Case report: multiple and atypical amoebic cerebral abscesses resistant to treatment

Abstract Background The parasite Entamoeba histolytica is the causal agent of amoebiasis, a worldwide emerging disease. Amebic brain abscess is a form of invasive amebiasis that is both rare and frequently lethal. This condition always begins with the infection of the colon by E. histolytica trophozoites, which subsequently travel through the bloodstream to extraintestinal tissues. Case presentation We report a case of a 71-year-old female who reported an altered state of consciousness, disorientation, sleepiness and memory loss. She had no history of hepatic or intestinal amoebiasis. A preliminary diagnosis of colloidal vesicular phase neurocysticercosis was made based on nuclear magnetic resonance imaging (NMRI). A postsurgery immunofluorescence study was positive for the 140 kDa fibronectin receptor of E. histolytica, although a serum analysis by ELISA was negative for IgG antibodies against this parasite. A specific E. histolytica 128 bp rRNA gene was identified by PCR in biopsy tissue. The final diagnosis was cerebral amoebiasis. The patient underwent neurosurgery to eliminate amoebic abscesses and was then given a regimen of metronidazole, ceftriaxone and dexamethasone for 4 weeks after the neurosurgery. However, a rapid decline in her condition led to death. Conclusions The present case of an individual with a rare form of cerebral amoebiasis highlights the importance of performing immunofluorescence, NMRI and PCR if a patient has brain abscess and a poorly defined diagnosis. Moreover, the administration of corticosteroids to such patients can often lead to a rapid decline in their condition.

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Unilateral pulmonary vein atresia presenting with recurrent haemoptysis in a child: a case report

BMC Pediatrics ◽

10.1186/s12887-020-02348-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Martin Ngie Liong Wong ◽

Ing Ping Tang ◽

Yek Kee Chor ◽

Kiew Siong Lau ◽

Anne Rachel John ◽

...

Keyword(s):

Foreign Body ◽

Pulmonary Vein ◽

Cardiac Ct ◽

Pulmonary Veins ◽

Final Diagnosis ◽

Foreign Body Aspiration ◽

Case Presentation ◽

Right Pulmonary Artery ◽

History Of ◽

Recurrent Haemoptysis

Abstract Background Haemoptysis is an uncommon presenting symptom in children and is usually caused by acute lower respiratory tract infection or foreign body aspiration. We report a rare case of right unilateral pulmonary vein atresia (PVA) as the underlying aetiology of recurrent haemoptysis in a child. Case presentation A 4 years old girl presented with history of recurrent haemoptysis. Bronchoscopic evaluation excluded a foreign body aspiration but revealed right bronchial mucosal hyperaemia and varices. Diagnosis of right unilateral PVA was suspected on transthoracic echocardiography which demonstrated hypoplastic right pulmonary artery and non-visualization of right pulmonary veins. Final diagnosis was confirmed on cardiac CT angiography. A conservative treatment approach was opted with consideration for pneumonectomy in future when she is older. Conclusion Rarer causes should be considered when investigating for recurrent haemoptysis in children. Bronchoscopy and cardiac imaging are useful tools to establish the diagnosis of unilateral PVA in our case.

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Mixed cortico-medullary adrenal carcinoma in children: looks are deceptive!!

Annals of Pediatric Surgery ◽

10.1186/s43159-021-00134-3 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Arti Khatri ◽

Nidhi Mahajan ◽

Niyaz Ahmed Khan ◽

Natasha Gupta

Keyword(s):

Past History ◽

Case Reports ◽

Final Diagnosis ◽

Adrenal Carcinoma ◽

Case Presentation ◽

First Case ◽

Contrast Enhanced ◽

Paediatric Age ◽

History Of ◽

Enhanced Computed Tomography

Abstract Background Mixed cortico-medullary adrenal carcinoma (MCMAC) is an extremely rare entity with scarce literature on its cytomorphology. Case presentation A 2-year-old girl presented with abdominal pain for 3 days and a past history of fever with significant weight loss. On examination, a non-tender left hypochondrial firm mass and an enlarged left supraclavicular node were found. Twenty-four-hour urinary levels of VMA were marginally high. Contrast-enhanced computed tomography of the abdomen showed a suprarenal heterogeneous mass encasing major vessels. Aspiration cytology of both mass and node showed similar features comprising a predominant population of singly scattered large cells with moderate cytoplasm, eccentric nucleus and prominent nucleolus in a necrotic background. Tumour cells expressed Synaptophysin and Melan-A. In view of increasing respiratory distress, debulking surgery was performed, and histopathology of the specimen revealed the presence of both malignant medullary and cortical components supported by immunohistochemistry making a final diagnosis of MCMAC. The patient succumbed to death in the postoperative period. The cytology slides were reviewed and were seen to show a dual cell population. Conclusion Coexistent malignant cortical and medullary tumour of the adrenal gland is the first case reported in the paediatric age group in the literature with only three previous case reports in adults.

