Pulmonary Aggregatibacter actinomycetemcomitans infection masquerades as malignancy in a patient with periodontitis

2021 ◽  
Vol 14 (2) ◽  
pp. e239636
Author(s):  
Emma Turner ◽  
Thomas Hastie ◽  
Pritam Daniel Sundaresan
Keyword(s):  
Systemic Disease ◽  
Systemic Infection ◽  
Aggregatibacter Actinomycetemcomitans ◽  
Periodontal Pathogen ◽  
Smoking History ◽  
Active Mass ◽  
Source Of Infection ◽  
Positron Emission ◽  
History Of ◽  
The Right

A 49-year-old man with a 37.5 pack-year smoking history presented with a suspected neoplasm of the right lung following the discovery of a metabolically active mass on positron emission tomography-CT imaging. The patient, who demonstrated poor oral hygiene, had a history of irregular problem-oriented dental visitation. Having excluded malignancy through histologic investigations, Aggregatibacter actinomycetemcomitans—a well-established periodontal pathogen—was subsequently cultured from his pulmonary aspirate. The patient was therefore managed with systemic antimicrobials and adjunctive dental extractions to eliminate the likely source of infection, whereafter the mass resolved without complication. This case corroborates previous reports of extraoral isolation of A. actinomycetemcomitans, which may mimic cancer clinically and radiographically. While a definitive causative link between untreated periodontitis and systemic infection remains to be elucidated, such cases present a compelling argument in favour of promoting oral health to prevent systemic disease.

DIAGNOSIS AND TREATMENT: MANAGEMENT OF IDIOPATHIC THROMBOCYTOPENIC PURPURA

PEDIATRICS ◽  
1964 ◽  
Vol 33 (6) ◽  
pp. 979-980
Author(s):  
Irving Schulman
Keyword(s):  
Idiopathic Thrombocytopenic Purpura ◽  
Systemic Disease ◽  
Purpura Fulminans ◽  
Systemic Infection ◽  
Bone Marrow Examination ◽  
Rational Approach ◽  
Thrombocytopenic Purpura ◽  
Disease States ◽  
History Of ◽  
Acute Itp

THE TERM idiopathic thrombocytopenic purpura (ITP) should be reserved for that hemorrhagic disorder characterized by a subnormal platelet count (usually below 50,000/cu mm) in the presence of a normal marrow containing normal or increased megakaryocytes and the absence of systemic disease capable of inducing thrombopenia. Bone marrow examination is mandatory to rule out leukemia, other infiltrative disorders, and hypoplastic and aplastic states; an L.E. preparation is indicated as are the careful search for systemic infection and renal disease and the detailed inquiry concerning drug ingestion. Although no specific antecedent event can be identified in most cases of ITP, it is recognized that some of the common childhood exanthemata may occasionally be followed by thrombocytopenic purpura (e.g., rubella, rubeola, varicella). The rational approach to treatment must be based upon understanding of the natural history of the disease. Acute ITP has an excellent prognosis and approximately 80% affected children will make a complete and permanent recovery without specific therapy. Of these, three-quarters will recover within 3 months of onset, most within 4 to 6 weeks. Approximately 20% of cases will persist longer than 6 months and are then usually designated as chronic. The mortality rate in acute ITP is extremely low and most of the urgency for treatment stems from concern over central nervous system hemorrhage. It seems clear that the incidence of CNS bleeding is no greater than 2-4% and that in most series reporting a greater incidence cases were not limited to ITP but included instances of thrombotic thrombocytopenic purpura and purpura fulminans, i.e., disease states associated with vasculitis.

Subdural false twins: concomitant appearance of subdural haematoma and spontaneous subdural empyema

2021 ◽  
Vol 14 (6) ◽  
pp. e240110
Author(s):  
Rúben Santos Cardoso ◽  
Sofia Tavares ◽  
Inácio Reis ◽  
José Luís Alves
Keyword(s):  
Multidisciplinary Approach ◽  
Systemic Infection ◽  
Blood Analysis ◽  
Surgical Drainage ◽  
Subdural Collection ◽  
E Coli ◽  
History Of ◽  
The Right ◽  
Burr Holes ◽  
Dural Opening

A 55-year-old man was taken to the emergency department due to right arm weakness for the past 3 days and fever (39.5°C). There was no impaired consciousness, no history of trauma and meningeal signs were absent on physical examination. Blood analysis and inflammatory markers were not evocative of a systemic infection. A cranial CT scan was requested, revealing hypodense bilateral hemispheric subdural collections, suggestive of chronic subdural haematomas. He was submitted to surgical drainage by burr holes, which confirmed the chronic subdural collection on the left side. Unexpectedly, after dural opening on the right side, a subdural purulent collection was found, which was later confirmed as an empyema due to Escherichia coli infection. A second surgical drainage was performed by craniotomy due to recurrence of the right subdural collection. Spontaneously appearing subdural empyemas due to E. coli are extremely rare and their treatment is not always straightforward. The reported case is an example of an apparently straightforward and frequent pathology that turned out to be a challenging case, requiring a multidisciplinary approach.

