Indian Journal of Critical Care Case Report

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2024 | March-April | Volume 3 | Issue 2

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From the Editor's Desk

[Year:2024] [Month:March-April] [Volume:3] [Number:2] [Pages:1] [Pages No:v - v]

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


Clinicopathological Conference Report

Mayur Parkhi, Kushal Gupta, Rajender Kumar, Arihant Jain, Debajyoti Chatterjee

Myocarditis in a Young Adult of Anaplastic Lymphoma Kinase Positive Anaplastic Large Cell Lymphoma: An Incidental Autopsy Finding

[Year:2024] [Month:March-April] [Volume:3] [Number:2] [Pages:7] [Pages No:31 - 37]

Keywords: Anaplastic large cell lymphoma, Anaplastic lymphoma kinase positive, Autopsy, Myocarditis

   DOI: 10.5005/jp-journals-11006-0095  |  Open Access |  How to cite  | 


Background: Myocarditis, an inflammatory condition, may result from multifactorial causes but in association with lymphoma is an extremely rare presentation. We report a nodal anaplastic lymphoma kinase (ALK) positive anaplastic large-cell lymphoma (ALCL) case in a young adult who was detected with systemic dissemination and showed findings of myocarditis on postmortem examination. Case presentation: An 18-year-old female presented with chief complaints of fever, fatiguability, and backache accompanied by loss of weight and appetite for 2 months. All the systems, on examination, appeared normal. Whole-body positron emission tomography–contrast enhanced computed tomography (PET–CECT) scan revealed 18F-fluorodeoxyglucose (FGD) avid multiple lymph nodes involving cervical, diaphragmatic, thoracoabdominal, and inguinal regions along with uptake in the wall of the sigmoid colon. The excisional node biopsy revealed a diagnosis of ALK-positive ALCL. During this time, the patient developed paroxysmal supraventricular tachycardia (PSVT) and recurrent hypoglycemic episodes and succumbed to her illness subsequently. Septicemia-related cardiogenic/refractory shock was kept clinically as the cause of the death. A detailed postmortem histopathological examination revealed advanced stage presentation of ALCL with systemic involvement of the large intestine, pancreas, ovaries, skin, skeletal muscle, urinary bladder, and soft tissue [stage IV Burkitt's Edema (BE)]. In addition, findings of lymphoma-associated myocarditis, extramedullary hematopoiesis, and secondary hemophagocytosis were evident. Conclusion: This case represents a very rare case of ALK-positive ALCL that developed myocarditis as diagnosed on postmortem examination. Myocarditis should be suspected in a case of lymphoma with arrhythmia/PSVT so that early intervention can be planned.



Arpitha Chandrashekar, Pooja P Sarada, Padmakumar V Arayamparambil, Garud S Chandan, Manjunath Ganesh

A Case of Traumatic Pneumatocele: A Challenging Road to Recovery

[Year:2024] [Month:March-April] [Volume:3] [Number:2] [Pages:3] [Pages No:38 - 40]

Keywords: Alveolopleural fistula, Case report, Traumatic pneumatocele, Venovenous extracorporeal membrane oxygenation

   DOI: 10.5005/jp-journals-11006-0096  |  Open Access |  How to cite  | 


Blunt chest trauma is commonly associated with pulmonary contusion, whose consequences can vary based on the mechanism of injury. Deceleration injuries cause parenchymal laceration and can lead to cavities called primary traumatic pneumatocele or pseudocyst which are mostly managed conservatively. Here is a case of a 18-year-old male with traumatic pneumatocele following road traffic accident complicated by acute respiratory distress syndrome and multidrug-resistant (MDR) infection. He required multiple proning sessions and underwent lobectomy, following which he required venovenous extracorporeal membrane oxygenation (VV-ECMO) and a prolonged intercostal drain for persistent alveolopleural fistula. As critical care physicians, it is important to be aware of traumatic pneumatocele, its identification and differentiation from other infective etiologies and various complications along with its management.



Noopur Kedare, Pavan Hanchanale, Vivek Bonde, Geethu Joe, Rajeev Soman

A Case of Chronic Subdural Hematoma Infected by Salmonella Species

[Year:2024] [Month:March-April] [Volume:3] [Number:2] [Pages:2] [Pages No:41 - 42]

Keywords: Bacteremia, Case report, Chronic liver disease, Chronic subdural hematoma, Salmonella

   DOI: 10.5005/jp-journals-11006-0097  |  Open Access |  How to cite  | 


In patients with chronic liver disease (CLD), there is a likelihood of bowel pathogens producing bacteremia, as the microbial filter function of the liver is lost. We describe a case of hematogenous seeding of chronic subdural hemorrhage (SDH) resulting from an unrecognized cranial injury in a patient with CLD.



Swarna D Kuragayala, Samantha Sathyakumar, Hima B Kotamarthy

Severe Cotrimoxazole-induced Hypoglycemia in a Patient with Pneumocystis jirovecii Pneumonia: A Case Report

[Year:2024] [Month:March-April] [Volume:3] [Number:2] [Pages:3] [Pages No:43 - 45]

Keywords: Cotrimoxazole, Hypoglycemia, Pneumocystis jirovecii pneumonia

   DOI: 10.5005/jp-journals-11006-0093  |  Open Access |  How to cite  | 


Aim: To report a case of prolonged severe hypoglycemia associated with cotrimoxazole in a nondiabetic human immunodeficiency syndrome (HIV)—positive patient. Case description: We describe a case of cotrimoxazole-associated hypoglycemia in a 30-year-old nondiabetic HIV-positive patient. The patient developed hypoglycemia after she was started on cotrimoxazole for the treatment of Pneumocystis jirovecii. Her renal and hepatic function was normal. Serum insulin and C-peptide measured at the time of hypoglycemia were found to be significantly elevated. Hypoglycemia was managed with intravenous administration of dextrose and resolved after cotrimoxazole was withdrawn. We also review the literature regarding this uncommon adverse effect of the commonly used drug.



