Year 2020, Volume 4 - Issue 2

Background: Carotid body tumors (CBTs) are benign, but they are quite controversial for the management because of their location and symptoms. Cervical CBTs are slightly uncommon paragangliomas. These are highly vascular tumors. Their location is at the bifurcation of common carotid artery (CCA) which is adjacent to many cranial nerves. Surgical management involves a lot of morbidity and mortality. Case Report: A 48-year-old female reported with painless small swelling on the right side of the neck region just below the angle of the mandible. The radiological evaluation by ultrasonography, contrast-enhanced computerized tomography, and magnetic resonance angiography revealed the swelling as carotid body tumor. The patient had been advised surgical management as presently the entity was almost without any symptoms. Conclusion: The cross-sectional imaging plays a great role in the diagnosis and management of CBTs as they are associated with many complications. The treating surgeon had to be very careful about surgical extirpation.

Background: Vitamin C is often used by complementary and alternative medicine practitioners for its antioxidant properties. We describe a case of severe hemolytic anemia and methemoglobinemia paradoxically resulting from an oxidative stress of high dose vitamin C in a patient with previously undiagnosed glucose-6-phosphate dehydrogenase (G6PD) deficiency. Case Presentation: A 47-year-old man presented with severe hemolytic anemia and methemoglobinemia days after receiving 395 g of intravenous (IV) vitamin C at an alternative medicine practice. He was managed conservatively with transfusions and his hemolysis subsided after several days. His G6PD level, measured months after his presentation, was deficient at 0.4 units/g. Conclusion: While vitamin C is often considered an antioxidant, its utilization in tissues produces its oxidized form (dehydroascorbic acid) which depletes intra-erythrocyte stores of glutathione. Patients with G6PD deficiency have reduced abilities to restore intracellular glutathione, placing them at risk for oxidative stress, and subsequent hemolysis that can be life threatening.

Background: Influenza A H1N1 pdm09-associated neurological complications are rare, particularly in adults. This case report highlights one of the uncommon presentations associated with H1N1 pdm09 infection. Case Presentation: We present the case of a 38-year-old male who was admitted to the hospital primarily with respiratory manifestations and developed acute cerebellar ataxia during hospital stay, causing a diagnostic dilemma, as his cerebrospinal fluid analysis and magnetic resonance imaging brain were unremarkable. Throat swab real-time reverse transcriptase polymerase chain reaction (rRT-PCR) turned out positive for influenza A (H1N1) pdm09 virus strain and a nontypeable influenza A strain. He showed the resolution of cerebellar signs and a remarkable recovery on oseltamivir therapy. Based on the acute onset, positive RT-PCR and recovery on antiviral, a diagnosis of H1N1-associated cerebellitis was made. Conclusion: This report highlights an extremely rare complication of influenza infection with only five reported cases in adults and case series in children. Vigilance and a high index of suspicion for patients presenting with rapid onset neurological deterioration during pandemics and seasonal epidemics can prevent devastating sequelae.

Background: Dubowitz syndrome is a rare multiple congenital syndrome with unknown etiology, characterized primarily by growth retardation, distinctive facial dysmorphism, cutaneous eczema, microcephaly, intellectual deficit, skeletal and genital abnormalities, abnormal hematological and endocrinal findings, and other systemic affections. Case Presentation: We report the case of a 3-year-old male patient presenting with repeated chest infections, failure to thrive, history of low birth weight, and seasonal skin allergies. Examination revealed abnormal facial features and skeletal and genital abnormalities along with delays in social development. Cardiac echocardiography showed atrial septal defect and ventricular septal defect. Blood tests revealed low growth hormone levels, and a clonidine stimulation test confirmed growth hormone deficiency. Conclusion: Careful examination of the patient leads to the diagnosis of Dubowitz syndrome and growth hormone deficiency. The combination of these two findings has rarely been reported before, but patients may get the benefit of testing for growth hormone deficiency to receive proper treatment.

Background: Littoral cell angioma (LCA) is a rare vascular tumour of the spleen with unique histologic and immunophenotypic features. LCA is generally diagnosed incidentally and has a benign clinical course. However, it has rarely been reported to behave as a malign entity. Case presentation: A 49-year-old woman with cerebral palsy admitted to the hospital suffering from abdominal pain and weight loss. Laboratory results revealed iron deficiency anaemia and mild thrombocytopenia. Computed tomography scan revealed splenomegaly with multiple hypoattenuating lesions. A diagnostic and therapeutic open splenectomy and sigmoid colectomy were performed to exclude possible lymphoproliferative disorders or malignant lesions. The histologic and immunohistochemical studies confirmed the diagnosis of LCA and sigmoid volvulus. The post-operative period was uneventful with a significant increase in haemoglobin and platelet levels. Unfortunately, the patient died due to sepsis 36 days after surgery. Conclusion: This is the first case of LCA and sigmoid volvulus. Although this association is likely to be entirely coincidental, clinicians should be aware of this rare clinicopathologic entity whilst evaluating the differential diagnosis of splenomegaly with solitary or multiple nodules.

