Case Reports in Medicine The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Metastasis to Sartorius Muscle from a Muscle Invasive Bladder Cancer Tue, 23 Dec 2014 00:10:13 +0000 Bladder cancer constitutes the ninth most common cancer worldwide and approximately only 30% of cases are muscle invasive at initial diagnosis. Regional lymph nodes, bones, lung, and liver are the most common metastases from bladder cancer and generally from genitourinary malignancies. Muscles constitute a rare site of metastases from distant primary lesions even though they represent 50% of total body mass and receive a large blood flow. Skeletal muscles from urothelial carcinoma are very rare and up to date only few cases have been reported in the literature. We present a rare case of 51-year-old patient with metastases to sartorius muscle 8 months after the radical cystectomy performed for a muscle invasive bladder cancer. Ioannis Katafigiotis, Antonios Athanasiou, Panagiotis K. Levis, Evangelos Fragkiadis, Stavros Sfoungaristos, Achilles Ploumidis, Adamantios Michalinos, Christos Alamanis, Evangelos Felekouras, and Constantinos A. Constantinides Copyright © 2014 Ioannis Katafigiotis et al. All rights reserved. Chronic Pulmonary Aspergillosis Complicating Bronchial Atresia Mon, 22 Dec 2014 00:10:23 +0000 Bronchial atresia is a rare pulmonary developmental anomaly characterized by the presence of a focal obliteration of a segmental or lobar bronchial lumen. The lung distal to the atretic bronchus is typically emphysematous along with the presence of mucus filled ectatic bronchi (mucoceles). BA is usually asymptomatic but pulmonary infections can rarely develop in the emphysematous lung distal to the atretic bronchus. We present a unique case of chronic pulmonary aspergillosis (CPA) in a patient with BA with no evidence of immune dysfunction. The patient was treated initially with voriconazole and subsequently underwent surgical excision of the involved area. On follow-up, she has done extremely well with no evidence for recurrence. In summary, we describe the first case of chronic pulmonary aspergillosis in an immunocompetent patient with bronchial atresia. Mazen O. Al-Qadi, Dereddi Raja S. Reddy, Brandon T. Larsen, and Vivek N. Iyer Copyright © 2014 Mazen O. Al-Qadi et al. All rights reserved. Efficient and Cost-Effective Alternative Treatment for Recurrent Urinary Tract Infections and Interstitial Cystitis in Women: A Two-Case Report Sun, 21 Dec 2014 12:19:38 +0000 Urinary tract infections (UTIs) are among the most common bacterial infections affecting women. UTIs are primarily caused by Escherichia coli, which increases the likelihood of a recurrent infection. We encountered two cases of recurrent UTIs (rUTIs) with a positive E. coli culture, not improving with antibiotics due to the development of antibiotic resistance. An alternative therapeutic regimen based on parsley and garlic, L-arginine, probiotics, and cranberry tablets has been given. This regimen showed a significant health improvement and symptoms relief without recurrence for more than 12 months. In conclusion, the case supports the concept of using alternative medicine in treating rUTI and as a prophylaxis or in patients who had developed antibiotic resistance. Anthony Mansour, Essa Hariri, Samar Shelh, Ralph Irani, and Mohamad Mroueh Copyright © 2014 Anthony Mansour et al. All rights reserved. A Giant Left Atrial Myxoma Sun, 21 Dec 2014 10:30:26 +0000 Atrial myxomas are the most common primary cardiac tumors. Patients with left atrial myxomas generally present with mechanical obstruction of blood flow, systemic embolization, and constitutional symptoms. We present a case of an unusually large left atrial myxoma discovered incidentally in a patient with longstanding dyspnea being managed as bronchial asthma. Medhat F. Zaher, Sharad Bajaj, Mirette Habib, Emile Doss, Michael Habib, Mahesh Bikkina, Fayez Shamoon, and Wissam N. Hoyek Copyright © 2014 Medhat F. Zaher et al. All rights reserved. Malignant Pediatric Gliosarcoma Defies General Survival Data Wed, 17 Dec 2014 12:36:59 +0000 Gliosarcoma, a variant of