Hanzelina,Ketut Ariawati,Anak Agung Ngurah Ketut Putra Widnyana
Issue:
Volume 2, Issue 2, June 2021
Pages:
19-24
Received:
29 April 2021
Accepted:
24 May 2021
Published:
31 May 2021
DOI:
10.11648/j.wjmcr.20210202.11
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Abstract: Hemophagocytic lymphohistiocytosis (HLH) is a rare disorder with incidence 1 in 50.000 to 150.000 live births. HLH has high fatality rate and poor prognosis, therefore early recognition and diagnosis are necessary. Hereby we aimed to describe the clinical, examination and management aspects of HLH. An eight-month-old girl came with bloating stomach for 1 week and fever since 2 weeks before admission. She also had chronic suppurated otitis media in previous month. Patient has twin sibling, whom in healthy condition. Patient looked pale with distended abdomen. We found enlarge liver and spleen which were palpabled 4 cm under the arch of costae and Schuffner IV, respectively. Multiple purpura were found on trunk, head and extremities. Laboratory tests revealed severe normochromic normocytic anemia, neutropenia, severe thrombocytopenia, hyperferritinemia and reactive anti CMV IgG. Blood culture resulted no growth. Urine culture revealed the growth of Klebsiella pneumonia, first ear swab culture showed an isolated Pseudomonas aeruginosa and second ear swab culture with Klebsiella pneumonia. The histopathologic examination from bone marrow aspiration revealed hemophagocytic histiocyte. Patient was given broad spectrum antibiotics and supportive therapy and oral dexamethasone after HLH was diagnosed. The patient was pronounced dead during second admission. HLH can be considered as one of the differential diagnosis in children with prolong fever, hepatosplenomegaly and cytopenia. Appropriate treatment protocol should be taken to avoid any complications.Abstract: Hemophagocytic lymphohistiocytosis (HLH) is a rare disorder with incidence 1 in 50.000 to 150.000 live births. HLH has high fatality rate and poor prognosis, therefore early recognition and diagnosis are necessary. Hereby we aimed to describe the clinical, examination and management aspects of HLH. An eight-month-old girl came with bloating stomach...Show More
Abstract: Reversible cerebral vasoconstriction syndrome (RCVS) is a rare cause of intracranial haemorrhage which is often unrecognized. There are no specific causes of the syndrome but many clinical conditions and drugs have been observed to be responsible for this syndrome. Often calcium channel blockers (CCBs) are used to relieve the symptoms. Here we will discuss a case of RCVS that was triggered by sexual intercourse. A 42 years old male presented to our hospital with a sudden thunderclap headache following sexual intercourse with vomiting several times. TCD (Transcranial Doppler) ultrasound showed high MFV (Mean flow velocity) in multiple arteries suggestive of moderate to severe stenosis. CT angiogram of the brain revealed multifocal segmental spasm. Then the patient was treated conservatively with analgesics and Nimodipine. The patient made a good recovery following this treatment. Reversible cerebral vasoconstriction syndrome remains an underdiagnosed presentation of thunderclap headache which can be triggered by sexual intercourse. It should be an important consideration in cases where SAH has been ruled out. Threatening outcomes could be averted if the excruciating headache is promptly evaluated and managed accordingly. All other parameters of general physical examination were within the normal limits. Any focal neurological deficit, the detailed neurological examination did not reveal. There was no neck stiffness or any other sign of meningeal irritation. Reversible cerebral vasoconstriction syndrome remains an underdiagnosed presentation of thunderclap headache which can be triggered by sexual intercourse. It should be an important consideration in cases where SAH has been ruled out. Threatening outcomes could be averted if the excruciating headache is promptly evaluated and managed accordingly.Abstract: Reversible cerebral vasoconstriction syndrome (RCVS) is a rare cause of intracranial haemorrhage which is often unrecognized. There are no specific causes of the syndrome but many clinical conditions and drugs have been observed to be responsible for this syndrome. Often calcium channel blockers (CCBs) are used to relieve the symptoms. Here we will...Show More