Background: Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome is a rare plasma cell dyscrasia, which could be presented as treatment-resistant polyneuropathy before the emergence of other systemic complications. Case Presentation: A 43-year-old male patient presented with progressive lower limb weakness and difficulty in walking, in addition to erectile dysfunction. After the diagnosis of POEMS syndrome, the patient was treated according to the standardized chemotherapeutic regimen for multiple myeloma that includes lenalidomide, without considering the increased risk of thromboembolic complications given that the patient had decreased ambulation due to his polyneuropathy and polycythemia. This warrants a better treatment regimen for these patients to eliminate any possible episode of thromboembolic complications, which might become fatal in the future. Conclusion: Although rare, it was recommended that deep vein thrombosis risk and its link to the proper treatment plan in patients with POEMS syndrome should be studied further.

Background: Peutz-Jeghers syndrome (PJS) is an autosomal dominant condition presenting with mucocutaneous pigmentation. We report a rare condition of PJS in an 11-year-old female. Case Presentation: An 11-year-old girl, previously healthy and developmentally normal, presented to the emergency department of the hospital with a 1-week history of vomiting and abdominal pain. She was given symptomatic treatment and referred to pediatric gastroenterology for further management and diagnosis based on the physical findings. The examination findings included hyperpigmented macules on fingertips, toes, lips, and oral mucosa. She had a history of rectal polypectomy in the past. Parents were cousins, but there was no significant family history. She was diagnosed as PJS based on her physical findings and multiple gastric polyps on endoscopy. Conclusion: PJS is characterized by mucocutaneous pigmentation and multiple gastrointestinal polyps. Rectal polyp can be a clue to the syndrome even before the appearance of hyperpigmented macules. They need lifelong follow-up because they are prone to gastrointestinal complications and malignancies.

Background: Dengue fever classically presents with fever, arthralgia, myalgia, leukopenia, and thrombocytopenia. A classical presentation with a positive serology test is usually enough to make the diagnosis in an endemic area. Case Presentation: A 30-year-old man presented with fever, leucopenia, thrombocytopenia, hepatitis, and delirium. Dengue Immunoglobulin M (IgM) serology was positive. Blood culture grew Salmonella typhi, his ferritin was raised, and bone marrow histology showed histiocytes and hemophagocytic activity. A 2-week course of ceftriaxone (60-75 mg/kg/day) and intravenous immunoglobulin (0.4 g/kg once a day) for 3 days resulted in complete resolution of his illness. Conclusion: We report a case of typhoid fever with hemophagocytic lymphohistiocytosis mimicking as dengue fever due to cytopenias and hepatitis, and dengue IgM serology was positive. Although rare, a high index of suspicion is required for early diagnosis and treatment.

Background: Adrenal myelolipomas are a type of benign tumors of hematopoietic nature that is non-functional and considered as a mature adipose tissue. Case Presentation: In this study, two cases of symptomatic myelolipoma were presented. One suffered from nausea and vomiting combined with pain and feeling of postprandial pressure causing weight loss with a minimum body mass index below 18 kg/m2. While, symptoms of postprandial pressure with pain in the right upper abdomen was present in another case. Both patients were selected for surgery. An open conventional surgery via abdominal access for the giant myelolipoma with a maximum diameter of 14 cm and minimal-invasive surgery for the 8 cm myelolipoma in a cachectic patient with 45 kg body weight was indicated. Patients recovered from their symptoms quickly. Conclusion: Surgery was indicated for symptomatic myelolipomas. The resection could be performed minimal-invasive up to 10 cm in specialized centers and via open surgery in every other case.

Background: The incidence of delayed hemothorax from blunt chest trauma was only up to 7.4%, massive hemothorax being much rarer. Case Presentation: We report a case of this uncommon situation involving a 65-year old gentleman with alleged motor-vehicle accident (MVA) sustaining multiple right 2nd to 8th rib fractures. Despite initial in-patient monitoring, he presented to us again on Day-7 post-MVA with acute shortness of breath and chest pain. Chest radiograph showed homogenous opacity over right lung field with the blunting of costophrenic angle. Right thoracostomy tube drained 800 ml of frank blood upon insertion with a total of 1,250 ml within 12 hours. The patient was subsequently transferred to cardiothoracic center for definitive care. Conclusion: Therefore, the possibility of delayed sequelae following blunt chest trauma should be considered and communicated to the patient to encourage vigilance and home monitoring. Despite rarely requiring emergency surgery, delayed massive hemothorax is potentially life threatening.