Genitourinary Tuberculosis: An Atypical Clinical Presentation

Genitourinary tuberculosis is one of the common forms of extrapulmonary tuberculosis. We report a case of atypical genitourinary tuberculosis: massive uterovaginal prolapse with cervical lesion mimicking cervical carcinoma. This particular case highlights the problem of healthcare in most of the developing countries. Lack of patient education, awareness, and access to a healthcare system resulted in a complicated situation. In an endemic area or in an immunocompromised individual, a higher index of suspicion would allow early recognition and treatment institution to minimise its late consequences as well as spreading of the disease. Though anti-TB is the mainstay of treatment, surgical intervention might be needed in selected cases.

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Genitourinary Tuberculosis: A Rare Cause of Obstructive Uropathy in Pregnancy

Case Reports in Obstetrics and Gynecology ◽

10.1155/2014/985682 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4

Author(s):

Emily H. Adhikari ◽

Elaine L. Duryea ◽

Martha W.F. Rac ◽

Jeanne S. Sheffield

Keyword(s):

Pregnancy Outcomes ◽

Early Recognition ◽

Obstructive Uropathy ◽

Extrapulmonary Tuberculosis ◽

Percutaneous Nephrostomy ◽

Foreign Born ◽

Imaging Studies ◽

Genitourinary Tuberculosis ◽

Prompt Treatment ◽

In Pregnancy

Background. A rare but morbid form of extrapulmonary tuberculosis (TB), genitourinary TB is an important cause of obstructive uropathy and is likely underdiagnosed in pregnancy.Case. A 30-year-old primigravida undergoing treatment for active pulmonary TB presented with anuria at 13-14-weeks gestation. Bilateral ureteral strictures above the level of the ureterovesicular junctions were seen on imaging studies. Given her pulmonary disease, her obstructive uropathy was attributed to genitourinary TB. Bilateral percutaneous nephrostomy tubes were placed during pregnancy with successful ureteral reimplantation postpartum.Conclusion. Genitourinary TB should be considered as an etiology of urinary tract pathology during pregnancy, especially in foreign-born and immunocompromised persons. Early recognition resulting in prompt treatment can prevent further deterioration of maternal renal function and optimize pregnancy outcomes.

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An Intraarticular Osteoid Osteoma: A Case Report & Review of Literature

Nepalese Journal of Radiology ◽

10.3126/njr.v3i2.9615 ◽

2014 ◽

Vol 3 (2) ◽

pp. 77-80

Author(s):

AR Pant ◽

MK Gupta ◽

PK Santhalia ◽

K Ahmad ◽

RPS Kalawar ◽

...

Keyword(s):

Shoulder Pain ◽

Osteoid Osteoma ◽

Rare Case ◽

Clinical Presentation ◽

Review Of Literature ◽

Delay In Diagnosis ◽

Atypical Clinical Presentation ◽

The Common ◽

Central Calcification ◽

Chronic Shoulder Pain

Osteoid osteoma (OO) is one of the common benign bone tumors but an uncommon cause of musculoskeletal pain. Its diagnosis is usually not difficult in classic clinical setup and in typical location in diaphyseal region. However, the diagnosis of juxta or intraarticular osteoid osteoma (IAOO) is challenging because of atypical clinical presentation responsible for delay in diagnosis and treatment. We report a rare case of IAOO as a cause of chronic shoulder pain to make clinician aware to help in its early diagnosis and management. A 28-year-old woman presented with chronic debilitating right shoulder pain. The diagnosis was established on CTscan after 2 years of onset of symptoms because of atypical clinical presentation as a chronic monoarthritis of the shoulder. CTscan demonstrated radiolucent nidus with central calcification with areas of surrounding sclerosis. The tumor was excised surgically and histopathologic examination confirmed the diagnosis of osteoid osteoma. So, in the scenario of an unexplained chronic monoarthritis, the possibility of intraarticular osteoid osteoma should also be kept in mind. CT-scan remains the investigation of choice for demonstrating the nidus and surgical exicision relieves the symptoms. DOI: http://dx.doi.org/10.3126/njr.v3i2.9615 Nepalese Journal of Radiology Vol.3(2)July-Dec, 2013: 77-80

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Different outcomes of spontaneous gall bladder perforation owing to timing of surgical intervention: report of 2 cases

International Surgery Journal ◽

10.18203/2349-2902.isj20204707 ◽

2020 ◽

Vol 7 (11) ◽

pp. 3835

Author(s):

Nawaz M. Dakhani ◽

Yamanur P. Lamani

Keyword(s):

