scholarly journals Lymphadenitis “As Rosary beads” - a diagnostic challenge

2019 ◽  
Vol 44 (3) ◽  
pp. 20-23
Author(s):  
Vitorino Modesto Dos Santos ◽  
Micheline Silva Abreu De Azevedo ◽  
Katia Rejane Marques Brito ◽  
Larissa Almondes Da Luz ◽  
Kayursula Dantas Ribeiro
Keyword(s):  
Case Reports ◽  
Clinical Manifestations ◽  
Definitive Diagnosis ◽  
Medical Attention ◽  
Diagnostic Challenge ◽  
Regional Lymph Nodes ◽  
Primary Health ◽  
Primary Focus ◽  
The Right ◽  
High Index Of Suspicion

Introduction: nodular lymphangitis (NL) may be a manifestation of various infectious and non-infectious conditions, characterised by subcutaneous inflammatory nodules that extend from the site of the primary focus to the regional lymph nodes. NL usually constitutes a challenge in primary health care, and histopathological and microbiological evaluations are necessary to establish the definitive diagnosis. Methods: We report a classic case of NL that developed in the upper limb of a middle-aged man after trauma on the right thumb. The objective:  was to emphasise some aspects of the differential diagnosis in a patient with NL and to reduce the rate of misdiagnosis in the scenery of initial medical attention. Results: the clinical manifestations were non-specific, but the microbiological study revealed typical characteristics of sporotrichosis. The treatment with itraconazole (200 mg daily) for six months was successful. Conclusion: NL constitutes a challenging condition and the early diagnosis depends on a high index of suspicion. Case reports may reduce late diagnoses with unfavourable results.

scholarly journals A case benign struma ovarii

2021 ◽  
Vol 10 (3) ◽  
pp. 1224
Author(s):  
P. G. Paul ◽  
Anjana Annal ◽  
K. Anusha Chowdary ◽  
George Paul ◽  
Manali Shilotri
Keyword(s):  
Adnexal Mass ◽  
Thyroid Tissue ◽  
Clinical Manifestations ◽  
Benign Disease ◽  
Definitive Diagnosis ◽  
Ovarian Tumors ◽  
Struma Ovarii ◽  
Standard Line ◽  
Imaging Characteristics ◽  
The Right

Struma ovarii is a rare ovarian tumor and a monodermal variant of dermoid tumors of the ovary in which thyroid tissue components constitute more than 50% of the mass. Struma ovarii accounts for 0.5–1.0% of all ovarian tumors and 2-5% of ovarian teratomas. Most cases are benign, but malignant transformation is found in a small percentage. It usually presents as a unilateral adnexal mass at fifth and sixth decades of life, with symptoms like other ovarian tumors. The definitive diagnosis is made by histological examination. Adnexectomy remains the standard line of treatment for benign disease. A 41-year-old lady presented with pain in abdomen for 3 months. On ultrasonography and MRI, a multiloculated solid cystic lesion of 7×6 cm with internal echoes was found in the right adnexa. Laparoscopic right adnexectomy was performed. Histopathology was consistent with struma ovarii. Due to its vague clinical manifestations and diverse imaging characteristics, pre-operative diagnosis is challenging. 

Tracheo-oesophageal groove Hodgkin’s lymphoma presenting as stridor: a diagnostic challenge

2021 ◽  
Vol 14 (1) ◽  
pp. e238271
Author(s):  
Joshua Agilinko ◽  
Anas Gomati ◽  
Ghada Bashat ◽  
Muhammad Shakeel
Keyword(s):  
Hodgkin’S Lymphoma ◽  
Case Reports ◽  
Rare Condition ◽  
Needle Aspiration ◽  
Hodgkin's Lymphoma ◽  
Diagnostic Challenge ◽  
Thyroid Papillary ◽  
Diagnostic Work ◽  
The Right ◽  
Team Setting

A 38-year-old male patient presented to the ear, nose and throat department with shortness of breath over last 2 months. The CT scan of the neck and chest revealed a 3.3×3 cm tumour behind the right thyroid lobe extending into the tracheo-oesophageal (TO) groove with tracheal compression. The ultrasound scan of the neck and targeted fine needle aspiration followed by core biopsy raised a suspicion of Hodgkin’s lymphoma. The patient underwent a right hemithyroidectomy and incisional biopsy of the right TO groove tumour. The histology confirmed a Hasenclever’s three nodular sclerosing Hodgkin’s lymphoma for which he received adjuvant chemotherapy. An incidental pT1a pN0 thyroid papillary microcarcinoma in the adjacent thyroid parenchyma was completely excised. This represents a case of TO Hodgkin’s lymphoma, of which there are no current published case reports. We aim to raise awareness about this rare condition by sharing the diagnostic work up and successful management in a multidisciplinary team setting.

