Tuberculosis of the Left Calcaneum and Collapsed Right Femoral Head: A Case Report

Introduction: Tuberculosis (TB), one of the oldest diseases known to affect humans, is caused by the bacteria Mycobacterium tuberculosis. The disease usually affects the lungs, although, in up to one-third of cases, other organs are involved. TB of the bone mimics other clinical conditions such as chronic osteomyelitis, Madura mycosis and actinomycosis. Case Report: A fifth child and last-born girl, in a family of living four children, aged 9 years, consulted Kigali University Teaching Hospital (CHUK) on December 7, 2017, from Kibuye Referral Hospital (Western of Rwanda) for ulcerated, infected left heel with swollen foot 4 months before our consultation. Physical examination revealed a patient with swollen and tender foot discharging serous bloody fluids accompanied by inability to stand with a painful right hip. Small left inguinal lymph nodes were present. Blood work-up, computed tomography scan of the left foot, and an incisional biopsy at the level of the left calcaneus were performed and revealed extrapulmonary TB. The histopathological features for TB were scanty, but the high index suspicion of possible extrapulmonary TB led to the confirmation of the diagnosis using auramine-rhodamine special stain. Anti-TB therapy for 12 months course was initiated and the monthly follow-up for 11 months was done. Conclusion: Although calcaneal TB is very rare, in countries with high incidence of TB, clinicians must have a high suspicion index and skeletal TB must be included in differential diagnosis of bone masses whenever possible bone mass biopsy and special staining technique in addition to most common diagnosis means should be done to rule out the possibility of bone TB. Keywords: Calcaneus, tuberculosis, Rwanda.

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Asystole in an older patient with recurrent falls. Case report

Case reports ◽

10.15446/cr.v6n1.82558 ◽

2020 ◽

Vol 6 (1) ◽

pp. 77-83

Author(s):

William Fernando Bautista-Vargas

Keyword(s):

Case Report ◽

Older Patients ◽

Implantable Devices ◽

Loop Recorder ◽

General Terms ◽

Recurrent Falls ◽

History Of ◽

Rule Out

Introduction: Recurrent falls are a usual problema in older patients. It is therefore important to learn how to differentiate a pathological or syncopal episode from a simple stumbling fall, especially in patients who have limitations for communicating clearly and are poorly understood, in general terms, during the medical consultation. Implantable loop recorders (ILR) have been used as an investigation tool in selected cases of recurrent falls in older patients. Consequently, this case report aims to describe its usefulness in this type of patients.Case presentation: An 87-year-old female patient, hypertensive, with a history of recent stroke and frequent falls —referred to as stumbling—, received an implantable loop recorder due to atrial fibrillation. During one follow-up appointment, a 36-second pause related to a fall was documented, so a bicameral pacemaker was implanted.Conclusions: Evaluating repeated falls in older patients is complex; it must be done in detail to rule out syncopal episodes. Implantable devices to diagnose arrhythmic causes are useful and allow achieving accurate diagnoses and establish specific behaviors aimed at improving the quality of life of patients.

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LO49: Can the HINTS exam rule out stroke in those with vertigo? A systematic review and meta-analysis

CJEM ◽

10.1017/cem.2019.92 ◽

2019 ◽

Vol 21 (S1) ◽

pp. S25

Author(s):

R. Ohle ◽

R. Montpellier ◽

V. Marchadier ◽

A. Wharton ◽

S. McIsaac

Keyword(s):

