Jornal de relatos de casos clínicos

When asthmatic patients present with cough, especially cough without wheezing, it is difficult to determine if the cough was due to asthma. A 7-year-old girl presented with persistent cough without wheezing and exacerbation of asthma. We performed bronchodilator reversibility test by determining the respiratory resistance. Respiratory resistance and impedance were measured by using the Forced Oscillation Technique (FOT) with MostGraph-01 (Chest CO., LTD., Japan). The changes were observed in colored 3-dimensional imaging patterns. The images clearly showed that the patient’s respiratory resistance decreased after administration of the bronchodilator. The measurement of respiratory impedance by the forced oscillation technique attributes to diagnose asthma.

Granulomatosis with Polyangiitis (GPA) represent the most common Antineutrophil Cytoplasmic Autoantibody (ANCA)-associated vasculitis. The treatment modalities indicated for the initial manifestations are steroids and cyclophosphamide therapy. Diffuse alveolar hemorrhage is a life- threatening though rare complication of GPA. A case of GPA with diffuse alveolar hemorrhage and hypoxemic respiratory failure is reported, as the manifestation of the disease, after inadequate drug regimen and that responded to aggressive cyclophosphamide and steroids therapy and non invasive mechanical ventilation.

Imatinib mesylate is a tyrosine kinase inhibitor that strongly inhibits the tyrosine kinases like BCR-ABL1, KIT and PDGFRB and is used in the treatment of chronic myeloid leukemia. As well as its proven effectiveness its frequent side effects are also well known. Apart from its other side effects its commonly encountered side effect in daily clinical use is edema. Although the path-physiology of this process has not yet been well understood, its strong blocking action on PDGFRB is thought to be responsible. In this case report we are presenting a chronic myeloid leukemia patient with cerebral edema who unfortunately died. To our knowledge, she has been the third patient who was reported due to this complication of imatinib. As we could not estimate another cause we strongly deduced that the cerebral edema was due to imatinib.

Introduction: Birt-Hogg-Dubé Syndrome is very uncommon in the North America. Several families have been reported since Birt, Hogg, and Dubé described the original kindred in 1977. Birt-Hogg-Dubé Syndrome (BHDS) is inherited in an autosomal dominant pattern and may be due to inactivation of a tumor-suppressor gene, which results in the various skin lesions such as cutaneous hamartomas and risk of internal malignancies. We report a rare case of Birt-Hogg-Dubé Syndrome who presented with lung sarcoma no skin manifestation which is the usual presentation as seen in literature. Case Report: A 25-year-old female presented with some vague chest and abdominal symptoms. CT of the chest showed a mass in the left upper lobe and a cyst in the lung. She underwent left side upper lobectomy. Pathology reported low grade sarcoma, but was otherwise nonspecific. She had small lung cysts in lower lobe consistent with a history of Birt-Hogg-Dube syndrome. At 3 years follow up, patient doing very well. Genetic testing confirmed syndrome in family. Discussion: Mortality and morbidity associated with Birt-Hogg-Dubé syndrome is related to internal manifestations such as pneumothorax or renal cell carcinoma. The morbidity of cutaneous lesions is limited to cosmetic appearance. Surgical removal has provided definitive treatment of solitary perifollicular fibromas. Birt-Hogg-Dubé syndrome patients with a history of smoking appear to have more severe lung disease than those who do not smoke. Conclusion: Birt-Hogg-Dubé Syndrome (BHDS) cannot be prevented, but associated findings of renal carcinoma, pulmonary cysts and pneumothorax can be monitored. Birt-Hogg-Dubé syndrome patients should be counseled regarding the increased risk of pneumothorax with activities altering ambient pressure, such as scuba diving and air travel, particularly if they have chest pain or shortness of breath. Smoking cessation in BHDS patients should be strongly encouraged.

Peginterferon-alfa 2a or alfa 2b plus ribavirin is the treatment of choice in chronic hepatitis C. Severe adverse effects may compromise efficacy of this regiment. There are few reports of warm autoimmune hemolytic anemia following interferon-alfa or peginterferon-alfa2b plus ribavirin treatment. This present report discusses autoimmune hemolytic anemia which developed during peginterferon alfa-2a/ribavirin treatment and caused dose cessation. The anemia was improved with discontinuation of peginterferon-alfa 2a/ribavirin and adminstration of erythropoietin stimulating agent.

Peginterferon-alfa 2a or alfa 2b plus ribavirin is the treatment of choice in chronic hepatitis C. Severe adverse effects may compromise efficacy of this regiment. There are few reports of warm autoimmune hemolytic anemia following interferon-alfa or peginterferon-alfa2b plus ribavirin treatment. This present report discusses autoimmune hemolytic anemia which developed during peginterferon alfa-2a/ribavirin treatment and caused dose cessation. The anemia was improved with discontinuation of peginterferon-alfa 2a/ribavirin and adminstration of erythropoietin stimulating agent.

Fournier’s Gangrene is a life threatening urosurgical emergency and a synergistic gangrene of scrotum. It is a rapidly progressive & devastating form of necrotising fasciitis of perinal, perineum and genital area associated with high mortality and morbidity. Radical surgical debridement, broad spectrum antibiotics, negative pressure wound dressings and hyperbaric oxygen therapy are considered to be the cornerstone of treatment and contribute to improved outcomes. We present a case of Fournier Gangrene in a 57 Year old male patient complicated by presence of rare multiple microbial which was successfully managed with early diagnosis, prompt measures and use of hyperbaric oxygen.

Mucocele of the rectum causing intestinal obstruction is a rare complication of retained long rectal stump. We present one such case.

Sphenochoanal polyp is a rare entity which originates from the sphenoid sinus and passes via the sphenoid ostium to the choana and presents like the more frequently occurring antrochoanal polyp. The authors reported the case of a 22-year-old woman who was diagnosed with a left sphenochoanal polyp that is a relatively uncommon entity. If unrecognized they can be mistaken for an antrochoanal polyp for which longer the delay in treatment more are the chances of complications. Pre-operative investigations included axial and coronal computed tomography. The sphenochoanal polyp was effectively treated using an endoscopic sinus surgery. Here the case is presented along with a review of the literature. To the horizon of our knowledge, no previous case of sphenochoanal polyp was reported from Eastern India. In conclusion we have to introduce patient education for the early detection of polyps and their interventions.