Ocular non-teratoid medulloepithelioma with teratoid metastases in ipsilateral intraparotid lymph nodes

2019 ◽  
pp. 112067211987007
Author(s):  
Jayati Sarangi ◽  
Aanchal Kakkar ◽  
Diya Roy ◽  
Rishikesh Thakur ◽  
Chirom Amit Singh ◽  
...  
Keyword(s):  
Lymph Nodes ◽  
Histopathological Examination ◽  
Previous History ◽  
Rare Presentation ◽  
Cervical Lymph Nodes ◽  
Extranodal Extension ◽  
Positron Emission ◽  
Parotid Neoplasm ◽  
History Of ◽  
The Right

Purpose: To describe a rare presentation of a case of intraocular non-teratoid medulloepithelioma with teratoid metastases in ipsilateral intraparotid lymph nodes. Case description: A 9-year-old male child with previous history of ciliary body non-teratoid medulloepithelioma presented with a swelling in the right pre-auricular region for 1 month. Magnetic resonance imaging and positron emission tomography–computed tomography showed a right intraparotid mass with enlarged ipsilateral cervical lymph nodes. A core biopsy was taken from the lesion, which on microscopy showed a tumor composed of small round cells arranged in cords, tubules lined by multilayered cells, and in cribriform pattern. These cells were embedded in a hypocellular, loose myxoid matrix. Based on the histopathological characteristics and previous history, a diagnosis of medulloepithelioma metastastic to ipsilateral parotid gland was made. The patient underwent right total conservative parotidectomy and bilateral neck dissection. Histopathological examination revealed metastatic medulloepithelioma in five out of eight intraparotid lymph nodes, with extranodal extension into the adjacent parotid parenchyma. Foci of hyaline cartilage were identified within the tumor, leading to a diagnosis of metastatic teratoid medulloepithelioma. Conclusion: Intraparotid lymph node metastases from intraocular medulloepithelioma is a rare possibility and we recommend that the parotid should be evaluated in cases of intraocular medulloepithelioma at initial presentation as well as during the follow-up period. Also, metastasis should be considered in all pediatric patients with solitary mass lesions showing unconventional histology for a primary parotid neoplasm.

scholarly journals PARATHYROMATOSIS: A RARE CASE OF RECURRENT HYPERPARATHYROIDISM LOCALIZED BY FOUR-DIMENSIONAL COMPUTED TOMOGRAPHY

2019 ◽  
Vol 5 (6) ◽  
pp. e384-e387 ◽  
Author(s):  
Abraham E. Wei ◽  
Matthew R. Garrett ◽  
Ankur Gupta
Keyword(s):  
Computed Tomography ◽  
Rare Case ◽  
Clinical Laboratory ◽  
Parathyroid Tissue ◽  
Severe Hypercalcemia ◽  
Positron Emission ◽  
Affected Tissue ◽  
History Of ◽  
The Right ◽  
Recurrent Hyperparathyroidism

Objective: To present a rare case of parathyromatosis. Methods: We present the clinical, laboratory, and imaging findings, along with a review of the literature. Results: A 33-year-old man with a history of right upper parathyroid adenoma removal 5 years prior due to hyperparathyroidism was admitted for severe hypercalcemia (15.6 mg/dL; normal, 8.5 to 10.5 mg/dL) with elevated plasma parathyroid hormone (PTH) (882 pg/mL; normal, 15 to 65 pg/mL). Ultrasound, computed tomography (CT), sestamibi, and positron emission tomography scans were unremarkable; however, a four-dimensional CT (4DCT) of the neck showed an area of increased signal enhancement and hypervascularity without discrete nodule in the posterior right thyroid region. The patient underwent parathyroid surgical exploration with right hemithyroidectomy and compartment neck dissection to remove the affected tissue. PTH levels dropped to 208 pg/mL postoperatively; calcium decreased but remained elevated at 12.7 mg/dL. Pathology revealed the presence of several small nodular foci of atypical hyperplastic parathyroid tissue in the right thyroid and soft tissue in the left central neck compartment consistent with parathyromatosis. Conclusion: This case report represents the first-time use of 4DCT to localize parathyromatosis. Parathyromatosis is a rare but problematic cause of recurrent hyperparathyroidism. Ultrasound and 4DCT may represent the best imaging modalities for identification and perioperative management to remove all affected tissue without reseeding.

