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The phenomenon of green urine discoloration, while rare, represents a captivating clinical puzzle that challenges the distinction between benign and pathological conditions. In this report, we present an intriguing case involving a 15-year-old trauma patient admitted following a motorcycle collision, where the ensuing unconsciousness necessitated propofol induction for intubation and sedation. Remarkably, around 48 hours post-admission, the patient displayed green urine discoloration, which resolved spontaneously within just 12 hours. This case serves as a compelling illustration of the uncommon occurrence of propofol-induced green urine in the context of critical care management, underscoring the imperative need to discern and appreciate medication-related chromatic alterations in urine.
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An abnormal enlargement of the air-filled paranasal sinuses is referred to as pneumosinus dilatans. Typically discovered incidentally through radiological examinations, it infrequently manifests as cosmetic, neurological, ocular, or rhinological pathologies. Thorough evaluation for associated conditions is essential in patients with pneumosinus dilatans, including meningiomas of the anterior skull base or the optic nerve sheath. In our work, we report a 75-year-old female patient who presented with dysarthria and lower facial asymmetry. The computed tomography (CT) scan revealed pneumosinus dilatans of the frontal and ethmoidal sinuses with subfalcine herniation. During hospitalization, the patient presented with conscience disorder secondary to ischemic stroke and respiratory distress secondary to aspiration pneumonia. In our work, we also discuss reported cases of the English literature.
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Patients with inflammatory bowel disease can present with numerous infectious complications, including intra-abdominal abscess, perforations of the intestine, fistula formation, and the occurrence of septicemia. Toxic megacolon (TM) is a potentially fatal complication of inflammatory bowel disease (IBD) and is associated with high morbidity and mortality. In this case report, we report a 49-year-old male patient who was admitted to the intensive care unit for the management of severe sepsis that was secondary to an inaugural toxic megacolon complicating a silent inflammatory bowel disease, with a Lichtiger score of 11. Nonresponse to anti-bacterial therapy, noradrenaline, and intravenous corticosteroid therapy required an emergency total colectomy. After surgery, the patient died because of his unresolved septic shock. Correct management of this condition requires an accurate assessment of the patient's history, a correct physical examination, abdominal radiographs, and sigmoid coloscopy, and frequently requires surgery. The indications for surgery in cases of toxic megacolon, massive hemorrhage, perforation, peritonitis, or non-response to medical therapy are the most important ones. Patients with a history of inflammatory bowel disease are particularly prone to infectious complications since therapy for these inflammatory diseases is based on the use of immunosuppressive drugs and frequent abdominal surgeries.
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INTRODUCTION: COVID-19 induced cytokine storm is a well-documented phenomena that contributes significantly in the disease's evolution and prognosis. Therefore, therapies such as therapeutic plasma exchange, constitute a mainstay of therapeutic management especially for critically-ill patients. METHODS: We conducted a monocentric retrospective cohort study in the Resuscitation Department of the Mohammed VI University Hospital of Oujda-Morocco, to evaluate the efficiency of therapeutic plasma exchange on critically-ill COVID-19 patients over a 6 months period. We divided our patients into two groups: patients who received TPE (Therapeutic Plasma Exchange) sessions (TPE group) and patients who only benefited from the standard protocol treatment (non TPE group). RESULTS: Our study included a total of 165 patients, 34.5% of which benefited from TPE sessions. We observed an improvement of oxygenation parameters (SpO2 and PaO2/FiO2 ratio) and a progressive respiratory weaning, as well as a significant decrease of biomarkers indicative of inflammation (lymphocyte count, CRP (C Reactive Protein), IL-6, Ferritin) and coagulopathy (d-dimers, fibrinogen) in the TPE group after 5 consecutive TPE sessions. In comparison with the non-TPE group, The TPE-group patients had a shorter ICU (Intensive Care Unit) length of stay, required less frequently mechanical ventilation, and we more likely to be extubated. Furthermore, the TPE group had a lower mortality rate. DISCUSSION: Multiple studies have reported the safety and efficiency of therapeutic plasma exchange in the COVID-19 induced cytokine storm. Given the urgent character of the pandemic at the time, each center followed its own protocol in implementing plasma exchange. CONCLUSION: Similar to the results reported in the literature, our study reports positive results after using TPE specifically in terms of respiratory weaning and an improvement of the cytokine storm biomarkers, and more importantly a lower mortality rate.