Smita Sharma, Gyanendra Agrawal, Esha Kaul, Diksha D Yadav

Secondary Hemophagocytic Lymphohistiocytosis Associated with Coronavirus Disease 2019

[Year:2024] [Month:March-April] [Volume:3] [Number:2] [Pages:3] [Pages No:46 - 48]

Keywords: Coronavirus disease 2019, Hemophagocytic lymphohistiocytosis, Macrophage activation syndrome

   DOI: 10.5005/jp-journals-11006-0100  |  Open Access |  How to cite  | 


Hemophagocytic lymphohistiocytosis (HLH) is an acute and rapidly progressive systemic inflammatory disorder characterized by cytopenia, hyperferritinemia, multiorgan involvement, and hemophagocytosis. The other names for HLH are hemophagocytic syndrome and macrophage activation syndrome. Coronavirus disease 2019 (COVID-19) is associated with cytokine storm and secondary HLH; both are a spectrum of dysregulated immune responses requiring immunomodulatory drugs. Early diagnosis and treatment are a must, as the mortality rate of HLH is 40%. Severe COVID-19 patients should be screened for hyperinflammation using standard laboratory tests and H-score to rule out secondary HLH. Highlight: This case report highlights the importance of a high index of suspicion of secondary HLH in clinician's minds, which can lead to early diagnosis, prompt treatment, and a good prognosis.



Rajathadri H Ravikumar, Mrudula Prasanna, Dalim K Baidya

Air Leak with Abdominal Distension in Severe ARDS: Beware of Tracheoesophageal Fistula!

[Year:2024] [Month:March-April] [Volume:3] [Number:2] [Pages:2] [Pages No:49 - 50]

Keywords: Acute respiratory distress syndrome, Case report, Tracheoesophageal fistula, Tuberculosis

   DOI: 10.5005/jp-journals-11006-0094  |  Open Access |  How to cite  | 


Introduction: The management of mechanical ventilation in acute respiratory distress syndrome (ARDS) poses a significant challenge. This complexity is further heightened when ARDS is compounded by the presence of tracheoesophageal fistula (TEF), presenting an exceptionally formidable obstacle. Case description: We present a case report detailing a young female patient diagnosed with severe tuberculous ARDS accompanied by a persistent air leaks. Our report delves into the challenges encountered in the identification, diagnosis, and subsequent management of this unique and complex clinical presentation. Conclusion: To achieve early identification and effective treatment of TEF, it is crucial to maintain both a high clinical suspicion and have a comprehensive knowledge of potential risk factors.



Shashikant Sharma, Gourav Mittal, Abhijeet Anand, Tanweer Qamar, Kishore Jhunjhunwala

Untwisting an Outward Form of Nitroglycerin for Radial Artery Cannulation: A Case Report

[Year:2024] [Month:March-April] [Volume:3] [Number:2] [Pages:3] [Pages No:51 - 53]

Keywords: Case report, Invasive blood pressure, Nitroglycerin, Radial artery, Septic shock, Ultrasound

   DOI: 10.5005/jp-journals-11006-0099  |  Open Access |  How to cite  | 


Arterial cannulation for invasive blood pressure monitoring and titration of vasopressors in patients with septic shock is a recommended practice in intensive care units. The radial artery, being superficial, easily accessible, and associated with fewer complications, makes it the first choice for invasive blood pressure monitoring. Using ultrasound increases the chances of successful cannulation on the first attempt. However, in patients with septic shock, strong sympathetic stimulation and the use of vasopressors cause severe spasms and make arterial cannulation difficult even under ultrasound guidance. We report a case of successful radial artery cannulation in the first pass using intra-arterial nitroglycerin in a 24-year-old female admitted with septic shock and on high doses of dual vasopressors.



Kushal R Kalvit, Abhishek Rajput, Malini Joshi, Vijaya P Patil

Cerebral Air Embolism Following Pressurized Peripheral Intravenous Fluid Bolus

[Year:2024] [Month:March-April] [Volume:3] [Number:2] [Pages:3] [Pages No:54 - 56]

Keywords: Air embolism, Case report, Fluid bolus, Intravenous

   DOI: 10.5005/jp-journals-11006-0101  |  Open Access |  How to cite  | 


Background: Air embolism is a potentially fatal condition that may occur secondary to various interventional procedures. Hemodynamic collapse, cardiac arrest, and/or neurological deficits are the most dreaded clinical manifestations. It is difficult to diagnose and is often missed, especially when the clinical presentation is atypical. Case description: A 57-year-old male with adenocarcinoma of colon underwent right hemicolectomy and ileotransverse anastomosis. The surgery went uneventful and the patient was hemodynamically stable overnight. He developed signs of circulatory shock the next day for which he was administered a fluid bolus via a peripheral intravenous (IV) line. He developed hemodynamic and respiratory instability immediately after receiving the fluid bolus. Echocardiography showed the presence of numerous air bubbles within the cardiac chambers on both sides. He subsequently developed persistent left hemiparesis and focal seizures suggestive of cerebral air embolism. Conclusion: Cerebral air embolism from peripheral IV access is rare in the absence of a patent foramen ovale (PFO) and is a preventable catastrophe. Clinical significance: Great caution needs to be taken by the bedside nurse as well as the clinician while appropriate priming of the IV line and early identification of a probable embolic episode is essential to prevent complications.


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