Journal of medical case reports
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Case Reports
Persistent hypoxemia and platypnea-orthodeoxia after left single-lung transplantation: a case report.
Platypnea-orthodeoxia is a relatively uncommon but striking clinical syndrome characterized by dyspnea and deoxygenation accompanying a change to sitting or standing from a recumbent position. Hypoxemia early after lung transplant can have multiple etiologies. We report a rare case of persistent hypoxemia and platypnea-orthodeoxia after left single-lung transplantation, as a result of right-to-left interatrial shunt through a patent foramen ovale, with subsequent resolution of hypoxemia after percutaneous closure of the patent foramen ovale. ⋯ Our case demonstrates that an open patent foramen ovale leading to massive right-to-left shunting is a possible complication after lung transplant, with significant morbidity, and that it can be treated successfully using a percutaneously placed occlusion device. Through this case report, we aim to improve pre-transplant procedures by demonstrating that a bubble contrast transesophageal echocardiogram can be performed pre-operatively to detect a patent foramen ovale.
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Case Reports
Diffuse large B-cell lymphoma presenting with central pontine myelinolysis: a case report.
The most common cause of central pontine myelinolysis is an overly rapid correction of hyponatremia, although it can also occur in patients with any condition leading to nutritional or electrolyte stress. We report a case of diffuse large B-cell lymphoma with central pontine myelinolysis developing at the onset of disease. To the best of our knowledge, hematological malignancies presenting with central pontine myelinolysis have been rarely reported, especially in previously untreated patients, as in our case report. ⋯ Central pontine myelinolysis is a serious condition that may result in neuropathological sequelae and mortality, and clinicians should be aware of its potential presence in patients with malignancies.
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Whitlow is an infection of a finger or around the fingernails, generally caused by bacterium. However, in rare cases, it may also be caused by the herpes simplex virus. As herpetic whitlow is not seen often, it may go under-recognised or be mistaken for a different kind of infection of the finger. Delayed recognition and/or treatment puts patients at risk of complications ranging from superinfection to herpetic encephalitis. ⋯ Whitlow is rarely caused by the herpes simplex virus, but this disease requires a swift recognition and treatment to prevent complications. This case serves to emphasise that not all whitlow is caused by a bacterial infection, and that it is important to differentiate between herpetic and bacterial whitlow, as these diseases require a different treatment.
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Kasabach-Merritt syndrome is a benign condition characterized by hemangiomatosis, severely disseminated intravascular consumption coagulopathy, and thrombocytopenia. The mortality rate increases from 12% to 30% in hemorrhagic cases. In general, the symptoms primarily manifest in the gastrointestinal tract, the skin, and the subcutaneous tissue. There is no publication about pulmonary manifestation of angiomatosis in combination with vascular malformation and hemoptysis. This is the first description of a Kasabach-Merritt syndrome-like condition in the lung. ⋯ In a case of angiomatosis with an associated pulmonary lobar vascular malformation, lobectomy can be safely performed to prevent life-threatening bleeding.
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Therapeutic total lung lavage under general anesthesia is the current mainstay of treatment for pulmonary alveolar proteinosis, which is a rare lung disease characterized by alveolar accumulation of surfactant. Therapeutic limited bronchoalveolar lavage is considered an alternative treatment to conventional total lung lavage. ⋯ Therapeutic limited bronchoalveolar lavage can be successfully performed as an interval bridging procedure, as a 'prewash', prior to conventional total lung lavage for pulmonary alveolar proteinosis.