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COVID-19 , Humanos , COVID-19/terapia , Intercambio Plasmático/métodos , SARS-CoV-2 , Síndrome de Liberación de Citoquinas/terapia , Enfermedad Crítica/terapia , Estudios Retrospectivos , BiomarcadoresRESUMEN
Emphysematous pyelonephritis (EPN) is a rare and serious complication of urinary tract infections that mainly occurs in diabetic patients. It results in the development of aerobic gas-forming bacteria1. Diagnosis is based mainly on a computed tomography scanner. Therapeutic management is based on the patient's clinical condition and radiological classification. Case presentation: We present a case of a 64-year-old female patient with type 2 diabetes under insulin and hypertension under amlodipine, who was admitted to the intensive care unit for a state of septic shock on EPN. The patient received resuscitation measures and antibiotic therapy, and the evolution was favorable. The patient was transferred to the urology unit after 10 days of hospitalization in the intensive care unit. Discussion: EPN is frequently caused by gram-negative cocci and generally develops in diabetics. The clinical signs of EPN are not very specific and are essentially based on the signs of acute pyelonephritis, which responds badly to treatment. Conclusions: It is essential to take preventive measures in diabetic patients to avoid this complication. Early diagnosis allows for avoiding surgery by preserving the kidney.
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Acute pancreatitis due to antipsychotic treatment is a rare but serious complication. Risperidone is among the rarest atypical antipsychotics associated with acute pancreatitis. Here, we report the case of acute pancreatitis developing 2 years after the use of Risperidone in a young man with schizophrenia. The mechanism and the time of occurrence in this case are at odds with what is generally reported in the literature.
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Leukoencephalopathy is progressive demyelination of the white matter, induced by a variety of factors. Among the causes of leukoencephalopathy, chemotherapy is an uncommon cause that generates potentially reversible lesions. The clinical presentation is classically made of alterations in mental status, hallucinations, hypertension, seizures, and acute visual changes. Imaging plays an important role in the diagnosis of this entity, especially by conventional and diffusion-weighted magnetic resonance imaging which enables an accurate diagnosis by identifying symmetric white matter lesions, especially in the parietal and occipital lobes. Herein, we report a 54-year-old female patient, newly diagnosed with non-metastatic moderately differentiated adenocarcinoma of the cecum. The patient received her first cancer chemotherapy (5-fluorouracil at 300 mg/m2). Five days later she was admitted to the intensive care unit for confusion following two generalized seizures. Conventional and diffusion-weighted magnetic resonance imaging was performed and showed diffuse white matter lesions of the parietal and occipital lobes. A diagnosis of 5-fluorouracil-induced leukoencephalopathy was established. The diagnosis of leukoencephalopathy should be considered in patients receiving cancer chemotherapy with alterations in mental status and seizures.
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Ischemic stroke remains today a major health problem that requires adequate management and etiological research. The prevalence in young people has increased. This article is a case report of a 37-year-old female diabetic patient who had an acute ischemic stroke due to spontaneous dissection of the right internal carotid artery. The article discusses the epidemiology, pathophysiology, diagnosis, and treatment of cervical artery dissection, which is a common cause of stroke in young patients. The use of antiplatelet and anticoagulant therapy, as well as endovascular and surgical interventions, is also discussed. Spontaneous carotid bulb dissection is an emergency in ischemic stroke in young people. The prognosis depends on the severity of the initial injury and the extent of collateral circulation, with successful recovery in 75% of cases.
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Neurological symptoms are prevalent in Coronavirus disease 2019 (COVID-19) cases, ranging from 30% to 80% depending on the severity of the disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We have documented a case of a 26-year-old woman who suffered from trigeminal neuritis caused by COVID-19, but responded well to corticotherapy. Two primary mechanisms may explain the neuroinvasive and neurovirulent properties of human coronaviruses. Neurological symptoms can persist long after recovery from COVID-19.
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Rhinoscleroma is an uncommon chronic infection caused by Klebsiella rhinoscleromatis, a gram-negative bacillus that affects the upper respiratory tract. Although the nasal cavity is the most affected area, pulmonary involvement has not been previously documented. This case report describes a 61-year-old man followed for nasal rhinoscleroma who was admitted to the intensive care unit with acute respiratory distress and septic shock due to bilateral infectious bronchopneumonia. Despite immediate intubation and intravenous antibacterial treatment, the patient died 10 days later. Klebsiella rhinoscleromatis was identified in a distal pulmonary swab and blood culture. While cases of rhinoscleroma and bacteremia caused by K rhinoscleromatis infection have been documented, the case we present here is the first to report on acute respiratory distress syndrome caused by fulminant pneumonia along with septic shock.
