Cases reported "Multiple Organ Failure"

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1/56. Toxic epidermal necrolysis associated with quinidine administration.

    Toxic epidermal necrolysis (TEN) is a rare, life threatening, drug induced cutaneous reaction first reported by Lyell in 1956. He named the condition TEN to distinguish it from staphylococcal scalded skin syndrome. It is characterized by a separation of the epidermis and dermis with subsequent desquamation of skin. The denuded areas of skin have the appearance of second-degree burn. Drug induced TEN is a disease of severe morbidity and high mortality. The drugs most frequently associated with onset of the condition are sulfonamides, anticonvulsants, non-steroidal anti-inflammatory drugs, and allopurinol. This study reports the occurrence of TEN in a patient receiving quinidine.
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2/56. Thyroid storm presenting as multiple organ dysfunction syndrome.

    Thyroid storm is a rare disorder characterized by hypertension, hyperthermia, and multiple systems involvement. Early recognition and treatment of thyroid storm are essential in reducing morbidity and mortality from this disorder. We present the case of a patient with an atypical (normothermic, normotensive) presentation of thyroid storm, accompanied by multiple organ dysfunction syndrome, including lactic acidosis and liver dysfunction, both of which are very rare complications. This case highlights both the multiple organ systems that can be involved in thyroid storm and the importance of recognizing atypical presentations of thyroid storm.
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3/56. Delayed fatal hemorrhage from pseudoaneurysm of the hepatic artery after percutaneous liver biopsy.

    Hemorrhage is the most common serious complication of percutaneous liver biopsy. liver biopsy is usually done in an outpatient setting because most significant hemorrhage is evident within a few hours after biopsy. Delayed hemorrhage occurs much less frequently but carries a much higher mortality. We present a 41-yr-old man with chronic hepatitis c who underwent a percutaneous liver biopsy uneventfully but was found to have a pseudoaneurysm of the hepatic artery 5 days later. Shortly after admission, the patient experienced bleeding into the liver from the pseudoaneurysm, which was controlled initially by angiographic embolization. However, recurrent bleeding could not be controlled by repeat angiography and surgical intervention, and the patient expired. The diagnosis and management of pseudoaneurysm of the hepatic artery complicating liver biopsy is reviewed.
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keywords = mortality
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4/56. Nonendemic pemphigus foliaceus presenting as fatal bullous exfoliative erythroderma.

    pemphigus foliaceus is a cutaneous autoimmune blistering disease that is characterized by lower morbidity and mortality than those observed in pemphigus vulgaris or paraneoplastic pemphigus. However, erythrodermic forms of the endemic variant of pemphigus foliaceus have been associated with a higher mortality. We report a case of nonendemic pemphigus foliaceus that presented as fatal bullous exfoliative erythroderma, and thus, we will emphasize the inclusion of this entity in the differential diagnosis and the use of skin direct immunofluorescence in the evaluation of patients with erythroderma.
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keywords = mortality
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5/56. Massive lower gastrointestinal hemorrhage caused by CMV disease as a presentation of hiv in an infant.

    The gastrointestinal (GI) manifestations of acquired immunodeficiency syndrome in children are related to opportunistic infections like cytomegalovirus (CMV). CMV disease of the GI tract is a major cause of morbidity and mortality in immunocompromised patients: it typically produces mucosal ulcerations that can result in pain, bleeding, diarrhea, and GI perforation, often around the cecum. Preoperative diagnosis may be difficult, plain films and barium enema are often non-specific, and endoscopic evaluation is impossible when there is massive bleeding. The patient usually needs surgery to establish the correct diagnosis and initiate appropriate treatment. The use of gancyclovir for CMV disease in the postoperative period has improved the prognosis.
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6/56. vibrio vulnificus septicemia in a patient with the hemochromatosis HFE C282Y mutation.

