Two Cardiac Arrests that Occurred after the Administration of Sugammadex: A Case of Kounis SyndromeRead the full article
Case Reports in Emergency Medicine publishes case reports and case series related to prehospital care, disaster preparedness and response, acute medical and paediatric emergencies, critical care, sports medicine, wound care, and toxicology.
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Descending Necrotizing Mediastinitis Resulting from Pharyngitis with Perforation of the Aryepiglottic Fold
Descending necrotizing mediastinitis and pharyngeal perforation are uncommon complications of pharyngitis that are associated with high morbidity and mortality. This case report describes a previously healthy 18-year-old male who presented to the emergency room with 5 days of severe sore throat, intermittent fevers, and vomiting and was found to have extensive posterior pharyngeal and mediastinal air along with extravasation of contrast on computed tomography, consistent with perforation of the left aryepiglottic fold as well as descending necrotizing mediastinitis. The patient had a complicated hospital course including multiple operative interventions, abscess formation, and development of pericardial and pleural effusions. Successful treatment required swift resuscitation including broad-spectrum antibiotics and significant coordination of emergent operative intervention between otolaryngology and cardiothoracic surgery. It is important to recognize descending necrotizing mediastinitis as a clinical entity that may result from oropharyngeal infections as early intervention significantly decreases subsequent complications and mortality. Furthermore, pharyngeal perforation is an extremely rare complication which requires either CT with oral contrast or esophagram for diagnosis.
Lateral Malleolar Fracture with Concurrent Achilles Tendon Rupture: A Case Report and Literature Review
Achilles tendon and malleolar fractures are commonly seen in isolation, but only a few cases of combined injuries have been reported. In this case, we present a 53-year-old male who sustained an isolated lateral malleolus fracture with an Achilles tendon rupture. Emergency Medicine physicians should consider the possibility of these injuries in combination.
Hypercalcemic Encephalopathy as an Initial Presentation of Multiple Myeloma
We report the case of an 84-year-old female presented to us with acute onset altered sensorium. On investigation, neurological and infectious causes were ruled out. On further evaluation, her serum calcium was found elevated (15.07 gm/dl). The diagnosis of hypercalcemic encephalopathy was made with the possibility of multiple myeloma due to raised total protein and globulin levels. Serum electrophoresis, immunofixation, and bone marrow examination confirmed the diagnosis of multiple myeloma. The patient was treated with bortezomib, dexamethasone, and lenalidomide. After 1 week, she improved with normalization of serum calcium. Herein, we highlight hypercalcemia as an important cause of encephalopathy. As our report suggests, metabolic encephalopathy can be the first presentation in multiple myeloma.
Brain Abscess Secondary to a Dental Infection
The risk of a brain abscess is a complication of odontogenic infection that is rarely considered by physicians and little spoken of, yet treating dental infections may avoid a potentially life-threatening condition. We report a case of 7-year-old boy with a brain abscess secondary to a dental infection. He was immediately taken to the operating theatre for drainage and cleaning of the abscess. A dental examination revealed root abscesses on temporary molars, which were extracted under general anaesthetic. Two months after his admission, the child was switched to oral antibiotherapy and could return home. A brain abscess represents a life-threatening disease. Childhood brain abscess is uncommon but may be encountered by all physicians and students as a clinical emergency. It is indispensable that physicians finding symptoms similar to those in this case study refer the patient for emergency care and that possible dental foci of infection be assessed, whether or not the patient is being followed for dental care.
The Untimely Popping Phial: Poppers as an Unusual Cause of Skin Corrosion of the Thigh
Background. Alkyl nitrites or “poppers” are widely used as sex-drugs due to their aphrodisiac and muscle relaxant effects. We describe the rare case of a large-sized dermatitis after direct skin contact with the poppers-fluid in a poppers user. Case Presentation. A 52-year-old patient presented to the emergency department due to burning pain on his proximal right thigh and scrotum. Clinical examination showed an 8 × 5 cm measuring burning wound resembling lesion. During further history the patient mentioned that the day before presentation a “poppers” phial unintentionally opened in his pocket and the fluid leaked. Conclusions. The present case shows severe skin defects after skin-contact with alkyl nitrates in a “poppers” user. Maculopathy and methemoglobinemia are prominent unwanted side effects of “poppers” use. However, our report demonstrates that attention should also be paid to potential harm for the skin.
Epileptic Seizure from Ginkgo Nut Intoxication in an Adult
The ginkgo tree is a well-known, highly adaptable urban plant. Ginkgo nuts are the product of the ginkgo tree. Interior ginkgo nuts are cooked and served in Asian countries; however, the potential toxicity of the gingko nuts is not commonly known. Herein, we report a 48-year-old male patient experiencing acute convulsions presumably due to overconsumption of gingko nuts. The patient was transferred to our department after several episodes of acute generalized tonicclonic seizures lasting approximately 30 seconds each and starting one hour before the visit. The patient also complained of vomiting, vertigo, diarrhea, and tremors in both upper limbs following the seizures. Elevated 4-O-methylpyridoxine (312 ng/mL), low blood pyridoxal phosphate (2.4 μg/L), and low vitamin B1 (20 ng/mL) levels were found in the blood analysis. No other remarkable abnormalities were detected. We diagnosed the patient with ginkgo nut intoxication, and he was orally administered 400 mg of pyridoxal phosphate. His symptoms resolved after treatment, and no seizures recurred thereafter. Our report may help raise awareness of the clinical presentation and management of this intoxication among emergency physicians.