Khat is a drug widely used in the Horn of Africa and the Arabian Peninsula. Khat leaves contain, among other substances, the psychoactive alkaloid cathinone, which induce central nervous system stimulation leading to euphoria, hyperactivity, restlessness, and insomnia. However, it also could cause psychological adverse effects such as lethargy, sleepiness, psychoses, and depression necessitating pharmacologic treatment. Here we report the case of a 35-year-old man from Somalia who became unconscious and developed aspiration pneumonia and subsequent ARDS after excessive consumption of khat leaves. His unconsciousness was possibly caused by the sleepiness developed after khat consumption and a benzodiazepine intake by the patient himself.  Thus, khat-induced adverse effects should not primarily be treated pharmacologically, but patients should be urged to quit khat consumption in order to eliminate or, at least, reduce the severity of present psychological adverse effects.

Marlene Wewalka

Andreas Drolz

Katharina Staufer

Thomas M. Scherzer

Valentin Fuhrmann

Christian Zauner

Development of ARDS after Excessive Kath Consumption: A Case Report

The patient was a 36-year-old woman with sarcoidosis and Sjogren&#39;s syndrome, and had been prescribed slow-release diclofenac sodium and prednisolone for the treatment of pain associated with uveitis and erythema nodosum. She was admitted to our emergency center with abdominal pain and distention. A chest X-ray showed free air under the diaphragm on both sides, and an emergency laparotomy was performed for suspected panperitonitis associated with intestinal perforation. Laparotomy revealed several perforations on the antimesenteric aspect of the transverse colon. The resected specimen showed 11 punched-out ulcerations, many of which were up to 10&#x2009;mm in diameter. The microscopic findings were non-specific, with leukocytic infiltration around the perforations. She showed good postoperative recovery, as evaluated on day 42. The present case highlights the need for exercising caution while prescribing slow-release nonsteroidal anti-inflammatory drugs with corticosteroids to patients with autoimmune diseases, as such treatment may exacerbate intestinal epithelial abnormalities.

Nobuki Shioya

Shigehiro Shibata

Masahiro Kojika

Shigeatsu Endo

Multiple Transverse Colonic Perforations Associated with Slow-Release Nonsteroidal Anti-Inflammatory Drugs and Corticosteroids: A Case Report

Acute necrotizing encephalopathy (ANE) is a severe neurological complication of influenza infection, including H1N1 influenza. Many cases of ANE have been reported in the pediatric literature, but very few cases have been described in adults. The cause of ANE remains unknown&#8212;the influenza virus is not known to be neurotropic, and evidence of direct viral involvement of the central nervous system (CNS) has not been demonstrated in the limited cases of ANE in which pathological specimens have been obtained. Here we report a fatal case of ANE from H1N1 influenza infection in an adult. Neuroimaging and postmortem analysis both showed widespread brain edema, necrosis, and hemorrhage, but molecular studies and postmortem pathology revealed no evidence of direct viral involvement of the CNS. This case of fatal ANE in an adult is consistent with the hypothesis generated from pediatric cases that the host immune response, and not direct viral invasion of the CNS, is responsible for pathogenesis of ANE.

Yu-Jin Lee

D. Scott Smith

Vivek A. Rao

Robert D. Siegel

Jon Kosek

Carol A. Glaser

Alexander C. Flint

Fatal H1N1-Related Acute Necrotizing Encephalopathy in an Adult

The left subclavian artery pseudoaneurysm is a rare entity with few cases reported in the literature. Most injuries were related to iatrogenic manipulation with catheters for canalization of central lines. In rare cases, this injury has been described secondary to a blunt trauma. We present an unusual case of pseudoaneurysm that includes the origin of left subclavian artery in the context of severe multiple injuries after a traffic accident. There were not clavicular or rib fractures, or another type of chest trauma to justify such a vascular injury. Once the injuries that were life threatening for the patient were stabilized, it proceeded to the treatment of the pseudoaneurysm by placing an endovascular prosthesis successfully with a favorable clinical evolution.