glioblastoma multiforme, is a dimorphic tumor known for its intra-axial occurrence and poor survival of less than a year. Here is an 11-year-old boy with gliosarcoma. He had a near total excision and postoperative chemoradiotherapy. He has lived through the disease for over 34 months with a residual disease.This case report is to report an unusual long survival of gliosarcoma in a teenager (Ravisankar et al., 2012). Jovita Martin, Premkumar Devadoss, Kalaichelvi Kannan, and Suresh Kumar Sundarraj Copyright © 2014 Jovita Martin et al. All rights reserved. Successful Use of Extracorporeal Membrane Oxygenation for Respiratory Failure Caused by Mediastinal Precursor T Lymphoblastic Lymphoma Wed, 17 Dec 2014 06:20:08 +0000 Precursor T lymphoblastic lymphoma (T-LBL) often manifests as a mediastinal mass sometimes compressing vital structures like vessels or large airways. This case was a 40-year-old male who developed T-LBL presenting as respiratory failure caused by mediastinal T-LBL. He presented with persistent life threatening hypoxia despite tracheal intubation. We successfully managed this respiratory failure using venovenous (VV) ECMO. Induction chemotherapy was started after stabilizing oxygenation and the mediastinal lesion shrank rapidly. Respiratory failure caused by compression of the central airway by tumor is an oncologic emergency. VV ECMO may be an effective way to manage this type of respiratory failure as a bridge to chemotherapy. Masafumi Oto, Kyoko Inadomi, Toshiyuki Chosa, Shima Uneda, Soichi Uekihara, and Minoru Yoshida Copyright © 2014 Masafumi Oto et al. All rights reserved. Actinomyces odontolyticus: Rare Etiology for Purulent Pericarditis Mon, 15 Dec 2014 11:06:56 +0000 Purulent pericarditis is one of the most common causes of cardiac tamponade and if left untreated has a mortality of 100%. Staphylococcus aureus and Streptococcus pneumonia have been implicated as the main etiology of purulent pericardial effusion followed by fungi and anaerobic sources. Actinomyces odontolyticus pericardial involvement has been reported in the literature only once. To our knowledge, this is the first fatal case of A. odontolyticus purulent pericarditis in the absence of periodontal disease. Ryan Mack, Kipp Slicker, Shekhar Ghamande, and Salim R. Surani Copyright © 2014 Ryan Mack et al. All rights reserved. Intrapericardial Bronchogenic Cyst: An Unusual Clinical Entity Mon, 15 Dec 2014 09:33:50 +0000 Mediastinal cysts are extremely rare clinical disorders. They usually have a pericardial origin. In this report, we present a 27-year-old male patient with a mediastinal bronchogenic cyst together with clinical presentation and management of the pathology. Murat Ugurlucan, Omer Ali Sayin, Matthias Felten, Didem Melis Oztas, Mehmet Semih Cakir, Mehmet Barburoglu, Murat Basaran, Ufuk Alpagut, and Enver Dayioglu Copyright © 2014 Murat Ugurlucan et al. All rights reserved. Endoscopic Stenting and Clipping for Anastomotic Stricture and Persistent Tracheoesophageal Fistula after Surgical Repair of Esophageal Atresia in an Infant Mon, 15 Dec 2014 09:10:41 +0000 Anastomotic stricture (AS) and recurrent tracheoesophageal fistula (TEF) are two complications of surgical repair of esophageal atresia (EA). Therapeutic endoscopic modalities include stenting, tissue glue, and clipping for TEF and endoscopic balloon dilation bougienage and stenting for esophageal strictures. We report herein a two-month infant with both EA and TEF who benefited from a surgical repair for EA, at the third day of life. Two months later he experienced deglutition disorders and recurrent chest infections. The esophagogram showed an AS and a TEF confirmed with blue methylene test at bronchoscopy. A partially covered self-expanding metal type biliary was endoscopically placed. Ten weeks later the stent was removed. This allows for easy passage of the endoscope in the gastric cavity but a persistent recurrent fistula was noted. Instillation of contrast demonstrated a fully dilated stricture but with a persistent TEF. Then we proceeded to placement of several endoclips at the fistula site. The