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Retained Intraabdominal Gossypiboma, Five Years after Bilateral Orchiopexy

Case Reports in Medicine ◽

10.1155/2010/420357 ◽

2010 ◽

Vol 2010 ◽

pp. 1-4 ◽

Cited By ~ 4

Author(s):

Mohammad Kazem Moslemi ◽

Mehdi Abedinzadeh

Keyword(s):

Medical Training ◽

Final Diagnosis ◽

The Body ◽

Surgical Sponge ◽

Human Errors ◽

Strict Adherence ◽

Case Presentation ◽

Radiologic Evaluation ◽

Surgical History ◽

History Of

Introduction.Gossypiboma or textiloma is used to describe a retained surgical swab in the body after an operation. Intraabdominal surgical sponge is an uncommon surgical error. The incidence of gossypiboma has been reported as high as 1 in 1000 to 15,000 intraabdominal operations. Gossypiboma may cause serious morbidity and may lead to mortality.Case presentation.Herein, we report a 24 years-old man who was admitted due to the intraabdominal mass after evaluation of primary infertility. He had a surgical history of bilateral abdominal orchiopexy 5 years previously, performed at another hospital. Hydatid cyst was suspected by abdominal computed tomography. After laparotomy excision, the cyst wall opened incidentally, and draining of a large amount of thick pus with retained surgical gauze within the cyst was found, with final diagnosis of gossypiboma.Conclusion.The policy that prevention is far more important than cure is highly appreciated. Accurate sponge and instrument counts, along with radiologic evaluation when a discrepancy is found, can be helpful. Although human errors cannot be completely avoided, continuous medical training and strict adherence to rules of the operation room should reduce the incidence of gossypiboma to a minimum. Surgical sponges should be counted once at the start and twice at the end of all surgical operations.

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Kikuchi-Fujimoto disease presenting in a patient with SARS-CoV-2: a case report

BMC Infectious Diseases ◽

10.1186/s12879-021-06048-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Samuel D. Racette ◽

Borislav A. Alexiev ◽

Michael P. Angarone ◽

Ajay Bhasin ◽

Kaitlin Lima ◽

...

Keyword(s):

Emergency Department ◽

Needle Biopsy ◽

Cervical Lymphadenopathy ◽

Expectant Management ◽

Final Diagnosis ◽

Lymph Node Biopsy ◽

Case Presentation ◽

Follicular Hyperplasia ◽

Node Biopsy ◽

History Of

Abstract Background We present a yet to be described association of SARS-CoV-2 infection with Kikuchi-Fujimoto disease. Case presentation A 32-year-old physician with history of SARS-CoV-2 infection presented to the emergency department with 2 weeks of fever, chills, and right sided cervical lymphadenopathy. He was treated empirically for presumed folliculitis with worsening of symptoms leading to repeat presentation to the emergency department. Extensive workup was unrevealing of an infectious cause and needle biopsy of the lesion was unrevealing. An excisional lymph node biopsy revealed follicular hyperplasia with necrotic foci showing abundance of histiocytes at the edge of necrosis with CD8 predominance of T-cells. Final diagnosis was deemed to be Kikuchi-Fujimoto disease. Antibiotic therapy was discontinued, and the patient’s symptoms resolved with steroid therapy and expectant management. Conclusions This is the first report of a patient developing Kikuchi-Fujimoto disease following SARS-CoV-2 infection. Clinicians should be aware of Kikuchi-Fujimoto disease as a possibility when approaching patients with hyper-inflammatory states who present with cervical lymphadenopathy.

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Asthma-like symptoms: is it always a pulmonary issue?

Multidisciplinary Respiratory Medicine ◽

10.4081/mrm.2018.167 ◽

2018 ◽

Vol 13 ◽

Author(s):

Davide Piloni ◽

Claudio Tirelli ◽

Rita Di Domenica ◽

Valentina Conio ◽

Amelia Grosso ◽

...

