scholarly journals Challenging diagnosis of leprosy in a psychotic homeless patient with atypical clinical manifestations: an interesting case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hendra Gunawan ◽  
Reyshiani Johan ◽  
Pati Aji Achdiat ◽  
Oki Suwarsa
Keyword(s):  
Sural Nerve ◽  
Skin Diseases ◽  
Histopathological Examination ◽  
Clinical Manifestations ◽  
Interesting Case ◽  
Granulomatous Reaction ◽  
Case Presentation ◽  
History Of ◽  
First Time ◽  
Reversal Reaction

Abstract Background A decision to diagnose certain skin diseases in patient undergoing psychotic break is challenging; this includes establishing the diagnosis of leprosy. Diagnosis of leprosy is established if there is at least one of the three cardinal signs of leprosy. Histopathological examination is not a gold standard, but remains useful in atypical or clinically suspicious cases. Case presentation We report for the first time, an interesting case of leprosy with atypical clinical manifestations in a psychotic homeless male with unknown history of present illness. Upon examination, hypopigmented macules, hyperpigmented macules, and plaques were observed, with unclear sensation impairment. Peripheral nerve thickening and acid-fast bacilli from slit-skin smear were not found. Histopathological examination from hypopigmented macule on the upper right limb showed no granulomatous reaction and other histopathological features of leprosy. Although the condition did not fulfill the cardinal signs of leprosy, we found lagophthalmos, claw hands, pseudomutilation of fingers and toes. Therefore, the diagnosis of suspected leprosy was established. The patient was hospitalized and attempts to administer oral rifampicin and clofazimine were made. Several days after treatment, annular erythematous macules appeared on the patient’s face, abdomen, and back. Histopathological examination results on sample taken from erythematous macule and right sural nerve were consistent with the diagnosis of leprosy with reversal reaction. Conclusion In certain conditions, histopathological examination of the skin and nerves are a highly rewarding test in establishing a diagnosis of leprosy.

Obstetrical history of a family with combined oxidative phosphorylation deficiency 3 and methylenetetrahydrofolate reductase polymorphisms

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Murat Cagan ◽  
Canan Unal ◽  
Gizem Urel Demir ◽  
Erdem Fadiloglu ◽  
Riza Koksal Ozgul ◽  
...  
Keyword(s):  
Oxidative Phosphorylation ◽  
Methylenetetrahydrofolate Reductase ◽  
Care Program ◽  
Oocyte Donation ◽  
Mthfr Polymorphisms ◽  
Healthy Baby ◽  
Case Presentation ◽  
Optimal Outcomes ◽  
History Of ◽  
First Time

Abstract Objectives Recurrent pregnancy loss (RPL) is a devastating complication of pregnancy with various etiologic backgrounds. Case presentation We present a case of combined oxidative phosphorylation deficiency 3 (COXPD3) carrier pregnant woman with Methylenetetrahydrofolate reductase (MTHFR) polymorphisms. She had five pregnancy losses and a postpartum death due to COXPD3. The patient was admitted to our clinic for the first time at her seventh pregnancy with oocyte donation. The patient was registered in a special antenatal care program and delivered a healthy baby at term. Her eighth pregnancy was terminated due to COXPD3 which was prenatally diagnosed. Conclusions Comprehensive and individualized approaches are necessary in RPL cases to obtain optimal outcomes.

scholarly journals The Frequency and Causes of Subepidermal Gaps or Blisters and the Compliance Rate Between Clinical Diagnosis and Pathology Reports from 2015 to 2019

2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Abbas Darjani ◽  
Hojat Eftekhari ◽  
Seyedeh Rojin Amini Rad ◽  
Narges Alizadeh ◽  
Rana Rafiee ◽  
...  
Keyword(s):  
Clinical Diagnosis ◽  
Skin Diseases ◽  
Histopathological Examination ◽  
Compliance Rate ◽  
Clinical Manifestations ◽  
Final Diagnosis ◽  
Direct Immunofluorescence ◽  
Diagnostic Challenge ◽  
Cross Sectional ◽  
Pathology Reports

