Global Journal of Medical Case Reports

Propranolol induced Raynaud phenomenon and facial edema in a patient with Hyperthyroidism: A case report

ÇERMA Adishah, POSHI Klodiana, TOTI Florian — Thu, 26 Dec 2024 00:00:00 +0000

Background: Propranolol is a non-cardio-selective beta-blocker, commonly used in patients with hyperthyroidism to treat the hyperadrenergic symptoms but also for its additional effect of blocking the peripheral conversion of inactive T4 to active T3. However, propranolol has many side effects, one of them being secondary Raynaud phenomenon. Case presentation: S.K., 55 years old was hospitalized in the Endocrinology Department as an untreated hyperfunctioning goiter with typical clinical manifestations such as fatigue, anxiety, palpitations, heat intolerance, difficulties in swallowing and breathing. Unimazole 5 mg (2-2-2 tb) and Propranolol 40 mg (¼ -0- ¼ tb) were prescribed. Thirty minutes after taking Propranolol (the dose 40 mg), she had difficulties breathing, was agitated, sweating and had nausea. Her face was hyperemic and edematous and her extremities were getting blue and cold. Her vitals remained stable and her airways were opened, as evaluated from laryngoscopy and CT-scan of the neck. 8 hours later, her clinical manifestations got worse: her facial edema spread in her lips and submandibular region. On both cases, she clinically improved after prednisolone administration. 12 hours after taking propranolol, she showed no more signs of cyanosis or edema. Propranolol was replaced by Nebivolol, with no side effects. Conclusion: Secondary Raynaud phenomenon is a common side effect of beta-blockers and should be taken in consideration in very patient presenting with cold and cyanotic peripherals. In these cases, propranolol should be stopped and replaced. Further studies on beta-blockers side effects in patients with hyperthyroidism should be made.

Late-Onset Rabies: A Case Report Highlighting the Importance of Prompt Medical Attention

Tue, 18 Feb 2025 00:00:00 +0000

Rabies is a virus present in more than 150 nations and territories worldwide, but it can be prevented through vaccination. Each year, tens of thousands of people die from rabies, primarily in Asia and Africa, with children under the age of 15 representing 40% of these fatalities. Up to 99% of rabies transmissions to humans occur through dog bites, making dogs the leading cause of rabies-related deaths in humans. We present a fatal case of rabies after a 5-month exposure incident. The patient, a 55-year-old Nigerian missionary from Enugu state, Nigeria presented with restlessness, hydrophobia, occasional barking gestures, abdominal discomfort and agitation. His condition was said to have progressively worsened as patients was unable to eat and drink fluids for days. His wife reported that the patient had experienced a bite from a stray dog on his right arm 5 months before presentation, for which no antirabies prophylaxis was given. The patient died on the second day of admission to the hospital (within 7 days of symptom onset).

A Case of Severe Pulmonary Aspergillosis Successfully Treated by Isavuconazole

Masafumi Seki — Sat, 08 Mar 2025 00:00:00 +0000

Isavuconazole (ISCZ) is a novel antifungal agent that is expected to be effective against severe fungal diseases. A case of chronic pulmonary aspergillosis that was refractory to existing agents, such as micafungin, but was successfully treated by ISCZ, is presented.

Between Ptosis and Mandibular Contraction, there is a Hidden Marcus Gunn Syndrome

Sat, 08 Mar 2025 00:00:00 +0000

INTRODUCTION Marcus Gunn syndrome or unilateral trigemino-oculomotor syncinesis is a very rare autosomal dominant genetic disorder characterised by a combination of congenital ptosis and mandibulopalpebral syncinesis during certain mandibular movements. The Marin Amat phenomenon is an autosomal dominant disorder which is the reverse of Marcus Gunn syndrome, i.e. the closure of one eye caused by a wide opening of the mouth, was described by Marin Amat in 1918. OBJECTIVES AND METHODS This is a description of a case series from the ophthalmology department of the CHU Mohammed VI d'Oujda, with the aim of describing the etiopathogenic, clinical and therapeutic aspects of Marcus Gunn syndrome. OBSERVATIONS We report a series of two cases of children with Marcus Gunn syndrome. Case 1: A 5-year-old boy with no previous pathological findings presented with unilateral ptosis of the left upper eyelid at the age of 4 months. His visual acuity was 10/10 in right eye on the right and 5/10 in left eye. Appendages showed ptosis on the left with no upper palpebral crease, and no associated oculomotor paralysis or strabismus. Examination of the anterior and posterior segments was unremarkable in both eyes. We observed retraction of the upper eyelid when opening the mouth and chewing. Second case: a 7-year-old girl, brought in by her parents for a ptosis of the left eye noted at birth. This is a 7-year-old girl brought in by her parents for ptosis of the left eye, diagnosed at birth. She had no particular pathological antecedents. Her visual acuity was 10/10 in right occlusion and 3/10 in left occlusion. Adnexal findings included partial ptosis of the left eye, with retraction of the upper eyelid when opening the mouth and chewing. The rest of the ophthalmological examination was unremarkable. We noted amblyopia on the left, and the somatic examination was unremarkable in both children. Orbital and head CT scans were normal in both children. Both children had undergone sectioning of the superior levator muscle with frontal suspension using prolene sutures, with good progression, followed by total optical correction and treatment of the amblyopia. DISCUSSION Marcus Gunn syndrome is a very rare condition, affecting 2-13% of cases of congenital ptosis. The first case was described by British physician Robert Marcus Gunn in 1883 as the “blinking jaw phenomenon”. It is characterized by unilateral ptosis associated with mandibulo-palpebral synkinesis, i.e. ptosis that is corrected by mouth opening or mandibular diduction. It may be isolated or associated with oculomotor disorders. Our two cases present a clinical picture that corroborates the description in the literature. Marcus Gunn syndrome is an autosomal dominant genetic disorder, but it can also occur under certain conditions (following childhood trauma, inflammatory processes or even tumour lesions). The etiopathogenesis is poorly understood, but is probably due to aberrant innervation of the levator muscle of the upper eyelid by trigeminal motor fibers, according to the literature. The result is a congenital brainstem lesion that leads to disinhibition of mandibulo-palpebral co-contraction, which is physiologically very weak and inhibited. Stimulation of the trigeminal nerve by contraction of the pterygoid jaw muscles excites the branch of the oculomotor nerve that innervates the levator of the upper eyelid, causing rhythmic upward jerking of the upper eyelid. CONCLUSION Marcus Gunn syndrome is a rare condition characterized by congenital ptosis and mandibulo-palpebral syncinesia. Its etiopathogeny remains poorly elucidated. Its management is an absolute emergency, as the occurrence of amblyopia depends on it. The choice of surgical technique is difficult, as it must correct both ptosis and syncinesia. BIBLIOGRAPHICAL REFERENCE 1. Awan KJ.Marcus Gunn (jaw-winking) syndrome. Am J Ophthalmol. 1976 Sep;82(3):503-4. Google 2. Nan Xiang, Wei-Kun Hu, Bin Li, Rong Liu. Management of morderate-to-severe Marcus-Gunn syndrome by anastomosis of levator and frontal muscles. Int J Ophthalmol. 2010;3(4):342-345. Google 3. 4. Beard D C. A new treatment for severe unilateral congenital ptosis and for ptosis with jaw-winking. Am J Ophthalmol. 1965 Feb;59:252-8. Google 5. Altman K. The Marcus Gunn (jaw-winking) phenomen: a case report. Br J Oral Maxillofac Surg. 1990 Feb;28(1):53-4. PubMed | Google Scholar