Diagnostic Accuracy ◽

Likelihood Ratio ◽

Meta Analysis ◽

Acute Vestibular Syndrome ◽

Emergency Medicine Physician ◽

Common Diagnosis ◽

Cranial Mri ◽

Vertebrobasilar Stroke ◽

Rule Out

Introduction: Acute vestibular syndrome (AVS - vertigo, nystagmus, head motion intolerance, ataxia, and nausea/vomiting) is a subset of patients presenting with vertigo. They are most often due to benign vestibular neuritis but can be a sign of a vertebrobasilar stroke. The HINTS (head impulse test, nystagmus, positive test of skew) exam has been proposed as an extremely accurate bedside test to rule out stroke in those presenting with AVS. Is the HINTS exam compared to MRI sufficiently sensitive to rule out vertebrobasliar stroke in an adult population presenting to the emergency department with AVS. Methods: We searched in Pubmed, Medline, Embase, the Cochrane database, and relevant conference abstracts from 1968 to December 2018 and performed hand searches. No restrictions for language or study type were imposed. Relevant studies were reviewed and data was extracted by two independent reviewers. Gold standard in ruling out stroke was; Negative late acute (72 hrs–10d) cranial MRI with DWI OR Negative early acute (0–72hrs) cranial MRI plus negative follow-up cranial MRI or clinical follow-up for TIA/stroke of ≥3 months. Included studies were prospective or retrospective with patients presenting with acute vestibular syndrome. Studies combined if low clinical and statstitical heterogeonity. Study quality was assessed using the QUADAS tool. Random effects meta analysis using Revman 5 and SAS9.3 was performed. Results: 6 studies with 715 participants were included( QUADAS 12/14 SD 1.2). Average study length 5.3 years ( STD 3.3 years) . Prevalence of vertebrobasilar stroke ranged 9.3-76% (Mean 39.1% SD 17.1). The most common diagnosis were vertebrobasilar stroke (Mean 34.8% SD 17.1%), peripheral cause (Mean 30.9% SD 16%). Intra cerebral haemorrhage (Mean 2.2%, SD 0.5%). Neurologist/neuro ophthalmologist performed the exam in 5/6 studies. 1 study reported a kappa between emergency medicine physician and neurologist of 0.24-0.41. The HINTS exam had a sensitivity of 96% (CI 95% 0.92-0.98, I2-0%), Specificity 91.4% (CI 95% 64.5-98.4% I2 94%). Positive likelihood ratio 11.9 ( CI 95% 2.9-48.8) and a negative likelihood ratio of 0.04 ( CI 95% 0.01– 0.14). Conclusion: The HINTS exam has excellent diagnostic accuracy for ruling out stroke when performed by a neurologist. The lack of ER proven diagnostic accuracy and high prevalence of serious diagnosis in those presenting with acute vestibular syndrome suggests care should be taken in ruling out central cause of dizziness in this population.

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Fibromatosis Presenting as Acute Mastoiditis: A Case Report

Ear Nose & Throat Journal ◽

10.1177/014556130508400213 ◽

2005 ◽

Vol 84 (2) ◽

pp. 94-96

Author(s):

Antonis Kaberos ◽

Dimitris G. Balatsouras ◽

Thisvi Vasilakaki ◽

Nicolas C. Economou ◽

Anastasios Leontiadis

Keyword(s):

Case Report ◽

Postoperative Period ◽

Acute Mastoiditis ◽

Microscopic Appearance ◽

Mastoid Bone ◽

The Right ◽

Second Procedure ◽

Work Up ◽

Detailed Work

We describe the case of a middle-aged man who presented with manifestations of acute mastoiditis caused by fibromatosis of the mastoid region. A lesion of the right mastoid bone had eroded its wall and extended toward the middle and posterior cranial fossae. The macroscopic and microscopic appearance of an excised portion of the lesion established the diagnosis of mastoid fibromatosis. After a more detailed work-up, a second procedure involving extensive removal of the tumor was performed, and the diagnosis was confirmed. The patient's postoperative period was uneventful, and he showed no evidence of recurrence during 3 years of follow-up.

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Hypoglossal Nerve Palsy As an Initial Presentation of Glomus Jugulare Tumor in Patient with Breast Cancer: A Case Report and Literature Review

Galen Medical Journal ◽

10.31661/gmj.v10i0.2222 ◽

2021 ◽

Vol 10 ◽

pp. e2222

Author(s):

Askar Ghorbani ◽

Vahid Reza Ostovan

Keyword(s):

Breast Cancer ◽

Case Report ◽

Nerve Palsy ◽

Hypoglossal Nerve ◽

Clinical Manifestations ◽

Glomus Jugulare Tumor ◽

Hypoglossal Nerve Palsy ◽

Glomus Jugulare ◽

Work Up

Background: Glomus jugulare tumor is a rare, slow-growing, hyper-vascular paraganglioma that originates from the neural crest derivatives in the wall of the jugular bulb. The most common clinical manifestations of glomus jugulare are pulsatile tinnitus, conductive hearing loss, and hoarseness due to its vascularity and invasion of surrounding structures. Isolated hypoglossal nerve palsy as a presenting feature of the glomus jugulare is very rare. Case Report: We report a 61-year-old woman with a past medical history of breast cancer and diabetic mellitus presenting with progressive difficulty handling food in her mouth and tongue atrophy. Investigations showed skull base lesion and solitary pulmonary nodule. Further work-up led to glomus jugulare and benign solitary pulmonary fibrous tumor diagnosis, although the first impression was metastatic involvement of the jugular foramen. Endovascular embolization of the glomus jugulare was performed, but the patient refused any open surgery due to co-morbidities and the risk of operation. She had no new symptoms at the one-year follow-up, and the size of the lesion became more minor on the follow-up imaging relative to the baseline. Conclusion: Glomus jugulare tumors should be considered and surveyed in the diagnostic work-up of patients with hypoglossal nerve palsy. [GMJ.2021;10:e2222]

