scholarly journals CASE REPORT OF CUTANEOUS MASTOCYTOSIS

2021 ◽  
pp. 42-43
Author(s):  
Disha Kalola ◽  
Jayani Parikh ◽  
Mayank Chaudhary
Keyword(s):  
Trigger Factors ◽  
Systemic Complications ◽  
Benign Condition ◽  
Abnormal Growth ◽  
Immuno Histochemistry ◽  
Nodular Lesions ◽  
Cutaneous Mastocytosis ◽  
Systemic Examination ◽  
High Index Of Suspicion ◽  
Rule Out

Mastocytosis is a heterogeneous group of disorder characterized by abnormal growth and accumulation of mast cells in skin and other organs such as bones, gastrointestinal tract, liver, spleen and lymph node. A 3 months old male child, presented with multiple, discrete, reddish, papulo-nodular lesions all over body which became more prominent and itchy after a warm bath and crying. Darrier sign was positive and systemic examination was normal. SCORMA index was calculated. Skin biopsy was suggestive of Langherans cell histiocytosis. Immuno- histochemistry profile was positive for CD68, Vimentin, LCA and CD117. This condition needs high index of suspicion and should be differentiated from other causes of urticaria. It is a benign condition, but parental counselling and avoidance of trigger factors is essential. It is imperative to rule out malignancy and systemic complications in a case of cutaneous mastocytosis.

scholarly journals Bilateral scapulothoracic osteochondromas in a patient with hereditary multiple exostosis: a case report and review of the literature

2016 ◽  
Vol 8 (3) ◽  
Author(s):  
Markus Rupp ◽  
Jendrik Hardes ◽  
Michael J. Raschke ◽  
Adrian Skwara
Keyword(s):  
Malignant Transformation ◽  
Clinical Symptoms ◽  
Diagnostic Testing ◽  
Femoral Fractures ◽  
Diagnostic Procedures ◽  
Hereditary Multiple Exostosis ◽  
Autosomal Dominant Disorder ◽  
Abnormal Growth ◽  
Adolescents And Adults ◽  
Rule Out

Hereditary multiple exostosis (HME) is an autosomal dominant disorder characterized by two or more benign growing, cartilage capped tumors of long bones called osteochondromas. If abnormal growth and clinical symptoms of osteochondromas newly appear in adults, malignant transformation of the usually benign growing tumors should be suspected and diagnostic testing should be initiated. Against the background of hypothesized higher malignant transformation of osteochondromas into chondrosarcoma in individuals with shoulder exostoses, we report a case of bilateral scapulothoracic osteochondromas in a patient suffering from HME. A 60-year-old female with HME complained of chest pain while being hospitalized for bilateral femoral fractures. A computed tomography scan of the chest was performed to rule out pulmonary embolism. However, bilateral osteochondromas in the scapulothoracic spaces were detected. Due to absence of radiographic evidences for malignant transformation in the patient, invasive diagnostic procedures such as biopsy and histological examination were recommended in order to exclude malignant transformation of both osteochondromas. Physicians should be aware that patients with HME who present with shoulder pain should be examined for osteochondromas in the scapulothoracic space. Due to possible sarcomatous transformation, regular follow-ups are necessary for adolescents and adults.

scholarly journals The Paradox of Happy Hypoxia in COVID 19

2021 ◽  
pp. 119-124
Author(s):  
Madhu Bansode ◽  
Pankaj Bansode
Keyword(s):  
Young Patients ◽  
The Elderly ◽  
Clinical Implications ◽  
X Rays ◽  
The Novel ◽  
Human Race ◽  
Self Monitoring ◽  
Diagnostic Modalities ◽  
High Index Of Suspicion ◽  
Rule Out

Ever since the human race has been exposed to the novel COVID 19 illness, newer and newer intriguing features of the COVID viral plethora are seen with each passing day. Many manifestations of the COVID 19 illness have been baffling and unexplainable to researchers currently. One such unusual presentation seen is ‘happy hypoxia’ or silent hypoxemia in a third of patients' total number. This review article is intending to put some light on the puzzling condition of happy hypoxia. We authors refer you through various theories postulated for happy hypoxia. It has definite clinical implications in the sense that it can be lifesaving if detected early and promptly in a COVID patient. We conclude that happy hypoxia or silent hypoxemia is a new entity and should be diagnosed with a high index of suspicion in COVID suspect patients in both young patients with no co morbidities and the elderly and diabetics. Diagnostic modalities like pulse oximeter should be widely used at hospitals and clinics and for self-monitoring by the patients at homes. Also, chest X-rays or HRCT imaging of the lungs is essential in the early stages to identify the early infective changes with compromised lung function and rule out this happy hypoxia. Also, further research is essential to find the exact ethologic of this subclinical though ominous prognostic entity.

