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June 2016

Volume 2  Issue 3

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Case Report 

Cryptococcal Meningitis in the Immunocompetent Host: A Case Report and Review of the Literature 

Caitlin M Gibson, Pharm D, BCPS*, Susan M Duquaine, PharmD, BCPS, Roger Bedimo, MD, MS, FACP 

A 79-year-old previously healthy male presented to the emergency department with a three-month history of headaches, falls, and personality changes. No acute changes were evident upon computed tomography scan of the head. Blood cultures grew yeast, and the patient was treated empirically for candidemia with fluconazole. The cultures were finalized seven days later, revealing Cryptococcus neoformans. A nucleated cell count of 97 cells/μL was found on lumbar puncture. The patient was diagnosed with CM and treated with amphotericin B + flucytosine.

 

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Case Report 

Multifocal Deposits of Amyloidoma in the Upper Airway Accompanied by deposits in the Cervical Nodes with Recurrences

Masaaki Suzuki*, Ryosuke Kotani, Rika Shimizu, Akira Sugimoto, Atsushi Ichinose, Kazuto Yamazaki 

A 55-year-old man was referred to us for investigation of his dysphagia. Endoscopic examination revealed a smooth, firm, pink-yellowish, giant swelling of the epiglottis, with small nodules in the left nasal cavity, nasopharynx, and uvula. A right cervical node was slightly prominent on palpation. CT scan revealed a well-defined, homogeneous mass containing calcification spots and no enhancement on contrast-enhanced scans. Based on histologic examination, the definitive diagnosis was amyloid light chain amyloidosis. Endoscopic surgery and cervical excision of amyloidoma was performed.

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Case Report 

Rufinamide Adjunctive Therapy Reduced Atypical Absence Seizures on EEG: Case Report and Review of the Literatur

William S Baek, MD* 

Rufinamide (RUF) is an FDA-approved triazole derivative for adjunctive therapy in Lennox-Gastaut syndrome (LGS) in ages 4 years and above. Atypical absence seizures (AAS) are generalized seizures associated with slow spike-wave complexes . We present a case of AAS where adjunctive off-label RUF resulted in significant improvement in seizure frequency and duration as demonstrated on EEG.

 

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Case Report 

Superior Vena Cava Syndrome, Anesthetic Challenges

Bell, Calvin* D.O., Maurtua, Marco M.D. 

Superior vena cava (SVC) syndrome can present many complications and anesthetic risks the most important being hemodynamic collapse and airway compression; which can be fatal upon induction of anesthesia. The SVC provides venous drainage from the head and upper extremities. These vessels are easily compressed most commonly from an extrinsic tumor specifically a bronchogenic carcinoma or lymphoma. As blood flow to the right atrium becomes obstructed alternative pathways must be established to allow venous return to the heart.

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Case Report 

Meckel’s gallstone ileus

F. Farid Mojtahedi, M.D.*, S.F.E. Paas, M.D., H. van der Krol, M.D., J.R. Kichari, M.D.

A 72-year-old male presented in our clinic with jaundice, dark urine, steatorrhea and unexplained weight loss. The patient had a medical history of ischaemic stroke, a melanoma and was known to have cholecystolithiasis. A computed tomography (CT) of the abdomen was performed, which showed aerobillia, distended small bowels and a gallstone impacted in the ileum. At surgery a gallstone was impacted in the ileum, at the neck of a Meckels diverticulum. The stone was removed and the patient had a good recovery. The impaction of a gallstone at the neck of a Meckels diverticulum is rare.

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