scholarly journals Sacral Tuberculosis: An Atypical Manifestation

2018 ◽  
Vol 17 (1) ◽  
Author(s):  
Faisal Amir Si Mirah ◽  
Ahmad Faizal Roslan ◽  
Ed Simor Khan Mor Japar Khan ◽  
Rajandra Kumar Karupiah ◽  
Zamzuri Zakaria @ Mohamad
Keyword(s):  
Correct Diagnosis ◽  
Lower Limbs ◽  
Mantoux Test ◽  
Ct Guided ◽  
Walking Aids ◽  
Grade 5 ◽  
History Of ◽  
Prolapsed Intervertebral Disc ◽  
The Right ◽  
High Index Of Suspicion

Sacral tuberculosis (TB) is extremely rare and its unusual entity might delay the diagnosis and treatment of this treatable disease. A 38-year-old lady presented with a 1 year history of lower back pain with radiculopathy more to right lower limb. The patient was initially treated as Prolapsed Intervertebral Disc (PID), but showed no improvement despite regular physiotherapy and medication. Subsequently, the pain was confined to the right gluteal area and became more severe. Quality of life was impaired in which patient started using walking aids and stopped working. There was a weight loss of 20kg. No other symptom of TB infection or history of contact with TB patient. Bowel and urinary functions were normal. Examination showed localized tenderness at the right gluteal area. Neurological assessment of both lower limbs were MRC grade 5. Blood investigations were normal including the ESR level (17mm/hour). Mantoux test was positive with 18mm induration. MRI revealed a large rim enhancing paravertebral collection at pre-sacral space which extended into bilateral piriformis and gluteal muscles. The patient underwent CT-guided drainage of both gluteals and specimens taken to confirm the diagnosis of TB. Patient showed significant improvement clinically within 1 week after the drainage procedure and initiation of antituberculous chemotherapy. The initial presentation of this patient mimics PID due to irritation of sciatic nerve at piriformis level. However a change in the presentation and failure of conservative treatment should raise a high index of suspicion and necessitates further investigation to establish correct diagnosis hence proper treatment can be initiated.

Hepatic brucelloma: a rare complication of a common zoonotic disease

2020 ◽  
Vol 13 (12) ◽  
pp. e237076
Author(s):  
George Vatidis ◽  
Eirini I Rigopoulou ◽  
Konstantinos Tepetes ◽  
George N Dalekos
Keyword(s):  
Rare Complication ◽  
Surgical Excision ◽  
Coombs Test ◽  
Inflammation Markers ◽  
Laboratory Findings ◽  
Ct Guided ◽  
Rare Manifestation ◽  
Bone Marrow Cultures ◽  
History Of ◽  
The Right

Hepatic brucelloma (HB), a rare manifestation of brucellosis, refers to liver involvement in the form of abscess. A 35-year-old woman stockbreeder was admitted due to 1-month history of evening fever, sweating and weight loss, while she was on 3-week course of rifampicin/doxycycline for suspected brucellosis. On admission, she had hepatosplenomegaly and a systolic murmur, while cholestasis, increased inflammation markers and a strong-positive Wright-Coombs test were the main laboratory findings. As blood and bone marrow cultures were unrevealing, further investigation with CT imaging showed a central liver calcification surrounded by heterogeneous hypodense area being compatible with HB. Material from CT-guided drainage tested negative for Brucella spp. After failure to improve on a 10-week triple regiment, surgical excision was decided and Brucella spp were identified by PCR. Our case highlights challenges in establishing HB diagnosis, which should be considered on the right epidemiological context and when serological and radiological evidence favour its diagnosis.

scholarly journals Percutaneous C-Arm Free O-Arm Navigated Biopsy for Spinal Pathologies: A Technical Note

Diagnostics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 636
Author(s):  
Masato Tanaka ◽  
Sumeet Sonawane ◽  
Koji Uotani ◽  
Yoshihiro Fujiwara ◽  
Kittipong Sessumpun ◽  
...  
Keyword(s):  
Histopathological Examination ◽  
Correct Diagnosis ◽  
Standard Technique ◽  
Percutaneous Biopsy ◽  
Technical Note ◽  
Spinal Tumors ◽  
Histopathological Diagnosis ◽  
Ct Guided ◽  
Ct Guided Biopsy ◽  
The Right

