Indian Journal of Critical Care Case Report

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2023 | January-February | Volume 2 | Issue 1

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From the Editor's Desk

[Year:2023] [Month:January-February] [Volume:2] [Number:1] [Pages:1] [Pages No:v - v]

   DOI: 10.5005/ijccr-2-1-v  |  Open Access | 

291

CASE REPORT

Faris Hussain, Liz Mary Paul, Ranjit Narayanan, Sreenath Kuniyil, P Shihabudheen, Priyanka R Nair

Scedosporium Brain Abscess in a Chronic Kidney Disease Patient: A Case Report and Review of Literature

[Year:2023] [Month:January-February] [Volume:2] [Number:1] [Pages:3] [Pages No:1 - 3]

Keywords: Brain abscess, Fungal infection, Pseudallescheria boydii, Scedosporium apiospermum

   DOI: 10.5005/jp-journals-11006-0030  |  Open Access |  How to cite  | 

Abstract

Scedosporium apiospermum (S. apiospermum) is a saprophytic fungus known to cause brain abscesses, mostly in near-drowning cases. Here, we describe an unusual case of a 60-year-old chronic kidney disease patient on immunosuppressive drugs for erythropoietin-related pure red aplasia who developed multiple S. apiospermum brain abscesses without any history of contact with water or trauma.

539

CASE REPORT

Oumaima Azzouzi Idrissi, Soumaya Touzani, Nawfal Houari, Abderrahim El Bouazzaoui, Brahim Boukatta, Nabil Kanjaa

Ischemic Stroke Associated with Upper Limb Ischemia Revealing a COVID-19 Infection: A Case Report and Review

[Year:2023] [Month:January-February] [Volume:2] [Number:1] [Pages:4] [Pages No:4 - 7]

Keywords: Coagulopathy, Coronavirus disease of 2019, Stroke, Upper limb ischemia

   DOI: 10.5005/jp-journals-11006-0036  |  Open Access |  How to cite  | 

Abstract

The coronavirus disease of 2019 (COVID-19) is known as a highly infectious disease with several systemic complications. Both vascular and neurological disorders emerged as challenging management conditions for practitioners. In order to highlight COVID-19-induced coagulopathy, we report the case of an ischemic stroke with upper acute limb ischemia (ALI), revealing a COVID infection in a 60-year-old male patient with a history of diabetes.

487

CASE REPORT

Cherian Roy, Rohit Patnaik, Adya K Panda, Nupur Karan, Subhransu S Padhi

Neurological Manifestations Following Ingestion of Hand Sanitizer: An Unfortunate Morbidity Tale during COVID-19 Pandemic

[Year:2023] [Month:January-February] [Volume:2] [Number:1] [Pages:3] [Pages No:8 - 10]

Keywords: Coronavirus disease of 2019, Glasgow Coma Scale, Hand sanitizer, Leukoencephalopathy, Polyneuropathy, Schizophrenia

   DOI: 10.5005/jp-journals-11006-0035  |  Open Access |  How to cite  | 

Abstract

Introduction: COVID-19 was declared a pandemic in January 2020. To stop the spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, the use of hand disinfectants increased significantly, even in household areas. These alcohol-based solutions may be the cause of suicides and homicides by both intentional and accidental exposures. Cases reported with magnetic resonance imaging (MRI) features of central nervous system involvement in toxic alcohol-based hand sanitizers are limited. Case description: A 26-year-old patient with schizophrenia was brought to the emergency department (ED) following self-ingestion of alcohol-based hand sanitizer. An initial non-contrast computed tomography (NCCT) brain was normal. During weaning from ventilatory support, we noticed a motor deficit in all four limbs with difficulty in weaning. Subsequent MRI brain showed features suggestive of toxic leukoencephalopathy. Nerve conduction studies (NCSs) revealed motor polyneuropathy in all four limbs. Conclusion: Alcohol-based hand sanitizer ingestion may produce extensive brain involvement with polyneuropathy, which can be fatal.

