Indian Journal of Critical Care Case Report

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2023 | July-August | Volume 2 | Issue 4

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FROM THE EDITOR'S DESK

From the Editor's Desk

[Year:2023] [Month:July-August] [Volume:2] [Number:4] [Pages:1] [Pages No:v - v]

   DOI: 10.5005/ijccr-2-4-v  |  Open Access | 

209

CASE REPORT

Arnab Choudhury, Sruthi Vamadevan, Ashwin Parchani, Sahil Kumar, Jithesh Gangadharan, Mukesh Bairwa

A Rare Presentation of Ecthyma Gangrenosum-like Lesions due to Staphylococcus lentus in an Immunocompetent Adult: A Case Report

[Year:2023] [Month:July-August] [Volume:2] [Number:4] [Pages:3] [Pages No:85 - 87]

Keywords: Case report, Ecthyma, Eschar, Immunocompetent, Neutropenia, Sepsis

   DOI: 10.5005/jp-journals-11006-0060  |  Open Access |  How to cite  | 

Abstract

Staphylococcus lentus (S. lentus) is a commensal organism commonly isolated from the skin of animals and in people working in close contact with animals. However, the role of this organism as a pathogen is less defined. We present a case of a 58-year-old gentleman who was presented to us with sepsis with multiorgan dysfunction, with ecthyma gangrenosum (EG)-like lesions in his face and legs. Further evaluation led to the isolation of S. lentus from the pus culture swab of the lesion. The culture sensitivity-guided antibiotic treatment led to the cure of sepsis and the resolution of lesions.

342

CASE REPORT

Preeti Ajapuje, Sampada Patwardhan, Romika Dawra, Shireesh Sathe, Dhairyasheel Kanase, Narendra Javdekar, Nilesh Juvekar, Advait Melinkeri, Amrita Prayag

Therapeutic Conundrum: Infective Endocarditis due to Extensively Drug-resistant Pseudomonas aeruginosa Treated with Ceftazidime/Avibactam Monotherapy: A Case Report

[Year:2023] [Month:July-August] [Volume:2] [Number:4] [Pages:3] [Pages No:88 - 90]

Keywords: Carbapenem-resistant, Case report, Pseudomonas aeruginosa infective endocarditis, Ceftazidime/Avibactam, Gram-negative infective endocarditis, Infective endocarditis

   DOI: 10.5005/jp-journals-11006-0061  |  Open Access |  How to cite  | 

Abstract

Infective endocarditis (IE) is a significant cause of mortality and morbidity, especially in patients with underlying acquired structural heart disease in developing countries. IE caused by non-Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella (HACEK) gram-negative bacteria (GNB) accounts for approximately 2% of all cases and is characterized by high mortality. Pseudomonas aeruginosa (P. aeruginosa) IE accounts for <0.4% of all endocarditis cases. Gram-negative endocarditis is further compounded by the problem of antimicrobial resistance. We report a very rare case of carbapenem-resistant P. aeruginosa IE (CRIE) from India to highlight the difficulties of managing such cases with the challenges of antimicrobial resistance in our settings.

299

CASE REPORT

Aarthee Asokan, Dhanaraj Mathuram, Mark A Augustus

Delayed Osmotic Demyelination Syndrome Treated Successfully with Therapeutic Plasma Exchange: A Case Report

[Year:2023] [Month:July-August] [Volume:2] [Number:4] [Pages:3] [Pages No:91 - 93]

Keywords: Case report, Central pontine myelinolysis, Extra pontine myelinolysis, Osmotic demyelination syndrome

   DOI: 10.5005/jp-journals-11006-0063  |  Open Access |  How to cite  | 

Abstract

Osmotic demyelination syndrome (ODS) is an uncommon neurological disorder, generally following rapid correction of hyponatremia resulting in demyelination of the white matter of the pons and certain extrapontine regions. The neurological symptomatology can vary from mild confusion to severe dense global paralysis, coma, or death. Once ODS is established, there is no proven treatment. Several experimental therapies, such as reinduction of hyponatremia, intravenous immunoglobulin (IVIG), plasma exchange, and steroids, have been tried with variable success. In this case report, we describe a case of ODS with global paralysis that responded well to plasma exchange therapy despite a full month has passed since the onset of symptoms. This is probably one of the first few cases reported from this part of the country.

