Year 2020, Volume 4 - Issue 6

Background: Secondary hemophagocytic lymphohistiocytosis (HLH) is characterized by severe cytopenias due to uncontrolled hemophagocytosis. Other laboratory signs and clinical symptoms result from disordered immune regulation, and cytokine storm is well recognized. It is often a fatal complication of infections. It is not as uncommon as thought of previously. Case Presentation: We discuss a 7-year-old boy, born out of non-consanguineous marriage with acute hepatitis A infection, who developed HLH during treatment and was successfully managed with methyl prednisolone pulse therapy followed by oral prednisone therapy. Conclusion: Secondary HLH is a rare complication in a case of hepatitis A. A high index of suspicion at the early stage of HLH may produce a favorable outcome.

Background: Liver abscess has been reported in children, but amoebic liver abscess is very rare in infants. This is a rare case report of an amoebic liver abscess in a 45-day-old baby. Case Presentation: A 45-day-old male baby was referred to the gastroenterology department with an 8-days history of fever and vomiting off and on. His feed intake was less than usual, but otherwise did not have any other systemic complaints. On examination, the liver was enlarged 3 cm below the coastal margin. Routine labs were conducted along with liver ultrasound and Computed tomography (CT scan) of the abdomen. Ultrasound revealed multiple liver abscesses. CT scan showed cystic lesions in the right lobe of the liver. Enzyme-linked immunosorbent assay test was positive for amoebiasis. The baby was treated with antibiotics and discharged after 2 weeks. He was advised to take oral metronidazole for 4 weeks. After a month, he was reviewed in the follow-up clinic with complete recovery and normal ultrasound. Conclusion: Amoebiasis is endemic in developing countries [1]. It is the second most common cause of mortality after malaria [2]. It is common in adults but rare in small children [3]. Awareness about good hygiene and drinking clean boiled water should be emphasized.

Background: Toys with magnetic balls and objects can lead to serious consequences in children. We report a child with a history of magic ball (magnetic toy) ingestion. Case Presentation: A 4-years-old girl, previously healthy and developmentally normal, presented to the emergency department of the hospital with a 10 days’ history of vomiting and abdominal pain. Parents took her to different hospitals, where she was treated as a case of acute gastroenteritis and gastritis. Routine laboratory tests were normal, and an abdominal ultrasound also did not reveal any abnormality. Parents also did not report anything unusual in history. An abdominal X-ray was done in the Emergency room, which showed a collection of approximately 18 rounded radiopaque objects in the right lower abdomen with the signs of intestinal obstruction. Magnetic balls were removed after laparotomy followed by uneventful recovery. Conclusion: Awareness about the serious consequences of magnetic toy ingestion and the need to supervise children while playing is emphasized. It is strongly recommended that to reduce further damage, the International Safety Standards for the use of small magnets should be established.

Background: This is an account of a patient working in an ophthalmology clinic in a tertiary care hospital, Riyadh, who initially presented with work-related musculoskeletal disorder of the upper limb. The primary complaint was pain in the right shoulder and arm for the past 6 months. She was diagnosed with tenosynovitis of the upper limb on the first presentation, but later investigations revealed cervical stenosis. Case Presentation: A 42-year-old Indian female nurse, working in ophthalmology outpatient clinic at a university hospital in Riyadh, Saudi Arabia, presented with the complaints of pain in the right shoulder and arm for the past 6 months. She was transferred to another area with less work load and reduced exposure to occupational work manual exertion and sustained awkward exposure. The symptoms improved after 6 months of her transfer to the current unit. Conclusion: Although the initial symptoms were in favor of work-related upper limb musculoskeletal disorder, the nature of symptoms led to extensive workup, magnetic resonance imaging, diagnosis of cervical stenosis, and referral to orthopedics and neurology for further management.

Background: Sarcomatoid carcinoma (SC) of paranasal sinuses is a rare variant of squamous cell carcinoma. We present the case of a patient with maxillary sinus tumor projecting into the oral cavity. Case Presentation: We describe a 79-year-old male who visited the oncology department with complaints of soft tissue growth in the oral cavity. An imaging showed an infiltrating left maxillary antrum mass with locoregional destruction and multiple bone metastases. Histopathology proved this mass as SC. The patient was unfit for surgical resection, so he managed palliatively with radiotherapy. Conclusion: Being a rare entity, management is debatable, but radical surgery followed by adjuvant radiotherapy confers a better disease control. However, if tumor is unresectable, then radiotherapy alone can be helpful in the palliative management of this tumor.

