BMJ case reports
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Necrotising skin and soft tissues infections are most commonly bacterial in origin. However, saprophytic fungi of the class Zygomycetes, family Mucoraceae, can cause highly aggressive infections (mucormycoses) mainly in immunocompromised patients. ⋯ This report describes a case of serious necrotising soft tissue infection caused by Mucor sp following primary fungal environmental wound contamination in a multiply injured patient. Despite undelayed diagnosis and proper treatment (surgical debridement and limb amputation, amphotericin B therapy) the patient presented a fatal outcome.
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Paradoxical embolus is a rare complication of thrombolysis. With a high prevalence of clinically silent septal defects and widespread use of thrombolysis, recognition of the risks, clinical signs and symptoms is important. A case is reported of paradoxical embolus following thrombolysis in a woman with a previously undiagnosed patent foramen ovale.
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A 64-year-old-man visited our clinic because of dysphagia and hoarseness. Fibreoptic laryngoscopic examination revealed pooling of saliva around his pharynx and larynx. However, the glottal closure was perfect without laryngeal paralysis in phonation, and the hoarseness was caused by the vibration of aspirated saliva. ⋯ After reconstructive surgery, the ptosis resolved and the patient was able to swallow without difficulty. Postoperative fibreoptic laryngoscopic examination showed that the saliva pooling sign had disappeared in both pyriform recesses. The patient's hoarseness had also disappeared.
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We describe an elderly female patient with known polymyositis who presented with new onset temporal headache that was diagnosed as giant cell arteritis but subsequently had a typical clinical course of cluster headache. This case illustrates the potential for diagnostic confusion between giant cell arteritis (GCA) and cluster headache (CH) and the need to consider CH as a potential differential diagnosis in those newly presenting with headaches, even in the elderly, and relapsing headaches in subjects with a diagnosis of GCA. Importantly, this needs to include female patients, a group historically thought to be much less likely to develop CH.