Category Archives: Case Report

Para-Infectious Acute Transverse Myelitis Following Sars-Cov2 Infection: A Case Report

Oana Mosora1, Valentin Moroșanu1, Adina Stoian1,2, Rodica Bălașa1,2

1. Neurology 1 Clinic, Emergency Clinical County Hospital Mures, Targu Mures, Romania
2. George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2021-0024

Introduction: The new pandemic has highlighted new ways of clinical presentation of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) including a possible link to central nervous system (CNS) manifestation.
Case report: We present a case of acute transverse myelitis following a SARS-CoV 2 infection in a 34-year-old man who presented with bilateral lower-extremity weakness and acute urinary retention. Cervical magnetic resonance imaging showed a T2 hyperintense signal abnormality at C3-C6 and D3-D7 levels consistent with acute myelitis.
Conclusion: SARS-CoV 2 can cause myelitis by immune-mediated mechanisms, therefore it is extremely important for the clinicians to recognise the signs and promptly treat this neurological complication.

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Management of late onset recurrent ventricular tachycardia following circumflex artery injury during minimally invasive mitral valve replacement surgery – Clinical case report

Timea Magdolna Szabo1,2, Mihaela Ispas1, Ayman Elkahlout1

1. Emergency Institute for Cardiovascular Diseases and Transplantation, Targu Mures, Romania
2. Pharmaceutical biochemistry and the chemistry of environmental factors, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2021-0013

Introduction: A rare complication of mitral valve surgery is the injury of the circumflex artery due to their close anatomical proximity resulting in a perioperative myocardial infarction and subsequent fibrosis with increased risk of developing ventricular arrhythmias.
Case presentation: We hereby describe the case of a 74-year-old male patient who underwent minimally invasive mitral valve replacement surgery for severe mitral regurgitation two weeks prior to presenting to the emergency department with dyspnea, palpitations and slight thoracic discomfort. He was diagnosed with recurrent sustained monomorphic ventricular tachycardia due to inferior wall myocardial infarction. Angioplasty of the culprit lesion was attempted, but the procedure failed due to the elastic recoil of the vessel. Our patient received antiarrhythmic therapy and an implantable cardioverter-defibrillator for secondary prevention of sudden cardiac death, with no further recorded episodes of ventricular tachycardia.
Conclusion: Although injury of the circumflex coronary artery during mitral valve surgery is described as rare, we strongly believe that increasing awareness of the potential risks involved can further prevent fatal complications.

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Metatypical Carcinoma – A Continuous Challenge for the Clinician

Oana Mirela Tiucă1, Andreea Cătălina Tinca2, Sabin Turdean3, Ovidiu Simion Cotoi4, Silviu Horia Morariu5

1. Dermatology Clinic, Mures Clinical County Hospital, Targu Mures, Romania
2. Pathology Service, Mures Clinical County Hospital, Targu Mures, Romania
3. Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
4. Department of Pathophysiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
5. Department of Dermatology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2020-0026

Introduction: Non-melanocytic skin cancers represent the most frequent type of cutaneous carcinomas. Also called basosquamous cell carcinoma and considered by some authors as a clinical form of basal cell carcinoma, metatypical carcinoma represents a controversial clinical entity.
Case presentation: This paper aims to present the case of a 42-year-old female patient who presented to the doctor’s office for the appearance of a painful cutaneous tumor located in the left submandibular region. Excisional biopsy was performed. The microscopic features were consistent with the diagnosis of metatypical carcinoma with the predominance of the squamous type.
Conclusions: Taking into consideration its aggressive behavior, careful follow-up of patients diagnosed with this rare type of cutaneous tumor is mandatory for precocious identification of possible metastases and improvement of long and short term prognosis.

