Forgotten Complication Research Articles

Kaposi Sarcoma: A Forgotten Complication in Well-Controlled HIV

Kaposi sarcoma (KS), often described as one of the AIDS-defining illnesses, has decreased in prevalence with the widespread use of antiretroviral therapy (ART). This case series includes an atypical presentation of KS in 2 patients with well-controlled HIV and a brief review of the literature on KS. Both patients had multiple cutaneous discolored plaques and ulceration with pathology confirmation of KS. They had normal CD4 counts and undetectable HIV and human herpesvirus-8 viral loads at the time of diagnosis. Therefore, patients with HIV with new skin lesions should be screened for KS regardless of the CD4 count or adherence to ART.

Retained gallstones: A forgotten complication after laparoscopic cholecystectomy

A 68-year-old woman with history of Laparoscopic Cholecystectomy (LC) for symptomatic gallstones 1 month ago, presented to the emergency department for mid abdominal pain since surgery. The pain is severe, continuous and unrelated to food. Her past medical history is significant for Diabetes Mellitus Type 2. On physical examination, she had localized abdominal tenderness and guarding at two surgical sites with skin induration. Laboratory studies were significant for leukocytosis (WBC 15,200) and elevated C- Reactive Protein of 150 mg/L. A contrast enhanced abdominal and pelvic CT scan showed postsurgical changes in the anterior abdominal wall and peritoneal calcification in the anterior aspect of the peritoneal cavity with associated fat stranding (Figure A and B).

S1604 Sump Syndrome: A Forgotten Complication From the Pre-ERCP Era

INTRODUCTION: Bacteremia of unknown origin is a challenging clinical scenario which may be encountered in the internal medicine ward. Etiologies like foreign bodies, bacterial endocarditis, or infected endovascular grafts are common sources. In this case we showcase an unusual presentation of a forgotten syndrome. CASE DESCRIPTION/METHODS: This is the case of a 71-year-old male with past medical history of hypertension and diabetes who presented to the hospital with symptoms of fever and chills since one day prior. The patient reported that these symptoms started suddenly without any inciting event. He denied any other symptoms on review of systems. Physical exam at that time was unremarkable. Initial labs were only remarkable for mild neutrophilia without associated leukocytosis and mild transaminitis. Blood cultures were taken and given clinical stability the patient was discharged home from the ER. The following day the patient was recalled after blood cultures results returned positive for E. coli and E. faecalis. Remarkably, this patient had been admitted 2 years prior with the exact clinical scenario, the same bacterial portfolio, and no clear etiology was elucidated at that time. Patient was admitted and work-up was performed in an attempt to find a plausible etiology. In view that the above mentioned cultured pathogens usually originate from the gastrointestinal tract, an abdominopelvic CT scan was requested. Interestingly, a very unique finding was described on the imaging study: pneumobilia and a dilated common bile duct. A thorough medical/surgical history revealed that, ten years prior, the patient had undergone a cholecystectomy with a choledochoduodenostomy due to an incidental finding of a porcelain gallbladder and a distal common bile duct benign stricture. Due to his surgical history, pneumobilia in the intrahepatic ducts and a dilated common bile duct were concluded to be expected findings in this patient’s abdominopelvic CT scan. Since there were no other etiologies that could explain the bacteremia, Sump Syndrome was diagnosed. DISCUSSION: Sump syndrome is a rare long-term complication of choledochoduodenostomy. In this type of surgery, the distal limb of the common bile duct may become a reservoir of bile due to a low flow state functioning as a sump. This can lead to complications such as bacterial overgrowth, like in the case above, and eventually lead to recurrent bacteremia.Figure 1.: Bile sump.Figure 2.: Bile sump.Figure 3.: Bile sump.

Acalculous Cholecystitis in Acute Hepatitis B Infection - A Forgotten Complication

As physicians we are no strangers to viral hepatitis and its penchant for infecting hepatocytes. Even though the virus preferentially targets hepatocytes, it has been shown to infect the biliary epithelium lining the gallbladder and the biliary tree. We present a case of a 32-year-old male with acalculous cholecystitis secondary to Hepatitis B infection. The patient presented to our facility with complaints of right upper quadrant (RUQ) pain, nausea, vomiting and a sense of malaise for 2 days. Upon physical examination, the patient had mild scleral icterus and RUQ tenderness with a negative Murphy's sign. He had an alanine transaminaseof 3569 IU/L, aspartate transaminase of 1868 IU/L, alkaline phosphatase of 117 IU/L, total bilirubin of 6.5 mg/dl and a direct of 4.3 mg/dl. Urine urobilinogen was 0.2 mg/dl (reference range 0.2-1.0 mg/dl). He underwent abdominal imaging on the day of presentation with ultrasound and computed tomography (CT). The CT scan demonstrated prominent enhancement of the gallbladder mucosa with mild gall bladder wall thickening and pericholecystic fat stranding. No biliary stones were seen on either the CT or the ultrasound. The patients abdominal pain persisted leading to a magnetic resonance cholangiopancreatography (MRCP) which showed a distended gallbladder with wall thickening measuring up to 4.6 mm and pericholecystic fluid. An unremarkable biliary tree was seen, confirming a diagnosis of acalculous cholecystitis. He was managed conservatively with antibiotics. Given the disproportionate elevation of liver enzymes, a hepatitis panel was performed which was positive for the Hepatitis B surface antigen and core antibody. Hepatitis e antigen, e antibody and surface antibody was negative. Hepatitis B DNA levels were undetectable. The patient responded to conservative management and was discharged with follow up at the hepatology clinic. Acalculous cholecystitis in viral hepatitis is attributed to infection of the epithelial cells as well as functional changes in biliary flow. In our review of literature, we found sporadic case reports describing this entity however, it may be underreported due to a lack of imaging and self-limited nature. In a series by Karacaer, Z., et al, in 852 patients with viral hepatitis, 0.4% had concomitant cholecystitis, leading us to believe that it may be more common than anticipated. With this case, we aim to reinforce that concomitant viral hepatitis and cholecystitis may not be as rare as thought

