Hepatitis and Meningoencephalitis due to Enterovirus in a Toddler

Background: Acute hepatitis caused by viral organisms which are typically implicated in the cases of encephalitis are rarely reported in literature. The presentation of enteroviral meningoencephalitis predominated with the clinical picture of hepatitis has rarely been recorded in populations other than neonates. Case Presentation: A male 2-year-old, presenting with a fever of 38 to 40 °C with chills and rigors, lethargy and drowsiness for 6 days. Along with the nausea, vomiting and watery diarrhea, he developed mouth ulcers (peri-oral vesicles) during the stay at the hospital. After extensive workup he was later diagnosed with meningoencephalitis and acute hepatitis due to Coxsackie virus A. After a stay of more than a month he was successfully treated and discharge. Conclusion: A more thorough evaluation should be carried out for atypical viral infections presenting with clinical presentation of hepatitis and meningoencephalitis.

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Jansky-Bielschowsky syndrome, a lysosomal disease: First diagnosed cash in Oman

Proceedings, annual meeting, Electron Microscopy Society of America ◽

10.1017/s0424820100123568 ◽

1992 ◽

Vol 50 (1) ◽

pp. 632-633

Author(s):

Line Buhl ◽

David Muirhead

Keyword(s):

Mental Retardation ◽

Clinical Picture ◽

Neurological Disorder ◽

Clinical Presentation ◽

Neuronal Ceroid Lipofuscinosis ◽

Infantile Form ◽

Lysosomal Disease ◽

Juvenile Form ◽

Progressive Encephalopathy ◽

Lysosomal Diseases

There are four lysosomal diseases of which the neuronal ceroid lipofuscinosis is the rarest. The clinical presentation and their characteric abnormal ultrastructure subdivide them into four types. These are known as the Infantile form (Santavuori-Haltia), Late infantile form (Jansky-Bielschowsky), Juvenile form (Batten-Spielmeyer-Voght) and the Adult form (Kuph's).An 8 year old Omani girl presented wth myclonic jerks since the age of 4 years, with progressive encephalopathy, mental retardation, ataxia and loss of vision. An ophthalmoscopy was performed followed by rectal suction biopsies (fig. 1). A previous sibling had died of an undiagnosed neurological disorder with a similar clinical picture.

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The vagaries of IgM: a case report of EBV infection with concomitantly false-positive IgM for CMV, VZV, and HSV

The Egyptian Journal of Internal Medicine ◽

10.1186/s43162-020-00006-z ◽

2020 ◽

Vol 32 (1) ◽

Author(s):

Raai Mahmood ◽

Khalid Mohamed ◽

Naba Saeed ◽

Kadhim Al-Banaa ◽

Jonathan Zimmerman ◽

...

Keyword(s):

Infectious Mononucleosis ◽

Total Bilirubin ◽

Viral Infections ◽

Total Bilirubin Level ◽

Peripheral Blood Smear ◽

Cross Reactivity ◽

Immunoglobulin M ◽

Case Presentation ◽

Ebv Infection ◽

Acute Infectious Mononucleosis

Abstract Background Serum IgM (immunoglobulin M) testing is commonly used to diagnose acute viral infections. However, most clinicians are unaware of the vagaries of IgM testing, including antigenic cross-reactivity between multiple viruses and risk misdiagnosis. Case presentation We report a case of infectious mononucleosis with concomitantly positive IgM for EBV, CMV, VZV, and HSV. A 26-year-old man presented with acute infectious mononucleosis picture. His blood work showed a total bilirubin level of 7.7 mg/dl, ALT 1077 U/L, AST 806 U/L, ALP 325 U/L, and INR 1.0. Monospot was positive; peripheral blood smear showed atypical lymphocytes; however, because EBV infectious mononucleosis does not typically cause elevation of liver enzymes over 1000, other etiologies were explored. Tests for hepatitis A, B, C, HIV, ANA, and ASMA returned negative. IgM for EBV-VCA, CMV, HSV, and VZV all returned positive, and the diagnosis of EBV IM was called into question. Subsequent tests of CMV and HSV PCR for viral load were negative (VZV was not clinically suspected), and later on, EBV-EBNA returned negative and EBV-VCA IgM and IgG returned positive, confirming the diagnosis of acute EBV infection. Conclusion We believe that IgM seropositivity can result from cross-reactivity among several viruses (especially herpes viruses), and although often relied on, a positive IgM should not serve as the sole determinant for diagnosis of acute viral infections.

