2021: Vol 8 No 7

2021: Vol 8 No 7
  • Antonio Grilo Novais, Diana Pinho Santos, Mariana Conceição, Sara Cunha, Joana Capelo, Pedro Crespo, Lina Carvalho
    Views: 659 HTML: 140 PDF: 303

    Mediastinal tumours can be incidental findings on chest x-ray or present with systemic symptoms and/or direct effect of the mediastinal mass. We report the case of a woman with symptomatic thymoma B1 and simultaneous thymus tuberculosis.

  • Mahesh Nepal, Sravani Lokineni, Le Yu Naing, Jay Bapaye, Erik Olson
    Views: 469 HTML: 81 PDF: 330

    Serrated polyposis syndrome (SPS) is the most common form of polyposis syndrome and has been shown to increase the risk of colorectal cancer (CRC). The genetic pathway of CRC in SPS is different from the classic adenomatous polyposis coli (APC) pathway, which accounts for 70–80% of cases of CRC. Most commonly, SPS mutations include BRAF and KRAS, with activation of the RAS-RAF-MAP kinase pathway involved in the pathogenesis of serrated lesions. We present a rare case of SPS in a 32-year-old woman with MSH6 and SMARCA4 variants, which have not previously been reported in the literature.

  • Yash Kripalani, Koulsoum Houssein, Anjum Shaikh
    Views: 572 HTML: 63 PDF: 343

    SARS-CoV-2 causes severe acute respiratory distress and other clinical complications such as thromboembolic events and gastrointestinal tract disorders, which generally present with abdominal pain. In the case report, we describe a patient who had severe viral necrotizing pancreatitis associated with COVID-19 infection.

  • Marieke van Nieuwland, Dennis Boumans, Gerben Jan Jacob Plas, Onno Dirk Vijlbrief, Celina Alves
    Views: 534 HTML: 106 PDF: 251

    Giant cell arteritis is a medical emergency as severe, irreversible complications may occur if it is not treated in a timely manner. However, in daily practice early diagnosis can be challenging. We report the case of a 70-year-old woman who presented with multiple ischaemic cerebral vascular accidents related to newly diagnosed giant cell arteritis. Review of her charts revealed a substantial delay from the onset of symptoms to diagnosis. This case demonstrates the need for additional efforts to reduce delay in referring patients with giant cell arteritis and the need to implement fast-track clinics to prevent serious complications.

  • Shruti Jesani , Sherif Elkattawy, Sarah Ayad, Iman El-Feki , Rani Chapla, Henal Patel, Vipin Garg
    Views: 631 HTML: 364 PDF: 435

    Tracheal tears are an uncommon phenomenon that can occur due to infection, blunt or penetrating trauma or iatrogenic causes secondary to endotracheal intubation or procedures such as bronchoscopy. Post-intubation tracheal laceration is a very rare yet serious complication with high morbidity and mortality rates. Here, we report the case of a 53-year-old woman with a medical history of hypertension who presented with complaints of facial swelling after undergoing arthroscopic debridement of the coracoacromial ligament as well as partial resection of the acromion for impingement of the right shoulder under general anaesthesia. The patient was found to have extensive pneumomediastinum, subcutaneous emphysema, and a large tracheal tear. We aim to highlight this rare complication of endotracheal intubation, discuss the presenting signs and symptoms, and explore the various management options.

  • Moni Roy, Sharjeel Ahmad, Arif Sarwari
    Views: 635 HTML: 177 PDF: 280

    Ciliocytophthoria is a phenomenon where degenerated cells in infections or malignancy can present as ciliated cells on microscopy and so may be confused with ciliated parasitic infection. We present an interesting case of recurrent shortness of breath, misdiagnosed as chronic obstructive pulmonary disease exacerbations leading to unnecessary exposure to antimicrobials and steroids. The case was diagnosed as Strongyloides hyper-infection syndrome. Another finding worth mentioning was that ciliated cells noted on broncho-alveolar lavage were thought to be a co-infection with Balantidium coli but were later confirmed as ciliocytophthoria.