J. Enamorado-Enamorado

J. J. Egea-Guerrero

J. Revuelto-Rey

E. Gordillo-Escobar

C. Herrera-Melero

Left Subclavian Artery Pseudoaneurysm after a Traffic Accident: A Case Report

We report the case of two-year-old girl with hypovolemic shock caused by bleeding from an abdominal cystic lymphangioma. The whole blood was contained within a large omental bag that could be completely removed. There were no associated anomalies. The child progressed satisfactorily.

E. Consuegra Llapur

J. M. L&#243;pez Alvarez

O. P&#233;rez Quevedo

M. Valer&#243;n Lemaur

S. Pavlovic Nesic

X. Garc&#237;a Urgell&#233;s

Cystic Lymphangioma as a Cause of Massive Abdominal Hemorrhage

Severe hypertriglyceridemia (SH) represents a therapeutic emergency because of the possibility of developing cardiovascular events and hyperlipemic acute pancreatitis (PA). Most patients with SH suffer primary or genetic abnormality in lipid metabolism in combination with a precipitating factor such as uncontrolled diabetes mellitus, alcoholism, and drug intake. The standard treatment of hypertriglyceridemia (HTG) with omega 3 fatty acids and fibrates, along with dietary changes, has no effect on an emergency situation. There are no clinical guidelines to SH, but therapy with insulin, heparin, a combination of both, plasmapheresis, or octreotide have been tested succesfully. We report the case of a 10-year-old girl with clinical acute pancreatitis and diabetic ketoacidosis debut, along with incidental finding of an SH, who had a good outcome after treatment with insulin intravenous infusion.

Yesica Rodr&#237;guez Santana

Andrea Nimo Rom&#225;n

Iker Garc&#237;a S&#225;ez

Jos&#233; Manuel L&#243;pez Alvarez

Eduardo Consuegra Llapur

Rafael Gonz&#225;lez Jorge

Treatment of Severe Hypertriglyceridemia with Continuous Insulin Infusion

A 63-year-old male with history of hypertension, dyspnea on exertion, and chronic chest pain was admitted for elective cardiac angiography. Arterial blood pressure was 160/90 mmHg in both arms. Femoral and popliteal pulses were extremely weak, and third (S3) and fourth (S4) heart sounds were audible. Aortography showed a mildly dilated aortic root with double brachiocephalic trunk and interruption of aortic arch at isthmus. Profuse and well-developed collaterals appeared at neck and thorax. The patient was recommended to take medical treatment for his hypertension and advanced heart failure. The aim of this paper, is to review the diagnostic and therapeutic options for treatment of the interrupted aortic arch.

Hassan  Javadzadegan

Jahan Porhomayon

Alireza Sadighi

Mehrdad  Yavarikia

Nader Nader

Isolated Interrupted Aortic Arch: Unexpected Diagnosis in a 63-Year-Old Male

Acute postpartum uterine inversion is a relatively rare complication. The uterus inverts and the uterine fundus prolapses to or through the dilated cervix. It is associated with major postpartum haemorrhage with or without shock. Shock is sometimes out of proportion to the haemorrhage. Minimal maternal morbidity and mortality can be achieved when uterine inversion is promptly and aggressively managed. We present this report of three cases of acute uterine inversion complicated with major postpartum haemorrhage and managed with Rusch balloon. The paper highlights the importance of early recognition and the safety of the use of intrauterine balloon to manage major postpartum haemorrhage in these cases.

Remon Keriakos

Smriti Ray Chaudhuri

Managing Major Postpartum Haemorrhage following Acute Uterine Inversion with Rusch Balloon Catheter

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Case Reports in Critical Care publishes case reports and case series in all areas of critical care medicine, including anesthesiology, perioperative and critical care medicine, and postoperative critical care management and recovery.

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Case Reports in Critical Care - Table of contents

title

Case Reports in Critical Care publishes case reports and case series in all areas of critical care medicine, including anesthesiology, perioperative and critical care medicine, and postoperative critical care management and recovery.

Case Reports in Critical Care