Indian Journal of Critical Care Case Report

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2024 | May-June | Volume 3 | Issue 3

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FROM THE EDITOR'S DESK

Subhash K Todi

From the Editor's Desk

[Year:2024] [Month:May-June] [Volume:3] [Number:3] [Pages:1] [Pages No:v - v]

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

86

Clinicopathological Conference Report

Shivakumar Shivanna, Rajeshwari T Nagaraju, Swapna B Mandala, Rohith G Chitrapur, Indira Menon

Insights into Uncommon Presentation—Acute T-cell Lymphoma with Mediastinal Mass and Pericardial Effusion: Exploring the Rare Phenomenon of Spontaneous Tumor Lysis

[Year:2024] [Month:May-June] [Volume:3] [Number:3] [Pages:4] [Pages No:57 - 60]

Keywords: Acute T-cell leukemia, Massive pericardial effusion, Mediastinal mass, Tumor lysis

   DOI: 10.5005/jp-journals-11006-0107  |  Open Access |  How to cite  | 

Abstract

Tumor lysis syndrome (TLS) is a life-threatening hemato-oncological emergency in which the patient presents with severe metabolic derangements that include hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia. However, very rarely, a highly aggressive neoplasm such as acute lymphoblastic leukemia (ALL) or Burkitt lymphoma can present with spontaneous TLS. Preventive actions can reduce its prevalence and severity. Here, we present a male patient who was admitted to the intensive care unit with unspecific symptoms and hidden malignancy. On further evaluation, the patient had hyperphosphatemia, hyperuricemia, a large mediastinal mass, pericardial effusion, and left-sided massive pleural effusion and was also found to be in spontaneous TLS. On further evaluation, the patient was diagnosed with acute T-cell lymphoblastic leukemia.

116

CASE SERIES

Vineeth C Karapparambil, Venugopalan Poovathumparambil, Abhiram A Kumar, Ahammed Shaheem Pilathodan, Deepak Rajan

Spinal Epidural Hematoma—The Great Mimicker: A Case Series

[Year:2024] [Month:May-June] [Volume:3] [Number:3] [Pages:3] [Pages No:61 - 63]

Keywords: Aortic dissection, Compression, Spinal cord, Spinal epidural hematoma, Stroke

   DOI: 10.5005/jp-journals-11006-0106  |  Open Access |  How to cite  | 

Abstract

Spontaneous spinal epidural hematoma (SSEH) refers to the occurrence of spontaneous bleeding into the epidural space of the spinal cord without trauma or any iatrogenic procedures that result in compressive myelopathy. It is a rare condition that presents with acute onset neck pain or back pain with neurological symptoms. Clinical presentation will be variable, and the occurrence of neurological symptoms may be delayed depending on the level and extent of involvement of the bleed. So, this condition can mimic many other diagnoses, and unless diagnosed and managed promptly, the patient will have a poor outcome. In this case report, we describe three cases that had varying presentations and were initially misleading.

189

CASE REPORT

Faris Hussain, Namitha Raveendranath, Shihabudheen Pichen, Ashique Eradiparambath, Nidhi Raghuram, Joshua John, Muneer Thari

A First Case Report of Talaromyces marneffei Infection in a Person with Immunocompromised Rheumatoid Arthritis and Non-HIV Diabetes in South India

[Year:2024] [Month:May-June] [Volume:3] [Number:3] [Pages:4] [Pages No:64 - 67]

Keywords: Acquired immunodeficiency syndrome, Diabetes mellitus, Itraconazole, Rheumatoid arthritis, Talaromycosis, Talaromyces marneffei