esophagogram confirmed the TEF was obliterated. At 12 months of follow-up, he was asymptomatic. Stenting was effective to alleviate the stricture but failed to treat the TEF. At our knowledge this is the second case of successful use of endoclips placement to obliterate recurrent TEF after surgical repair of EA in children. Mohammed Amine Benatta, Amine Benaired, and Ahmed Khelifaoui Copyright © 2014 Mohammed Amine Benatta et al. All rights reserved. A Case of Systemic Lupus Erythematosus Presenting with an Acute Abdomen: Successful Treatment with Steroid Sun, 14 Dec 2014 06:48:41 +0000 Abdominal pain continues to pose diagnostic challenges for emergency clinicians. A 56-year-old Japanese woman was referred to our hospital due to severe abdominal pain which presented as occasional epigastric pain five months before and intermittent abdominal pain. She had a past history of ileus twice, for both of which laparotomy was performed without an alimentary tract resection. The wall thickening with marked three-wall structure from terminal ileum to sigmoid colon was seen and bladder wall was irregularly thick and enhanced irregularly. Among the differential diagnosis of the acute abdomen, autoimmune diseases were suspected, especially lupus erythematosus and Henoch-Schönlein purpura. On the second day of admission, abdominal pain worsened. The results of examinations of antinuclear antibody, anti-double-stranded DNA antibody, ANCA, and the complements were not obtained at that time; however, we started 1-g steroid pulse treatment for three days with success. With the results obtained later, the patient was given a diagnosis of probable systemic lupus erythematosus (SLE). The present case shows that SLE can present with acute abdomen and should be included in the wide range of the differential diagnosis of acute abdomen. Haruka Fukatsu, Seisuke Ota, Koichi Sugiyama, Akinori Kasahara, and Tadashi Matsumura Copyright © 2014 Haruka Fukatsu et al. All rights reserved. Toxic Anterior Segment Syndrome following Phacoemulsification Secondary to Overdose of Intracameral Gentamicin Wed, 10 Dec 2014 08:30:59 +0000 Objective. To report a case of toxic anterior segment syndrome (TASS) that was caused by inadvertent anterior chamber and cornea stromal injection with high dose gentamicin following cataract surgery. Methods. Case report. Results. We report a 72-year-old female patient who developed TASS that was caused by high dose gentamicin (20 mg/0.5 mL), which was inadvertently used during the formation of the anterior chamber and hydration of the corneal incision. Unlike previous cases, hyphema and hemorrhagic fibrinous reaction were seen in the anterior chamber. Despite treatment, bullous keratopathy developed and penetrating keratoplasty was performed. The excised corneal button was sent for histopathological examination. Conclusions. Subconjunctival gentamicin is highly toxic to the corneal endothelium and anterior chamber structures. Including it on the surgical table carries a potentially serious risk for contamination of the anterior chamber. Yaran Koban, Selim Genc, Gorkem Bilgin, Halil Huseyin Cagatay, Metin Ekinci, Melin Gecer, and Zeliha Yazar Copyright © 2014 Yaran Koban et al. All rights reserved. Kikuchi-Fujimoto Disease: A Rare Cause of Fever in the Returning Traveller Wed, 10 Dec 2014 06:47:09 +0000 Background. Kikuchi-Fujimoto disease (KFD) is typically a self-limited, benign illness which presents with fever and lymphadenopathy. It is rare in Caucasians, normally occurring in those of Asian descent. The aetiology is poorly understood, but it appears to be an autoimmune disorder with a possible infectious trigger. The clinical features are such that it is often mistaken for infectious diseases or malignancy. Case Report. Here we describe a case of a 36-year-old Asian man who presented following a recent trip to Delhi, India. He described fever, neck swelling, and arthralgia. Given his travel history an infectious cause for his presentation was presumed but multiple investigations were negative. Persistence of his symptoms led to lymph node biopsy to investigate