Indian Journal of Critical Care Case Report

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2023 | May-June | Volume 2 | Issue 3

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FROM THE EDITOR'S DESK

Subhash Todi

From the Editor's Desk

[Year:2023] [Month:May-June] [Volume:2] [Number:3] [Pages:1] [Pages No:v - v]

   DOI: 10.5005/ijccr-2-3-v  |  Open Access | 

159

CASE REPORT

Priyadharshini Ramakrishnan, Sasi Mayukha Challa Venkat, Chandrasekhar Ethiraj, Balasubramaniam Palanisamy, Balaji Venkatachalam

The Central Venous Catheter that Took a Wrong Stroll

[Year:2023] [Month:May-June] [Volume:2] [Number:3] [Pages:4] [Pages No:55 - 58]

Keywords: Central venous catheter, Central venous cannulation, Internal jugular vein

   DOI: 10.5005/jp-journals-11006-0048  |  Open Access |  How to cite  | 

Abstract

Central venous catheter (CVC) insertion is one of the most commonly performed procedures in anesthesia and critical care medicine practice in order to ease the administration of intravenous (IV) medications and hemodialysis as well. CVC misplacement can occur, even in expert hands, despite the widespread use of ultrasound (USG) guidance. Such catheterization sometimes comes with risks of unpremeditated puncture of other vascular structures and pleura or other nearby structures, causing serious life-threatening complications.1 CVC insertion using USG guidance has remarkably reduced the complications associated with anatomical disruptions.2 Nevertheless, the catheter could still get misplaced if it follows an aberrant route even after proper puncture of the desired vessel. In order to highlight the rare complications that could occur with CVC placements, we report a case describing the CVC misplacement into the innominate artery extending into the anterior end of the arch of the aorta and subsequent patient management requiring a sternotomy.

215

CASE REPORT

Maulik P Patel

Subglottic Stenosis in ICU Managed with CPAP

[Year:2023] [Month:May-June] [Volume:2] [Number:3] [Pages:2] [Pages No:59 - 60]

Keywords: Morbidities, Portable continuous positive airway pressure, Repetitive prolonged endotracheal intubation, Subglottic stenosis

   DOI: 10.5005/jp-journals-11006-0052  |  Open Access |  How to cite  | 

Abstract

This case report describes subglottic stenosis secondary to repetitive endotracheal intubation causing significant morbidity and psychological trauma, which was managed by portable continuous positive airway pressure (CPAP) in the hospital and then at home.

296

CASE REPORT

Sarika Katiyar, Rishi Katiyar

Posterior Reversible Encephalopathy Syndrome Following Red Blood Cells Transfusion: A Case Report

[Year:2023] [Month:May-June] [Volume:2] [Number:3] [Pages:3] [Pages No:61 - 63]

Keywords: Blood transfusion, Posterior reversible encephalopathy syndrome, Vasogenic cerebral edema

   DOI: 10.5005/jp-journals-11006-0053  |  Open Access |  How to cite  | 

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a very infrequent disease characterized by alteration in mental status, which may lead to seizures and deficits. Here we describe a 42-year-old female with seizures after transfusion for chronic anemia. Her brain magnetic resonance imaging (MRI) showed edema in occipital regions consistent with the clinical finding. Many immunological and nonimmunological complications are present after blood transfusion, but PRES is rare and preventable.

646

CASE REPORT

Bhavinkumar Patel, Atul Jani, Nimesh Patel, Chetan Trivedi

Opsoclonus-myoclonus-ataxia Syndrome Associated with Dengue Fever: A Case Report

[Year:2023] [Month:May-June] [Volume:2] [Number:3] [Pages:2] [Pages No:64 - 65]

Keywords: Dengue, Intravenous immunoglobulin, Opsoclonus-myoclonus-ataxia syndrome, Steroids

   DOI: 10.5005/jp-journals-11006-0050  |  Open Access |  How to cite  | 

Abstract

Opsoclonus-myoclonus-ataxia syndrome (OMAS) is a rare neurological disorder characterized by irregular multidirectional eye movements, myoclonus, cerebellar ataxia, sleep disturbances, and cognitive dysfunction. Although most commonly occurring as a paraneoplastic syndrome, this condition has occasionally been described following infectious illnesses. This article reports a rare case of OMAS in association with dengue virus infection. This report represents an unusual clinical syndrome associated with a viral infection and reinforces the need for clinical vigilance with regard to neurological syndromes in the context of emerging arboviruses.

