Case Reports in Medicine The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. Idiopathic Harlequin Syndrome Manifesting during Exercise: A Case Report and Review of the Literature Tue, 21 Feb 2017 06:18:18 +0000 Harlequin syndrome is a rare autonomic disorder characterized by unilateral facial flushing and sweating with contralateral anhidrosis induced by exercise, heat, and emotion. It is usually idiopathic but could be the first manifestation of several serious underlying medical conditions. Medical or surgical treatments are not required for idiopathic Harlequin syndrome, but social and psychological factors may indicate sympathectomy or botulinum toxin injection. In this article, we report a case of idiopathic Harlequin syndrome and review the literature. Hussein Algahtani, Bader Shirah, Raghad Algahtani, and Abdulah Alkahtani Copyright © 2017 Hussein Algahtani et al. All rights reserved. Combination Treatment of Perioperative Rehabilitation and Psychoeducation Undergoing Thoracic Surgery Thu, 09 Feb 2017 06:52:49 +0000 Postoperative pulmonary complications are a risk associated with thoracic surgery. However, there have been few reports on cases at high risk of postoperative complications. Cancer patients often have negative automatic thoughts about illness, and these negative automatic thoughts are associated with reduced health behavior and physical activity. This case series demonstrates the successful combination treatment of perioperative rehabilitation and psychoeducation for negative automatic thoughts in two cancer patients who underwent thoracic surgery. One patient underwent pneumonectomy with laryngeal recurrent nerve paralysis; the other patient, who had a history of recurrent hepatic encephalopathy and dialysis, underwent S6 segmentectomy. Both patients had negative automatic thoughts about cancer-related stress and postoperative pain. The physical therapists conducted a perioperative rehabilitation program in which the patients were educated to replace their maladaptive thoughts with more adaptive thoughts. After rehabilitation, the patients had improved adaptive thoughts, increased physical activity, and favorable recovery without pulmonary complications. This indicates that the combination treatment of perioperative rehabilitation and psychoeducation was useful in two thoracic cancer surgery patients. The psychoeducational approach should be expanded to perioperative rehabilitation of patients with cancer. Kazuhiro Hayashi, Takayuki Inoue, Motoki Nagaya, Satoru Ito, Hiroki Nakajima, Keiko Hattori, Izumi Kadono, Kohei Yokoi, and Yoshihiro Nishida Copyright © 2017 Kazuhiro Hayashi et al. All rights reserved. A Case of Congenitally Corrected Transposition of Great Arteries: An Infrequent Happenstance Thu, 09 Feb 2017 00:00:00 +0000 Congenitally corrected transposition of the great arteries (CCTGA) is rare form of congenital heart diseases. It may be present with or without associated anomalies. Patients with CCTGA are usually diagnosed at early stages of life due to associated anomalies, but they may even remain asymptomatic till later decades of their life. We report a case of a 42-year-old man who presented at neurosurgery department with dizziness, seizures, and loss of consciousness, in whom isolated CCTGA was discovered incidentally. Further investigation depicted right ventricular hypertrophy, mild valvular regurgitation, mildly dilated pulmonary artery, low heart rate with AV dissociation, and third-degree heart block. These indicated for implantation of permanent pacemaker into the patient. The implantation of VVI mode pacemaker was uneventful and the patient is being followed up in the past eight months in favorable condition. Prakash Ajmera and Vikas Medep Copyright © 2017 Prakash Ajmera and Vikas Medep. All rights reserved. Pernicious Anemia Associated Cobalamin Deficiency and Thrombotic Microangiopathy: Case Report and Review of the Literature Mon, 06 Feb 2017 07:12:51 +0000 A 43-year-old Hispanic male without significant previous medical history was brought to emergency department for syncope following a blood draw to investigate a 40 lbs weight loss during the past 6 months associated with decreased appetite and progressive fatigue. The patient also reported a 1-month history of jaundice. On examination, he was hemodynamically stable and afebrile with pallor and diffuse jaundice but without skin rash or palpable purpura. Normal