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Recurrent Herpes Zoster in an Immunocompetent Male: A Case Report

Journal of Nepal Medical Association ◽

10.31729/jnma.6629 ◽

2021 ◽

Vol 59 (243) ◽

pp. 1180-1181

Author(s):

Niraj Parajuli ◽

Rushma Shrestha ◽

Laila Lama ◽

Anupama Karki

Keyword(s):

Case Report ◽

Herpes Zoster ◽

Young Male ◽

Oral Acyclovir ◽

Immunocompetent Host ◽

Varicella Zoster ◽

Recurrent Herpes ◽

The Right ◽

Work Up ◽

Rule Out

Herpes zoster is an infection caused by reactivation of varicella-zoster virus presenting as multiple grouped vesicular eruptions in a dermatomal pattern with associated pain. Recurrent herpes zoster is an uncommon event in an immunocompetent host. Here, we report a case of a young male presenting with herpes zoster over the T9 and T10 dermatome with the previous scarring of herpes zoster over the T6 dermatome over the right upper trunk. The patient improved on treatment with oral acyclovir and analgesics. In any patient with recurrenrt hepes zoster, work-up should be done to rule out immunosuppresion.

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Idiopathic Hypertrophic Pachymeningitis: A Case Report from Bangladesh

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v3i2.36776 ◽

2018 ◽

Vol 3 (2) ◽

pp. 110-112

Author(s):

Meera Momtaz Sabeka ◽

Md Nazrul Islam

Keyword(s):

Case Report ◽

Physical Examination ◽

Optic Atrophy ◽

Severe Headache ◽

Imaging Studies ◽

Hypertrophic Pachymeningitis ◽

History Of ◽

Diagnostic Clue ◽

Work Up ◽

Rule Out

A 52 years old lady presented with sudden severe headache with the history of similar intense headache twenty years back which ended up with left sided blindness. Her physical examination was unremarkable except optic atrophy of the left eye. Investigation included biochemical work up, imaging studies and CSF study. The MRI of brain with contrast gave the key diagnostic clue with characteristic findings of hypertrophic pachymeningitis. Other investigations helped to rule out possible etiologies and the diagnosis idiopathic hypertrophic pachymeningitis was finally made. The patient has been treated with steroid and enjoyed improvement in her yearlong symptoms.Journal of National Institute of Neurosciences Bangladesh, 2017;3(2): 110-112

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Rare cause of emergency in the first week of life: congenital hepatoblastoma (case report)

Oxford Medical Case Reports ◽

10.1093/omcr/omaa002 ◽

2020 ◽

Vol 2020 (2) ◽

Author(s):

Gloria Ha Young Yoo ◽

Veronica Mugarab-Samedi ◽

Gregory Hansen ◽

Grant Miller ◽

Laurence Givelichian ◽

...

Keyword(s):

Case Report ◽

Organ Dysfunction ◽

Metabolic Disorders ◽

Causative Factor ◽

Hemodynamic Instability ◽

Term Infant ◽

Sick Newborn ◽

Cardiac Lesions ◽

Rule Out

Abstract During the first week of life, a sudden deterioration in a newborn commonly includes investigations to rule out infections, lung pathologies, cardiac lesions, neurological insults, metabolic disorders or gastrointestinal emergencies. It is unusual, however, to consider malignancy as the primary causative factor. In this case report, we describe a rare and unusual presentation of congenital hepatoblastoma, its complications and management in a neonate with multi-organ dysfunction. A term infant presented with sudden deterioration, hemodynamic instability and an acute abdomen on his 4th day of life. Surgical exploration revealed a ruptured neoplasm that pathology diagnosed as a congenital hepatoblastoma. After the patient was stabilized, chemotherapy was initiated. At present, the patient is 8 months old and under continuous follow-up of oncology service. This case highlights the importance of considering rare diagnoses including congenital malignancy when investigating and managing a sick newborn with multi-organ dysfunction.

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Subcutaneous and Intramuscular Injection of Petrol (Hydrocarbon): A Case Report and Review of the Literature

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s2424835518720104 ◽

2018 ◽

Vol 23 (01) ◽

pp. 149-152

Author(s):

Evelyn Patricia Murphy ◽

Deirdre Seoighe ◽

Suzanne Beecher ◽

Joseph F. Baker ◽

Alan Hussey

Keyword(s):

Case Report ◽

Intramuscular Injection ◽

Review Of The Literature ◽

Hand Therapy ◽

Long Term Outcomes ◽

Anterior Compartment ◽

Self Harm ◽

Work Up

Deliberate injection of hydrocarbon remains an uncommon method of self harm. There is a paucity of information pertaining to soft tissue toxicity throughout the literature. Prompt recognition of the potential ramifications is needed to try salvage limb function. Hydrocarbon toxicity can result in multi organ failure. This case report demonstrates the recommended diagnostic approach, work up and treatment involved in such a case. A 26 year old male deliberately injected petrol into the anterior compartment of his non dominant forearm in a suicide attempt. Multidisciplinary involvement from surgeons, psychiatrists and hand therapists was needed to maximize functional outcome. He avoided systemic toxicity but required an urgent fasciotomy. He required significant follow up with hand therapy to regain usage of the limb. However his long term outcomes were poor with a power grading 3/5 in the anterior compartment muscles.