Background: Percutaneous biopsy under computed tomography (CT) guidance is a standard technique to obtain a definitive diagnosis when spinal tumors, metastases or infections are suspected. However, specimens obtained using a needle are sometimes inadequate for correct diagnosis. This report describes a unique biopsy technique which is C-arm free O-arm navigated using microforceps. This has not been previously described as a biopsy procedure. Case description: A 74-year-old man with T1 vertebra pathology was referred to our hospital with muscle weakness of the right hand, clumsiness and cervicothoracic pain. CT-guided biopsy was performed, but histopathological diagnosis could not be obtained due to insufficient tissue. The patient then underwent biopsy under O-arm navigation, so we could obtain sufficient tissue and small cell carcinoma was diagnosed on histopathological examination. A patient later received chemotherapy and radiation. Conclusions: C-arm free O-arm navigated biopsy is an effective technique for obtaining sufficient material from spine pathologies. Tissue from an exact pathological site can be obtained with 3-D images. This new O-arm navigation biopsy may provide an alternative to repeat CT-guided or open biopsy.

scholarly journals Concomitant hepatic tuberculosis and hepatocellular carcinoma: a case report and review of the literature

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hind S. Alsaif ◽  
Ali Hassan ◽  
Osamah Refai ◽  
Khaled Awary ◽  
Haitham Kussaibi ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Malignancy ◽  
Ct Guided ◽  
Case Presentation ◽  
Hepatic Tuberculosis ◽  
Ct Guided Biopsy ◽  
History Of ◽  
Abdominal Examination ◽  
Peripheral Arterial ◽  
High Index Of Suspicion

Abstract Background Hepatocellular carcinoma (HCC) is the most common primary liver malignancy that is strongly associated with chronic liver disease. Isolated hepatic tuberculosis is an uncommon type of tuberculosis. Concomitant occurrence of both conditions is extremely rare. Case presentation We report the case of a 47-year-old man who presented with fever and abdominal pain for 3 months prior to presentation. He reported a history of anorexia and significant weight loss. Abdominal examination revealed a tender, enlarged liver. Abdominal computed tomography (CT) demonstrated a solid heterogeneous hepatic mass with peripheral arterial enhancement, but no venous washout, conferring a radiological impression of suspected cholangiocarcinoma. However, a CT-guided biopsy of the lesion resulted in the diagnosis of concomitant HCC and isolated hepatic tuberculosis. Conclusion A rapid increase in tumor size should draw attention to the possibility of a concomitant infectious process. Clinicians must have a high index of suspicion for tuberculosis, especially in patients from endemic areas, in order to initiate early and proper treatment.

scholarly journals Pulmonary Tuberculosis mimicking a right Eventration on Radiography: The falsity of single view radiograph in the diagnosis of a precursor of pulmonary disease: A Case Report

2021 ◽  
Vol 4 (1) ◽  
pp. 33-37
Author(s):  
John Ogunkoya ◽  
Oluwatosin Yetunde Adesuyi
Keyword(s):  
Pulmonary Tuberculosis ◽  
Lower Lobe ◽  
Middle Lobe ◽  
The Body ◽  
Single View ◽  
Lymph Node Enlargement ◽  
History Of ◽  
Chest X Ray ◽  
The Right ◽  
High Index Of Suspicion

Background: The diaphragm is one of the most important muscles of respiration in the body separating the abdomen from the thorax. Abnormalities of the diaphragm could be congenital or acquired, morphological or functional while pulmonary infection e.g. pulmonary tuberculosis, is implicated in its etiology. Case presentation: A 63-year- old man with six weeks history of cough productive of yellowish sputum. Chest X-ray showed a uniform well-circumscribed opacity in the right lower lobe abutting on or in continuum with the right diaphragm consistent with a diaphragmatic hump. Sputum Gene Xpert was positive for Mycobacterium tuberculosis. Chest CT scan revealed bilateral lymph node enlargement with hyperdense lesions in the anterior basal segment of the right lower lobe and medial bronchopulmonary segments of the right middle lobe. He was treated for 6 months with first-line anti-tuberculosis drugs. Discussion: The incidence of the diaphragmatic hump on chest radiograph worldwide and among Nigerians is unknown. The association of diaphragmatic hump with chest infection has been well document. The association of diaphragmatic hump with pulmonary tuberculosis is uncommon. Conclusion: A high index of suspicion is needed to diagnose pulmonary tuberculosis with atypical clinical and radiological presentations. Such prompt diagnosis will aid the treatment of the disease.