Case Report ◽

Gall Bladder ◽

Clinical Presentation ◽

Surgical Intervention ◽

Bladder Perforation ◽

Type I ◽

Delay In Diagnosis ◽

Type Iii ◽

Pain Abdomen ◽

Atypical Clinical Presentation

Gall bladder perforation (GBP) is a rare life-threatening complication with a high mortality due to atypical clinical presentation and delay in diagnosis due to atypical clinical presentation. Case report 1, 70-year-old female presented with complaints of pain abdomen, vomiting and blackish pigmentation over abdomen since a week. She was in shock on presentation, with necrotic patch over abdomen and abscess collection at umbilicus. Ultrasound revealed GBP at fundus with thick collection in gastrohepatic recess with overlying abdominal wall cellulitis. CECT was not possible and the patient could not be taken for surgery due to unstable vitals and expired the next day. Case report 2, a 68-year-old male presented with complaints of pain abdomen over right side with vomiting. Abdomen was tender diffusely with guarding in right hypochondrium. Ultrasound showed distended gall bladder (GB) with multiple calculi. Magnetic resonance cholangiopancreatography (MRCP) showed a GBP at fundus with pericholecystic collection extending into hepatogastric recess. He underwent total cholecystectomy and post-operative period was uneventful. Acute cholecystitis has a perforation rate of 2-11% due to cystic duct obstruction, ischemia and necrosis. Our first patient had type-III GBP and was in shock and did not survive due to bad condition on arrival whereas the second patient had type-I GBP and underwent cholecystectomy without any complications. Type-I and type-II GBP as proposed by Niemeier have better outcomes compared to type-III. Rapid diagnosis and surgical intervention are very much necessary for reducing mortality as they rarely present with typical signs and symptoms of perforation.

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Hemoperitoneum Secondary to Spontaneous Rupture of a Retroperitoneal Varix

Case Reports in Hepatology ◽

10.1155/2017/1829676 ◽

2017 ◽

Vol 2017 ◽

pp. 1-3

Author(s):

Derrick D. Eichele

Keyword(s):

Abdominal Pain ◽

Clinical Presentation ◽

Surgical Intervention ◽

Acute Abdominal Pain ◽

Early Recognition ◽

Relevant Literature ◽

Hypovolemic Shock ◽

Rare Condition ◽

Unique Case ◽

Life Threatening

Hemoperitoneum due to a ruptured retroperitoneal varix is an exceedingly rare condition and a poor prognostic sign with catastrophic and life-threatening complication of portal hypertension. We present a unique case of a 56-year-old female with cirrhosis secondary to primary sclerosing cholangitis who presented with acute abdominal pain and hypovolemic shock prior to a cardiac arrest following a ruptured retroperitoneal varix without prior esophageal varices and a newly identified intrahepatic cholangiocarcinoma. The clinical presentation with abdominal pain and hemorrhagic shock is consistently reported in the relevant literature. Early recognition affords appropriate management and urgent surgical intervention leading to survival.

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An Overview of Dementias

Perspectives on Swallowing and Swallowing Disorders (Dysphagia) ◽

10.1044/sasd21.3.75 ◽

2012 ◽

Vol 21 (3) ◽

pp. 75-84

Author(s):

Venkata Vijaya K. Dalai ◽

Jason E. Childress ◽

Paul E Schulz

Keyword(s):

Clinical Presentation ◽

Treatment Options ◽

Current Treatment ◽

Great Variability ◽

Health Concern ◽

Public Health Concern ◽

Life Threatening ◽

The Common ◽

Neurodegenerative Dementias ◽

Made In

Dementia is a major public health concern that afflicts an estimated 24.3 million people worldwide. Great strides are being made in order to better diagnose, prevent, and treat these disorders. Dementia is associated with multiple complications, some of which can be life-threatening, such as dysphagia. There is great variability between dementias in terms of when dysphagia and other swallowing disorders occur. In order to prepare the reader for the other articles in this publication discussing swallowing issues in depth, the authors of this article will provide a brief overview of the prevalence, risk factors, pathogenesis, clinical presentation, diagnosis, current treatment options, and implications for eating for the common forms of neurodegenerative dementias.

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Atypical Clinical Presentation of Laryngopharyngeal Reflux: A 5-Year Case Series

Journal of Clinical Medicine ◽

10.3390/jcm10112439 ◽

2021 ◽

Vol 10 (11) ◽

pp. 2439

Author(s):

Jerome R. Lechien ◽

Stéphane Hans ◽

Francois Bobin ◽

Christian Calvo-Henriquez ◽

Sven Saussez ◽

...

