Leucocoria : Most Common Initial Sign of Retinoblastoma

Retinoblastoma is the most common intraocular cancer of childhood. We report the case of a 3-year-old child with unilateral leucocoria noticed by parents who revealed a retinoblastoma. Leucocoria can also indicate other vision threatening conditions : Coats’ disease, cataract, toxocariasis, retinopathy of prematurity for which prompt medical attention is needed.

Primary cutaneous precursor B-cell lymphoblastic lymphoma with concomitant skin and nodal involvement in a child

Primary cutaneous B-cell lymphoblastic lymphoma (PB-LBL) is an exceedingly rare malignant neoplasm in children. Skin lesions may represent the initial sign. Herein, we report a case of a PB-LBL with cutaneous lesions as a primary extranodal involvement, occurring in a 5-year-old infant.

Atypical maculopapular rash as the initial sign of COVID-19: A case report from a COVID hospital

Maculopapular rash mainly distributed over the trunk, is reported as the most common cutaneous manifestation in COVID-19 patients. The palms, soles, and face are usually spared. The rash is associated with itching in 56% of patients and is observed along with COVID-19 symptoms. Maculopapular rash is considered as a feature of severe COVID-19 and the lesions usually resolve in 10 days. We report a COVID-19 patient whose initial manifestation was an atypical maculopapular rash with urticarial wheals and erythema multiforme-like lesions. The patient denied drug intake before the onset of skin lesions. The rash was distributed over the face, palms, and soles in addition to the trunk and limbs. The patient had only mild symptoms of COVID-19. The rash lasted for 3 weeks and resolved with post-inflammatory hyperpigmentation and peeling of the skin of the fingertips. We report this case to highlight the possibility of skin rash being the initial sign of COVID-19.

Metaphyseal Burst Sign; The First Case Report of Subchondral Insufficiency Fracture of the Knee in Iran

Metaphyseal burst sign, which is soft tissue edema in the metaepiphyseal region, is defined as a novel initial sign of subchondral insufficiency fracture of the knee (SIFK). We reported the first Iranian case of the SIFK in femoral medial condyle characterized by a metaphyseal burst sign which could be an early sign of the SIFK. Early diagnosis and treatment could dramatically relieve the sign and symptoms of patients with significant improvement of the MRI scan.

Clinical efficacy of corticosteroids in the early stage of worsening of COVID-19 pneumonia

Background: The World Health Organization (WHO) recommends using corticosteroids in patients with severe coronavirus disease 2019 (COVID-19) and acute respiratory distress syndrome (ARDS), and a large randomized controlled clinical trial in the UK found that dexamethasone was effective in reducing the number of deaths in patients with severe COVID-19.Case presentation: Herein, we described a case of COVID-19 with the clinical characteristics of the mild-symptomatic stage deteriorating to a critically ill state, who showed dramatic improvement with corticosteroids in the early stage of worsening of COVID-19 pneumonia.Discussion: This article further discusses the most suitable timing and dosage of corticosteroid to maximize its effect during the worsening of COVID-19 pneumonia.Learning points:• One of the main pathophysiological hypotheses for severe COVID-19 pneumonia is related to cytokine storm and viral load.• The clinical factors should be considered as the initial sign of a cytokine storm, and corticosteroid therapy may be useful in these patients.

Keep an Eye Out for Crohn’s Disease: Orbital Myositis as the Initial Sign before Gastrointestinal Manifestations

Extraintestinal manifestations of Crohn's disease sometimes occur and can present prior to intestinal symptoms. Ocular manifestations of Crohn's disease are considered rare, with orbital myositis an even rarer manifestation with only a handful of cases reported in the literature. We present the case of a young woman who was diagnosed with orbital myositis, which was initially attributed to pseudotumor cerebri after an extensive negative work-up. Months later, the patient presented with haematochezia, and was subsequently diagnosed with Crohn's disease.

Phytophotodermatitis: A Case Report

A rare phototoxic dermatological reaction seen in Indian Sub-continent, known as Phytophotodermatitis, occurs with exposure to ultraviolet light after contact with certain plant chemicals. Phytophotodermatitis named from the terms ‘phyto’ means plant, ‘photo’ means light, and ‘dermatitis’ means skin inflammation. The signs and symptoms of Phytophotodermatitis typically initiated 24 hours after comes in contact with skin, and the peak is reached between 48 to 72 hours. The indications may be from mild or severe. The signs are redness, tenderness, burning sensation, pain, inflammation, itching, blistering, thickened layer of skin after blisters rupture. The area of blisters is usually asymmetrical in shape. These are seen in the areas of the skin, that were exposed to the chemical. For example, the drip form of blister seen in the skin if it is exposed to fruit juice. If the skin were brushed against a plant, it would show streaks like pattern. Though the early symptoms subside, within 7-14 days, signs of blackening of the skin may show hyperpigmentation. This stage of Phytophotodermatitis is known as post-inflammatory pigmentation and might last for many months. In some cases, the affected person will have a very mild inflammatory reaction, if they are exposed to sunlight, while some may not even know that they experienced a reaction. The hyperpigmentation is the initial sign to know that they have got Phytophotodermatitis. Initial symptoms get aggravated because of wet skin, sweat and heat. Darkening of skin-colour is observed in the persons while they are exposed to sunlight. In this case, we are reporting about a patient having this condition and the cause for the occurrence.

Optic disc metastasis presenting as an initial sign of non-small-cell lung cancer: a case report

Most intraocular metastases are detected in the choroid, iris, ciliary body, or retina. Conversely, tumors rarely metastasize to the optic disc, and they even less frequently present as the initial sign of cancer. In this study, we presented the case of a patient who first visited the ophthalmology department because of gradual visual impairment without any systemic symptoms, and she was ultimately diagnosed with non-small-cell lung cancer. This case report illustrated that visual impairment may be the first sign of non-small-cell lung cancer; therefore, we should not neglect ocular metastasis even when the patient has no systemic symptoms on her/his first visit to the ophthalmology department.