BMJ case reports
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Establishing accurate symptomatology associated with novel diseases such as COVID-19 is a crucial component of early identification and screening. This case report identifies an adult patient with a history of clotting dysfunction presenting with rare cutaneous manifestations of COVID-19, known as 'COVID-19 toes'', previously described predominantly in children. ⋯ This supports the coagulopathic hypothesis of this manifestation of COVID-19 and provides possible screening questions for patients with a similar history who might be exposed to the virus. Additionally, nervous system complaints associated with this disease are rare and understudied, so this novel symptom may also provide insight into this aspect of SARS-CoV-2.
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A 64-year-old man was intubated and ventilated for COVID-19-associated acute respiratory distress syndrome. He had a background history of chronic obstructive pulmonary disease and ischaemic heart disease. His oxygen saturations dropped rapidly to 80% on day 9 of ICU admission. ⋯ The mucus plug was successfully suctioned from the patient's airway using bedside bronchoscopy subsequently improving the patient's oxygen saturation. A follow-up chest X-ray and CT scan of the thorax demonstrated interval resolution of the left upper lobe collapse. While expansion of his existing pneumothorax was first on the list of differential diagnoses, the use of ultrasonography early in the patient's assessment ensured it was ruled out prior to attempting chest drain insertion, thus prompting the acquisition of the chest X-ray which subsequently demonstrated the left upper lobe collapse as the correct diagnosis.
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Accidental ingestion of a grill brush wire bristle is a rare event. Retrieval rarely requires surgical intervention as the wire typically causes symptoms above the gastro-oesophageal junction and can frequently be removed endoscopically. There are few reported cases of gastrointestinal injury due to ingestion of wire bristles lodging past the gastro-oesophageal junction in adults. ⋯ Our case series illustrates how the commonly used wire grill brush may cause a serious injury. This diagnosis should be considered in patients who present with abdominal pain, non-specific symptoms and normal labs, with liner radio-opaque imaging findings and a history of grill use. Education as to the dangers of grill wire brushes to clean grills should be provided commercially.
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A 73-year-old male patient underwent operative treatment for dislocation of multiple costochondral junctions alongside multiple bony rib fractures and a flail chest following high-energy trauma. During the operative fixation of the flail chest, the costochondral lesions were surgically stabilised with plates and screws, which were fixated on the osseous anterior rib, sternum or the rib cartilage. ⋯ The patient did not require any pain medication and had no pain during daily activities, at rest or at night. Although being a biomechanically demanding region, which is often not defined in current rib fracture classification, operative treatment of costochondral lesions is feasible with outcome similar to the treatment of bony rib fractures.
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Case Reports
Uncommon but imperative cause of repeated acute stent thrombosis: Kounis syndrome type III.
A 69-year-old woman with a history of allergic reactions to unknown metals who presented 1 year prior with acute coronary syndrome complicated by acute stent thrombosis (ST) was admitted due to new-onset chest pain during mild exercise. She electively underwent coronary angiography, revealing a newly developed stenosis in the fourth branch of the posterior descending artery, treated with an everolimus-eluting stent. ⋯ The tentative diagnosis was confirmed by pathological examination of aspirated materials. Kounis syndrome type III may be a frequently undiagnosed clinical entity, emphasising the importance of pathological examination of aspirated materials when implanting coronary stents and history-taking of allergies to stent metals.