BMJ case reports
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Case Reports
Severe lactic acidosis and multiorgan failure due to thiamine deficiency during total parenteral nutrition.
A 16-year-old perioperative paediatric patient presented with refractory lactic acidosis and multiorgan failure due to thiamine-deficient total parenteral nutrition during a recent national multivitamin shortage. Urgent empiric administration of intravenous thiamine resulted in prompt recovery from this life-threatening condition. Despite readily available treatment, a high index of suspicion is required to prevent cardiovascular collapse and mortality.
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A 30-year-old woman with chronic foot pain after an orthopaedic surgery and chronic neck pain presented to the emergency department (ED) with a history of self-rotatory vertigo with unsteadiness. She had started low-dose pregabalin, 25 mg two times a day 9 months before experiencing symptoms with the dose gradually increased to 150 mg two times a day over this period. ⋯ Pregabalin was tapered over 2 months with a complete disappearance of the symptoms. We concluded that symptoms were due to pregabalin treatment.
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A man in his 40s developed a severe cutaneous adverse reaction following treatment of septic arthritis with flucloxacillin. The eruption had overlap features of cutaneous vasculitis and acute generalised exanthematous pustulosis which was complicated by renal and liver impairment. This case heightens the variation in presentation of a severe drug eruption.
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Review Case Reports
Acute spontaneous atraumatic bilateral anterior dislocation of the shoulder joint with Hill-Sachs lesions: first reported case and review of literature.
The anatomy of the shoulder joint comprises a relatively large humeral head with a shallow glenoid cavity allowing a remarkable range of motion at the expense of inherent instability. Despite anterior shoulder dislocations being the most common type encountered, bilateral dislocations are rare and almost always posterior. The aetiology is usually direct or indirect trauma related to sports, seizures, electric shock or electroconvulsive therapy. ⋯ MRI illustrated the Hill-Sachs lesions with superior labral tear from anterior to posterior, and confirmed the acute nature of the injury by demonstrating the bone marrow oedema. The patient was treated surgically with arthroscopic anterior stabilisation. At 6 months following surgery, the patient has a pain free full range of movement of both shoulders with no further dislocations and has returned to work.
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Case Reports
Acute three-vessel cervical arterial occlusion due to spontaneous quadruple cervical artery dissection.
Cervical artery dissection (CAD) is one of the most frequent causes (14.5%) of stroke in young adults. Cases with involvement of more than two arteries are rare. ⋯ According to Papagiannaki et al, the incidence of simultaneous three or four CADs is 1-3/million in the general population. To the best of our knowledge, there are only three published cases of spontaneous quadruple CAD.