scholarly journals Isolated myxoid degeneration of aortic valve: diagnostic dilemma

2019 ◽  
Vol 12 (3) ◽  
pp. e228414
Author(s):  
Htay Htay Kyi ◽  
Kewan Hamid ◽  
Luay Alkotob ◽  
Thair Dawood
Keyword(s):  
Aortic Valve ◽  
Acute Pulmonary Oedema ◽  
Diagnostic Dilemma ◽  
Positron Emission ◽  
Valve Insufficiency ◽  
History Of ◽  
History Of Epilepsy ◽  
The Right ◽  
Myxoid Degeneration

Myxoid degeneration of the aortic valve as a cause of acute aortic valve regurgitation in young age is uncommon. We report a 39-year-old African-American man with a history of epilepsy and hypertension who presented with a 1-month history of worsening shortness of breath. He was diagnosed with acute pulmonary oedema. Transoesophageal echocardiogram showed normal ejection fraction but severe aortic valve insufficiency with small masses on the ventricular side of the right and non-coronary cusps, small vegetations cannot be ruled out but other valves were normal. Subsequent cultures were negative for endocarditis. Myocardial positron emission tomography (PET) scan was strongly suggestive of cardiac sarcoidosis. However, this diagnosis was ruled out as well when he underwent aortic valve replacement with bioprosthetic valve as he did not want to take long-term anticoagulation. Histological examination of the aortic valve showed myxoid degeneration. The patient was doing very well 1 year after the surgery.

scholarly journals Purtscher’s retinopathy: a case report

2020 ◽  
Vol 10 (3) ◽  
pp. 103-105
Author(s):  
Sushma Chaudhary ◽  
Sharad Gupta ◽  
Reena Yadav ◽  
Vinit Kumar Kabmle ◽  
Satbodh Shrestha
Keyword(s):  
Systemic Disease ◽  
Fluorescence Angiography ◽  
Purtscher’S Retinopathy ◽  
Corrected Visual Acuity ◽  
History Of ◽  
Anterior Segments ◽  
The Right ◽  
Sudden Blindness ◽  
Time Of Presentation ◽  
Definite Treatment

Purtscher’s retinopathy is a rare haemorrhagic and vaso-occlusive vasculopathy following severe head trauma associated with sudden blindness. Here we report a case of 28 years old male pre­sented to out-patient department with history of sudden and painless loss of vision in his right eye for two days. He gave history of head injury following bike accident. At the time of presentation his best corrected visual acuity was 1/60 in the right eye and 6/6 in the left eye. On examina­tion, anterior segments of both eyes were normal. On fundus examination, right eye revealed retinal whitening in the peripapillary region (Purtscher’s flecken), an intraretinal hemorrhage and signs of macular edema whereas left eye was unremarkable. Findings were suggestive of right eye purtscher’s retinopathy. Optical coherence tomography and fundus fluorescence angiography was done to support the diagnosis. Purtscher’s retinopathy should not be neglected because it is associated with different systemic disease. Its pathophysiology remains unclear and there is no definite treatment but meticulous management is urgent to prevent from severe complications.

scholarly journals A Case of Persistent Hiccup after Laparoscopic Cholecystectomy

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Elisa Grifoni ◽  
Costanza Marchiani ◽  
Alessia Fabbri ◽  
Gabriele Ciuti ◽  
Andrea Pavellini ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Histological Analysis ◽  
Rare Complication ◽  
Malignant Lesion ◽  
Tracer Uptake ◽  
Surgical Specimen ◽  
Positron Emission ◽  
Transthoracic Biopsy ◽  
History Of ◽  
The Right

A 79-year-old man, with history of recent laparoscopic cholecystectomy, came to our attention for persistent hiccup, dysphonia, and dysphagia. Noninvasive imaging studies showed a nodular lesion in the right hepatic lobe with transdiaphragmatic infiltration and increased tracer uptake on positron emission tomography. Suspecting a malignant lesion and given the difficulty of performing a percutaneous transthoracic biopsy, the patient underwent surgery. Histological analysis of surgical specimen showed biliary gallstones surrounded by exudative inflammation, resulting from gallbladder rupture and gallstones spillage as a complication of the previous surgical intervention. This case highlights the importance of considering such rare complication after laparoscopic cholecystectomy.

