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Fall 2014 – A Case of Severe, Refractory Antipsychotic-induced Orthostatic Hypotension

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A Case of Severe, Refractory Antipsychotic-induced Orthostatic Hypotension.

Author: 1Sahil Gambhir, 2Nicholas Sandersfeld, DO, 2Dale D’Mello, MD

Author Affiliations: 1College of Human Medicine, Michigan State  University, East Lansing, MI, USA; 2Department of Psychiatry, College of Human  Medicine, Michigan State University, East Lansing, MI

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/12/Fall-2014-Antipsychotic-Hypotension.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF[/button]

Corresponding Author: Sahil Gambhir, Gambhir1[at]msu.edu

Key Words: Orthostatic hypotension; antipsychotics; refractory; side effects; schizophrenia; management guidelines.

Abstract: Introduction: Antipsychotics have many adverse effects including orthostatic hypotension. Orthostatic hypotension is ideally treated with non-pharmacological strategies; however, these often fail leading to utilization of pharmacological methods. Currently, there is no agreed upon management or protocol for addressing antipsychotic-induced orthostatic hypotension and research in this area is limited. Patient profile: A 60-year-old man with a long history of schizophrenia who was receiving Haldol† Deconoate 200 mg injections every 4 weeks due to previous non-compliance. He was admitted to the inpatient psychiatric service due to worsening psychosis and suicidal behavior. Intervention: Despite use of medications, the patient was switched to risperidone with a goal of transition to an atypical long-acting injectable. The psychosis improved, but the patient developed orthostatic hypotension. After his medications were held, his blood pressure continued to be grossly abnormal. A number of different tests were completed followed by standard non-pharmacological treatment, which proved unsuccessful. Despite receiving intravenous fluid boluses to maintain his blood pressure, the patient required pharmacological treatment. This included midodrine and fludrocortisones, and concluded with Adderall† as his blood pressure stabilized. Conclusion: This case of a 60-year-old man with antipsychotic-induced orthostatic hypotension elucidates the frustration healthcare professionals and patients face with this common treatment-resistant condition. A treatment algorithm for managing drug-induced orthostatic hypotension is proposed and is a nidus for development of future protocols.

Published on date: September 31, 2014

Senior Editor: Kaitlyn Vitale

Junior Editor:Mike Klinger

DOI: Pending

Citation: Gambhir S, Sandersfeld N, D’Mello D. A Case of Severe, Refractory Antipsychotic-Induced Orthostatic Hypotension. Medical Student Research Journal. 2014;4(Fall): 15-7.

References:

  1. Cardiac side effects of psychiatric drugs. Mackin, P. Hum Psychopharmacol, 2008 Jan; 23 (1): 3-14. doi: doi: 10.1002/hug.915
  2. Stahl, S. Chapter 10. Antipsychotic Agents. In: Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications, 3e. New York: Cambridge University Press; 2008.
  3. Effect of midodrine on chlorpromazine-induced orthostatic hypotension in rabbits: comparison with amezinium, etilefrine, and droxidopa. Kurihara, J; Takata, Y; Suzuki, S; Okubo, Y; Kato, H. Biological Pharmacology Bulletin, 2000 Dec; 23(12):1445-9.
  4. Evaluation and Management of Orthostatic Hypotension. Lanier, Jeff; Mole, Matt; Clay, Emily. American Family Physicians, 2011 Sept 1; 84(5): 527-536.
  5. Antipsychotic pharmacotherapy and orthostatic hypotension: identification and management. Gugger, JJ. CNS Drugs, 2011 Aug; 25(8): 659-71
  6. Freeman R. Chapter 20. Syncope. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson J, Loscalzo J. eds. Harrison’s Principles of Internal Medicine, 18e. New York: McGraw-Hill; 2012.
  7. Crawford MH. Chapter 16. Syncope. In: Crawford MH. eds. Current Diagnosis & Treatment: Cardiology, 4e. New York: McGraw-Hill; 2014.