sensations and power in all extremities were evident on neurological exam. Presence of hemolytic anemia, schistocytosis, thrombocytopenia, and elevated lactate dehydrogenase (LDH) was suggestive of thrombotic thrombocytopenic purpura (TTP). However, presence of leukopenia, macrocytes, and an inadequate reticulocyte response to the degree of anemia served as initial clues to an alternative diagnosis. Two and one units of packed red blood cells were transfused on day 1 and day 3, respectively. In addition, one unit of platelets was transfused on day 2. Daily therapeutic plasma exchange (TPE) was initiated and continued until ADAMTS-13 result ruled out TTP. A low cobalamin (vitamin B12) level was evident at initial laboratory work-up and subsequent testing revealed positive intrinsic factor-blocking antibodies supporting a diagnosis of pernicious anemia with severe cobalamin deficiency. Hematological improvement was observed following vitamin B12 supplementation. The patient was discharged and markedly improved on day 9 with outpatient follow-up for cobalamin supplementation. Farhanah Yousaf, Bruce Spinowitz, Chaim Charytan, and Marilyn Galler Copyright © 2017 Farhanah Yousaf et al. All rights reserved. Myopericarditis and Pericardial Effusion as the Initial Presentation of Systemic Lupus Erythematosus Sun, 05 Feb 2017 11:50:32 +0000 Myopericarditis with a pericardial effusion as the initial presenting feature of SLE is uncommon. We report an unusual case of myopericarditis and pericardial effusion with subsequent heart failure, as the initial manifestation of SLE. The timely recognition and early steroid administration are imperative in SLE-related myopericarditis with cardiomyopathy to prevent the mortality associated with this condition. Prema Bezwada, Ahmed Quadri, Atif Shaikh, Ceasar Ayala-Rodriguez, and Stuart Green Copyright © 2017 Prema Bezwada et al. All rights reserved. Cooccurrence of Metastatic Papillary Thyroid Carcinoma and Salmonella Induced Neck Abscess in a Cervical Lymph Node Sun, 05 Feb 2017 11:48:29 +0000 Cervical lymph node metastasis is common in patients with papillary thyroid carcinoma (PTC). Salmonella species are rarely reported as causative agents in focal infections of the head and neck. The cooccurrence of lymph node metastasis from PTC and a bacterial infection is rare. This report describes a 76-year-old woman with a cervical lymph node metastasis from PTC and Salmonella infection of the same lymph node. The patient presented with painful swelling in her left lateral neck region for 15 days, and neck ultrasonography and computed tomography showed a cystic mass along left levels II–IV. The cystic mass was suspected of being a metastatic lymph node; modified radical neck dissection was performed. Histopathological examination confirmed the presence of PTC in the resected node and laboratory examination of the combined abscess cavity confirmed the presence of Salmonella Typhi. Following antibiotic sensitivity testing of the cultured Salmonella Typhi, she was treated with proper antibiotics. Cystic lesions in lymph nodes with metastatic cancer may indicate the presence of cooccurring bacterial infection. Thus, culturing of specimen can be option to make accurate diagnosis and to provide proper postoperative management. Jae-Myung Kim, Ju-Yeon Kim, Eun Jung Jung, Eun Jin Song, Dong Chul Kim, Chi-Young Jeong, Young-Tae Ju, Young-Joon Lee, Soon-Chan Hong, Sang-Kyung Choi, and Woo-Song Ha Copyright © 2017 Jae-Myung Kim et al. All rights reserved. Implications of Antiphospholipid and Antineutrophilic Cytoplasmic Antibodies in the Context of Postinfectious Glomerulonephritis Wed, 01 Feb 2017 08:16:32 +0000 While antineutrophil cytoplasmic antibody (ANCA) positivity has been documented in some patients with postinfectious glomerulonephritis (PIGN) and is associated with more severe disease, antiphospholipid antibodies (APA) are not known to be a common occurrence. We describe a child with severe acute kidney injury who was noted to have prolonged positivity of both ANCA and APA; a renal biopsy showed noncrescentic immune complex mediated glomerulonephritis with subepithelial deposits compatible with PIGN. He recovered without maintenance immunosuppressive therapy and at last follow-up had normal renal function. We discuss the cooccurrence and implications of ANCA and APA in children with PIGN. Daniel Leifer and Lavjay Butani Copyright © 2017 Daniel Leifer