227

CASE REPORT

Faris Hussain, P Shihabudheen, Noushad Babu, Nihal Muhammed, Vivek Prasad, EP Ashique, IP Shahsadhi, FT Shana

A Case Report on Fulminant Clostridium difficile Colitis Managed with Vancomycin Administered through Ileostomy

[Year:2023] [Month:May-June] [Volume:2] [Number:3] [Pages:3] [Pages No:66 - 68]

Keywords: Clostridium difficile, Ileostomy, Intensive care unit, Vancomycin retention enema, Sepsis

   DOI: 10.5005/jp-journals-11006-0056  |  Open Access |  How to cite  | 

Abstract

Clostridium difficile (CDF) is a widespread nosocomial infection, usually presented as diarrhea. In fulminant cases, paralytic ileus is common. In postoperative patients with a functioning ileostomy, it is rare. Here, we describe a patient who was admitted with features of septic shock secondary to ileal obstruction and perforation. Since the patient was in sepsis, not responding to broad-spectrum antibiotics and antifungals, and computed tomography (CT) showed edematous bowel loops, we suspected CDF. Investigations confirmed pseudomembranous enterocolitis and responded to treatment which included oral vancomycin along with intravenous (IV) metronidazole and vancomycin as retention enema through rectum, and ileostomy downwards using Foley's catheter. This case report is a newer insight to prompt decision-making and intervention than those described in the conventional treatment algorithm of Clostridium difficile infection (CDI).

515

CASE REPORT

Neeraja Vijayan, Nakka Vihari, Mohd Nadeem, Naresh K Midha, Varatharajan Sakthivadivel, MK Garg

Phenytoin Overdose-induced Rhabdomyolysis: A Rare Case Report

[Year:2023] [Month:May-June] [Volume:2] [Number:3] [Pages:3] [Pages No:69 - 71]

Keywords: Acute kidney injury, Phenytoin, Rhabdomyolysis

   DOI: 10.5005/jp-journals-11006-0054  |  Open Access |  How to cite  | 

Abstract

Introduction: Phenytoin is the commonly used antiepileptic medication for abortive as well as maintenance therapy. Even though phenytoin is associated with various side effects, only a few cases of phenytoin-induced rhabdomyolysis have been reported so far. Most cases are either due to parenteral use for status epilepticus or hypersensitivity reaction to maintenance therapy. Case description: We present an 18-year-old male, on regular treatment for a seizure disorder, who presented with altered sensorium following ingestion of 15–20 tablets of phenytoin (1500–2000 mg) and was found to have acute kidney injury (AKI) due to rhabdomyolysis secondary to phenytoin toxicity. The patient recovered completely with hemodialysis and supportive care. Conclusion: Phenytoin overdose-induced rhabdomyolysis is a rare occurrence with high risk of acute kidney injury. Awareness of clinicians about this rare complication is helpful for early diagnosis and treatment.

258

CASE REPORT

Amit Goel, Upendra Singh, Eshaan Patel, Mohd Javed

Gastroenteritis-triggered BRASH Syndrome in a Patient with Chronic Kidney Disease: A Case Report

[Year:2023] [Month:May-June] [Volume:2] [Number:3] [Pages:3] [Pages No:72 - 74]

Keywords: Acute gastroenteritis, Bradycardia, renal failure, AV nodal blocking drugs, shock, and hyperkalemia syndrome, Chronic kidney disease, Hyperkalemia

   DOI: 10.5005/jp-journals-11006-0055  |  Open Access |  How to cite  | 

Abstract

Introduction: Patients with chronic kidney disease (CKD) are on regular renal support. However, coexisting comorbidities, ongoing treatment and drug interactions requires exploration of other associated conditions which could prove life-threatening. Case description: We present here the management of a CKD patient on atrioventricular (AV) node-blocking medications with acute gastroenteritis presenting in shock, refractory bradycardia, and severe hyperkalemia. Conclusion: Bradycardia, renal failure, AV nodal blocking drugs, shock, and hyperkalemia (BRASH) syndrome is broadly reported in a group of CKD patients receiving long-term AV node blockers. Hypovolemia, renal hypoperfusion, and deranged renal parameters are major risk factors. Largely high morbidity and mortality are associated with BRASH syndrome. However, prompt diagnosis and management can lead to an overall better patient outcome.