Fall 2014 – Sebaceous Carcinoma of the Abdominal Wall: A Potential Indicator of Muir Torre Syndrome

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Sebaceous Carcinoma of the Abdominal Wall: A Potential Indicator of Muir Torre Syndrome

Author: Stacie L. Clark

Author Affiliations: College of Human Medicine, Michigan State University, Grand Rapids, MI, USA

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/12/Fall-2014-Sebaceous-Carcinoma.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF[/button]

Corresponding Author: Stacie L. Clark, clarkst[at]msu.edu

Key Words: sebaceous gland; sebaceous carcinoma; abdominal wall; Muir-Torre syndrome; colorectal cancer; HNPCC.

Abstract: Introduction: Sebaceous carcinoma is a rare dermatologic tumor affecting the pilosebaceous apparatus of the skin. While the majority of sebaceous carcinomas arise from sebaceous glands in the ocular area, extraocular sebaceous carcinomas, arising from any region populated with sebaceous glands have also been reported. Sebaceous carcinoma can present as a single lesion or in association with secondary malignancies, most commonly with those found in Muir Torre syndrome (MTS), an autosomal dominant condition associated with several types of sebaceous neoplasms as well as a variety of visceral malignancies. The most common form of MTS has been described as a variant of hereditary non polyposis colorectal cancer (Lynch syndrome). Patient profile: Here, we describe the case of a 55-year-old male, with a known history of colorectal cancer, presenting with a rapidly enlarging abdominal wall mass. Interventions and outcomes: Surgical excision of the mass histologically demonstrated sebaceous carcinoma. This diagnosis, the incidental discovery of a papillary thyroid carcinoma and the patient’s history of colorectal cancer, prompted referral for genetic counseling, the results of which are still pending. Discussion: Sebaceous carcinoma is one of several diagnostic criteria of MTS and its presence should prompt a complete evaluation for underlying internal malignancies.

Published on date: September 31, 2014

Senior Editor: Timothy Smith

Junior Editor: Joginder Singh

DOI: Pending

Citation: Clark SL. Sebaceous Carcinoma of the Abdominal Wall: A Potential Indicator of Muir Torre Syndrome. Medical Student Research Journal. 2014;4(Fall):12-4.

References:

  1. Nelson BR, Hamlet KR, Gillard M, Railan D, Johnson TM. Sebaceous carcinoma. Journal of the American Academy of Dermatology. July 1995;33(1):1-15. doi: 10.1016/0190-9622(95)90001-2
  2. Ponti G, Ponz de Leon M. Muir-Torre Syndrome. The Lancet Oncology. Dec 2005;6(12):980-987. doi:10.1016/S1470-2045(05)70465-4
  3. Dores GM, Curtis RE, Toro JR, Devesa SS, Farumeni JF. Incidence of cutaneous sebaceous carcinoma and risk of associated neoplasms: insight into Muir-Torre Syndrome. Cancer. July 2008;113(12):3372-3381. doi: 10.1002/cncr.23963
  4. Schwartz RA, Torre DP. The Muir-Torre syndrome: a 25-year retrospect. Journal of the American Academy of Dermatology. July1995;33(1):90-104. doi:10.1016/0190-9622(95)90017-9
  5. Cohen PR, Kohn SR, Kurzrock R. Association of sebaceous gland tumors and internal malignancy: the Muir-Torre syndrome. The American Journal of Medicine. May 1991;90:606-613. doi:10.1016/S0002-9343(05)80013-0
  6. Srivastava D, Taylor R. Appendage Tumors and Hamartomas of the Skin. In: Goldsmith LA, Katz SI, Gilchrest BA, Paller AS, Leffell DJ, Wolff K. eds. Fitzpatrick’s Dermatology in General Medicine, 8e. New York, NY: McGraw-Hill; 2012:1337-1362.
  7. Dasgupta T, Wilson LD, Yu JB. A retrospective review of 1349 cases of sebaceous carcinoma. Cancer. July 2008;115(1):158-165. doi: 10.1002/cncr.23952

 

Fall 2014 – Acute Bronchiolitis – Case Report and Review of Management Guidelines

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Acute Bronchiolitis – Case Report and Review of Management Guidelines.