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Prenatal Diagnosis of Binder Phenotype, Naso-Maxillar Hypoplasia

Lucian Gheorghe Pop1, Ioan Dumitru Suciu2, Nicolae Bacalbasa3, Oana Daniela Toader1,3

1. National Institute of Mother and Child Care Alessandrescu-Rusescu, Bucharest, Romania
2. Floreasca Emergency Hospital, General Surgery Department, Bucharest, Romania
3. University of Medicine and Pharmacy-Carol Davila-, Bucharest, Romania
4. University of Medicine and Pharmacy -Carol Davila-, Bucharest, Romania

DOI: 10.2478/amma-2020-0032

Facial dysmorphism is a common diagnosis which represents a broad spectrum of aetiologies with different outcomes spreading from normal outcome to foetal demise or new-borns with multiple malformations. Prenatal diagnosis can be difficult, making counseling a challenging task even in experienced hands. This paper aims to present an unusual case of facial dysmorphism (Binder phenotype) which resulted in a normal pregnancy. However, throughout the pregnancy, future parents experienced excruciating anxiety, which required multiple prenatal counseling appointments. We believe that in case of a Binder phenotype, genetic testing, multiple scanning appointments and extensive discussion with future parents are vital in the prevention of an unneeded ending of a pregnancy.

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Genitourinary Bacterial Infection: a Cause of Infertility in Men? A Cases Series and Short Review of Literature

Răzvan Lucian Coșeriu1, Camelia Vintilă1, Bianca Irina Kosovski2, Anca Delia Mare3, Cristina Nicoleta Ciurea3

1. Department of Immunology, Mures County Clinical Hospital – Infectious Diseases Laboratory, Targu Mures, Romania
2. Department of Physiopathology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
3. Department of Microbiology, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2020-0024

Introduction: The role of bacterial infections on the onset and the development of male infertility is still highly controversial, as the clinical cases have different outcomes and the practitioners have no guidelines that will help them select the cases that could better benefit from antibiotic treatment.
Case presentation: Four case reports are presented in order to emphasize the possible clinical implications of genitourinary bacterial infections on male infertility. The first patient had two bacterial strains isolated from the semen culture, Escherichia coli, and then Enterococcus faecalis. The antibiotic treatment was not effective. The second patient had a semen culture positive with Enterococcus faecalis. The treatment was successful: the bacteria were eradicated and the patient was able to conceive a baby. Enterococcus faecalis was also identified in the third and the fourth case. These patients were able to conceive, despite the different clinical management strategies of the cases.
Conclusion: Bacterial prostatitis might play a role in male infertility, but the clinical cases are still highly unpredictable. Every case presents a different viewpoint and raises awareness of the complexity of the problem.

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Ovarian Endometriosis and Malignant Transformation in Clear Cell Carcinoma

Ioana Maria Maier1, Adrian Cornel Maier2

1. Doctoral school, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2. Department of Urology, Faculty of Medicine, University “Dunarea de Jos” Galati, Romania

DOI: 10.2478/amma-2020-0023

Atypical endometriosis is considered to be precursors for malignancy. Coexistence of atypical endometriosis and ovarian neoplasm has been found in some studies. We describe the case of a 48-year old women diagnosed with clear cell carcinoma of ovary. The review of histological slide confirms the presence of benign endometriosis in both ovaries, the atypical endometriosis and clear cell carcinoma in the right ovary and the presence of uterine leiomyoma.

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SARS-CoV2 Infection in a Multiple Sclerosis Patient Treated with Natalizumab – A Case Presentation

Georgiana Șerban, Rodica Bălașa

George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2020-0022

Introduction: The novel coronavirus, SARS-CoV2, has rapidly spread worldwide and led to an intense collaboration among both physicians and researchers in order to stop its dissemination. Little is yet known about how this virus behaves, but recent studies have suggested the role of integrins in the viral penetration of target cells. Natalizumab is an anti-α4-β1 integrin monoclonal antibody used in the treatment of multiple sclerosis (MS), a neurodegenerative auto-immune disease affecting primarily young adults. MS patients have a greater susceptibility to develop severe infections especially enhanced by the disease-modifying therapies (DMTs) which are currently recommended for their treatment. Natalizumab is considered the safest high-efficacy DMT in times of COVID-19 outbreak.
Case presentation: We hereby describe the first case from Romania of a MS patient treated with Natalizumab who subsequently acquired SARS-CoV2 infection and whose recovery was excellent, with no functional neurological or respiratory sequelae.
Conclusion: The favourable evolution of our patient supports the potential therapeutic effect Natalizumab might have in SARS-CoV2 treatment by specifically blocking integrins and by its immunosuppressant characteristics.

