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Acute Pharyngitis01:30

Acute Pharyngitis

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Acute Pancreatitis I: Introduction01:27

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Acute respiratory failure is a condition characterized by the inability of the lungs to perform their primary function: gas exchange. This failure leads to insufficient oxygen levels (hypoxemia) in the blood, elevated carbon dioxide levels (hypercapnia), or both, causing critical impairment in organ function.
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Type I Respiratory Failure, or hypoxemic respiratory failure, occurs when the partial pressure of oxygen (PaO2) in arterial blood falls below 60 mmHg while breathing room air without a corresponding increase in arterial carbon dioxide levels (PaCO2). This condition highlights a significant impairment in the lungs' capacity to oxygenate the blood.
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Acute Respiratory Failure-V01:29

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Acute Pyelonephritis I: Introduction01:27

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Drug-induced paraspinal myositis mimicking acute bilateral sciatica.

Richard Pearse1, Ravindran Visagan1, Kiran Reddy2

  • 1Emergency Department, Guy's and Saint Thomas' NHS Foundation Trust, London, UK.

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|February 24, 2019
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Summary

Cocaine use can cause rare paraspinal myositis, leading to severe sciatica and acute kidney injury. Prompt diagnosis and steroid treatment resolved symptoms, highlighting the importance of social history in emergency presentations.

Keywords:
drug misuse (including addiction)musculoskeletal syndromesorthopaedicsradiologyunwanted effects / adverse reactions

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Area of Science:

  • Toxicology
  • Neurology
  • Rheumatology

Background:

  • Cocaine-induced myopathy and myotoxicity are documented.
  • This case presents a rare instance of cocaine-induced paraspinal myositis.
  • The condition manifested with acute sciatic symptoms.

Observation:

  • A 35-year-old male presented with severe, bilateral sciatica.
  • Initial investigations revealed elevated inflammatory markers, creatinine, and creatine kinase (CK).
  • Lumbar MRI showed paraspinal inflammation, and muscle biopsy confirmed myositis.

Findings:

  • The patient was a cocaine user, linking the myositis to substance misuse.
  • Treatment with prednisolone resulted in significant improvement in renal function, CK levels, and C-reactive protein (CRP).
  • The patient recovered fully within six weeks.

Implications:

  • This case underscores the importance of detailed social history, including substance misuse, in emergency department evaluations for severe musculoskeletal pain.
  • Drug-induced myotoxicity, though rare, can present with severe symptoms and renal failure.
  • Early recognition and management of cocaine-induced paraspinal myositis are crucial for patient recovery.