Year 2021, Volume 5 - Issue 1

Background: Vitamin B12 (VB12) deficiency is a pleomorphic disease with a wide range of manifestations. Its major cause is pernicious anemia, an autoantibody-mediated disease that results in low levels of intrinsic factor [1,2]. Case Presentation: We present a case report of a middle-aged man with severe megaloblastic anemia due to VB12 deficiency in relation to an unsuspected Crohn’s disease with exclusive ileum involvement. He also had some unusual neurological manifestations of this vitamin’s deficiency, such as hypersudoresis. Unlike most cases, the anemia was not hypoproliferative and hemolysis existed. Conclusion: This case reports some unusual aspects of VB12 deficiency and reminds us that ileum disease should be considered in patients with a negative autoimmune profile.

Background: The basaloid carcinoma has not been previously described in the urinary bladder. Case presentation: A 61-year-old man presented with hematuria. The patient had a history of skin tumor with 37 basal cell carcinomas, which had often been treated with surgical excision. The cystoscopy showed a superficial 6 mm papillary lesion. A transurethral resection (TUR) instillation was performed, and the histological analysis revealed an invasive basaloid carcinoma pT1. Because of this uncommon histological aspect, a second Look TUR was conducted and showed no tumor and was followed by an intravesical Bacillus Calmette-Guerin therapy. Knowing the patient presented two major aspects of the Gorlin Syndrome, a genetic analysis of patched mutation had been done but showed no mutation of the gene. After 5 years of cystoscopy follow-up, the patient presented no recurrence of the tumor in the bladder. Conclusion: The basaloid carcinoma is an exceptional variant tumor in the urinary bladder.

Background: Extraosseous giant cell tumors involving visceral organs (pancreas, kidneys, bladder, etc.) and soft tissues present similar histological features to those occurring in the bones. Rarely, they may affect pancreas and their origin remains still controversial, with some authors supporting the epithelial and some others the mesenchymal origin. Case Presentation: We report the case of a pancreatic giant cell tumor with osteoclast-like cells, negative for epithelial markers. A 64-year-old man presented with a 2-month history of progressively worsening abdominal pain, radiating to the lumbar region. He reported no other symptoms. The abdominal clinical examination was unremarkable and there was no associated jaundice. Liver function tests remained within normal limits. His past medical history had nil of note. He underwent an outpatient abdominal computed tomography which revealed a large cystic lesion at the body of the pancreas measuring 10 × 7 × 6.5 cm. We proceeded with a limited excision of the pancreatic mass alone, avoiding major dissections that would unnecessarily increase morbidity and mortality and the postoperative course was good. The histological morphological and immunohistochemical assessment revealed two tumor cell types: osteoclast-like multinucleated giant cells and pleomorphic mononuclear cells, with bone formation and without important cellular and nuclear atypia. Conclusion: Pancreatic giant cell tumors with osteoclast-like giant cells are rare tumors of the pancreas with various clinical characteristics and controversial origin. En bloc resection has prevailed as the only beneficial treatment so far.

Background: Pulmonary hydatid cystic disease or pulmonary cystic echinococcosis is caused by the tapeworm Echinococcus granulosus. The cysts are usually incidental findings of well-defined round lesions on chest radiographs or on a computer tomography which can rupture and cause symptoms. Case Presentation: This case report presents a complicated clinical course of pulmonary hydatid cystic disease in a 50-year-old farm worker, in whom the diagnosis was not initially thought of. Conclusion: The discussion highlights the importance of considering this disease in the differential diagnosis of any pulmonary cystic lesion, as significant complications arose because of the investigations performed.

Background: Headache is a common medical complaint and a leading reason for medical consultation. Physical examination of the patient with headache is often omitted. Case Presentation: We present a 66-year-old, right-handed female patient who was investigated for headache with a series of neuroimaging modalities in another center and was diagnosed as herpes zoster of the scalp in our clinic. Conclusion: It is crucial to keep in mind that physical examination is critical to the diagnostic process in headache.

Background: Bacillus Calmette-Guerin (BCG) bladder instillations have been long known to successfully treat non-muscle invasive bladder cancer. The objective of this report is to highlight the first case to our knowledge of Varicella Zoster virus (VZV) shingles reactivation to BCG. Case presentation: An 80-year-old male with history of Parkinson’s disease and recurring high-grade T1 bladder cancer. Five days after first repeat BCG instillation, patient presented to the emergency room with a progressively worsening rash that started 1 day after treatment, characterized as VZV shingles reactivation. Intravenous acyclovir treatment produced rapid clinical improvement. Conclusion: Reactivation of dormant VZV infection may be a reaction to BCG intravesical instillation. This is, to the authors’ knowledge, the first documented case of this complication. Although coincidence cannot be completely ruled out, the timing of this case and the context of immunosuppression-immunomodulation inherent to BCG therapy make causality plausible.

Background: Sweet syndrome (SS), also known as acute febrile neutrophilic dermatosis, is a rare dermatological disorder characterized by fever and the sudden onset of a rash, which consists of multiple tender, red or bluish-red bumps or lesions. These lesions usually occur on the arms, legs, trunk, face, or neck. In some cases, additional systems of the body can become involved. Case Presentation: A 20-year-old male presented with chief complaints of fever, cough, and skin lesions. Laboratory investigations revealed an elevated erythrocyte sedimentation rate, C- reactive protein, neutrophils, and total leukocyte count. A skin biopsy was performed, and the patient was diagnosed with SS. Conclusion: The patient was treated with oral corticosteroids and other medications to alleviate his symptoms. He was discharged on a tapering dose of prednisolone, and follow-up after a month showed that he remained afebrile with no relapse of skin lesions.

Background: In this report, we discuss the diagnosis and management of a case of COVID-19-induced acute kidney injury (AKI). Case Presentation: A 58-year-old male with PCR-based COVID-19 diagnosis (at a specialized hospital, Minia, Egypt) was admitted and received supportive medications along with corticosteroids and hydroxychloroquine. After 2 days, the patient developed tachypnoea and desaturation. Therefore, he was transferred to the intensive care unit with a continuous positive airway pressure. On the third day, he developed oliguria with spiking kidney function tests, metabolic acidosis, and eventually anuria on the 6th day. AKI diagnosis was established, and the patient received daily dialysis sessions for 10 days until discharge together with tocilizumab and methylprednisolone. The patient was discharged after normalization and stabilization of his clinical parameters and a second negative PCR swab with continuous follow-up. Conclusion: Early monitoring of kidney function tests during the infection might help in preventing further kidney damage.