Keyword(s):

Contrast Medium ◽

Aortic Arch ◽

Pulmonary Function Tests ◽

Vascular Ring ◽

Final Diagnosis ◽

Double Aortic Arch ◽

Case Presentation ◽

Volume Curve ◽

Flow Volume Curve ◽

History Of

Background: Double aortic arch is a rare congenital and complete vascular ring around trachea and esophagus. It is usually diagnosed during infancy. The symptoms are generally related to respiratory and gastroesophageal tracts. Case presentation: A 20-year-old female patient was referred to our outpatient clinic for persistent dry cough. She had a history of an episode of inhalation of food bolus as an infant and recurrent bronchitis, anorexia and allergic bronchial asthma since the childhood. Since the beginning, an intrathoracic obstruction was suspected at pulmonary function tests. After 1 month of complete asthma treatment, the cough was unchanged and the spirometry confirmed the presence of an intrathoracic obstruction. Then, she underwent a chest CT with contrast medium, a contrast transthoracic echocardiography, a fiberbronchoscopy and an esophageal radiography with contrast medium. The final diagnosis was made and a double aortic arch was found. Conclusion: A careful observation of the flow/volume curve should always be guaranteed and the presence of congenital vascular anomalies should be suspected in case of difficult-to-treat asthma.

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An Unusual Presentation of Cholecystoduodenal Fistula: Abdominal Pain out of Proportion to Exam

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2019.4.42686 ◽

2019 ◽

Vol 3 (3) ◽

pp. 305-306

Author(s):

Ryan McCreery ◽

Matthew Meigh

Keyword(s):

Abdominal Pain ◽

Multimodality Imaging ◽

Rare Complication ◽

Gallbladder Disease ◽

Final Diagnosis ◽

Cholecystoduodenal Fistula ◽

Case Presentation ◽

History Of ◽

Biliary Enteric Fistula ◽

Specific Symptoms

Cholecystoduodenal fistula (CDF) is a rare complication of gallbladder disease. Clinical presentation is variable, and preoperative diagnosis is challenging due to the non-specific symptoms of CDF. We discuss a 61-year-old male with a history of atrial fibrillation who presented with severe abdominal pain out of proportion to exam. The patient was diagnosed promptly and successfully managed non-operatively. This case presentation emphasizes the need to maintain a broad differential diagnosis for abdominal pain out of proportion to exam, with the possibility of a biliary-enteric fistula as a possible cause. It also stresses the importance of a multimodality imaging approach to arrive at a final diagnosis.

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Pleomorphic Adenoma and Trauma: a Case Report With Rare Clinical Presentation

10.21203/rs.3.rs-147433/v1 ◽

2021 ◽

Author(s):

Basma Morsy ◽

Eglal Moussa ◽

Nourhan Aly ◽

Enas Omar ◽

Samar El Achy

Keyword(s):

Pleomorphic Adenoma ◽

Salivary Gland Tumor ◽

Surgical Excision ◽

Final Diagnosis ◽

Gland Tumor ◽

Case Presentation ◽

Patient Reported ◽

History Of ◽

Dna Alterations ◽

Immunohistochemical Analyses

Abstract BackgroundPleomorphic adenoma (PA) is the most common benign salivary gland tumor. Many factors have been implicated in the etiology of PA, one of which is genetic alteration in PLAG1 and HMGA2 genes. Few cases were reported about PAs appearing in patients with history of trauma or denture wear.Case presentationA 73-year-old female patient presented to the clinic with a gradually increasing mass that appeared two months ago in the upper left labial vestibule. The patient reported wearing a maxillary complete denture for 15 years. Clinical examination revealed a typical denture fissuratum, so surgical excision was the treatment of choice. Upon excision, a fully encapsulated mass was exposed and sent for histological and immunohistochemical analyses that confirmed a final diagnosis of PA.ConclusionThis case suggests a contributory role for trauma in the development of PA, following DNA alterations or through oxidative stress resulting from Chronic Mechanical Irritation (CMI).

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Vulvar Leiomyomatosis: A Diagnostic Challenge Case Report

Current Women s Health Reviews ◽

10.2174/1573404815666190128152642 ◽

2020 ◽

Vol 16 (1) ◽

pp. 81-83

Author(s):

Malihe Hasanzadeh ◽

Somayeh Moeindarbari ◽

Leila Mousavi Seresht ◽

Amir Hosein Jafarian ◽

Anahita Hamidi ◽

...

