RESUMO
Introduction and importance: Aluminum phosphide (ALP) is a commonly used suicidal agent in an agrarian country like Nepal. The unmasking of the Brugada pattern in the electrocardiogram (ECG) associated with ALP poisoning is a rare phenomenon, and studies pertaining to it are scarce in the medical literature. Case presentation: An 18-year-old female presented to the emergency department with multiple episodes of vomiting, headache, blurring of vision, and abdominal pain after 4 h of consumption of ALP with suicidal intent. A 12-lead ECG revealed a coved ST-segment elevation and T-wave inversion in leads V1-V3 with right bundle branch block suggestive of a type 1 Brugada pattern. Her past medical and family history was not significant. The patient made an uneventful recovery with the required supportive treatments. Clinical discussion: Cardiac arrhythmias are the major cause of death in ALP poisoning. Unmasking of the Brugada ECG pattern is a rare but potentially fatal complication implicated in various pharmacological toxicities, including tricyclic antidepressants, cocaine, procainamide, disopyramide, flecainide, and rarely with ALP. Conclusions: ALP poisoning can unmask the Brugada ECG pattern, which can lead to ventricular fibrillation and/or sudden cardiac death.
RESUMO
INTRODUCTION AND IMPORTANCE: Traumatic diaphragmatic injury (TDI), although rare, is associated with high mortality and morbidity and timely recognition is important. CASE PRESENTATION: We present a case of a 44-year-old male who fell from a three-story building and presented with complaints of shortness of breath and chest pain. On examination, his chest compression test and extended focused assessment with sonography in trauma (E-FAST) were positive. Chest X-ray showed loss of diaphragmatic contour, fracture of fifth to eleventh ribs on the left side, and opacities in the left hemithorax. Contrast-enhanced computed tomography of chest, abdomen, and pelvis showed bowel loops over the left hemithorax with grade 1 splenic injury. A diagnosis of ruptured diaphragmatic hernia with grade I splenic injury was made and emergency primary repair of the diaphragm was done via thoracotomy. DISCUSSION: Clinical diagnosis of TDI is difficult and can be misdiagnosed as a pneumothorax. In addition, the subtle presentation can often be missed. CT scan of the chest and abdomen is the imaging of choice to reach a diagnosis. Once diagnosed, emergency surgery via laparotomy or thoracotomy is mandatory. Delay in diagnosis can have a fatal consequence or delayed complications which have high mortality. CONCLUSION: Diaphragmatic injury should be suspected in all blunt thoracoabdominal traumas, and the presence of this injury should be excluded to prevent late complications. Timely intervention can provide excellent outcomes.
RESUMO
With the surge of cases during the second wave of COVID-19 in Nepal, a number of mucormycosis coinfection cases have also come to our attention. We present a case of a 65-year-old female who was admitted to our emergency department with complaints of pain, swelling, and tingling sensation of the left side of the face along with blood-tinged nasal discharge for 20 days. She had been tested positive for COVID-19 a month back and managed with oxygen support and corticosteroids. Magnetic Resonance Imaging showed invasive fungal sinusitis, with the positive black turbinate sign and mild extension along with the dura mater of the left temporal lobe, and left cavernous sinus. She was diagnosed with rhinocerebral mucormycosis and managed with systemic antifungal therapy and insulin. As per the treatment modality, surgical debridement could not be done because the patient did not give consent.