  • Raquel Costa, Tiago Mendes, Joana Fontes, Marta Pereira, Carlos Gonçalves
    Views: 906 HTML: 155 PDF: 474

    Kluver-Bucy syndrome (KBS) is a characterized by a group of cognitive dysfunctions that include hypersexuality, placidity, hyperorality, memory deficits and hypermetamorphosis. This syndrome is often seen in pathological states that destroy the temporal lobes, normally bilaterally. Herpes simplex encephalitis (HSE) is one of the causes of KBS, as the herpes virus can cause dysfunction/destruction of the temporal lobes. KBS is a very rare syndrome, with just a few cases described in the literature. We present the case of a 21-year-old-man who was diagnosis with KBS after HSE.

  • Anis Mzabi, Wafa Benzarti, Wiem Romdhane, Wafa Baya, Sana Aissa, Imen Gargouri, Chedia Laouani
    Views: 871 HTML: 60 PDF: 336

    Erythema nodosum (EN) is an inflammatory condition of the subcutaneous fat and has been reported in patients with haematological malignancies (lymphomas) or solid tumours. Lung cancer is the most common cause of paraneoplastic syndrome. We report a case of EN occurring as a paraneoplastic disease.
    A 48-year-old Tunisian woman, a non-smoker with no relevant medical history, presented with painful, erythematous, firm nodules on her legs with ankle swelling. The patient did not report any other symptoms. There were no abnormalities on examination except for moderate fever. An extensive infectious and immunological investigation was negative. Antistreptolysin antibodies were undetectable. Chest radiography showed a focal opacity in the right lung and a CT scan revealed a mass in the lower right pulmonary lobe with hilar and mediastinal lymphadenopathies, a nodule in the right adrenal gland, condensation in the iliac bone and multiple bilateral nodular cerebral expansive processes. Bronchial biopsies revealed a primitive and moderately differentiated adenocarcinoma. No argument for tuberculosis or sarcoidosis was found.

  • Tatiana Pires, Catarina Duarte Santos, Miguel Gonzalez Santos, Luís Luz, Ana Ferrão, Maria J. Banza
    Views: 513 HTML: 109 PDF: 249

    Eosinophilic granuloma is a localized, non-invasive form of Langerhans cell histiocytosis. It usually develops in the long bones and is more frequent in children under the age of 10 years. It is very rare in adults. 
    We present the case of a young woman admitted to hospital for persistent refractory left parietal headache, later revealed to be caused by an eosinophilic granuloma.

  • Ruben Benainous, Mohanad Alunji, Pierre Yves Brillet, Robin Dhote
    Views: 719 HTML: 989 PDF: 204

    In secondary syphilis, Treponema pallidum can spread to the lungs. A new case is described of a patient with multiple excavated subpleural pulmonary nodules, a rare localization of secondary syphilis. Despite the numerous pulmonary samples analysed in the literature, T. pallidum is rarely visualised directly on bronchial fibroscopy or biopsy. The diagnosis of secondary syphilis is suspected from historical and physical findings and confirmed by high values obtained from non-treponemal tests.

  • Yash Kripalani, Lipeeka Parulekar
    Views: 783 HTML: 62 PDF: 425

    The prevalence of venous thromboembolism (VTE) in COVID-19 patients is higher than in non-COVID-19 patients. Since the beginning of the pandemic, deep vein thrombosis, myocardial infarction, ischaemic stroke and pulmonary embolism (PE) have been reported in patients with COVID-19. D-dimer levels are now routinely measured in hospitalized patients so that prophylaxis can be initiated. However, a standardized protocol for prophylaxis has yet to be developed for pregnant women with COVID-19, who have an increased risk of VTE. We describe the case of a young primigravida woman with a positive COVID RT-PCR test who developed PE despite receiving adequate prophylaxis.

  • Sarah Ayad, Kirolos Gergis, Sherif Elkattawy, Noreen Mirza, Basel Abdelazeem, Latika Patel, Carlos Remolina
    Views: 873 HTML: 306 PDF: 495

    Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Clinical manifestations are diverse and can vary from mild respiratory symptoms to severe hypoxic respiratory failure. In severe cases, infection can cause gastrointestinal, renal, cardiac, neurological and haematological complications and result in multi-organ failure. There are very few reports of parapneumonic effusion in patients with COVID-19. We describe two patients with COVID-19 who had loculated empyema and discuss the clinical course and therapeutic options.

