31/119. back to the basics: hemorrhage after vaccination: a case report. A 50-day-old girl with swelling and ecchymosis of right hand dorsum after DTP vaccination on ipsilateral deltoid area was referred to the pediatric infectious disease outpatient unit with a presumed diagnosis of gangrenous cellulites. physical examination and laboratory evaluation revealed intramuscular bleeding as a result of vitamin k deficiency. We would like to emphasize the importance of both vitamin K prophylaxis in the newborn to prevent hemorrhagic disease of the newborn and of the education of persons administering vaccines about this very basic aspect of pediatrics for early recognition. ( info) |
| Neuro-ophthalmic manifestations are common in giant cell arteritis (GCA) and sometimes may be the only presenting feature. Clinicians should be aware of typical and atypical features of GCA in order to intervene in time before permanent damage occurs. ( info) |
33/119. Periorbital ecchymosis as a sign of perforating injury of the globe. The distinction between penetrating eye injury with retained intraocular foreign body and perforating globe injuries is not always easy clinically. The case is presented of a 25-year-old man who sustained a perforating eye injury that was through a clear self-sealing corneal entry site and had no conjunctival or periorbital injury. He had periorbital ecchymosis on presentation suggesting that the globe had been perforated with resulting retro-orbital blood tracking to the periorbital region. This sign would not be expected had the foreign body remained intraocular. The management options of these cases are discussed. ( info) |
34/119. Bilateral eyelid ecchymoses and corneal crystals: an unusual presentation of multiple myeloma. PURPOSE: This report describes a case of multiple myeloma that presented as bilateral eyelid ecchymoses and corneal crystals in the absence of widespread signs of systemic disease. methods: A 55-year-old man was found to have the sudden appearance of bilateral eyelid ecchymoses after he flexed 90 degrees at the waist. On examination, amyloid deposition was found in the area of the lid ecchymoses, and corneal crystals were dispersed centrally and peripherally throughout all levels of the cornea on slit lamp examination. urinalysis revealed Bence-Jones proteins and free kappa light chains. bone marrow plasmacytosis suggested multiple myeloma. RESULT: Ophthalmic and systemic findings led to a workup, which resulted in a diagnosis of multiple myeloma. CONCLUSION: Our case demonstrates that multiple myeloma may present clinically with ophthalmic findings such as bilateral eyelid ecchymoses and corneal crystals in the absence of widespread signs of disease. The ocular findings may be the first manifestations of disease. Therefore, a systemic workup should be performed on patients with this presentation, including urine and bone marrow analyses. ( info) |
35/119. Penetrating ocular injury caused by venomous snakebite. PURPOSE: To report the case of a patient who experienced a penetrating ocular injury with direct intraocular injection of venom from a snakebite. DESIGN: Case report. methods: A 34-year-old man was bitten by a snake on his right eye. The snake was identified as Deinagkistrodon acutus. Antivenom was provided, but facial swelling, periorbital ecchymoses, massive subconjunctival hemorrhage, severe corneal edema, and exophthalmos of the right eye were noted. dyspnea due to airway edema then developed. RESULTS: He received emergent intubation. Evisceration was performed, and a continuously active bleeding scleral wound was found. No local infection developed under systemic and topical antibiotics. Pathologic examination of the excised cornea showed necrosis on the endothelial side. CONCLUSIONS: Early evisceration was the treatment of choice for treatment of a penetrating ocular injury caused by venomous snakebite. Maintaining stable life signs and prevention of infection remained the major concerns. ( info) |
