Year 2019, Volume 3 - Issue 2

Background: Pulmonary involvement in Goodpasture's syndrome is exceptionally isolated without renal impairment. Usual lung damage includes alveolar hemorrhage resulting in pulmonary-renal syndrome. Isolated and atypical lung involvement can precede kidneys damage. Case presentation: We report the case of an 80 year-old man admitted for dyspnea related to a tumor-like lung lesion which malignant nature we were unable to confirm. Three months later, the patient presented acute renal failure with rapidly progressive glomerulonephritis leading to the diagnosis of anti-glomerular basement membrane disease while the lung lesion remained stable. He received corticosteroid and immunosuppressive therapy with partially favorable renal outcome and complete regression of the lung lesion. Conclusion: Slight modifications of the urinary sediment should be sought in case of lung abnormalities. Anti-glomerular basement membrane antibodies must be considered in case of any kidney damage associated with pulmonary involvement even if atypical.

Background:Venolymphatic malformation s (VLM)are combination of venous and lymphatic components of low flow type of category.These malformations do not connect to the main channels directly. These present in the form of swelling and other characteristics as per the type of malformation. The diagnostic evaluation become more baffling if the overlying skin is normal. Case presentation:We present a 55-years old female who had swelling on the medial part of the knee which was causing some pain only during movements.The evaluation of the entity was done by ultrasound (US),color flow imaging (CFI) and magnetic resonance imaging (MRI).The diagnosis of venolymphatic malformation of vastus medialis was confirmed.Conclusion: VLM swellings of extremities can be diagnosed with confidence with CFI and MRI modalities.

Background:Colorectal cancer with ovarian metastasis is a rare occurrence, especially during pregnancy. Case presentation:A 43-year-old pregnant Chinese woman at 36 weeks gestation presented with a big adnexal mass and constipation. Elective cesarean section was performed, and a normal infant was delivered. Intraoperative frozen section pathology revealed differentiated adenocarcinoma with necrosis in the right ovarian tumor. In the further exploration of abdominal cavity, sigmoid colon cancer was diagnosed. Conclusion: High clinical suspicion is needed to diagnose colorectal cancer during pregnancy, which can present with symptoms that are common during pregnancy such as constipation. This can make the diagnosis of colorectal cancer during pregnancy difficult. Once diagnosed, surgery can be considered if resectable, taking into account gestational age. Fetal safety is a major consideration during treatment.

Background: Lycopodium powder consists of dried spores of club moss plants, principally Lycopodium Clavatum which is flammable when in contact with air due to its high oil content. Case presentation: A 15-year-old, previously healthy, female student presented to the Emergency Department with a 1-hour history of shortness of breath following accidental inhalation of Lycopodium in school. The dyspnoea was rapidly progressive and associated with multiple episodes of non-productive cough, chest tightness and nausea. A portable chest x-ray showed opacified bronchi in the right lower lung with para hilar peribronchial prominence virtually indistinguishable from those seen in lower respiratory tract infection. She began desaturating on 15L of oxygen and was unable to tolerate NIPPV (non-invasive positive pressure ventilation) hence shifted to the ICU where a 3L nasal cannula was started, which was well tolerated. IV Methylprednisolone was started at 40 mg q6h and was tapered to q8h the next day. The patient clinically improved and was stable by day 6. Conclusions: An extremely rare case of Lycopodium inhalation by a school student led us to realize not only the importance of a thorough history in cases where presentations can overlap but also safety recognition during school laboratory training sessions.

Background: Earring lesions in the neck region comprises spectrum of different pathologies.Papillary cystadenoma lymphomatosum (PCL) is one of such entity which falls in this spectrum. The cystic lesions of the tail of parotid gland can lead to utter confusion over the diagnosis and about its site of origin. The exact anatomy has to be delineated for the correct location and diagnosis. The wrong location and diagnosis can lead to many iatrogenic complications. The cross sectional imaging plays a pivot role .Computerized Tomography (CT) and Magnetic Resonance imaging can diagnose the entity to fairly complete diagnosis. Case Presentation: We present 41-years female who presented with this type of pathology with small swelling at the angle of mandible. She reported because of cosmetic reasons and was subjected to CECT and MRI.Coronal sections were able to delineate the lesion in both CECT and MRI. The lesion after histological analysis turned out to be Warthin's tumor. Conclusion: Ear ring lesions remain undiagnosed if not evaluated by cross sectional radiological imaging. The concern becomes greater because of the malignant potential of the neoplasm.

Background: Vertebral osteomyelitis most often presents with back pain and is usually a secondary complication of a distant infection with hematogenous seeding. A source of infection is detected in about half of the cases. Burkholderia cepacia has rarely been implicated as an etiology. Case Presentation: We present a 50 year old Caucasian male with low back pain for 10 days associated with urinary incontinence without any fever or chills. He had laboratory and imaging evidence of vertebral osteomyelitis. Patient underwent bone biopsy and was diagnosed with vertebral osteomyelitis and discitis caused by Burkholderia cepacia. The patient was treated with intravenous meropenem for initial two weeks and thereafter oral ciprofloxacin and continues to do well several weeks later. Conclusion: Vertebral osteomyelitis due to B. cepacia has rarely been reported as a cause and though rare this organism should be considered in the differential diagnosis of vertebral osteomyelitis in the appropriate clinical setting.