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Unexplained worsening of parkinsonian symptoms in a patient with advanced Parkinson’s disease as the sole initial presentation of COVID-19 infection: a case report

The Egyptian Journal of Neurology Psychiatry and Neurosurgery ◽

10.1186/s41983-021-00314-3 ◽

2021 ◽

Vol 57 (1) ◽

Author(s):

Walaa A. Kamel ◽

Ismail Ibrahim Ismail ◽

Mohamed Ibrahim ◽

Jasem Y. Al-Hashel

Keyword(s):

Parkinson’S Disease ◽

Parkinson's Disease ◽

Viral Infections ◽

Neurological Complications ◽

Initial Presentation ◽

Nasopharyngeal Swab ◽

Initial Manifestation ◽

Advanced Parkinson’S Disease ◽

Case Presentation ◽

Dystonic Posturing

Abstract Background Parkinson’s disease (PD) is a neurodegenerative condition that has been reported following viral infections in rare occasions. Several neurological complications have emerged in association with coronavirus disease 2019 (COVID-19), since its declaration as a pandemic. Herein, we present a novel case of unexplained worsening of PD as the sole initial presentation of COVID-19, in the absence of fever or respiratory symptoms. Case presentation A 56-year-old male with advanced PD presented with severe rigidity, dystonic posturing of both feet, and confusion of 4 days duration. His condition progressed to an akinetic-rigid state and confusion during the following week, and a routine nasopharyngeal swab tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on the 9th day of onset. He developed fever and dyspnea later and was intubated on the 10th day. Conclusion To our knowledge, worsening of PD symptoms as the sole initial manifestation of SARS-CoV-2 infection, in the absence of other cardinal features of COVID-19, has not been reported in the literature. We suggest testing for COVID-19 infection in patients with PD, especially advanced cases, who present with unexplained worsening of symptoms, even in the absence of COVID-19 cardinal features.

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COVID-19 in Children

Infektološki glasnik ◽

10.37797/ig.41.1.3 ◽

2021 ◽

Vol 41 (1) ◽

pp. 15-21

Author(s):

Diana Didović ◽

Srđan Roglić ◽

Lorna Stemberger-Marić ◽

Ivana Valenčak-Ignjatić ◽

Andrea Nikčević

Keyword(s):

Clinical Presentation ◽

Viral Infections ◽

Rare Complication ◽

Older Children ◽

Symptomatic Infection ◽

Number Of Children ◽

Multisystem Involvement ◽

Laboratory Results ◽

Inflammatory Syndrome

COVID-19 in children accounts for up to 8% of all the cases and is less severe than in adults. This could be an underestimation. A significant number of children are asymptomatic. Symptomatic infection is hard to distinguish from other respiratory tract viral infections based on symptoms and laboratory results. Anosmia is the only symptom in children that is highly suggestive of COVID-19. Infected children mostly have a positive household member. However, the role of children in SARS-CoV-2 transmission is still controversial. Data suggest that schoolchildren have a greater impact in SARS-CoV-2 transmission compared to younger children. Multisystem inflammatory syndrome in children is a new entity reported since April 2020 and is considered a rare complication of SARS-CoV-2 infection. It occurs in previously healthy older children and adolescents presenting with multisystem involvement and elevated inflammatory markers. Most children respond well to immune-modifying therapy. Treatment of COVID-19 in children is based solely on data received from adults and consists of supportive treatment and, in rare occasions, antiviral therapy (remdesivir), corticosteroids (dexamethasone) and monoclonal antibodies (tocilizumab). Further studies in children are needed in order to better understand this disease. This article discusses clinical presentation and therapeutic options for COVID-19 in children.