36/119. MPR-hCT imaging of the pancreatic fluid pathway to Grey-Turner's and Cullen's sign in acute pancreatitis. Subcutaneous manifestations (Grey Turner's sign and Cullen's sign) of severe acute pancreatitis (SAP) are often discussed but rarely observed in a daily clinic setting. This paper will demonstrate the anatomic pathways followed by the extravasated pancreatic enzymes and how their effects lead to these ecchymoses by multiplanar reformation (MPR) images obtained by helical computed tomography (hCT). A 34-year-old female was admitted with SAP. A hCT scan revealed a swollen pancreas and cholecystolithiasis. The fluid collection around the pancreas extended to the pelvic cavity, infiltrating subcutaneous tissue in the left anterior and lateral abdominal wall. She was treated with interventional endoscopy (IVE) and continuous arterial infusion (CAI) therapy immediately following admission, she survived the SAP and these ecchymoses resolved within 7 days of presentation. MPR images obtained by hCT revealed that, the infiltration of the extra-pancreatic fluid collection between the leaves of the anterior renal fascia through the anterior and posterior pararenal space had reached into a relationship with the subcutaneous tissues in the left flank at the clinical site of discoloration as the pathway of extension to Grey Turner's sign, and also revealed anterior extension from the inflamed gastrohepatic ligament and across the falciform ligament to Cullen's sign. ( info) |
37/119. Seat-belt injuries in children involved in motor vehicle crashes. BACKGROUND: The efficacy of seat belts in reducing deaths from motor vehicle crashes is well documented. A unique association of injuries has emerged in adults and children with the use of seat belts. The "seat-belt syndrome" refers to the spectrum of injuries associated with lap-belt restraints, particularly flexion-distraction injuries to the spine (Chance fractures). methods: We describe the injuries sustained by 8 children, including 2 sets of twins, in 3 different motor vehicle crashes. RESULTS: All children were rear seat passengers wearing lap or 3-point restraints. All had abdominal lap-belt ecchymosis and multiple abdominal injuries due to the common mechanism of seat-belt compression with hyperflexion and distraction during deceleration. Five of the children had lumbar spine fractures and 4 remained permanently paraplegic. CONCLUSIONS: These incidents illustrate the need for acute awareness of the complete spectrum of intra-abdominal and spinal injuries in restrained pediatric passengers in motor vehicle crashes and for rear seat restraints that include shoulder belts with the ability to adjust them to fit smaller passengers, including older children. ( info) |
38/119. Parry-Romberg syndrome. The authors report an unusual case of Parry-Romberg syndrome (PRS). magnetic resonance imaging and computed tomography scan of the craniofacial region and surgical correction of enophthalmos were performed. Results after the operative intervention included persistent palpebral edema and ecchymosis and transient choroid vasculitis of the right eye, highlighted with echography and fluorescein angiography. The fundus oculi examination showed retinal choroid folds. Immunological test results were weakly positive. The authors conclude enophthalmos, associated with right side hemi atrophy, and the transient choroids vasculitis support the diagnosis of PRS. Furthermore, it is suggested the case had an autoimmune etiology, rather than a hemi facial asymmetry caused by a facial trauma that occurred in puberty. ( info) |
39/119. Acute promyelocytic leukemia: an unusual cause of fatal secondary postpartum hemorrhage. INTRODUCTION: Postpartum haemorrhage can rarely be associated with an underlying coagulation or haematological disorder. We wish to discuss a case of acute promyelocytic leukemia (APL) presenting as secondary postpartum hemorrhage (PPH), its clinical and pathological features and maternal outcome. CASE REPORT: We describe a 28-year-old woman who presented with secondary PPH accompanied by bleeding from gums, marked pallor, hematemesis, ecchymotic and purpuric spots all over the body, 8 days post-partum. Investigations revealed her to be having APL, a diagnosis not suspected by the referring clinic. She was given supportive therapy but died before chemotherapy could be started. CONCLUSION: The case emphasizes the importance of suspecting, investigating and energetically treating uncommon causes such as acute leukemia when an unusually severe clinical picture in a postpartum setting suggests such a possibility. This may prove to be life saving, particularly if the leukemia happens to be APL, a cancer with a very high cure rate. ( info) |
40/119. Cullen's sign: it doesn't always mean hemorrhagic pancreatitis. Periumbilical ecchymosis, Cullen's sign, is most often considered a sign of hemorrhagic pancreatitis. We present a case of splenic rupture secondary to infectious mononucleosis in a middle-aged patient whose presenting complaint was the presence of Cullen's sign, secondary to the hemoperitoneum. The splenic rupture was managed conservatively, and the Cullen's sign resolved within 14 days of presentation. ( info) |