scholarly journals Pregnancy in Noncommunicating Rudimentary Horn of Unicornuate Uterus: A Case Report and Review of the Literature

2019 ◽  
Vol 2019 ◽  
pp. 1-3 ◽  
Author(s):  
Melese Gezahegn Tesemma
Keyword(s):  
Ectopic Pregnancy ◽  
Hypovolemic Shock ◽  
Emergency Laparotomy ◽  
Rudimentary Horn ◽  
Unicornuate Uterus ◽  
Ultrasound Evaluation ◽  
Compatible Blood ◽  
High Index Of Suspicion ◽  
Time Of Presentation ◽  
Rule Out

Pregnancy implanted in the rudimentary horn of unicornuate uterus is very rare with an incidence of 1 in 75,000 to 1 in 150,000 pregnancies. Both prerupture and postrupture diagnosis of ectopic pregnancy in the rudimentary horn of a unicornuate uterus is difficult. Here is a case of a 21-year-old gravida 5 para 3 abortion 1 mother presented with abdominal pain of 2 days duration following a falling accident. The patient was severely anemic and was in hypovolemic shock at the time of presentation. She had diffused lower abdominal tenderness with hemoperitonium. After clinical and ultrasound evaluation, emergency laparotomy was decided for preop diagnosis of ruptured cornual ectopic pregnancy to rule out uterine rupture at gestational age of 16 weeks. Intraoperatively, ruptured ectopic pregnancy in noncommunicating rudimentary horn was diagnosed. Resection of rudimentary horn and ipsilateral salpingectomy was done. She was transfused with 5 units of compatible blood. It is better to increase awareness about pregnancy occurring in this rare uterine anomaly, so as to have a high index of suspicion as early detection before it gets ruptured is difficult.

scholarly journals Atypical Bilateral Fuchs Uveitis: Diagnostic Challenges

2015 ◽  
Vol 6 (3) ◽  
pp. 284-288 ◽  
Author(s):  
Cristóbal Couto ◽  
Erika Hurtado ◽  
Dana Faingold ◽  
Carmen Demetrio ◽  
Ariel Schlaen ◽  
...  
Keyword(s):  
Case Report ◽  
Laboratory Tests ◽  
Clinical Findings ◽  
Posterior Segment ◽  
In Vivo Confocal Microscopy ◽  
Keratic Precipitates ◽  
Vitreous Opacities ◽  
High Index Of Suspicion ◽  
Rule Out

Bilateral Fuchs uveitis associated with vitreous infiltration and posterior segment involvement requires a thorough diagnostic evaluation. The lack of well-defined diagnostic criteria makes identification of this entity difficult. The aim of this case report was to present the characteristics of a patient with atypical Fuchs uveitis and the procedures needed to rule out the differential diagnosis with specific attention to the utility of in vivo confocal microscopy (IVCM). Case Report: One case of chronic bilateral uveitis with severe vitreous opacities is presented. After extensive systemic workup, including vitrectomy, the case had no identifiable systemic etiology. IVCM of the cornea revealed the presence of dendritiform keratic precipitates. Conclusion: The diagnosis of Fuchs uveitis is based on clinical findings as no confirmatory laboratory tests are available. A high index of suspicion is key to an early diagnosis, especially in the cases with vitreous opacities and posterior segment manifestations. Auxiliary tests such as IVCM may aid the clinician in the diagnosis of Fuchs uveitis.

scholarly journals Acute milk-alkali syndrome

2018 ◽  
Vol 2018 ◽  
Author(s):  
Bidhya Timilsina ◽  
Niranjan Tachamo ◽  
Prem Raj Parajuli ◽  
Ilan Gabriely
Keyword(s):  
Renal Failure ◽  
Metabolic Alkalosis ◽  
List Type ◽  
Over The Counter ◽  
Excess Calcium ◽  
Severe Hypercalcemia ◽  
History Of ◽  
High Index Of Suspicion ◽  
Learning Points ◽  
Rule Out