Background: Skin diseases are the fourth most common cause of human illness, and blisters with different clinical manifestations make a diagnostic challenge. Objectives: This study aimed to evaluate the frequency and causes of subepidermal gaps or blisters, as well as the compliance rate between the initial and final clinical diagnoses based on pathology reports. Methods: In this cross-sectional study, pathology reports of subepidermal blisters or gaps were evaluated in the patients referred to the Razi Laboratory of Rasht from 2015 to 2019. The samples were examined by a pathologist after hematoxylin and eosin staining. The reports included demographic information, clinical differential diagnoses, final diagnosis, direct immunofluorescence findings, and salt split results. Finally, the compliance rate of clinical diagnosis with pathology reports was determined. Results: A total of 183 pathology reports were evaluated, 170 of which contained the final diagnosis. Females were more frequently affected by the disease, and pemphigoid bolus and lichen planus were the most prevalent final diagnoses. The compliance rate between the initial and final diagnoses was 94%. About 37.2% of the reports lacked direct immunofluorescence (DIF) and salt split, and only 42.6% of the samples had undergone DIF examination, while 20.2% had both DIF and salt split. There was no significant association between the compliance rate of the final diagnosis with age, sex, and undergoing diagnostic tests. Conclusions: A high incidence of subepidermal gaps or blisters was seen in middle-aged individuals and females. The compliance rate of the initial clinical diagnosis with the final diagnosis based on pathological reports was high. Our findings emphasize the importance of histopathological examination and the complementary role of direct immunofluorescence and salt split in diagnosis.

scholarly journals Propionibacterium acnes-associated sarcoidosis complicated by acute bird-related hypersensitivity pneumonitis

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Michiru Sawahata ◽  
Noritaka Sakamoto ◽  
Hideaki Yamasawa ◽  
Yuki Iijima ◽  
Hirotoshi Kawata ◽  
...  
Keyword(s):  
Lung Biopsy ◽  
Hypersensitivity Pneumonitis ◽  
Propionibacterium Acnes ◽  
Lipoteichoic Acid ◽  
Specific Monoclonal Antibody ◽  
Past Medical History ◽  
Case Presentation ◽  
Different Types ◽  
History Of ◽  
First Time

Abstract Background The number of reports on sarcoidosis complicated by hypersensitivity pneumonitis (HP) is limited, and most describe cases complicated by chronic bird-related HP. Here, we present for the first time a case with Propionibacterium acnes-associated sarcoidosis complicated by acute bird-related HP. Case presentation A 62-year-old man with a past medical history of sarcoidosis was admitted to our department, and chest computed tomography showed diffuse ground-glass opacities, which appeared as he rapidly increased the number of pigeons he kept for a competition. Random transbronchial lung biopsy revealed well-formed non-caseating epithelioid granulomas, which contained positively stained substances on immunohistochemistry using the PAB antibody, a specific monoclonal antibody against P. acnes lipoteichoic acid. Poorly formed non-caseating granulomas without positively stained substances were also detected. Conclusion We describe the successful identification of this exceptionally rare case of sarcoidosis complicated by acute bird-related HP in which two morphologically and immunohistologically different types of granulomas were present in the same lung.

scholarly journals Primary leiomyoma of the ureter: a case report

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Shingo Morinaga ◽  
Shigeyuki Aoki ◽  
Motoi Tobiume ◽  
Genya Nishikawa ◽  
Hiroyuki Muramatsu ◽  
...  
Keyword(s):  
Malignant Tumors ◽  
Histopathological Examination ◽  
Urine Cytology ◽  
Benign Tumors ◽  
Case Presentation ◽  
Old Japanese ◽  
Retrograde Pyelogram ◽  
History Of ◽  
The Right ◽  
Enhanced Computed Tomography