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Ambulatory Treatment of Pressure Sores in a Patient without Neurological Lesions

Anca Cighir, Paul Antoniu Adrian Boțan

George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania

DOI: 10.2478/amma-2020-0021

Introduction: Pressure sores have been defined as areas of localized soft tissue ischemic necrosis caused by prolonged pressure related to posture, which usually occur over a bony prominence. The most affected areas are those that undergo a lot of tension such as trochanters, sacrum, malleoli, heels and occiput. Most people that are affected by pressure sores have an underlying pathology that makes them immobile, confining them to chairs or bed for longer periods of time. Pressure ulcers may have direct causes (pressure, shear, friction, immobility, loss of sensation) or indirect causes.
Case presentation: This paper will present the case of a 53-year-old male. After about 3 weeks of being immobilized in bed in dorsal decubitus due to an acute respiratory distress which required intubation and mechanical ventilation, the patient developed very large pressure sores on the left sacral and buttock area and left sole. He was treated in the outpatient department using multiple therapeutic protocols based on the alternation of antibiotic creams and modern absorbent dressings.
Conclusions: The evolution of this patient was long but favorable, the left sacral and buttock area eschar closing completely while the sole eschar had a good evolution, but is still undergoing treatment.

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Asymptomatic Myxomatous Degeneration of the Mitral Valve, in a Young Male

Carmen Opris1, Horatiu Suciu1,2, Catalin Satala3, Cosmin Banceu2, Cosmin Opris1, Alexandra Stoica2, Tudor Capilna2, Simona Gurzu3,4

1. Department of Adult and Children Cardiovascular Recovery, Emergency Institute for Cardio-Vascular Diseases and Transplantation, Targu Mures, Romania
2. Department of Surgery, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
3. Department of Pathology, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania
4. Research Center (CCAMF), George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, Targu Mures, Romania

DOI: 10.2478/amma-2020-0018

Background: In young patients, the most common cause of mitral valve regurgitation is prolapse or flail of the valve, which is morphologically reflected by myxomatous degeneration. In rare cases, such this presented in this paper, this lesion might be incidentally identified, in young people.
Case presentation: A 43-year-old male, with familial history of hypertension, presented in our Department of Cardiology for a routine check-up. Despite of lack of symptoms, an intense murmur was detected at mitral auscultation area. The echocardiography revealed a severe mitral regurgitation caused by flail of posterior mitral valve. The patient was transferred to the Cardiac Surgery Department for surgical intervention consisting in mitral valve repair. The histopathological examination revealed severe myxomatous degeneration of the spongiosa and fibrosa layers. The recovery after surgery was very good with no postoperative complications. The patient was discharged seven days after surgery, with no significant mitral regurgitation at the three-month follow-up.
Conclusions: In young, asymptomatic patients, the proper time for mitral valve repair should be decided by an interdisciplinary team. For a better understanding of myxomatous degeneration particularities, histopathological assessment should be done in any replaced valve. Certification of such lesions, under microscope, might be an indicator for familial cardiovascular screening, in first degree relatives.

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Necrobiosis Lipoidica Diabeticorum

Anca Cighir, Paul Antoniu Adrian Boțan

George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania

DOI: 10.2478/amma-2020-0013

Introduction: Necrobiosis lipoidica diabeticorum is a rare complication occuring mostly in diabetic patients appearing as a skin redness that soon transforms into an extensive necrosis. The usual aspect of such lesions is a deep ulceration with irregular borders developing especially on the lower limbs.
Case presentations: This paper intends to present two cases of necrobiosis lipoidica diabeticorum focusing on the clinical aspect of this disease and the original treatment applied in the Plastic Surgery Department of the Clinical County Hospital of Targu Mures. Both patients suffered from type II insulin-requiring diabetes. The first case is a 63 year old female with different stages of necrobiosis lipoidica diabeticorum lesions developed on the anterior aspect of both legs. This patient was treated using only conservative methods. The second case is a 64 year old male who developed an extensive full-thickness necrosis on the right dorsal aspect of the hand and forearm. The lesions required conservative treatment and the surgical debridement of the extensive necrotic tissues.
Conclusions: Necrobiosis lipoidica diabeticorum is a dramatic condition requiring a well informed approach in order to save the healthy tissues as much as possible. In both cases, the wounds healed spontaneously after a long period of time.

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