Cardiorenal syndrome type 1 (CRS 1) occurs when acute heart failure leads to acute kidney injury. There are several etiologies of CRS 1, including Chagas disease. Here, we present the first case report of CRS 1 in a patient with acute Chagas disease. Electrocardiography, transthoracic echocardiography, and cardiac magnetic resonance imaging showed signs of acute myocarditis. Laboratory examination revealed severe loss of kidney function, with a creatinine clearance of 30 mL/min, which fully normalized after treatment. Due to emergence of Chagas disease in the Brazilian Amazon, it is important to report unique clinical features in order to improve patients' outcomes.
Introduction: Optic perineuritis is a rare disorder with multiple possible etiologies, including systemic autoimmune or infectious syndromes and, more rarely, neurosyphilis. The aim of this report is to describe an uncommon manifestation of this reemerging infectious disease. Case report based on a retrospective analysis of the medical records of the patient. Case report: A previously healthy 35-year-old female presented to the hospital with a seven-day history of progressive right eye vision loss and pain on extraocular movement, with development of a pink maculopapular rash on the trunk. On the sixth day of her disease, similar symptoms appeared in the contralateral eye. Physical examination showed reduced fotomotor reflex and finger counting at 50 cm in both eyes. Magnetic resonance imaging revealed bilateral and circumferential thickening with enhancement of the optic nerve sheath, suggesting bilateral optic nerve perineuritis. Serum Venereal Disease Research Laboratory (VDRL) was 1/64 and cerebrospinal fluid (CSF) showed 440 cells (86% lymphocytes), proteins 97 mg/dL, glucose 47 mg/dL, lactate 21 mg/dL and VDRL 1/4. She was treated with IV crystalline penicillin for 21 days and had partial improvement of bilateral vision within two months. At follow-up, her visual acuity was 20/40 in the right eye and 20/100 in the left; her CSF normalized, with nonreactive VDRL. Conclusion: Neurosyphilis is a treatable cause of optic perineuritis, and its recognition is important to establish the right antibiotic treatment.
Introduction: Anti-GABA-Br is an autoantibody associated with autoimmune encephalitis and small cell lung carcinoma. Clinical seizures, including status epilepticus, represent the most common feature of anti-GABA-Br related disorders. This case reports a previously healthy 40-year-old man with rapidly progressive dementia and Anti-GABA-Br positive cerebrospinal fluid (CSF). This is a case report based on retrospective analysis of a single patient’s medical record. Case report: From May 2019 to October 2020, the patient presented with dulling, decreased speech frequency and gait disturbance. He became unable to perform all basic and instrumental activities of daily living. Physical examination was marked by: pancerebellar dysfunction and impaired working memory. Brain magnetic resonance imaging (MRI) showed global brain volumetric reduction with bilateral T2/FLAIR (T2-weighted-Fluid-Attenuated Inversion Recovery) hypersignal in cortical regions of insula and mesial temporal lobes, without contrast enhancement. Analysis of CSF: 8.3 cells/ mm³ (96% lymphocytes) and protein 64 mg/ml. There was no evidence of: clinical/electroencephalographic seizures or pathological patterns on electroencephalograms. He received methylprednisolone for five days followed by cyclophosphamide infusions (one per month for seven months). Azathioprine started after tapering prednisone. On March 2022, the patient underwent a new MRI with hypersignal improvement although atrophy had persisted. CSF after treatment had no inflammatory changes and was antiGABA-Br positive. The patient presented a partial recovery and was still dependent on instrumental activities. Conclusion: Anti-GABA-Br encephalitis has a predilection for males, affects variable ages and is best characterized by generalized seizures with evolution to refractory status epilepticus although behavioral changes may occur. There are few reports of seizure free cases.
Introduction: Aceruloplasminemia is a rare autosomal recessive disorder, characterized by transmembrane cerulopasmin deficiency. Impaired iron metabolism occurs, leading to its systemic accumulation, including brain. This is a case report based on retrospective analysis of a single patient’s medical record. Case report: This case reports a 57-year-old female, previously functional, with metabolic syndrome, admitted due to dystonia and ataxia with compound heterozygosis for ACP gene. Over the course of two years and six months, she manifested: depression, anedhonia, some instrumental activities limitations, plus walking and speech disturbances. Her physical examination presented disorientation in time/space, dysarthrophonia, saccadic intrusions, dysdiadocokinesia, enlarged base gait, oral dyskinesia and cervical dystonia. Brian magnetic resonance image (MRI) demonstrated GRE/SWI signal attenuation diffusely in cortex and bilaterally in lentiform and caudate nucleus. Laboratory tests: ferritin 2.540 ng/ml; serum iron 27 ug/dL; serum ceruloplasmine below 8 mg/dL; negative infectious and rheumatological serologies; normal levels of cobalamin, hemoglobin and thyroid hormones. Genetic testing confirmed compound heterozygosis for ACP gene (variant C1149 G>A |p.trp 383*), compatible with the aceruloplasminemia hypothesis. Conclusion: Attention should be drawn to this patient’s MRI showing SWI hyposignal on basal ganglia and cortex, because it’s a highly suggestive finding. Individual case reports indicate the effectiveness of Deferiprone as a treatment in individuals with aceruloplasminemia, however there is no universally accepted treatment regimen.
Introduction: Quetiapine, an atypical antipsychotic, works through the agonism of multiple brain receptors, including dopaminergic, serotonergic, and adrenergic receptors. Compared to typical antipsychotics, quetiapine has a more favorable profile of adverse reactions. Myoclonus is infrequent. However, there have been reports of quetiapine overdose associated with generalized myoclonus. Electroencephalogram (EEG) modifications linked to the use of quetiapine are unusual. Aldicarb, commonly known as ‘chumbinho’ in Brazil, is a carbamate used as a rodenticide. Its toxicity is caused by the inhibition of acetylcholinesterase. A few reported cases of myoclonus related to its use may be due to the anticholinesterase effect causing hyperactivity. This is a case report based on retrospective analysis of the patient’s records. Case report: A 23-year-old woman was admitted after a suicide attempt by ingesting carbamate and quetiapine 36 hours after the attempt. Her initial symptoms were vomiting and sialorrhea, followed by generalized tonic-clonic seizures and coma. At admission, she was already sedated with midazolam, with her last tonic-clonic generalized seizure two hours earlier. Her pupils were myotic, with persistent tachycardia and diffuse muscular hyperexcitability – clonic movements were evoked with minimal stimuli. Brain imaging and cerebrospinal fluid analysis showed no alterations. A loading dose of 20 mg/kg of phenytoin was administered. Upon admission, an EEG showed status myoclonus. Midazolam was then titrated to 0.8 mg/kg/h, and clobazam (30 mg/day) and levetiracetam (1.500 mg/day) were added, with resolution of the status epilepticus after three days. Conclusion: Status epilepticus should be considered a possible presentation of quetiapine and carbamate intoxication.
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