Abstract Background Only 14 cases of leiomyoma with ureteral origin have been reported previously. Such primary leiomyomas often present as hydronephrosis, making the diagnosis difficult. Radical nephroureterectomy is often performed because of the possible diagnosis of a malignant tumor. We report the 15th case of primary leiomyoma with a ureteral origin. Case presentation A 51-year-old Japanese man presented with a chief complaint of asymptomatic gross hematuria with a history of hypertension. Enhanced computed tomography showed a tumor at the upper part of the right ureter that appeared to be the cause of hydronephrosis and contracted kidney; no retroperitoneal lymphadenopathy and distal metastasis were observed. A well-defined 20-mm (diameter) defect was identified at the upper of the right ureter on retrograde pyelogram with no bladder cancer on cystoscopy. Urine cytology and right divided renal urine cytology findings were negative. Laparoscopic nephroureterectomy was performed, and the extracted tumor measured 20 × 13 mm. Histopathological examination revealed primary leiomyoma with no recurrence 16 months after the operation. Conclusions Preoperative examination with the latest available ureteroscopic technology can help preserve renal function in the case of benign tumors by enabling preoperative ureteroscopic biopsy or intraoperative rapid resection. Moreover, nephroureterectomy is recommended in the case of preoperative suspicion of ureteral malignant tumors.

scholarly journals Extra-synovial Pigmented Villonodular Synovitis of the knee joint, Case Repor

2021 ◽  
pp. 192
Author(s):  
Keyword(s):  
Histopathological Examination ◽  
Giant Cells ◽  
Pigmented Villonodular Synovitis ◽  
Villonodular Synovitis ◽  
Biopsy Result ◽  
Posterior Aspect ◽  
Case Presentation ◽  
History Of ◽  
Full Flexion ◽  
Pigmented Villonodular

Background: PVNS is a rare, benign & aggressive disorder arising from either synovial joints or tendon sheaths; it may erode articular structures and bones. We present a case with unique features of PVNS being extra-synovial and by this report we open a gate for more researches in this field. Case Presentation: This case report concerns a 35-year-old female with a history of right knee pain for 6-month duration proceeded by gradual swelling over posterior aspect of the knee, she denies any history of trauma, clinical examination was unremarkable but apart from tenderness over the infrapatellar region with full flexion. MRI shows a heterogenous signal extra-articular and extra-synovial lesion in posterior aspect of the knee suggesting Pigmented Villonodular Synovitis, FNA revealed a hemosiderin-laden macrophages and multinucleated giant cells, Tru-cut biopsy result was suggesting PVNS as synovial cells were seen admixed with hemosiderin-laden macrophages with fibroblastic elements. Through posterior approach; the lesion was surgically excised and histopathological examination confirmed the diagnosis, the lesion was recurrent after 1-year and MRI revealed the same features, the lesion was excised by arthroscopic intervention. Conclusion: We concluded that PVNS cannot be excluded when extra-synovial lesion is assessed, and further researches on this topic will expand our understanding of the etiological and pathological aspects of this tumor.

scholarly journals A Solitary Giant Neurofibroma of Inguinal Region—A Case Report

2020 ◽  
Author(s):  
Haiying Zhou ◽  
Hui Lu
Keyword(s):  
Tumor Resection ◽  
Clinical Manifestations ◽  
Inguinal Region ◽  
Case Presentation ◽  
Neurogenic Tumors ◽  
Long Time ◽  
Giant Neurofibroma ◽  
History Of ◽  
Recurrence Tendency

Abstract Background:Neurofibroma is a rare nerve sheath tumorofneuroectodermal origin, especially the huge and isolated neurofibroma located in the inguinal region. To our knowledge, no such case has previously been reported.Case presentation:We report a case of 34-year-old male patient with a 4-year history of progressive enlargement of the medial root mass in his left thigh with sitting and standing disorders along with pain. The tumor was completely removed by operation, and pathological diagnosisshowed neurofibroma. There was no obvious neurologic defect after surgery, and no recurrence tendency was found in the follow-up of 2years.Conclusions:For a large solitary mass with slow growth and no malignant clinical manifestations for a long time, clinicians can not rule out the hypothetical diagnosis of neurofibroma, even though its growth site is very rare, such as this case of a huge tumor located in the groin. For neurogenic tumors, early operation should be performed, and the prognosis of patients after tumor resection isexcellent.

