Pyogenic psoas abscess: a rare complication after orthotopic heart transplantation.

We describe a 57-year-old man who developed a primary psoas abscess after treatment for acute allograft rejection, 5 years after orthotopic heart transplantation. The infective organism was methicillin-resistant Staphylococcus aureus (MRSA), and the patient underwent successful treatment with computed tomography-guided percutaneous drainage combined with teicoplanin and fusidic acid.     

Open fracture as a rare complication of olecranon enthesophyte in a patient with gout

Enthesophytes are analogous to osteophytes of osteoarthritis. Enthesopathy is the pathologic change of the enthesis, the insertion site of tendons, ligaments, and joint capsules on the bone. In gout, the crystals of monosodium urate monohydrate may provoke an inflammatory reaction that eventually may lead to ossification at those sites (enthesophytes). Here we report the case of a man with chronic gout who sustained an open fracture of an olecranon enthesophyte when he fell on his left elbow. To our knowledge, no other case of open fracture of an enthesophyte has been reported in the English literature.     

Severe gastrointestinal bleeding resulting in total gastrectomy in a patient with major burns--a case report.

Gastrointestinal hemorrhage is a known but rare complication of major burns. This case report describes the management of this potentially life threatening problem in a young adult with 45% body surface area burns who developed massive gastrointestinal-tract bleeding. The patient required a total gastrectomy that was complicated by a burst abdomen. Despite undergoing a series of major insults. the patient survived and was eventually discharged from hospital with an acceptable level of morbidity. The problems faced by the burn centre team and the issues involved in the decision making process are discussed in the management of this unusually devastating complication.     

Spontaneous large intra-abdominal wall haematoma as a rare complication in a maintenance haemodialysis patient

The incidence of spontaneous bleeding in various parts of the body has been reported to be high in patients receiving maintenance haemodialysis. We present a case of spontaneous large haematoma of the intra-abdominal wall which developed in a 71-year-old Japanese man with 9 years' maintenance haemodialysis. Due to the clinical symptoms and signs, ileus was suspected and an emergency operation was performed. In maintenance haemodialysis the possibility of spontaneous bleeding should always be considered whenever unexplained and unexpected symptoms and signs are apparent.     

Drug induced pericarditis in a patient with chronic renal failure

Drug induced pericarditis is reported very rarely. We presented a patient with pericarditis due to antituberculosis therapy induced pericarditis and chronic renal failure. We did not find clinical and serologic findings of pseudo-lupus clinical symptoms and pericarditis regressed in a short time with cessation of antituberculosis drugs and initiated steroid.     

Constrictive tuberculous pericarditis in a HIV-positive patient

Constrictive pericarditis is a relatively rare clinical manifestation nowadays. We present the case of an HIV-positive patient with constrictive calcified pericarditis due to an infection with Mycobacterium tuberculosis. Pericardectomie was performed. The therapeutical approach is discussed and the literature is reviewed.     

False aneurysm of the right pulmonary artery--a rare complication of aorto-pulmonary shunt in a patient with tricuspid atresia

A 12-year-old girl with tricuspid atresia who underwent a side-to-end anastomosis between the ascending aorta and the right pulmonary artery at the age of two months, developed a false aneurysm of the right interlobar trunk artery. The diagnosis was established by angiography, computed tomography and bronchoscopy. Emergency surgical intervention was required because of impending aneurysmal rupture into the right interlobar bronchus. Creation of a left Blalock-Taussig shunt to tide over the anticipated postoperative hypoxemia and right middle and lower lobectomy were carried out successfully. The false aneurysm in this case occurred following an episode of a streptococcal infection and was probably mycotic in origin. But it is possible that the presence of aorto-pulmonary shunt itself might have affected as a predisposing factor for aneurysm formation in this case.     

Pleuroperitoneal communication in a patient on automated peritoneal dialysis: A rare but important complication

Despite its rare frequency, a pleuroperitoneal communication is a well-documented complication for patients on peritoneal dialysis. It occurs in ~2% of continuous ambulatory peritoneal dialysis, with uncertain incidence for those on automated peritoneal dialysis. We report a case of a 30-year-old female patient with end-stage kidney disease with sudden dyspnea 2 days after starting automated peritoneal dialysis. Her chest x-ray revealed a significant pleural effusion on the right side. A thoracocentesis was performed, with a pleural glucose/plasma glucose of 1.08. Additionally, a computed tomography scan revealed a pleuroperitoneal communication upon dialysate infusion added with media contrast. A pleural-to-serum glucose gradient of greater than 50 mg/dL may indicate the diagnosis of a pleuroperitoneal communication in patients on peritoneal dialysis. Current literature also indicates that a pleural-to-serum glucose ratio above 1.0 may provide a more sensitive analysis. This case highlights the diagnosis process for this complication, with both laboratory and image findings corroborating the clinical hypotheses of a pleuroperitoneal communication in a patient on automated peritoneal dialysis.     