scholarly journals An Unexpected Cause of a Subcutaneous Nodule: A Case Report ofDirofilariaInfection

2012 ◽  
Vol 2012 ◽  
pp. 1-3
Author(s):  
Bruno Man-Hon Cheung ◽  
Yi-Lan Huang ◽  
Yie-Wen Lin ◽  
Yung-Sen Chang ◽  
Shian-Min Liu
Keyword(s):  
Definitive Diagnosis ◽  
Subcutaneous Nodule ◽  
Medical Attention ◽  
Hematogenous Spread ◽  
Incidental Diagnosis ◽  
Systemic Involvement ◽  
Subcutaneous Nodules ◽  
Source Of Infection ◽  
Natural Hosts ◽  
The Right

Humans are not natural hosts ofDirofilaria; however, pulmonary or subcutaneous infections may occur through mosquitoes transmission. Patients presenting with simple subcutaneous nodules may not seek early medical attention, and hence systemic involvement through hematogenous spread may occur. Definitive diagnosis of Dirofilaria infection is made by histopathological examinations of the infected tissues. We report a patient with an incidental diagnosis of Dirofilaria infection confirmed by histopathological findings of a subcutaneous nodule on the right thigh. The source of infection remains unknown.

scholarly journals Clinical Manifestations and Outcome of Fluoroquinolone Associated Acute Interstitial Nephritis

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S297-S297
Author(s):  
Saira Farid ◽  
Omar AbuSaleh ◽  
Maryam Mahmood ◽  
Zerelda Esquer Garrigos ◽  
Abdurrahman Hamadah ◽  
...  
Keyword(s):  
Renal Function ◽  
Interstitial Nephritis ◽  
Treatment Duration ◽  
Case Reports ◽  
Clinical Manifestations ◽  
Acute Interstitial Nephritis ◽  
Flank Pain ◽  
High Index Of Suspicion ◽  
Baseline Renal Function ◽  
Antibiotic Treatment Duration

Abstract Background Fluoroquinolones (FQ) are among the most commonly prescribed antibiotics. Nephrotoxicity related to FQ use is infrequently reported and the mechanism of renal injury is incompletely elucidated. We describe clinical manifestations and outcome of patients with biopsy proven acute interstitial nephritis (AIN) associated with FQ use at our institution. Methods We conducted a retrospective review of biopsy-proven AIN attributed to FQ use at Mayo Clinic Rochester from 1993 to 2016. Cases were reviewed by a renal pathologist and attributed to FQ use by an expert nephrologist. We also reviewed and summarized all published case reports of biopsy proven AIN that were attributed to FQ use. Results We identified 24 patients with FQ-related biopsy-proven AIN. The most commonly used FQ was ciprofloxacin (71%) with median antibiotic treatment duration of 7 days (Figure 1). The median duration between starting FQ and the diagnosis of AIN was 8.5 (IQR: 17). Common clinical manifestations included fever (50%), flank pain (8%), and skin rash (21%). However, 17% of the patients were asymptomatic at the time of diagnosis (Figure 2). Majority (58%) of the patients recovered following discontinuation of antibiotics and returned to baseline renal function at a median of 20.5 (IQR: 15.5). Six patients required temporary hemodialysis and 9 patients received steroids. Conclusion Onset of FQ-related AIN can be delayed and a high index of suspicion is needed by physicians prescribing these agents. Overall outcomes are favorable with recovery to baseline renal function within 3 weeks of discontinuing the offending drug. Disclosures All authors: No reported disclosures.

scholarly journals All That Wheezes Is Not Asthma: A Case of Diffuse Large B-Cell Lymphoma of the Larynx

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Bushra Rahman ◽  
Jawad Bilal ◽  
Qurat Ul Ain Riaz Sipra ◽  
Irbaz Bin Riaz
Keyword(s):  
B Cell ◽  
Cell Lymphoma ◽  
Case Reports ◽  
B Cell Lymphoma ◽  
Laryngeal Neoplasms ◽  
Diagnostic Challenge ◽  
Large B Cell Lymphoma ◽  
Acute Airway Obstruction ◽  
High Index Of Suspicion ◽  
Large B Cell