and Lavjay Butani. All rights reserved. Xeroderma Pigmentosum with Severe Neurological Manifestations/De Sanctis–Cacchione Syndrome and a Novel XPC Mutation Wed, 01 Feb 2017 00:00:00 +0000 Several genetic disorders caused by defective nucleotide excision repair that affect the skin and the nervous system have been described, including Xeroderma Pigmentosum (XP), De Sanctis–Cacchione syndrome (DSC), Cockayne syndrome, and Trichothiodystrophy. Cutaneous photosensitivity with an increased risk of skin malignancy is a common feature of these disorders, but clinical manifestations commonly overlap these syndromes. Several genes have been found to be altered in these pathologies, but we lack more genotype-phenotype correlations in order to make an accurate diagnosis. Very few cases of DSC syndrome have been reported in the literature. We present a case of a 12-year-old Colombian male, with multiple skin lesions in sun-exposed areas from the age of 3 months and a history of 15 skin cancers. He also displayed severe neurologic abnormalities (intellectual disability, ataxia, altered speech, and hyperreflexia), short stature, and microcephaly, which are features associated with DSC. Genetic testing revealed a novel germline mutation in the XP-C gene (c.547A>T). This is the first case of an XP-C mutation causing De Sanctis–Cacchione syndrome. Multigene panel testing is becoming more widely available and accessible in the clinical setting and will help rapidly unveil the molecular etiology of these rare genetic disorders. Esteban Uribe-Bojanini, Sara Hernandez-Quiceno, and Alicia María Cock-Rada Copyright © 2017 Esteban Uribe-Bojanini et al. All rights reserved. A Giant Lumbar Pseudomeningocele in a Patient with Neurofibromatosis Type 1: A Case Report Tue, 31 Jan 2017 00:00:00 +0000 This is a rare case of giant lumbar pseudomeningocele with intra-abdominal extension in patient with neurofibromatosis type 1 (NF1). The patient’s clinical course is retrospectively reviewed. A 34-year-old female affected by NF1 was referred to our institution for persistent low back pain and MRI diagnosis of pseudomeningocele located at L3 level with paravertebral extension. From the first surgical procedure by a posterior approach until the relapse of the pseudomeningocele documented by MRI, the patient underwent two subsequent posterior surgical procedures to repair the dural sac defect with fat graft and fibrin glue. One month after the third operation, the abdominal MRI showed a giant intra-abdominal pseudomeningocele causing compression of visceral structures. The patient was asymptomatic. The pseudomeningocele was treated with an anterior abdominal approach and the use of the acellular dermal matrix (ADM) sutured directly on the dural defect on the anterolateral wall of the spinal canal. After six months of follow-up the MRI showed no relapse of the pseudomeningocele. Our case highlights the possible use of ADM as an effective and safe alternative to the traditional fat graft to repair challenging and large dural defects. Mauro Dobran, Maurizio Iacoangeli, Paolo Ruscelli, Martina Della Costanza, Davide Nasi, and Massimo Scerrati Copyright © 2017 Mauro Dobran et al. All rights reserved. Meretoja’s Syndrome: Lattice Corneal Dystrophy, Gelsolin Type Tue, 31 Jan 2017 00:00:00 +0000 Lattice corneal dystrophy gelsolin type was first described in 1969 by Jouko Meretoja, a Finnish ophthalmologist. It is caused by an autosomal dominant mutation in gelsolin gene resulting in unstable protein fragments and amyloid deposition in various organs. The age of onset is usually after the third decade of life and typical diagnostic triad includes progressive bilateral facial paralysis, loose skin, and lattice corneal dystrophy. We report a case of a 53-year-old female patient referred to our Department of Ophthalmology by severe dry eye and incomplete eyelid closure. She had severe bilateral facial paresis, significant orbicularis, and perioral sagging as well as hypoesthesia of extremities and was diagnosed with Meretoja’s syndrome at the age of 50, confirmed by the presence of gelsolin mutation. At our observation she had bilateral diminished tear film break-up time and Schirmer test, diffuse keratitis, corneal opacification, and neovascularization in the left eye. She was treated with preservative-free lubricants and topical cyclosporine, associated with nocturnal complete occlusion of both eyes, and underwent