Porphyria Cutanea Tarda in a 54-Year-Old Patient with a History of Hepatitis C: A Case Report

Background Porphyria CutaneaTarda (PCT) is the most common type of porphyria and is caused by a decrease in the activity of the hepatic enzyme uroporphyrinogen decarboxylase. It is expressed in both a sporadic form and genetic form and typically presents with cutaneous manifestations described as skin blisters in sun exposed areas. Case A 54-year-old male presented complaining of bullous itchy lesions on his hands and upper extremities that were at different stages of healing. Lab results were consistent with porphyria including elevated serum total porphyrins. He was scheduled for phlebotomy every other week for six weeks, hydroxychloroquine, minimize any sun exposure and to completely stop smoking. Conclusion Widespread skin lesions associated with underlying liver disease is a characteristic presentation for PCT. Hepatitis C is an antecedent risk factor for PCT, but can now be treated with antiviral therapy with the expectation of attainment of a sustained virologic response. Improvements in arresting progressive liver disease in Hepatitis C patients may improve PCT symptoms, as well. Keywords: Porphyria CutaneaTarda; Hepatitis C; Acquired liver disease.

Prevalence and Management Outcomes of Malaria among Different Age Categories Accessing Healthcare Services in a Private Secondary Health Facility in Nigeria

Background Malaria remains a Public Health challenge in Sub-Sahara Africa causing high mortality and morbidity. This study looks at the Prevalence and Management Outcomes of malaria cases that presented by different age categories at a Private Secondary Hospital by the residents of Agbani Road, Enugu state. Methodology This is hospital based cross-sectional retrospective study of patients who presented with fever from Month of January 2017 to Month of December, 2020. Malaria Diagnosis was made by WHO recommended RDT test kits and Microscopy, Structured questionnaire was used to collect information on Long Lasting Insecticidal Nets (LLINs) use from all the patients who patronize the hospital. All malaria positive cases were treated according to Malaria Treatment Guidelines. Analysis of data was done by SPSS.Version22. Results Out of 678 febrile Patients, 65% (443/678) stronglytested positive to malaria: P-value = 0.00135. 50% (221/443) malaria cases, 68% (70/103) admitted cases, 78% (31/40) complicated cases and 91% (10/11) death respectively occurred moreamong < 10years and pregnant mothers. 89% (396/443) successful treatment rate was achieved (P=0.000) and 83% (39/47) of resistantmalaria responded to antibiotics, P-value0.0001).9% (40/443) of the treated cases and Only 1 % (7/73) of cases who use LLINs returnedwith malaria within 28days. Conclusion Malaria Prevalence and outcomesis worseamong < 10 years and pregnant mothers and some anti-malaria resistant cases responded to antibiotics.LLINs use reducesprevalence of malaria re-infection in this setting. Keywords: Malaria;Prevalence; Management outcomes; Agbani Road; Enugu State; Nigeria.

Thoracic Splenosis Mimicking Metastatic Neuroendocrine Tumor (NET)

A 64-year-old man presented with abdominal pain. CT scan showed a 5mm left ureter stone, mesenteric root mass as well as a left lung pleuralbased lesion. Metastatic Neuroendocrine Tumor (NET) was suspected, hence a Gallium-68 Dotatate PET was performed. It showed intense uptake in the mesenteric mass, as well as in the pleural nodule, and no intense uptake in the liver. The liver is the most common site for small bowel NET metastasis. It is unusual to have pleural metastasis without liver metastasis. A review of this patient’s past medical history revealed a motor vehicle accident 20 years ago which required an exploratory laparotomy and splenectomy. Gallium 68 Dotatate PET scan can detect splenosis because it has somatostatin receptors. In patients with an existing neoplasm, metastases should be ruled out before confirming the diagnosis of splenosis. CT-guided biopsy of pleura nodule was performed, which confirmed the diagnosis of splenosis.