Introduction. Extracorporeal cardiopulmonary resuscitation (ECPR) is a challenging approach for treating refractory out-of-hospital cardiac arrest (OHCA). Case Presentation. The authors describe a case of a 40-year-old Caucasian female who suffered from refractory OHCA, was admitted to a hospital while receiving ongoing cardiopulmonary resuscitation, and was connected to venoarterial extracorporeal membrane oxygenation 73 minutes after collapse. Ventricular tachyarrhythmias alternating with pulseless electrical activity resolved after eight hours. Following complete cardiac and neurological recovery, only adenoviral genome was found in myocardial biopsy. After 11 months, another episode of identical arrhythmias was rescued by an implantable cardioverter-defibrillator. Conclusion. Adequate prehospital and early hospital logistics is a prerequisite for successfully implementing extracorporeal cardiopulmonary resuscitation for refractory OHCA.

Ilona L&#xe1;lov&#xe1;

Lucie Filipovsk&#xe1;

Hana Skalick&#xe1;

Ond&#x159;ej &#x160;m&#xed;d

Ale&#x161; Linhart

Helena Koll&#xe1;rov&#xe1;

Jan B&#x11b;lohl&#xe1;vek

Refractory Ventricle Arrhythmias Alternating with Pulseless Electrical Activity in a Young Woman Rescued by Extracorporeal Cardiopulmonary Resuscitation

Pemphigus vegetans is a rare variant of deep acantholytic pemphigus which usually presents with vesiculobullous rash and vegetative plaques on the folds. We report a case of pemphigus vegetans patient who presented with rashes on tips of fingers and toes resembling paronychia and onychomadesis that misled the diagnosis for months. The final diagnosis of Hallopeau-type pemphigus vegetans was made based on histopathology and direct immunofluorescence studies. Interestingly, not only the clinical presentation was atypical, but blood tests for anti-desmoglein 1 and 3 antibodies by ELISA technique were also negative. Thus, the rare unusual manifestation of pemphigus vegetans in this patient may associate with different autoantibodies to desmosomal proteins compared with those of classic pemphigus patients.

Thanisorn Sukakul

Supenya Varothai

Chronic Paronychia and Onychomadesis in Pemphigus Vegetans: An Unusual Presentation in a Rare Autoimmune Disease

A 46-year-old man with severe back pain visited our hospital. Magnetic resonance imaging revealed extensive bone metastasis and rectal wall thickness. Colonoscopy revealed circumferential stenosis with edematous mucosa, suggesting colon cancer. However, histological findings of biopsy specimens revealed inflammatory cells but no malignant cells. The patient underwent endoscopic ultrasound, which demonstrated edematous wall thickness without destruction of the normal layer structure. After unsuccessful detection of neoplastic cells by boring biopsies, we performed endoscopic mucosal resection followed by boring biopsies that finally revealed signet ring cell carcinoma. Herein, we present a case and provide a review of the literature.

Yoshito Hirata

Keishi Kanno

Nobusuke Kishikawa

Shinji Tomoda

Kazuki Kimura

Tomoki Kobayashi

Daisuke Miyamori

Yuichiro Otani

Masafumi Mizooka

Koji Arihiro

Shiro Oka

Shinji Tanaka

Susumu Tazuma

Primary Signet Ring Cell Carcinoma of Rectum Diagnosed by Boring Biopsy in Combination with Endoscopic Mucosal Resection

Left ventricular assist device (LVAD) is nowadays a routine therapy for patients with advanced heart failure. We present the case of a 74-year-old male patient who was admitted to our center with terminal heart failure in dilated cardiomyopathy and ascending aortic aneurysm with aortic valve regurgitation. The LVAD implantation with simultaneous aortic valve and supracoronary ascending aortic replacement was successfully performed.

Katharina Huenges

Bernd Panholzer

Jochen Cremer

Assad Haneya

Left Ventricular Assist Device Implantation with Concomitant Aortic Valve and Ascending Aortic Replacement

Introduction. Gastrointestinal histoplasmosis (GH) is a well-described albeit uncommon disease. It is found almost exclusively in the immunocompromised host, especially those with untreated HIV and low CD4 counts. Presentation with intestinal perforation is seen mostly commonly in the colon. We present a patient with jejunal perforation, and there have been only 3 previous cases reported in the literature. Case. A 39-year-old male with known, untreated HIV presented to the ED with an acute abdomen after experiencing worsening intermittent abdominal pain for 2 months before that was associated with nausea, vomiting, diarrhea, and weight loss. CT of the abdomen and pelvis revealed evidence of gas in the mesentery, small bowel thickening, edema, and free fluid in the abdomen. Emergency exploratory laparotomy was conducted. Intraoperative findings included a perforated jejunum that was studded with nodular lesions as well as mesenteric masses. Histopathologic exam of these mesenteric masses and jejunal lesions were positive for histoplasmosis. Conclusion. Disseminated histoplasmosis is a life-threatening disease that occurs nearly exclusively in immunocompromised hosts. Untreated, mortality is as high as 80&#x0025;. This rare presentation with jejunal perforation highlights the need for awareness of histoplasmosis involvement throughout the entirety of the GI tract.

Bryan R. Anderson

Jaron Marriott

Chinthaka Bulathsinghala

Humayun Anjum

Salim Surani

Gastrointestinal Histoplasmosis Presenting as an Acute Abdomen with Jejunal Perforation

Background. Injection with N-butyl-2-cyanoacrylate is a proven and successful therapeutic modality for treatment of patients with bleeding gastric varices. However, a variety of complications have also been associated with its use. Here, we report a rare case of retrogastric abscess which occurred almost six months after this therapy. This abscess was attributed to the hampered microbial clearance caused by the venous obliterations from N-butyl-2-cyanoacrylate. The abscess was successfully treated with 3 months of antibiotics.

Ikram Hussain

Andrew Eu Boon Kwek

Veeraraghavan Meyyur Aravamudan

Chern Hao Chong

Tiing Leong Ang

A Rare Case of Retrogastric Abscess Occurring Six Months after N-Butyl-2-Cyanoacrylate Injection into Gastric Varices

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Case Reports in Medicine publishes case reports and case series in all areas of clinical medicine.

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Case Reports in Medicine - Table of contents 2018

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Case Reports in Medicine publishes case reports and case series in all areas of clinical medicine.

Case Reports in Medicine