scholarly journals The Abnormal Imaging of SARS-CoV-2: A Predictive Measure of Disease Severity

2021 ◽  
Vol 8 ◽  
Author(s):  
Shangwen Pan ◽  
Huaqing Shu ◽  
Yaxin Wang ◽  
Ruiting Li ◽  
Ting Zhou ◽  
...  
Keyword(s):  
Left Lung ◽  
Clinical Manifestations ◽  
Chloride Ions ◽  
Lesion Area ◽  
Fourth Level ◽  
Radiographic Score ◽  
Significant Difference ◽  
History Of ◽  
Critical Patients ◽  
First Time

To investigate the characteristics of SARS-CoV-2 pneumonia and evaluate whether CT scans, especially at a certain CT level, could be used to predict the severity of SARS-CoV-2 pneumonia. In total 118 confirmed patients had been enrolled. All data including epidemiological, clinical characteristics, laboratory results, and images were collected and analyzed when they were administrated for the first time. All patients were divided into two groups. There were 106 severe/critical patients and 12 common ones. A total of 38 of the patients were women. The mean age was 50.5 ± 11.5 years. Overall, 80 patients had a history of exposure. The median time from onset of symptoms to administration was 8.0 days. The main symptoms included fever, cough, anorexia, fatigue, myalgia, headaches, and chills. Lymphocytes and platelets decreased and lactate dehydrogenase increased with increased diseased severity (P < 0.05). Calcium and chloride ions were decreased more significantly in severe/critical patients than in common ones (P < 0.05). The main comorbidities were diabetes, chronic cardiovascular disease, and chronic pulmonary disease, which occurred in 47 patients. In all 69 patients had respiratory failure, which is the most common SARS-CoV-2 complication, and liver dysfunction presented in 37 patients. Nine patients received mechanical ventilation therapy. One patient received continuous blood purification and extracorporeal membrane oxygenation (EMCO) treatments. The average stay was 18.1 ± 10.8 days. Four patients died. The median of the radiographic score was four in common, and five in the severe/critical illness, which was a significant difference between the two groups. The radiographic score was in negative correlation with OI (ρ = −0.467, P < 0.01). The OI in severe/critically ill cases decreased significantly as the disease progressed, which was related to the lesion area in the left lung and right lungs (ρ = 0.688, R = 0.733). OI, the lesion area in the left lung and right lungs, lymphocytes, etc. were associated with different degrees of SARS-CoV-2 pneumonia (P < 0.05). The lesion area in both lungs were possible predictive factors for severe/critical cases. Patients with SARS-CoV-2 pneumonia showed obvious clinical manifestations and laboratory result changes. Combining clinical features and the quantity of the lesion area in the fourth level of CT could effectively predict severe/critical SARS-CoV-2 cases.

scholarly journals Pneumoconiosis with a Sarcoid-Like Reaction Other than Beryllium Exposure: A Case Report and Literature Review

Medicina ◽  
2020 ◽  
Vol 56 (11) ◽  
pp. 630
Author(s):  
Fumiko Hayashi ◽  
Takashi Kido ◽  
Noriho Sakamoto ◽  
Yoshiaki Zaizen ◽  
Mutsumi Ozasa ◽  
...  
Keyword(s):  
Chest Radiography ◽  
Analytical Electron Microscopy ◽  
Clinical Manifestations ◽  
Dust Exposure ◽  
Dust Deposition ◽  
High Resolution Computed Tomography ◽  
Case Presentation ◽  
Old Japanese ◽  
History Of ◽  
Beryllium Disease