Background: The concurrent presentation of non-Hodgkin lymphoma and multiple myeloma is a very rare condition and only few cases have been reported. Case Presentation: In this case report, we discuss a patient who presented with abdominal pain, weight loss, and melena. After the patient’s admission, several examinations were conducted. Microscopic findings in pathological studies and immunohistochemistry staining studies revealed a malignant non-Hodgkin B-cell lymphoma. A monoclonal free light chain protein was documented in the urine protein electrophoresis. Serum protein electrophoresis was reported to be normal. Bone marrow biopsy demonstrated cellularity plasma cell aggregations as multiple myeloma. Small bowel segmental resection surgery was the treatment plan. To prevent the relapse of chemotherapy, rituximab in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy was tolerated by the patient. Finally, melena did not last after the resection and hemoglobin returned to its normal range. Conclusion: In conclusion, this case report suggests that both multiple myeloma and non-Hodgkin’s lymphoma are hematopoietic malignancies which originate from B-cell lymphocytes. To understand, properly manage, and treat this rare condition, multiple studies are required, and this can be achieved by comparing similar cases.

Background: The aim of this study was to understand the local manifestations and complications of mosquito repellent toxicity. Case Presentation: A 16-year-old female presented to the emergency department with the complaints of severe pain over the left upper limb, with tense swelling and difficulty in movement. On the evaluation of history, the patient confirmed to have injected 2 ml of mosquito repellent “Good Knight” liquid into the flexor aspect of the left forearm just above the wrist joint a week back, and she gradually developed swelling and pain, for which she was being treated elsewhere. She was brought with restricted movement of the wrist joint with moderate pain and swelling extending up to the elbow region. Conclusion: In this case, the patient had injected around 2 ml of mosquito repellent liquid into the anterior compartment of the forearm above palmar carpal ligament. This solution is an acidic, toxic solution that causes irritation in skin tissues, in which one gets a direct exposure. This patient developed acute compartment syndrome which could have further led to Volkmann's contracture. Such chemical irritants can lead to life-threatening scenarios if left untreated and may irreversibly damage the structures that they have been exposed to. Timely intervention to release the compartment pressures may help to save the limb deformity or limb loss.

Background: Metanephric adenoma of the kidney is a rare, usually solitary, and benign tumor of the kidney, predominately affecting female patients in the fifth or sixth decade of life. It is considered by some specialists to be the hyperdifferentiated benign end of the Wilm’s tumor spectrum. Case Presentation: The case was a 49-year-old woman with abdominal pain, a palpable mass in the right abdomen, and mild hematuria, without any other symptoms or laboratory findings. An ultrasonography and computed tomography revealed a tumor in the upper pole of the right kidney with a diameter of 5.3 cm. There was no infiltration of the neighboring structures and tissues. The differential diagnosis included papillary renal cell carcinoma, adult Wilm’s tumor, and metanephric adenoma. A partial nephrectomy was followed. The histological examination of the tumor revealed relatively small unvarying basophilic epithelial cells with scant cytoplasm, uniform nuclei, and some areas with nuclear grooves, delicate chromatin, and indistinct nucleoli in a loose non-cellular stroma and developed in a tightly packed alveolar, tubular, and rarely papillary pattern. The mitotic rate was extremely low. Tumor cells were positive for paired box gene 8, cluster differentiation 57, and Wilm’s tumor 1 and negative for racemase, cytokeratin 7, and EMA. The cell proliferation rate Ki-67 was extremely low, and there was diffuse, strong cytoplasmic positivity for BRAF V600E staining. Based on morphology and immunohistochemistry, the diagnosis of metanephric adenoma was made. Conclusion: Although metanephric adenomas may be difficult to diagnose clinically, the histological examination and the immunohistochemistry assay, including BRAF V600 staining, can make a safe diagnosis, avoiding the administration of incorrect treatment.

Background: Care and rehabilitation following surgical repair of post-traumatic vestibular stenosis with scarring tissue should be intense and meticulous as treatment failure and risk of re-stenosis is high. Case presentation: We present a case of a 26-year-old male presented at 1 month post-motor vehicle accident which he sustained laceration injury to the left alar nasal sulcus. Upon examination, he had narrowed right vestibular opening and pin-point opening of the left nostril. He underwent a series of dilatation of the left nostril using Hegar dilators and resection of fibrous tissue. Postoperatively, he was advised to perform daily nasal dilatation using glue gun stick for three consecutive months. Lignocaine 2% gel was supplied as a lubricant for stick entry. Upon follow-up review, the patient exhibit excellent clinical outcome with patent bilateral nostrils. Conclusion: This report highlights a noveland cost-effective post-operative care using glue gun stick to maintain a patent and functional vestibular opening.

Background: Hypocalcemia is one of the most common disorders of metabolism in children. One of the most known causes is hypovitaminosis D, an extremely widespread condition in the world, both in developed and developing countries. Etiology is related to poor exposure to sunlight and inadequate diet, especially in subjects with dark skin or exclusively breastfed or born to mothers with vitamin D deficiency by ethnic and cultural reasons. Case Presentation: We report a case of a teenager from Morocco, who presented a tetanic crisis in the course of influenza B. The laboratory tests showed severe hypocalcemia and low serum vitamin D concentration with increased parathyroid hormone value. The administration of calcium and vitamin D normalized the clinical and laboratory parameters. Conclusions: Adolescents of ethnic groups at risk frequently find themselves in a chronic situation of altered metabolism deriving from vitamin D deficiency. Hence, a simple insult, as influenza B virus, can lead to severe pathological manifestations.