Case Report Archives - Page 21 of 21 - The Western Journal of Emergency Medicine

Polycystic Kidney Disease with Renal failure Presenting as Incarcerated Inguinal Hernia in the ED

Autosomal dominant polycystic kidney disease may present to the emergency department (ED) with vomiting, abdominal pain or hernias, renal insufficiency or failure, or bleeding from cerebral aneurysms. A 37-year-old man presented to the ED with signs and symptoms of incarcerated inguinal hernia. Laboratory studies showed renal failure with anion gap acidosis, and bedside ultrasound showed multicystic kidneys. Computed tomography confirmed the diagnosis. Emergency physicians should be aware of this common connective tissue defect and its serious associated conditions.

WestJEM Read More

Clitoral Priapism with No Known Risk Factors

Clitoral priapism is a rare condition that is associated with an extended duration of clitoral erection due to local engorgement of clitoral tissue resulting in pain. Although the pathophysiology is not completely understood, it has been associated with specific classes of medications, diseases that alter clitoral blood flow or others associated with small to large vessel disease. We present a case report of a 26-year-old patient who developed clitoral priapism without a clear medication or disease related etiology. The patient was treated with opiates, imipramine, non-steroidal anti-inflammatory medication, and local ice packs. She recovered uneventfully.

WestJEM Read More

Fever, Sacral Pain, and Pregnancy: An Incarcerated Uterus

Uterine incarceration is an uncommon but serious presentation in the emergency department that requires early recognition to improve maternal and fetal outcomes.

WestJEM Read More

Ovarian Teratoma with Torsion Masquerading as Intussusception in 4-Year-Old Child

We present the case of a four-year-old female who presented to the emergency department (ED) with a five-day history of intermittent abdominal pain and emesis. Initial diagnosis was suspicious for intussusception; however, on operative exploration, she was found to have a right adnexal torsion secondary to an ovarian teratoma. A right salpingo-oophorectomy was performed.

WestJEM Read More

Acute Ischemic Stroke in a Pediatric Patient

Acute ischemic stroke in a pediatric patient is a complex disease with a variety of etiologies that differ from adults. Though rare, they are a real phenomenon with potentially devastating consequences. Some treating institutions are using anti-thrombotic drug therapy with unclear benefits. Available literature, which is limited to case reports and retrospective reviews of databases, clouds this topic with both positive and negative outcomes. Emergency department management should focus on stabilization and resuscitation with immediate involvement of a pediatric neurologist and intensivist. The decision to use anti-thrombotic drug therapy, including anti-platelet drugs and thrombolytics, should be in consult with the specialists involved until randomized controlled trials determine their safety and efficacy in the pediatric population.

WestJEM Read More

Critical Care

Necrotizing Vasculitis as a Complication of Propylthiouracil

Acute dermatologic conditions are a concern for acute care practitioners. Comprising 1.4% of presenting complaints to emergency departments, most skin complaints are relatively benign; however, some conditions can be quite severe. Prompt diagnosis is essential to avoid unnecessary morbidity and mortality.

WestJEM Read More

Complications of MRSA Treatment: Linezolid-induced Myelosuppression Presenting with Pancytopenia

Methicillin-resistant Staphylococcus aureus (MRSA) infections have grown to epidemic proportions in the United States. With the development of increasing drug resistance of MRSA to traditional antimicrobials, there has been a search for a more effective antibiotic treatment. Linezolid is one of the most effective oral medications used for outpatient treatment of MRSA infections. We present a case of pancytopenia after outpatient treatment with linezolid. Myelosuppression is a rare but serious side effect of linezolid of which emergency physicians need to be aware in order to provide early intervention.

WestJEM Read More

Herpes Zoster Ophthalmicus

Herpes zoster is a common diagnosis in the emergency department (ED). Caused by the reactivation of the varicellazoster virus (VZV), zoster usually presents as a painful dermatomal rash. In addition to skin or mucosal involvement, VZV reactivation commonly affects the ophthalmic division of the trigeminal nerve and subsequently the eye. This manifestation is termed herpes zoster ophthalmicus (HZO). HZO is considered an ophthalmologic emergency, as sequelae often include severe chronic pain and vision loss. In order to ensure proper follow up and to minimize morbidity, the accurate and timely diagnosis of HZO in the ED is extremely important. While typically an easy diagnosis to make based on history and skin findings, occasionally HZO presents as an isolated ophthalmologic process that is difficult to distinguish from other more benign causes of a red eye.

WestJEM Read More

A Case of Complicated Urinary Tract Infection: Klebsiella pneumoniae Emphysematous Cystitis Presenting as Abdominal Pain in the Emergency Department

This case report describes an atypical presentation of an atypical disease entity: Emphysematous Cystitis, a rapidly progressive, ascending urinary tract infection, in an emergency department (ED) patient whose chief complaint was abdominal pain and who had a urinalysis not consistent with the diagnosis of cystitis.