Author: Neil D. Dattani, Clare M. Hutchinson

Author Affiliations: Norwich Medical School, Faculty of Medicine and health Sciences, University of East Anglia, Norwich, United Kingdom

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/12/Fall-2014-Acute-Bronchiolitis.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF[/button]

Corresponding Author: Clare M. Hutchinson, claremhutchinson[at]gmail.com

Key Words: Bronchiolitis; Case reports; Pediatrics; Practice guidelines; Therapeutics.

Abstract: Introduction: The treatment of acute bronchiolitis is controversial, despite the fact that several well-designed trials have been conducted on the subject. Patient profile: A 10-month-old boy presented to the emergency department with a 3-day history of upper respiratory tract symptoms and an expiratory wheeze. Chest X-ray showed right upper lobe atelectasis. He was diagnosed with acute bronchiolitis. Interventions: He received nebulized salbutamol (albuterol) and oral dexamethasone in the emergency department. He was admitted to hospital overnight for continued salbutamol treatment via a metered-dose inhaler. Discussion: Five main treatment regimens exist for acute bronchiolitis nebulized epinephrine (adrenaline), other bronchodilators, nebulized hypertonic saline, glucocorticoids, and combinations of these. Nebulized epinephrine decreases the rate of hospitalization, other bronchodilators improve symptoms, and nebulized hypertonic saline reduces the length of hospitalization. There is no strong evidence for glucocorticoids or combinations of these treatments. Combined treatment with epinephrine and dexamethasone reduces rate of hospitalization.

Published on date: September 31, 2014

Senior Editor: Kevin Patterson

Junior Editor: Patrick Roach

DOI: Pending

Citation: Dattani ND, Hutchinson CM. Acute Bronchiolitis – Case Report and Review of Management Guidelines. Medical Student Research Journal. 2014;4(Fall):8-11.

References:

  1. Zorc JJ, Hall CB. Bronchiolitis: recent evidence on diagnosis and management. Pediatrics. 2010 Feb;125(2):342-9. doi: 10.1542/peds.2009-2092
  2. Hartling L, Bialy LM, Vandermeer B, Tjosvold L, Johnson DW, Plint AC, Klassen TP, Patel H, Fernandes RM. Epinephrine for bronchiolitis. Cochrane Database of Systematic Reviews 2011, Issue 6. Art. No.: CD003123. doi: 10.1002/14651858.CD003123.pub3
  3. Skjerven HO, Hunderi JO, Brügmann-Pieper SK, et al. Racemic adrenaline and inhalation strategies in acute bronchiolitis. New England Journal of Medicine2013 June 13;368(24):2286-93. doi: 10.1016/j.jemermed.2013.10.022
  4. Gadomski AM, Scribani MB. Bronchodilators for bronchiolitis. Cochrane Database of Systematic Reviews 2014, Issue 6. Art. No.: CD001266. doi: 10.1002/14651858.CD001266.pub4
  5. Zhang L, Mendoza-Sassi RA, Wainwright C, Klassen TP. Nebulised hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database of Systematic Reviews 2013, Issue 7. Art. No.: CD006458. doi: 10.1002/14651858.CD006458.pub3
  6. Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, Johnson DW, Klassen TP, Hartling L. Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database of Systematic Reviews 2013, Issue 6. Art. No.: CD004878. doi: 10.1001/jama.2013.284921
  7. Ducharme FM. Management of acute bronchiolitis. British Medical Journal 2011 Apr 6;342:d1658. doi: 10.1136/bmj.d1658
  8. Plint AC, Johnson DW, Patel H, et al. Epinephrine and Dexamethasone in Children with Bronchiolitis. New England Journal of Medicine 2009 May 14;360(20):2079-89. doi: 10.1056/NEJMoa0900544
  9. Enriquez A, Chu IW, Mellis C, Lin WY. Nebulised deoxyribonuclease for viral bronchiolitis in children younger than 24 months. Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD008395. doi: 10.1002/14651858.CD008395.pub2
  1. Roqué i Figuls M, Giné-Garriga M, Granados Rugeles C, Perrotta C. Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD004873. doi: 10.1002/14651858.CD004873.pub4
  2. Beggs S, Wong Z, Kaul S, Ogden KJ, Walters JAE. High-flow nasal cannula therapy for infants with bronchiolitis. Cochrane Database of Systematic Reviews 2014, Issue 1. Art. No.: CD009609. doi: 10.1002/14651858.CD009609.pub2
  3. Umoren R, Odey F, Meremikwu MM. Steam inhalation or humidified oxygen for acute bronchiolitis in children up to three years of age. Cochrane Database of Systematic Reviews 2011, Issue 1. Art. No.: CD006435. doi: 10.1002/14651858.CD006435.pub2
  4. Liet J, Ducruet T, Gupta V, Cambonie G. Heliox inhalation therapy for bronchiolitis in infants. Cochrane Database of Systematic Reviews 2013, Issue 10. Art. No.: CD006915. doi:  10.1002/14651858.CD006915.pub2
  5. Spurling GKP, Doust J, Del Mar CB, Eriksson L. Antibiotics for bronchiolitis in children. Cochrane Database of Systematic Reviews 2011, Issue 6. Art. No.: CD005189. doi: 10.1002/14651858.CD005189.pub3
  6. American Academy of Pediatrics Committee on Infectious Diseases; American Academy of Pediatrics Bronchiolitis Guidelines Committee. Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection. Pediatrics. 2014 Aug;134(2):415-20. doi: 10.1542/peds.2014-1665

