Idiopathic calcinosis cutis of the right iliac region: Common lesion at uncommon

Calcinosis cutis is an uncommon soft tissue lesion characterized by the deposition of calcium salts in the skin or subcutaneous tissue attributed to a wide variety of causes. We present a case of idiopathic calcinosis cutis in an adult male, who presented with a swelling in the right iliac region. Chalky white aspirate and amorphous basophilic granular material on microscopy suggestive of calcium deposits were noted. Histopathological examination of the excised mass coupled with appropriate clinical background led to the final diagnosis of idiopathic calcinosis cutis. We present this case with a complete diagnostic workup to undermine the importance of considering this lesion in the differential diagnoses of a subcutaneous hard lump in an otherwise healthy patient.

Myxoid liposarcoma of small bowel presenting with intussusception and obstruction: A case report

Gastrointestinal liposarcomas are extremely rare with the most common reported morphological subtype being dedifferentiated liposarcoma and well-differentiated liposarcoma. These tumors are rarely diagnosed preoperatively and diagnosis is only confirmed on histopathological analysis. Treatment of gastrointestinal liposarcomas consists of surgical excision with widely negative margins followed by post-operative irradiation and close follow-up. We report an exceedingly rare case of myxoid liposarcoma of the small bowel (ileum) presenting with an unusual presentation with intussusception and intestinal obstruction. A 42-year-old male presented to the emergency department with features of intestinal obstruction. Contrast-enhanced computed tomography abdomen revealed ileo-ileal intussusception with an endoluminal soft-tissue lesion at the leading edge. The patient was taken for surgical intervention and the involved segment of the bowel along with the lesion was resected and re-anastomosis done. Histological sections of the mass along with immunohistochemistry suggested the pathological diagnosis of myxoid liposarcoma.

Unilateral absence of internal carotid artery: A rare case report

Unilateral absence of internal carotid artery (ICA) is a rare congenital anomaly. We present the case of a 35-year-old man with episodes of recurrent strokes in the past and now presenting with right-sided upper limb weakness. Radiological diagnostic workup revealed a thin left ICA in the neck with non-visualization beyond petrous bone in the intracranial course. The ipsilateral brain parenchyma is supplied by vessels from the contralateral side of the Circle of Willis. As the patient had no evidence of a cerebrovascular accident on radiological evaluation and no neurological signs and symptoms, he was discharged with anticoagulant medications with the advice of follow-up. This is the first report to describe a case of ICA agenesis with a pattern of collateral circulation that doesn’t fit any of the six types described by Lie.

Scrub typhus, a rare of cause of fulminant hepatic failure: A common disease with uncommon presentation

Scrub typhus (bush typhus) is a potentially lethal mite-borne, acute febrile infectious illness caused by Orientia tsutsugamushi, reported precipitating frequent outbreaks in the Asia-pacific belt. Usual presentation after a median incubation period of 10–14 days, stretches from pathognomonic eschar, high-grade fever, centrifugal skin rash, jaundice, regional lymphadenopathy to frontal headache, nevertheless complicated at times with myocarditis, acute respiratory distress syndrome, acute kidney injury, encephalitis, and shock. Although patients with scrub typhus invariably do display mild liver injury, fulminant hepatic failure (FHF) is rarely reported. We describe herein, a case of FHF in an elderly male that responded well to antibiotics. Early diagnosis and sensitive antibiotic administration aids in mortality prevention of the former.

Ellis van Creveld syndrome: An unusual presentation at birth

Ellis Van Creveld, a syndrome comprising of chondrodysplasia, bilateral polydactyly of the hands with skeletal abnormalities, and congenital heart defect is a rare autosomal recessive disease. The prevalence of the disease in the world is 1/6000–20,000 newborns. In the Indian population, it is difficult to estimate the exact prevalence of the disease but, it is mostly seen in the Amish population. The cardinal features are short stature, dysplastic nails and teeth, polydactyly, narrow chest, and heart defects. The crucial differentials are Jeune dystrophy, Weyers syndrome, and McKusick-Kaufman syndrome. Here, we report a neonate, born of a non-consanguineous marriage with a syndromic appearance consisting of a bell-shaped chest, polydactyly, natal teeth, and single atrium. Prognosis is related to respiratory and heart defects in the early neonatal period.

