Journal of hospital medicine case reports

HUS is a life‐threatening disease that causes microangiopathic hemolysis, thrombocytopenia, kidney failure, stroke, myocardial infarction, and death.
Complement activation plays an important role in a variety of illnesses; thus drugs that inhibit complement activation, such as eculizumab, may be beneficial in these illnesses. A man in Austria developed a cataract shaped like a star in his eye after he was punched, according to a report of his case. The 55-year-old went to his doctor because his vision in that eye had progressively worsened over the previous six months, according to doctors who treated the man. The patient said he'd been punched nine months earlier, the doctors wrote in their report. When the eyeball is struck, the energy of the blow sends shock waves through the eye that can disrupt the nature of the eye's lens, causing it to become opaque in regions, he explained. Trauma to the eye is one reason why doctors emphasize the importance of wearing protective eyewear during sports, Fromer said. Karen came to LiveScience in 2010, after writing for Discover and Popular Mechanics magazines, and working as a correspondent for the Journal of the National Cancer Institute.
Use of “Krokodil,” a deadly Russian designer drug, has been spreading rapidly across Europe.1, 2 It can turn an addict’s skin dark, scaly, and necrotic and cause it to wither away.
Our patient is a 30-year-old man who presented to the hospital with pain, swelling, and ulceration of his left thigh. Our case highlights the need for physicians to be cognizant of this deadly flesh-eating drug.
This article originally appeared in the March 2014 issue of The American Journal of Medicine. Do Health & Fitness Apps Work?There are tens of thousands of health and fitness apps (applications) for smart phones and tablets. Noninvasive modalities have led to identification of these masses, which may be mistaken for a tumor if massive. Surgical excision of the LHAS is reserved for patients who have superior vena cava (SVC) obstruction or an intractable rhythm disturbance (8, 9). Male patient, 80 years old hospitalized due to tumor on his left neck to diagnosis, his nails were seen by chance when he was waiting for his lung X ray examination. Male patient, 65 years old hospitalized due to urinary tract infection , his nails also was seen by chance when he was waiting for his clinical evaluation by infectologist. Typical or enteropathic HUS (eHUS) occurs after a gastrointestinal infection (usually Escherichia coli O157:H7) and is treated with supportive care and sometimes plasmapheresis.
Althogh eculizumab is of proven efficacy in treating aHUS and paroxysmal nocturnal hemoglobinuria, its role in other diseases driven by complement activation is uncertain. Mark Fromer, an ophthalmologist at Lenox Hill Hospital in New York City, and eye surgeon for the New York Rangers hockey team, after he saw the image.

Punches and the balls used in sports are most often the cause, but bumps from air bags and steering wheels have also created cataracts, Fromer said. In most cases, cataracts look more like a vaguely shaped cloud, and can be white or yellowish. The patient mentioned that he had been injecting a homemade drug called “Krokodil” into his affected area for the past 6-7 months. It can be manufactured at home from codeine, along with easily available additives, and is significantly cheaper than heroin.
Because of “Krokodil’s” ease of manufacture, low cost, and potency, there is a good chance that it could become popular in the US. Given that 58% of adults in the US have smart phones, these apps have the potential to help millions of people. The absence of encapsulated fat cells and the presence of fetal fat cells distinguish it from lipoma (2, 3). Computed tomography (CT), magnetic resonance imaging (MRI), transthoracic echocardiograms (TTE) and TEE allow simple non-invasive diagnostic imaging of the interatrial septum.
Lipomatous hypertrophy of the interatrial septum: diagnosis by echocardiography and magnetic resonance imaging.
Lipomatous hypertrophy of the interatrial septum and upper right atrial inflow obstruction.
He had not noticed anything on his fingernails, we observed red lunula on both thumb nails (Fig. Like aHUS, the pathogenesis of eHUS also involves uncontrolled activation of the complement system, resulting in thrombotic microangiopathy.
In fact, such cataract surgery is the most widely performed surgery in the world, with 2 million procedures done in the U.S.
We report a case of a young man who has been admitted multiple times in a 5-month period, with rapidly progressing necrotic leg ulcers, after intravenous abuse of homemade heroin. He initially noticed blisters at the skin popping sites, which rapidly turned black along with painful swelling of the legs. TEE has the potential to provide enhanced resolution of the interatrial septum and may allow exact delineation of the structure?s extent when CT, MRI or TTE are not adequate (6).
Because complement activation may also play a role in eHUS, eculizumab may also be useful in this condition. Although she initially appeared to respond, her clinical condition worsened a few days later; she became anuric, hemodynamically unstable, and developed hypoxemic respiratory failure. Our case represented an example of a case of eHUS that was worsening despite aggressive supportive care and plasmapheresis; however, she improved after receiving 3 doses of eculizumab.
Within 1 month, the black necrotic area peeled off, leaving a painful necrotic ulcer (Figure).

Its regular use results in severe damage to the vasculature, muscles, and bones, and in multiorgan failure with a mean survival time of 2 years since its first use.3, 6Use of this novel flesh-eating drug has been spreading rapidly across Europe1, 2 because of its low cost and higher addictive potential.
Although we cannot rule out spontaneous improvement it seems unlikely given the patient's clinical course. Two months before this admission, he noticed rapidly progressing swelling of his left little finger with blisters, which later turned black and auto-amputated.
With a significant number of prescription opiate drug abusers in the United States, “Krokodil” could find a fertile breeding ground here.
The red lunula is an uncommon nail dyschromia; all the cases we have seen until now have been by chance. This case provides further evidence suggesting that inhibition of complement activation may provide a beneficial effect to certain patients with severe refractory eHUS. We started eculizumab, after which her hematocrit, LDH, haptoglobin, and thrombocytopenia improved, followed by gradual improvement in her acute renal failure, encephalopathy, and flaccid paralysis. The patient was a daily heroin user, which cost him approximately $300 per day, forcing him to obtain cheaper homemade heroin substitutes prepared from codeine. Anomalies of shape, form or color in lunula may be an indication of injury or serious disease, as a deficiency or infection [1,2]. Final results of the initial stool cultures (obtained at the outside hospital) were positive for shiga toxin producing E. While in the hospital, he was treated with intravenous antibiotics and intensive wound care along with precautions for opiates and benzodiazepine withdrawals.
Color anomalies, known as lunula dyschromias, can be confluent or spotted, or can be characterized by longitudinal colored bands. Colors with a red or blue tinge can be indicative of heart or lung disease, rheumatoid arthritis or hypertension. More subtle tones may be a sign of conditions like respiratory illness, vitamin deficiency or anemia [2]. Red lunula is associated with rheumatoid arthritis, systemic lupus erythematosus (20% of the patients with SLE have been reported to have this abnormality) [3], cardiac failure, hepatic cirrhosis, lymphogranuloma venereum, pulmonary disease, carbon monoxide poisoning, among others [4]. It may be idiopathic, and it also has been reported in patients with dermatological diseases, such as chronic urticaria, psoriasis vulgaris, lichen sclerosis and atrophic or alopecia areata [1,4]. However it has been described as a possible result of the increment of arteriolar blood flow, a vasodilatory capacitance phenomenon, or changes in the optical properties of the overlying nail, so that normal blood vessels become more apparent [4].

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