ABSTRACT
BACKGROUND: Chronic appendicitis is a condition unfamiliar to many physicians and is often referred to as a controversial diagnosis. This can give rise to diagnostic delay. CASE PRESENTATION: We present two cases of chronic appendicitis: a Caucasian female aged 21 years and a Caucasian male aged 34 years. The patients had different clinical presentations, which led the initial investigations in very different directions-tropical infectious disease and possible malignancy, respectively. In both cases, radiological imaging was the key investigation leading to the final surprising diagnosis. CONCLUSION: With these two case stories, we wish to draw attention to chronic appendicitis as a possible differential diagnosis in younger patients with chronic or recurrent abdominal pain, particularly if the pain is located in the lower abdomen and is accompanied by fever.
Subject(s)
Appendicitis , Abdomen , Abdominal Pain/diagnosis , Abdominal Pain/etiology , Adult , Appendicitis/diagnostic imaging , Appendicitis/surgery , Chronic Disease , Delayed Diagnosis , Diagnosis, Differential , Female , Humans , Male , Young AdultABSTRACT
Clostridium sordellii is a Gram-positive bacterium which can cause a serious toxic shock syndrome with a mortality of up to 69%. C. sordellii is a part of the normal vaginal flora in up to 10% of all women. This case describes a fatal case of a healthy 49 year-old woman with a C. sordellii-infection originating from an ovarian cyst. Quick diagnosis is difficult because of the non-specific flu-like symptoms. Survival requires immediate source control and specific antibiotic therapy capable of suppressing toxin production. In rodents superantigen antibodies have shown neutralizing effects.
Subject(s)
Clostridium Infections/microbiology , Clostridium sordellii , Ovarian Cysts/microbiology , Shock, Septic/microbiology , Adenocarcinoma/diagnostic imaging , Adenocarcinoma/microbiology , Clostridium sordellii/isolation & purification , Colorectal Neoplasms/diagnostic imaging , Colorectal Neoplasms/microbiology , Diagnosis, Differential , Fatal Outcome , Female , Humans , Middle Aged , Tomography, X-Ray ComputedABSTRACT
Brain parenchymal extravasation of contrast has been described after infusion of larger amounts of iodinated X-ray contrast agent. We describe a case in which a patient after infusion of 500 ml iomeprole 350 mg/ml developed neurological symptoms and a subsequent cerebral computed tomography (CT) scan was interpreted as subarachnoid haemorrhage. The patient was fully recovered within 48 hours, and a follow-up CT scan 26 hours later showed no signs of haemorrhage. In patients with sudden onset of neurological symptoms after infusion of large quantities of contrast media and a CT scan showing signs of subarachnoid haemorrhage, spinal puncture or magnetic resonance imaging should be considered prior to interventional procedures in order to verify the diagnosis.