Fall 2014 – A Review of the Psychological and Emotional Issues in Men with Prostate Cancer and their Partners

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A Review of the Psychological and Emotional Issues in Men with Prostate Cancer and their Partners.

Author: Dane E. Klett

Author Affiliations: School of Medicine, Creighton University, Phoenix, AZ, USA

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/12/Fall-2014-Prostate-Cancer.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF[/button]

Corresponding Author: Dane E. Klett

Key Words: sexual health; relationships; intimacy; radiotherapy; psycho-supportive treatment; hormone therapy.

Abstract: Howard L. Harrod on his struggles with prostate cancer (PCa): ‘Not only had I a sense of having been mutilated, but I had lost the very capacities that were symbolically associated with manhood’.1 Many patients with PCa experience this jolt to their sense of manhood, thus making PCa unique among the various cancer diagnoses and worthy of independent discussion.
In addition, PCa remains the most common male cancer and the third leading cause of all male cancer deaths.2 Most physicians are aware of the link between cancer and mental health issues, but many forget or overlook just how important it is to address a patient’s state of mental health.

Published on date: September 31, 2014

Senior Editor: Caela Hesano

Junior Editor: Regina Mater

DOI: Pending

Citation: Klett DE. A Review of the Psychological and Emotional Issues in Men with Prostate Cancer and their Partners. Medical Student Research Journal. 2014;4(Fall):4-7.

References:

  1. Harrod HL. A piece of my mind. An essay on desire. JAMA. Feb 19 2003;289(7):813-814.
  2. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J. Clin. Jan 2013;63(1):11-30. doi:10.3322/caac.21166
  3. Watts S, Leydon G, Birch B, et al. Depression and anxiety in prostate cancer: a systematic review and meta-analysis of prevalence rates. BMJ Open. 2014;4(3):e003901. doi: 10.1136/bmjopen-2013-003901
  4. Jayadevappa R, Malkowicz SB, Chhatre S, Johnson JC, Gallo JJ. The burden of depression in prostate cancer. Psychooncology. Dec 2012;21(12):1338-1345. doi: 10.1002/pon.2032
  5. Sharpley CF, Bitsika V, Christie DR. Diagnosing ‘male’ depression in men diagnosed with prostate cancer: the next step in effective translational psycho-oncology interventions? Psychooncology. Apr 3 2014. doi: 10.1002/pon.3530
  6. Zisman A, Leibovici D, Kleinmann J, Siegel YI, Lindner A. The impact of prostate biopsy on patient well-being: a prospective study of pain, anxiety and erectile dysfunction. J. Urol. Feb 2001;165(2):445-454. doi: 10.1016/S0022-5347(05)65543-7
  7. Lintz K, Moynihan C, Steginga S, et al. Prostate cancer patients’ support and psychological care needs: Survey from a non-surgical oncology clinic. Psychooncology. Dec 2003;12(8):769-783. doi: 10.1002/pon.702
  8. Kunkel EJ, Bakker JR, Myers RE, Oyesanmi O, Gomella LG. Biopsychosocial aspects of prostate cancer. Psychosomatics. Mar-Apr 2000;41(2):85-94. doi: 10.1176/appi.psy.41.2.85
  9. Bergman J, Litwin MS. Quality of life in men undergoing active surveillance for localized prostate cancer. J. Natl. Cancer Inst. Monogr. Dec 2012;2012(45):242-249. doi: 10.1093/jncimonographs/lgs026
  10. Chipperfield K, Fletcher J, Millar J, et al. Predictors of depression, anxiety and quality of life in patients with prostate cancer receiving androgen deprivation therapy. Psychooncology. Mar 11 2013(22):2169-2176. doi: 10.1002/pon.3269
  11. Couper J, Bloch S, Love A, Duchesne G, Macvean M, Kissane D. Coping patterns and psychosocial distress in female partners of prostate cancer patients. Psychosomatics. Jul-Aug 2009;50(4):375-382. doi: 10.1176/appi.psy.50.4.375
  12. Lilleby W, Fossa SD, Waehre HR, Olsen DR. Long-term morbidity and quality of life in patients with localized prostate cancer undergoing definitive radiotherapy or radical prostatectomy. Int. J. Radiat. Oncol. Biol. Phys. Mar 1 1999;43(4):735-743. doi: 10.1016/S0360-3016(98)00475-1
  13. Dahn JR, Penedo FJ, Gonzalez JS, et al. Sexual functioning and quality of life after prostate cancer treatment: considering sexual desire. Urology. Feb 2004;63(2):273-277. doi: 10.1016/j.urology.2003.09.048
  14. Kissane DW, McKenzie M, Bloch S, Moskowitz C, McKenzie DP, O’Neill I. Family focused grief therapy: a randomized, controlled trial in palliative care and bereavement. Am. J. Psychiatry. Jul 2006;163(7):1208-1218. doi: 10.1176/appi.ajp.163.7.1208
  15. Couper JW, Love AW, Dunai JV, et al. The psychological aftermath of prostate cancer treatment choices: a comparison of depression, anxiety and quality of life outcomes over the 12 months following diagnosis. Med. J. Aust. Apr 6 2009;190(7 Suppl):S86-89.
  16. Kornblith AB, Herr HW, Ofman US, Scher HI, Holland JC. Quality of life of patients with prostate cancer and their spouses. The value of a data base in clinical care. Cancer. Jun 1 1994;73(11):2791-2802.
  17. Couper JW. The effects of prostate cancer on intimate relationships. The Journal of Men’s Health & Gender. 9// 2007;4(3):226-232. doi: 10.1016/j.jmhg.2007.04.008
  18. Singer PA, Tasch ES, Stocking C, Rubin S, Siegler M, Weichselbaum R. Sex or survival: trade-offs between quality and quantity of life. J. Clin. Oncol. Feb 1991;9(2):328-334.
  19. Tavlarides AM, Ames SC, Diehl NN, et al. Evaluation of the association of prostate cancer-specific anxiety with sexual function, depression and cancer aggressiveness in men 1 year following surgical treatment for localized prostate cancer. Psychooncology. Jun 2013;22(6):1328-1335. doi: 10.1002/pon.3138
  20. Hyun JS. Prostate cancer and sexual function. World J Mens Health. Aug 2012;30(2):99-107. doi: 10.5534/wjmh.2012.30.2.99
  21. Llorente MD, Burke M, Gregory GR, et al. Prostate cancer: a significant risk factor for late-life suicide. Am. J. Geriatr. Psychiatry. Mar 2005;13(3):195-201. doi: 10.1097/00019442-200503000-00004
  22. Dale HL, Adair PM, Humphris GM. Systematic review of post-treatment psychosocial and behaviour change interventions for men with cancer. Psychooncology. Mar 2010;19(3):227-237. doi: 10.1002/pon.1598
  23. Tyson MD, Andrews PE, Etzioni DA, et al. Marital status and prostate cancer outcomes. Can J Urol. Apr 2013;20(2):6702-6706. doi: 10.1016/j.juro.2012.02.222

