Journal of Clinical Case Reports

A 27-year-old man, with no known diseases, was admitted to our hospital with respiratory insufficiency and sepsis after 21 days of low-grade fever and non-productive cough without any other symptoms. He was diagnosed with fever of intermediate duration and doxycycline was initiated. An X-ray showed severe pleural effusion and a right lower lobe atelectasis. A pleural effusion sample study revealed an empyema, and an emergent thoracic tube was placed. Five days of empyema sample culture did not show pathological findings; thus, we performed a timeextended culture. After 8 days, Streptococcus constellatus was isolated. We completed 10 days of intravenous empiric treatment followed by oral cephalosporin. The patient required two thoracic drainages; there were no complications. He was completely asymptomatic 3 months after discharge. This report summarises the importance of oral microbiota as pathogens involved in community-acquired pneumonia among healthy young people and the atypical presentation of a typical complicated pneumonia.

Sarcomas are a rare and heterogeneous group of malignant tumors of mesenchymal origin that comprise less than 1% of all adult malignancies and 12% of pediatric cancers. Liposarcoma is defined as a malignant mesenchymal neoplasm that is composed of lipogenic tissue, and is a common malignant soft tissue tumor, accounting for 10% to 16% of all sarcomas. This case is about a 47-year-old male, who visited his family doctor with complaints of asymmetrically enlarged left thigh mass with a week of evolution, associated with light left thigh pain that appeared 1 month before presentation. Physical examination showed a difference of 11.5 centimeters (cm) in the measurement between both thighs. An ultrasound was requested and showed a massive neoformation on the posterior aspect of the left thigh, compatible with liposarcoma. The patient was referred to the General Surgery Service where he performed magnetic resonance imaging (MRI), which confirmed the presence of bulky neoformation, compatible with undifferentiated liposarcoma. As part of the protocol, the patient was then referred to the Portuguese Oncology Institute in Oporto, where he performed genetic tests and therapeutic guidance. Soft tissue sarcomas are a heterogeneous group of tumors with a large spread in biological behavior, prognosis, and requested treatment modalities. Myxoid liposarcoma show a good prognosis in most cases. However, it is biologically different from other liposarcomas, with the presence of the t (12;16) translocation, high radio and chemosensitivity and a high prevalence of extrapulmonary metastases.

Long QT syndrome (LQTS) is a rare congenital and inherited or acquired heart condition in which delayed repolarization of the heart following a heartbeat increases the risk of episodes of torsades de pointes. These episodes may lead to fainting and sudden death due to ventricular fibrillation. Long QT syndrome is a channelopathy, characterized by the disorder of ion channels, which results in a prolongation of QT interval and ventricular arrhythmias. Clinical manifestation of long QT syndrome varies from asymptomatic to life threatening arrhythmias. The first sign of the disease may be sudden cardiac death. Episodes may be provoked by various stimuli, depending on the subtype of the condition. Therefore, once the syndrome is diagnosed, prevention of adverse events should be started that could often change the lifestyle and sometimes future career.

We present a case of an asymptomatic 15-year-old athlete girl, in whom long QT syndrome type 1 was diagnosed leading to termination of her professional sport career. Prolongation of QT interval was identified during routine health screening. The intermediate probability of long QT syndrome was calculated according to Schwartz and Crotti criteria, therefore genetic testing was performed showing pathogenic mutation of KCNQ1 gene. After the genetic confirmation of the disease, patient’s medical examination was reviewed showing QTc interval prolongation on recovery phase during exercise stress test.

A scrutiny examination of athlete’s electrocardiograms is needed. Automatic calculation of QTc interval can be imprecise and manual recalculation is necessary. Accurate evaluation of LQTS ECG criteria helps to determine the probability of genetic syndrome, indications for genetic testing, lifestyle and treatment recommendations.

Gastrointestinal stromal tumors are the most common mesenchymal tumors of the gastrointestinal tract. Contrast-enhanced computed tomography is the most commonly used for evaluating response to treatment. Targeted therapies may cause some changes in tumor structure. Reduced lesion vascularity, cavitations, and intratumoral hemorrhage are some changes in patients after imatinib therapy, even without any size reduction. Paradoxically, a transient increase in size may be seen in some cases due to cystic change and intratumoral hemorrhage. Alternative tumor response criteria were developed by Choi et al. in gastrointestinal stromal tumor. They showed that not only the tumor size but also the tumor density are important in evaluating the response. In the present study, we report a 67-year old man who had been diagnosed with the gastrointestinal stromal tumor and treated with imatinib. After 3 months of imatinib treatment, liver lesions reported progression in response assessment.

