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1.
Oman Med J ; 38(3): e513, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-37325262

RESUMO

Due to overlapping clinical features, scrub typhus infection may be missed in presence of dengue. Concurrent infection with those two pathogens is rare and creates a diagnostic dilemma. We present a case of a 65-year-old male who was admitted with a high-grade fever and maculopapular rash. A complete hemogram revealed thrombocytopenia with raised hematocrit and positive diagnostic tests for dengue. The patient was treated conservatively with intravenous fluids and antipyretic medications in response to which the hematocrit improved, and the rash disappeared. But fever with thrombocytopenia continued to persist. On further clinical examination, a small eschar was noted on his abdomen. Doxycycline was started upon which the fever subsided, and thrombocytopenia improved. This case illustrates the importance of early recognition of coinfection in unremitting febrile illness in tropical countries to prevent potentially dangerous complications.

3.
BMJ Case Rep ; 15(3)2022 Mar 03.
Artigo em Inglês | MEDLINE | ID: mdl-35241448

RESUMO

Polymyositis is an immune-mediated inflammatory myopathy usually presenting with weakness of proximal muscles in a symmetric pattern. Generalised subcutaneous oedema as presenting feature of inflammatory myopathy, especially polymyositis, has rarely been reported. We report here a case of a young woman who was admitted to our facility with generalised severe subcutaneous oedema. During hospital stay, she gradually developed significant proximal muscle weakness with bulbar symptoms. The initial presentation of the patient masqueraded with other causes of anasarca. However, detailed clinical features, laboratory evaluation, electromyography and muscle biopsy clinched the diagnosis of polymyositis. She was treated with systemic corticosteroids and azathioprine. The patient responded well to treatment and the swelling gradually subsided.


Assuntos
Miosite , Polimiosite , Azatioprina/uso terapêutico , Edema/complicações , Feminino , Humanos , Debilidade Muscular/tratamento farmacológico , Debilidade Muscular/etiologia , Miosite/complicações , Miosite/diagnóstico , Miosite/tratamento farmacológico , Polimiosite/diagnóstico
5.
Oman Med J ; 36(6): e317, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34804599

RESUMO

Systemic lupus erythematosus (SLE) is an autoimmune disease with multisystem involvement. Superior vena cava (SVC) syndrome is mainly caused by malignant tumors such as lung carcinoma, lymphoma, and metastatic tumors. We report a 20-year-old woman who was admitted with features of SVC syndrome secondary to SVC thrombus. Further evaluation confirmed the diagnosis of SLE without associated antiphospholipid syndrome (APS). The patient was treated with heparin with oral anticoagulant, steroids, and hydroxychloroquine. Complete resolution of thrombus was documented within a few weeks. SVC thrombosis as an initial presenting feature of SLE without associated APS has not been reported so far in the literature.

6.
BMJ Case Rep ; 14(5)2021 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-33958367

RESUMO

Tropical pyomyositis manifests as single or multiple abscesses inside skeletal muscles and it has a higher prevalence in immunocompromised patients. Scrub typhus, a zoonotic disease is caused by Orientia tsutsugamushi and the clinical manifestations range from simple febrile illness to organ threatening complications. Here, we present a rare case of an immunocompetent young man diagnosed as tropical pyomyositis in association with scrub typhus. Imaging of both thighs revealed multiple intramuscular abscesses. Blood and aspirated pus were culture negative. Patient was treated aggressively with parenteral antibiotics (linezolid, clindamycin and meropenem) and surgical debridement. But, fever did not subside and total leucocyte count remained persistently high. After serological confirmation of scrub typhus, the patient was put on oral doxycycline and he had a dramatic improvement within next few days. To the best of our knowledge, this is probably the first reported case of tropical pyomyositis in association with scrub typhus.


Assuntos
Orientia tsutsugamushi , Piomiosite , Tifo por Ácaros , Animais , Doxiciclina , Humanos , Masculino , Piomiosite/diagnóstico , Piomiosite/tratamento farmacológico , Tifo por Ácaros/complicações , Tifo por Ácaros/diagnóstico , Tifo por Ácaros/tratamento farmacológico , Zoonoses
7.
BMJ Case Rep ; 13(12)2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33370933

RESUMO

The SARS-CoV-2 has wreaked havoc globally and has claimed innumerable lives all over the world. The symptoms of this disease may range from mild influenza-like symptoms to severe acute respiratory distress syndrome with high morbidity and mortality. With improved diagnostic techniques and better disease understanding, an increased number of cases are being reported with extrapulmonary manifestations of this disease ranging from renal and gastrointestinal to cardiac, hepatic, neurological and haematological dysfunction. Subacute thyroiditis is a self-limiting and painful thyroid gland inflammation most often secondary to viral infections. We report a case of subacute thyroiditis in a 58-year-old gentleman presenting with a painful swelling in the neck who was subsequently detected to be positive for SARS-CoV-2. We seek to highlight the broad clinical spectrum of the COVID-19 by reporting probably the first case of subacute thyroiditis possibly induced by SARS-CoV-2 infection from India.