  • Laura Costa, Diana Carvalho, Elisabete Coelho, Dina Leal, Luís Lencastre
    Views: 605 HTML: 62 PDF: 357

    The authors present a case of purulent pericarditis probably secondary to respiratory infection, a rare entity in the antibiotic era. Pericardial fluid analysis identified streptococci and oral anaerobes as the causative agents. A prolonged and complicated diagnostic and therapeutic course, which included a long stay in the intensive care unit, is described, and a review of purulent pericarditis provided. Pericardial effusion, particularly in the setting of concomitant respiratory infection and immunocompromise or other risk factors, should raise the suspicion of bacterial pericarditis and prompt its timely diagnosis and treatment. Purulent pericarditis can be lethal and has potentially severe complications, so adequate antimicrobial therapy and source control are key.


  • Jahanzeb Malik
    Views: 883 HTML: 60 PDF: 478

    Ticagrelor is a directly acting cyclopentyltriazolo-pyrimidine which does not require conversion into an active metabolite. It inhibits the P2Y12 receptors on platelets reversibly. Unlike clopidogrel and prasugrel, resistance to ticagrelor is rarely reported. Various mechanisms have been proposed for this resistance. The case of a 62-year-old man with diabetes who had undergone index percutaneous coronary intervention (PCI) 22 days previously is described. The patient presented to us with stent thrombosis. His primary PCI was successfully carried out with a drug-eluting stent. He showed resistance to ticagrelor on thromboelastography platelet mapping. He responded well to prasugrel (another P2Y12 inhibitor) in combination with aspirin.

  • Sravani Lokineni, Mahesh Nepal, Amr Mohamed
    Views: 764 HTML: 650 PDF: 297

    Paraneoplastic Raynaud’s phenomenon has often been reported in leukaemia, lymphoma and sarcoma. Nevertheless, an association with lung cancer is not frequently reported in the literature even though lung cancer is a common malignancy. We present a case of paraneoplastic Raynaud’s phenomenon as the presenting feature of underlying lung malignancy.

  • Marta Brandão Calçada, Sara Montezinho, Andreia M Teixeira, Bruno Gomes, Bernardo Macedo
    Views: 573 HTML: 66 PDF: 328

    Sarcoidosis is a systemic granulomatous disease in which medullary involvement is a rare extrapulmonary manifestation. We present the case of a 37-year-old man with right abdominal and dorso-lumbar pain lasting for months. Computerized tomography showed renal microlithiasis and retroperitoneal, hilar and mediastinal adenopathies. Laboratory results showed an elevated erythrocyte sedimentation rate, IgG, ?2-microgobulin and angiotensin-conversion enzyme, serum calcium in the upper limit and hypercalciuria. There was a slight elevation of the CD4/CD8 ratio in bronchoalveolar lavage, without lymphocytic alveolitis. An endobronchial ganglion biopsy was inconclusive. A positron emission tomography scan demonstrated supra and infra-diaphragmatic, splenic and medullary involvement, suggesting lymphoproliferative disease (LPD). A bone marrow biopsy (BMB) revealed sarcoid-like epithelioid cell granulomas, excluding LPD. Sarcoidosis was assumed and corticosteroids were started. Although cytopenias were not present, the extensive ganglion, splenic and medullary involvement made LPD exclusion imperative, while BMB allowed for a definitive diagnosis.

  • Mafalda Sá Pereira, Raquel Freitas, Pedro Correia Azevedo
    Views: 533 HTML: 72 PDF: 307

    Cardiac tamponade is a life-threatening medical emergency and can arise in many clinical situations.
    We present the case of a 59-year-old man with adrenoleukodystrophy and Addison’s disease who was admitted to the emergency department with severe abdominal pain that turned out to be cardiac tamponade of unknown aetiology. 
    An association between cardiac tamponade and Addison’s disease has been reported in the literature, so this aetiology should be considered in the differential diagnosis for patients presenting with unexplained cardiac tamponade.

