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Mashup Score: 1Clinical and neuroradiographic features of fentanyl inhalation-induced leukoencephalopathy - 1 month(s) ago
A man in his late 40s with no known past medical history was unresponsive for an unknown period of time. Crushed pills and white residue were found on a nearby table. On presentation he was obtunded and unresponsive to verbal commands but withdrawing to painful stimuli. The initial urine drug screen was negative, but a urine fentanyl screen was subsequently positive with a level of 137.3 ng/mL. MRI of the brain showed reduced diffusivity and fluid attenuated inversion recovery (FLAIR) hyperintensity symmetrically in the bilateral supratentorial white matter, cerebellum and globus pallidus. Alternative diagnoses such as infection were considered, but ultimately the history and workup led to a diagnosis of fentanyl-induced leukoencephalopathy. Three days after admission the patient became able to track, respond to voice and follow basic one-step commands. The patient does not recall the mechanism of inhalation. While there are case reports of heroin-induced leukoencephalopathy following
Source: casereports.bmj.comCategories: General Medicine News, General HCPsTweet
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Mashup Score: 2ZAP-70 mutation: a case with familial autoimmune haemolytic anaemia and immune deficiency - 2 month(s) ago
Zeta-chain associated protein kinase 70 kDa (ZAP-70) deficiency is one of the rare immunodeficiency disorders due to autosomal recessive homozygous or compound heterozygous loss-of-function mutations in the ZAP-70 GENE . In the literature, patients with ZAP-70 deficiency have been reported with a broad spectrum of clinical manifestations including recurrent respiratory infections (81.8%), cutaneous involvement (57.9%), lymphoproliferation (32.4%), autoimmunity (19.4%), enteropathy (18.4%) and increased risk of malignancies (8.1%). The most common immunological phenotype in those patients was low CD8+ T cell counts (97.9%) and normal non-functioning CD4+ T cell. Haematopoietic stem cell transplantation was applied as a curative treatment for this disorder.
Source: casereports.bmj.comCategories: General Medicine News, General HCPsTweet
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Mashup Score: 3Diffuse Pneumonitis after Lutetium-177-PSMA-617 Treatment in a Patient with Metastatic Castration-Resistant Prostate Cancer - 3 month(s) ago
We present the case of a patient with heavily pretreated metastatic castration-resistant prostate cancer (mCRPC) who received lutetium Lu-177 vipivotide tetraxetan (also known as 177Lu-PSMA-617) due to progressive disease despite chemotherapy, hormonal therapy and radiation, including palliative mediastinal and central nervous system radiation. He was subsequently hospitalised for worsening acute onset dyspnoea despite clinically responding to therapy. Interval imaging revealed progressive multifocal ground-glass opacities superimposed on a background of underlying peribronchovascular fibrosis. Further workup, including an extensive workup to identify a possible infectious aetiology, ruled out most aetiologies leaving radiation pneumonitis (RP), radiation recall pneumonitis (RRP) and drug-induced pneumonitis as possible diagnoses secondary to 177Lu -PSMA-617. The associated imaging findings of ground-glass opacities and consolidation can be like other aetiologies such as acute infectio
Source: casereports.bmj.comCategories: General Medicine News, Hem/OncsTweet
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Mashup Score: 1Complete atrioventricular block—an uncommon clinical presentation in an adult patient with proven dengue fever - 5 month(s) ago
Dengue is a viral disease that clinically presents with fever, thrombocytopenia-related haemorrhagic complications and shock in its severest form. This female patient in her 40s primarily presented to the emergency department of the cardiac centre as syncopal attacks with a complete atrioventricular block. Temporary cardiac pacing as an emergency procedure helped to maintain cardiac rhythm and haemodynamics. A history of recent onset fever helped us to suspect and confirmed by serology for dengue pathology. Normal sinus rhythm was restored after 2 days, and we removed the temporary pacing. Cardiac arrhythmia did not recur in 6 months of follow-up. The aetiology for dengue-related cardiac arrhythmia is still not established. In the recovery phase from fever, complete heart block may show up as a primary presentation in the emergency. Its timely diagnosis and temporary pacing may allow spontaneous recovery. The inclusion of electrocardiography in dengue patient guidelines should help cli
Source: casereports.bmj.comCategories: General Medicine News, Cardiologists1Tweet
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Mashup Score: 3
Coronary stent dislodgement and migration is a rare phenomenon that can potentially result in life-threatening complications. We encountered the unusual case of a coronary artery stent that stripped from its delivery balloon and embolised into the left internal carotid artery during percutaneous coronary intervention. Such an event is a stressful experience for the interventional cardiologist but also an uncommonly encountered situation for a neurointerventionalist whose expertise may be sought to help navigate the situation. Planning the interventional approach and taking into consideration the tools available as well as potential complications is crucial to maximise the chances of best possible outcome for the patient. We were able to retrieve the stent safely and successfully, but, at the same time, we were prepared to manage any adverse events in the best way possible.
Source: casereports.bmj.comCategories: General Medicine News, NeurologyTweet
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Mashup Score: 11Clinical course and management of an unknown multiple-magnet ingestion in a teenage male - 7 month(s) ago
Foreign body ingestion in the paediatric population, especially when the details surrounding the ingestion are unknown, can be particularly difficult to manage. Magnets pose a unique challenge, as their magnetic field and caustic properties can instigate significant damage to the gastrointestinal tract if not treated in a timely manner. We report the case of a teenage male who presented to the emergency department with a chief complaint of cramping and abdominal pain. He was found to have multiple metallic foreign bodies within the lumen of the stomach, the distal ileum and the ascending colon/ileocecal valve region, which he did not have any recollection of ingesting. The management of an unknown multiple-magnet ingestion in the older paediatric population is not well documented, and this case may provide unique insight for the management of similar cases.
Source: casereports.bmj.comCategories: General Medicine News, General NewsTweet
Inhaling fentanyl may cause potentially irreversible brain damage (toxic leukoencephalopathy), warn doctors in the journal @BMJCaseReports, after treating a middle-aged man found unresponsive in his hotel room after snorting the drug. https://t.co/OGy1K8bQxv https://t.co/bqfqrIS5l9