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Kafle R, Bhatta A, Gami S, Sapkota A, Sharma D, Yadav A, Chikanbanjar VK. Macrophage Activation Syndrome secondary to Systemic Juvenile Idiopathic Arthritis: A Case Report. JNMA J Nepal Med Assoc 2021; 59:1166-1169. [PMID: 35199753 PMCID: PMC9124332 DOI: 10.31729/jnma.7019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 11/17/2021] [Indexed: 11/24/2022] Open
Abstract
Macrophage activation syndrome is a rare but a life threatening condition commonly associated with Systemic Juvenile Idiopathic Arthritis. Its clinical presentation includes fever, hepatosplenomegaly, hypertriglyceridemia, hypofibrinogenemia, hyperferritinemia and impaired liver enzymes. The symptoms are alarming yet non-specific and often lead to a delayed diagnosis. A 12 year male presented with a history of intermittent fever and was started on antibiotics but failed to respond after several days of hospital stay. After a series of investigations to rule out multiple diagnoses he was diagnosed as a case of Macrophage Activation Syndrome secondary to Systemic onset Juvenile Arthritis and was treated with steroids.
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Affiliation(s)
- Rishikesh Kafle
- Department of Pediatrics, Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Anwesh Bhatta
- Department of Pediatrics, Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu, Nepal
| | - Sumit Gami
- Patan Academy of Health Sciences, Lalitpur, Nepal
| | - Abhin Sapkota
- Vayodha Hospitals Private Limited, Balkhu, Kathmandu, Nepal
- Correspondence: Dr. Abhin Sapkota, Vayodha Hospitals Private Limited, Balkhu, Kathmnadu, Nepal. , Phone: +977-9860420710
| | | | - Arabindra Yadav
- Department of Pediatrics, Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu, Nepal
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Mandal S, Singh B, Gami S, Shah S, Poulose J. Medulloblastoma in an Adult Female Patient: A Rare Presentation. Cureus 2021; 13:e16713. [PMID: 34513353 PMCID: PMC8405177 DOI: 10.7759/cureus.16713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 11/27/2022] Open
Abstract
Medulloblastoma (MB) is an aggressive malignant tumor of the posterior fossa of the CNS that mainly affects children younger than 15 years of age. It is uncommon in the adult population compared to children. Any adult patient presenting with cerebellar mass must be evaluated with brain tissue biopsy to rule out MB. Our patient is a 27-year-old female who presented with sudden onset of frontal headache and was diagnosed with MB.
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Affiliation(s)
- Shobha Mandal
- Internal Medicine, Guthrie Robert Packer Hospital, Sayre, USA
| | - Bishnu Singh
- General Medicine, Himal Hospital Private Limited, Kathmandu, NPL
| | - Sumit Gami
- Medicine, Universal College of Medical Sciences, Bhairahawa, NPL.,Internal Medicine, Patan Academy of Health Sciences, Patan, NPL
| | - Sunil Shah
- Medicine, Ministry of Health, Malé, MDV.,Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Joyson Poulose
- Hematology and Oncology, Guthrie Robert Packer Hospital, Sayre, USA
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Khatri P, Panth H, Khadka S, Thapa P, Regmi R, Shah S, Gami S, Upadhyaya A, Alam MR, Sharma S. Pure Autonomic Failure: A Case Report of Recurrent Orthostatic Hypotension. JNMA J Nepal Med Assoc 2021; 59:589-592. [PMID: 34508404 PMCID: PMC8369549 DOI: 10.31729/jnma.6480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 06/14/2021] [Indexed: 12/03/2022] Open
Abstract
Pure autonomic failure is a neurodegenerative disorder affecting the autonomic nervous system which clinically presents with orthostatic hypotension. It is a diagnosis of exclusion after detailed clinical examinations and relevant investigations. Here, we discuss a case of 68 years old male who had complaints of multiple episodes of loss of consciousness on standing from a sitting position for the last 3 years. The diagnosis was considered by clinical examinations revealing autonomic dysfunctions with normal appropriate investigations. The patient was treated successfully with midodrine, fludrocortisone, and other non-pharmacological interventions. We focused on doing various autonomic dysfunction tests in the evaluation of a patient with recurrent orthostatic hypotension. We suspect that pure autonomic failure might not have been considered in the differential diagnosis of recurrent orthostatic hypotension and suggest that it is to be kept as a differential in such a scenario. Midodrine has an effective role in syncope due to sympathetic vasoconstrictor failure.
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Affiliation(s)
- Prabin Khatri
- Department of Internal Medicine, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Himal Panth
- Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Sabina Khadka
- Nepalese Army Institute of Health Sciences, Sanobharyang, Kathmandu, Nepal
| | | | | | - Sunil Shah
- Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Sumit Gami
- Universal College of Medical Sciences, Bhairahawa, Nepal
| | | | | | - Srijana Sharma
- Universal College of Medical Sciences, Bhairahawa, Nepal
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Abstract
Primary central nervous system lymphoma (PCNSL) is a rare form of CNS tumor. Immunosuppression is the most important risk factor of PCNSL, but few immunocompetent individuals are also affected. The most common clinical feature of PCNSL includes dizziness and ataxia. Our patient was a 71-year-old immunocompetent female who presented with progressive ataxia, imbalance, and dizziness for one year. A homogenous enhancing lesion was found in magnetic resonance imaging (MRI) of the head. One month later, on a follow-up MRI, a significant increase in the tumor size with surrounding edema was seen. The patient underwent craniotomy and resection of the mass. Subsequently, a diagnosis of diffuse large B cell lymphoma was made on pathology examination. Guideline-directed treatment options were discussed. This case highlights that the prognosis of patients with PCNSL highly depends on the factors such as age and physical status. Early diagnosis by accurate interpretation of imaging and management is crucial for better health outcomes.
