RESUMEN
BACKGROUND: The number of contrast media-related procedures is ever increasing due to the widespread availability of theoretically safe, low osmolar iodinated contrast material. Although intravenously administered contrast is known to precipitate myasthenic crisis, oral contrast aspiration as a causative factor is not yet documented as such. A 48-year-old Sinhalese man diagnosed as having myasthenia gravis, was evaluated for progressive dysphagia with an upper gastrointestinal contrast study. Iodinated contrast material (iohexol) was used as the contrast medium and there was direct evidence of contrast aspiration during the study. Several minutes after the procedure, severe respiratory distress with evidence of myasthenic crisis requiring intubation and intensive care admission was noted. Treatment with intravenous immunoglobulin, high-dose steroids, and broad-spectrum intravenously administered antibiotics led to an uneventful recovery, although the latter part of the clinical course was complicated with total left lung collapse. Myasthenic crisis can be precipitated by various factors and a successful recovery requires mechanical respiratory support with immunomodulatory and steroid therapy. This is the first reported case that describes the development of myasthenic crisis following iohexol-associated aspiration pneumonitis.
Asunto(s)
Medios de Contraste/efectos adversos , Yohexol/efectos adversos , Miastenia Gravis/etiología , Neumonía por Aspiración/etiología , Aspiración Respiratoria/complicaciones , Insuficiencia Respiratoria/etiología , Inhibidores de la Colinesterasa/uso terapéutico , Trastornos de Deglución/diagnóstico por imagen , Progresión de la Enfermedad , Glucocorticoides/uso terapéutico , Humanos , Inmunoglobulinas Intravenosas/uso terapéutico , Factores Inmunológicos/uso terapéutico , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana Edad , Miastenia Gravis/terapia , Ácido Micofenólico/uso terapéutico , Neumotórax/etiología , Prednisolona/uso terapéutico , Bromuro de Piridostigmina/uso terapéutico , Respiración Artificial , Insuficiencia Respiratoria/terapiaRESUMEN
BACKGROUND: Incidence of Dengue infection is on the increase in Sri Lanka with it being associated with significant maternal and neonatal morbidity in pregnancy. CASE PRESENTATION: A 33-year-old pregnant woman at 38 weeks of gestation, presented with acute onset of fever, was later diagnosed with Dengue illness. Due to the emergence of warning symptoms and signs and rapidly dropping platelet count, the baby was delivered by urgent caesarian section. She went into the critical phase during the postoperative period and due to concealed bleeding, required blood transfusion. On the 5th day of life, the neonate was also diagnosed with possible dengue by vertical transmission and required blood and PLT transfusions for recovery. CONCLUSIONS: This case report illustrates how a high index of suspicion, early diagnosis, close monitoring, timely intervention and critical consideration of physiological changes of pregnancy when interpreting clinical situation, led to achieving a successful outcome.
Asunto(s)
Transmisión Vertical de Enfermedad Infecciosa , Periodo Periparto , Complicaciones Infecciosas del Embarazo/diagnóstico , Dengue Grave/diagnóstico , Dengue Grave/transmisión , Adulto , Transfusión Sanguínea , Cesárea , Femenino , Fiebre/diagnóstico , Fiebre/etiología , Humanos , Recién Nacido , Masculino , Embarazo , Complicaciones Infecciosas del Embarazo/terapia , Tercer Trimestre del Embarazo , Dengue Grave/terapia , Sri LankaRESUMEN
BACKGROUND: Incidence of dengue fever as well as dengue hemorrhagic fever is increasing in Sri Lanka especially among elderly population. As the number of cases is rising, rare complications of dengue illness also can be seen in clinical practice when compared to the past few years. Prompt identification and treatment of such complications is challenging due to lack of awareness and unavailability of standard treatment. CASE PRESENTATION: 69 years old man presented with acute onset fever and was diagnosed as having dengue illness. On the 4th day of illness, the disease was progressed into dengue haemorrhagic fever and recovered uneventfully. Although he recovered from primary illness, his general condition continued to deteriorate due to new onset of features of parkinsonism. Cerebrospinal fluid analysis and electro encephalogram showed evidence of encephalitis. Cerebrospinal fluid analysis also revealed positive IgM antibodies against dengue virus. Then the diagnosis of post encephalitic parkinsonism following dengue viral infection was made and started on. He was started on SINEMET (carbidopa 10 mg and levodopa 100 mg) half tablet 6 hourly started. After 1 week of treatment he showed marked improvement and then patient was discharged with further follow up plan. CONCLUSION: Although the management of dengue illness and dengue haemorrhagic fever is straightforward, recognition and treatment of rare complications like post encephalitic parkinsonism following dengue viral infection is difficult without great clinical suspicion.