A Rare Case of Drug-induced Vasculitis in Out-patient Department

Drug-induced vasculitis can be defined as inflammation of blood vessels triggered by a spectrum of drugs. It presents not only with a localized skin rash but also may involve the internal organ systems, including the gastrointestinal tract, kidneys, lungs, central nervous system, and joints. Here, we report the case of a 60-year-old woman who developed purpuric pruritic rashes on bilateral lower limbs and buttocks after the ingestion of sulphasalazine. The patient took the prescribed regimen for 14 days while experiencing an adverse drug reaction. At the follow-up visit, the patient was admitted and treated with methylprednisolone monotherapy with 32 mg/day for the first 3 days and after that, methylprednisolone 16 mg for the next 3 days. The rashes resolved after 6 days. Clinicians should ascertain the patient knowledge of how and when to obtain urgent care as the patient may experience ill effects after taking prescribed treatment. Timely advice may save patients’ costs of admission and treatment to manage adverse events.

Ruptured mediastinal pseudocyst with pancreaticopleural fistula formation in a 15-year-old boy presenting with white-out hemithorax: A case report

Pancreaticopleural fistula (PPF) is a rare complication of chronic pancreatitis described more commonly in adults with alcoholic and necrotizing pancreatitis. We report a rare case of ruptured mediastinal pseudocyst with the formation of PPF in a 15-year-old boy who presented with progressive dyspnea and large left-sided pleural effusion that recurred despite repeated drainage. On the basis of imaging findings and pleural fluid analysis, the diagnosis of PPF with ruptured mediastinal pseudocyst was made. The diagnosis of PPF should be considered in patients with non-resolving large left-sided pleural effusions. The diagnosis can be confirmed either by significantly raised amylase levels in pleural fluid or direct visualization of the fistula on Computed tomography/magnetic resonance cholangiopancreatography.

Fat necrosis as a differential diagnosis for recurrence in a treated case of breast cancer: A case report

Fat necrosis is a benign inflammatory process that can involve adipose tissue that most frequently affects peri-menopausal women. It can mimic breast cancer clinically or radiologically. The incidence of breast fat necrosis overall is roughly 0.6%, representing 2.75% of all benign lesions. Fat necrosis presents in 0.8% of breast tumors and 1–9% of breast reduction surgery cases. Most at risk are middle-aged women, with an average age of 50 years, and women with pendulous breasts. Traumatic Fat Necrosis is an important differential diagnosis to be kept in mind in Carcinoma Breast patients who are treated with surgery and adjuvant radiation therapy. We present a case where radiation is followed by a large non-healing ulcer in a known case of breast carcinoma patient.

Systemic lupus erythematosus in a male patient in lower Assam

Systemic lupus erythematosus (SLE) is one of the numerous diseases called “the great imitators” because it frequently resembles or is misdiagnosed as other illnesses. SLE is a chronic autoimmune inflammatory disorder that affects multiple systems and has a wide range of symptoms. The female to male ratio varies between 7 and 15 to 1. A number of observations point to an estrogen impact as the cause of this variance. Because sex hormonal impacts are likely to be modest in youngsters, the female to male ratio is 3:1. Renal involvement and seizures are more common in male SLE patients than photophobia and cutaneous symptoms. Males likewise appear to have a more devastating consequence. As a result, we feel that male lupus patients are uncommon, the illness’s symptoms are life-threatening, and that early discovery of the disease will result in a better outcome for these patients. Here, we report the case of SLE with an unusual presentation in a 44-year-old man from lower Assam to emphasize the importance of a high index of suspicion in such patients.

A giant leiomyoma of the breast

Breast leiomyoma is a rare benign tumor arising from the nipple and/or areola or from smooth muscle metaplasia of myoepithelial or myofibroblast cells. Despite its benign morphology, breast leiomyoma can create diagnostic confusion. Here, we report a rare case of a single leiomyoma of the breast in a 52-year-old woman. The patient reported a lump in her right breast for 1 year, and in the past 6 months, it has grown in size. Physical examination showed a dense mass in the right breast, without axillary lymphadenomegaly. Excisional biopsy revealed a well-defined cell tumor by intertwining the spindle cell folds with fibrillar and eosinophilic cytoplasm. Histopathological and immunohistochemical studies help to discriminate between leiomyoma and other benign and malignant breast lesions. Her results are discussed in our report.