for malignancy; surprisingly this revealed a necrotizing lymphadenitis in keeping with KFD. The patient made a full recovery with supportive treatment only. Conclusion. This case presented an opportunity to reflect on two common presenting complaints—fever in the returning traveller and unexplained lymphadenopathy. Both presentations have a wide range of aetiologies to consider. Although KFD is rare, it is an important diagnosis to make as it can prevent further expensive and invasive investigations, as well as potentially harmful treatments and psychological stress to the patient. Matthew R. Wilson, Gordon Milne, and Evangelos Vryonis Copyright © 2014 Matthew R. Wilson et al. All rights reserved. A Kikuchi-Fujimoto Disease Case Mimicking T Cell Lymphoma with Prolonged Fever Tue, 09 Dec 2014 11:26:38 +0000 Kikuchi-Fujimoto disease (KFD) is a self-limited disease characterized by necrotizing lymphadenitis. Although cervical lymphadenitis in young women is the most familiar clinical presentation, it may take place in the etiology of fever in cases presenting with fever of unknown origin. A 33-year-old male case admitted with fever, nausea, vomiting, weight loss, and leukopenia for one month, subsequently developing axillary lymphadenopathy during followup, diagnosed as KFD with typical histopathological findings, and showing full recovery after the excision of lymph node was presented in this report. Serap Yadigar, Ilker Inanc Balkan, and Nese Saltoglu Copyright © 2014 Serap Yadigar et al. All rights reserved. Aneurysms of the P2P Segment of Posterior Cerebral Artery: Case Report and Surgical Steps Tue, 09 Dec 2014 00:10:24 +0000 The posterior cerebral artery (PCA) is divided into 4 segments: precommunicating segment (P1), postcommunicating segment (P2), quadrigeminal segment (P3), and calcarine segment (P4). Small aneurysms are more prevalent than large aneurysms in patients with ruptured aneurysms. P2 and P3 aneurysms are usually managed by the subtemporal approach. This is a case report of rupture saccular aneurysm of posterior cerebral artery on P2P segment. The authors show the surgical steps of these rare aneurysms with an illustrative case. Paulo Aguiar, Luana Gatto, Maick Neves, Carlos Martins, Fabio Nakasone, and Gustavo Isolan Copyright © 2014 Paulo Aguiar et al. All rights reserved. Occult Papillary Thyroid Carcinoma Metastasis to the Sacrum and the Skull: An Unusual Presentation Mon, 08 Dec 2014 00:10:29 +0000 This case represents occult follicular variant of papillary thyroid carcinoma (FVPTC) with large metastasis to the sacrum. The patient, a 42-year-old female, presented after hemithyroidectomy for benign follicular adenoma with lower back pain associated with fever and sweating. A lytic lesion of the left sacral bone was found on the CT with biopsy showing metastatic carcinoma with morphology and immunophenotype of thyroid gland primary tumor proven to be FVPTC. The patient had completion thyroidectomy with benign pathology. Fatima S. Jouhar, Asif Quadri, Bachar Afandi, and Sadir Al Rawi Copyright © 2014 Fatima S. Jouhar et al. All rights reserved. Large Vessel Vasculitis Occurring in Rheumatoid Arthritis Patient under Anti-TNF Therapy Wed, 03 Dec 2014 06:39:41 +0000 Vasculitis is a heterogeneous group of disorders characterized by the presence of necrotic inflammatory phenomena and destruction of blood vessels. Vasculitis is classified as primary (idiopathic) or secondary to infections, connective tissue diseases and drugs but can also be considered as a paraneoplastic phenomenon. Evidence shows that the increasing use of biological agents results in a growing number of reports of autoimmune diseases induced by these therapies. An inflammatory articular chronic disease such as rheumatoid arthritis may be complicated by extra-articular manifestations, such as cutaneous or systemic vasculitis. Herewith, we describe the case of a great vessels arteritis in a patient affected by rheumatoid arthritis in therapy with an anti-TNF agent (etanercept). Valentina Cestelli, Amelia Spinella, Federica Campomori, Carmela Esposito, Sara Ciaffi, Gilda