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A Serious Diagnosis Lacking Common Symptoms
​BY JENNIFER TUONG; IVAN KHARCHENKO; JEAN LUC AGARD; & AHMED RAZIUDDIN, MDA 65-year-old man who had HIV well-controlled with highly active antiretroviral therapy, hypertension, sciatica, and restless leg syndrome presented to the emergency department with left leg pain. He also had had chemotherapy and radiation for anal cancer. The patient said the pain had started 45 minutes earlier when he was sitting on the toilet.He described the pain as sore in quality and 10/10 on the pain scale. He reported that it had started in his lower back and radiated to his left leg. He said he had had no trauma or weakness to the regi...
Source: The Case Files - May 28, 2019 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Severe Symptoms, but a Truly Treatable Disease
​BY NOURA MAHDI; DARRON LEWIS; JEREMY OSBORNE; & AHMED RAZIUDDIN, MDA 73-year-old man was brought to the emergency department from his nursing home for rectal bleeding and anemia. The patient mentioned he had had episodes of bright red rectal bleeding and constipation for a few months. A colonoscopy had been done prior to the visit, which revealed a large intestine tumor and biopsy confirming adenocarcinoma. He was awaiting an appointment with his surgeon.The patient reported bloody rectal leakage, and a CBC done at the nursing home showed a hemoglobin level of 7.2. He also complained of dyspnea but denied any other ...
Source: The Case Files - March 20, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: research

Evaluation and Management of Acute-Onset Hemiparesis in an Adolescent With Leukemia
We present a case of a 15-year-old boy with pre-B acute lymphoblastic leukemia on chemotherapy, having recently received a high-dose methotrexate infusion in addition to intrathecal methotrexate therapy, who presented to our ED with acute right-sided hemiparesis. He was initially suspected as having a possible ischemic stroke. Magnetic resonance imaging (diffusion-weighted and fluid-attenuated inversion recovery sequence) demonstrated focal areas of diffusion restriction, an early sign of delayed-onset methotrexate neurotoxicity. Our patient received appropriate supportive care and leucovorin rescue with gradual clinical r...
Source: Pediatric Emergency Care - March 1, 2018 Category: Emergency Medicine Tags: Illustrative Cases Source Type: research

Chemotherapy induced stroke mimic: 5-Fluorouracil encephalopathy fulfilling criteria for tissue plasminogen activator therapy
Stroke mimics, especially those involving chemotherapy related neurotoxicity, can confound the clinical diagnosis of acute stroke. Here we describe the case of a 63year-old male with a recent history of stage IIIC colon cancer who presented with confusion on the second day of modified FOLFOX6 (5-fluorouracil/oxaliplatin) chemotherapy and subsequently received alteplase, tissue plasminogen activator therapy (tPA), for presumed ischemic stroke. Magnetic resonance imaging scans after tPA administration did not reveal evidence of an infarction and the patients' neurological symptoms resolved completely after discontinuation of...
Source: The American Journal of Emergency Medicine - July 6, 2017 Category: Emergency Medicine Authors: May Thuy Nguyen, Robyn Stoianovici, Luigi Brunetti Source Type: research

A woman with recurrent vomiting and body cramps
Clinical introduction A 68-year-old woman with pancreatic cancer undergoing chemotherapy presented to the emergency department with a week of vomiting and body cramps. Vital signs were: BP 130/70 mm Hg; HR 80 bpm; RR 14 bpm and oxygen saturation 100% while breathing ambient air. Laboratory investigations showed normal calcium, magnesium and albumin levels; hypokalaemia level at 2.3 mmol/L (normal range 3.5–5.0 mmol/L) and bicarbonate level at 42 mmol/L (normal range 22–29 mmol/L). While the nurse was taking vital signs, the patient complained of a right hand cramp (figure...
Source: Emergency Medicine Journal - November 23, 2015 Category: Emergency Medicine Authors: Yildiz, H., Dupriez, F. Tags: Pancreas and biliary tract, EMJ Image Challenge, Stroke, Ethics Source Type: research