482

CASE REPORT

Shivakumar Shivanna, Pavitra Pushpa, Indira Menon, Deepa Das, Swapna M Babu, Deepak I Tauro

Acute Fulminant Liver Failure Secondary to Yellow Phosphorus Poisoning: Role of Extended N-acetylcysteine Therapy

[Year:2023] [Month:January-February] [Volume:2] [Number:1] [Pages:3] [Pages No:11 - 13]

Keywords: Drug-induced, Fatal toxicity, Intensive care unit

   DOI: 10.5005/jp-journals-11006-0033  |  Open Access |  How to cite  | 

Abstract

Yellow phosphorus is widely used in agricultural applications as well as a rodenticide. Poisoning from unintentional consumption and suicidal intent is common in the Indian subcontinent. Acute fulminant liver failure caused by yellow phosphorus intoxication is fatal. Treatment options include early intervention with supportive care, N-acetylcysteine (NAC), plasmapheresis, and liver transplantation. We used an extended NAC therapy, which resulted in a favorable outcome for our patient.

381

CASE REPORT

Chandrashish Chakravarty, Ananya Mandal

A Rare Cause of Community-acquired Sepsis: Aeromonas and Multiorgan Failure

[Year:2023] [Month:January-February] [Volume:2] [Number:1] [Pages:3] [Pages No:14 - 16]

Keywords: Aeromonas, Multiorgan dysfunction, Sepsis

   DOI: 10.5005/jp-journals-11006-0037  |  Open Access |  How to cite  | 

Abstract

Aeromonas hydrophila is a motile, gram-negative bacillus and facultative anaerobe that is native to aquatic environments and is increasingly reported in humans. While Aeromonas-associated gastroenteritis is fairly common worldwide, Aeromonas bacteremia is much less prevalent and is commonly associated with immunosuppression or malignancy, a recent history of recreational or occupational contact with fresh water, or ingestion of contaminated seafood. Bacteremia in healthy individuals is uncommon and often associated with trauma. Excluding trauma, the vast majority of healthy individuals with Aeromonas sepsis are elderly individuals and/or individuals with exposure to freshwater environments. This case is remarkable for A. hydrophila sepsis with an initial presentation of acute gastroenteritis. We report a case of a 23-year-old lady, a healthcare worker, working at the intensive care unit of a tertiary care hospital for 1 year, presenting with abdominal pain for 3 days, aggravated by eating, associated with vomiting and watery, nonbloody diarrhea, and dysuria. The patient has no other comorbidities. The patient also presented with a fever, normal liver enzymes, and a normal white blood cell count. She had no evidence of immunosuppression or malignancy, no recent history of freshwater contact, no history of seafood ingestion, and no evidence of Aeromonas infection anywhere other than in her blood. This case study highlights an uncommon cause of septicemia in a young, healthy female.

349

CASE REPORT

Sangam Yadav

Indoxacarb Toxicity: Treat the Patient, Not the Monitor

[Year:2023] [Month:January-February] [Volume:2] [Number:1] [Pages:2] [Pages No:17 - 18]

Keywords: High-flow oxygen, Indoxacarb, Methemoglobinemia, Methylene blue

   DOI: 10.5005/jp-journals-11006-0038  |  Open Access |  How to cite  | 

Abstract

Introduction: Here, we report the successful management of indoxacarb poisoning resulting in methemoglobinemia (MetHb) in a young female. Previously published literature has revealed the pathophysiology and occurrence of MetHb after indoxacarb ingestion requiring high oxygen therapy for treatment. Case description: A 25-year-old female presented with indoxacarb poisoning, resulting in MetHb. She was managed on room air despite the low saturation shown on pulse oximetry. She also received treatment with methylene blue (MB) and vitamin C. The patient recovered completely and was shifted to the ward. Conclusion: Through this case report, we want to highlight the lacunae in managing indoxacarb toxicity. We suggest that in-depth knowledge of the pathophysiology of indoxacarb toxicity and clinical observations are quintessential before the initiation/continuation of oxygen therapy in such cases. We also emphasize the importance of detailed history taking before initiating treatment with a drug like MB.

316

CASE REPORT

Ankit Bhatia, Sharad Joshi, Nitesh Tayal

Rare Myocarditis Following Acute Metapneumovirus Infection

[Year:2023] [Month:January-February] [Volume:2] [Number:1] [Pages:2] [Pages No:19 - 20]

Keywords: Human metapneumovirus, Myocarditis, Pneumonia

   DOI: 10.5005/jp-journals-11006-0041  |  Open Access |  How to cite  | 

Abstract

A paramyxovirus known as human metapneumovirus (HMPV) is a known causative organism for respiratory tract infections in children. Extrapulmonary manifestations, including cardiac complications, particularly in adults, are very rare. Only two cases of HMPV-causing myocarditis have been cited in the literature in adults. We describe a case of a 53-year-old male diagnosed with severe myocarditis after an episode of infection by HMPV. He was managed conservatively and recovered fully in 1 week time. This is only the third case of HMPV-induced myocarditis in adults. With the emergence of advances in diagnostic technology, viruses like HMPV are rapidly becoming known as significant pathogens in adults also.

