RESUMEN
Acute coronary syndrome (ACS) can present with varied symptomatology, often deviating from classic presentations, particularly in patients without the characteristic chest pain. This case report describes an ST-elevation myocardial infarction (STEMI) that closely mimicked acute gastroenteritis, illustrating the challenges of differential diagnosis in atypical ACS presentations. We present the case of a 65-year-old Japanese male with a history of hypertension and dyslipidemia who arrived at the emergency department with acute abdominal pain, vomiting, diarrhea, and fever, symptoms suggesting viral gastroenteritis. The absence of chest pain diverted initial clinical suspicion away from cardiac causes. However, cardiovascular risk factors and a gallop rhythm prompted further cardiovascular evaluation. Subsequent blood tests and electrocardiogram findings suggested an acute myocardial infarction, later confirmed by coronary angiography as STEMI due to a 90% stenosis in the right coronary artery, which was successfully treated with percutaneous coronary intervention. The presentation of myocardial infarction can vary, with non-chest pain symptoms such as vomiting and fever occasionally leading the clinical picture, which may result in diagnostic delays and worsened prognosis. This case was particularly challenging due to the presence of all four symptoms typically associated with gastroenteritis, as well as the sequence of symptom onset being atypical for gastrointestinal diseases. This case exemplifies the need for a high degree of clinical suspicion for ACS in patients with atypical presentations, such as those mimicking gastroenteritis, to prevent misdiagnosis and ensure prompt and appropriate management, especially in patients with known cardiovascular risk factors.
RESUMEN
A 15-year-old male patient presented with recurrent fever. Three months prior, he experienced repeated fevers of 38°C, headaches, and malaise for three days. He experienced repeated fevers over 38°C for >72 hours two weeks prior to the current visit. A computed tomography scan showed enlarged lymph nodes around the ileum, suggesting familial Mediterranean fever (FMF) or inflammatory bowel disease. Endoscopic examination revealed a deformed Bauhin valve and inflammatory changes in the ileum, making inflammatory bowel disease unlikely. Thus, FMF was suspected, and after a thorough explanation, the patient was treated with colchicine, and his symptoms improved. Genetic testing revealed a mutation in the MEFV gene P369S-R408Q, and atypical FMF was diagnosed.
RESUMEN
Hypersensitivity pneumonitis is an allergic disease caused by various factors such as animal proteins and chemicals. The masked musang, a small animal of the Viverridae family native to East Asia, tends to infiltrate spaces like the attics of residences, causing damage through the deposition of excrement and other means. The older Japanese patient had been experiencing cough, shortness of breath, and fever for two months before presenting to our hospital. The symptoms improved upon admission to a local medical facility but deteriorated upon discharge. This cycle was repeated twice before the patient was admitted to our hospital. Based on the recurrent pattern of improvement during hospitalization and exacerbation upon returning home, along with the results of CT imaging and bronchoscopy, we suspected hypersensitivity pneumonitis. An environmental investigation at the patient's residence revealed a masked musang nest in the attic above the patient's room. After cleaning the attic, the symptoms did not recur. Consequently, we diagnosed hypersensitivity pneumonitis due to living environmental pollution caused by masked musangs. To the best of our knowledge, there have been no previous case reports of hypersensitivity pneumonitis caused by masked musangs. When wild animals invade human living environments, there is a possibility that not only infectious diseases but also immunological disorders, including allergic diseases, may appear.
RESUMEN
Odontoid osteomyelitis is a rare infectious disease that manifests as fever and posterior neck pain, while crowned dens syndrome is a relatively common inflammatory disorder with similar signs and symptoms. We describe the case of a 90-year-old woman presenting with fever, posterior neck pain, throat pain, and headache. Crowned dens syndrome was initially diagnosed based on the clinical picture and calcification around the odontoid process on cervical spine CT. However, the diagnosis was revised to odontoid osteomyelitis following the detection of Staphylococcus aureus in blood cultures that were performed due to the presence of headache. Infectious complications included spinal epidural abscess extending to the hypoglossal canal and osteomyelitis spreading to the clivus. Nonetheless, the patient achieved complete recovery after 13 weeks of antimicrobial therapy. No reports of odontoid osteomyelitis with calcification around the odontoid process have been reported. This case underscores the importance of avoiding a hasty diagnosis of crowned dens syndrome when calcification around the odontoid process is observed in patients presenting with fever and posterior neck pain. It is crucial to perform a thorough medical history review and physical examination to exclude other conditions. In cases where infection is suspected, blood cultures and cervical spine MRI are essential to investigate odontoid osteomyelitis and other complications.
RESUMEN
Meningitis caused by the zoonotic pathogen Campylobacter fetus in immunocompetent adults is rare. We report a 48-year-old Japanese woman with no underlying disease who was found to have meningitis caused by C. fetus. Both C. fetus subsp. fetus and C. fetus subsp. venerealis were isolated from the cerebrospinal fluid culture. The mode of infection in our patient was considered to be associated with the consumption of raw beef and raw cattle liver on a regular basis. Public awareness and education to avoid the consumption of raw or undercooked meat might help prevent C. fetus meningitis.