Sandri, and Clodoveo Ferri Copyright © 2014 Valentina Cestelli et al. All rights reserved. Sudden Unexpected Death in a Patient with Tumour Associated Pulmonary Embolism Thu, 27 Nov 2014 07:23:16 +0000 Tumour embolisms are rare and in most cases sudden causes of death. Diagnosing this rare condition is still very challenging in the daily clinical routine. In this report we present a case of a lethal sudden pulmonary tumour embolism in a 71-year-old male patient, who was admitted for elective invasive coronary angiography due to suspected coronary artery disease. The patient had suspected Ormond’s disease and no previous history of tumour burden. Possible diagnostic and treatment options are discussed herein and an overview of the current literature is also presented. D. Laohachewin, F. André, D. Tschaharganeh, H. A. Katus, and G. Korosoglou Copyright © 2014 D. Laohachewin et al. All rights reserved. Ultrasound-Guided Pulse-Dose Radiofrequency: Treatment of Neuropathic Pain after Brachial Plexus Lesion and Arm Revascularization Wed, 26 Nov 2014 00:10:10 +0000 Neuropathic pain following brachial plexus injury is a severe sequela that is difficult to treat. Pulsed radiofrequency (PRF) has been proved to reduce neuropathic pain after nerve injury, even though the underlying mechanism remains unclear. This case report describes the use of ultrasound-guided PRF to reduce neuropathic pain in a double-level upper extremity nerve injury. A 25-year-old man who sustained a complete left brachial plexus injury with cervical root avulsion came to our attention. Since 2007 the patient has suffered from neuropathic pain (NP) involving the ulnar side of the forearm, the proximal third of the forearm, and the thumb. No pain relief was obtained by means of surgery, rehabilitation, and medications. Ultrasound-guided PRF was performed on the ulnar nerve at the elbow level. The median nerve received a PRF treatment at wrist level. After the treatment, the patient reported a consistent reduction of pain in his hand. We measured a 70% reduction of pain on the VAS scale. PRF treatment allowed our patient to return to work after a period of absence enforced by severe pain. This case showed that PRF is a useful tool when pharmacological therapy is inadequate for pain control in posttraumatic neuropathic pain. Ernesta Magistroni, Davide Ciclamini, Bernardino Panero, and Valter Verna Copyright © 2014 Ernesta Magistroni et al. All rights reserved. Malignant Granular Cell Tumor of the Back: A Case Report and Review of the Literature Mon, 24 Nov 2014 12:54:48 +0000 Malignant granular cell tumors are rare, intensely aggressive entities. This paper presents a case of a large rapidly recurrent malignant granular cell tumor with regional and distal metastases on the back of a 54-year-old Cuban man. The primary tumor recurred within six months of the original wide local excision and with satellite lesions apparent at twelve months, and the mass was diagnosed using the histological criteria established by Fanburg-Smith et al. for malignant granular cell tumors. By fifteen months, right axillary lymphadenopathy, multiple satellite lesions, pulmonary nodules, and distant metastasis in the right thigh were present. At sixteen months, wide local excision of recurrent mass and local satellite masses along with right axillary dissection and placement of Integra with subsequent split-thickness skin graft were performed by surgical oncology and plastic surgery teams. The surgical specimen measured 32.0 × 13.5 × 5.5 cm, containing multiple homogeneous masses with the largest mass 22.0 × 9.0 × 4.6 cm. Following surgery, patient was started on Pazopanib 800 mg/day based on phase III randomized trial data in the treatment of soft tissue sarcomas showing this as a potential novel therapy for malignant granular cell tumors. Laura Stone McGuire, Danny Yakoub, Mecker G. Möller, Andrew Rosenberg, and Alan Livingstone Copyright © 2014 Laura Stone McGuire et al. All rights reserved. Diagnostic Difficulties in Woman with Crohn’s Disease, Ascites, and Elevated Value of Serum CA125 Antigen Sun, 23 Nov 2014 