Year 2021, Volume 5 - Issue 10

Background: Posterior reversible encephalopathy syndrome (PRES) is an unusual clinical entity seen associated with blood pressure (BP) fluctuations presenting with acute neurological symptoms. This is an unusual case of PRES due to severe preeclampsia, with clinical presentation of cortical blindness and hypertension, with absence of headache or seizures. Case Presentation: A primigravida, with no significant medical history, presented with significant proteinuria and worsening generalized itching and normotensive at 37 weeks 6 days of gestation. Due to elevated urate and raised urine protein induction of labor was planned. Ten minutes after vaginal delivery, patient reported sudden loss of vision with only being able to perceive light. She developed hypertension, hyperreflexia, and clonus. Aggressive management for severe pre-eclampsia was initiated. Her vision started improving as soon as her BP started normalizing. Imaging revealed the possibility of PRES with a superimposed focus of acute ischemia. She was discharged on antihypertensives and followed up by renal physicians. Within 2 months she recovered very well. Conclusion: This is an unusual case of PRES due to severe pre-eclampsia, with clinical presentation of only cortical blindness with absence of headache or seizures. Prompt recognition and aggressive management of severe pre-eclampsia resulted in resolution of symptoms.

Background: Cholecystoenteric fistula (CEF) is a rare intraoperative finding during video laparoscopic cholecystectomy. The presence of a double cholecystogastric (CGF) and cholecystocolonic fistula (CCF) is even more rare, and its management is not fully codified. Case Presentation: We present the case of a 26-year-old woman known for cholelithiasis and a previous episode of uncomplicated acute cholecystitis and subsequent indication to elective cholecystectomy. Routine pre-operative studies did not show signs of biliary abnormalities. Intraoperative findings consisted of a coexisting CGF and CCF, which were successfully treated laparoscopically. Conclusion: Laparoscopic approach can be safe and feasible in selected cases of double complete CEFs.

Background: Starting 2020, the medical guidelines were shacked by COVID-19 pandemic. The threshold for hospital admission increased in order to limit Severe Acute Respiratory Syndrome coronavirus 2 spread. All this affected screening such as for lung cancer which remained largely undiagnosed. On the other hand, it became challenging to differentiate easily between COVID-19 and other diseases such as atypical infections and simple community acquired pneumonia. Moreover, immunocompromised patients are at higher risk of COVID-19 infection overshadowing any other infection such as tuberculosis and non-tuberculosis infections. Case Presentation: We present the case of an 85-year-old female with a long history of scleroderma treated with methotrexate. Patient had non-resolving pneumonia and after two negative RT-PCR, bronchoalveolar lavage showed positive Real Time Polymerase Chain Reaction. Imaging showed persistent 2.6 cm solid nodule in left upper lobe worrisome for an underlying neoplasm. However, culture of Bronchoalveolar lavage grew with few colonies of acid fast bacilli making the diagnosis atypical mycobacteria highly probable especially that patient is chronically immunosuppressed. Unfortunately, she refused further genotyping. Conclusion: To authors’ knowledge that are no, or few reported cases of associated COVID-19 with atypical mycobacterial infections and the treatment modalities are unclear. The diagnosis of mycobacterial infections is usually difficult and in the setting of COVID-19 this becomes more challenging. Hence, a more thorough clinical approach is needed for the future to help clinicians diagnose and treat complicated cases of COVID-19 and concomitant other infections such as TB or Nontuberculous Mycobacteria. Furthermore, amidst the pandemic screening of lung cancer should continue while maintaining safety precautions.

Background: Juvenile breast hypertrophy is a rare benign condition leading to rapid and massive enlargement of one or both breasts in young girls during peri-pubertal period. Patients encounter physical and psycho-social problems. Therefore, the condition warrants early appropriate management. Breast imaging studies (ultrasound and magnetic resonance imaging) are particularly important in order to exclude tumors and occult pathologies. First line treatment modality is reduction mammoplasty that significantly improves quality of life with lesser chances of recurrence. Case Presentation: We report two post-menarchal girls with juvenile breast hypertrophy who presented as different clinical cases facing psychological and social embarrassment. Breast ultrasound showed right breast mass in both patients that were biopsied. The lesions turned out to be fibroadenomas on histopathological correlation. Patients were then referred to plastic surgery and endocrinology department. Conclusion: Juvenile breast hypertrophy is definitely a disturbing cosmetic problem. Early investigations and appropriate management will surely leave a positive impact on the quality of life.

Background: Infections are risk factors for venous thromboembolism (VTE) [1]. The role of chronic infections in VTE pathogenesis, such as tuberculosis (TB), is ill defined although several case reports and small series have suggested an association between TB and VTE [2]. Case presentation: We are presenting a case of a 31-year-old male presented with shortness of breath. Computed tomography showed massive pulmoanry embolism and inferior vena cava thrombus who was therefore thoroughly investigated for an underlying condition. He was found to have significant mediastinal lymph nodes which in turn biopsed. The tissue culture of lymph node grown Mycobacterium Tuberculosis. He was treated successfully with anti tuberculous medications. Conclusion: Tubeculous lymphadenitis presented with multiple venous thromboembolism in a healthy fit and well young man. His only symptoms was shortness of breath. Improvement shown after starting antituberculous medications.