289

CASE REPORT

Mitra Kar, Nidhi Tejan, Ashima Jamwal, Shailesh Sengar, Chinmoy Sahu, Sangram S Patel

Sphingomonas paucimobilis Bacteremia in an Immunocompetent Patient: A Case Report and Review of Literature

[Year:2023] [Month:July-August] [Volume:2] [Number:4] [Pages:3] [Pages No:94 - 96]

Keywords: Bacteremia, Bacillus, Case report, Dengue, Soil, Sphingomonas paucimobilis, Water

   DOI: 10.5005/jp-journals-11006-0062  |  Open Access |  How to cite  | 

Abstract

Introduction: Sphingomonas paucimobilis (S. paucimobilis) is a non-fermenting, gram-negative bacillus with very low pathogenic potential. These bacilli are found to inhabit the soil and aquatic milieu and are usually transmitted in the hospital environment by means of contaminated drugs, equipment, and water, causing infection in immunocompromised individuals. Case description: We present a case of a 26-year-old immunocompetent patient suffering from dengue hemorrhagic fever followed by secondary bacteremia with S. paucimobilis which was isolated from peripheral blood and bone marrow samples. Conclusion: A microorganism with low pathogenic potential like S. paucimobilis is also capable of causing bacteremia in immunocompetent individuals. Awareness among physicians about this rare pathogen can promote early treatment with appropriate antibiotics.

265

CASE REPORT

Satyajit Choudhury, S Anushapreethi, Pragnya P Jena, Sagarika Panda, Shakti B Mishra

Burkholderia pseudomallei Brain Abscess: Atypical Infection at the Atypical Site: A Case Report

[Year:2023] [Month:July-August] [Volume:2] [Number:4] [Pages:3] [Pages No:97 - 99]

Keywords: Burkholderia, Brain abscess, Case report, Melioidosis

   DOI: 10.5005/jp-journals-11006-0064  |  Open Access |  How to cite  | 

Abstract

Burkholderia pseudomallei (B. pseudomallei), a gram-negative bacterium, is ubiquitously found in water, soil, and surface. Although it infrequently affects the brain, it causes significant morbidity and mortality. Neuromelioidosis can manifest either as encephalomyelitis or brain abscess. Herein we are reporting an extremely rare case of Burkholderia brain abscess following trauma and undergoing surgery for abscess drainage. The postoperative period was complicated by refractory seizure, which was managed by early initiation of appropriate antibiotics along with an optimal dose of antiepileptic drug. Early detection and initiation of appropriate antibiotic therapy, along with surgical management, remains the mainstay of treatment.

263

CASE REPORT

Suresh Jaganathan, Balaji Thirugnanam, Nitish Mukunthan, Shanmugapriya Senthilkumar

Concomitant Fat Embolism Syndrome and Pulmonary Embolism—A Hidden Enemy in Polytrauma Patient: A Case Report

[Year:2023] [Month:July-August] [Volume:2] [Number:4] [Pages:3] [Pages No:100 - 102]

Keywords: Acute pulmonary embolism, Case report, Fat embolism syndrome, Long bone fractures

   DOI: 10.5005/jp-journals-11006-0065  |  Open Access |  How to cite  | 

Abstract

Fat embolism syndrome (FES) and pulmonary embolism (PE) are the most common systemic complications seen after a long bone fracture. Though there may be a partial overlap of clinical symptoms and signs, the pathophysiology and management of both entities are totally different. It is important to correctly diagnose the entity to proceed with appropriate treatment. Both complications in most cases occur separately. But in very rare cases both fat embolism and PE coexist together, giving a diagnostic and therapeutic challenge. We present one such rare case of a young female post-road traffic accident with a bilateral tibia fracture who underwent bilateral tibia intramedullary interlocking nailing under regional anesthesia after initial stabilization. Postoperatively patient developed signs of pulmonary thromboembolism which was diagnosed with computed tomography pulmonary angiogram (CTPA). The patient was treated with anticoagulation, and at a later date, she developed signs of encephalopathy. Diagnosis of cerebral fat embolism was made based on magnetic resonance imaging (MRI) brain findings. She had a stormy postoperative period. We hereby describe the challenges we faced in the perioperative period to diagnose and treat her successfully.

412

CASE REPORT

Vamsi K Kaza, Swarna D Kurgayala

Eosinophilic Granulomatosis with Polyangiitis Presenting as Acute Non-segment Elevation Myocardial Infarction: A Case Report

[Year:2023] [Month:July-August] [Volume:2] [Number:4] [Pages:3] [Pages No:103 - 105]

Keywords: Case report, Eosinophilic granulomatosis with polyangiitis, Non-ST-elevation myocardial infarction, Vasculitis

   DOI: 10.5005/jp-journals-11006-0066  |  Open Access |  How to cite  | 

Abstract

Coronary artery involvement though known is rare in eosinophilic granulomatosis with polyangiitis. Cardiac involvement is associated with worse outcomes but early detection and appropriate treatment can prevent progression, and reduce overall mortality. We highlight the need for an open approach in younger patients presenting with chest pain, particularly the ones without major risk factors for atherosclerosis. This should prompt suspicion of a vasculitic cause of the chest pain and thereby help with early detection.