Keyword(s):

Clinical Presentation ◽

Laryngopharyngeal Reflux ◽

Case Series ◽

Clinical Findings ◽

Aerodigestive Tract ◽

Common Disease ◽

Upper Aerodigestive Tract ◽

Suppurative Otitis Media ◽

Adequate Treatment ◽

Atypical Clinical Presentation

Background: Laryngopharyngeal reflux (LPR) is a common disease in otolaryngology characterized by an inflammatory reaction of the mucosa of the upper aerodigestive tract caused by digestive refluxate enzymes. LPR has been identified as the etiological or favoring factor of laryngeal, oral, sinonasal, or otological diseases. In this case series, we reported the atypical clinical presentation of LPR in patients presenting in our clinic with reflux. Methods: A retrospective medical chart review of 351 patients with LPR treated in the European Reflux Clinic in Brussels, Poitiers and Paris was performed. In order to be included, patients had to report an atypical clinical presentation of LPR, consisting of symptoms or findings that are not described in the reflux symptom score and reflux sign assessment. The LPR diagnosis was confirmed with a 24 h hypopharyngeal-esophageal impedance pH study, and patients were treated with a combination of diet, proton pump inhibitors, and alginates. The atypical symptoms or findings had to be resolved from pre- to posttreatment. Results: From 2017 to 2021, 21 patients with atypical LPR were treated in our center. The clinical presentation consisted of recurrent aphthosis or burning mouth (N = 9), recurrent burps and abdominal disorders (N = 2), posterior nasal obstruction (N = 2), recurrent acute suppurative otitis media (N = 2), severe vocal fold dysplasia (N = 2), and recurrent acute rhinopharyngitis (N = 1), tearing (N = 1), aspirations (N = 1), or tracheobronchitis (N = 1). Abnormal upper aerodigestive tract reflux events were identified in all of these patients. Atypical clinical findings resolved and did not recur after an adequate antireflux treatment. Conclusion: LPR may present with various clinical presentations, including mouth, eye, tracheobronchial, nasal, or laryngeal findings, which may all regress with adequate treatment. Future studies are needed to better specify the relationship between LPR and these atypical findings through analyses identifying gastroduodenal enzymes in the inflamed tissue.

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1001 Intra-Articular Distal Radius Fracture Surgical Intervention Threshold Origins and Development

British Journal of Surgery ◽

10.1093/bjs/znab134.344 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

G Esworthy ◽

N Johnson ◽

J Dias ◽

P Divall

Keyword(s):

Distal Radius ◽

Clinical Presentation ◽

Surgical Intervention ◽

Threshold Value ◽

British Society ◽

Relevant Today ◽

Clinical Presentations ◽

Post Traumatic ◽

Current Guidance ◽

Traumatic Arthritis

Abstract Background Treatment of intra-articular distal radius fractures is guided by the displacement of the articular fragments. Symptomatic post-traumatic arthritis is expected to occur if step displacement is > 2mm; this value is often used as an indication for surgery if closed reduction is not possible. Method A systematic review was performed to establish the origin and adaptations of the threshold, with papers screened and relevant citations reviewed. Orthopaedic textbooks were reviewed to ensure no earlier mention of the threshold was present. Results Knirk and Jupiter, 1986, are the first to quantify a threshold, with all their patients developing arthritis with >2mm displacement. Some papers have discussed using 1mm, although 2mm is most widely reported. Current guidance from the British Society for Surgery of the Hand supports 2mm. Although this paper is still widely cited, the authors published a re-examination of the data showing methodological flaws which is not as widely reported. They claim their conclusions are still relevant today; however, the radiological arthritis does not correlate with the clinical presentation. Conclusions Knirk and Jupiter originated the threshold value of 2mm. The lack of correlation between the radiological and clinical presentations warrants further investigation. The principle of treatment remains restoration of normal anatomical position.

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The Challenges of Children with Bipolar Disorder

Medicina ◽

10.3390/medicina57060601 ◽

2021 ◽

Vol 57 (6) ◽

pp. 601

Author(s):

Robert M. Post ◽

Heinz Grunze

Keyword(s):

