Year 2019, Volume 3 - Issue 1

Background: Factor XII- is an important part of coagulation cascade. Its deficiency is benign but has been rarely associated with myocardial infarction and venous thrombosis. Case Presentation: We present a case of a young lady who presented with pulmonary embolism after supraventricular arrhythmia ablation. She was later found out to have factor XII deficiency. Her treatment course with rivaroxaban was uncomplicated and she stayed well afterwards. Conclusion: This report adds to the growing evidence of possible not-so-benign nature of factor XII deficiency.

Background HIV is known as a risk factor for venous thromboembolic events. However, portal vein thrombosis is rare among HIV infected patients. Few cases have been described in the literature. Case presentation We report a case of abdominal pain in a 25-year old HIV-positive man with a low CD4 count and co-infection with hepatitis B. The pain existed since four days. Computed tomography showed portal vein thrombosis and anticoagulation therapy was initiated. Conclusion This case provokes questions about the etiology of portal vein thrombosis in HIV-positive patients and might determine risk factors. It emphasizes the importance of considering portal vein thrombosis as a cause of abdominal pain in HIV infected patients, in particular when they have low CD4 counts or co-infection with hepatitis B. In addition, HIV and viral hepatitis should be considered in patients who present with thrombotic events.

Background: Bronchopulmonary sequestration, simply called as pulmonary sequestration, is a relatively rare congenital anomaly with few reports of initial diagnosis occurring during adulthood. It consists of a nonfunctioning mass of lung tissue that lacks normal communication with the tracheobronchial tree and that receives its arterial blood supply from the systemic circulation. Case Presentation: We report two cases with bronchopulmonary sequestration and a short review of the clinical/radiologic features of bronchopulmonary sequestration. Conclusion: Look carefully at the retrocardiac area of chest radiography in adults for the definition of unexpected lesions. It can be bronchopulmonary sequestrations. It can be diagnosed easily with a feeding artery by an aberrant systemic artery which usually arises from the aorta.

Background: Spinal epidural lipomatosis (SEL) is an excessive fat deposition within the epidural space of spinal canal leading to compression of nervous structures and neurological manifestations. Exogenous glucocorticoid administration is the major cause of symptomatic SEL. The reported patient had SEL related to endogenous Cushing syndrome which is among few reported cases in the literature. Case presentation: A 14 year girl with features of Cushing syndrome had severe back pain and magnetic resonance imaging of spine showed SEL. Subsequently, computed tomography of abdomen showed right adrenal adenoma.The patient underwent adrenalectomy which improved her signs of hypercortisolism and SEL. Conclusion: In view of severe neurological deficits and therapeutic consequences, SEL should be considered in all patients with Cushing syndrome who present with symptoms of spinal cord compression. Correction of underlying endocrinopathy is imperative in management of SEL.

Background: Headache is one of the most common somatic symptoms in patients who search emergency department (ER). Diagnosing and treating the most common headache disorders are not so difficult. Thus, recognizing some types of headaches, either primary or secondary, can be challenging. Case Presentation: We present an interesting and challenging case of a patient who referred to the ER because of a benign headache and proved to suffer from a metastatic tumor of the retina due to lung carcinoid. Conclusion: Unusual headache syndromes do not appear to be as rare in clinical practice as has been generally believed. To our knowledge, this is the first time to report a metastatic carcinoid of retina presenting with isolated headache and redness of sclera as a primary symptom. Appropriate identification of secondary cause of a headache is the key to successful treatment.

Background: Common carotid artery occlusion (CCAO) can be noticed while carrying out routine sonography and color flow imaging (CFI) of the carotid vessels. The complete evaluation is required when detected in these types of cases. The presenting feature may vary from minor to the major category. Internal carotid artery (ICA) and external carotid artery (ECA) may or may not be the part of occlusion. Case report: we report a 39-years old male who reported with sudden loss of vision in right eye. He underwent carotid ultrasonography (US) and was found to be having complete occlusion of right CCA and ICA. Conclusion: Non alarming stroke may not be the finding in complete occlusion of CCA and their distal branches. There can be isolated finding of retinal artery occlusion as happened in our case. Color flow imaging is the modality of choice for clinching the diagnosis.

