查看更多>>摘要：? 2022 Elsevier Inc.Lyme disease is the most frequently reported vector-borne illness in the United States. It is caused by infection with Borrelia burgdorferi via the bite of an infected blacklegged tick (Ixodes spp.) Lyme disease has three stages: early localized, early disseminated, and late. Early disseminated Lyme disease may include neurologic manifestations such as cranial nerve palsy, meningitis, and radicular pain (also called radiculoneuritis). Isolated radiculoneuritis is a rare presentation of early disseminated Lyme disease and is likely underrecognized. We report a case of isolated Lyme radiculoneuritis in a child in Massachusetts characterized by fever and allodynia of the upper back that was treated in the emergency department. Laboratory investigation demonstrated elevated inflammatory markers and positive Lyme testing. Magnetic resonance imaging with gadolinium contrast revealed nerve root enhancement in C5-C6 and C6-C7. The symptoms resolved with oral doxycycline. Neuropathic pain should raise suspicion for neurologic manifestations of Lyme disease in North America even in the absence of meningitis and cranial nerve palsy. We report how timely recognition of this rare syndrome in North America is important and may prevent progression to late disease.
查看更多>>摘要：? 2022 The AuthorsThis report presents the case of a patient whose inhalation exposure to benzyl alcohol led to clinical manifestations similar to toluene intoxication, including sudden altered mental status, metabolic acidosis, hypokalemia, hypophosphatemia, and hyperammonemia. Toxicity from benzyl alcohol inhalation is quite rare, and hyperammonemia associated with renal tubular dysfunction in poisoning cases has not been reported in the past.
查看更多>>摘要：? 2022This case is significant to the practice of emergency medicine and describes a unique post-operative infection that to my knowledge has not been described in this age group or under this set of circumstances before. Pyometra is a rare disease that is classically seen in an older cohort, and not commonly on the differential for pediatric patients presenting to the ED with vaginal discharge and fever. While post operative complications such as abscesses may be common following a surgery, intrauterine infections in this context are rare and the treatment is unique. It is important for emergency physicians to have knowledge of pyometra to keep on their differential for abdominal pain and fever after surgery, as well as be familiar with its management and which consultants may need to get involved.
查看更多>>摘要：? 2022 Elsevier Inc.Interstitial pregnancies are a rare form of ectopic pregnancy that occur when there is implantation of a fetus into the interstitial portion of the uterus. These can be particularly challenging to diagnose and have a high risk of morbidity and mortality due to the relatively late presentation compared to other ectopic pregnancies. Here we present a gravida 3, para 2 female patient at 14 weeks gestational age who suffered uterine rupture and hemoperitoneum leading to cardiac arrest in the Emergency Department. This case demonstrates the importance of ultrasound as a critical tool in the diagnosis of interstitial pregnancy and the sonographic findings. It is essential for emergency clinicians to be aware of this rare diagnosis.
查看更多>>摘要：? 2022 Elsevier Inc.Background: First-trimester bleeding and pregnancy loss are common reasons for presentation to emergency departments. Women of childbearing age frequently receive urine and serum pregnancy tests, which are thought to be reliable markers of pregnancy. Case presentation: We report a case of a 34-year-old woman who presented to an emergency department with vaginal bleeding and abdominal pain and was found to have negative urine and serum markers of pregnancy. A transvaginal ultrasound detected non-viable fetal tissue and the patient underwent an uncomplicated spontaneous abortion. Conclusions: Physicians should consider the use of ultrasonography to assess for pregnancy or retained fetal products in the appropriate patient, even with negative serum or urine markers of pregnancy.
查看更多>>摘要：? 2022 The AuthorsChlorpheniramine is an H1 receptor antagonist of the alkylamine class. It is a widely used anti-allergy drug due to its strong antihistamine effect and mild adverse effects. In the case of chlorpheniramine overdose or poisoning, the primary manifestation is central nervous system symptoms. To date, no case of rhabdomyolysis induced by acute poisoning with chlorpheniramine has ever been reported. This study reports a case of acute chlorpheniramine poisoning at an oral dose of 4000 mg, which is the highest reported poisoning dose to date. The diagnosis of rhabdomyolysis (creatine kinase, 195,489 U/L) and acute kidney injury (serum creatinine, 150.1 umol/L) was confirmed based on laboratory results. After haemoperfusion and continuous renal replacement therapy, the patient's renal function fully recovered. This paper aims to analyse the clinical data of this patient and summarize its clinical characteristics. At the same time, the mechanism of chlorpheniramine-induced rhabdomyolysis is also explored in the context of the literature review.
查看更多>>摘要：? 2022 Elsevier Inc.Visual hallucinations are visual perceptions that are not associated with a real object. Visual hallucinations are often associated with dementia, eye disease, visual pathway disease, psychiatric disorders, delirium, migraines, ictal phenomena, or medication effects. We report a case of a 74-year-old woman with a previous cerebrovascular accident(CVA) without residual deficit and no previous psychiatric history presenting for one week of worsening hallucinations progressing from shapes to cats to human figures in the left visual field. She had no focal neurologic deficits nor visual field defects detected on physical exam. CT head without intravenous(IV) contrast demonstrated a nonspecific hypodensity in the right parieto-occipital region. MRI brain with and without IV contrast confirmed an acute stroke. Patient was admitted for risk factor modification and secondary prevention. She continues to have infrequent hallucinations of floating hands and fingers at follow-up appointment 2 weeks after the initial presentation to the Emergency Department. Posterior circulation CVAs can present with subtle or unusual symptoms. CVA should be included in the differential for new onset hallucinations, particularly in elderly patients.
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