Year 2017, Volume 1 - Issue 3

Background: Herpes simplex virus 1 and 2 (HSV-1 and HSV-2) and varicella zoster virus (VZV) are neurotropic herpesviruses that cause vesicular mucocutaneous eruptions. They both establish latency in peripheral ganglia and can reactivate to cause episodic outbreaks. HSV occurs more often in the young and may reactivate frequently. VZV reactivation is associated with advancing age due to a decline in the VZV-specific T cell population. While both viruses have been isolated from the same sensory ganglia, they rarely cause simultaneous disease. In most of these cases, the viruses have been isolated at different body sites in immunocompromised hosts. However, clinical disease with concurrent detection of both HSV and VZV from the same anatomic location has been described. In a prior study of dual positive specimens, a lower PCR cycle threshold (Ct) was consistently observed for VZV, suggesting that zoster caused subsequent reactivation of HSV. Case presentation: Here we describe the case of a 64-year-old patient with uncontrolled diabetes who presented with painful penile ulcers and a dermatomal, crusted, left lower abdominal rash. His penile ulcers were positive for both HSV-2 and VZV by PCR. Ct data suggested that primary zoster led to secondary genital HSV-2. Hyperglycemia is known to cause reversible T cell dysfunction and was the likely precipitating factor for the patient's illness, which responded to oral valacyclovir. Conclusion: To our knowledge, this is the first report of diabetes-related concurrent herpesvirus reactivation. Clinicians should consider the possibility of simultaneous HSV and VZV infection in patients who present with dermatomal zosteriform lesions since higher antiviral doses are recommended for herpes zoster as compared to herpes simplex.

Background: Linezolid like many other systemic drugs can cause reversible sight threatening adverse reaction. A proper causality assessment tool can help decide discontinuing a drug when an adverse event is suspected. Case presentation: We describe a case of progressive visual loss in a 28-year-old lady under long term linezolid for extensively drug resistant tuberculosis. A marked improvement in vision was seen on discontinuation of linezolid. Conclusion: A knowledge of visual monitoring in patients under long term linezolid therapy among physicians and ophthalmologists is important, especially in developing countries where infectious disease is still a problem and use of antimicrobials is hardly monitored.

Background: Hereditary spastic paraparesis (HSP) is a rare neurodegenerative condition that results in gradual deterioration of lower limb function due to spastic weakness. It can manifest at any age and predominantly presents as gait abnormalities especially tip toe walking. They are classified as simple or complicated based on additional clinical/neurological symptoms apart from lower limb involvement. These are genetically heterogeneous disorders with mutations discovered in more than 50 genes. The association of thin corpus callosum (TCC) along with clinical features of spastic paraplegia is particularly described in mutations of SPG11 gene. Case presentation: We describe two unrelated cases of childhood onset HSP-TCC associated with mutations in exon16 and exon 28: exon 30 respectively. Both these patients also have associated learning difficulties. Conclusion: The constellation of clinical symptoms and MRI findings led to targeted genetic testing and subsequent identification of their diagnosis.

Background: Medial tibial stress syndrome (MTSS) or shin splints is the result of soft tissue injuries surrounding the tibial shaft. The most common causative factor is that of repetitive trauma while doing exertional exercises and maneuvers. These injuries cause pain in the lower leg and affect the lower part of the tibia shaft. This is frequently encountered in athletes and dancers. Case presentation: We present a 22 year old college student who happened to be in the athletic team and reported with the left leg pain. Various radiological investigations diagnosed him as a case of medial tibial stress syndrome (MTSS). Magnetic resonance imaging played a pivot role in grading the injury and patient was advised accordingly. Conclusion: MTSS may remain unnoticed until the time it causes concern of non-resolving pain of the lower leg. The case requires careful evaluation for the management purpose. Fredericson MRI classification helps in deciding about the conservative or surgical management.