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Lung cancer can be revealed by thromboembolic complications. Its association with pregnancy is becoming more frequent due to the increasing number of smoking women. The care of a pregnant woman with cancer is quite delicate because it requires finding a balance between the treatment of the mother and the potential foetal risk. Case presentation: The authors report the case of a 38-year-old patient, with a twin pregnancy of 16 weeks, complicated by proximal and distal peripheral venous thrombosis of the left lower limb under low molecular weight heparin therapy at a curative dose. A week later, the patient presented to the emergency room with respiratory distress associated with chest pain and low-abundance metrorrhagia. The obstetrical ultrasound performed confirmed the vitality of only one of the two foetuses. The transthoracic ultrasound objectified a very abundant pericardial effusion producing a tamponade, which was drained percutaneously and whose cytological study revealed a liquid rich in tumour cells. After the unfortunate death of the second twin and an endouterine evacuation, a chest computed tomography angiogram demonstrated a bilateral proximal pulmonary embolism associated with bilateral moderate pulmonary effusion as well as multiple thrombosis and secondary aspect liver lesions with a suspicious parenchymal lymph node of the upper lung lobe. A liver biopsy concluded to a secondary hepatic localization of a moderately differentiated adenocarcinoma whose immunohistochemical complement revealed a pulmonary origin. A multidisciplinary consultation meeting leaned towards treatment with neoadjuvant chemotherapy. The patient died 7 months later. Discussion: Venous thromboembolic disease is more common in pregnant women. Delayed diagnosis is common in these cases, resulting in a high rate of locally advanced or metastatic disease. Since the treatment of pregnancy-associated cancer does not rely on a standardized approach, the decision on how to proceed must be made by a multidisciplinary team. Conclusion: The cornerstone of management remains to find the balance between treating the mother as well as possible while preventing the foetus from the possible harm of cytotoxic drugs frequently used to treat lung cancer. Because of the delayed diagnosis, the maternal prognosis often remains poor.
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Wernicke's encephalopathy is an acute neuropsychiatric syndrome resulting from thiamine deficiency, which is associated with significant morbidity and mortality. The diagnosis of Wernicke's encephalopathy is based on the clinical manifestations and rapid reversal of symptoms with thiamine. Case presentation: The authors present the case of a 25-year-old female patient at the 19th week of gestation (Gravid 1 para 0) with an unremarkable medical history who was admitted to the hospital for an areflexic flaccid tetraparesis with ataxia after persistent vomiting. The brain and spinal MRIs did not reveal any abnormalities, and the evolution was marked by an important improvement after supplementation with thiamine. Conclusion: Gayet Wernicke encephalopathy is a medical emergency. Clinical symptoms are inconstant and varied. MRI is the reference examination to confirm the diagnosis, but in 40% of cases it is strictly normal. Early thiamine administration can prevent morbidity and mortality in pregnant women.
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Autonomic dysfunction is a prevalent symptom of Guillain-Barré syndrome (GBS); cardiovascular involvement in this scenario has been mentioned infrequently in the literature. Case Presentation: A 65-year-old man with GBS presented with reversible left ventricular systolic failure. On first presentation, our patient had no history or indications of heart malfunction. During the clinical manifestation of his autonomic dysfunction, he had electrocardiographic alterations, modestly increased cardiac enzymes, significant left ventricular systolic dysfunction, and segmental wall motion irregularity. Once the initial episode was over, these anomalies and his symptoms resolved quickly. Discussion: We believe the reversible left ventricular dysfunction was caused by the toxic impact of elevated catecholamines as well as transiently injured sympathetic nerve endings in the myocardium, which was apparently caused by GBS. We recommend that echocardiography be performed in patients who exhibit clinical signs of autonomic dysfunction, particularly if they are associated with abnormal electrocardiographic findings, cardiac enzyme elevation, or hemodynamic instability, so that appropriate medical therapy can be instituted as soon as possible. Conclusion: GBS is a not a very rare situation in our context. Thus, doctors are supposed to know the life-threatening complications such as neurogenic stunned myocardium and be prepared to dodge it.