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Unusual Site for a White Nodule on the Palatine Tonsil: Presentation, Differential Diagnosis, and Discussion

Case Reports in Dentistry ◽

10.1155/2021/1371329 ◽

2021 ◽

Vol 2021 ◽

pp. 1-4

Author(s):

Ashwag Yagoub Aloyouny

Keyword(s):

Differential Diagnosis ◽

Clinical Presentation ◽

Surgical Intervention ◽

Fungal Infections ◽

The Body ◽

Palatine Tonsil ◽

Unusual Site ◽

Case Presentation ◽

Lymphoepithelial Cysts ◽

Malignant Lesions

Introduction. Palatine tonsils are part of the mucosa-associated lymphoid tissue, located in the oropharyngeal region. Although these tissues protect the body from foreign intruders, they are more prone to infections due to their anatomical structure and location. For instance, the differential diagnosis of a white lesion on the palatine tonsil can range from benign to malignant lesions. Oral lymphoepithelial cysts commonly arise as painless, yellowish nodules on the floor of the mouth and the ventral or lateral surface of the tongue. Case Presentation. This paper presents a rare case of an unusual site of a lymphoepithelial cyst (LEC) in the oral cavity. The lesion was located in the tonsil of a 20-year-old woman with a chief complaint of a painless, white lump in the back of the mouth for nine months. Discussion. The differential diagnosis of a white lesion on the palatine tonsil is caused by several factors, such as bacterial, viral, and fungal infections; trauma; stones; cysts; abscess; or cancer. In this case, both the clinical presentation and extra- and intraoral examinations were highly associated with LEC. Oral LEC etiopathogenesis is uncertain, and several theories have been proposed to discuss the causes of LEC. In addition, oral LEC could be monitored without surgical intervention if the nodule is asymptomatic. Conclusion. We emphasize the importance of a thorough clinical examination of oral and oropharyngeal lesions, which are usually neglected.

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Original SARS-CoV-2 vaccine model

Experimental and Clinical Gastroenterology ◽

10.31146/1682-8658-ecg-178-6-128-132 ◽

2020 ◽

pp. 128-132

Author(s):

I. E. Khoroshilov

Keyword(s):

Immune System ◽

Gastrointestinal Tract ◽

Respiratory System ◽

Clinical Picture ◽

Viral Infections ◽

Single Case ◽

Viral Rna ◽

Human Gastrointestinal Tract ◽

Oral Transmission ◽

Coronavirus Infection

The new coronavirus infection COVID-19 that appeared at the end of 2019 is signifi cantly different from the viral infections that existed previously. The new SARS-CoV-2 coronavirus combines two transmission routes—aerosol and oral-intestinal. The targets for this virus are both cells of the respiratory system and the human gastrointestinal tract. Along with the classical form of this disease, the so-called “gastrointestinal” form is described, in which the clinical picture is dominated by signs of damage to the gastrointestinal tract (diarrhea, vomiting, anorexia). These symptoms are detected, in general, in 20% of patients with COVID-19. More than 80% of patients have mild forms, a third of these individuals had diarrhea. Although SARSCoV-2 viral RNA is detected in faeces samples of patients with COVID-19, it does not carry an infectious onset, and not a single case of fecal-oral transmission has been confi rmed. Since the intestines are the most powerful organ of our immune system, we can introduce SARS-CoV-2 viral RNA into the gastrointestinal tract to ensure the formation of immunity to this infection.

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Interesting Clinical Presentation of Myxoid Liposarcoma of Oropharynx

International Journal of Head and Neck Surgery ◽

10.5005/jp-journals-10001-1139 ◽

2013 ◽

Vol 4 (1) ◽

pp. 57-58

Author(s):

Sagaya Raj ◽

Shuaib Merchant ◽

Azeem Mohiyuddin ◽

P Arun

Keyword(s):