Difficulties associated with the diagnosis of tuberculous osteomyelitis of the ribs in children

2021 ◽  
Vol 16 (2) ◽  
pp. 74-79
Author(s):  
M.D. Zvereva ◽  
◽  
S.S. Kanash ◽  
S.I. Petrova ◽  
V.A. Evseev ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Clinical Symptoms ◽  
Correct Diagnosis ◽  
Diagnostic Procedures ◽  
Diagnostic Methods ◽  
Mantoux Test ◽  
Comprehensive Treatment ◽  
Tuberculous Osteomyelitis ◽  
The Right ◽  
Tuberculosis In Children

Diagnosis of tuberculosis in children is challenging because of variable clinical symptoms and no specific signs. We report a case of tuberculous osteomyelitis of the ribs, which demonstrates difficulties associated with the diagnosis of generalized tuberculosis in an 8-year-old child (correct diagnosis was established after 1.3 years). Diagnostic procedures included: Mantoux test, skin test with recombinant tuberculosis allergen, computed tomography, pathomorphological and bacterioscopic testing. The patient presented with disease progression and lesions to the lung tissue, pleura, and ribs and did not respond to antibacterial therapy, hormones, and cytostatics. This required repeated diagnosis revision. The diagnosis of tuberculosis of the right 4th and 5th ribs was confirmed after surgery using bacterioscopic and immunohistochemical examinations. The child received comprehensive treatment in a specialized tuberculosis hospital and had positive dynamics. Despite the correct routing, low suspicion for tuberculosis in primary and secondary healthcare institutions has led to an insufficient use of currently available diagnostic methods and late diagnosis of tuberculosis in a child residing in a megapolis. Key words: generalized tuberculosis, children, tuberculosis of the rib, immunodiagnostics, diagnosis of tuberculosis, immunohistochemistry

scholarly journals Atypical case of mucous membrane pemphigoid in a 26-year-old man

2018 ◽  
pp. bcr-2018-225872
Author(s):  
Deepak Sambhara ◽  
Ji Hyae Lee ◽  
Seth M Pantanelli
Keyword(s):  
Mucous Membrane ◽  
Previous History ◽  
Immunohistochemical Analysis ◽  
Mucous Membrane Pemphigoid ◽  
Epithelial Basement Membrane ◽  
The Face ◽  
History Of ◽  
The One ◽  
The Right ◽  
High Index Of Suspicion

A 26-year-old Caucasian man with no previous history of chemical injury presenting with an inability to open his right eye was investigated for mucous membrane pemphigoid and treated. Examination was notable for symblepharon of the right eye and impetigo-like lesions on the face and neck. A biopsy with immunohistochemical analysis was significant for linear deposits of C3 and immunoglobulin G at the level of the epithelial basement membrane, confirming the diagnosis of mucous membrane pemphigoid. Although mucous membrane pemphigoid classically presents bilaterally in women in the sixth and seventh decades of life, our patient was a young man with unilateral cicatrising conjunctivitis who may have been easily misdiagnosed without a high index of suspicion. A biopsy is required in cases of cicatrising conjunctivitis so that even atypical cases such as the one presented herein can be appropriately managed.

scholarly journals A Case of Anterior Spinal Artery Syndrome Caused by Streptococcus mitis Endocarditis

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Aria Mahtabfar ◽  
Hamoon Eshraghi ◽  
Melroy D’Souza ◽  
William Berrigan ◽  
Kathleen Casey
Keyword(s):  
Heart Valves ◽  
Vital Signs ◽  
Anterior Spinal Artery ◽  
Prosthetic Heart Valves ◽  
Streptococcus Mitis ◽  
Anterior Spinal Artery Syndrome ◽  
History Of ◽  
The Right ◽  
High Index Of Suspicion ◽  
Spine Mri

Background. Infectious endocarditis (IE) typically occurs in the setting of intravenous drug use, prosthetic heart valves, or rheumatic heart disease. However, there are a few reports of IE occurring in the setting of immunosuppression secondary to cancer and/or chemotherapy. Here, we present a case of a cancer patient who developed anterior spinal artery (ASA) syndrome secondary to a septic embolus from IE. Case Presentation. A 78-year-old male with a history of gastroesophageal cancer treated with chemotherapy and radiation presented to the hospital after a fall at home. He reported experiencing dyspnea and orthopnea for two weeks prior to presentation. In the ED, his vital signs were stable, and his examination was significant for a flaccid paralysis of the right lower extremity. Diagnosis of septic emboli secondary to IE was made after the echocardiogram showed the presence of vegetations on the aortic valve, blood cultures were positive for Streptococcus mitis, and thoracic spine MRI was indicative of an infarction at T10. Discussion. This case highlights the presence of IE in the setting of cancer and chemotherapy. Although cancer is a rare cause of IE, clinicians must maintain a high index of suspicion in order to minimize the sequelae of IE.

scholarly journals A Young Woman with Ischemic Stroke: Should We Pay More Attention to Varicella Zoster Infection