Summary A 74-year-old woman presented with progressive lethargy, confusion, poor appetite and abdominal pain. She was found to have non-PTH-mediated severe hypercalcemia with renal failure and metabolic alkalosis. Extensive workup for hypercalcemia to rule out alternate etiology was unrevealing. Upon further questioning, she was taking excess calcium carbonate (Tums) for her worsening heartburn. She was diagnosed with milk-alkali syndrome (MAS). Her hypercalcemia and alkalosis recovered completely with aggressive hydration along with improvement in her renal function. High index of suspicion should be maintained and history of drug and supplements, especially calcium ingestion, should be routinely asked in patients presenting with hypercalcemia to timely diagnose MAS and prevent unnecessary tests and treatments. Learning points: Suspect milk-alkali syndrome in patients with hypercalcemia, metabolic alkalosis and renal failure, especially in context of ingestion of excess calcium-containing supplements. Careful history of over-the-counter medications, supplements and diet is crucial to diagnose milk-alkali syndrome. Milk-alkali syndrome may cause severe hypercalcemia in up to 25–30% of cases.

scholarly journals Atypical arthritis in a toddler: beware, save the heart

2020 ◽  
Vol 7 (5) ◽  
pp. 1177
Author(s):  
Sharani Boopathy ◽  
Kanimozhi Thandapani ◽  
Arulkumaran Arunagirinathan
Keyword(s):  
Rheumatic Fever ◽  
Acute Rheumatic Fever ◽  
Age Of Onset ◽  
Joint Involvement ◽  
Cardiac Complications ◽  
General Physical ◽  
Systemic Examination ◽  
High Index Of Suspicion ◽  
Local Examination

Acute rheumatic fever still poses a dreadful threat to pediatric morbidity and mortality. A 2 year old toddler presented to us with non migratory polyarticular joint pain and swelling. General physical and systemic examination was normal. Local examination revealed swelling and tenderness of multiple small and large joints. Further evaluation fulfilled Modified Jones criteria and she was diagnosed to have acute rheumatic fever. Other close differentials were simultaneously ruled out. Child was started on naproxen because of aspirin toxicity. There was significant response for therapy and complete resolution of joint involvement was noted on follow up. We report this case to emphasize the fact that rheumatic fever might have bizarre clinical presentation and may also affect infants and toddlers deviating the typical age of onset. There is a need for earliest possible initiation of adequate management and follow up to prevent permanent cardiac complications. This warrants high index of suspicion even in uncommon age group.

scholarly journals A rare case of bilateral adrenal pheochromocytoma with unusual presentation: the case report

2020 ◽  
Vol 7 (6) ◽  
pp. 2039
Author(s):  
Nirmal Kumar Madesan ◽  
Vinay Kumar J. Rajendra
Keyword(s):  
Severe Hypertension ◽  
Young Male ◽  
The Body ◽  
First Line ◽  
Systemic Complications ◽  
Cerebrovascular Events ◽  
Chief Complaints ◽  
Adrenal Pheochromocytoma ◽  
Nodular Lesions ◽  
Control Right

Here we report a 25 years old male patient came to our emergency department with chief complaints of headache from 3 months, blurring of vision 7 days, abdominal pain 7 days, and vomiting from 2 days. Young male, with no known comorbidities, presented to our casualty with headache since, 3 months, episodic in nature, increased over the last 1 week, holocranial, gradually progressive in severity. last recorded Blood pressure outside was 220/120 mmHg and papilledema were noted on fundoscopy. USG abdomen and pelvis, CECT abdomen done and diagnosed to have bilateral adrenal pheochromocytoma. Patient underwent bilateral adrenalectomy was performed with good intra op BP control. Right adrenals were enlarged and shows multiple nodular lesions, left adrenal noted shows nodular lesions. Surgery remains the first line of management in malignant pheochromocytoma. Norepinephrine, epinephrine, and dopamine all act on their target receptors, which causes a physiological change in the body. Increase in catecholamines cause severe hypertension and multiple systemic complications like (cardiovascular, cerebrovascular events) and can lead to death if untreated.

Causes and diagnosis of chest pain

2016 ◽  
Author(s):  
Caroline Patterson ◽  
Derek Bell
Keyword(s):  
Chest Pain ◽  
Care Setting ◽  
High Clinical Suspicion ◽  
Occult Disease ◽  
Life Threatening ◽  
Risk Scoring ◽  
Chest X Ray ◽  
High Index Of Suspicion ◽  
Symptoms And Signs ◽  
Rule Out

Differentiating life-threatening from benign causes of chest pain in the critical care setting is a challenge when the symptoms and signs overlap, and patients are unable to communicate fully. A high index of suspicion is required for occult disease. Once the clinician has ensured the patient is haemodynamically stable, it is imperative to rule out myocardial infarction in the first instance. Where possible, a thorough history and a full examination should be undertaken. Electrocardiogram, chest X-ray, and routine observations are often diagnostic. Targeted investigation such as computed tomography, or transthoracic or transoesophageal ultrasonography may be required to confirm these diagnoses. Timely intervention optimizes survival benefit. Treatment may be necessary prior to confirmation of diagnosis, based on high clinical suspicion and risk scoring. Other causes of chest pain should be considered once the immediately life-threatening conditions are excluded.