Fall 2014 – Broken

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Broken.

Author:  Timothy DeKoninck

Author Affiliations: College of Human Medicine, Michigan State University, East Lansing, MI, USA

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Corresponding author: Timothy DeKoninck; dekonin4[at]msu.edu

Key Words: N/A

Abstract: There are several elements symbolized in the mosaic that represent a doctor-patient relation- ship. This piece of work strives to piece together and serve as a reminder of the elements that make for a successful and impactful relationship.

Published on date: September 31, 2014

Senior Editor: N/A

Junior Editor: N/A

DOI: pending

Citation: DeKoninck T. Broken. Medical Student Research Journal. 2014;4(Fall):2-3.

References: N/A

Fall 2014 – Letter from the Editors

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Letter From the Editors.

Author: Jessica L Wummel1, Jack C Mettler2

Author Affiliations: 1College of Human Medicine, Michigan State University, East Lansing, MI, USA, 2College of Human Medicine, Michigan State University, Flint, MI, USA

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/11/MSRJ-Fall-2014-Letter-from-the-Editors.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF[/button]

Corresponding Author: Jessica L Wummel; Jessica[at]msrj.org, Jack C Mettler; Jack[at]msrj.org

Key Words: N/A

Abstract: The editors of MSRJ are excited to announce our Fall 2014 issue, the first issue of the new academic year. We have been overwhelmed with amazing articles from medical students around the world and this has allowed us to publish our largest issue yet! This issue includes stimulating articles written by students from the University of Toronto, Creighton University School of Medicine, Saba University School of Medicine, Michigan State University College of Osteopathic Medicine, and Michigan State University College of Human Medicine.

Published on date: September 31, 2014

Senior Editor: N/A

Junior Editor: N/A

DOI: Pending

Citation: Wummel JL, Mettler JC. Letter From the Editors. Medical Student Research Journal. 2014;4(Fall):1.

References: N/A

Submission Contest Winners – Congratulations!

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Last year, the editorial staff at MSRJ invited medical students to enter our submission contest. This contest was open to any medical student author who submitted during the contest dates. Authors had the chance to win a $300 scholarship in each of the following categories: Best Original Research, Best Review, Best Reflection, and Best Case Report. The response we received to this call was overwhelming. Our submission rate greatly increased during this contest time with amazing articles from around the globe. Throughout the year, our staff tirelessly reviewed these articles and after much deliberation, we are very pleased to announce the winners of this contest! Listed below are our winners in each category including a short biography of the research team.

Continue reading →

Spring 2014 – Isolated Orbital Mucormycosis in an Immunocompetent Adolescent

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Isolated Orbital Mucormycosis in an Immunocompetent Adolescent.