placement of lacrimal punctal plugs. Ocular symptoms are the first to appear and our role as ophthalmologists is essential for the diagnosis, treatment, and monitoring of ocular alterations in these patients. I. Casal, S. Monteiro, C. Abreu, M. Neves, L. Oliveira, and M. Beirão Copyright © 2017 I. Casal et al. All rights reserved. An Undiagnosed Case of Hypothalamic Hamartoma with a Rare Presentation Thu, 26 Jan 2017 08:51:17 +0000 Background. Hypothalamic hamartomas (HHs) are rare tumor-like malformations that may present with complex partial seizures refractory to anticonvulsants in adulthood. The condition may be misdiagnosed because of rarity. Case Presentation. We report a 25-year-old man with complaint of seizures presented by falling, tonic spasm of limbs, oral automatism, vocalization, and hypermotor activities. His seizures started at the age of one month and presented as eye deviation and upper limbs myoclonic jerk, followed by frequent seizures with variable frequency. The patient had delayed developmental milestones and was mentally retarded. He was hospitalized and underwent video-EEG monitoring and neuroimaging, and the diagnosis of HH was made. The patient became candidate for surgery after that. Conclusion. In this case, the underlying etiology of seizures was diagnosed after 25 years. HH is a rare condition and neurologists may encounter very small number of these cases during their practice. Therefore, they should consider it in patients who present with suspected signs and symptoms. Shervin Badihian, Saeideh Bahrani, Nasim Tabrizi, Houshang Moein, Mohammad Zare, Majid Barekatain, Reza Basiratnia, Elham Rahimian, Amirali Mehvari Habibabadi, Payam Moein, and Jafar Mehvari Habibabadi Copyright © 2017 Shervin Badihian et al. All rights reserved. Lipoma Arborescens of the Knee: Report of Three Cases and Review of the Literature Tue, 24 Jan 2017 08:40:04 +0000 Lipoma arborescens is a chronic, slow-growing, intra-articular lesion of benign nature, which is characterized by villous proliferation of the synovium, with replacement of the subsynovial connective tissue by mature fat cells. It usually involves the suprapatellar pouch of the knee joint. It is not a neoplasm but is rather considered a nonspecific reactive response to chronic synovial irritation, due to either mechanical or inflammatory insults. We report three cases of lipoma arborescens affecting the knee, the first in a young male without previous history of arthritis or trauma, the second in a 58-year-old male associated with osteoarthritis, and the final in a 44-year-old male diagnosed with psoriatic arthritis, which cover the entire pathologic spectrum of this unusual entity. We highlight the clinical findings and imaging features, by emphasizing especially the role of MRI, in the differential diagnosis of other, more complex intra-articular masses. Ioannis Tsifountoudis, Dimitrios Kapoutsis, Anastasios-Nektarios Tzavellas, Ioannis Kalaitzoglou, Apostolos Tsikes, and George Gkouvas Copyright © 2017 Ioannis Tsifountoudis et al. All rights reserved. Bilateral Tensor Fasciae Suralis Muscles in a Cadaver with Unilateral Accessory Flexor Digitorum Longus Muscle Sun, 22 Jan 2017 00:00:00 +0000 Muscle variants are routinely encountered in the dissection laboratory and in clinical practice and therefore anatomists and clinicians need to be aware of their existence. Here we describe two different accessory muscles identified while performing educational dissection of a 51-year-old male cadaver. Tensor fasciae suralis, a rare muscle variant, was identified bilaterally and accessory flexor digitorum longus, a more common muscle variant, was present unilaterally. Tensor fasciae suralis and accessory flexor digitorum longus are clinically relevant muscle variants. To our knowledge, the coexistence of tensor fasciae suralis and accessory flexor digitorum longus in the same individual has not been reported in either cadaveric or imaging studies. Logan S. W. Bale and Sean O. Herrin Copyright © 2017 Logan S. W. Bale and Sean O. Herrin. All rights reserved. Passage of an Anterior Odontoid Screw through Gastrointestinal Tract Tue, 17 Jan 2017 07:30:25 +0000 Purpose. Anterior screw fixation has become a popular surgical treatment method for instable odontoid fractures. Screw loosening and migration are a rare, severe complication following anterior odontoid fixation, which can lead to esophagus perforation and