   DOI: 10.5005/jp-journals-11006-0111  |  Open Access |  How to cite  | 

Abstract

Talaromycosis is a fungal infection caused by Talaromyces marneffei. The infection was formerly known as penicilliosis. It is the only penicillin species with a dimorphic character and causes systemic mycosis infections in humans. This infection commonly happens in immunocompromised individuals, especially those who are infected with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) or any other immunodeficiency state. The symptoms associated with T. marneffei include fever, weight loss, cough, breathing difficulty, abdominal pain, diarrhea, swollen lymph nodes, and general discomfort. The clinical manifestations impacted by T. marneffei can vary from mild skin lesions to circulatory collapse or respiratory failure. The lungs, liver, and mouth are frequently impacted by talaromycosis in persons who do not have HIV, while it can occasionally spread through the blood and affect the entire body. Here is a case of 70-year-old female patient who had a history of rheumatoid arthritis on steroids, diabetes and hypertension with a recent past history of community-acquired pneumonia treated with intravenous antibiotics from a local hospital. Despite being on appropriate broad-spectrum antibiotics, her condition deteriorated, and she was referred here. On admission, she was in sepsis, and she remained sick in spite of being on carbapenems and azithromycin. As she was an immunocompromised host, partial response to initial empiric therapy was considered early transbronchial lung biopsy, which revealed T. marneffei species. She was started on itraconazole oral therapy, to which she responded well and was later discharged. Unfortunately, she got re-admitted on the 25th day with type 1 respiratory failure and shock. The possibility of hospital-acquired infection was considered, and all higher antibiotics, including polymyxin and vancomycin, were initiated in addition to itraconazole therapy and plain amphotericin B as an add-on antifungal therapy; could not revive the patient, and she passed away. This case demonstrates the possibility of T. marneffei infection in any immunocompromised host rather than the fact of its occurrence only in HIV patients and the high mortality associated with it even with reasonable good critical care support.

127

CASE REPORT

Ankit Bhatia, Sharad Joshi, Nitesh Tayal, Abhishek Gupta, Pawan Gupta

Unraveling the Enigma: Pulmonary Infarction, Lung Cavitation, and Hypercalcemia Induced by Parathyroid Adenoma

[Year:2024] [Month:May-June] [Volume:3] [Number:3] [Pages:3] [Pages No:68 - 70]

Keywords: Case report, Cavitation, Hypercalcemia, Parathyroid, Pulmonary embolism

   DOI: 10.5005/jp-journals-11006-0109  |  Open Access |  How to cite  | 

Abstract

We present an uncommon case involving a 69-year-old male with an array of seemingly unrelated features of lung cavitation, acute pulmonary embolism with infarction, and hypercalcemia. The investigations unveiled an underlying cause: a parathyroid adenoma, triggering a cascade of events culminating in lung cavitation. Pulmonary infarction arising from pulmonary embolism is a rare complication due to the lung's dual blood supply. Hypercalcemia, typically associated with conditions like primary hyperparathyroidism (PHPT) and malignancy, can rarely lead to thrombosis, though the underlying mechanism remains poorly understood. The case study describes an instance of acute pulmonary embolism with pulmonary infarction, presenting as lung cavitation, ultimately traced back to parathyroid adenoma-induced hypercalcemia. The patient underwent a successful parathyroidectomy, leading to normal calcium levels and a favorable outcome during follow-up. This case underscores the importance of hypercalcemia in the evaluation of thrombotic events and highlights the need for further research to elucidate the intriguing link between calcium and thrombosis.

133

CASE REPORT

Amit K Rohila, Ankur Gupta, Ankur Sharma, Rahul Choudhary, Mahaveer S Rodha, Rengarajan Rajagopal

A Radiological Artifact Mimicking Aortic Dissection in Emergency Room: A Diagnostic Challenge

[Year:2024] [Month:May-June] [Volume:3] [Number:3] [Pages:3] [Pages No:71 - 73]