The forgotten complication: aspiration pneumonia in the canine patient

Aspiration pneumonia is a common complication, with many risk factors, seen in canine patients in referral centres and first opinion practices. Nurses play a vital role in recognising signs of aspiration pneumonia: cough, changes in breathing rate and effort, and abnormal thoracic auscultation. Treatment centres on supportive care, while providing antibiotic therapy for the bacterial infection. This article will focus on management of the canine aspiration pneumonia patient.

Painless Diabetic Peripheral Neuropathy: The Forgotten Complication

Painless Diabetic Peripheral Neuropathy: The Forgotten Complication

Post extubation stridor due to bilateral vocal cord palsy following button battery ingestion – A rare and forgotten complication of button battery ingestion in children

We report a patient who developed bilateral vocal cord palsy following button battery ingestion. A two and half year old girl presented with a history of button battery ingestion. Rigid oesophagoscopy was performed within 3 hours. Patient developed post extubation stridor with respiratory distress. Bilateral vocal cord palsy is a rare complication of button battery ingestion which can lead to an airway catastrophe. Decision on timing of extubation is crucial to avoid immediate post-operative respiratory distress. Expedited removal of lodged button battery, increased vigilance for possible complications and long term follow up is of utmost importance.

The diabetic hand: a forgotten complication?

The diabetic hand: a forgotten complication?

The Forgotten Complication of Recurrent Nephrolithiasis: "Squamous Cell Carcinoma of the Renal Pelvis"-A Case and Review of the Literature.

Squamous cell carcinoma (SCC) of the renal pelvis is an aggressive tumor with insidious onset of unspecific symptoms and advanced stages at diagnosis. It is a rare entity, accounting for 0.5–8% of renal tumors. In this paper, we describe the case of a patient with a history of recurrent nephrolithiasis that presented with an aggressive form of SCC of the renal pelvis with rapid relapse after resection.

The diabetic hand: a forgotten complication?

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Diabetes: the forgotten complication of parathyroidectomy

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

The diabetic hand: a forgotten complication?

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

334 Lemierre's Syndrome: A Forgotten Complication of Acute Pharyngitis

334 Lemierre's Syndrome: A Forgotten Complication of Acute Pharyngitis

Pulmonary Venous Obstruction in the Atrial Switch Operation: A Forgotten Complication

The reported case involved a 7-year-old girl with congenitally corrected transposition of the great arteries (ccTGA) and situs inversus who after surgical management experienced symptoms of dyspnea and left-sided obstructive heart disease. Her symptoms, chest X-ray, and cardiac catheterization demonstrated pulmonary venous obstruction, a known but rare complication associated with intra-atrial baffle obstruction. The incidence of the reported disorder, the follow-up assessment, and the current literature regarding complications of Senning/Mustard surgery are discussed in the context of patients with ccTGA.

Numbness of the ear following inferior alveolar nerve block: the forgotten complication

This article presents a distant complication in the auricle following the administration of a standard inferior alveolar nerve block. The patient experienced profound numbness of the auricle on the ipsilateral side of the injection that lasted for about an hour following unintended injection to the auriculotemporal nerve.

Lymphedema: The seemingly forgotten complication

Lymphedema, a frequent and debilitating symptom in patients who undergo treatment for breast cancer, is often neglected. This article outlines a therapeutic strategy and provides a case study that illustrates that effective in-home treatment of this complication is possible. Effective treatment can dramatically improve the quality of life of this patient population.

Blindness in leprosy--a forgotten complication.

Leprosy remains one of the world's major blinding diseases and yet few ophthalmologists are aware of the spectrum of ocular complications. Cross-sectional studies of the eye changes in leprosy patients, made under standardised conditions, have been carried out in 24 different leprosy centres throughout the world and the preliminary results are presented. They show that up to 20% of leprosy patients develop sight-threatening lesions and between 5% and 7% are blind (depending on the definition of blindness). Visual impairment in leprosy needs special consideration by leprologists and ophthalmologists, not only because much of it is preventable, but also because it is a severe burden to be added to the problems of mobility and social stigma that characterise this ancient disease.

Brucellar sternoclavicular arthritis, the forgotten complication.

Of 511 cases of brucellosis studied between December 1983 and February 1986, four (0.8%) had sternoclavicular (STCL) arthritis. Two were male and two female, and only one was younger than 50 years old. All four cases had significantly high specific IgG antibody titres (1 of 1280), measured by the indirect immunofluorescent (IIF) test, and two had Brucella melitensis isolated from their blood. In two cases, STCL arthritis was the presenting problem, and it was associated in one with ankle arthritis, hepatitis, renal impairment, orogenital ulcers and a haematological picture of myelodysplasia; in the other it was a relapsing STCL arthritis. In the remaining two cases, STCL arthritis was part of an extensive osteoarticular disease, which was associated in one with cachexia, liver cirrhosis, heart failure and prostatitis with urine retention, and in the other with severe thrombocytopenia. Excellent results were obtained from six to eight weeks' therapy with streptomycin, rifampicin and cotrimoxazole or tetracycline.