Clinical and Medical Case Reports

IIntroduction: Tongue swelling is one of the most common complications of endotracheal tube intubation associated with these devices. We present a rare complication of macroglossia following the use of an i-gel device. History: A 25-year-old male patient was admitted following a motorcycle accident resulting in a left sided tibia-fibula fracture. He underwent a reduction with an intramedullary nail fixation. General anaesthesia time was approximately three hours and the airway was maintained with a size 5 i-gel device. Following extubation a large ulcer was noted on the dorsum of the tongue with an associated significant swelling causing dysphagia. It was noted that the patient was drooling and had dysphonia. Nasoendoscopy revealed vocal cord oedema. Concerns were raised of the safety of the airway an he was admitted to ITU. The patient responded well to nebulised adrenaline and dexamethasone infusions over the next 48 hours and did not require re-intubation. His swelling and symptoms resolved fully and was discharged from hospital after 6 days. Discussion: Tongue swelling secondary to i-gel is not currently well documented when compared to other airway devices. Tongue swellings can be secondary to trauma, as well as compression of the venous drainage of the tongue. Patients may require HDU/ITU treatment. Conservative treatment with adrenaline and dexamethasone may provide a good outcome.

Aspergillus is a ubiquitous mould that can cause a wide variety of clinical syndromes ranging from mere colonization to fulminant invasive disease. Invasive aspergillosis (IA) is the most severe presentation of aspergillosis. The lung is usually the portal of entry, from which the pathogen may disseminate to almost any organ, often the brain and skin. The diagnosis remains a significant challenge. IA is generally encountered in immunocompromised patients with steroid treatment, chemotherapy resulting in severe neutropenia, hematopoietic stem cell, and solid organ transplantation. We reported a case of aspergillosis presented as cholangitis, with no lung involvement, in a patient with history of kidney transplantation and recent Diagnosis of Large B-Cell Lymphoma (DLBCL). The patient had several predisposing factors, such as immunosuppressive drug therapy and steroid therapy. The patient died 50 days after a diagnostic splenectomy for DLBCL. The Polymerase Chain Reaction (PCR) assessment performed on biopsy specimen from duodenum was positive for Aspergillus spp. It is a case of rare, isolated aspergillosis of biliary tract in a patient with both solid organ transplantation and haematological malignancy.