Year 2020, Volume 4 - Issue 12

Background: Eosinophilic gastritis is an eosinophilic inflammation of the stomach mucosa characterized by eosinophilia in the absence of other known causes. It is usually the result of contact with a food allergen. Allergy to cow’s milk is one of the possible reasons. It often presents with different symptoms, one of these being hematemesis. From the current literature, we know that eosinophilic disease can result in severe tissue damage. Case presentation: We report two patients who were admitted to the gastroenterology department with severe hematemesis and were diagnosed via gastroscopy with the rare presentation of erosive gastropathy. Our patients eventually recovered after initiation of hydrolyzed milk. Conclusion: It is important to consider gastroscopy to aid in the rapid diagnosis of eosinophilic gastritis, even in the case of a relatively young child. This is because the strongest evidence for diagnosis is histological biopsy.

Background: Primary Sjogren’s syndrome is an autoimmune disorder characterized by diminished lacrimal and salivary gland functions. Other than the exocrine gland involvement, it is also known to affect other visceral organs, resulting in extraglandular manifestations. Obvious cardiac involvement is rare, with pericardial effusions being the commonest feature. Sjogren’s syndrome is also known to cause renal involvement, with tubulointerstitial nephritis being the most typical. Case Presentation: We report of a 37-year-old female with primary Sjogren’s syndrome who developed bilateral parotid swelling, generalized edema, palpable purpura, arthralgias, and dyspnea. Skin biopsy of the purpuric lesions demonstrated leukocytoclastic vasculitis. Echocardiography revealed a low left ventricular ejection fraction (~45%) and a small pericardial effusion (10 mm). These findings together with an abnormally raised NT-proBNP of 2,424 pg/ml were highly suspicious for an autoimmune myocarditis. Proteinuria (1.8 g/24 hours) was present and renal biopsy confirmed membranoproliferative glomerulonephritis. Cryoglobulins were positive. Upon commencement of the treatment, with intravenous bumetanide, pulsed methylprednisolone, and enalapril, the patient experienced rapid symptom resolution. Conclusion: The extraglandular manifestations of primary Sjogren’s syndrome are many and may affect more than one organ at the same time. Although rare, autoimmune myocarditis is an important differential in Sjogren’s syndrome patients who present with dyspnea.

Background: Siliconosis was first described in the late 1980s and it is still remaining as a rare condition and mainly as a diagnosis of exclusion after breast cancer investigation. There are only limited cases reported and published with even smaller amount related to the breast implants (31 studies and 8 related to breast implants found in PubMed search in December 2019). Case presentation: Authors present the case of siliconosis secondary to bilateral cosmetic breast augmentation performed back in 1989. The patient was troubled with a myriad of complications and underwent an exchange of implants with Trilucent™ implants in 1997 and their subsequent removal in 1998. Later, they underwent bilateral mastopexy and is currently free of implants. Ever-since the first operation patient complained of pain, localized tenderness, swelling, axillary fullness, paraesthesia and partial paralysis in her upper limbs amongst other symptoms. Objective investigations including plain radiographs, USS, CT, MRI, nerve conduction studies, rheumatological screen yielded essentially negative results. Thoroughly investigation for breast cancer was conducted, including several operations and biopsies of axillary swellings with confirming reactive lymphadenopathy. A working diagnosis of siliconosis has been made and the patient was treated expectantly. Conclusion: This case should remind our colleagues of the ethical and professional responsibilities we have toward our patients in explaining all the potential risks involved in breast augmentation and also to keep an open mind when meeting patients complaining of systemic symptoms post breast augmentation.

Background: Adrenal myelolipoma is a rare benign neoplasm which is composed of mature adipose tissue and scattered islands of hematopoietic elements. Usually, myelolipoma is small (

Background: Brugada syndrome (BrS) is a rare form of channelopathy caused by mutation of SCN5A gene that encodes for sodium channel and is associated with increased risk of ventricular arrhythmia and sudden cardiac death. BrS has a characteristic electrocardiographic (ECG) pattern. Various stressors can induce Brugada-like pattern on ECG in the absence of BrS known as Brugada phenotype. Case Presentation: We report a case of a 28-year-old African-American male patient who presented to the emergency department with a chief complaint of atypical chest pain. He was noted to have an elevated blood pressure and a type 1 Brugada pattern on his 12-lead ECG. His ECG changed from type 1 to type 3 Brugada pattern upon controlling blood pressure, which indicated the presence of a Brugada phenocopy. Conclusion: It is important to recognize the underlying stressors that can lead to Brugada-like patterns on the ECG since these stressors are treatable without any sequel.