WestJEM Read More

Fatal Metformin Overdose Presenting with Progressive Hyperglycemia

A 29-year-old man with no history of diabetes ingested over 60 grams of metformin in a suicide attempt. He presented to the emergency department with acute renal insufficiency, severe lactic acidosis, and rapidly-progressive hyperglycemia. The patient’s peak serum glucose level of 707 mg/dL is the highest yet reported in a case of metformin toxicity. Treatment included sodium bicarbonate infusion and hemodialysis, but the patient suffered several cardiac arrests with pulseless electrical activity and ultimately expired 25 hours after the ingestion.

WestJEM Read More

Survival after an Intentional Ingestion of Crushed Abrus Seeds

We present a case of a man who survived an intentional ingestion of crushed Abrus seeds after he was treated with aggressive gastric decontamination and supportive care.

WestJEM Read More

Fluoxetine Overdose-Induced Seizure

A 37-year-old woman experienced a witnessed generalized seizure in the Emergency Department three hours after ingesting approximately 1400 mg of fluoxetine in a suicide attempt. Although the majority of fluoxetine ingestions are benign, seizures may occur after large intentional overdoses.

WestJEM Read More

Subchorionic Hemorrhage Appearing as Twin Gestation on Endovaginal Ultrasound

This case study describes a pregnant patient with vaginal bleeding who had a bedside endovaginal ultrasound in the emergency department (ED). The emergency physician identified a live intra-uterine pregnancy (IUP) with another structure that appeared to be a second gestational sac. The patient subsequently had an endovaginal ultrasound in the radiology department 46 minutes later. The attending radiologist described one live IUP and a subchorionic hemorrhage. Comparison of the ED and radiology ultrasound showed that the second structure, identified as a subchorionic hemorrhage, had significantly decreased in size. Endovaginal ultrasound in the evaluation of possible ectopic pregnancy is a useful bedside tool in the ED. We discuss a pitfall that can occur with endocavitary ultrasound when a twin gestation is presumed.

WestJEM Read More

Chest Swelling and Fever in an Intravenous Drug User

This case report describes a sternoclavicular infection in an IV drug user. The history and physical exam suggested an abscess. In the emergency department (ED) the patient refused incision and drainage but did consent to simple needle aspiration. Subsequent culture of the aspirate revealed Pseudomonas aeruginosa. He was admitted for IV antibiotics. After admission, a bone scan suggested the presence of osteomyelitis. The patient refused operative débridement, but ultimately did consent to bedside incision and drainage. By day five, the fever had resolved and the patient signed out AMA. He was given a prescription for Ciprofloxacin. The patient had an unscheduled follow up in the ED five months later for an unrelated heroin overdose. Physical examination demonstrated complete resolution of the infection.

WestJEM Read More

Takotsubo Cardiomyopathy: A Case Series and Review of the Literature

Takotsubo cardiomyopathy (TCM) is an unusual form of acute cardiomyopathy showing left ventricular apical ballooning. It is often triggered by intense physical or emotional distress. We report here four cases of TCM and a review of the literature on the topic.

WestJEM Read More

Loss of Digits after Trauma in a Patient with Systemic Lupus Erythematosus

A 19-year-old female with Systemic Lupus Erythematosus (SLE) presented with ischemia of her left hand following trauma. Medical therapy was initiated but failed to improve her symptoms, and revision amputation was ultimately performed. The patient’s final diagnosis was digital ischemia due to secondary Raynaud’s Phenomenon (RP). The authors discuss diagnosis, complications, and treatment of this relatively uncommon disorder. The authors report this case in order to discuss how secondary RP can be complicated by ischemia and the multidisciplinary approach that needs to take place to prevent the latter from occurring.

WestJEM Read More

EKG Criteria for Fibrinolysis: What’s Up with the J Point?

Author Affiliation Joseph Brownfield, MD Department of Emergency Medicine, Keck/USC School of Medicine, Los Angeles, CA Mel Herbert, MD Department of Emergency Medicine, Keck/USC School of Medicine, Los Angeles, CA INTRODUCTION Reading EKGs is an integral skill in Emergency Medicine, especially given the fact that determining the presence and amount of ST segment elevation […]

WestJEM Read More

New Onset Thyrotoxicosis Presenting as Vomiting, Abdominal Pain and Transaminitis in the Emergency Department

This case report describes an unusual presentation of an emergency department (ED) patient with nausea, vomiting, and epigastric pain, who was initially suspected of having viral hepatitis. The patient returned to the ED seven days later with persistent tachycardia and was diagnosed with new onset thyrotoxicosis.

WestJEM Read More

Recovery from Severe Hyperthermia (45°C) and Rhabdomyolysis Induced by Methamphetamine Body-Stuffing

The acute toxic effects of sympathomimetic stimulant drugs include hypertensive crisis, coronary and cerebral vasospasm, cardiac dysrthythmias, seizures, hyperthermia, rhabdomyolysis, and metabolic derangements such as hyperglycemia, metabolic acidosis, and either hyper- or hypokalemia.

WestJEM Read More