Healthy Young Man Research Articles

P305 ACUTE MYOPERICARDITIS IN 2021: COVID19 RELATED?

The term myopericarditis is used when there are primarily pericarditis symptoms with myocardium involvement as evidenced by cardiac biomarker elevation or imaging studies revealing normal wall motion. We report a case of a young 23–years old man, who presented to the Emergency Department with fever and diarrhea lasting 5 days followed by acute chest pain, modified by trunk position. The electrocardiogram (ECG) showed diffuse inferior and anterolateral ST–segment elevation. No signs of hemodynamic instability were detected. Laboratory tests showed WBC 8840/mmc, CRP 53,2 mg/L, TnT 986 ng/L, a mildly altered liver function with AST 92 UI/L, ALT 88 UI/L, GGT 82 UI/L and an altered pancreatic function with amylase 190 UI/L, lipase 267 UI/L. Naso–pharyngeal swab was negative. The patient received COVID–19 mRNA vaccination 4 months before symptoms, with high immune response, detected with IgG dosage (465 BAU/ml). Ecocardiography showed a left ventricle with normal size, function, and segmental contractility. Valvular apparatus in normal range. Hyper–refraction of the posterior pericardium with minimal effusion. The diagnosis of acute myopericarditis was glaring and we treated the patient with high dosage of non–steroidal anti–inflammatory drugs, colchicine and ACE Inhibitors, based on the increased troponin levels (nadir 1439 nl/L), in order to prevent the possible cardiovascular remodeling. On laboratory testing, the deepening of the main causes of viral or autoimmune myopericarditis did not clarify the etiopathogenesis. No arrhythmias occurred on ECG monitoring. Cardiac MRI showed multiple areas of altered signal (T2) and altered uptake in lateral and inferior ventricular segments and in adjacent pericardium. The pain was gone in two days and left ventricle function was still preserved upon discharge. In conclusion we report a successful treatment of acute myopericarditis of unknown pathogenesis, in a healthy young man. As there are described cases of myopericarditis and myositis associated with COVID–19 in the absence of respiratory symptoms, and others related to SARSCoV2 mRNA vaccination, we dutifully excluded both.

Intraoperative cardiac arrest: a rare case of anomalous coronary arteries in a previously apparently healthy young man

Sudden cardiac arrest in an apparently healthy patient is an uncommon and distressing experience for clinicians, and a prompt response improves outcome. A previously undiagnosed underlying cardiac anomaly places patients at risk of intraoperative critical incidents that could be fatal. We herein report a rare case of anomalous coronary arteries in a previously asymptomatic 25-year- old male who was rescheduled for a non-cardiac surgery after two previous episodes of intraoperative cardiac arrests.

The Brief Case: Streptococcus intermedius Brain Abscesses in an Otherwise Healthy Young Man Diagnosed by 16S rRNA Gene Sequencing.

A previously healthy 26-year-old man presented to the emergency department (ED) after he developed chest discomfort, right arm weakness, and malaise that progressed over the next 9 days to include headache, nausea, and vomiting. He had no significant past medical history, no history of alcohol, intravenous or intranasal drug use, no exposure to livestock, wild animals, or cats, no known exposure to contaminated food or water, and no recent travel. He had one female sexual partner.

Closing the Brief Case: Streptococcus intermedius Brain Abscesses in an Otherwise Healthy Young Man Diagnosed by 16S rRNA Gene Sequencing

Closing the Brief Case: Streptococcus intermedius Brain Abscesses in an Otherwise Healthy Young Man Diagnosed by 16S rRNA Gene Sequencing