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Affiliation(s)
- Shobha Mandal
- Internal Medicine, Guthrie Robert Packer Hospital, Sayre, USA
| | - Sunil Shah
- Medicine, Ministry of Health, Malé, MDV.,Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
| | - Sumit Gami
- Medicine, Universal College of Medical Sciences, Bhairahawa, NPL.,Internal Medicine, Nidan Hospital, Kathmandu, NPL
| | - Barun Ray
- Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, NPL
| | - Joyson Poulose
- Hematology and Oncology, Guthrie Robert Packer Hospital, Sayre, USA
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Mandal S, Gami S, Khadka S, Ray B, Ghimire S. A Case Report on Extensive Arterial Thrombosis: A Rare Complication of COVID-19 Infection. Cureus 2021; 13:e15378. [PMID: 34249531 PMCID: PMC8249212 DOI: 10.7759/cureus.15378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 11/24/2022] Open
Abstract
Coronavirus disease (COVID-19) is a global health crisis leading to increased morbidity and mortality worldwide. It is associated with increased activation of the clotting system leading to thrombotic complications increasing the risk of life-threatening complications. We report a case of a 70-years-old COVID-19 positive patient who presented with both lower extremities and forearm pain. On workup, she was found to have an extensive arterial clot. In patients with COVID-19, arterial clots may be the initial presenting symptoms to the hospital and can be fatal if not brought to attention on time.
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Affiliation(s)
- Shobha Mandal
- Internal Medicine, Guthrie Robert Packer Hospital, Sayre, USA
| | - Sumit Gami
- Medicine, Universal College of Medical Sciences, Bhairahawa, Bhairahawa, NPL.,Internal Medicine, Nidan Hospital, Lalitpur, NPL
| | - Sushmita Khadka
- Internal Medicine, Guthrie Robert Packer Hospital, Sayre, USA
| | - Barun Ray
- Internal Medicine, Bishweshwar Prasad Koirala Institute of Health Sciences, Dharan, NPL
| | - Subash Ghimire
- Internal Medicine, Guthrie Robert Packer Hospital, Sayre, USA
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Shah S, Karki D, Gami S, Panth H, Neupane N. Kawasaki Disease Shock Syndrome: A Nine-Year-Old Girl With Atypical Presentation of Kawasaki Disease in Emergency Department. Cureus 2021; 13:e15471. [PMID: 34262809 PMCID: PMC8260190 DOI: 10.7759/cureus.15471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2021] [Indexed: 11/29/2022] Open
Abstract
Kawasaki disease (KD) is an acute rheumatological illness usually affecting children between six months and five years of age. It is a vasculitis syndrome of medium-sized vessels that has typical clinical characteristics such as fever, rash, cervical lymphadenopathy, conjunctivitis, and mucosal changes. However, sometimes, it may present with the features of shock when it is known as Kawasaki disease shock syndrome (KDSS). The actual etiology of this disease is still unknown. The primary treatment of this disease is aspirin and intravenous immunoglobulin (IVIG). The most common and serious complication of KD is cardiac complications which can be avoided by IVIG if given on time. KDSS is the other rare but serious early complication that can be presented to the ED as an initial presenting feature. Early diagnosis of KDSS in the ED and its treatment is very important to prevent early and late complications, including cardiac complications of this disease. Although the usual age group for this disease is under five years, here we have presented a rare case of KDSS in a nine-year-old female child.
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Affiliation(s)
- Sunil Shah
- Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Medicine, Ministry of Health, Malé, MDV
| | | | - Sumit Gami
- Medicine, Universal College of Medical Sciences, Bhairahawa, NPL
- Internal Medicine, Nidan Hospital, Lalitpur, NPL
| | - Himal Panth
- Medicine, Universal College of Medical Sciences, Bhairahawa, NPL
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Mandal S, Gami S, Shah S. A Case Report on an Extremely Rare Disease: Factor XI Deficiency. Cureus 2020; 12:e10746. [PMID: 33150098 PMCID: PMC7603878 DOI: 10.7759/cureus.10746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 11/23/2022] Open
Abstract
Factor XI deficiency is a rare condition with an estimated prevalence of about one in one million and is more commonly seen in Ashkenazi Jews (8-9%) due to consanguinity. It occurs because of mutations in the factor XI gene (F11) on chromosome 4(4q35). Patients with this disorder may remain asymptomatic until they undergo any surgical procedure or delivery. The most common sites of bleeding include the oral cavity, pharynx, and genitourinary tract, where there is high fibrinolytic activity. Our patient was asymptomatic his whole life. He never had spontaneous bleeding or bruising; however, he had severe bleeding requiring multiple transfusions of fresh frozen plasma during and after surgeries.
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Affiliation(s)
- Shobha Mandal
- Internal Medicine, Guthrie Robert Packer Hospital, Sayre, USA
| | - Sumit Gami
- Medicine, Universal College of Medical Sciences, Bhairahawa, NPL
- Internal Medicine, Nidan Hospital, Kathmandu, NPL
| | - Surendra Shah
- Hematology and Oncology, Guthrie Robert Packer Hospital, Sayre, USA
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