Author: Jolie Krystle H. Guevara

Author Affiliations: University of the East Ramon Magsaysay Memorial Medical Center, Manila, Philippines

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/07/MSRJ-Spring-2014-Isolated-Orbital-Mucormycosis.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF[/button]

Corresponding Author: Jolie Krystle H. Guevara; Jolieg800[at]gmail.com

Key Words: rhinocerebral; zygomycosis; pediatric; amphotericin B; corticosteroids; exenteration.

Abstract: Introduction and patient profile: Mucormycosis is a life-threatening disease that usually affects patients with diabetes and other immunocompromised states. However, recent literature has shown an emergence of this disease in immunocompetent individuals. Here we are presenting a rare case of a healthy 13-year-old adolescent diagnosed to have isolated orbital mucormycosis, previously treated with oral and intravenous corticosteroids. The patient presented with a chief complaint of left eye swelling of 3 weeks’ duration, which progressed to proptosis and a visual acuity of no light perception. Interventions and outcomes: Diagnosis of mucormycosis was done using histopathological techniques supported by radiologic imaging. Successful treatment of mucorymycosis was achieved via amphotericin B administration and orbital exenteration in this case. Discussion: The use of corticosteroids may weaken the immune system of healthy patients and can cause rapid progression of the disease. Early clinical diagnosis is important because this infection can rapidly be fatal.

Published on Date: May 31, 2014

Senior Editor: Jon Zande

Junior Editor: Romina Kim

DOI: Pending

Citation: Guevara JKH. Isolated Orbital Mucormycosis in an Immunocompetent Adolescent. Medical Student Research Journal. 2014;3(Spring):55-9.

References:

1. Venkatachalam VP, Anand N. Paranasal mucormycosis: unusual representation in otherwise healthy child. Indian J Otolaryngol Head Neck Surg 2007; 59: 2646.

2. De Mol P, Meis JM. Disseminated Rhizopus microsporus infection in a patient on oral corticosteroid treatment: a case report. Neth J Med 2009; 67(1): 258.

3. Grewal RK, Grewal SS, Zachariah RM. Orbital mucormycosis (phycomycosis). Indian J Ophthalmol 1985; 33(4): 23941.

4. Shinde RV, Karande GS, Mohite ST, Patil SR. Rhino-orbital mucormycosis in diabetes mellitus. J Clin Diagn Res 2013; 7(6): 11457. http://dx.doi.org/10.7860/JCDR/2013/5528. 3083.

5. Badiee P, Jafarpour Z, Alborzi A, Haddadi P, Rasuli M, Kalani M. Orbital mucormycosis in an immunocompetent individual. Iran J Microbiol 2012; 4(4): 21014.

6. Bharathi R, Arya AN. Mucormycosis in an immunocompetent patient. J Oral Maxillofac Pathol 2012;  16(2): 3089. http://dx.doi.org/10.4103/0973-029X.99100.

7. Shatriah I, Mohn-Amin N, Tuan-Jaafar TN, Khanna RJ, Yunus R, Madhavan M. Rhino-orbital cerebral mucormycosis in an  immunocompetent patient: case report and review of literature. Middle East Afr J Ophthalmol 2012; 19(2): 25861. http://dx.doi.org/10.4103/0974-9233.95269.

8. Mignogna M, Fortuna G, Leuci S, Adamo D, Ruoppo E, Siano M, et al. Mucormycosis in immunocompetent patients: a case-series of patients with maxillary sinus involvement and a critical review of the literature. Int J Infect Dis 2011; 15(8): e53340. http://dx.doi.org/10.1016/j.ijid.2011.02.005.

9. Petrikkos G, Skiada A, Lortholary O, Roilides E, Walsh TJ, Kontoyiannis DP. Epidemiology and clinical manifestations of mucormycosis. Clin Infect Dis 2012; 54(s1): s2334. http://dx.doi.org/10.1093/cid/cir866.

10. Roden MM, Zaoutis TE, Buchanan WL, Knudsen TA, Sarkisova TA, Schaufele RL, et al. Epidemiology and outcome of zygomycosis: a review of 929 reported cases. Clin Infect Dis 2005; 41: 63453. http://dx.doi.org/10.1086/432579.