ACUTE VARICOCELE THROMBOSIS AFTER VACCINATION WITH MRNA SARS-COV-2 VACCINE- A CASE REPORT

ObjectivesThe dilatation of the pampiniform plexus, the venous system that drains the testicle, causes varicocele. Varicocele thrombosis is rare, with few reported cases in the medical literature [1-6]. Patients may present with acute scrotal pain, mimicking a testicular torsion or strangulated hernia. Diagnosis is difficult, therefore, when based solely on clinical history and examination. Our objective is to present an unusual case of varicocele thrombosis, after Covid 19 vaccination.MaterialsUltrasonography (US) with Doppler interrogation is the first-line imaging choice for diagnosis [1]. The therapeutical management is primarily conservative; however, some cases might require surgery [1,6]. The Coronavirus 2019 pandemic stimulated the development of vaccines with unprecedented speed and employing novel technologies. Serious adverse effects remained low after worldwide vaccination [7,8].ResultsWe report the case of a 35-year-old male patient who presented in the Urology Department accusing intense, continuous scrotal pain and swelling, with onset the next day after receiving the second dose of an mRNA Covid-19 vaccine (BNT162b2, Cominarty, Pfizer/BioNTech). There were no associated urinary signs and no fever. The patient was a healthy young man, with no known malignancy or blood dyscrasia. He could not recall suffering any local trauma between the vaccination and the appearance of the symptoms.The clinical exam revealed a tender, scrotal swelling inferior to the left testicle.The ultrasound exam demonstrated homogenous, normal echogenic testicles without changes in vascularity on Doppler US. Multiple variceal dilatations with a spontaneous diameter of up to 5 mm were observed around the left testis. The lumen of several dilated veins appeared filled with echogenic debris. The blood flow was slow in the remaining veins, with a sluggish aspect. Continuous, progressive probe compression was applied, with no complete venous collapse observed. The greyscale aspect was consistent with partially obstructing thrombi. The venous filling defects were confirmed on Colour Doppler. No signs of thrombosis were present at the level of the spermatic cord or the inguinal canal.ConclusionsPampiniform plexus thrombosis should be considered in the differential diagnosis of acute testicular pain.This case report reveals an unprecedented etiology of varicocele thrombosis, as a side effect of an mRNA SARS-COV2 vaccine.

COVID-19 and acute ST-elevation myocardial infarction (STEMI) and ventricular thrombus in a young ethiopian man without known cardiac risk factors: A case report

Patients with coronavirus disease 2019 (COVID-19) can present with pneumonia and acute respiratory distress syndrome but rarely with acute myocardial infarction, especially in the absence of known cardiovascular disease risk factors. We present the case of a previously healthy young Ethiopian man with COVID-19 and no known cardiovascular risk factors who was diagnosed with acute ST-elevation myocardial infarction and left ventricular thrombus.

1664 A rare case of Stenotrophomas maltophilia affecting an ACL Endobutton: A Case Report and Review of the literature

Abstract Background Stenotrophomas maltophilia (SM) is a ubiquitous opportunistic gram-negative bacillus known to cause hospital acquired infections, commonly in immunosuppressed individuals. However, occurrence of this microorganism is rarely reported in the musculoskeletal system. We report a case of a young healthy man with recurrent knee swelling caused by SM. This organism has been reported to form biofilms over orthopaedic implants, with increased resistance to antibiotic therapy, making it difficult to eradicate once established. Case Report A 34-year-old man with psoriasis and asthma presented with right knee swelling and pain, and no history of preceding trauma or fever. He has a past surgical history of anterior cruciate ligament tear and underwent reconstruction with an endobutton two years prior, and a lateral meniscal repair treated in the previous year. At presentation, he was apyrexial and was noted to have a moderate right knee effusion. Initial radiographic imaging identified a large joint effusion with no obvious evidence of bone destruction, laboratory studies also showed a raised white cell count of 11.4 *10^9/L, C-reactive protein of 54mg/L and aspiration cultures were negative. He subsequently underwent numerous washouts, and removal of endobutton with open synovial biopsy which showed SM. The organism was sensitive to cotrimoxazole. The patient had appropriate antibiotics with resolution of symptoms, however he still presented with recurrence. Conclusions The persistence of SM despite intervention makes it difficult to treat. Although a rare organism, surgeons should consider it as a differential in recurring knee effusion with orthopaedic implants, and institute early and appropriate management for best outcomes.

