DR.MOHAMMED IRFAN SHEIKH
DR.MOHAMMED IRFAN SHEIKH
in Case Study
Cholelithiasis
Cholelithiasis
A 60-year-old man with cirrhosis and a remote history of colon cancer, for which he had undergone a hemicolectomy, presented to the emergency department with a fever. He reported no diarrhea, vomiting, or abdominal pain. His temperature was 38.5°C. There was no tenderness to palpation across his abdomen. Laboratory studies revealed a white-cell count of 12,300 per cubic millimeter (normal range, 3600 to 11,000) and a total bilirubin level of 2.0 mg per deciliter (34.2 μmol per liter) (normal range, 0.2 to 1.3 mg per deciliter [3.4 to 22.2 μmol per liter]), although his baseline total bilirubin level was 2.0 mg per deciliter owing to his liver disease. The aminotransferase levels, alkaline phosphatase levels, and urinalysis results were within the normal range. Two sets of blood cultures obtained on admission grew Escherichia coli. Computed tomography, which was performed to determine possible intraabdominal sources of infection, revealed no abscess, ascites, or colitis but did show multiple small, round, calcified gallstones (Panels A and B). Although no definitive source of the bacteremia was found, the patient became afebrile within the first 48 hours after antibiotic treatment was initiated. Cholecystectomy was considered but not pursued because of the patient’s high operative risk owing to cirrhosis. He completed a course of antibiotics and was doing well at a follow-up visit 11 months after his discharge from the hospital. Ongoing surveillance has not identified a recurrence of colon cancer.
DR.MOHAMMED IRFAN SHEIKH
DR.MOHAMMED IRFAN SHEIKH
in Case Study
Left-Middle-Lobe Pneumonia
Left-Middle-Lobe Pneumonia
A 34-year-old man presented to the emergency department with a 5-day history of fever, cough, and dyspnea. He had received a diagnosis of situs inversus when he was 2 years of age, after a chest radiograph had been obtained in order to evaluate a cough. Physical examination was notable for heart sounds in the right side of his chest and for crackles in the middle field of the left lung. Radiography of the chest revealed a cardiac apex, aortic arch, and gastric bubble in the right side of the body and a lobar infiltrate in the left lung. A left-middle-lobe pneumonia was diagnosed. The patient reported that he had had chronic cough and recurrent sinusitis since childhood, and he also reported infertility — conditions that suggest a diagnosis of Kartagener’s syndrome, which is characterized by situs inversus, recurrent sinusitis, and bronchiectasis (which was not seen on his chest radiograph). This syndrome is a form of primary ciliary dyskinesia, an autosomal recessive condition that is caused by mutations in genes encoding ciliary components, resulting in abnormal motility of sperm-cell flagella and of cilia lining the respiratory tract and fallopian tubes. Primary ciliary dyskinesia also affects organ lateralization during embryogenesis, resulting in situs inversus in approximately half the cases. The patient was treated with moxifloxacin, and his pneumonia resolved completely. He received pneumococcal and influenza vaccines and was referred to the pulmonology service for follow-up. At last follow-up, 7 months after the initial presentation, the patient was doing well.
DR.MOHAMMED IRFAN SHEIKH
DR.MOHAMMED IRFAN SHEIKH
in Case Study
Sturge–Weber Syndrome
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