Sphincter of oddi dysfunction induced by ketamine: A case report.

Key Clinical Message: Chronic ketamine use can lead to sphincter of oddi dysfunction (SOD), causing various hepatobiliary complications. Recognizing substance abuse history is vital for early detection. Timely intervention can prevent irreversible liver and pancreas damage. Abstract: Ketamine is commonly abused as a recreational drug worldwide due to its ability to induce euphoria-like effects. Ketamine abuse is associated with many hepatobiliary side effects ranging from cholestasis to biliary sepsis and death. Here we present a case of a young 29-year female with upper abdominal pain due to SOD resulting from chronic use of ketamine. SOD can result in obstruction or dysfunction of the bile and pancreatic ducts. Ketamine induces SOD by activation of the muscarinic receptors in the sphincter of oddi. Detail history of substance abuse is crucial for early identification of ketamine-induced SOD. Early identification and treatment of this rare condition can prevent permanent injury to the liver and pancreas.

Granulomatosis with polyangiitis mimicking COVID-19 pneumonia: A case report.

Granulomatosis with polyangiitis (GPA), formerly known as Wegener's granulomatosis, is a necrotizing vasculitis characterized by small-to-medium-sized vessel involvement and the presence of antineutrophil cytoplasmic antibodies (ANCA). We present a case of a 26-year-old Asian woman who was transferred to our center from a nearby hospital, where she presented with shortness of breath, tested positive for COVID-19, and was being managed for COVID-19 pneumonia. She also had hemoptysis, skin lesions, and left foot numbness. Serological markers and VATS-guided lung biopsy confirmed the diagnosis. Treatment with methylprednisolone and rituximab led to stabilization, despite complications of subcutaneous emphysema and lower extremity neuropathic symptoms. Early recognition and appropriate management of GPA are crucial for optimal outcomes.

Clarithromycin-induced acute liver injury in a patient with positive Helicobacter pylori: a case report and review of the literature.

Introduction and importance: While 14-day triple therapy with clarithromycin is a common approach for eradicating Helicobacter pylori infection, it is essential to note that this treatment does not come without potential side effects. Case presentation: We present the case of a 34-year-old male who presented to the emergency department with severe vomiting and abdominal pain. Subsequent evaluation revealed that the patient had developed drug-induced liver injury (DILI). Clinical discussion: DILI can cause acute hepatocellular or cholestatic damage, and chronic injury can lead to hepatocellular, cholestatic, vascular, or neoplastic manifestations. Conclusion: Clinicians should exercise caution and be alert to the potential hepatotoxic effects of medications, especially when initiating triple therapy for H. pylori infection.

Kimura disease masquerading tuberculosis: a rare case presentation.

Kimura disease (KD) is an inflammatory disorder characterized by the development of subcutaneous lymphoid masses and regional lymphadenopathy. Due to its rarity and similarity to another disease, the diagnosis is complex. Case presentation: Here, the authors present a case of KD in 26-year-old male from Nepal who initially did not respond to antitubercular therapy. Later on, KD was diagnosed based on histopathology. He was followed up in medical outpatient with a good response to corticosteroid therapy. Clinical discussion: The diagnosis of KD is quite difficult in low-resource settings. The diagnosis is histopathological. Associated lymphadenopathy may mimic tuberculosis. Many patients respond well to the high-dose of steroid therapy; some might also require surgical excision or chemotherapy. Conclusion: Hence, the physician should include KD as a differential when a male in his 20s or 30s presents with a subcutaneous nodular mass in the head and neck.

Cervical spondylotic myelopathy presenting as a "pancake enhancement" on MRI of the spinal cord: A case report and review of literature.

Spondylotic myelopathy involves chronic spinal cord compression from degenerative spine changes presenting a myriad of neurological and pain symptoms. We report a case of cervical myelopathy with transverse pancake-like gadolinium enhancement seen on MRI in a 42-year-old gentleman with progressive bilateral upper extremity numbness, tingling, and impaired gait.

High-altitude illness: Menace in Himalayas of Nepal.

Nepal is a country of Himalayas including Mt Everest, the tallest mountain in the world, where a lot of people travel to high altitudes. Significant number of people develop high-altitude illness which includes acute mountain sickness (AMS), high altitude pulmonary edema (HAPE) and high-altitude cerebral edema (HACE) leading even to death. Addressing this issue demands more efforts on both the preventive and treatment aspects to decrease the sufferings of people in this modern time of advanced healthcare and technology.

Rheumatic heart disease in the heart of Himalayas.

Rheumatic heart disease results from the damage to heart valves caused by one or more episodes of rheumatic fever leading to a variety of cardiac complications. Although less common in developed parts of the world, it is one of the most common acquired heart diseases in low- and middle-income countries including Nepal, affecting children and young people. Primary prevention with prompt treatment of streptococcal throat infections and long-term secondary antibiotic prophylaxis with benzathine penicillin G are the key intervention strategies. Echocardiography based screening in schoolchildren has become an effective measure for early identification of the cases. More coordinated policies and effective interventions are needed to successfully decrease the burden of the rheumatic heart disease in resource limited settings like Nepal.