A Case to Remember

Sudden Hemiplegia in a young patient

A Case to Remember, Book Review, Volume 4, Issue 1, Pages 1 - 44 (2005)

Abstract

Stroke is more common in older patients; when it occurs in younger persons the causes may be slightly different. If adequately investigated, a cause can be ascertained in significant proportion of younger patients with stroke. Dissection of the internal carotid artery is an important cause of stroke in this age group and probably accounts for about 20% of cases. An association with elevated plasma homocysteine has been previously reported. We report a case of spontaneous internal carotid artery dissection associated with raised plasma homocysteine in a twenty-two year old, previously healthy man.

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Simvastatin-induced myositis occurring in a patient with viral hepatitis A

A Case to Remember, Volume 3, Issue 3, Pages 85 - 128 (2004)

A 60 year old female was admitted with jaundice, malaise & loss of appetite. Two weeks before admission she had complained of diarrhoea with abdominal pain. There was no previous history of jaundice, blood transfusion or foreign travel. She denied pruritus, and stools were of normal colour, although her urine was dark. She was non-smoker & did not drink alcohol regularly. She was known to have ischaemic heart disease & hypercholestolaemia and had been taking ramipril 5mg , clopidogrel 75mg, simvastatin 20mg & omeprazole 20mg daily for the previous two years.

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Thoracic aortic dissection mistakenly diagnosed as pulmonary embolism: A potentially fatal error

A Case to Remember, Volume 3, Issue 3, Pages 85 - 128 (2004)

Abstract

Thoracic aortic dissection may present in many different ways leading to delayed diagnosis, often with catastrophic results. We present a patient with sudden onset epigastric pain, breathlessness, fever and a left sided pleural effusion, who was initially treated for a chest infection, subsequently for pulmonary embolism, with a serendipitous diagnosis of aortic dissection eventually being made. The strength of association of pleural effusion and aortic dissection and the need for vigilance with regard to the diagnosis of aortic dissection is emphasised.

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An unusual cause for PUO

A Case to Remember, Volume 3, Issue 1, Pages 1 - 44 (2004)

A 22 year old woman presented with a seven week history of arthralgia, intermittent fever, fatigue, and sore throat. In the week prior to hospital referral she had become more unwell, with painful swelling of her left knee and a non-pruritic, erythematous rash over her forearms. Prior to this illness she had been fit and well with no previous medical or drug history.

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Syncope in the Hospital

A Case to Remember, Volume 2, Issue 3, Pages 75 - 107 (2003)

Abstract

A case is presented in which a man with anomalous coronary artery anatomy and thrombotic oronary stenoses had an episode of syncope. Further subsequent presyncopal events coincided with ventricular tachycardia on ambulatory ECG; stenting of the lesions eliminated further symptoms. The importance of seeking prognostically significant cardiac causes of syncope is discussed.

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Milk-Alkali Syndrome: An Unusual Cause of Acute Renal Failure

A Case to Remember, Volume 2, Issue 2, Pages 39 - 74 (2003)

Milk–alkali syndrome is described as a triad of hypercalcaemia, metabolic alkalosis and renal impairment, resulting from the ingestion of calcium and absorbable alkali1. It was more common in the early part of the century when antacids were used for the symptomatic treatment of peptic ulcer disease. The use of antacids has since been overtaken by H2- receptor antagonists and proton pump inhibitors. More recently, there have been various case reports of milk-alkali syndrome due to the increasing use of calcium carbonate as part of the management of osteoporosis and chronic renal failure, and also the increasing availability of calcium carbonate ‘over the counter’. We describe a case of milk-alkali syndrome due to self-medication with calcium carbonate.

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Fatal pneumocystis carinii pneumonia as a complication of methotrexate in rheumatoid arthritis

A Case to Remember, Volume 2, Issue 1, Pages 1 - 36 (2003)

Abstract

Low dose methotrexate has been used successfully to treat patients with refractory rheumatoid arthritis.1 Methotrexate-induced pneumonitis occurs in about 1 to 5% of patients, although opportunistic infections have also been reported.1 We report a case of fatal pneumocystis carinii pneumonia (PCP) in an otherwise healthy female patient treated with methotrexate for rheumatoid arthritis and review the literature.

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Pneumonia is not always what it seems

A Case to Remember, Volume 1, Issue 3, Pages 77 - 117 (2002)

A 33 year old, previously healthy woman was referred to hospital with a 3 month history of cough, 6kg weight loss, dyspnoea and night sweats. She described intermittent expectoration of purulent sputum without haemoptysis. There was no history of recent travel outside UK or contact with tuberculosis. Her general practitioner had treated her with course of amoxycillin followed by ciprofloxacin with no relief.

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