European Journal of Medical Case Reports

Background: Ureteral duplications are among the most common anomalies of the urinary tract. However, complete ureteral duplication, in which two ureters originating from the same kidney merge distally and then open separately into the bladder, is a rarer variation. This case report presents a female patient with a distal ureteral stone who underwent successful surgical management, highlighting the clinical significance and surgical approach to this rare anatomical variation.

Case Presentation: This case report discusses in detail the successful surgical management of a patient with a stone in the right distal ureteral segment and right complete ureteral duplication, a rarer variation where two ureters arising separately from the same kidney form a confluence point in the distal segment and subsequently open independently into the bladder.

Conclusion: Complete ureteral duplication can often be overlooked during preoperative imaging. This case highlights the importance of detailed radiological assessment and surgical planning in managing such anomalies.

Background: HSV2 associated encephalitis is a rare occurrence, described in neonates and immunocompromised individuals.

Case presentation: We describe a case of HSV-2 associated encephalitis associated with genital herpetic lesions. MRI brain showed large confluent T2/FLAIR hyperintensities involving left medial temporal lobe, left insula and left anterior cingulate gyrus. LP-CSF showed presence of marked neutrophilic leucocytosis mimicking  a pyogenic meningo-encephalitis etiology. CSF biofire ME test (Film Array Multiplex PCR based Meningoencephalitis panel) was positive for HSV-2.  The patient was treated with IV acyclovir for 14 days and subsequent to improvement in symptoms was discharged. In view of recurrence of symptoms he required readmission and was given a further 14 day course of IV Acyclovir and subsequent to normalization of CSF parameters was discharged. Our patient required prolonged course of IV acyclovir of more than 3 weeks.

Conclusion: This case serves to highlight that treatment in HSV-2 encephalitis may need to be prolonged if the patient is not having resolution of symptoms or acellularity in CSF/ negative PCR report has not been achieved.   

Background: Drug fever can complicate the diagnosis of recurrent fever, especially when multiple physicians are involved in treatment.

Case Presentation: We report the case of a 56-year-old man with recurrent fever responsive to antibiotics, initially suggesting a persistent bacterial infection. Detailed history-taking revealed that he discontinued minocycline, prescribed for rosacea dermatitis, when starting new antibiotics, and resumed it after the fever subsided. Eosinophilia and a clear improvement in the general condition between fevers led to the suspicion of drug fever. A rechallenge confirmed minocycline-induced fever.

Conclusion: This case emphasizes the importance of thoroughly reviewing medication history and patients’ medication-taking behavior when drug fever is suspected. 

Background: Swyer syndrome is seen in females with primary amenorrhea, unambiguous female genital appearance, normal vagina, and cervix but XY karyotype. It is characterized by bilateral streaky ovaries, hypoplastic infantile uterus, normally developed Mullerian structures, and hypergonadotropic hypogonadism.  Affected individuals usually have a uterus and fallopian tubes, but their gonads are not functional. Instead, the gonads are small and underdeveloped and contain little gonadal tissue. 

Case Presentation: A 17-year-old girl presented with primary amenorrhea visited our clinic. Family history and the age at diagnosis were collected. After obtaining consent, a physical examination for secondary sexual characteristics was done. Initial laboratory tests like Thyroid profile, FSH, LH, and Estradiol for evaluating primary amenorrhea were investigated. Radio diagnosis to find uterine and ovaries size was done. Karyotyping and Fluorescent In situ Hybridization (FISH) tests were done to find the genotype of the girl. Parents of the affected child have a history of second-degree consanguineous marriage. The child’s height was 167 cm and weighed 44 kg. On examination, breasts were in tanner stage 2, with absent axillary hair but well-developed pubic hair. External genitalia was of the female type, per vaginal examination was normal and the cervix was small.

Conclusion: The purpose of reporting this case is to have a rare clinical condition and to know the importance of chromosome pattern XY female for appropriate management as there is a high chance of gonadal malignancies if undetected. Also, to counsel about fertility-related problems. importance of chromosome pattern XY female for appropriate management as there is a high chance of gonadal malignancies if undetected. 

Background: Longitudinal extensive transverse myelitis, which designates inflammation of the spinal cord in more than 3 vertical vertebral segments, is a rare presentation of paraneoplastic syndrome, being more common in lung or lymphoproliferative neoplasms. Before diagnosing myelitis of paraneoplastic etiology, the aim is to exclude inflammatory, metabolic, infectious and ischemic/traumatic causes.

Case Presentation: We present a 62-year-old man observed in the emergency department for low back pain that had lasted 2 weeks, paresthesia of the lower limbs and severe inability to walk. He also referred sphincter anesthesia in the previous 3 days. Several examinations were carried out and the dorso-lumbar magnetic resonance imaging highlighted findings of longitudinal extensive transverse myelitis from D5-D6 to the conus medullaris. The etiological study showed papillary thyroid carcinoma as a condition for this paraneoplastic syndrome. After thyroidectomy, the patient progressively recovered from the deficits presented.

Conclusions: The clinical and imaging diagnosis of myelitis is not difficult, however, finding the underlying etiology can be challenging. A whole set of laboratory and imaging tests are necessary to confirm the cause and direct treatment with the intention of potentially reversing the neurological condition.