324

CASE REPORT

Anant D Kulsange

A Pin is Mightier than the Sword!

[Year:2023] [Month:January-February] [Volume:2] [Number:1] [Pages:4] [Pages No:21 - 24]

Keywords: Aspiration, Bronchoscopy, Computed tomography chest, Pin, Radiology

   DOI: 10.5005/jp-journals-11006-0039  |  Open Access |  How to cite  | 

Abstract

Introduction: Accidental ingestion and aspiration of foreign bodies are common in extremes of ages and are a significant cause of morbidity and mortality, especially in the pediatric population. Case description: Here, we present a case report of an adult female patient who presented with aspiration of a hairpin wherein, a chest radiograph and Computed tomography (CT) chest demonstrated the presence of the hairpin in the right lower lobe segmental bronchus. Initial retrieval attempts under bronchoscopy and fluoroscopic guidance with snare retrieval were unsuccessful. The patient later presented with abdominal pain and on evaluation with an X-ray and CT abdomen, the hairpin was found to be in the transverse colon and was eventually evacuated after per-rectal contrast administration. Discussion and conclusion: Imaging plays an important role in confirming the presence of foreign bodies, localizing them, and is crucial in further management of these patients. In particular, sharp objects commonly cause complications as they pass through the aerodigestive and gastrointestinal tract. Radiography allows for the rapid evaluation of such patients as well as ruling out complications such as consolidation or pneumoperitoneum. Fluoroscopy and computed tomography play an ancillary role in complicated cases. Aggressive clinical management is warranted in these cases and radiologists must be familiar with their imaging appearances and clinical implications.

308

CASE SERIES

Suvadeep Sen, Deepak Gupta

Toxic Gastroenteritis after Bottle Gourd Ingestion: A Case Series of Seven Patients

[Year:2023] [Month:January-February] [Volume:2] [Number:1] [Pages:3] [Pages No:25 - 27]

Keywords: Bitter bottle gourd, Bottle gourd juice, Cucurbitacin poisoning, Toxic enteritis

   DOI: 10.5005/jp-journals-11006-0031  |  Open Access |  How to cite  | 

Abstract

Introduction: In India, bottle gourd is consumed as a juice due to various health advantages. Bottle gourd and vegetables from the same family contain trace amounts of cucurbitacins which impart a bitter taste to these vegetables. Increase in the levels of these compounds due to various reasons can lead to serious gastrointestinal side effects along with multiorgan dysfunction. Discussion: Here we present a case series of seven patients which presented to us with significant health issues after consuming bitter bottle gourd juice and the manner in which they were treated. All seven patients made remarkable recoveries. Conclusion: Though a popularly consumed vegetable throughout India for various health benefits, it could pose a serious health risk if consumed when bitter and the above issue requires extensive research and education regarding the toxicity of the substance. Prompt identification and simple resuscitation efforts can prevent significant mortality and morbidity.

557

CASE SERIES

Senthilnathan Thiruchengode Angamuthu, Sivakumar Mudalipalayam Nandakumar

A Case Series of Acquired Methemoglobinemia Due to Pesticides: Conventional to Novel Therapies

[Year:2023] [Month:January-February] [Volume:2] [Number:1] [Pages:3] [Pages No:28 - 30]

Keywords: Acquired methemoglobinemia, Exchange transfusion, Hyperbaric oxygen therapy, Methylene blue

   DOI: 10.5005/jp-journals-11006-0034  |  Open Access |  How to cite  | 

Abstract

Methemoglobinemia is a rare but life-threatening clinical condition which has to be rapidly diagnosed and treated to have a favorable outcome. There are multiple known causes for Acquired Methemoglobinemia of which pesticides are rare and less reported. We report a case series of Methemoglobinemia due to pesticide consumption, who had a varying response to treatment modalities. We discuss about the various treatment options for methemoglobinemia from conventional Methylene blue to novel treatments like Exchange transfusion and Hyperbaric Oxygen Therapy. We found that monitoring Methemoglobin levels may be required for a longer duration due to the possibility of relapse. For refractory cases not improving with Methylene blue, exchange transfusion is an effective alternate treatment.

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