Keywords: Aortic artifact, Acute coronary event, Aortic dissection, Case report

   DOI: 10.5005/jp-journals-11006-0103  |  Open Access |  How to cite  | 

Abstract

Introduction: Aortic dissection can be challenging to diagnose in the emergency room. The diagnosis of aortic dissection in an emergency depends upon the clinical findings and computed tomography (CT) aortogram to look for the dissection. This case describes how a radiological artifact mimicked aortic dissection and posed a diagnostic challenge. Case description: We discuss the case of a 52-year-old lady who complained of chest pain and discomfort upon presenting to the emergency room with a significant blood pressure difference between both upper limbs, giving an impression of an acute coronary event and possible aortic dissection. Bedside two-dimensional (2D) echocardiography was done, which showed a suspected aortic flap. On a CT aortogram, a dissection was initially seen, which was later found to be an artifact of the aorta, causing a diagnostic dilemma. Conclusion: This case describes the importance of knowing this radiological mimicker and considering other differentials before diagnosing aortic dissection.

97

CASE REPORT

Devarakonda Prithvi, Lalit Jha, Amarjeet Kumar, Ajeet Kumar, Kunal Singh

Unknown Relationship between Lung Collapse and Atrial Fibrillation: A Case Report

[Year:2024] [Month:May-June] [Volume:3] [Number:3] [Pages:2] [Pages No:74 - 75]

Keywords: Atrial fibrillation, Bronchoscopy, Case report, Lung collapse, Suctioning

   DOI: 10.5005/jp-journals-11006-0104  |  Open Access |  How to cite  | 

Abstract

Atrial fibrillation (AF) stands as the most common cardiac arrhythmia linked to an increased risk of stroke, congestive heart failure, and higher mortality rates. Prompt intervention and management are imperative when AF with hemodynamic instability emerges. Here, we describe the case of a 74-year-old male admitted to the intensive care unit with right pleural effusion. He experienced a sudden onset of recurrent AF, which was reversed through synchronized cardioversion. AF was recurring and persistent; its resolution occurred following the removal of a mucus plug using a fiberoptic bronchoscope, suggesting a pathophysiological link between AF and lung collapse.

86

CASE REPORT

Partha P Jana, Vineet Rao, Geethu Joe, Rajeev Soman

A Delayed Diagnosis of Infective Endocarditis: A Case Report

[Year:2024] [Month:May-June] [Volume:3] [Number:3] [Pages:2] [Pages No:76 - 77]

Keywords: Case report, Diagnosis, Echocardiography, Infective endocarditis

   DOI: 10.5005/jp-journals-11006-0112  |  Open Access |  How to cite  | 

Abstract

Diagnosis of infective endocarditis (IE) remains a clinical challenge. Transthoracic echocardiogram (ECHO) (TTE) and positron emission tomography (PET) scans have limitations. We report this case of endocarditis where two-dimensional (2D) ECHO and PET scan were nondiagnostic on initial evaluation, and the organism grown on blood culture was probably misidentified. The patient was subsequently diagnosed with mitral valve endocarditis and was started on definitive antimicrobial therapy.

84

CASE REPORT

Kapil G Zirpe, Sushma K Gurav, Abhijit M Deshmukh, Ramunaidu Yellapu, Anand M Tiwari, Prasad B Suryawanshi, Upendrakumar S Kapse

Vigilance to Prevent Organ Wastage—Bilateral Pneumothorax: A Complication of Apnea Test

[Year:2024] [Month:May-June] [Volume:3] [Number:3] [Pages:3] [Pages No:78 - 80]

Keywords: Apnea test, Barotrauma, Brainstem death, Case report, Oxygen flow rate, Pneumothorax

   DOI: 10.5005/jp-journals-11006-0114  |  Open Access |  How to cite  | 

Abstract

A 30-year-old male patient, known case of hypertensive, was diagnosed to have a large intracranial hemorrhage. Brainstem death was diagnosed after clinical examination. The first apnea test (AT) was positive for brain death. While performing second apnea test, 5 minutes after disconnection of ventilator, saturation dropped to 78%.........heart rate......blood pressure dropped to 70 mmHg. The AT was abandoned. Chest auscultation revealed diminished breath sounds on the left>right side. Bilateral pneumothorax was confirmed with bedside point-of-care ultrasound (POCUS). The patient's saturation improved after the insertion of the bilateral intercostal drain. The second AT was done after patient stabilization. Organ retrieval was done successfully. Tension pneumothorax is an uncommon complication during AT. The ratio internal cannulae diameter of insufflation catheter to endotracheal tube (ETT) internal diameter (ID) should be <0.6–0.7 to avoid inadvertent dynamic hyperinflation or barotrauma. The oxygen flow rate should be 6–8 L/minute.