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Our objective in this study is to know the predictors of thromboembolic events 1 year after hospitalization for severe COVID-19 and the benefit of preventive oral anticoagulation for 1 month to placebo after release. We conducted a prospective study to determine the benefit of preventive anticoagulation upon discharge from the hospital and to determine the predictive factors of thromboembolic events. We included 720 patients in the SARCOV-19 Registry, with a mean age of 62.07 (±18.11), and 61.1% male. After 1 year, 60 thromboembolic events were observed, 45 in patients on a placebo, and 15 in patients on a direct oral anticoagulant. The predictive factors determined for these events were the presence of cardiac disease, elevation of D-dimer during hospitalization, myocardial damage defined by elevation of troponins more than 6 times normal, and the use of mechanical ventilation. However, the use of preventive anticoagulation protects against thrombotic events and reduces the risk of a thromboembolic event at 1 year with a relative risk of 0.49 compared to a placebo. The prolongation of the preventive anticoagulation at the exit will protect with a decrease of almost 50% of the risk against thrombotic events and this without increasing the risk of bleeding.
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COVID-19 , Tromboembolia , Humanos , Masculino , Persona de Mediana Edad , Femenino , Alta del Paciente , Estudios Prospectivos , Tromboembolia/etiología , Tromboembolia/prevención & control , Hospitales , Sistema de Registros , Anticoagulantes/efectos adversosRESUMEN
Introduction: An uncommon cause of acute pancreatitis, primary hyperparathyroidism accounts for less than 1% of cases. Case presentation: A 41-year-old male with acute pancreatitis and hypercalcemia is described in this case. Primary hyperparathyroidism was discovered during the work-up for hypercalcemia. During the first 24 hours after his hospitalization, the patient was monitored in the intensive care unit, and after a positive outcome, he was discharged. Discussion: Pancreatitis is a rare presentation of hyperparathyroidism. The first documented case of this association was by Erdheim in 1903 on a post-mortem study (2). Hyperparathyroidism is often only discovered after two or three episodes of recurrent pancreatitis (5), thankfully, in this case, the patient has been diagnosed from its first episode and eventually treated to prevent any other ones. hypercalcaemia leads to increase calcium in the pancreatic responsible for aggression of the pancreatic parenchyma and ducts, Other authors suggest that the pancreatic secretion in patients with hypercalcaemia is lower than normal, but the enzyme activity remains normal, resulting in the formation of protein plugs in the pancreatic ducts leading to their obstruction and self-digestion. Conclusion: Hypercalcemia can cause acute pancreatitis. This report describes rare case of a patient with acute pancreatitis caused by hyperparathyroidism.
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Introduction: The COVID-19 pandemic continues to be rampant with considerable morbidity and mortality worldwide since its emergence in December 2019. Several studies have focused on identifying different predictive factors of poor prognosis, including biological markers, such as C Reactive Protein among others. The objective of our work was to determine whether the CRP levels on admission to the intensive care unit are predictive of an unfavorable evolution of patients with COVID-19 through the experience of the Anesthesia and Intensive Care Unit of the University Hospital of Oujda and to compare our results with those reported in the literature. Methods: We conducted a retrospective, monocentric, descriptive and analytical study in the Department of Anesthesia and Intensive Care of the Mohammed VI University Hospital of Oujda, Morocco, between March 2020 and October 2021, including all critically ill patients admitted to the department during this period and meeting the inclusion criteria. The baseline admission CRP value was arbitrarily set at 100mg/d, thus conditioning the division of our patients into two groups (group 1: CRP < 100mg/L, group 2: CRP ≥ 100mg/L). Results: Among our 1035 included patients, 291 patients with had a CRP<100mlg/L (group 1) and 744 presented a CRP level equal or superior to 100mg/L (group 2). Lung parenchymal involvement was more severe or even critical (CT involvement > 75%) in group 2 (60.8%) compared to group 1 (39.2%). In group 2, 79.8% of patients were mechanically ventilated, compared to 20.2% of patients in group 1. Finally, the mortality rate in patients with a CRP ≥ 100mg/l was 77.4%, compared with 22.6% for patients with a CRP < 100mg/l. These findings are all statistically highly significant (p<0.001). Conclusion: Given the high contagiousness of the virus and the emergence of several variants, the management of the COVID-19 pandemic has focused more on prevention through vaccination against the virus, but also on an early identification of patients likely to evolve unfavorably for a personalized management.
