A patient diagnosed with dengue fever was recently treated at a hospital in California. This rare case raises the concern that dengue fever may become a larger threat in the future for the contiguous United States, which is not currently considered endemic for the disease. Over the past decade, there has been an increase in the number of cases; therefore, dengue fever must be given greater consideration in the differential diagnosis, especially with a patient travel history to endemic parts of the world. This case report examines the management of a patient presenting with dengue fever and demonstrates that continued vigilance, prompt testing, and patient education can improve patient care and decrease disease prevalence in the future.
Presentation of botulism in adults is extremely rare and symptoms can be easily confused for symptoms of acute stroke, Guillain-Barre, or myasthenia gravis. The purpose of this clinical case report is to ensure adult botulism will be included in the differential diagnoses for a patient with this presentation so swift and accurate care can be provided to ensure optimal patient outcome. A 41-year-old-female presented with complaints of sudden onset of difficulty speaking. The patient reports a history of intravenous polysubstance abuse and symptoms progressed to bilateral facial weakness, ptosis, and external ophthalmoplegia. With no notable findings from a non-contrast computed tomography and magnetic resonance imaging and given the symptoms, a diagnosis of wound botulism from intravenous drug use was made. Botulism antitoxin was given and the patient was admitted into the intensive care unit for supportive follow-up care. A colony of Clostridium species was discovered in this patient’s arm and the patient showed significant improvement after a few days of care.
Hydrocephalus is a rare disorder characterized by the accumulation of cerebrospinal fluid (CSF) inside the ventricles of the brain. The disease has multiple etiologies including, but not limited to, congenital malformations, neoplasms, and infections. The case discussed in this report pertains to a 19-year-old male who presented with acute hydrocephalus. Initial workups such as physical exams, CBC, chemistry panel, CT imaging and ECG were performed. Furthermore, initial treatment with Diamox and dexamethasone was started. The patient was then moved to the neurosurgery department at a tertiary hospital where an EVD was placed. Unfortunately, the patient had a complication during the EVD placement and developed an epidural hematoma and swelling in the posterior fossa a few days afterward. Furthermore, the patient was diagnosed with a Factor VII deficiency and started on replacement therapy. Despite medical treatment, the patient's condition continued to deteriorate, and he passed away 44 days after admission into the tertiary hospital. Due to the patient's age group as well as the presence of a concurrent clotting disorder, ascertaining the ideal treatment proved to be difficult. Therefore, a review of the case as well as meta-analysis of related articles may shine a light on how to not only diagnose the underlying causes of hydrocephalus but also discuss strategies that can be undertaken if comorbid conditions are present.
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