07:27:36 +0000 Variety of symptoms and atypical clinical course of Crohn’s disease (CD) often create the need for additional diagnostic procedures. In the described case of woman with CD, there was a suspicion of coexistence of ovarian cancer. This issue is particularly important in patients treated with immunosuppressants and biological agents. The discussion focused on the usefulness of CA125 (cancer antigen 125, mucin 16) serum level estimation in clinical practice and draws attention to the possible reasons for the increase of its value which is not associated to ovarian cancer. Maria Kłopocka, Ariel Liebert, Joanna Bielińska, and Marcin Manerowski Copyright © 2014 Maria Kłopocka et al. All rights reserved. Successful Rehabilitation of Partial Edentulous Maxilla and Mandible with New Type of Implants: Molecular Precision Implants Wed, 19 Nov 2014 14:03:30 +0000 The extraction of teeth results in rapid bone resorption both vertically and horizontally in the first month. The loss of alveolar ridge reduces the chance of implant rehabilitation. Atraumatic extraction, implant placement in extraction socket, and an immediate prosthesis have been proposed as alternative therapies to maintain the volume and contours tissue and reduce time and cost of treatment. The immediate load of implants is a universally practiced procedure; nevertheless a successful procedure requires expertise in both the clinical and the reconstructive stages using a solid implant system. Excellent primary stability and high bone-implant contact are only minimal requirements for any type of implant procedure. In this paper we present a case report using a new type of implants. The new type of implants, due to its sophisticated control system of production, provides to the implantologist a safe and reliable implant, with a macromorphology designed to ensure a close contact with the surrounding bone. Matteo Danza, Dorina Lauritano, and Francesco Carinci Copyright © 2014 Matteo Danza et al. All rights reserved. Management of Varicella Gangrenosa: A Life-Threatening Condition from Chickenpox Wed, 19 Nov 2014 13:34:14 +0000 Varicella gangrenosa, in which gangrenous ulceration of the skin and/or deeper tissues is seen, is a rare but alarming complication of Varicella infection. An early surgical intervention is generally advised, especially in case of sepsis and/or the presence of large necrotic lesions. We describe a case of a previously healthy 12-month-old boy presenting with sepsis due to Varicella gangrenosa. He presented with moderate lesions of moist gangrene. We treated our patient initially with antibiotics (ceftriaxone and metronidazole) and later on flucloxacillin and antiviral therapy (acyclovir) whereupon his condition rapidly improved and all skin lesions healed entirely. This report highlights the possibility of conservative treatment and emphasizes the significance of acyclovir in the management of chickenpox complicated by moist gangrene due to bacterial superinfection. Judith P. M. Schots, Peter Moons, and Jan H. M. B. Stoot Copyright © 2014 Judith P. M. Schots et al. All rights reserved. Fecal Transplantation Treatment of Antibiotic-Induced, Noninfectious Colitis and Long-Term Microbiota Follow-Up Wed, 19 Nov 2014 00:00:00 +0000 Fecal microbiota transplantation (FMT) is an effective treatment for recurrent Clostridium difficile infection (CDI) and is considered as a treatment for other gastrointestinal (GI) diseases. We followed up the relief of symptoms and long-term, over-a-year microbiota stabilization in a 46-year-old man, who underwent FMT for antibiotic-induced, non-CDI colitis nine months after being treated for CDI by FMT. Fecal and mucosal microbiota was analyzed before the second FMT and during 14 months after FMT by using a high-throughput phylogenetic microarray. FMT resolved the symptoms and restored normal GI-function. Microbiota analysis revealed increased bacterial diversity in the rectal mucosa and a stable fecal microbiota up to three months after FMT. A number of mucosa-associated bacteria increased after FMT and some of these bacteria remained increased