requires revision operation. Methods. We report a case of screw loosening and migration after anterior odontoid fixation, which perforated the esophagus and was excreted without complications in a 78-year-old male patient. Results. A ventral dislocated anterior screw perforated through the esophagus after eight years after implantation and was excreted through the gastrointestinal (GI) tract. At a 6-month follow-up after the event the patient was asymptomatic. Conclusion. Extrusion via the GI tract is not safe enough to be considered as a treatment option for loosened screws. Some improvements could be implemented to prevent such an incident. Furthermore, this case is a fine example that recent preoperative imaging is mandatory before revision surgery for screw loosening. L. Leitner, C. I. Brückmann, M. M. Gilg, G. Bratschitsch, P. Sadoghi, A. Leithner, and R. Radl Copyright © 2017 L. Leitner et al. All rights reserved. Simultaneous Left Ventricular and Deep Vein Thrombi Caused by Protein C Deficiency Tue, 17 Jan 2017 06:52:13 +0000 Protein C deficiency is a risk of venous thrombosis because of poor fibrinolytic activity. It remains controversial whether protein C deficiency causes arterial thrombosis. A 21-year-old woman was referred with a chief complaint of right leg pain and numbness. Contrast-enhanced computed tomography revealed a low-density mass in the left ventricle (LV), splenic infarction, and peripheral arterial obstructions in her right leg. Thrombosis extending from the renal vein to the inferior vena cava was also detected. Electrocardiography revealed ST depression in leads II, III, and aVF. Transthoracic echocardiography revealed hypokinesis of the apex and interventricular septum and a hypoechoic mass in the LV (26 × 20 mm). She was diagnosed with acute arterial obstruction caused by the LV thrombus, which might have resulted from previous myocardial infarction. Protein C activation turned out to be low (41%) 5 days after admission. The anticoagulant therapy was switched from heparin to rivaroxaban 16 days after admission. The LV thrombus disappeared 24 days after initial treatment, and she has had no thrombotic episodes for 2.8 years under rivaroxaban therapy. Thrombophilia should be investigated for cases of simultaneous left ventricular and deep venous thrombi. Rivaroxaban can be effective in prevention of further thrombotic events. Harufumi Maki, Motohiro Nishiyama, and Motoaki Shirakawa Copyright © 2017 Harufumi Maki et al. All rights reserved. Acute Truncal Lymphedema Secondary to Axillary Metastatic Melanoma Presenting Like Cellulitis Sun, 15 Jan 2017 00:00:00 +0000 There are reported cases of diphencyprone used in treating cutaneous metastases of melanoma. Here, we report a patient with previous primary melanoma on his left back treated with surgical excision and lymphadenectomy, followed by radiotherapy for the recurrent tumor on the primary site. Despite radiotherapy and treatment with dabrafenib and trametinib, in-transit metastases have developed and topical diphencyprone was applied to these metastases. Six weeks later, the patient developed fever and a spreading erythematous tender indurated plaque covering the left side of the body including axillae, back, and flank, clinically suggestive of cellulitis. Systemic antibiotic therapy did not improve the condition and a biopsy showed sparse lymphocytic infiltrate. With the diagnosis of possible acute lymphedema, a CT scan was requested that showed significant axillary lymph node metastasis. The fever was considered secondary to dabrafenib and trametinib therapy. This case highlights that, in patients with lymphadenectomy, atypical forms of lymphedema on the body may appear. Truncal lymphedema is an infrequent event. Shelley J. E. Hwang, Benjamin Y. Kong, Shaun Chou, Deepal Wakade, Matteo S. Carlino, and Pablo Fernandez-Penas Copyright © 2017 Shelley J. E. Hwang et al. All rights reserved. Unusual Presentation of Hydatid Cyst in Breast with Magnetic Resonance Imaging Findings Wed, 11 Jan 2017 00:00:00 +0000 We report a case of 59-year-old woman with a painful left breast mass, compatible with types II-III hydatid cyst. Lesion was evaluated with mammography, ultrasound, computed tomography, and magnetic resonance imaging modalities. Magnetic resonance imaging had important diagnostic role with demonstrating characteristic features of the lesion and had capability of showing complications. Surgery