S1493 A Benign Common Bile Duct Tumor: A Diagnostic Dilemma

Introduction: Benign extrahepatic bile duct tumors are uncommon, accounting for 6% of all extrahepatic bile duct masses. They tend to occur later in life and can present early with obstructive jaundice. They are morphologically and histologically similar with each other which makes it challenging to make an accurate diagnosis. These lesions can progress to malignancy so timely diagnosis and appropriate treatment is critical. We present a case of a benign common bile duct (CBD) tumor presenting in a healthy young man that had both features of a papillary and a tubulo-villous neoplasia, causing a diagnostic dilemma. Case Description/Methods: Patient is a 48-year-old man with history of pancreatic DB-IPMN, presenting with a one-month history of post-prandial upper abdominal pain. Physical exam was unremarkable. Labs showed elevated liver enzymes with ALT, AST, and ALP of 186, 78 U/L, 537 U/L, respectively; total bilirubin was 1 mg/dL. Abdominal MRI showed diffuse dilation of intrahepatic and extrahepatic ducts, as well as dilation of the pancreas duct with a prominent ampulla. ERCP showed a bulging ampulla with abnormal appearing tissue in the distal CBD [Figure 1]. Biopsy of the of distal CBD revealed intra-papillary neoplasm of bile duct (IPNB) without features of high-grade dysplasia [Figure 2A]. A fully covered metal stent was placed with immediate improvement in symptoms and laboratory markers. Case reviewed in tumor board which recommended obtaining more tissue prior to definitive management. A repeat ERCP with SpyGlass cholangioscopy-directed biopsies and biopsies of the ampulla revealed tubule-villous adenoma with high grade dysplasia [Figure 2B]. The patient underwent curative pancreaticoduodenectomy. Final histology did not reveal invasive cancer. Discussion: IPNB is an uncommon benign extra-hepatic bile duct tumor, characterized by papillary or villous growth within the bile duct lumen. It is more common in elderly men and can progress from atypia to invasive cholangiocarcinoma. About half of IPNBs show stromal invasion at the time of surgical resection. Accurate and timely diagnosis before metastasis is critical as surgical resection has excellent outcome with 5-year tumor free survival being 80%. Our case highlights an IPNB of the distal CBD extending into the ampulla, masquerading as a more common adenoma of the duodenal ampulla.Figure 1.: ERCP showing prominent ampulla (1a) and biliary sphincterotomy (1b)Figure 2.: Figure 2A: (Biospy#1) Intraductal papillary Neoplasia (papillary proliferation of biliary epithelium along with delicate fibrovascular cores) Figure 2B: (Biospy#2) (a) At low power (40x) demonstrating tubulovillous adenoma with papillary features. Figure 2B: (Biospy#2) (b) At high power (400x) showing an area with high grade dysplasia with cribriforming, nuclear atypia, and abundant mitotic figures.

Human gnathostomiasis in Sri Lanka: an underreported disease?

A healthy young man from Sri Lanka, currently living in Switzerland, consulted at the University Hospital of Geneva with a history of painful erythema and swelling of the left forearm. Laboratory tests showed a slight eosinophilia. Western blot serology for Gnathostoma spp, inconclusive at presentation, became positive 2weeks later.

Recurrent Syncopal Episode and Undetectable Vitamin B12

Syncope is a common cause of hospital admissions, with a high prevalence found in people 10-30 years of age, and in those 70 years and older. The condition often requires an extensive yet unrevealing workup. Vitamin B12 deficiency, however, is rarely thought to be the primary root of recurrent syncope. We had a case of vitamin B12 deficiency without findings of anemia, which presented as a recurrent syncope in an otherwise relatively young healthy man.

Hypoplastic Coronary Artery Disease Presenting with Ventricular Fibrillation Cardiac Arrest.

