Year 2020, Volume 4 - Issue 3

Background: In the recent decades, Lemierre's syndrome (LS) has been increasingly diagnosed with a wide range of causative organisms, especially with increased awareness of such an entity. Case Presentation: We report an unusual case of LS in a previously healthy 15-year-old boy who presented initially with high grade fever, nonspecific gastrointestinal symptoms, and unilateral purulent otorrhea. Patient subsequently deteriorated requiring intensive care and exhibited altered mental status prompting an urgent contrast enhanced computed tomography brain which clinched the diagnosis. Patient underwent mastoidectomy followed by IV antibiotics that were streamlined according to his pus culture. He also developed bilateral lung empyema requiring bilateral chest tube drainage. Anticoagulation was commenced for the thrombosis and patient was discharged home well. Conclusion: This was an intriguing case in view of the unusual organism causing LS, initial diagnostic dilemma, and challenges in management.

Background: Pleuropericardial cysts are rare and usually clinically silent, but can occasionally cause life-threatening complications. The majority of them is congenital due to developmental deficits and is most commonly found incidentally via routine radiography between the third and fifth decade of life. Case Presentation: A 37-year-old Caucasian woman who referred to the Emergency Room because of asthma exacerbation diagnosed suffering of pneumonia. During the follow-up and after antibiotics, chest X-Ray and computed tomography revealed a probably acquired large pleuropericardial cyst of unknown cause. Conclusion: We report an unusual case of possible infection which revealed an asymptomatic large pleuropericardial cyst which was detected accidentally via X-Ray and was left untreated due to its benign course.

Background: Subclavian pseudoaneurysm is a rare sequalae of untreated ipsilateral clavicular bone fracture and may be complicated with distal embolization, causing an acute ischemia of ipsilateral upper limb. Case Presentation: We present a challenging case of subclavian pseudoaneurysm who was later discovered to have a previously missed clavicular bone fracture. The case was complicated with concurrent recurrent ischemic limb and transient ischemic attack of the brain. Conclusion: Although subclavian artery pseudoaneurysm as a cause for transient ischemic attack has not been described in literature, we believe that our case has highlighted the possibility of such association.

Background: Cardiac myxoma is the most frequent “benign” tumor of the heart and presents an important diagnostic challenge. Case presentation: A 51-year-old woman was admitted at the hospital for anorexia, fatigue, nausea, and vomiting for the last 10 days. Laboratory results showed hemoglobin 5.26 g/dl, platelets 83× 10^9 μl, Lactate Dehydrogenase (LDH) 348 U/l, bilirubin 2.0 mg/dl, haptoglobin 100 mg/dl, negative Coombs test, blood smear with schistocytes and urea 327 mg/dl, creatinine 8.56 mg/dl. Non-autoimmune hemolytic anemia and acute kidney injury was assumed. After seven plasma exchange treatments, she went into acute pulmonary edema. Body tomography was performed, and revealed a mass in the left atrium. She underwent atriotomy and after surgery hemoglobin values stabilized but kidney function did not improve, and she became dialysis dependent. Conclusion: Myxomas can mimic other diseases which may delay diagnosis and compromise prognosis. In this particular case, the myxoma manifested with intravascular hemolytic anemia. This is an, especially, interesting case because a myxoma caused kidney failure without recovery.

Background: Extra-nodal diffuse large B-cell lymphoma (DLBCL) is an exceedingly uncommon disease. Case Presentation: Herein, we report a case of a 60-year-old male patient who presented with DLBCL of the left leg, and involving the gastrocnemius muscle. The patient received CHOP regimen-based neoadjuvant chemotherapy (i.e., six courses of cyclophosphamide, doxorubicin, vincristine, and prednisone), which reduced the tumor size to the point where complete resection became possible. Afterward, the tumor was completely resected. The tumor bed subsequently received conventional radiotherapy (i.e., 36 Gy/18 fractions). The patient is being followed up regularly and has remained disease-free for over 1.5 years. Conclusion: This case demonstrates that DLBCL is an aggressive malignancy but can be effectively managed with multi-modality treatment strategy.

Background: Uterine curettage after spontaneous pregnancy loss may result in complications, including acquired arteriovenous fistula (AVF), and most cases settle spontaneously with conservative or medical management. Persisting symptoms require more definitive treatment and this is usually with hysterectomy. This report shows that the embolization as a uterine-sparing surgical alternative can offer a definitive endovascular treatment strategy. Case presentation: A 34-year-old lady presented with anemia from recurrent per-vaginal bleeding which persisted for 3 months after curettage for failed early pregnancy. Ultrasound showed AVF and a large pseudoaneurysm. Angiography and embolization was performed using gelatin sponge which was able to successfully treat the vascular lesions. At 2 years follow-up, she had complete symptom resolution and preserved her uterus. Conclusion: There are only a small number of case reports in the literature to support embolization as a minimally invasive surgical alternative as a definitive treatment.