also confirmed the diagnosis of a hydatid cyst. Ali Koc, Inanc Samil Sarici, Umit Erkan Vurdem, Ozgur Karabiyik, and Ummugulsum Ozgul Gumus Copyright © 2017 Ali Koc et al. All rights reserved. Inflammatory Duodenal Polyposis Associated with Primary Immunodeficiency Disease: A Novel Case Report Tue, 10 Jan 2017 13:39:36 +0000 Agammaglobulinemia is a rare form of B-cell primary immunodeficiency disease characterized by reduced levels of IgG, IgA, or IgM and recurrent bacterial infections. Agammaglobulinemia is most commonly associated with diffuse nodular lymphoid hyperplasia. Duodenal polyps are a rare entity; however, due to wide use of esophagogastroduodenoscopy, incidental diagnosis of duodenal polyps appears to be increasing. Although inflammatory duodenal polyposis has been reported in the literature, its association with common variable immunodeficiency has not been reported till date to the best of our knowledge. We report a case of a 59-year-old male with chronic symptoms of agammaglobulinemia associated with inflammatory duodenal polyposis. Irfan Ali Shera, Sheikh Mudassir Khurshid, and Mohd Shafi Bhat Copyright © 2017 Irfan Ali Shera et al. All rights reserved. Inferior Vena Cava and Renal Vein Thrombosis Associated with Thymic Carcinoma Tue, 10 Jan 2017 08:01:00 +0000 Thymic tumors are rare mediastinal tumors that can present with a wide variety of symptoms. They can cause distant manifestations and are frequently associated with paraneoplastic syndromes. In our case, we describe the evolution of a 68-year-old male whose first manifestation was thrombosis of the inferior vena cava and renal veins. Thrombosis of large abdominal veins is rare, especially without being associated with any other comorbidity or risk factors. Vlad Teodor Berbecar, Roxana Jurubita, Marina Paraschiv, Bogdan Obrisca, Bogdan Sorohan, and Gener Ismail Copyright © 2017 Vlad Teodor Berbecar et al. All rights reserved. Free Floating Thrombus in Carotid Artery in a Patient with Recurrent Strokes Tue, 10 Jan 2017 00:00:00 +0000 We present a case of 72-year-old male with reported past medical history of recurrent transient ischemic attacks (TIAs) presenting with myriad of neurological symptoms. Patient was transferred from outlying hospital with complaints of right sided facial droop and dysarthria. Computed tomography angiography (CTA) showed high grade proximal left internal carotid artery (ICA) stenosis along with interesting finding of a free floating thrombus (FFT) in the left ICA. After discussion with the neurosurgical team, our case was treated conservatively with combination of antiplatelet therapy with Aspirin and anticoagulation with Warfarin without recurrence of TIAs or strokes on six-month follow-up. Moni Roy, Ashish Kumar Roy, Jeffrey R. DeSanto, and Murad Abdelsalam Copyright © 2017 Moni Roy et al. All rights reserved. Rare Presentation of Left Lower Lobe Pulmonary Artery Dissection Thu, 05 Jan 2017 13:17:46 +0000 Background. Pulmonary arterial dissection with chronic pulmonary arterial hypertension as its major cause is a very rare but life-threatening condition. In most cases the main pulmonary trunk is the affected site usually without involvement of its branches. Segmental or lobar pulmonary artery dissection is extremely rare. Case Presentation. We report a unique case of left lower lobe pulmonary artery dissection in a 70-year-old male, with confirmed chronic pulmonary hypertension. To confirm dissection MDCT pulmonary angiography was used. Multiplanar reformation (MPR) images in sagittal, coronal, oblique sagittal, and curved projections were generated. This case report presents morphologic CT features of rare chronic left lobar pulmonary artery dissection associated with chronic pulmonary hypertension at a place of localised pulmonary artery calcification. CT pulmonary angiography excluded signs of thromboembolism and potential motion or flow artefacts. Conclusion. To the best of our knowledge, no case of lower lobe pulmonary artery dissection with flap calcification has been reported yet. CT imaging of the chest is a key diagnostic tool that is able to detect an intimal flap and a false lumen within the pulmonary arterial tree and is preferred in differential diagnosis of rare complications of sustained pulmonary arterial hypertension. René Hako, Ján Fedačko, Štefan Tóth, Radoslav Morochovič, Pavol Kristian, Tímea Pekárová, Petri Tuomainen, and Daniel Pella Copyright © 2017 René Hako et al. All rights reserved. Systemic Inflammatory Response and Severe Thrombocytopenia after Endovascular Thoracic Aortic Aneurysm Repair Thu, 05 Jan 2017 00:00:00 +0000 After Endovascular repair of thoracic aortic aneurysm, a systemic inflammatory response, named postimplantation syndrome, can develop. This syndrome is characterized by fever, leukocytosis, and elevated CRP plasma levels and its pathogenetic mechanisms are still unknown. Although this syndrome generally resolves within few days, some patients develop a persisting severe inflammatory reaction leading to mild or severe complications. Here we describe the case of a male patient who developed postimplantation inflammatory syndrome and severe thrombocytopenia after endovascular repair of thoracic aortic aneurysm. Treatment with prednisone (50 mg/bid) for two weeks did not improve the clinical and laboratory findings. We utilized danazol, a weak androgen that has been shown to be effective in the treatment of immune and idiopathic thrombocytopenic purpura, and after 12 days of treatment with danazol (200 mg/bid), the patient improved progressively and platelet number increased up to 53,000/μL. Patients undergoing endovascular repair of thoracic aortic aneurysm should be carefully monitored for the development of postimplantation syndrome. This clinical condition is relatively common after the endovascular repair of aortic aneurysm but is rarely observed after endovascular repair of thoracic aortic aneurysms. The different known therapeutical approaches are still empiric, with reported beneficial effects with the use of NSAID, corticosteroids, and danazol. Valentina Silvestrin, Stefano Bonvini, Michele Antonello, Franco Grego, Roberto Vettor, and Marco Rossato Copyright © 2017 Valentina Silvestrin et al. All rights reserved. Polyneuropathy as Novel Initial Manifestation in a Case of “Nonsecretory” POEMS Syndrome with Sjögren’s Syndrome Wed, 04 Jan 2017 08:53:09 +0000 POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) is a paraneoplastic syndrome driven by plasma cell dyscrasias. We report a patient with novel initial manifestation of polyneuropathy, which was considered due to Sjögren’s syndrome but with poor response to methylprednisolone (120 mg/d) and intravenous immunoglobulin (IVIg). Further investigation by imaging tests and following biopsy eventually confirmed the diagnosis of POEMS syndrome secondary to solitary plasmocytoma. To our knowledge, this is the first reported case of POEMS syndrome with Sjögren’s syndrome occurring in the absence of a peripheral monoclonal gammopathy, highlighting the diagnostic challenges posed by this disease and reviewing the diagnostic role of (18) F-FDG PET/CT in POEMS syndrome. Minrui Liang, Zhixing Jiang, Zhiguang Lin, Bobin Chen, Hejian Zou, Weiguo Wan, and Jun Liu Copyright © 2017 Minrui Liang et al. All rights reserved. Rare Occurrence of a Poorly Differentiated Neuroendocrine Tumor of the Bladder Mon, 02 Jan 2017 13:09:27 +0000 Neuroendocrine tumors rarely occur in the urinary bladder. They can be carcinomatous, subdivided into small cell and large cell pathology. Small cell carcinoma of the bladder is a rarity that may present at an advanced pathologic stage. No treatment regimens have been standardized for local or metastatic disease. Review of the recent literature shows equivalent survival data for localized disease treated with chemoradiotherapy combined with either bladder sparing surgery or radical cystectomy. Patients with significant comorbidities are an additional challenge. We report a case of poorly differentiated neuroendocrine tumor of the bladder, which could not be classified as small or large cell carcinoma, complicated by significant comorbidities. After management with transurethral resection of the tumor, adjuvant chemotherapy, and radiation, the patient is alive and asymptomatic nearly 1 year after initial TURBT with no evidence of disease recurrence. Katherine Dowd, Charles Rotenberry, Douglas Russell, Mitchell Wachtel, and Werner de Riese Copyright © 2017 Katherine Dowd et al. All rights reserved. Gemella Species Bacteremia and Stroke in an Elderly Patient with Respiratory Tract Infection Mon, 02 Jan 2017 09:31:16 +0000 Gemella species are part of normal human flora. They are rarely associated with infections. As opportunistic pathogens, they can cause life-threatening infection in individuals with risk factors. We