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Proteína C-Reactiva , COVID-19 , Humanos , Pandemias , Pronóstico , Estudios RetrospectivosRESUMEN
OBJECTIVE: Our objective in this study was to determine the predictive factors of thromboembolic complications in patients with previous heart disease and severe covid-19 infection and the impact of previous use of antithrombotics on protection against these complications. METHODS: We conducted a single-center retrospective study of 158 patients with heart disease admitted to an intensive care unit for severe SARS-COV-2 infection. In order to determine the predictive factors, we used logistic regression analysis. RESULTS: Out of 158 patients, 22 were complicated by a thrombo-embolic event (13.9%), mean age of our population 64.03 (SD = 15.27), with a male predominance of 98 (62%). For the predictive factors of thromboembolic complications, and after multivariate analysis, we find the short duration of hospitalization (OR = 0.92; 95%CI (0.863-0.983), P = .014, previous use of antithrombotic drugs ((OR = 0.288, 95%CI (0.091-0.911), P = .034 for antiplatelet agents) and (OR = 0.322, 95% CI (0, 131-0.851), P = .021) for anticoagulants) as protective factors, and admission thrombocytosis as a risk factor (OR = 4.58, 95%CI (1.2-10.627), P = .021). D-dimer was not detected as a risk factor, and this can be explained by the characteristics of our population. Although prior use of antithrombotic drugs protects against thromboembolic complications during severe infection, there was no benefit in mortality. CONCLUSION: Prior use of antithrombotic drugs is a protective factor against thromboembolic complications in patients with a history of heart disease but without effect on mortality.
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COVID-19 , Enfermedades Cardiovasculares , Cardiopatías , Tromboembolia , Humanos , Masculino , Femenino , Fibrinolíticos/uso terapéutico , COVID-19/complicaciones , Enfermedades Cardiovasculares/tratamiento farmacológico , Enfermedades Cardiovasculares/complicaciones , Estudios Retrospectivos , SARS-CoV-2 , Tromboembolia/tratamiento farmacológico , Tromboembolia/etiología , Tromboembolia/prevención & control , Anticoagulantes , Cardiopatías/tratamiento farmacológicoRESUMEN
Coronavirus 2019 (COVID-19) disease has caused significant morbidity and mortality worldwide since its emergence in December 2019. Despite its respiratory tropism; there is a nontrivial relationship between this virus and the neurovascular system exposing patients to higher morbidity and mortality. We report the case of a young patient admitted for hemiplegia with acute respiratory failure, in whom imaging found multiple ischemic strokes with pulmonary embolism and severe involvement suggestive of COVID-19 pneumopathy. Stroke in the context of COVID-19 infection has distinct characteristics in terms of disease mechanism, patient demographics, but also clinical, biological, and neuroradiological specificities. The pathogenesis and optimal management of COVID-19-associated ischemic stroke remain unclear, but the coagulopathy and endotheliopathy triggered by the cytokine storm represent possible target mechanisms.
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Introduction: Mirizzi syndrome is an obstructive jaundice caused by extrinsic compression of the common bile duct by a stone embedded in the cystic duct [1].Cholangitis is a diagnostic and therapeutic emergency whose main risk is that of septic shock [1]. It can also progress to "Ictero-Uremigenic Angiocholitis" associated with sometimes extremely serious renal failure [2]. Case presentation: We reported the case of a 73-year-old patient admitted to the emergency room with septic shock on severe cholangitis. Given the presence of acute febrile cholangitis with criteria of septic shock on the one hand and acute renal failure on the other hand, the diagnosis of ictero-uremigenic Angiocholitis was made. Discussion: Angiocholitis is an inflammation and infection of the bile ducts, the etiologies of which are diverse, among them: Mirizzi's syndrome [1].The anatomical basis of Mirizzi syndrome has generally been attributed to an abnormal relationship between the cystic duct and the common hepatic duct [3]. Angiocholitis constitutes a diagnostic and therapeutic emergency, its complications threaten the vital prognosis [4]. Ictero-uremigenic Angiocholitis where the septic component dominates represents a real picture of sepsis, cholestatic jaundice, oliguria with renal failure [2]. Conclusion: fortunately rare, but always to be feared, the ictero-uremigenic Angiocholitis produces a typical picture of Angiocholitis, accompanied by a serious septic shock which passes largely to the fore associating in a very short period of time an organic renal insufficiency [2], the Age over 70 is a serious factor, it constitutes a therapeutic emergency requiring desobstruction of the main bile duct and possibly recourse to hemodialysis [4].