The rising cases of multi-drug resistant bacteria have received considerable attention from patients and clinicians as a result of difficulties encountered during treatment. This has posed great challenges to pharmaceutical practitioners for continued search for effective antibiotics. The present study aimed at investigating antibiotic susceptibility profile of Gram-negative bacteria isolated from infected wound in two selected privately owned healthcare centers in Gboko town. A total of thirty (30) wound samples, fifteen (15) from each of the hospital were collected using swab sticks and analyzed and the isolates tested for MDR using disc diffusion method. The result showed that the wounds were infected with Escherichia coli (46.7%), Salmonella spp (40%) and Pseudomonas spp (13.3%). The three isolates displayed varying degrees of resistance to antibiotics. Escherichia coli showed the highest resistance to streptomycin (92.8%), Augmentin (92.8%), Septrin (78%), Gentamycin (78.5%), Amoxacillin (71.4%) and Chloramphenicol (71.4%) and least resistance was observed with Pefloxacin (50%), Tarivid (50%), Sparfloxacin (57%), Ciprofloxacin (50%) antibiotics. Salmonella spp showed the highest resistance to Septrin (100%), Augmentin (91%), Streptomycin (91%), Amoxacillin (83.3%), Chloramphenicol (83.3%), Tarivid (83.3%) and least resistance to Sparfloxacin (33.3%), Ciprofloxacin (41.6%) and Pefloxacin (41.6%) antibiotics. Pseudomonas spp showed (100%) resistance to Gentamycin, Augmentin, Amoxacillin, Ciprofloxacin, Sparfloxacin, Septrin and Streptomycin, though the resistance was observed to be slightly minimal to Pefloxacin (75%), as well as Tarivid and Chloramphenicol. Antibiotic susceptibility test is recommended prior to administration of antibiotics for effective treatment and periodic monitoring is also advocated to check emerging MDR trends as a guide to health authorities.

Pulmonary embolism is a sudden blockage in the lung artery. Pregnancy is an example of Virchow’s triadhypercoagulability, stasis of blood and endothelial injury; together these factors lead to an increased incidence of venous thromboembolism.

Tricuspid valve replace in patients with active endocarditis can be a challenging decision in surgical options. In this experience, we replaced the tricuspid valve using a handmade single tube of CorMatrix Extracellular Matrix (ECM) (CorMatrix Cardiovascular Inc, Roswell, Ga). Its showed to be safe and useful in a young patient with extensive valve destruction and early follow-up showed symptomatic resolution and valve normal function.

We present a peculiar case of acute pancreatitis. A 23-year-old man was admitted to our Gastroenterology Unit with a diagnosis of acute pancreatitis based on clinical symptoms and on biochemical data. After the necessary diagnostic work-up, a diagnosis of acute traumatic pancreatitis was made, due to a migrated foreign body (needle).

Background: It is known that twin pregnancy caries higher risks to the mother and her fetuses. More importantly, its occurrence in septate uterus seems to carry more fatal complications. This case report is presented to show the occurrence of spontaneous twin pregnancy in septate uterus and successful expectant management of cotwin death in this type of uterine malformation.
Case Presentation: A 25-year-old primigravid mother with septate uterus admitted to hospital at gestational age of 33 weeks + 4 days with diagnosis of cotwin death. She was on expectant management until 37 weeks at which time cesarean section was done to delivery alive baby.
Conclusion: Spontaneous twin pregnancy can occur in septate uterus. This pregnancy, like the one in normal uterus, can be complicated by cotwin death which possibly be expectantly managed until fetal lung maturity is achieved.

An 83-year-old man presented with hypertensive brainstem encephalopathy manifesting as general weakness, dysarthria, gait disturbance, urinary incontinence, and decreased cognitive function. The patient had a history of gamma knife radiosurgery (GKR) for cerebellopontine angle (CPA) meningioma 10 years prior. Compared with previous magnetic resonance (MR) imaging results, a recent MR image revealed massive brainstem hyperintensity in T2-weighted images, not in the parieto-occipital lobes. The lesions were nearly completely resolved several days after normalization of the blood pressure. Isolated hypertensive brainstem encephalopathy without concomitant typical parieto-occipital abnormalities are unusual and the diagnosis is challenging especially after gamma knife radiosurgery for cerebellopontine angle meningioma. We describe a patient with hypertensive brainstem encephalopathy that was initially confused with peritumoral edema.