Year 2020, Volume 4 - Issue 9

Background: Intrahepatic cholangiocarcinoma (ICC) is arising from the intrahepatic bile ducts and accounts for 8%-10% of all malignant hepatic tumors. Case Presentation: We report the case of a 42-year-old woman having ICC with thyroid-like follicular pattern. The patient had 9-cm solitary liver mass showing morphological pattern resembling thyroid follicles. Immunohistochemistry was negative for thyroid markers. The patient had no evidence of a previous or concomitant thyroid tumor. This case can be added to the list of extrathyroidal primary tumor that morphologically resembles thyroid neoplasms. Only three such cases have been previously reported in the literature. Such a pattern is known to occur in primary kidney and breast tumor. Thyroid like pattern broadens the morphological spectrum of cholangiocarcinoma. Conclusion: Careful evaluation of this morphological rare variant of ICC is very essential to prevent misdiagnosis of metastatic thyroid follicular neoplasm.

Background: The main use of Granulocyte colony stimulating factor (G-CSF) is stem cell mobilization in neutropenic patients and healthy donors as well as for engraftment. Most of their secondary effects are mild and temporary; however, there is a relation between spontaneous splenic rupture and G-CSF treatment. Case Presentation: We report a case of an 88-year old man, who presented with a spontaneous splenic rupture after use of G-CSF. Conclusion: Although it is an uncommon side effect, the mortality is very high, so clinicians should be aware of the importance about maintaining a high index of suspicion for this condition.

Background: A brain abscess is a rare but serious complication of sinusitis. It mostly involves adolescents and more specifically those of the male sex. A cerebral abscess is characterized by a heterogeneous clinical picture. The pathogenic organism mostly involved belongs to the Streptococcus milleri group. The diagnosis process is based on imaging. Treatment is based on an antibiotic therapy for 4-8 weeks which can be followed by surgery. Long-term sequelae occur in 40% of the cases, and mortality is about 10%. Case Presentation: This paper reports the clinical case of a 16-year-old boy affected by a sinusitis-induced brain abscess. The worsening of the clinical picture and of the neuroimaging, despite antibiotic therapy, made a surgical intervention necessary. An intravenous antibiotic therapy was administered for 2 weeks followed by oral antibiotics. Despite this, the condition of the patient was worsening, and he had to be treated again with intravenous antibiotic therapy for 4 weeks. This therapeutic choice had a positive outcome and the boy was declared healed. Conclusion: Sinusitis is an infection that can be complicated by brain abscess in 6%-8% of cases. Large-sized cerebral abscesses accompanied by neurological symptoms require prompt surgical treatment and a targeted antimicrobial therapy to reduce hospitalization and to speed up the healing process.

Background: Acute necrotizing encephalopathy of childhood (ANEC) is a rare but distinctive type of encephalopathy predominantly involving infants and young children. This case report describes the characteristic neuroimaging findings which can aid in early diagnosis of ANEC. Case Presentation: An 11-year-old boy presented with a 2-day history of fever and flu-like illness and was given symptomatic treatment. He subsequently deteriorated on day 3 of illness with generalized tonic-clonic seizure and impaired consciousness. Magnetic resonance imaging done revealed abnormal signal intensities at bilateral thalami, brainstem, and cerebellum, which are suggestive of ANEC, correlating with his clinical presentation. Treatment was started immediately, but the patient had a very poor recovery. Conclusion: ANEC is a very rare encephalopathy and has very high mortality and morbidity with severe neurologic sequelae. Early diagnosis is important so that appropriate management can be provided.

Background: Amyloid fibrils are protein polymers. Functional amyloids play a beneficial role in a variety of physiologic processes. Amyloidosis results from the accumulation of pathogenic amyloids in a variety of tissues. Case Presentation: The authors present a case of a 60-year-old male with a pseudotumoral silicosis, a history of intermittent fever, and renal insufficiency with intermittent proteinuria (maximum of 3 g/dl). The diagnosis of amyloidosis was made from multiple biopsies. During the investigation, it was never possible to characterize the subtype of amyloidosis [the patient had findings either in favor of AL amyloidosis and AA amyloidosis (AA)]. A definite diagnosis was only obtained from an autopsy, and AA was found to be the subtype. Conclusion: At the time of this publication and to the best of authors’ knowledge, AA has never been described to be associated with pseudotumoral form of pulmonary silicosis. We believe that an inflammatory response associated with pulmonary silicosis was the trigger to the development of AA.