223

CASE REPORT

Rupak Banerjee, Lawni Goswami, Debasis Rout, Suresh Ramasubban, Jayanta Sharma

Methylene Blue to the Rescue in Severe Vasoplegia after Oral Nimodipine in a Patient with Aneurysmal Subarachnoid Hemorrhage

[Year:2023] [Month:May-June] [Volume:2] [Number:3] [Pages:3] [Pages No:75 - 77]

Keywords: Delayed cerebral ischemia, Methylene blue, Oral nimodipine, Subarachnoid hemorrhage, Vasoplegia

   DOI: 10.5005/jp-journals-11006-0057  |  Open Access |  How to cite  | 

Abstract

Aim and background: We report the first case in India of refractory vasoplegia from oral nimodipine after aneurysmal subarachnoid hemorrhage (aSAH) and its successful rescue with intravenous methylene blue. Case description: A 53-year-old man presented with fever, headache, and neck pain from SAH due to the rupture of a suspected mycotic aneurysm. He was on peroral nimodipine postcoiling. After 1 hour, he developed severe hypotension, unresponsive to triple vasopressors. His low diastolic pressure pointed toward vasoplegia and after ruling out other causes with point-of-care ultrasound (POCUS), 200 mg of methylene blue was administered intravenously. The vasopressor requirement decreased immediately. No side effects were observed except chromaturia. Conclusion: Nimodipine is recommended orally to reduce unfavorable outcomes from delayed cerebral ischemia. Mild hypotension is common, but in rare cases, it may lead to profound refractory vasoplegia. This case demonstrates the successful use of methylene blue as a potential rescue therapy.

227

CASE REPORT

Dweepala PDK Priyadarshini, Shazia Khan

An Outbreak of Corynebacterium striatum in a Pulmonary Intensive Care Unit

[Year:2023] [Month:May-June] [Volume:2] [Number:3] [Pages:4] [Pages No:78 - 81]

Keywords: Corynebacterium striatum, Emerging pathogen, Outbreaks

   DOI: 10.5005/jp-journals-11006-0058  |  Open Access |  How to cite  | 

Abstract

Background: Corynebacterium striatum (C. striatum) is an emerging pathogen. We outline three cases of C. striatum pneumonia where a significant hospital outbreak was prevented by the support of the microbiology department. Case presentation: We are reporting a series of cases of nosocomial pneumonia outbreak in a tertiary care hospital's pulmonary intensive care unit, in which the predominant causative isolate for pneumonia was C. striatum. All three patients in this case series had preexisting chronic respiratory illnesses and were immunocompromised. The duration of the spread was seven to 10 days. Once the hospital outbreak was identified, they were isolated, treated with an appropriate antibiotic, and discharged. C. striatum was not isolated from any of the patient's isolates after that. Conclusion: As a potential source of infection, C. striatum should be taken into account. Immediate isolation of the infected is necessary as this organism can cause outbreaks. It is important to identify such outbreaks, isolate the patients and treat them appropriately.

297

CASE REPORT

Sanjay K Nihalani, Apoorva B Singhal, Gerasmos Capatos, Kalpana Krishnareddy, Seemin Shiraz, Anil Agarwal

A Rare Case Report: VA ECMO Support for Cardiogenic Shock Caused by Arrhythmia-induced Cardiomyopathy

[Year:2023] [Month:May-June] [Volume:2] [Number:3] [Pages:3] [Pages No:82 - 84]

Keywords: Atrial fibrillation, Cardiomyopathy, Extracorporeal membrane oxygenation

   DOI: 10.5005/jp-journals-11006-0059  |  Open Access |  How to cite  | 

Abstract

Herein we report a rare case of venoarterial extracorporeal membrane oxygenation (VA ECMO) support in a patient with arrhythmia-induced cardiomyopathy and cardiogenic shock. The patient had a lactate of more than 20 at the time of initiation of ECMO. Arrhythmia-induced cardiomyopathy is a potentially reversible state in which atrial or ventricular tachycardia/arrhythmias results in a decrease in left ventricular (LV) function, causing systolic heart failure and in rare cases, cardiogenic shock.1 VA ECMO is now increasingly used for various forms of cardiogenic shock, including the above condition that is unresponsive to conventional therapy. This is a case report of middle age man who presented with atrial fibrillation (AF) and rate related cardiomyopathy resulting in severe cardiogenic shock. He failed to respond to conventional management, including rate control medications, inotropic, and vasopressor agents. He had a cardiac arrest and was revived postcardiopulmonary resuscitation. Only with the early initiation of VA ECMO could the stabilization of hemodynamics be maintained. Further, ECMO support gave us the time for the reversible cardiomyopathy to resolve, and the patient survived who otherwise may not have in view of poor ejection fraction (EF) of 10%.

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