93

CASE REPORT

Swetha Narayanan, G Jithesh, Madhav Banjade, Mukesh Bairwa

Influenza-induced Pancreatitis and Pancreatic Encephalopathy: A Rare Clinical Presentation

[Year:2024] [Month:May-June] [Volume:3] [Number:3] [Pages:2] [Pages No:81 - 82]

Keywords: Case report, Influenza, Pancreatitis, Pancreatic encephalopathy

   DOI: 10.5005/jp-journals-11006-0102  |  Open Access |  How to cite  | 

Abstract

Instances of the H1N1 influenza virus contributing to acute pancreatitis (AP) are indeed rare. Similarly, pancreatic encephalopathy (PE) represents an unusual complication of AP that is often underdiagnosed and unreported. Here, we present a unique case involving influenza-induced pancreatitis and subsequent PE in a middle-aged female who initially presented with acute shortness of breath, complaints of abdominal pain, and altered sensorium. A nasopharyngeal reverse transcription polymerase chain reaction (RT-PCR) for influenza A confirmed the infection with H1N1. Ultrasonography of the abdomen and contrast-enhanced computed tomography revealed features indicative of AP. Due to the altered sensorium, a noncontrast computed tomography (NCCT) of the brain was conducted, yielding normal results. Cerebrospinal fluid (CSF) analysis also returned normal results. With a regimen of conservative management for pancreatitis and treatment with oseltamivir, the patient experienced improvement in both shortness of breath and sensorium. This case underscores the unusual manifestation of influenza-related complications and emphasizes the significance of a multidisciplinary approach to diagnosis and management.

72

CASE REPORT

Marutheesh Mallappa, Gayathri K Reddy, Murali Jayaraman, Harish M Maheshwarappa

Euglycemic Diabetic Ketoacidosis—A Rare Cause for Delayed Extubation: Case Report

[Year:2024] [Month:May-June] [Volume:3] [Number:3] [Pages:3] [Pages No:83 - 85]

Keywords: Case report, Diabetic ketoacidosis, Euglycemic, Sodium/glucose cotransporter-2 inhibitors

   DOI: 10.5005/jp-journals-11006-0105  |  Open Access |  How to cite  | 

Abstract

Aim and background: Euglycemic diabetic ketoacidosis (DKA) is ketoacidosis in individuals with near-normal blood sugar levels, making it difficult to diagnose. This can result in overlooked cases. Case description: A 46-year-old male with diabetes and hypertension presented with abdominal pain and fever. Gallstones and bile duct dilation were found. Elevated glucose levels and sugar in urine were detected. Gangrenous changes in the gallbladder were discovered during surgery. Severe metabolic acidosis required a ventilator and intensive care unit (ICU) transfer. Euglycemic DKA was considered due to sodium/glucose cotransporter-2 inhibitor (SGLT-2i) use. Treatment included fluids, insulin, and dextrose infusion. Extubation was successful the next day. Conclusion: Euglycemic DKA should be considered in critically ill patients with diabetes, even with low blood sugar or no ketones in the urine. Diagnosis involves assessing metabolic acidosis, measuring serum ketones, and ruling out other causes. Clinical significance: Euglycemic DKA is a metabolic emergency that poses a serious risk to life. Anesthesiologists, emergency medicine and intensive care units struggle with the absence of hyperglycemia because it might delay diagnosis and treatment, which harms patient outcomes, and its incidence has risen with the use of SGLT-2i.

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