BMJ case reports
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We present an interesting case of a 38-year-old woman who presented with a history of left-sided chest pain, dyspnoea and palpitations. The symptoms have been occurring since age 18, and were previously diagnosed as costochondritis. Because of the suspicious history, the patient underwent further cardiac investigations. ⋯ A diagnostic coronary angiogram revealed a large left circumflex artery fistulating into the right atrium. Surgery was performed to ligate the fistula. The patient recovered well and has been asymptomatic since.
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Henoch-Schönlein purpura (HSP) is a small vessel vasculitis that affects the gastrointestinal and central nervous systems and the kidneys. The disease primarily affects children, but may occur in elderly children with allergic purpura and also in adults. Central nervous system involvement may be the first sign; however, it is rarely encountered. ⋯ Its radiological signs can be observed in grey and white matter at the posterior region of the cerebral hemispheres. HSP should be considered in children with PRES in the presence of rash, joint and gastrointestinal symptoms. We reported a 5-year-old patient who developed acute renal failure and PRES by reason of HSP.
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Pulmonary lower lobe atelectasis/collapse is a common problem in patients undergoing mechanical ventilation. It also occurs in non-intubated patients with traumatic brain or spinal cord injuries, morbid obesities and chest wall disorders. ⋯ Here, we report an example of successful selective intrabronchial air insufflation in an intubated patient with bilateral lower lobe collapses after surgery for an incarcerated hernia. To our knowledge, this is the first successful report of recruitment manoeuvre by trans-glottic bronchoscopy in an intubated, mechanically ventilated patient.
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Case Reports
Bleeding associated with acquired factor V inhibitor in a patient on warfarin treated successfully with prednisolone.
An 85-year-old man on warfarin for atrial fibrillation presented with skin bleeding. International normalised ratio (INR) and activated partial thromboplastin time (APTT) were elevated and did not correct even after warfarin reversal with vitamin K, prothrombin complex concentrate (PCC) and fresh frozen plasma. Mixing coagulation studies with normal plasma suggested the presence of an inhibitor rather than the multiple coagulation factor deficiencies expected with warfarin. ⋯ The bleeding resolved following a course of corticosteroids. Coagulation studies and factor V level returned to normal along with resolution of the inhibitor. We report the case of the diagnostic dilemma posed and successful therapy implemented despite the limited evidence-based data being available for the treatment of this rare condition.
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Case Reports
Lymphocytic interstitial pneumonia as a manifestation of SLE and secondary Sjogren's syndrome.
A 47-year-old woman with systemic lupus erythematosus (SLE) diagnosed at age of 35 years was admitted for dyspnoea, substernal chest pain, dry mucosas and difficulty in swallowing. Physical examination revealed vesicular breath sounds bilaterally. Laboratory work showed antinuclear antibody (ANA) (speckled pattern, 1:40), positive anti-Sjogren's syndrome antigen (SSA) and antisingle side band (SSB) and negative double-strand DNA (dsDNA), with normal C3,C4,C50. ⋯ While pSS is commonly associated with interstitial lung involvement, secondary Sjogren's syndrome (sSS) is only rare. It has been described the initial sSS presentation by Sica symptoms development only, and our case is the first report of LIP presentation as initial manifestation of sSS. Our patient remained stable after corticosteroids and hydoxychloroquine therapy and no progression of disease after 6 months follow-up.