Year 2019, Volume 3 - Issue 3

Background: Iatrogenic vascular injury during lumbar discectomy is a rare but serious and life threatening complication. The pituitary rongeur is the usual cause of injury during the disc surgery. A deep bite can injure the major vessels, especially the abdominal aorta or the common iliac arteries. Case Presentation: We present a 33-year-old female patient with complaints of continuous abdominal pain and difficulty in walking. Her complaints began a couple of days before her admittance to our clinic. In the medical history, the patient had undergone a lumbar discectomy operation due to L4-L5 disc hernia 4 months ago. Her follow-up physical examinations were uneventfully in the first and third month of the lumbar disc surgery. The patient had no any chronic diseases in her medical history. Computed tomographical angiography revealed a 57 × 42 mm pseudoaneurysm formation from the abdominal aorta arising closely from the abdominal aortic bifurcation level. A primary repair for the posterior abdominal aortic defect and a patchplasty for the aortotomy was performed. Conclusion: Clinician should suspect of vascular complications in terms of ongoing complaints, such as abdominal pain or a pulsatile mass in the abdominal region after lumbar disc surgery. In such cases, the clinical evaluation and imaging procedures must be done carefully.

Background: Multimodality treatment is the mainstay of therapy for patients with locally advanced squamous cell anal cancer. This consistes of concurrent radiation and chemotherapy (including fluoropyrimidines and mitomycin). Several adverse skin reactions are associated with fluoropyrimidines. Case Presentation: Here, we describe the occurrence of an erythema multiforme in a patient treated with radiotherapy and concomitant mitomycin C and capecitabine for anal cancer. Conclusion: We underline the potential cutaneous drug-induced toxicity during pelvic radiotherapy with capecitabine.

Background: Erdheim-Chester disease (ECD) is a non-Langerhans cell histiocytoses with multiorgan xanthomatous infiltration of tissues by histiocytes, surrounded by fibrosis. Case presentation: A 68-year-old Caucasian female was admitted to the emergency department for dyspnea. The patient was given empiric antibiotic therapy with Piperacilin/Tazobactam, but after 10 days the patient underwent respiratory failure accompanied with worsening of the renal function, noninvasive ventilation and diuretics for perfusion were given, but the treatment was unresponsive. Kidney Computed Tomography showed enlargement of both kidneys, suggesting an inflammatory process. A renal biopsy was performed which confirmed the diagnosis of ECD. Conclusion: It is an overlooked diagnosis due to its rarity, variable presentation, and the subsequent manifestations may also develop after several years.

Background: Thyroid ectopia refers to a congenital disease with abnormal descending of the thyroid gland. The most common subtype is lingual thyroid ectopia. Sublingual and submental thyroid ectopia are much less common. It may also be found in other neck locations and distant positions .70%-90% of patients with ectopic thyroid do not have eutopic thyroid tissue. It is necessary to distinguish ectopic thyroid from other causes of neck masses. Case Presentation: A 18-year-old man was referred for the evaluation of a palpable mass in the submental region. On biochemical examination, the thyroid function tests were normal while receiving levothyroxine therapy. Ultrasonography revealed a mass measuring 4.2 × 2.7 × 2.6 cm in the submental region. The thyroid scan did not show any uptake in the thyroid region. A zone of the tracer activity was noted in the central neck, compatible with the palpated mass in the submental region. CT images showed a hyperdense soft tissue in the submental region, too. Conclusion: Thyroid ectopia is a rare condition and it is often accompanied by hypothyroidism. Ectopia often occurs in lingual and sublingual locations, and submental one is less common. Thyroid scintigraphy is the best imaging modality for the detection of thyroid ectopia. For precise localization, the CT scan correlation may be needed.

Background: Despite recent advances in management of acute liver failure (ALF), morbidity and mortality are still significantly high. Management strategies amongst others involve determination of etiology and greater than 50% of cases often require liver transplantation. Case presentation: A 36-year old Cameroonian male presented to our facility (a tertiary level health institution in Cameroon) with 10 days history of gastrointestinal symptoms (diarrhea, abdominal pain, and vomiting) for which he auto-medicated with herbs and intravenous cefriaxone for 3 days. Two days prior to the presentation he developed yellowish discoloration of the eyes which prompted consultation. His evolution inpatient was marked by development of ALF Lack of necessary diagnostic tools and intensive care unit substandard care led to worsening of ALF. The patient died on day 6 of hospitalization. Conclusion: The case presented brings to lamp light the difficulties encountered in making an aetiologic diagnosis for ALF and the substandard care provided in patients with ALF in resource-limited settings. A lot still needs to be done to empower facilities in developing nations in care of ALF.

