BMJ case reports
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Case Reports
ECG phasic voltage changes associated with spontaneous pneumothorax in a patient with vanishing lung syndrome.
Alternating or phasic ECG voltage changes are most commonly associated with intrinsic myocardial electrophysiological perturbations or mechanical oscillation within a pericardial effusion. Rare descriptions of electrical alternation have been reported with pneumothorax. We present a case of a 53-year-old woman with vanishing lung syndrome who presented with spontaneous left pneumothorax and phasic ECG voltage changes that resolved after re-expansion of the lung.
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A 44-year-old man presented to hospital 24 h after an intentional overdose of metformin and gliclazide. He had a critical metabolic acidosis on presentation with a pH of 6.88, and very rapidly deteriorated into distributive shock refractory to large volume fluid resuscitation and massive doses of vasopressors. We introduced a methylene blue infusion as a rescue therapy in an attempt to improve the patient's haemodynamics, which was successful. The patient made a full recovery with no long-term sequelae.
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We report a case of a 64-year-old man presented to A&E with a 2-week to 4-month history of right hip pain, right leg weakness and fasciculations, extensive bruising and a vesicular skin rash. He had a CT of the chest/abdomen/pelvis, which revealed multiple extensive haematomas including an iliopsoas haematoma causing a lumbar plexopathy and resulting in the right hip and leg symptoms. ⋯ Haematology review together with mixing studies suggested a diagnosis of acquired haemophilia A. He was treated at the local tertiary centre with activated prothrombin complex concentrate and steroids and made a full recovery.