A rare post-coronavirus disease 2019 complication of maxillary mucormycotic osteomyelitis in a Southeast Asian patient

Mucormycosis, a rapidly invasive form of fungal infection caused by Mucorales fungi, has high morbidity and mortality rates. Rhino-orbital-cerebral mucormycosis is the most common form of mucormycosis. With the coronavirus disease 2019 (COVID-19) outbreak, a causal correlation between mucormycosis and COVID-19 has been suspected, contributing to the abrupt increase in opportunistic fungal infection cases. We present a case of a Southeast Asian woman in her 60s with complaints of pus discharge in the palatal region with maxillary teeth mobility for 3 months. Physical examination revealed multiple nonvital upper teeth with severe mobility. Incisional biopsy of the maxilla and multidetector computed tomography of the head and neck confirmed the diagnosis of osteomyelitis of the maxilla secondary to mucormycosis. Surgical treatment was performed, and amphotericin B and posaconazole were administered. No operative complications or further bone destruction were observed at 8 months postoperatively.     

Salmonella pericarditis in a patient with primary idiopathic chylopericardium

We report a case of a 40-year-old man with chylopericardium who developed purulent pericarditis caused by Salmonella enteritidis. Thoracoscopic pericardiectomy with debridement effectively controlled the pericardial infection.     

Staphylococcal pericarditis in a chronic renal failure patient

A 34-year-old female with end-stage renal disease was admitted for severe metabolic acidosis, uremic encephalopathy, pericarditis and severe anemia following a bout of acute gastroenteritis. She improved on aggressive medical management including intensive hemodialysis and was initiated onto maintenance heparin-free hemodialysis (twelve hours per week) and discharged. After a week, she presented with fever with chills and rigors for three days, was toxic, severely orthopenic and had a pulsus paradoxus of 36 mmHg. Echocardiography suggested cardiac tamponade. Aspiration revealed frank pus with polymorphonuclear predominance and Staphylococcus aureus on culture. CT of the thorax revealed pericardial effusion. In the absence of any obvious septic foci, concomitant pleuro-pulmonary sepsis, mediastinal or intra-abdominal pathology; a diagnosis of "acute primary purulent pericarditis" was made. Patient was put on parenteral antibiotics-ceftriaxone and metrogyl. Vancomycin was added after sensitivity results. Pericardial drainage was required initially. After toxemia improved, paradox decreased and fever subsided, the pericardial catheter was removed and antibiotics continued for a period of four weeks. Maintenance hemodialysis was continued during hospital stay and after discharge.     

Bilateral occipital neuropathy as a rare complication of positioning for thyroid surgery in a morbidly obese patient

BACKGROUND: Peripheral neuropathies in various locations are described as complications after anesthesia and surgery. This is the first case report of temporary bilateral occipital neuropathy from positioning for thyroid surgery in a morbidly obese patient. METHODS: A 48-year-old women with a history of depression, fibro-myalgia, asthma, sleep apnea, diabetes mellitus and morbid obesity (127 kg, 165 cm) underwent 4 hours anesthesia with propofol/remifentanil without muscle relaxation for thyroid surgery. The neck with a very low range of motion secondary to fat tissue needed to be extended to facilitate surgery as much as possible. The head was carefully padded and there were no episodes of hypotension or hypoxemia throughout the case or in the PACU. At post op day 1 she complained of bilateral numbness in the distribution area of both greater occipital nerves. On post op day 2 tingling sensations and improvement of numbness was noticed. The patient recovered without residual symptoms after 6 weeks. CONCLUSION: Pressure or shear stress to the nerve, hypoperfusion or metabolic disturbances are discussed as the leading etiology of nerve damage during surgery in the literature. Pressure from fat tissue during prolonged head extension for surgery seems to be the cause in this case and should therefore be avoided whenever possible in morbidly obese patients, especially when other risk factors for neuropathy like diabetes are present.     

Caudal block complication in a patient with trisomy 13

In this report we describe a complication of a caudal block in a 4-year-old child with trisomy 13. The patient's history was remarkable for microcephaly, developmental delay, seizures, apnea, and prolonged emergence times. Induction of anesthesia and tracheal intubation were uneventful. A caudal block was aborted after positive aspiration of cerebrospinal fluid. A radiogram suggestive of spinal dysraphism, found on subsequent review, was confirmed by a magnetic resonance imaging scan consistent with tethered cord and dural ectasia. Congenital abnormalities associated with trisomy 13 and cutaneous signs suggestive of spinal abnormalities are reviewed. Avoidance of neuraxial regional anesthesia in these patients is recommended.     

Diaphragm rupture in a liver transplant patient under chronic immunosuppressive therapy with sirolimus: rare complication after liver transplantation

A diaphragm rupture is a very rare event. A variety of conditions such as coughing, delivery, and vigorous exercise causing a sudden increase of the intra-abdominal pressure can result in diaphragm rupture [1]. The diagnosis can be difficult because of non-specific symptoms and no history of blunt or penetrating trauma. Due to anatomical reasons, diaphragmatic lesions in the left side are more common than those in the right side. Chronic immunosuppressive therapy in transplanted patients, especially with antiproliferative drugs such as mTOR inhibitor, has been considered as a risk factor for the development of incisional hernia [2, 3]. We present the case of diaphragm rupture in a liver transplant patient under chronic immunosuppressive therapy with sirolimus.