11. Ferguson AD. Rhinocerebral mucormycosis acquired after a short course of prednisone therapy. J Am Osteopath Assoc 2007; 107(11): 4913.

12. Alsuhaibani AH, Thubaiti GA, Al Badr FB. Optic nerve thickening and infarction as the first evidence of orbital involvement with mucormycosis. Middle East Afr J Ophthal 2012; 19(3): 3402. http://dx.doi.org/10.4103/0974-9233. 97957.

13. Spellberg B, Walsh TJ, Kontoyiannis DP, Edwards J, Ibrahim AS. Recent advances in the management of mucormycosis: from bench to bedside. Clin Infect Dis 2009; 48(12): 174351. http://dx.doi.org/10.1086/599105.

14. Kontoyiannis DP, Lewis RE. Invasive zygomycosis: update on pathogenesis, clinical manifestations, and management. Infect Dis Clin North Am 2006; 20(3): 581607.

15. Schleimer RP, Kato A, Peters A, Conley D, Kim J, Liu MC, et al. Epithelium inflammation and immunity in the upper airways of humans: studies in chronic rhinosinusitis. Proc Am Thorac Soc 2009; 6(3): 28894. http://dx.doi.org/10.1513

 

 

Spring 2014 – Leiomyosarcoma of Small Bowel Discovered by Double Balloon Enteroscopy: a Case Report

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Leiomyosarcoma of Small Bowel Discovered by Double Balloon Enteroscopy: a Case Report

Authors: Malika Gill*, Shabana F. Pasha, Matthew A, Zarka

Author Affiliations:
Royal College of Surgeons Ireland, Dublin, Ireland

Division of Gastroenterology and Hepatology, Mayo Clinic Arizona, AZ, USA

Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, AZ, USA

[button link=”http://msrj.chm.msu.edu/wp-content/uploads/2014/07/MSRJ-Spring-2014-Leiomyosarcoma-of-Small-Bowel.pdf” type=”icon” icon=”download” color=green] Full Text Article PDF[/button]

Corresponding Author: Malika Gill; malikagill[at]rcsi.ie

Key Words: leiomyosarcoma; double balloon eneroscopy; small bowel tumors; balloon-assisted enteroscopy; deep enteroscopy; capsule endoscopy.

Abstract: Introduction and Patient Profile: Introduction of deep enteroscopy (capsule endoscopy (CE), balloon-assisted enteroscopy, and spiral enteroscopy) has led to a significant improvement in diagnosis and management of obscure gastrointestinal bleeding (OGIB). Small bowel (SB) lesions are traditionally discovered by CE or double balloon enteroscopy (DBE). Leiomyosarcomas are rare SB tumors and must be diagnosed early to prevent the risk of metastasis and to improve prognosis. A 46-year-old previously healthy woman presented with 3 weeks of abdominal pain and OGIB. Interventions and Outcomes: Patient underwent usual endoscopic modalities in identifying the source of her gastrointestinal bleeding. Computerized tomography scan identified intussusception of the SB; however, conventional endoscopy and CE were negative for etiology of source of bleeding. Ultimately, DBE successfully located the site of gastrointestinal bleeding, confirmed by pathology as a leiomyosarcoma of the SB. Discussion: Conventional endoscopy and CE may miss some lesions, while DBE can navigate altered SB anatomy, take biopsies, and even provide therapy to the lesion. Although double balloon enteroscopies are expensive and require longer sedation than average endoscopic modalities, they may provide another tool for the diagnosis of SB lesions when other modalities are unsuccessful.

Published on date: May 31, 2014

Senior Editor: Sahil Bobby Gambhir

Junior Editor: Tina Chaalan

DOI: Pending

Citation: Gill M, Pasha SF, Zarka MA. Leiomyosarcoma of Small Bowel Discovered by Double Balloon Enteroscopy: a Case Report. Medical Student Research Journal. 2014;3(Spring):51-4.

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