Vol. 4 No. 1

Objectives: To describe brucellosis and its possible complications according to clinical, laboratory and radiological findings.

Methods: We describe a case of Brucella pericarditis visualized at transthoracic echocardiography with clinical manifestations.

Results: Clinical manifestations, imaging and laboratory findings provided the correct diagnosis of Brucella pericarditis. The patient recovered fully following doxycycline and rifampin therapy.

Conclusion: Brucellosis should be considered in the differential diagnosis of disorders that affect the pericardium in endemic areas.

Dermatomyositis (DM) and sarcoidosis are two idiopathic systemic disorders. Reports of patients with both conditions are extremely rare. Here we describe two patients who presented with DM and DM-associated antibodies, and later developed biopsy-proven sarcoidosis. There are increasing reports of the occurrence of sarcoidosis in the context of autoimmune diseases. These observations might imply similarities in the pathogenetic mechanisms.

We report a case of silicone-induced Still’s-like inflammatory syndrome diagnosed after extensive investigation in the department of internal medicine of a secondary hospital. A 45-year-old female healthcare specialist presented with fever, headache, sore throat, myalgia and fatigue. A history of breast augmentation surgery in 2007 was confirmed. Physical examination of the patient was normal while laboratory tests showed a very high white blood cell count. The patient was admitted to hospital due to suspected infection and further laboratory tests were carried out. Inflammatory markers were persistently high despite empirical treatment with doxycycline for possible infection by Rickettsia/Coxiella. As the fever did not resolve and the patient had not improved after more than 3 weeks, the case was investigated as fever of unknown origin. Eventually, the existence of liver granulomas as well as the presence of anti-silicone antibodies confirmed the diagnosis of silicone-induced Still’s-like inflammatory syndrome. In conclusion, this case supports a linkage between silicone breast implants and autoimmune connective tissue diseases.

Chronic lymphocytic leukaemia (CLL) is one of the most common haematological malignancies worldwide, with an increasing prevalence in the elderly population. Obinutuzumab is a type II anti-CD20 monoclonal antibody which showed superiority over rituximab in combination chemotherapy with chlorambucil for the treatment of CLL in the CLL11 trial (NCT01010061) and is becoming part of standard first line treatment for CLL in the elderly based on its potent efficacy and benign safety profile. We report the case of a chemotherapy naive patient who develop tumour lysis syndrome despite appropriate prophylaxis, and had partial remission of her disease after receiving only the initial test dose of obinutuzumab.

Diffuse alveolar haemorrhage (DAH) is a catastrophic pulmonary complication of systemic lupus erythematosus. It can result in refractory hypoxaemia despite mechanical ventilation. Increasing lung compliance and worsening pulmonary hypertension can potentiate cardiogenic shock from acute right ventricular failure. In such patients with cardiopulmonary collapse, veno-arterial (V-A) ECMO maybe a viable option that can provide the required haemodynamic support. However, the use of V-A ECMO in such patients is limited due to an associated increased risk of bleeding. Our case report describes the successful use of V-A ECMO without the use of systemic anticoagulation in a patient with DAH. Despite the absence of systemic anticoagulation, no thrombotic complications within the circuit were noted.

Acute neurological manifestations of infectious mononucleosis are uncommon and have been predominantly reported in the paediatric population. We report a case of acute Epstein-Barr virus cerebellitis in an adult in whom spontaneous resolution of symptoms and signs occurred after 2 weeks of supportive treatment. An infective cause for an acute cerebellar syndrome in an adult must always be considered in the differential diagnosis when appropriate.

Left ventricular pseudoaneurysm (LVPA) is associated with a significant mortality rate of up to 45% in the first year after diagnosis. It is a very rare entity and hence the true incidence and natural history are not clearly known. Clinical presentation varies widely and requires a high index of suspicion for diagnosis. We report the case of a 72-year-old woman with a remote history of left ventricular aneurysm repair during coronary bypass surgery who presented to the emergency department with acute onset of left-sided chest pain and a pulsatile chest wall swelling. She was haemodynamically stable but required an intravenous morphine drip for pain control. Contrast-enhanced computed tomography of the chest showed a large LVPA dissecting through the anterior chest wall. Surgical treatment was discussed with the patient but she opted in favour of comfort care. She died 5 days later from complete rupture of the LVPA. With this report, we aim to raise the level of awareness of LVPA that could anatomically expand and rupture. Early diagnosis and timely surgical intervention is the treatment of choice.

Creutzfeldt-Jakob disease (CJD) is a rare, incurable and fatal condition that can only be confirmed through neuropathological investigation, such as brain biopsy or post-mortem study. However, a probable diagnosis can be made using clinical criteria. CJD manifests as rapidly progressive dementia with myoclonus and to a lesser extent visual impairment and cerebellar and pyramidal/extrapyramidal signs. We report the case of a previously independent adult male that met all the clinical criteria. Taken together, the investigation results suggested probable CJD.