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Acute calcific tendinitis of the longus colli (ACTLC) is a rare, self-resolving condition caused by calcium hydroxyapatite crystal deposition in the longus colli muscle tendons. We present a case of a 46-year-old female with a history of hypertension who presented with right-sided neck pain, worsening abdominal pain, nausea, bloody emesis, and generalized body aches in the context of recent alcohol use. Physical examination revealed neck pain with limited range of motion, induration, and tenderness in the right and posterior neck areas. Laboratory findings showed elevated white cell count, inflammatory markers, and metabolic acidosis with an elevated anion gap and lactic acid level. Computed tomography (CT) of the neck with contrast demonstrated amorphous calcification in the longus colli tendons and retropharyngeal effusion, consistent with the diagnosis of ACTLC. The patient was treated with nonsteroidal anti-inflammatory drugs (NSAIDs) and supportive care, leading to symptom resolution. This case highlights the importance of considering ACTLC in the differential diagnosis of acute neck pain and the role of CT imaging in establishing the diagnosis. Prompt recognition and appropriate management of ACTLC can prevent unnecessary interventions and lead to improved patient outcomes.
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Background: and Importance: Nitrobenzenes are aromatic oxidizing nitrate compounds, acute ingestion of which can cause methemoglobinemia (metHb) that impairs oxygen transport. Clinical presentation ranges from cyanosis to asphyxia depending on the level of methemoglobin in the blood. Lack of improvement of hypoxia despite administration of oxygen can also be a clue to the diagnosis. Case presentation: A 23-year-old male with accidental ingestion of nitrobenzene presented with multiple episodes of vomiting, headache, and dyspnea. His venous blood was dark brown in color and oxygen saturation was not improving despite high-flow oxygen. He was managed with methylene blue and Vitamin C on this background with an appropriate history of nitrobenzene ingestion. Discussion: Acute nitrobenzene poisoning results in methemoglobinemia which is diagnosed by Co-oximeter but in resource-limited settings, clinical findings such as no improvement in SpO2 despite supplemental oxygen and chocolate brown appearance of blood aid in the diagnosis. Prompt treatment of methemoglobinemia with methylene blue along with Vitamin C has shown successful and effective outcomes. Conclusion: Diagnosis of acute nitrobenzene poisoning can be made with proper history, physical and bedside examinations in resource-limited settings even without the aid of a co-oximeter.
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Facial paralysis is one of the common problems leading to facial deformation. COVID-19 virus rarely has been shown to be associated with facial palsy. Here we present a case of a 60-year-old woman who presented with features of left lower motor facial palsy signs along with common features suggestive of COVID-19 infection. Brain imaging did not reveal any pertinent pathology but her polymerase chain reaction for COVID-19 was positive. This case highlights the fact that acute COVID-19 infection can be considered a cause of motor neuron facial palsy in the ongoing pandemic of COVID-19. Cases with neurological features suggestive of facial palsy therefore should be suspected of acute COVID-19 infection based on other pertinent findings of COVID-19 infection and thus polymerase chain reaction testing should be done. Keywords: case reports; COVID-19; facial palsy.