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Myxoedema ascites-Rare presentation of long standing hashimotos thyroiditis

IP Indian Journal of Immunology and Respiratory Medicine ◽

10.18231/j.ijirm.2021.044 ◽

2021 ◽

Vol 6 (3) ◽

pp. 204-206

Author(s):

Garima Shah ◽

Shubham Sharma ◽

Bikram Shah

Keyword(s):

Hashimoto’S Thyroiditis ◽

Abdominal Distension ◽

Autoimmune Disorder ◽

Hashimoto's Thyroiditis ◽

Dramatic Improvement ◽

Rare Presentation ◽

Thyroid Medication ◽

Clinical Conditions ◽

Rule Out

Hypothyroidism is among the common clinical conditions which are encountered in the medicine OPD. An autoimmune disorder called Hashimoto’s thyroiditis is a common cause for hypothyroidism followed by over response to hyperthyroidism treatment, radiation therapy, medications, congenital disease etc. Patients can present with sensitivity to cold, weight gain, constipation, menstrual abnormalities, and slow mentation with irritability, dry skin, hair loss, and fatigue. Rarely, uncontrolled hypothyroidism can present as pericardial effusion, pleural effusion and ascites. Ascites as the feature of hypothyroidism is uncommon and only less than four percent of patients with hypothyroidism /develop ascites.As it is rarely presented as ascites so its diagnosis is delayed but once it is diagnosed, treatment leads to clinical improvement.: A 20-year-old female presented to medicine OPD with non- tender abdominal distension, vomiting. She was a known case of Hashimoto's thyroiditis an autoimmune disorder; however, she was not compliant to thyroid medication. All necessary investigations were carried out to rule out the cause for ascites. With all the negative reports including imaging and supportive fluid cytology we attributed the symptoms to uncontrolled hypothyroidism as the patient was non-compliant to the thyroid medications. Also the picture of macrocytic anaemia in our patient supported the diagnosis. She was started on levothyroxine and was counselled. On a follow-up visit there was dramatic improvement of all the symptoms including ascites and her TSH was normal-2.017. Ascites as a symptom of hypothyroidism is rare and its pathophysiology is not fully understood however there are few theories and studies in the past which do explain ascites as the manifestation of hypothyroidism. Severe uncontrolled hypothyroidism though uncommon but can cause ascites. Being a reversible cause of ascites, it becomes important for clinicians to take hypothyroidism as one of the differential diagnosis for ascites. Our case supports the need of taking hypothyroidism as one of the cause, as it is easily treatable and patient can show dramatic improvement.

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A Rare Concomitant Oncocytic Adrenocortical Neoplasm and Hepatocellular Carcinoma over a Four-year Duration: A Case Report and Review of Literature

Case Reports in Pathology ◽

10.1155/2019/9137120 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Daniyah Saleh ◽

Wafaey Gomaa ◽

Jaudah Al-Maghrabi

Keyword(s):

Hepatocellular Carcinoma ◽

Case Report ◽

Case Reports ◽

Second Primary ◽

Review Of Literature ◽

Liver Mass ◽

Primary Tumors ◽

Primary Neoplasm ◽

Work Up

Oncocytic adrenocortical neoplasms (OANs) are very rare. Although most cases have benign behavior, the risk of recurrence/metastasis is variable. Based on Lin-Weiss-Bisceglia (LWB) system criteria, OANs can be classified as benign, borderline, or malignant. A concomitant development of OANs with second primary neoplasm is extremely uncommon, and is limited to very few case reports. None of these reported cases was found to be associated with hepatocellular carcinoma (HCC). In this case report, we present a 64-year-old female patient who had a progressively increasing left supra-renal mass over a three-year interval. During her regular imaging-based follow up after successful left adrenalectomy, a new suspicious solitary, hypodense liver mass was detected and removed. All necessary work-up was done and strongly support the diagnosis of two distinct primary tumors including borderline malignant potential OAN and subsequent HCC. A significant clinical and morphological characteristic of OANs make its identification valuable.

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