Assuntos
Amidas/administração & dosagem , Azitromicina/administração & dosagem , Tratamento Farmacológico da COVID-19 , COVID-19 , Prednisolona/administração & dosagem , Pirazinas/administração & dosagem , SARS-CoV-2/isolamento & purificação , Glândula Tireoide/diagnóstico por imagem , Tireoidite Subaguda , Antivirais/administração & dosagem , COVID-19/complicações , COVID-19/diagnóstico , COVID-19/fisiopatologia , Diagnóstico Diferencial , Glucocorticoides/administração & dosagem , Humanos , Masculino , Pessoa de Meia-Idade , Cintilografia/métodos , Testes de Função Tireóidea/métodos , Tireoidite Subaguda/diagnóstico , Tireoidite Subaguda/fisiopatologia , Tireoidite Subaguda/terapia , Tireoidite Subaguda/virologia , Resultado do Tratamento , Ultrassonografia Doppler em Cores/métodos
8.
BMJ Case Rep ; 13(9)2020 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-32967943

RESUMO

Rowell's syndrome is a rare disorder characterised by an association of lupus erythematosus with erythema multiforme (EM)-like skin lesions. EM as the initial clinical presentation of systemic lupus erythematosus is also atypical and even rarer. We report the case of an 18-year-old girl admitted to our hospital with fever and polyarthralgia along with multiple discrete ill-defined target lesions with crust formation over forehead, cheek, external ears, scalp, upper chest and back (predominantly over sun-exposed areas) with ulceration over hard palate. Investigations revealed pancytopaenia, a positive rheumatoid factor, positive antinuclear antibody with a speckled pattern, anti-Smith antibody and strongly positive anti-Ro. Patient was diagnosed with Rowell's syndrome as per clinical and laboratory features. Majority of skin lesions including oral ulcerations subsided gradually after treatment with steroids and hydroxychloroquine.


Assuntos
Artralgia/imunologia , Eritema Multiforme/imunologia , Febre/imunologia , Lúpus Eritematoso Sistêmico/diagnóstico , Pancitopenia/imunologia , Adolescente , Anticorpos Antinucleares/sangue , Anticorpos Antinucleares/imunologia , Antipiréticos/uso terapêutico , Artralgia/sangue , Artralgia/tratamento farmacológico , Quimioterapia Combinada/métodos , Eritema Multiforme/sangue , Eritema Multiforme/tratamento farmacológico , Feminino , Febre/sangue , Febre/tratamento farmacológico , Humanos , Hidroxicloroquina/uso terapêutico , Lúpus Eritematoso Sistêmico/complicações , Lúpus Eritematoso Sistêmico/tratamento farmacológico , Lúpus Eritematoso Sistêmico/imunologia , Pancitopenia/sangue , Pancitopenia/diagnóstico , Pancitopenia/tratamento farmacológico , Prednisolona/uso terapêutico , Fator Reumatoide/sangue , Fator Reumatoide/imunologia , Síndrome , Resultado do Tratamento
10.
BMJ Case Rep ; 13(8)2020 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-32843475

RESUMO

SARS-CoV-2 has wreaked havoc globally and has claimed innumerable lives all over the world. Apart from the characteristic respiratory illness, this disease has been associated with florid extrapulmonary manifestations and complications. A 59-year-old female healthcare worker presented with features of acute-onset non-compressive myelopathy with a sensory level at T10 segment along with high-grade fever for 4 days. MRI of dorsal spine was suggestive of myelitis at T7 vertebral level. She was initiated on injectable steroids and did show some initial signs of recovery. A day later, she developed an acute-onset respiratory failure but could not be revived despite our best efforts. Her nasopharyngeal and oropharyngeal swab turned out to be positive for SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR). We hereby report a case of acute transverse myelitis with COVID-19 as a probable aetiology.


Assuntos
Infecções por Coronavirus/complicações , Mielite Transversa/virologia , Pneumonia Viral/complicações , Vértebras Torácicas/virologia , Betacoronavirus , COVID-19 , Diagnóstico Diferencial , Evolução Fatal , Feminino , Glucocorticoides/uso terapêutico , Humanos , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Mielite Transversa/diagnóstico por imagem , Mielite Transversa/tratamento farmacológico , Pandemias , Insuficiência Respiratória/virologia , SARS-CoV-2 , Vértebras Torácicas/diagnóstico por imagem
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