    vibrio vulnificus is an extremely invasive gram-negative bacillus found in marine waters that causes overwhelming bacteremia and shock that is associated with high mortality. Impaired iron metabolism has been implicated in the susceptibility to V vulnificus bacterial infections. We report a case of fatal V vulnificus sepsis in a 56-year-old man who died within 1 to 3 days after consuming raw seafood. At autopsy, he was found to have micronodular cirrhosis and iron overload. Postmortem genetic analysis revealed the presence of the hemochromatosis gene (HFE) C282Y mutation. To our knowledge, this is this first documented fatal case of V vulnificus infection in a patient proven to carry the HFE C282Y mutation. Because this patient was heterozygous for the major hereditary hemochromatosis mutation and was not previously diagnosed with clinical iron overload, the spectrum of clinical susceptibilities to V vulnificus infection may include carriers of the C282Y mutation.
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7/56. Severe falciparum malaria in five soldiers from east timor: a case series and literature review.

    Despite chemoprophylaxis, malaria remains a serious threat for large numbers of non-immune soldiers deployed in endemic areas. Five adult cases of severe falciparum malaria are reported. Three cases were complicated by multiorgan failure and one of these patients died from cerebral malaria. These cases serve to highlight issues, in an Australian intensive care unit, associated with the management of severe malaria, an uncommon disease in our country. The need for rapid diagnosis and commencement of appropriate treatment is paramount in preventing further morbidity and mortality. Understanding and management of malaria continues to evolve rapidly. The pathophysiology of acute lung injury, shock and brain injury associated with malaria are examined in light of recent research. This article discusses the current controversies of exchange blood transfusion and the use of the new artemisinin derivatives.
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8/56. Diffuse neonatal hemangiomatosis associated with Simpson-Golabi-Behmel syndrome: a case report.

    Diffuse neonatal hemangiomatosis (DNH) is a rare disorder characterized by multiple cutaneous and visceral hemangiomas that usually presents in newborns and has a high mortality rate.While previously reported cases of DNH describe multiple cutaneous hemangiomas, we present a patient with a single hemangioma of the ear, who also had DNH of the central nervous system and visceral organs. Furthermore, in this report we present a new constellation of findings, namely, a Simpson-Golabi-Behmel syndrome (SGBS). The practical implication on the basis of the experience with our patient is the need to ensure adequate diagnostics for patients with large hemangiomas as well as for patients with multiple cutaneous hemangiomas, because DNH also can occur in single hemangiomas in rare cases.
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9/56. Septic shock and multiple organ failure after hematopoietic stem cell transplantation: treatment with recombinant human activated protein c.

    Severe sepsis with multiple organ failure after hematopoietic stem cell transplantation (HSCT) results in extremely high morbidity and mortality. Recent studies have highlighted the importance of sepsis-induced activation of the coagulation system in the pathophysiology of severe sepsis. Activated protein c is an important modulator of coagulation and inflammatory derangements during severe sepsis. Low levels of protein c occur in severe sepsis and are predictive of poor outcome. Recombinant human activated protein c (drotrecogin alfa (activated)) was recently approved by the Food and Drug Administration (FDA) for severe sepsis. The phase III trial that resulted in the approval of this agent, however, enrolled a general sepsis population and excluded patients undergoing HSCT. We report a case of fulminant septic shock and multiple organ failure after HSCT that was treated with drotrecogin alfa (activated) in addition to standard therapy, and recovered. The high mortality rates of patients who develop severe sepsis after HSCT demand that new avenues of treatment be considered for this very high-risk patient population. This case illustrates the potential application of a novel therapeutic approach. Clinical trials are warranted to further investigate the safety and efficacy of drotrecogin alfa (activated) in patients with severe sepsis after HSCT.
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ranking = 2
keywords = mortality
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10/56. New thoughts on sepsis: the unifier of critical care.

    In the united states, more than $16 billion annually is spent managing patients with severe sepsis and its sequelae. Insight into the inflammatory response, endothelial tissue, and the coagulation cascade suggest promising new treatment regimens that limit morbidity and mortality due to sepsis and multisystem organ failure. This article will discuss new information regarding the pathophysiology of the inflammatory response and sepsis. Current thoughts on clinical management and a promising new agent, Activated protein c, will be presented.
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ranking = 1
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