023] [Accepted: 05/08/2023] [Indexed: 05/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE An arteriovenous malformation (AVM) in the inferior mesenteric artery is a rare vascular pathology that accounts for 6 % of the causes of gastrointestinal bleeding. AVMs are typically classified as congenital persisting embryonic vasculature that link both systems and do not develop into arteries or veins [3], but they may also develop later in life. The majority of documented cases are iatrogenic after colon surgery. CASE PRESENTATION Herein we describe a 56-year-old man who presented complaining of fresh blood per rectum with passage of clots not related to defecation with no previous similar episodes, he was found to have extensive inferior mesenteric branches AVM invading the colonic splenic flexure via Computed Tomography (CT) angiography following three non-revealing upper and lower endoscopies which was later managed surgically with left hemicolectomy with primary end to end colo-colic anastomosis. CLINICAL DISCUSSION Although AVMs seldom manifest in multiple sites through the gastrointestinal tract, it is more prevalent in the stomach, small intestine, and ascending colon, and very unusual to affect the Inferior mesenteric artery and vein and to extend to the splenic flexure colonic wall. CONCLUSION Even if rare, inferior mesenteric AVMs should be suspected in a patient presenting with GI Bleeding with unrevealing endoscopies, where CT Angiography is to be considered.
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Affiliation(s)
- Yumna Njoum
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine.
| | - Khaled Alshawwa
- Department of Surgery, Al-Makassed Charitable Society Hospital, Jerusalem, Palestine
| | - Bashar Jaber
- Department of Surgery, Al-Makassed Charitable Society Hospital, Jerusalem, Palestine
| | - Omar Abu-Zaydeh
- Department of Surgery, Al-Makassed Charitable Society Hospital, Jerusalem, Palestine
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Barghouthi DI, Abu-Hilal LH, Njoum Y, Hasan AD, Alshawwa K, Hourani F. Gray Platelet Syndrome-Unusual Presentation with Spontaneous Splenic Rupture: A Case Report and Literature Review. J Investig Med High Impact Case Rep 2023; 11:23247096231196697. [PMID: 37649376 PMCID: PMC10472819 DOI: 10.1177/23247096231196697] [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: 06/27/2023] [Revised: 07/26/2023] [Accepted: 08/04/2023] [Indexed: 09/01/2023] Open
Abstract
Gray platelet syndrome (GPS) is a rare hereditary hemorrhagic disorder characterized by macrothrombocytopenia and the absence of alpha-granules in platelets. Clinically, mild-to-moderate bleeding is the main manifestation, often accompanied by thrombocytopenia, splenomegaly, and myelofibrosis. Here, we present a case of a 15-year-old male patient with a history of hepatosplenomegaly, and thrombocytopenia for 8 years, who presented with sudden generalized abdominal pain. Despite initial suspicion of gastroenteritis, diagnostic imaging revealed an extensive hemoperitoneum. Subsequent genetic testing confirmed the diagnosis of GPS, which had not been previously identified. This case highlights the importance of considering inherited platelet disorders should be considered in adolescents with long-standing thrombocytopenia, and emphasizes the need for thorough evaluation in patients with suggestive symptoms.
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Affiliation(s)
| | | | - Yumna Njoum
- Faculty of Medicine, Al-Quds University, Jerusalem, Palestine
| | - Abeer Dar Hasan
- Department of Surgery, Al-Makassed Hospital, Jerusalem, Palestine
| | - Khaled Alshawwa
- Department of Surgery, Al-Makassed Hospital, Jerusalem, Palestine
| | - Fadi Hourani
- Department of Surgery, Al-Makassed Hospital, Jerusalem, Palestine
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