Head And Neck ◽

Clinical Presentation ◽

Surgical Excision ◽

Myxoid Liposarcoma ◽

Lateral Wall ◽

Posterior Wall ◽

Low Grade ◽

Present Case Report ◽

Case Presentation ◽

Histologic Pattern

ABSTRACT Aims To describe an unusual presentation of myxoid liposarcoma of oropharynx and a brief review of literature. Introduction Liposarcomas of head and neck are very rare. Its treatment and prognosis mainly depends on the site and the histologic pattern of the tumor. Case presentation The present case report describes a 65-year-old male with complaints of dysphagia, dyspnea, and a peculiar complaint of mass in the throat which turned out to be a low-grade myxoid liposarcoma arising from right lateral wall of oropharynx extending intraluminal in the esophagus, compressing posterior wall of trachea. The mass was successfully excised surgically and postoperative period was uneventful and patient was asymptomatic 4 months after surgery. Conclusion Myxoid liposarcoma is a rare tumor in head and neck and surgical excision with adequate margin is the treatment of choice. How to cite this article Mohiyuddin A, Raj S, Merchant S, Arun P. Interesting Clinical Presentation of Myxoid Liposarcoma of Oropharynx. Int J Head and Neck Surg 2013;4(1):57-58.

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A case of severe SARS-CoV-2 infection with negative nasopharyngeal PCR in pregnancy

Case Reports in Perinatal Medicine ◽

10.1515/crpm-2020-0075 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Anna Fuchs ◽

Lauren Harris ◽

Ashley Huber ◽

Mia Heiligenstein ◽

Cassandra Heiselman ◽

...

Keyword(s):

Clinical Presentation ◽

Clinical Status ◽

Igg Antibodies ◽

Premature Rupture Of Membranes ◽

Premature Rupture ◽

Case Presentation ◽

Preterm Premature Rupture ◽

High Clinical Suspicion ◽

Maternal Status

Abstract Objectives SARS-CoV-2 remains a pressing issue for our obstetric community during the current pandemic. We present a case of a 22-year-old nulliparous woman 31 weeks pregnant, with significant clinical SARS-CoV-2 disease, in the setting of negative nasopharyngeal PCR testing but positive IgG antibodies. Case presentation This was a 22-year-old patient 31 weeks pregnant who presented with fever, tachycardia, and subsequently preterm premature rupture of membranes (PPROM) and pulmonary emboli with multifocal pneumonia. The patient underwent three negative SARS-CoV-2 tests via nasopharyngeal PCR testing during her hospital stay as well as a negative workup for fever. After a cesarean section for worsening maternal status after 7 days of hospitalization, the patient was admitted for worsening clinical status to the SICU. At the time of SICU admission patient was found to have serum IgG positive antibodies and was managed with intubation, antibiotics, and anticoagulation. Patient eventually left hospital against medical advice on hospital day 16 on oral antibiotics but was found to be recovering well at later outpatient follow up. Conclusions Diagnosis of SARS-CoV-2 remains a complicated picture in the setting of testing limitations. This case highlights an antepartum clinical presentation of severe SARS-CoV-2 and recommends a high clinical suspicion for diagnosis of SARS-CoV-2 and initiation of treatment in the pregnant population, even in the presence of negative nasopharyngeal PCR testing.

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Recurrent Onychomadesis of the Toenails in Children and Adults: A Case Series

Skin Appendage Disorders ◽

10.1159/000519016 ◽

2021 ◽

pp. 1-3

Author(s):

Dana Sous ◽

Michela V.R. Starace ◽

Lu Chen ◽

Elizabeth L. Nieman ◽

Milan J. Anadkat ◽

...

Keyword(s):

Risk Factors ◽

Side Effects ◽

Treatment Strategy ◽

Viral Infections ◽

Nail Plate ◽

Case Series ◽

Drug Side Effects ◽

Case Presentation ◽

Nail Bed ◽

Physical Trauma

Introduction: Onychomadesis occurs when the nail plate separates from the nail matrix and nail bed, eventually leading to shedding of the nail. This condition has been attributed to viral infections, autoimmune disorders, drug side effects, and physical trauma. A subset of patients has a recurrent form of onychomadesis without a clear trigger; this phenomenon is not well characterized in the literature. Case Presentation: We present a case series of pediatric and adult patients with recurrent toenail onychomadesis in order to better characterize the disorder and explore possible etiologies, risk factors, and treatments. Discussion/Conclusion: For the cases herein, we propose microtrauma associated with footwear as the underlying etiology given the periodicity of nail shedding, exclusion of other etiological factors, and presence of predisposing risk factors in certain patients. Many patients saw improvement with application of urea 40% cream, suggesting this can be a valuable part of a treatment strategy, in addition to minimizing injury to involved digits.

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