Hypoplastic coronary artery disease (HCAD) is a rare cause of cardiac arrest and should be suspected in cases of sudden cardiac death (SCD) in young adults.The mechanism in HCAD leading to ventricular fibrillation cardiac arrest is not well understood.Implantable cardioverter-defibrillator (ICD) implantation is recommended for secondary prevention of ventricular fibrillation.

Abrupt-onset, profound erectile dysfunction in a healthy young man after initiating over-the-counter omeprazole: a case report

BackgroundProton pump inhibitors are frequently used (and often overused) medications with adverse effects including vitamin B12 deficiency, Clostridium difficile colitis, and increased risk of chronic kidney disease. Erectile dysfunction is largely unrecognized as an adverse effect of proton pump inhibitors despite increasing evidence that proton pump inhibitors may contribute to impaired nitric oxide generation and endothelial dysfunction.Case presentationA 38-year-old Caucasian man with mild hypertension and no other significant medical history developed profound erectile dysfunction within 2 days of initiating over-the-counter omeprazole therapy, with erectile function rapidly normalizing following discontinuation of the drug. At the time of the episode, the patient was on a stable dose of lisinopril and was taking no other medications or supplements. In the 2 years following the episode, the patient has had no further erectile difficulties.ConclusionFurther study of erectile dysfunction as an adverse effect of proton pump inhibitors is needed. In the meantime, proton pump inhibitors should be considered as a potential cause of erectile dysfunction in healthy young patients and as a cause or contributor to erectile dysfunction in older patients in whom erectile dysfunction is often attributed to age or comorbidities.

Extreme Leukocytosis in a Man after a Half Marathon Race

Leukocytosis is most often defined as an elevated white blood cell count greater than 11.0 × 109 per L in adults, and is a relatively common finding. Normal adult levels of leucocytes is 4.5 to 11.0 × 109 per L. It is of importance for clinicians to be able to distinguish nonmalignant from malignant conditions, and to differentiate between the most common non-malignant causes of leukocytosis. Extreme leukocytosis can be seen in a broad spectrum of clinical conditions in the human body under stress. It is most commonly found in patients suffering from leukemia or severe bacterial infections, but can also be seen in people after hard exercise [1-7]. The present clinical case describes a young healthy man, suffering from extreme leukocytosis after a syncope during a half marathon.

Spontaneous Rupture of Hepatocellular Carcinoma at First Presentation

Hepatocellular carcinoma (HCC) is the leading primary malignancy of the liver and typically develops in the background of chronic liver disease, particularly those with cirrhosis due to viral hepatitis B and C. Ruptured tumor is the most serious complication of HCC primarily occurring in older patients with significant mortality rate. In this report, we present a case of acute abdomen with the features of impending shock as the first presentation of a spontaneously ruptured HCC in a previously healthy young man.

Death by Stimulation of the Left Vagus Nerve in a Case of Neck Grasping in a Healthy Young Man

Fatal neck pressure due to manual strangulation is a relatively common event. Sudden deaths that occur inthe first seconds of pressure are attributed to effects of the nerve. According to leading authors, the processoccurs through a reflex arc where the afferent (sensory) nerve impulses emerge in the carotid complex of thenerve endings, but not in the vagus trunk itself.On the contrary, we describe one such fatality. The body of a man in his early twenties came to attention inour Institute. According to testimonies and investigations, the victim had a domestic fight with his brother.After a verbal altercation, the victim was grabbed by the neck and immediately fell dead. During the externalexamination, only two small finger-nail superficial abrasions were found in the left cervical region. No othersigns of violence were detected. The dissection of the neck only revealed a perineural hematoma in theleft vagus trunk in the cervical tract. The cause of death was attributed to neurally mediated cardiac arrestinduced by direct left vagus nerve compression.