  • Massimiliano Guillermo Trinidad Pereira, Consuelo Martínez Antolinos, Adriana Canosa Fernandez, Elisa Martinez Alfaro, Julián Solís García del Pozo
    Views: 490 HTML: 110 PDF: 221

    We present the case of an HIV-positive patient admitted because of costal pain secondary to neoplasia. During investigations, a colonoscopy showed non-specific ulcerations. Histological examination resulted in a diagnosis of intestinal spirochetosis. This infection can be asymptomatic or cause non-specific symptoms such as diarrhoea or abdominal pain. Intestinal spirochetosis should be included in the differential diagnosis of colon lesions in patients with HIV infection.

  • Chidinma Ejikeme, Sherif Elkattawy, Fisayo Kayode-Ajala, Sarah Ayad, Abraheim Al-nasseri, William Kessler
    Views: 758 HTML: 897 PDF: 409

    Reactive thrombocytosis after splenectomy is a feared cause of thrombosis throughout the arterial and venous system. There are many causes of splenomegaly, ranging from cirrhosis to lymphoma to hereditary spherocytosis. In this report, we will discuss a case of reactive thrombocytosis after splenectomy in a patient with hereditary spherocytosis. Splenomegaly is a relatively common finding in HD patients, causing extravascular haemolysis and thus leading to haemolytic anaemia. Splenectomy is usually considered when patients start to manifest severe symptoms such as abdominal pain, jaundice or worsening liver function tests. Our patient was a good surgical candidate and successfully underwent splenectomy but afterwards developed arterial and venous thrombosis due to reactive thrombocytosis. An extensive hypercoagulable work-up was unremarkable. The patient was started on hydroxyurea and anticoagulation with eventual improvement of platelet levels.

  • Iván Fernández Castro, María Jesús Isorno-Porto, Ignacio Novo-Veleiro, Clara Casar-Cocheteux, Lucía Barrera-López, Ariadna Helena Andrade-Piña, María López-Rodríguez, Antonio Pose Reino
    Views: 562 HTML: 107 PDF: 308

    Introduction: Aortitis is seen in a wide variety of diseases. It was rarely found in the past but this is changing because of new imaging techniques.

    Case description: We present the case of a 45-year-old man who was found on thyroid ultrasound to have infrarenal aortitis and pathological lymphadenopathies in different locations. After an exhaustive diagnostic process, tuberculous aortitis, an infrequent manifestation of extrapulmonary tuberculosis, was diagnosed. The condition resolved after a 6-month course of antibiotics and a 6-week course of corticosteroids.

    Conclusion: Tuberculous aortitis is an atypical manifestation of Mycobacterium tuberculosis infection. The absence of typical symptoms and the difficulty of isolating the microorganism makes its diagnosis difficult. Therefore, clinical suspicion, microbiological tests and imaging are key for reaching the diagnosis and starting treatment for a serious disease that can cause aortic aneurysm and dissection.

  • Carolina Amado, Mariana Silva Leal, Pedro Silva Neto, Gisela Ferreira
    Views: 584 HTML: 76 PDF: 256

    Eosinophilic colitis is a rare heterogeneous inflammatory disorder. The pathogenesis is not well understood even though it seems to be multifactorial, with hypersensitivity as a major contributor. The clinical presentation depends on the eosinophilic infiltration of different sections within the gastrointestinal tract. Diagnosis is based on the presence of peripheral eosinophilia and histopathological evidence of colon wall eosinophilic infiltration.
    The authors present the case of a woman with a predominantly subserous pattern of eosinophilic colitis potentially triggered by intake of an Ulmus rubra-rich product.

  • Abuzar Asif, Moni Roy, Sharjeel Ahmad
    Views: 550 HTML: 91 PDF: 292

    Pulmonary coccidioidomycosis and pulmonary actinomycosis are unheard of as co-pathogens. Infection with these organisms on their own can mimic lung cancer, thus presenting a diagnostic challenge. We present the case of a 75-year-old woman presenting with haemoptysis with a chest CT chest finding of a lung mass suggestive of lung cancer. A diagnosis of concomitant infection by Coccidioides posadasii/immitis and Actinomyces odontolyticus was made based on culture and histopathology results. The patient was successfully treated with a combination of antifungal and antibacterial therapy. This is the first reported case of co-infection by these two microorganisms.