Abstract Background: Lipomas are most frequent benign soft tissue tumours with incidence of about 6 %. For giant lipoma, chest wall is the rare site. Extension in the thoracic cavity is unique. No case of chest wall lipoma with extension in thoracic cavity is reported. Case presentation: We report a rare case of left anterior chest wall lipoma in 45 year old man for 15 years. It had extension in the thoracic cavity. On CT scan, its size was 145mm x 132mm x 90mm and in the chest cavity it was 119mm x 60mm x 72mm size. Patient had minimum symptoms. Core biopsy confirmed the benign nature. Surgical excision under GA was done. Recovery was uneventful. Histopathology report confirmed as "Giant Lipoma". Conclusion: Giant lipoma of the anterior chest with extension into thoracic cavity is a rare presentation. Even with such large size, they can give minimum symptoms. Proper pre-operative assessment of such large lesions is very important for proper management.

Background Castration-resistant prostate cancer (CRPC) has a dismal prognosis. Despite treatment, median survival of these patients is around 12-22 months. Case Presentation In this report, we present the case of a 71-year-old man, with CRPC and painful bone metastases treated with an association of middle-half-body radiotherapy, androgen deprivation therapy (ADT) and cyclophosphamide-based metronomic chemotherapy. Five years after palliative radiotherapy the patient is still receiving metronomic chemotherapy and ADT. He is totally asymptomatic, with undetectable PSA values and negative 18F-Choline-PET/CT. The only side-effect was the development of non-insulin-dependent diabetes. Conclusion This treatment for its tolerability and feasibility, it could be particularly useful in older patients with CRPC. Furthermore, considering the low costs, it could be an important therapeutic option for patients living in low-resourced countries.

Background Papillary thyroid carcinoma is a type of well differentiated cancer showing fair response to iodine ablation therapy. Mainly it spreads into nodes and mediastinum however other areas of metastases include lungs and bone. Case presentation: Female of 54 presented with soft partially mobile lumps in skull and back, associated with chronic pain. These painless lumps were declared lipomas due to their soft consistency on clinical examination, by the local practitioners for last three years. But detailed radiological investigations by tertiary care hospital, followed by FNAC, showed papillary variant of thyroid cancer with metastatic lytic deposits. Conclusion: Clinical examination of all suspicious lumps should be followed by radiological correlation and tissue diagnosis so that patients may avoid future complications.

Background: Ischio-pubic Osteochondritis / Van Neck-Odelberg disease, is characterized by an atypical ossification pattern of the ischio-pubic synchondrosis. Radiologically it may mimic stress fracture, neoplasm, osteomyelitis, or posttraumatic osteolysis. 99mTc-MDP bone scintigraphy with SPECT/CT is one of the effective tools for its diagnosis. Case presentation: A male patient, 11 years of age visited nuclear medicine department of our hospital complaining of pain in the right hip with no history of any fever, trauma or fall. There were no clinical signs of inflammation or any swelling. X-ray showed lytic lesion in the ischio-pubic ramus with area of lucencies. A 99mTc-methylene diphosphonate (99mTc-MDP) bone scan showed focal area of increased uptake in the right inferior ischio-pubic ramus. SPECT/CT hybrid imaging showed areas of demineralization at the edges of ischio-pubic synchondrosis with areas of sclerosis, making a diagnosis of Ischio-pubic osteochondritis / van Neck-Odelberg disease / Synchondrosis ischio-pubic syndrome (SIS). Patient was later treated with anti-inflammatory drugs and steroids. Conclusion: Ischio-pubic Osteochondritis is one of the common differential diagnosis in children presenting with pain in the groin, hip or gluteal region and limping gait. Ample awareness of this ailment is necessary for early diagnosis and proper management, to alleviate the suffering of child.

Background: Ingestion of the endodontic instrument during root canal treatment is rare but can result in serious complications. Case presentation: The present paper reports a case in which endodontic file was accidentally swallowed by the patient undergoing root canal therapy, which entered into the stomach and the dentist did not use the rubber dam in his private clinic which is mandatory in root canal treatment. Conclusion: Handling of dental objects requires for using of a rubber dam is almost mandatory in modern endodontic practice which is to protect the patient from the inhalation or ingestion of endodontic instruments.Tooth isolation using the dental dam is the standard of care it is integral and essential for any nonsurgical endodontic treatment. We should provide more safely care to the patient.