Shiga-toxin-producing Escherichia coli (STEC) is a worldwide, foodborne pathogen that can lead to lifethreatening complications. Transmission has been associated with undercooked meat products, contaminated food and water sources, person-to-person contact, and direct exposure to infected farm animals. As the name suggests, the major virulence factors contributing to its pathogenicity are Shiga toxins, which can cause a spectrum of clinical presentations ranging from mild watery diarrhea to severe hemorrhagic colitis due to its toxic effects on the gastrointestinal tract. We report a case of a 21-year-old man seeking medical attention due to severe crampy abdominal pain and bloody diarrhea who was ultimately diagnosed with a less commonly encountered severe form of colitis in the setting of STEC infection. Thorough investigations while maintaining a high level of clinical suspicion allowed prompt medical care with a complete resolution of symptoms. This case highlights the importance of having high clinical suspicion for STEC even with more severe forms of colitis and sheds light on the role of medical personnel in managing such cases.
Pertussis is a commonly underdiagnosed infection with incidence that has been steadily rising in adolescents and adults over the last three decades. Some reports suggested cyclical pattern of pertussis infection occurrence with peaks every two to five years. The complications of pertussis can be infectious or mechanical in the setting of persistent cough. We report an unusual case of a 67-year-old woman who presented with combined lung and liver extrusion in the setting of pertussis infection. This article will review the systematic approach of diagnosis and management of pertussis infections in adults.
Defects in the tumor suppressor candidate 3 (TUSC3) gene have been identified in individuals with autosomal recessive intellectual disability (ARID). Our report on two sisters from Qatar with a mutation in the TUSC3 gene focuses on the behavioral manifestations and management provided to them. The sisters, daughters of consanguineous parents, exhibited aggressive and impulsive behavior, along with hyperactivity and emotional dysregulation. They also exhibited abnormal sleep and eating patterns. Behavioral therapy and psychotropic medications including aripiprazole 3.75mg, clonidine 0.025mg, and guanfacine 1mg were used for the management of aggressive and agitated behavior. The two girls showed a reduction in aggressive behavior, hyperactivity, impulsivity, and insomnia in response to 2mg daily of guanfacine. Few families around the world were reported to have mutations in the TUSC3 gene resulting in intellectual disability. We describe the first two reported cases of TUSC3 gene mutation in Qatar. We encourage further research to study the effects of TUSC3 gene mutation, its manifestations, and treatment.
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