BMJ case reports
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We report a case of neglected anterior dislocation of the hip. A young man presented 5 months following a fall from a tree where he sustained the injury. An MRI of the hip confirmed avascular necrosis of the dislocated head of femur. A modified girdlestone operation was performed leaving the patient with a painfree functional hip.
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A man with end-stage liver disease who presented with shortness of breath. He exhibited clinical platypnea (worsening shortness of breath on sitting up) and orthodeoxia (oxygen desaturation on sitting up). Follow-up investigations led to the diagnosis of hepatopulmonary syndrome.
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Case Reports
Right-sided infective endocarditis presenting with purpuric skin rash and cardiac failure in a patient without fever.
We describe the case of a 70-year-old woman who presented with symptoms of cardiac failure, and was found on clinical examination to have a purpuric rash over her lower extremities. Further evaluation of cardiac failure revealed tricuspid regurgitation with two large tricuspid valve vegetations. Blood cultures yielded a growth of Streptococcus viridans. She was treated with an intravenous ceftriaxone and gentamicin and made a complete recovery with resolution of the rash.
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Following a minor road traffic accident (RTA) a 55-year-old woman developed a new onset of whole body tremor and abnormal gait. This was in the context of significant previous depressive episodes and a traumatic background relating to RTAs. After extensive investigation, no organic causes were identified. ⋯ The patient has also been seen regularly by a psychologist for mindfulness therapy. There has been a significant improvement after seven sessions of mindfulness therapy and the patient has long periods without a tremor and is now able to walk normally. In addition, this case highlights the importance of communication skills with our patients in diagnostic uncertainty.
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Anaphylaxis is a rare condition in pregnancy. Drugs are the aetiological agents most often implicated. ⋯ Significant risk of neonatal neurological damage or death can occur even when the maternal clinical outcome is favourable. The authors present the case of a newborn, born at gestational age of 29 weeks, who died at 11 days of life with hypoxic-ischaemic cerebral injuries as a consequence of maternal anaphylaxis following the administration of amoxicillin in the community setting.