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The literature article "missing elements of the history" by larry a.
Allen, m.
D.
, amrut v.
Ambardekar, m.
D.
, kalpana m.
Devaraj, m.
D.
, joseph j.
Maleszewski, m.
D.
, and eugene e.
Wolfel, m.
D.
Published by the new england journal of medicine on 6 feburary 2014 was reviewed for reportability.
The article reports on a (b)(6) year old woman who has a bilatera asr summit hip implant system.
The article reports she "presented to her primary care physician with cough, exertional dyspnea, and foot swelling that had developed 2 weeks earlier while she was vacationing in (b)(6).
She had no rhinorrhea, pharyngitis, fever, rash, diarrhea, or new joint symptoms.
Her medical history was notable for polyarthritis, for which her rheumatologist prescribed minocycline and meloxicam.
She had undergone right total hip replacement 4 years previously, left total hip replacement 3 years previously, and left total knee replacement 1 year previously.
There was no history of hypertension or diabetes.
She had never used tobacco, illicit drugs, or herbal supplements and did not consume large amounts of alcohol.
She was married and primarily had been a homemaker for her three children, and she did not have known occupational exposures.
There was no family history of early-onset pulmonary or cardiovascular disease.
Vital signs were within normal limits.
She received a diagnosis of pneumonia and ¿travel-related edema¿ and was treated with a course of antibiotics; no chest imaging or blood tests were performed, and she did not receive diuretics.
" over time she presented with dyspnea, edema, fatigue, that bilateral lower-leg edema that progressed to the point where she required left ventricular assist device leading to a heart transplant 5 months later.
13 months prior to heart transplant she was informed of the asr recall and was recommended to plain radiography and clinical examination every 6 months which revealed no evidence of abnormality of the prosthesis.
"however, 7 months after transplantation, the patient was advised to undergo further hip imaging and measurement of serum cobalt levels owing to further safety concerns with her hip prostheses.
Pelvic mri showed bilateral thin-walled fluid collections that were consistent with pseudotumors caused by a reaction to metal implants (¿metallosis¿) (fig.
3); the serum cobalt level was 287.
6 g per liter (reference value, <1.
0).
" arrangements were made with the heart transplantation team for the patient to receive replacements of the asr products performing left hip first and then right hip 9 weeks later.
Revision surgery confirmed the metallosis with findings of gross metal staining along the entire anterior aspect of the abductor system, a pseudotumor on the iliotibial band and metallosis present on the hip joint.
The article reports: "the postoperative course was complicated by deconditioning, a fall, and deep-vein thrombosis.
After removal of both metal-on-metal hips, the serum cobalt levels rapidly decreased, the serum bnp level decreased, and the lvef returned to the normal range (table 1).
With rehabilitation, the patient reported, ¿i feel stronger daily.
¿.
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