in feces up to 14 months. Notably, the increased bacteria included Bifidobacterium spp. and various representatives of Clostridium clusters IV and XIVa, such as Clostridium leptum, Oscillospira guillermondii, Sporobacter termitidis, Anaerotruncus colihominis, Ruminococcus callidus, R. bromii, Lachnospira pectinoschiza, and C. colinum, which are presumed to be anti-inflammatory. The presented case suggests a possible role of microbiota in restoring and maintaining normal GI-functionality and improves our knowledge on the etiology of antibiotic-induced, noninfectious colitis. Reetta Satokari, Susana Fuentes, Eero Mattila, Jonna Jalanka, Willem M. de Vos, and Perttu Arkkila Copyright © 2014 Reetta Satokari et al. All rights reserved. Argon Laser Photoablation for Postburn Conjunctival Pigmentation Tue, 18 Nov 2014 10:48:25 +0000 We report a case of an ocular burn injury from boiling water which resulted in conjunctival pigmentation, 1 week following injury. For cosmetic purposes, 2 sessions of argon laser photoablation were performed. One month after laser treatment, conjunctival pigmentation had been successfully removed and the patient was very satisfied with the results. Argon laser photoablation may be an effective way to remove postburn conjunctival pigmentation. Seong Joon Ahn, Jae Hoon Jeong, Hyo Jong Cho, Dong-Hoon Lee, and Hyun Chul Kim Copyright © 2014 Seong Joon Ahn et al. All rights reserved. Prick by Prick Induced Anaphylaxis in a Patient with Peanuts and Lupine Allergy: Awareness of Risks and Role of Component Resolved Diagnosis Tue, 18 Nov 2014 06:46:16 +0000 A case of anaphylaxis is reported in the course of a prick by prick with Lupinus albus and roasted peanut in a 20-year-old woman. We focused on some main topics. First of all it seems important to underscore the potential risks connected to the practice of the prick-by-prick with fresh foods in allergic patients, especially when testing cross-reactive substances, such as White Lupine, peanuts, or soy. It is important that clinicians who perform prick tests be aware of the risk related with in vivo tests in allergic patients. Second, we discuss the problem of the hidden allergens, such as White Lupine flour, or soy flour which are utilized to improve wheat flour because of their lower cost. Patients with a demonstrated allergy to peanuts should be assessed for lupine allergy and informed about the “hidden allergens” issue. Finally, we believe that component resolved diagnosis, the serum specific IgE against molecular components, that is normally considered a second-level diagnostic step has an important role even as a first line approach at least in some selected cases. Anna Ciccarelli, Claudia Calabrò, Clara Imperatore, and Guglielmo Scala Copyright © 2014 Anna Ciccarelli et al. All rights reserved. Tumour Calcification and Calciphylaxis in End-Stage Renal Disease Tue, 18 Nov 2014 06:21:45 +0000 Although soft tissue and vascular calcifications are common in CKD and progress as an independent risk factor of all-cause mortality, tumour calcification and calciphylaxis are uncommon in patients with end-stage renal disease (ESRD). Here, we discuss a rare case of a patient with tumour calcification complicated with calciphylaxis developed septic shock from infection. Our patient is a 57-year-old man in his late stage of renal disease who presented with a huge mass at the right hip and necrotic cutaneous ulcers on the lower legs followed by local and systemic infection and death due to septic shock. Jia Di, Zhenxing Jiang, and Min Yang Copyright © 2014 Jia Di et al. All rights reserved. Case of Thyrotoxic Periodic Paralysis in a Caucasian Male and Review of Literature Mon, 17 Nov 2014 13:44:46 +0000 Objective. Thyrotoxic periodic paralysis (TPP), a known condition in Asian men, is becoming increasingly common in men from Western countries. Since suspicion for TPP as a differential in diagnosis is of utmost importance to avoid overcorrection of hypokalemia and other complications, we are reporting a case of TPP in a 25-year-old Caucasian male. Methods. The patient presented with intermittent