2016 ◽  
Vol 8 (2) ◽  
pp. 145-150 ◽  
Author(s):  
Cláudia Borbinha ◽  
João Pedro Marto ◽  
Sofia Calado ◽  
Miguel Viana-Baptista
Keyword(s):  
Ischemic Stroke ◽  
Hemorrhagic Transformation ◽  
Vascular Events ◽  
Varicella Zoster ◽  
Fluid Analysis ◽  
History Of ◽  
The Right ◽  
High Index Of Suspicion ◽  
Varicella Zoster Infection

Ischemic and hemorrhagic stroke are recognized complications of Varicella zoster virus (VZV) infections, although uncommon and poorly documented. The authors report the case of a 31-year-old woman admitted with acute ischemic stroke of the right posterior cerebral artery and a history of a thoracic rash 1 month before. Aspirin and simvastatin were prescribed, but the patient suffered a stepwise deterioration the following days, with new areas of infarction on brain imaging. Despite no evidence of cardiac or large vessel embolic sources, anticoagulation was started empirically 6 days after stroke onset. One week later, symptomatic hemorrhagic transformation occurred. The diagnosis of VZV vasculopathy was then considered, and treatment with acyclovir and prednisolone was started with no further vascular events. Cerebrospinal fluid analysis and digital subtraction angiography findings corroborated the diagnosis. The patient was discharged to the rehabilitation center with a modified Rankin scale (mRS) score of 4. On the 6-month follow-up, she presented only a slight disability (mRS score 2). In conclusion, VZV vasculopathy needs to be considered in young adults with stroke. A high index of suspicion and early treatment seem to be important to minimize morbidity and mortality. Anticoagulation should probably be avoided in stroke associated with VZV vasculopathy.

scholarly journals Dystrophic Calcifications in the Breast from Secondary Hyperparathyroidism

Breast Care ◽  
2017 ◽  
Vol 13 (1) ◽  
pp. 44-46 ◽  
Author(s):  
Kyoung Min Lee ◽  
Jee Eun Lee ◽  
Eun Suk Cha ◽  
Jin Chung ◽  
Jeoung Hyun Kim ◽  
...  
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Correct Diagnosis ◽  
Term Treatment ◽  
Dystrophic Calcification ◽  
Palpable Mass ◽  
Long Term Treatment ◽  
History Of ◽  
The Right ◽  
Stage Renal Disease ◽  
End Stage

Background: Soft tissue calcification is common in patients with secondary hyperparathyroidism who have received long-term treatment with hemodialysis. However, calcifications in the breast parenchyma are not common. We report a case of a woman with dystrophic breast calcifications from secondary hyperparathyroidism. Case Report: A 65-year-old woman presented with a palpable mass in her right breast which she had discovered 1 month ago. She had a medical history of end-stage renal disease. Mammography and ultrasound revealed large dystrophic calcifications in both breasts. Core needle biopsy was performed for calcifications in the right breast, and the pathologic diagnosis was dystrophic calcification in the stroma from secondary hyperparathyroidism. Conclusion: Reviewing our case will contribute to a fast and correct diagnosis in patients with dystrophic breast calcifications and lab results indicating secondary hyperparathyroidism, and will help discriminate these benign lesions from malignancies.

scholarly journals Hemichorea-hemiballismus in a patient with hyperglycaemic hyperosmolar state

2020 ◽  
Vol 8 (10) ◽  
pp. 3710
Author(s):  
Rifkatu S. Reng ◽  
Odumodu Kenechukwu ◽  
Shuaibu Ramatu ◽  
Oyakhire Shyngle ◽  
Omonua Special ◽  
...  
Keyword(s):  
Basal Ganglia ◽  
Involuntary Movement ◽  
Rare Complication ◽  
Cerebral Atrophy ◽  
Lower Limbs ◽  
High Grade Fever ◽  
Rare Manifestation ◽  
History Of ◽  
Hypertensive Woman ◽  
The Right

Hemichorea-hemiballismus (HCHB) is a rare manifestation of hyperglycaemic hyperosmolar state caused by contralateral lesion in basal ganglia. A 74-year-old, known diabetic and hypertensive woman presented with one-week history of high-grade fever and loss of consciousness associated with involuntary movement of the right upper and lower limbs for 10 hours prior to presentation. Physical examination revealed pyrexia, tachycardia and altered sensorium. Blood glucose was 53.8 mmol/l, hemoglobin A1c (Hb A1c) 9.9% and brain computed tomography (CT) scan showed cerebral atrophy with bilateral basal ganglia hyperdensities. Escherichia coli was cultured from the urine. She did well on treatment with soluble insulin, rehydration and intravenous ceftriaxone. HCHB is a rare complication seen in patients with poorly controlled diabetes mellitus. This report highlights the reversibility of the disease with prompt diagnosis and appropriate insulin treatment. HCHB should be distinguished from other intracranial pathologies.

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