IgG4-related kidney disease with systemic Epstein-Barr virus infection: A case report

IgG4-related disease (IgG4-RD) is a newly recognized multi-organ fibro-inflammatory condition with characteristic histopathological findings of increased IgG4+ plasma cells in tissue and usually with increased IgG4 serum levels. Kidney involvement in IgG4-RD has been well described since 2006. Epstein-Barr virus (EBV) has reportedly been associated with nodal IgG4-RD, but not in extra-nodal disease. We report a case of renal IgG4-RD in the setting of acute EBV infection in a young healthy man, resulting in severe renal failure. Biopsy of kidney revealed IgG4+ plasma cell-rich tubulointerstitial nephritis, tissue eosinophilia, early-stage membranous nephropathy, and scattered EBV-positive cells. Oral prednisone and acyclovir only partially rescued his renal function.

A severe case of thrombocytopenia, anasarca, fever, renal insufficiency or reticulin fibrosis, and organomegaly syndrome with myocardial and skeletal muscle calcification despite hypocalcemia: a case report

BackgroundTAFRO (thrombocytopenia, anasarca, fever, renal insufficiency or reticulin fibrosis, and organomegaly) syndrome is a recently recognized disease with a variety of presentations of variable severity. In acute settings, this disease also involves organ dysfunction because of the associated systemic inflammation. However, cases of TAFRO syndrome with myocardial and/or skeletal muscle calcification have never been reported.Case presentationA 24-year-old healthy young Asian man was admitted with intermittent epigastric pain and fever for 2 weeks. Computed tomography revealed pleural effusion, ascites and systemic lymphadenopathy. Laboratory tests showed thrombocytopenia, elevated C-reactive protein, hypoalbuminemia, anemia and renal dysfunction. Based on these findings and bone marrow biopsy, we diagnosed his disease as TAFRO syndrome and commenced hemodialysis for the renal dysfunction. However, he developed refractory hypocalcemia with unstable vital signs, for which we administered calcium gluconate hydrate. Thereafter, myocardial and skeletal muscle calcification was revealed radiologically, with the myocardial calcification causing sick sinus syndrome. He was treated with tocilizumab and finally discharged in an ambulatory condition after prolonged hospitalization, with residual calcific lesions.ConclusionThis is the first report of a patient with TAFRO syndrome and the complication of organ calcification. The etiology of calcification in this case is not clear. Systemic inflammation with possible hypercytokinemia might have been involved in the unexpected complication of systemic calcification. It is important to carefully handle the general management of TAFRO syndrome because of the possibility of various complications.

Acute Myocarditis With Cardiogenic Shock in a Healthy Young Man

Acute Myocarditis With Cardiogenic Shock in a Healthy Young Man

РАЗВИТИЕ БЫСТРОТЫ У ШКОЛЬНИКОВ СРЕДСТВАМИ КЫРГЫЗСКИХ НАРОДНЫХ ПОДВИЖНЫХ ИГР НА УРОКАХ ФИЗИЧЕСКОЙ КУЛЬТУРЫ

This article discusses the values of systematic sports, its impact on the health of the younger generation. The role of subjective and objective factors in creating the necessary conditions for the education of a spiritually rich, morally clean and physically healthy young man is revealed. Certain aspects of the development of speed and motor activity in physical education lessons are considered. The authors prove that one of the effective levers for improving the physical and educational activity of students during a physical education lesson and extracurricular sports is the method of competitive play, which uses popular outdoor games and physical exercises. Describes in detail a method that removes the compulsion to learn, makes children happy and gradually ensures the overall development of children without much effort, including the development of physical qualities and the activation of motor activity.

Trauma induced adult purpura fulminans: A case report

Introduction: Purpura fulminans is characterised by sudden and rapid advancement of hematologic and cutaneous manifestations in the form of skin necrosis and disseminated intravascular coagulation which progresses to multi organ failure resulting in death if left unidentified. Even as neonatal purpura is popularly documented, there is paucity of literature regarding adult purpura fulminans which may occur secondary to sepsis, be an autoimmune response or be of idiopathic origin. Autopsy findings are usually negative. The following case is of a young healthy army man who died suddenly of purpura fuminans consequent to a single lacerated injury sustained to lower limb. Keywords: Purpura, Purpura fulminans, Adult, Injury, Trauma.