Background: Coronavirus disease 2019 (COVID-19) infection can involve the cardiovascular system with many presentations, including pericardial effusion. Nevertheless, there is no evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA detected in pericardial effusion during the acute phase of COVID-19 infection. Case Presentation: We report an acute, large but located pericardial effusion during acute COVID-19 infection, which required emergent pericardiocentesis. SARS-CoV-2 RNA was found in the pericardial fluid. The patient also presented with concomitant pleural and peritoneal effusion. The patient was treated with colchicine and was discharged 16 days later. Conclusion: SARS-CoV-2 RNA can be detected in pericardial effusion during the acute phase of COVID-19 infection. Concomitant presence of pleural and peritoneal effusion could confirm the hypothesis of exaggerated systemic inflammatory response triggered by the virus.

Background: Intestinal obstruction due to right paraduodenal hernia in early postpartum period is rare. There is only one published case report on left-sided paraduodenal hernia (PDH) in early postpartum period, which was treated by open surgery [1]. However, we would like to present first ever case of right-sided PDH causing acute small bowel obstruction in early postpartum period, which was treated laparoscopically. Case Presentation: Our patient was a 29-year-old female who had undergone full-term normal delivery 4 days prior. She presented with acute small bowel obstruction to the emergency ward. Right PDH was diagnosed on contrast-enhanced abdominal computed tomography. She underwent laparoscopic repair. Right PDH is a congenital condition caused by incomplete rotation of the midgut in early embryological developmental phase. In our patient, increased intra-abdominal pressure during gestation probably forced more and more bowel loops to enter and get entrapped into the pre-existing defect. Conclusion: Right PDH is a rare entity and can rarely cause acute intestinal obstruction in immediate postpartum period.

Background: Rotablation is used in heavily calcified lesions when balloon angioplasty fails to expand the lesion before stenting. Case Presentation: A 68-year-old male patient was admitted with angina 9 months after implantation of a 3.5 × 23 mm drugeluting stent in the crux of right coronary artery. Intravascular ultrasound revealed that the strut-to-strut diameter of the stent in the underexpanded region was 1.6 mm. High-pressure balloon inflation up to 26 atm was performed many times and the procedure was again completed with 3.0 and 3.5 mm kissing balloon inflation at 22 atm. After 4 months following the second procedure, the patient was admitted with the same symptoms. This time a 1.75 mm rotablator was used cautiously under low speed (150,000 rpm) to ablate the stent struts which handicap adequate expansion and lead to recurrent stenosis. Conclusion: Rotablation can also be used to fix an underexpanded stent if the other options fail.

Background: Intussusception in adults is distinct from pediatric intussusception in many aspects. In contrast to intussusceptions in children, a demonstrable etiology is found in 70%-95% of the cases in the adult population, and approximately 40% of them are caused by primary or secondary malignant neoplasms. But lymphomas, as a cause of lead point in adult intussusception, are extremely rare and only less than 50 cases have been reported in the literature. Case Presentation: We are reporting a 44-year-old male who presented with a right iliac fossa mass and clinical features of intussusception and who was operated upon. Per-operative findings were consistent with ileocecal intussusception and a radical right hemicolectomy was conducted. Histopathological examination revealed it as a case of Diffuse Large B Cell Lymphoma presenting as the lead point. This case is discussed because of the rarity of the disease and possible cure if diagnosed early and treated aggressively. Conclusion: Ileocolic intussusception is adults is usually caused by malignancy and mostly as adenocarcinoma. Non-Hodgkin lymphoma as a lead point is extremely rare and is usually a histologic surprise. However, a radical en mass resection without reduction is ideal in all forms of adult colocolic and ileocolic intussusception.

Background: Pemphigus vulgaris (PV) is a rare autoimmune chronic blistering skin disease of type II hypersensitivity reaction. Case Presentation: The authors present a case of a 42-year-old male with the chief complaint of crusted plaques on face, chest, and scalp for 3 months associated with itching. On investigation, direct immunofluorescence showed immunoglobulin G antibodies. The patient was prescribed antibiotics, anti-inflammatory agents etc., but they did not show any effect. So, the physicians opted for pulse therapy. Conclusion: PV is a rare chronic ulceration of the mucosa where crusted plaques and blisters are seen. This condition can be effectively resolved using glucocorticoids and immunosuppressant. If untreated, this may lead to the death of the patient.