lower extremity weakness after consumption of a large high-carbohydrate meal. Clinical examination revealed diffusely enlarged thyroid gland, no muscle power in lower extremities, tremors, and brisk deep tendon reflexes. Results. Clinical and laboratory findings were consistent with Graves’ disease and the patient had hypokalemia. The patient responded to potassium repletion and was treated with propylthiouracil and propranolol. After treatment with radioactive iodine, the patient developed postablative hypothyroidism for which he was treated with levothyroxine. Conclusion. Since this condition is overlooked by physicians in Western countries, we present a case of TPP in a Caucasian male thus showing the importance of consideration of TPP in Caucasians despite its rare occurrence and the need for prompt diagnosis to avoid the danger of hyperkalemia in management of the paralytic attack in TPP patients. Tina K. Thethi, Rosemarie Parks, Bonnie Katalenich, Pankdeep Chhabra, Julie McCaw, Stephanie Syu, Tuyen Nguyen, Joshua Larrazolo, Kartik Munshi, Jay Waddadar, and Prathima Nagireddy Copyright © 2014 Tina K. Thethi et al. All rights reserved. Outcome of Two Corneal Collagen Crosslinking Methods in Bullous Keratopathy due to Fuchs’ Endothelial Dystrophy Mon, 17 Nov 2014 12:01:16 +0000 Four eyes of 2 patients with corneal edema due to Fuchs’ endothelial dystrophy were treated with CXL using the standard protocol. Since no improvement in visual acuity, corneal clarity, thickness, or pain sensation was evident in any eye at month 12, 2 eyes of the 2 patients were retreated, this time, following intraoperative corneal dehydration with glycerol 70% drops. This retreatment also failed to produce any significant effect on vision, corneal clarity, thickness, or pain in either eye. Collagen crosslinking with the current protocols may not be effective in the management of eyes with corneal edema due to Fuchs’ endothelial dystrophy. Further studies are required to establish the efficacy of CXL and optimize the technique and/or dehydration method utilized in these cases. Omur O. Ucakhan and Ayhan Saglik Copyright © 2014 Omur O. Ucakhan and Ayhan Saglik. All rights reserved. Mesenteric Inflammatory Venoocclusive Disease in a Patient with Sjögren’s Syndrome Sun, 16 Nov 2014 12:40:10 +0000 Mesenteric inflammatory venoocclusive disease is an uncommon cause of intestinal ischemia. Certain diseases, such as hypercoagulation disorders, autoimmune diseases, or drugs have been associated with the pathogenesis of mesenteric inflammatory venoocclusive disease. Here, we report a patient with Sjögren’s syndrome who underwent surgery for suspected acute appendicitis with a subsequent pathological diagnosis of mesenteric inflammatory venoocclusive disease. Raquel Rios-Fernández, José-Luis Callejas-Rubio, Mercedes Caba-Molina, Rosa Ríos-Peregrina, and Norberto Ortego-Centeno Copyright © 2014 Raquel Rios-Fernández et al. All rights reserved. Resolution of Left Ventricular Thrombus Secondary to Tachycardia-Induced Heart Failure with Rivaroxaban Thu, 13 Nov 2014 09:49:50 +0000 A 42-year-old man was admitted to our hospital because of lumbago and tachycardia-induced heart failure. Transthoracic echocardiography revealed impaired left ventricular function and a ball mass of thrombus in the left ventricle (LV). He was found to have systemic embolism in the spleen, kidneys, brain, and limbs. The patient was treated with limb thrombectomy followed by anticoagulation. Seven days after the direct factor Xa inhibitor, rivaroxaban, was initiated, transthoracic echocardiography was repeated, revealing disappearance of the LV thrombus without any clinical signs of cardiogenic embolism. His heart failure responded well and the LV wall motion had improved. This case suggests rivaroxaban has fibrinolytic effects on thrombi even in the LV. Kosuke Nakasuka, Shigenori Ito, Tsubasa Noda, Takahiro Hasuo, Satoru Sekimoto, Hiroyuki Ohmori, Masahiko Inomata, Takayuki Yoshida, Nozomu Tamai, Tomoaki Saeki, Shin Suzuki, Yoshimasa Murakami, and Koichi Sato Copyright © 2014 Kosuke Nakasuka et al. All rights reserved.