Unusual presentation of sarcoidosis, requiring a positron emission tomography/CT (PET/CT) for diagnosis

2021 ◽  
Vol 14 (1) ◽  
pp. e237424
Author(s):  
Kenneth O'Riordan ◽  
Tauseef Mohyuddin ◽  
Manus Moloney
Keyword(s):  
Positron Emission Tomography ◽  
Bone Biopsy ◽  
Kidney Injury ◽  
Ct Scanning ◽  
Emission Tomography ◽  
Lower Back ◽  
Positron Emission ◽  
Pet Ct ◽  
History Of ◽  
The Right

A 43-year-old man presented to hospital after routine laboratory tests showed an acute kidney injury and hypercalcaemia. He had no relevant medical history and normal physical examination, other than a 6-week history of lower back pain for which he had been taking naproxen. Low parathyroid hormone (PTH) levels indicated a PTH-independent hypercalcaemia. Investigations including CT of thorax, abdomen and pelvis and subsequent bone biopsy and renal biopsy were unremarkable. Positron emission tomography/CT (PET/CT) scan was ultimately considered as a diagnostic test and showed abnormalities in the right subpectoral and portacaval region with intense fluorodeoxyglucose F 18 uptake in local lymph nodes. A biopsy of the right subpectoral node showed granulomatous change consistent with sarcoidosis. PET/CT scanning can play an important role in the investigation of suspected malignancy, infection and inflammatory disease and in this case, was required to diagnose an atypical presentation of sarcoidosis.

Solitary Fibrous Tumor of the Orbit with Extraorbital Extension: Case Report

Neurosurgery ◽  
2001 ◽  
Vol 49 (5) ◽  
pp. 1241-1245 ◽  
Author(s):  
Satoru Hayashi ◽  
Hideyuki Kurihara ◽  
Junko Hirato ◽  
Tomio Sasaki
Keyword(s):  
Residual Tumor ◽  
Middle Cranial Fossa ◽  
Short Term ◽  
First Case ◽  
Positron Emission ◽  
History Of ◽  
Cranial Fossa ◽  
Mitotic Figures ◽  
Fibrous Tumor ◽  
The Right

ABSTRACT OBJECTIVE AND IMPORTANCE Solitary fibrous tumors (SFTs) are rare tumors of mesenchymal origin that typically arise in the pleura. Only 24 cases of SFTs in the orbit have been reported, all located within the orbit and generally with a benign course. We report the first case of an orbital SFT with extraorbital extension and short-term regrowth. CLINICAL PRESENTATION A 54-year-old man presented with proptosis and double vision that had persisted for 7 months. The tumor extended from the right extraconal inferolateral orbit to the extradural middle cranial fossa and cavernous sinus, via the superior orbital fissure, on magnetic resonance imaging scans. Positron emission tomography with [18F]fluorodeoxyglucose demonstrated faint uptake in the orbital portion. INTERVENTION Resection of the tumor was performed twice, because of short-term regrowth of the residual tumor in the orbit. The histological diagnosis was a SFT. The MIB-1 labeling index was 7% and the mitotic count was 5 mitotic figures/10 high-power fields at the time of the second operation. These findings indicate the malignant nature of the tumor. CONCLUSION The natural history of SFTs of the orbit remains unclear, and the importance of careful and continued follow-up monitoring of the tumor should be emphasized.

scholarly journals Pharmacoresistant Abdominal Seizures in Symptomatic Localization-Related Epilepsy

2021 ◽  
Vol 11 (1) ◽  
pp. 106-109
Author(s):  
Vadakke Puthanveetil Tushar ◽  
Sachin Sureshbabu ◽  
Kunnath Gopalakrishnan Sruthi ◽  
Smilu Mohanlal
Keyword(s):  
Abdominal Pain ◽  
Focal Epilepsy ◽  
Obstructive Hydrocephalus ◽  
Recurrent Abdominal Pain ◽  
Resonance Imaging ◽  
Present Case Report ◽  
Ventriculoperitoneal Shunting ◽  
Positron Emission ◽  
History Of ◽  
The Right

Abdominal epilepsy is an uncommon cause of recurrent abdominal pain with or without other complaints seen in children and adults which often goes unnoticed. Here we are presenting a case of abdominal epilepsy in a 7-year boy who had recurrent abdominal pain since many years. He had a history of ventriculoperitoneal shunting which was performed for obstructive hydrocephalus at 1 month and left hemiparesis. He was evaluated at multiple centers for abdominal complaints before being referred here. The video electroencephalogram done showed inter ictal and ictal abnormalities which correlated with magnetic resonance imaging and positron emission tomography abnormalities on the right side. He was started on antiepileptics with a partial response and continued to get events even with four antiepileptics but the frequency and severity reduced significantly. The present case report is to highlight the drug refractoriness of abdominal seizures in a patient with symptomatic focal epilepsy.

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