Background: Even though rivaroxaban has been mainly associated with hemorrhage-related adverse effects, rivaroxaban-induced skin necrosis has received less attention or went unrecognized. Little has been documented about hypersensitivity reactions caused by the treatment with rivaroxaban. Case Presentation: This paper reports a skin necrosis with an apparent similarity to skin adverse events caused by the different anticoagulants. It happened in a 30-year-old female patient during rivaroxaban treatment. The correlation of the skin lesions to the used drug was made by the act of repeated discontinuation and reuse of rivaroxaban and the noticed remission and exacerbation of skin necrosis. Conclusion: This case highlights the vigilance required by healthcare in recognizing potential adverse effects of newly marketed drugs and in making medication changes whenever necessary.

Background: Salmonella infection usually causes mild self-limiting gastroenteritis. Nontyphoidal salmonella can sometimes cause bacteremia and extra-intestinal infection. In rare occasions, it can result in splenic abscess. Case Presentation: We reported a case of splenic abscess resulting from Salmonella enteritidis infection. Our patient is a 57-yearold man with diabetes mellitus, came with acute febrile illness associated with epigastric pain. He was diagnosed to have splenic abscess based on computed tomography and subsequently recovered well after antibiotic therapy and abscess drainage. Conclusion: Diagnosis of splenic abscess is often difficult and requires high index of suspicion. Early diagnosis is often associated with better outcome. Abscess drainage is an important treatment modality of splenic abscess.

Background: Cortical involvement and leptomeningeal enhancement are rare in neuromyelitis optica spectrum disorder (NMOSD). Cerebrospinal fluid (CSF) total protein is usually raised typically ranged between 0.5 and 1.5 g/l. Case Presentation: A 22-year old lady who was previously well presented with a subacute onset of bilateral lower limb weakness for 1 week, which progressed in an ascending pattern involving the upper limbs. Magnetic resonance imaging spine showed longitudinally extensive transverse myelitis as well as leptomeningeal enhancement of the entire spine. CSF protein was high with 3.33 g/l. Serum Aquaporin-4 IgG was positive. After failed steroid therapy, she responded dramatically with plasma exchange. Conclusion: The presence of very high CSF protein and the presence of extensive leptomeningeal enhancement should not dissuade clinicians from considering the diagnosis of NMOSD, but merely reflects its severity and may need aggressive immunotherapy such as combination of steroids and plasma exchange.

No abstract available

Background: Skeletal tuberculosis accounts for 1% to 5% of all tuberculosis (TB) cases. Multifocal skeletal tuberculosis is rare. Early diagnosis of multifocal skeletal TB is crucial and challenging for proper treatment and to prevent development of complications. The purpose of this case report is to highlight importance of bone scan in suspected cases of skeletal tuberculosis. Case Presentation: We describe a case of 24-year-old female, referred to Nuclear Medicine Department for bone scintigraphy. Patient had complaint of neck stiffness and generalized body aches. Patient underwent 99mTc-methylene diphosphonate scintigraphy which showed multifocal bony pathology mimicking bony metastasis. However, patient was treated with antituberculous therapy and showed excellent response on follow up bone scan. Post-therapy: patient recovered without developing any complications. Conclusion: Multifocal skeletal tuberculosis must be kept in the differential diagnosis of multifocal bony pathology seen on bone scintigraphy.

Background: Type B aortic can be a life-threatening emergency, with a 10-year survival rate ranging from 30% to 60%. Case Presentation: A 58-year-old man with a history of hypertension presented with intense abdominal pain lasting for 2 hours. Computed tomographic angiography of the thorax and abdomen revealed extensive type B aortic dissection. Despite intensive medical therapy, blood pressure remained uncontrolled, motivating a thoracic endovascular aortic repair, with clinical improvement. Conclusion: History of arterial hypertension and/or the use of drugs followed by severe chest or back pain without evidence of myocardial ischemia is highly suggestive of acute aortic dissection. The goals of treatment are to control pain and maintain organ perfusion. Patients with type B aortic dissection tend to be older and are generally managed medically. However, recent papers have shown an increasing interest to consider thoracic endovascular aortic repair in patients with acute uncomplicated disease in order to prevent later complications.

Background: Radiation retinopathy is a chronic, gradually progressive retinal microangiopathy that can occur with variable latency after exposure to radiation of head and neck. Nasophargeal carcinoma is a frequent head and neck tumor of the south-East Asian countries. Case Presentation: A 54-year old Asian male presented with decreased vision for 2 years in left eye. He had diffuse cystoid macular edema, retinal hemorrhages, exudates, and telangiectatic vessels. In the right eye, he had focal macular edema, exudates, and micro-aneurysm. He had undergone external beam radiation for nasopharyngeal carcinoma 32 years ago. He was treated with several injections of Anti-vascular endothelial growth factors elsewhere for persistent macular edema secondary to vein occlusion in the left eye, and had fewer response. Conclusion: The chronic maculopathy responded to treatment with intra vitreal sustained-release dexamethasone implant (Ozurdex®) and laser photo coagulation.