Background: High sensitivity troponin I (Hs troponin I) is a precise and sensitive marker of myocardial injury. However, interferences by antibodies are not uncommon in immunoassays. Macrotroponin is one such phenomenon, in which immune complexes are formed between troponin and circulating antibodies, giving rise to false-positive results. Case Presentation: This is a case of a 30-year-old male with elevated high sensitivity troponin I results of 419 ng/l (99th percentile upper reference limit for males is 34.2 ng/l). The test was performed on Abbott Alinity i immunoassay analyzer (Abbott Gmbh & Co. KG, Wiesbaden, Germany). Electrocardiogram, exercise tolerance test, and echocardiogram were all unremarkable. The results of creatinine kinase-myocardial component, troponin T, and conventional troponin I on VITROS ECi Immunodiagnostics System (Ortho-Clinical Diagnostics, Rochester, NY) were within normal limits. Laboratory experiments were carried out to evaluate the case, and the investigations conducted indicated the presence of macrotroponins in the specimen, which demonstrated cross immunoreactivity with the Alinity (Abbott) assay but not with the VITROS (Ortho) assay. Conclusion: Clinicians and laboratorians should be aware of the possible interference by macrotroponin in their assays and should be alerted when there is a discordance between the laboratory and clinical findings.

Background: Green discoloration of urine following propofol use is a rare yet benign side effect. While rare with propofol infusions, it is even less recognized following single doses of propofol and can cause anxiety for both patients and healthcare professionals. Case Presentation: This paper presents the case of a patient with alcohol-induced liver cirrhosis who transiently produced green urine following a single dose of propofol at the induction of anesthesia. The exact incidence and mechanism are not known; however, it is thought to be due to the extrahepatic pharmacokinetics associated with propofol metabolism and clearance. Due to its rarity, it can propagate anxiety and lead to unnecessary investigations. Conclusion: Propofol is a very commonly used anesthetic drug. The case highlights that the prompt recognition of this rare adverse effect can prevent unnecessary investigations and provide reassurance to the patient and healthcare providers.

Corona pandemic has unfurled its wings to disrupt the healthcare system of developing as well as developed countries and created havoc among healthcare professionals. Today, there is an atmosphere of trepidation at the possibility of getting new cure against this dreadful virus. People are looking with anxious eyes toward scientists to develop a vaccine against this virus. Already killed thousands of lives, this virus is spreading at a pace of fire. Some healthcare professionals and researchers are working out of the way to develop a new vaccine, and some are targeting the existing drug approach. Several successful trials were performed on Coronavirus disease-2019 (COVID-19) patients involving existing drugs in combination till date. This case series underlined those successful case studies of COVID-19. Different combinational approaches have been adopted by researchers such as the use of tissue plasminogen activators, extracorporeal membrane oxygenation and convalescent plasma therapy, intravenous immunoglobulins, antivirals drugs, antimalarials, antibiotics, interleukin antagonists, and corticosteroids to combat COVID-19. These therapies have corroborated to be constructive at some levels among individuals having a severe medical history as well as individuals without any profound medical history.

Background: Gastric volvulus, characterized by twisting of the stomach over its axis, is an under-recognized complication of hiatal hernia. It is difficult to pass an endoscope through a volvulus, and hence, surgery is considered as the most common treatment modality. However, in this report, we provide a stepwise approach with images to provide therapeutic treatment via endoscopy with its role in the diagnosis of this condition. Case Presentation: We present the case of a 78-year-old female who presented with an acute episode of nausea and vomiting, associated with severe upper abdominal and mid-chest pain radiating to her back. Esophagogastroduodenoscopy showed the presence of gastric volvulus in the sac of a large hiatal hernia, which was confirmed on computed tomography. We avoided the need for an emergency surgery by successfully reducing the gastric volvulus via endoscopy under monitored anesthesia care and endotracheal intubation. Conclusion: Endoscopic reduction can be an effective therapy for the treatment of gastric volvulus, especially in patients who are poor surgical candidates.

Background: Melanomas involving the gastrointestinal (GI) tract are usually metastatic from primary cutaneous sites. Primary GI melanoma is a rare entity and mostly presents with non-specific symptoms. The diagnosis in most of the cases is made retrospectively on the immunohistochemistry findings. Case Presentation: A 32-year-old male presented with massive upper GI bleeding necessitating a total gastrectomy, and to our surprise, on immunohistochemical staining, the diagnosis of primary gastric melanoma was confirmed. Conclusion: The possibilities of rare mesenchymal tumors of the stomach should be considered while treating such patients. A high index of suspicion in such atypical scenarios should warrant a positron emission tomography integrated with computed tomography to complete the staging workup. The natural course of the disease and its outcome is not known due to the paucity and rarity of this entity. Although the prognosis is dismal, it would help to prognosticate the patient and family before embarking onto a major surgical resection.