Background. Disorders of sex development (DSD) are known as the inborn atypical development of chromosomal, gonadal, or anatomic sex. New opportunities in counseling DSD patients have emerged with an advent of the next generation DNA sequencing (NGS) techniques. Case presentation. Two clinical 46, XY DSD cases having similar phenotypical features, including ambiguous genitalia, are presented in this paper. In the first patient, no causative variant was found, meanwhile, a heterozygous variant in the CHD 7 gene considered as likely-benign was identified (chr8:61693942, rs377139749, NM_017780.3:c.2053_2058dupGCAAAA p.Lys686_Thr687insAlaLys). Neither gonadal ability to produce androgens, nor tissue androgen sensitivity was impaired, therefore leading to a decision to maintain the initially assigned male sex in this patient. In the other patient, the study revealed previously reported heterozygous missense variant in the SEMA3A gene (chr7:83636785, rs769957117, NM_006080.2:c.А1024G:p.Met342Val) responsible for HH type 16 (OMIM 614897). As well, a novel hemizygous variant in the AR gene (chrX:66942818, AR:NM_000044:c.G2599C:p.Val867Leu) was identified. In conjunction with the features of HH, this leads to a decision to reassign the sex of rearing to a female. Conclusion. NGS technique may be helpful in optimal sex assignment in DSD cases.

Background Radical cystoprostatectomy (RC) with ileal conduit reconstruction represents a standard of care procedure for advanced bladder cancer. Patients submitted to RC and urinary diversions are at high risk of developing recurrent tumors or other complications related to the diversion. Lifelong diagnostic follow-up is recommended in these patients. Case presentation We present a case of a patient with a history of RC and nephroureterectomy for upper tract recurrence who developed gross hematuria 8 years after his initial treatment. The patient was exposed to several diagnostic steps including imaging, laboratory and endoscopic examinations. Conclusion Patients with advanced and recurrent urothelial cancer who present with gross hematuria need a stepwise diagnostic approach which is difficult and complicated in many cases.

Background: Refeeding Syndrome (RS) is an under-recognised pathophysiological process that can result in arrhythmias, coma and death if not identified and managed appropriately. Case Presentation This case report discusses RS in a 77 year-old female who presented with six days of total anorexia secondary to abdominal pain and vomiting. The patient was identified to have an ischaemic closed loop obstruction of the small bowel in the right femoral hernia with associated proximal small bowel obstruction. Following a small bowel resection, nutrition was reintroduced where on day three the patient developed hypophosphatemia, the hallmark of RS. Conclusion This case highlights the importance of considering RS in patients with a seemingly short duration of starvation due to acute intercurrent illness such as in this case a small bowel obstruction.

Background: Ectopic endocervical pregnancy is a rare clinical dilemma, threatening to life. Case Presentation: A 30 years young lady presented with painless vaginal bleeding of short duration without the history of amenorrhea. On radiological examination, she was diagnosed as a case of cervical polyp/fibroid. Provisional clinical diagnosis was as a case of retained products of conception. She had a history of three previous Caesarian sections; hence, hysterectomy was performed. Histopathologically, the uterus was found to have adenomyosis, while endocervical canal was embedded by wellformed chorionic tissue from internal os to the external os. The ectocervix was spared of invasion by chorionic tissue. Conclusion: Based on histopathological findings, a diagnosis of ectopic endocervical pregnancy associated with adenomyosis uterus was established. In given clinical scenario, ectopic pregnancy in endocervical region may be included in differential diagnosis of painless vaginal bleeding in young ladies.

Background: With the introduction of recombinant formulations insulin allergy is rare, occurring in less than 1% of patients treated with insulin. However, it is a serious situation requiring immediate attention, both due to the hypersensitivity reaction and severe life threatening glucose disequilibrium. Case presentation: A case of a 68-year-old male known diabetic for 35 years noticed some generalized itching, accompanied with maculopapular, mixed vasculitic and bullous lesions. Humalog Mix50/50 was stopped and patient was started on different combinations but to no avail. Before insulin desensitization a trial of degludec was given. Fortunately, the patient tolerated degludec and vildagliptin, and sugars came under control. Conclusion: This combination of multi-hexamer-forming ultra-long-acting insulin plus a DPP4 inhibitor vildagliptin could be an effective combination in controlling blood sugars in patients who have severe allergy to multiple drugs including oral hypoglycemic agents and various insulin preparations.

Background: Insulin overdose can result in fatal hypoglycemia. We report on a diabetic child who received an unintentional insulin overdose. Case presentation: A 13-year-old girl with type1 diabetes, who was on insulin pump therapy, developed high blood glucose (BG) level due to pump malfunction. She gave herself 7 ml (700 units) instead of 7 units by an error. She presented to hospital 2 hours later when this was recognized. The initial BG in the emergency room was 13.9 mmol/L. A dextrose infusion was started 6 hours after the insulin injections when her BG dropped significantly before it reached a lowest level of 3.3 mmol/L 9 hours after the event. It was only possible to discontinue this infusion 15 hours after insulin injections when BG was stable. Conclusion: Hypoglycemia could be delayed in insulin overdose in diabetic children. This may necessitate prolonged monitoring beyond the usual half-life of insulin.