ABSTRACT BACKGROUND: Hyponatremia is a commonest electrolyte imbalance which is defined as "serum sodium level less than 135mEq/L". It is seen especially in elderly patients presenting in emergency department of hospitals. There are wide range of differentials in hyponatremic patients but it can be the initial sign of pituitary disease specifically in old age population. Diagnosis can often be challenging because symptoms can be attributed to normal aging process and high index of clinical suspicion is necessary. CASE PRESENTATION: Here we present the case of 61-year old female presented in our facility with history of vomiting, drowsiness and fatigue for 2 days before admission. On investigating, her CBC, LFT's, RFT's and urine R/E were within normal limits. Serum electrolytes showed hyponatremia. CXR was also normal. As patient was not in fluid overload, so our differentials based on euvolumic hyponatremia included syndrome of inappropriate anti-diuretic hormone secretion(SIADH), severe hypothyroidism or glucocorticoid insufficiency. Urine osmolarity was not in range of SIADH. Serum cortisol was normal. FSH, LH, estrogen and progesterone were low although these should be high as patient was post-menopausal. Prolactin was normal. MRI brain with contrast showed supra and intrasellar mass consistent with pituitary macroadenoma. Depending on presentation and investigations, Non-functioning pituitary adenoma(NFPA) presenting with panhypopituitarism complicated by hyponatremia was the final diagnosis. CONCLUSION: Our case highlights the importance of diagnosing NFPA in elderly patients who present with hyponatemia which can often be challenging and should not be delayed as this is life-saving, hence targeted treatment should be started as soon as possible.

Background: Hematohidrosis, also known as hematidrosis or bloody sweat. It is a rare condition manifested by sweaty spotty bleeding out of the skin and mucous membranes . Apart from sporadic case reports from around the world there is a lack of formal study that describe the exact incidence. There is uncertainty of the etiopathogenesis. However rupture of the capillary ramification around the sweat glands due to severe physical or mental stress has been proposed as an explanation, in addition to some other disorders as systemic disease and vicarious menstruation. Diagnosis is being confirmed by testing the secretions for blood components. Case presentation: Herein, we report a case of hematohidrosis in a-28‑year‑old female with repeated episodes of bloody sweating from all over the face, the genitalia and the fingertips that has been responding to propranolol and topical timolol. Conclusion: Being a rare disorder, the diagnosis is substantially dependent on high clinical suspicion and physician awareness, which is of paramount importance in patient's assurance that helps in alleviation of psychological stress. We assume that sympathetic overactivity is pivotal in provoking these events, and that beta blockers might be effective treatment.

Crohn's disease confined to the appendix is uncommon and is estimated to be 0.2 - 1.8% of all appendicectomies. Case Presentation: Herein, we report a 13 - year - old female who presented in the emergency department with typical symptoms and signs of acute appendicitis and elevated inflammatory markers. An abdominal ultrasound was performed which corroborated the initial diagnosis of acute appendicitis. Consequently, the patient underwent an appendicectomy. On operation, appendix was found to be enlarged, swollen and with marked thickening of the appendiceal wall. The terminal ileum and the caecum were normal. A drain was placed because of the probable leaking from the appendiceal stamp, which was impossible to bury. Histological findings indicated the diagnosis of the appendiceal Crohn's disease. Postoperatively, the patient recovered without complications. Conclusion: In rare situation of Appendiceal Crohn's disease, the treatment of choice is appendicectomy and no further treatment is needed.

Background: Ewing's family tumors are malignant and occur in children and young adults.Sinonasal region is slightly rare in occurrence and can present in various types of symptomatology .Ewing sarcoma (ES) and primitive neuro-ectodermal tumor(PNET) are the most common entities in this family. The preliminary diagnosis is always confused because of delayed symptoms and improper histopathological and immunohistochemistry (IHC). Most of the complaints are because of tumor mass pressing and displacing the neighboring structures. Case presentation: 36-years old male adult reported with progressively increasing face swelling on the bridge of the nose and forehead predominately on left side of three years duration. There was pain and blocking of left side nose first and then on the other side. There were also off and on episodes of epistaxis. Ultrasonography (US) and color flow imaging (CFI) confirmed the swelling of solid consistency with hypervascularity. The patient underwent CECT and MRI studies which delineated the entity and was confirmed by histopathology. Conclusion: Sino nasal masses require detailed cross sectional imaging studies, histopathological and immunohistochemistry confirmation for proper and in time management strategies.

Backgound: Pyomyositis is a medical condition characterized by pus collection and abscess formation within the skeletal muscles . There are two main loci, where pyomyositis develops; tropic regions that primarily occurs in healthy children along with temperate areas, where the affected population is primarily immunocompromised adults . The most common predisposing factor is any state of immunodeficiency . The most common culprit is Staphylococcus aureus (S. aureus). The classic clinical presentation of the disease is cramping muscle pain accompanied by fever. The anatomical parts most commonly affected are the lower extremities . Complications include pericarditis, septic emboli, endocarditis and even rhabdomyolysis . Cultures of drainage specimens and radiographic imaging point to the correct diagnosis . Antibiotic coverage and drainage of purulent material is the treatment of choice . Case presentation: Herein, we cite an eighty-two-years old male patient with pyomyositis, S. aureus bacteremia and newly diagnosed type II diabetes mellitus, who presented with muscle weakness complicated by rhabdomyolysis. Conclusion: Diabetes mellitus may be the substrate for the development of pyomyositis.