RESUMEN
Background: In rare dermatology cases the differential diagnosis is challenging, e.g. when one nail is growing below another, the provisional diagnosis could be confusing. It may present as chronic paronychia, candidiasis, bacterial infections, rheumatoid arthritis, psoriasis, subungual tumours, or cysts. Case description: We present a case of iatrogenic rupture of the nails of both big toes following a commonly known recommendation from physiotherapists in the initial stages of hallux valgus or chronic arthritis by using kinesio tape to prevent the big toe from fixation in the valgus position. The initial provisional diagnosis of retronychia was revised, and a final diagnosis of onychomadesis was made. The patient's complaint was solved after around one year without any specific therapy. Conclusion: The differential diagnosis for onychomadesis needs a careful and detailed history that may prevent a patient from a frightening diagnosis and painful, long-lasting treatments. LEARNING POINTS: The differential diagnosis of retronychia, onychomycosis and onychomadesis is challenging.Both onychomadesis and retronychia share a common pathophysiologic mechanism.A careful and detailed history prevents a patient from a frightening diagnosis and painful, long-lasting treatment of nail disorders.
RESUMEN
We described a rare case of vaccine-induced acalculous cholecystitis (ACC). A 52-year-old female developed ACC after 8 h of receiving a 3rd dose of the Pfizer-BioNTech COVID-19 vaccination. The symptoms subsided completely with conservative treatment for 12 days, and the ultrasound and laboratory findings went back to normal.
RESUMEN
Imminent upper airway obstruction due to life-threatening tracheal stenosis of any cause is challenging. A 77-year-old woman, with a history of temporal tracheostomy for prolonged mechanical ventilation, presented with life-threatening tracheal stenosis to the emergency department. After failed intubation with a 5.0 mm internal diameter endotracheal tube, the patient was ventilated via a tube exchanger using Ventrain. Ventrain is a manual ventilation device that, in addition to oxygen supply during inspiration, initiates expiration by actively removing gas from the lungs by suction. Despite the nearly obstructed airway the patient was adequately ventilated with 'permissive' hypercarbia of 50 mm Hg and Saturation of peripheral Oxygen (SpO2) 95%-98% until surgical re-tracheostomy was performed. The haemodynamic stability of the patient indicated that the active expiration prevented intrapulmonary pressure build-up by air trapping and subsequent barotrauma and/or haemodynamic deterioration, which may well be observed during traditional jet ventilation especially in case of a completely obstructed airway.