Keyword(s):

Case Report ◽

Virgin Female ◽

Surgical Excision ◽

Final Diagnosis ◽

Definite Diagnosis ◽

Diagnostic Challenge ◽

Case Presentation ◽

Smooth Muscle Tumors ◽

History Of

Introduction: Vulvar leiomyomas are rare and usually misdiagnosed as Bartholin’s cyst on initial presentation. Leiomyoma of vulva accounts for only 0.03% of all gynecological neoplasm. Definite diagnosis is based on surgical excision of the tumor. The aim of this report is to introduce a case of leiomyoma of the vulva which was initially misdiagnosed as Bartholin’s cyst. Case Presentation: We present a case of a 36-year old virgin female (BMI>30) who was referred to the clinic with a 5-year history of left labial mass which was initially diagnosed as Bartholin’s cyst. The mass was removed and the pathologist confirmed that the final diagnosis was vulvar leiomyoma. Conclusion: Vulvar leiomyoma is usually misdiagnosed with Bartholin cyst and distinguishing between benign and malignant forms is confusing, so it is a diagnostic challenge. Surgical excision is the treatment of choice in all smooth muscle tumors of the vulva. Continuing follow-up after treatment is highly recommended.

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Aspergillus Spondylodiscitis After Spinal Stenosis Surgery: A Case Report

Iranian Journal of Neurosurgery ◽

10.32598/irjns.5.3.9 ◽

2020 ◽

Vol 5 (3 And 4) ◽

pp. 155-160

Author(s):

Mohsen Aghapoor ◽

◽

Babak Alijani Alijani ◽

Mahsa Pakseresht-Mogharab ◽

◽

...

Keyword(s):

Antifungal Drugs ◽

The Body ◽

Lower Limbs ◽

Lumbar Pain ◽

Case Presentation ◽

Delay In Diagnosis ◽

Death Case ◽

Therapeutic Results ◽

History Of ◽

Probable Diagnosis

Background and Importance: Spondylodiscitis is an inflammatory disease of the body of one or more vertebrae and intervertebral disc. The fungal etiology of this disease is rare, particularly in patients without immunodeficiency. Delay in diagnosis and treatment of this disease can lead to complications and even death. Case Presentation: A 63-year-old diabetic female patient, who had a history of spinal surgery and complaining radicular lumbar pain in both lower limbs with a probable diagnosis of spondylodiscitis, underwent partial L2 and complete L3 and L4 corpectomy and fusion. As a result of pathology from tissue biopsy specimen, Aspergillus fungi were observed. There was no evidence of immunodeficiency in the patient. The patient was treated with Itraconazole 100 mg twice a day for two months. Pain, neurological symptom, and laboratory tests improved. Conclusion: The debridement surgery coupled with antifungal drugs can lead to the best therapeutic results.

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An Obscure Colon Dilatation and its Underlying Cause: Case Report and Literature Review

10.31487/j.gscr.2020.01.03 ◽

2020 ◽

pp. 1-5

Author(s):

Anton Stift ◽

Kerstin Wimmer ◽

Felix Harpain ◽

Katharina Wöran ◽

Thomas Mang ◽

...

Keyword(s):

Case Report ◽

Sigmoid Colon ◽

Immunohistochemical Staining ◽

Late Onset ◽

Hirschsprung Disease ◽

Endoscopic Examination ◽

Case Presentation ◽

Idiopathic Megacolon ◽

History Of ◽

Cells Of Cajal

Introduction: Congenital as well as acquired diseases may be responsible for the development of a megacolon. In adult patients, Clostridium difficile associated infection as well as late-onset of Morbus Hirschsprung disease are known to cause a megacolon. In addition, malignant as well as benign colorectal strictures may lead to intestinal dilatation. In case of an idiopathic megacolon, the underlying cause remains unclear. Case Presentation: We describe the case of a 44-year-old male patient suffering from a long history of chronic constipation. He presented himself with an obscurely dilated large intestine with bowel loops up to 17 centimeters in diameter. Radiological as well as endoscopic examination gave evidence of a spastic process in the sigmoid colon. The patient was treated with a subtotal colectomy and the intraoperative findings revealed a stenotic stricture in the sigmoid colon. Since the histological examination did not find a conclusive reason for the functional stenosis, an immunohistochemical staining was advised. This showed a decrease in interstitial cells of Cajal (ICC) in the stenotic part of the sigmoid colon. Discussion: This case report describes a patient with an idiopathic megacolon, where the underlying cause remained unclear until an immunohistochemical staining of the stenotic colon showed a substantial decrease of ICCs. Various pathologies leading to a megacolon are reviewed and discussed.

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