Localized laryngeal lymphoma is a rare entity with an incidence of less than 1% of all laryngeal neoplasms. Diffuse large B-cell lymphoma (DLBCL) is the most common type of laryngeal neoplasms. Here, we describe a case of a young 28-year-old female with large B-cell lymphoma who remained undiagnosed for a long time owing to a myriad of nonspecific presentation including “wheezing.” Although primary laryngeal lymphomas constitute a diagnostic challenge since they are rare, one should have a high index of suspicion for lymphoma of the larynx in patients presenting with unresolved wheezing as it can present catastrophically with acute airway obstruction requiring immediate surgical intervention which was observed in this case. Treatment includes radiotherapy, chemotherapy, immunotherapy, or a combination of these. We hope that the discussions ensuing from case reports regarding uncommon presentations of laryngeal lymphoma may spur the formation of regional/international databases for the description of lymphomas with unusual presentations. This effort can lead to in-depth study of cases and prompt awareness of “rare and subtle presentations” of laryngeal lymphoma.

Thyroid Carcinoma in a Patient with a Coexisting Functional Adenoma

1979 ◽  
Vol 87 (6) ◽  
pp. 768-774 ◽  
Author(s):  
Andrew Blitzer ◽  
Max L. Som
Keyword(s):  
Case Reports ◽  
Lower Lobe ◽  
Follicular Carcinoma ◽  
Surgical Excision ◽  
Malignant Degeneration ◽  
Functional Area ◽  
Regional Lymph Nodes ◽  
Hot Nodule ◽  
Risk Patients ◽  
The Right

Fourteen case reports have been published in which “hot” nodules have been documented as carcinoma, with or without coexisting adenomas. The diagnosis of these lesions is difficult, since hot nodules usually represent benign disease. These carcinomas are not functional, but represent coexistence of a functional area or a malignant degeneration. Hot nodule carcinomas should be suspected in high-risk patients. A euthyroid, 31-year-old woman who, as a teenager, had radiotherapy for acne is reported. She was followed up with yearly scans for a hot nodule in the right lower lobe of her thyroid. When she was 36, a node was discovered in the right side of her neck, and carcinoma was suspected. Surgical excision revealed a papillary-follicular carcinoma adjacent to an adenoma with metastases to regional lymph nodes.

scholarly journals Case Report: Sarcoidosis with azygos vein enlargement mimicking metastatic cancer

F1000Research ◽  
2020 ◽  
Vol 9 ◽  
pp. 661
Author(s):  
Abdallah Qasim ◽  
Omar Kousa ◽  
Mohamed Mansour ◽  
Ahmad K. Aly ◽  
Dana Awad ◽  
...  
Keyword(s):  
Fungal Infections ◽  
Case Reports ◽  
Metastatic Cancer ◽  
Systemic Disease ◽  
Clinical Manifestations ◽  
Azygos Vein ◽  
Diagnostic Challenge ◽  
Serious Infections ◽  
Noncaseating Granulomas ◽  
Rule Out

Sarcoidosis is a systemic disease with heterogeneous clinical manifestations that is characterized histologically by the presence of noncaseating granulomas in the affected organs. It can be a diagnostic challenge, especially when mimicking malignancy or fungal infections. Previous case reports of sarcoidosis presenting with multiple masses are highly suggestive of infectious or malignant etiology.  In this case, our patient presented with enlarged lymph node and was found to have innumerable nodules in the mediastinum, lungs, and liver. Azygos vein enlargement was also seen on radiological imaging, and malignancy was highly suspected; hence, an extensive workup was conducted, including laboratory, radiology and biopsy evaluation, which were diagnostic of sarcoidosis. Our case showed the importance of correlation of the history, physical examination, radiological and histopathologic studies in confirming the diagnosis and the need to rule out other serious infections and malignancies, especially with azygous vein enlargement, which can sometimes be missed in chest radiograph.

scholarly journals Unusual Pneumonia Mimic

2019 ◽  
Author(s):  
Joana Ricardo Pires ◽  
Maria José Moreira ◽  
Margarida Martins ◽  
Clarinda Neves
Keyword(s):  
Clinical Presentation ◽  
Lower Lobe ◽  
Community Acquired Pneumonia ◽  
Diagnostic Challenge ◽  
X Ray ◽  
Severe Hypoxaemia ◽  
Chest X Ray ◽  
The Right ◽  
High Index Of Suspicion ◽  
Exploratory Laparoscopy