Background: Chronic beryllium disease (CBD) is a granulomatous disease that resembles sarcoidosis but is caused by beryllium. Clinical manifestations similar to those observed in CBD have occasionally been reported in exposure to dusts of other metals. However, reports describing the clinical, radiographic, and pathological findings in conditions other than beryllium-induced granulomatous lung diseases, and detailed information on mineralogical analyses of metal dusts, are limited. Case presentation: A 51-year-old Japanese man with rapidly progressing nodular shadows on chest radiography, and a 10-year occupation history of underground construction without beryllium exposure, was referred to our hospital. High-resolution computed tomography showed well-defined multiple centrilobular and perilobular nodules, and thickening of the intralobular septa in the middle and lower zones of both lungs. No extrathoracic manifestations were observed. Pathologically, the lung specimens showed 5–12 mm nodules with dust deposition and several non-necrotizing granulomas along the lymphatic routes. X-ray analytical electron microscopy of the same specimens revealed aluminum, iron, titanium, and silica deposition in the lung tissues. The patient stopped smoking and changed his occupation to avoid further dust exposure; the chest radiography shadows decreased 5 years later. Conclusion: The radiological appearances of CBD and sarcoidosis are similar, although mediastinal or hilar lymphadenopathy is less common in CBD and is usually seen in the presence of parenchymal opacities. Extrathoracic manifestations are also rare. Despite limited evidence, these findings are similar to those observed in pneumoconiosis with a sarcoid-like reaction due to exposure to dust other than of beryllium. Aluminum is frequently detected in patients with pneumoconiosis with a sarcoid-like reaction and is listed as an inorganic agent in the etiology of sarcoidosis. It was also detected in our patient and may have contributed to the etiology. Additionally, our case suggests that cessation of dust exposure may contribute to improvement under the aforementioned conditions.

scholarly journals An “over-fused middle cerebral artery” anomaly: a case report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Huifang Wang ◽  
Hui Liu
Keyword(s):  
Blood Pressure ◽  
Case Report ◽  
Middle Cerebral Artery ◽  
Speech Impairment ◽  
Case Presentation ◽  
Arterial Network ◽  
Motor Aphasia ◽  
History Of ◽  
Time Of Admission ◽  
First Time

Abstract Background MCA has several anomalies, such as accessory MCA, duplicated MCA and twig-like MCA, up to now all these reported anomalies were hypothesized to due to the failure in fusion of the primitive arterial network. No anomaly of over fused MCA has been reported. Case presentation A 59- year- old male was hospitalized with a history of paroxysmal slurred speech and left side headache for a week, his blood pressure was 160/80 mmHg and he manifested mild incomplete motor aphasia at the time of admission. The head and neck CTA and DSA all presented a huge and tortuous left MCA, we diagnosed it an anomaly and termed it over-fused MCA. The patient’s speech impairment and headache were relieved by controlling his blood pressure. Conclusions Such an anomaly of over-fused MCA is reported for the first time, it’s not needed to put special intervention on the anomaly of the patient temporarily, but more observation are needed.

scholarly journals Diagnosis of hereditary hemorrhagic telangiectasia in a pediatric patient admitted with diabetes: the utility of genetic testing

2021 ◽  
Vol 2 (3) ◽  
pp. 01-02
Author(s):  
Alvaro E. Galvis ◽  
Beatrice Batoczki ◽  
Iris S. Pecson ◽  
Evan Vidal ◽  
Craig T. Nakamura
Keyword(s):  
Genetic Testing ◽  
Pediatric Patient ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Autosomal Dominant ◽  
Wide Spectrum ◽  
Clinical Manifestations ◽  
Autosomal Dominant Disorder ◽  
Case Presentation ◽  
History Of ◽  
Vascular Dysplasia

Background: Hereditary hemorrhagic telangiectasia (HHT) formerly known as Osler-Weber-Rendu syndrome is a rare autosomal dominant disorder characterized by vascular dysplasia and a wide spectrum of clinical manifestations. Case presentation: We report the case of an undiagnosed pediatric patient who presented hypoxemia on clinical exam as the only suggestive feature for the presence of HHT. Conclusions: Although HHT diagnosis is based on the finding of characteristic clinical features genetic testing should also be implemented when a family history of the disease is present to help confirm or refute the diagnosis.

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