A Rare Nonmalignant Mass of the Pancreas: Case Report and Review of Pancreatic Sarcoidosis

2010 ◽  
Vol 76 (1) ◽  
pp. 79-84
Author(s):  
Martin Wijkstrom ◽  
Rabih I. Bechara ◽  
Juan M. Sarmiento
Keyword(s):  
Signs And Symptoms ◽  
Whipple Procedure ◽  
Unknown Etiology ◽  
Benign Condition ◽  
Pancreatic Malignancy ◽  
First Case ◽  
Pancreatic Involvement ◽  
Positron Emission ◽  
History Of ◽  
High Index Of Suspicion

Sarcoidosis is a systemic granulomatous disease of unknown etiology affecting patients from all genetic backgrounds. Pancreatic involvement is rare; the first case was described on autopsy in 1937. We present a case of pancreatic sarcoidosis without a history of the disease presenting as biliary obstruction mimicking pancreatic malignancy. We also review the literature with respect to management and outcomes of similar cases. The patient described here presented with all the signs and symptoms of a pancreatic malignancy, which was confirmed on a CT scan; the positron emission tomography scan and the CA 19-9 level were also confirmatory of the suspected diagnosis. In this setting, if the mass looks resectable, a Whipple procedure would be the next logical step. However, such strategy would be aggressive management for a benign condition that could be palliated with diverting rather than resective procedures without changing the outlook of the disease. We suggest keeping a high index of suspicion in patients with a history of the disease if demographic concordance exists.

Presence of bronchial nodules, younger age, and heavier body weight are associated with a diagnosis of eosinophilic lung disease in dogs with cough

2022 ◽  
pp. 1-8
Author(s):  
Enrico Bottero ◽  
Pietro Ruggiero ◽  
Elena Benvenuti ◽  
Emanuele Mussi ◽  
Daniele Falcioni ◽  
...  
Keyword(s):  
Body Weight ◽  
Lung Disease ◽  
Medical Records ◽  
High Specificity ◽  
Patient Characteristics ◽  
Bronchial Mucosa ◽  
Diffuse Inflammation ◽  
Younger Age ◽  
Nodular Lesions ◽  
Rule Out

Abstract OBJECTIVE To describe the association between a diagnosis of eosinophilic lung disease (ELD) in dogs with signalment and bronchoscopic features and evaluate the accuracy of visualization of nodules for the diagnosis of ELD. ANIMALS 781 dogs with cough that underwent bronchoscopy between 2014 and 2016. PROCEDURES Data were extracted from the medical records of each included dog. Multivariable logistic regression was performed to investigate associations between ELD and patient characteristics. RESULTS ELD was diagnosed in 113 (14.5%) dogs. More than 3 nodular lesions of the bronchial mucosa were detected in 64 (8.2%) dogs. The odds of having ELD were greater in dogs with nodules (adjusted OR [aOR], 26.0; 95% CI, 13.0 to 52.0) and static bronchial collapse (aOR, 2.3; 95% CI, 1.1 to 4.6), and lower in dogs having focal versus diffuse inflammation (aOR, 0.05; 95% CI, 0.01 to 0.37). The odds of having ELD decreased for each 1-year increase in age (aOR, 0.86; 95% CI, 0.80 to 0.92), and increased for each 1-kg increase in weight (aOR, 1.04; 95% CI, 1.01 to 1.06). Visualization of nodules during bronchoscopy had a overall accuracy of 89.4% (95% CI, 87.0% to 91.4%), sensitivity of 41.6% (32.4% to 51.2%), and specificity of 97.5% (96.0% to 98.5%) for a diagnosis of ELD. CLINICAL RELEVANCE On the basis of high specificity and negative predictive value, lack of visualization of bronchial nodules during bronchoscopy can be used to preliminarily rule out ELD. However, visualization of bronchial nodules does not imply presence of ELD. This could be especially relevant when results of BAL cytology are available several days after the actual bronchoscopy.

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