Disease in atypical organ locations can mimic other pathologies, hampering the right diagnosis. Such conditions may even be emergencies, like appendicitis. Subhepatic appendix is a very rare entity which may be caused by caecum dehiscence failure. The authors present the case of a 55-year-old immunocompetent man admitted to the Emergency Department with sepsis and severe hypoxaemia. Chest x-ray showed right lower lobe infiltrate, and community-acquired pneumonia was diagnosed. The patient was started on broad-spectrum antibiotics, but he continued to deteriorate and after 3 days developed abdominal complaints. Exploratory laparoscopy revealed an abscess caused by perforated subhepatic appendicitis. Subhepatic appendicitis presents a diagnostic challenge and its clinical presentation may mimic that of other entities. This case highlights an atypical presentation, where the early development of inflammatory lung injury mimicked common pneumonia. Maintenance of a high index of suspicion and knowledge of these atypical locations is crucial.

scholarly journals A rare case of thyroid tuberculosis

2018 ◽  
Vol 5 (7) ◽  
pp. 2679
Author(s):  
Sivakumar Thirunavukkarasu ◽  
Atreya M. Subramanian
Keyword(s):  
Histopathological Examination ◽  
Follicular Adenoma ◽  
Giant Cells ◽  
Diagnostic Challenge ◽  
Caseous Necrosis ◽  
Right Lobe ◽  
Thyroid Tuberculosis ◽  
Anti Tubercular Therapy ◽  
The Right ◽  
High Index Of Suspicion

Thyroid tuberculosis although known to be a rare entity provides a diagnostic challenge to the clinician. Clinically, radiologically and even histologically proving to be difficult to arrive at a diagnosis. Its incidence according to literature is 0.1-0.4%. Tuberculosis may be found at multiple sites but incidence in the thyroid, pancreas, striated and cardiac muscle is extremely rare. Herein, we discuss a case of a 60 year old female complaining of a swelling in the front of the neck (more on the right side) since 45 days. Clinically it appeared to be a thyroid swelling. An ultrasound showed a bulky right lobe with heterogeneous echoes. FNAC showed features suggestive of a follicular adenoma. Intraoperatively a firm thyroid was palpable and total thyroidectomy was done. Histopathological examination was done revealing langhan giant cells and an area of caseous necrosis, confirming tuberculosis. The patient was started on thyroid replacement therapy and anti-tubercular therapy. The patient had no significant complications in the 6 months follow up period. In tuberculosis endemic areas, one must maintain a high index of suspicion for thyroid swellings which may show foci of tuberculosis, especially if they have an elevated ESR and other foci of tuberculosis. 

scholarly journals Spectrum of juvenile antiphospholipid syndrome in two siblings: Case reports and review of literature

2020 ◽  
Author(s):  
Basil Fathalla ◽  
Khulood W Khawaja ◽  
Samina Afzal
Keyword(s):  
Lupus Erythematosus ◽  
Case Reports ◽  
Clinical Manifestations ◽  
Human Leukocyte ◽  
Anticardiolipin Antibodies ◽  
Leukocyte Antigen ◽  
Hla Dr ◽  
Whole Exome ◽  
High Index Of Suspicion ◽  
Diagnosis Criteria

Abstract BackgroundAntiphospholipid syndrome (APS) in children together with familial APS is extremely rare, differs from adult APS, and has no validated diagnosis criteria. Use of adult APS classification criteria for the diagnosis of pediatric APS may result in missed or delayed diagnoses in children as non-thrombotic clinical manifestations may precede thrombotic manifestations for prolonged periods. We report rare triple positivity of antiphospholipid antibodies (aPL) in two siblings presenting with a variable spectrum of juvenile primary APS manifestations and a review of literature.Case reportTwo siblings presented with a variable spectrum of juvenile primary APS manifestations at 13 years of age. Both patients had high triple aPL positivity on multiple occasions at least 12 weeks apart including positive anticardiolipin antibodies, anti-β2-glycoprotein 1 antibodies, and lupus anticoagulant tests. The older brother, currently 16 years of age, had a spectrum of clinical manifestations during his disease course including cutaneous thrombotic microangiopathy, arthralgia, and pulmonary embolism. His sister is currently 14 years of age and she presented with non-thrombotic clinical manifestations, was immediately screened, and diagnosed with triple aPL positivity at 13 years of age. A seven years old healthy brother was screened once and had negative aPL test results. Systemic investigations including work up for systemic lupus erythematosus in both symptomatic siblings were unremarkable and whole exome sequencing was inconclusive. Human leukocyte antigen (HLA) screen revealed positive HLA-DR4 and DQB1*0302 tests for both symptomatic siblings but not for the healthy brother.ConclusionWe conclude that non-thrombotic clinical manifestations may precede thrombotic manifestations in primary APS in children, and this may cause significant delays in the diagnosis. Familial primary APS is very rare but may occur and high index of suspicion is required to test relatives with subtle clinical manifestations. Our case reports further support possible HLA-DR and -DQ associations with aPL antibodies.

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