present an unusual case of an elderly patient, with no predisposing risk factors, who presented with respiratory tract infection and Gemella species bacteremia and suffered a stroke in the absence of features of endocarditis. Sriraksha Jayananda, Narasimha Swamy Gollol-Raju, and Nada Fadul Copyright © 2017 Sriraksha Jayananda et al. All rights reserved. A Case of a Paracardial Osteophyte Causing Atrial Compression Thu, 29 Dec 2016 14:08:02 +0000 Osteophytes are pointed or beaked osseous outgrowths at the margins of articular surfaces that are often associated with degenerative changes of articular cartilage. They are the most common aspect of osteoarthritis and they infrequently cause symptoms by compression of the adjacent anatomic structures, such as nerves, vessels, bronchi, and esophagus. We present here a rare case of a patient with a left atrial deformation by a large osteophyte. Stergios Tzikas, Konstantinos Triantafyllou, Christodoulos Papadopoulos, and Vassilios Vassilikos Copyright © 2016 Stergios Tzikas et al. All rights reserved. Severe Rhabdomyolysis as Complication of Interaction between Atorvastatin and Fusidic Acid in a Patient in Lifelong Antibiotic Prophylaxis: A Dangerous Combination Tue, 27 Dec 2016 11:05:14 +0000 Atorvastatin and HMG-CoA reductase inhibitors are the most frequently used medication in the world due to very few adverse toxic side effects. One potentially life threatening adverse effect is caused by clinically significant statin induced rhabdomyolysis, either independently or in combination with fusidic acid. The patient in our case who previously had cardiac insufficiency, atrial fibrillation, and thoracic aorta aneurysm and was treated with insertion of an endovascular metallic stent in the aorta is presented in the report. He had an inoperable aortitis with an infected stent and para-aortic abscesses with no identified microorganism. The patient responded well to empirical antibiotic treatment with combination therapy of fusidic acid and moxifloxacin. This treatment was planned as a lifelong prophylactic treatment. The patient had been treated with atorvastatin for several years. He developed severe rhabdomyolysis when he was started on fusidic acid and moxifloxacin. The patient made a fast recovery after termination of treatment with atorvastatin and fusidic acid. We here report a life threatening complication of rhabdomyolysis that physicians must be aware of. This can happen either in atorvastatin monotherapy or as a complication of pharmacokinetic interaction between atorvastatin and fusidic acid. Anirban Nandy and Shahin Gaïni Copyright © 2016 Anirban Nandy and Shahin Gaïni. All rights reserved. Isolated Ventricular Noncompaction Cardiomyopathy Presenting as Recurrent Syncope Mon, 26 Dec 2016 07:29:58 +0000 Isolated ventricular noncompaction (IVNC) occurs because of interruption of trabecular morphogenesis in the myocardium leading to ventricular noncompaction. Patients present with heart failure or with systemic complications secondary to thromboembolism or arrhythmias. High index of suspicion is necessary for early diagnosis. We present a case of 48-year-old male with unexplained recurrent syncope who was eventually diagnosed with IVNC. Sukhdeep Bhogal, Vatsal Ladia, Puja Sitwala, Kais AlBalbissi, and Timir Paul Copyright © 2016 Sukhdeep Bhogal et al. All rights reserved. Fetus in the Bladder: Rare Complication of Vesicouterine Fistula Mon, 26 Dec 2016 06:33:50 +0000 The work presents a rare case of spontaneous migration of an 11-week fetus from the uterine cavity into the urinary bladder cavity through the long-standing vesicouterine fistula. Vladimir Lesovoy, Yuryi Parashchuk, Dmytro Shchukin, Roman Safonov, Karyna Didenkova, Maria Lisova, and Inessa Safonova Copyright © 2016 Vladimir Lesovoy et al. All rights reserved. Right Atrial Clot Formation Early after Percutaneous Mitral Balloon Valvuloplasty Sun, 25 Dec 2016 14:28:04 +0000 Mitral balloon valvuloplasty which has been used for the treatment of rheumatic mitral stenosis (MS) for several decades can cause serious complications. Herein, we presented right atrial clot formation early after percutaneous mitral balloon valvuloplasty which was treated successfully with unfractioned heparin infusion. Ahmet Hakan Ateş, Uğur Arslan, Aytekin Aksakal, Huriye Yücel, İlksen Atasoy Günaydın, Adem Ekbul, and Mehmet Yaman Copyright © 2016 Ahmet Hakan Ateş et al. All rights reserved.