268

CASE REPORT

Sanjay Chaudhary, Gunjan Mundhra, Manoj Ghimire, Rabi Shrestha, Subekshya Khadka, Devang K Sanghavi, Anirban Bhattacharyya, Pramod Guru

Extracorporeal Membrane Oxygenation as a Rescue Support in Autologous Hematopoietic Stem Cell Transplant-associated Peri-engraftment Syndrome: A Case Report

[Year:2023] [Month:July-August] [Volume:2] [Number:4] [Pages:4] [Pages No:106 - 109]

Keywords: Autologous hematopoietic stem cell transplant, Case report, Extracorporeal membrane oxygenation, Jirovecii pneumonia, Peri-engraftment respiratory distress syndrome, Pneumocystis

   DOI: 10.5005/jp-journals-11006-0067  |  Open Access |  How to cite  | 

Abstract

Introduction: Extracorporeal life support (ECLS) is often used as a salvage therapy for respiratory failure refractory to conventional interventions, but its use in immunosuppressed states, including hematopoietic stem cell transplant (HSCT) has been considered a relative contraindication due to increased risk of complications and high mortality. Case description: We present the case of a 49-year-old male with multiple myeloma who developed peri-engraftment respiratory distress syndrome (PERDS) and Pneumocystis jirovecii pneumonia (PJP) following HSCT and was successfully managed with two runs of venovenous extracorporeal membrane oxygenation (VV-ECMO). Conclusion: If used judiciously, ECMO can be an effective support strategy in carefully selected immunocompromised patient populations.

251

CASE REPORT

Kamil Inci, Lale Karabiyik

Immobilization-induced Hypercalcemia in a Critically Ill Adult: A Case Report

[Year:2023] [Month:July-August] [Volume:2] [Number:4] [Pages:3] [Pages No:110 - 112]

Keywords: Case report, Hypercalcemia, Hypoxıc ischemic encephalopathy, Intensive care unit

   DOI: 10.5005/jp-journals-11006-0068  |  Open Access |  How to cite  | 

Abstract

Immobilization-induced hypercalcemia (IIH) is a rarely seen condition of which etiology is unclear. It has been described as a complication in adult patients with prolonged movement limitations depending on severe acute trauma, multiple bone fractures, and stroke or young adults with immobilization depending on spinal cord injuries. Diagnosis requires a detailed evaluation to exclude other conditions causing hypercalcemia. This is a case report of a 64-year-old male with prolonged immobilization related to hypoxic brain injury who presented with severe hypercalcemia and contributed to identifying hypercalcemia as a result of immobilization.

401

CASE REPORT

Mridula M Muthe, Pareekshith R Rai, Anagha R Joshi, Vikrant P Firke

Out of Breath, Out of Bounds: A Case Report of Traumatic Lung Herniation

[Year:2023] [Month:July-August] [Volume:2] [Number:4] [Pages:4] [Pages No:113 - 116]

Keywords: Case report, Computed tomography chest, Hernia, Lung herniation, Thoracoscopy, Traumatic

   DOI: 10.5005/jp-journals-11006-0069  |  Open Access |  How to cite  | 

Abstract

Introduction: Intercostal lung herniation is characterized by congenital or acquired herniation of the lung or other viscera through the thoracic wall. Case description: A young adult male presented with a history of trauma to the chest due to the handlebar of a bicycle. Chest radiograph findings were concerning for a lung contusion, mild pneumothorax, and hemothorax. A computed tomography (CT) scan in addition showed herniation of lung parenchyma along the anterior aspect of the left second rib. Given the relatively small size of the defect, the patient underwent a reduction of the herniated lung, followed by primary closure. He had an uneventful postoperative period and was doing well on follow-up. Discussion and conclusion: Computed tomography (CT) plays a crucial role in selecting the appropriate management approach in the intercostal lung herniation. The goals of imaging are to assess the defect size, lung viability, and severity of the injury and rule out other trauma-related findings. Small defects with minimal herniation are amenable to conservative management, but those with large defects and/or disruption of the thoracic wall require surgery with flap/mesh reconstruction. With prompt treatment, these patients are expected to have good long-term functional outcomes.

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