Bipolar Disorder ◽

Early Recognition ◽

Childhood Onset ◽

Traditional Treatment ◽

Treatment As Usual ◽

Treatment Regimens ◽

Oppositional Defiant ◽

Treatment Of Depression ◽

The Common ◽

Depressive Episodes

Childhood onset bipolar disorder (CO-BD) presents a panoply of difficulties associated with early recognition and treatment. CO-BD is associated with a variety of precursors and comorbidities that have been inadequately studied, so treatment remains obscure. The earlier the onset, the longer is the delay to first treatment, and both early onset and treatment delay are associated with more depressive episodes and a poor prognosis in adulthood. Ultra-rapid and ultradian cycling, consistent with a diagnosis of BP-NOS, are highly prevalent in the youngest children and take long periods of time and complex treatment regimens to achieve euthymia. Lithium and atypical antipsychotics are effective in mania, but treatment of depression remains obscure, with the exception of lurasidone, for children ages 10-17. Treatment of the common comorbid anxiety disorders, oppositional defiant disorders, pathological habits, and substance abuse are all poorly studied and are off-label. Cognitive dysfunction after a first manic hospitalization improves over the next year only on the condition that no further episodes occur. Yet comprehensive expert treatment after an initial manic hospitalization results in many fewer relapses than traditional treatment as usual, emphasizing the need for combined pharmacological, psychosocial, and psycho-educational approaches to this difficult and highly recurrent illness.

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Tuberculosis in Otorhinolaryngology: Clinical Presentation and Diagnostic Challenges

International Journal of Otolaryngology ◽

10.1155/2011/686894 ◽

2011 ◽

Vol 2011 ◽

pp. 1-4 ◽

Cited By ~ 11

Author(s):

Rajiv C. Michael ◽

Joy S. Michael

Keyword(s):

Mycobacterium Tuberculosis ◽

Pulmonary Tuberculosis ◽

Clinical Presentation ◽

Extrapulmonary Tuberculosis ◽

Common Type ◽

The Body ◽

Diagnostic Challenge ◽

Cervical Adenitis ◽

Important Form

Tuberculosis affects all tissues of the body, although some more commonly than the others. Pulmonary tuberculosis is the most common type of tuberculosis accounting for approximately 80% of the tuberculosis cases. Tuberculosis of the otorhinolaryngeal region is one of the rarer forms of extrapulmonary tuberculosis but still poses a significant clinical and diagnostic challenge. Over three years, only five out of 121 patients suspected to have tuberculosis of the otorhinolaryngeal region (cervical adenitis excluded) hadMycobacterium tuberculosisculture-proven disease. Additional 7 had histology-proven tuberculosis. Only one patient had concomitant sputum-positive pulmonary tuberculosis. We look at the various clinical and laboratory aspects of tuberculosis of the otorhinolaryngeal region that would help to diagnose this uncommon but important form of extrapulmonary tuberculosis.

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Prionopathies and Prionlike Protein Aberrations in Neurodegenerative Diseases

Neurographics ◽

10.3174/ng.2000035 ◽

2021 ◽

Vol 11 (2) ◽

pp. 127-148

Author(s):

K.N. Anderson ◽

W.B. Overcast ◽

J.R. Brosch ◽

B.D. Graner ◽

M.C. Veronesi

Keyword(s):

Neurodegenerative Diseases ◽

Protein Misfolding ◽

Clinical Presentation ◽

Prion Diseases ◽

Imaging Biomarkers ◽

Amyloid Pet ◽

Imaging Features ◽

Jakob Disease ◽

The Common ◽

Neuro Imaging

Protein misfolding has been an area of intense research and is implicated in a number of neurodegenerative diseases. Key proteins in the brain lose their native ability to fold and instead assume abnormal conformations. Misfolded proteins cluster to form pathologic aggregates, which cause cellular dysfunction, neuronal death, and neurodegeneration. The prionopathies are best known among the neurodegenerative diseases for their ability to misfold, self-propagate, and infect other organisms. There is increasing evidence of a rationale for a prionlike mechanism of spread of other neurodegenerative diseases through a similar seeding mechanism. In this review, we detail the role of a key protein aberration known to the various prion diseases, including sporadic, variant, and iatrogenic Creutzfeldt-Jakob disease; variably protease-sensitive prionopathy; Gerstmann-Straussler-Scheinker disease; fatal familial insomnia; and kuru. We also discuss the clinical presentation, the available, and emerging imaging options for these diseases. In the second part of this review, we delineate how a prionlike seeding process may be driving the progression of other neurodegenerative diseases, including Parkinson disease, Alzheimer disease, and Huntington disease. A discussion of clinical presentation and imaging features of these example diseases follows to make a case for a common approach to developing imaging biomarkers and therapies of these diseases.Learning Objective: Upon completion of this article, one should be able to describe the various types of prion diseases, recognize and identify the common the neuro-imaging findings in prion diseases, describe seeding mechanism of prion disease, list the common amyloid PET tracers used for Alzheimer’s disease, and list common imaging biomarkers in neurodegenerative diseases.

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