Year 2021, Volume 5 - Issue 3

Background: Hepatobronchial fistula is infrequent and secondary to pyogenic abscess caused by Streptococcus intermedius. This agent causes infections such as hepatic abscesses, endocarditis, bacteremia, and others. The treatment includes drainage, antibiotic management, and surgical intervention in some cases. Case Presentation: We describe a case of a 50-year-old male with a pyogenic liver abscess complicated by hepatobronchial fistula, admitted to the Internal Medicine Department with fever, long-lasting chills, and weight loss. The diagnostic approach revealed a pyogenic abscess secondary to S. intermedius. After percutaneous drainage, the patient presented purulent expectoration. A cavitogram revealed a hepatobronchial fistula. Treatment with antibiotics and closure of the defect was satisfactory. Conclusion: This is a case of a hepatic abscess due to S. intermedius complicated with hepatobronchial fistula, a rare clinical entity; the opportune hybrid approach (surgical plus interventional and radiological) reduces the risk of a major thoracoabdominal operation, which influenced the good prognosis of our patient.

Background: Adult Onset Stills Disease (AOSD) and Kikuchi Fujimoto Lymphadenitis (KFL) are both rare Rheumatological diseases. Co-occurrence is very rare. Case Presentation: This is a case of AOSD and KFL co-occurrence presenting with polyarthritis, rash, and B Symptoms. Elevated serum lactate dehydrogenase and ferritin with anemia and lymphadenopathy raised suspicions of lymphoma. Histology confirmed KFL and clinical features, and raised ferritin confirmed AOSD. After starting sulfasalazine, the patient was admitted to the hospital with ‘Drug Reaction with Eosinophilia and Systemic Symptoms’ (DRESS) Syndrome. Prior to sepsis exclusion, Gentamicin was given and subsequent hearing loss was noted. Sustained remission was achieved with Tocilizumab and azathioprine. Tocilizumab was stopped during pregnancy. Conclusion: The diagnostic challenges of two rare overlapping Rheumatological diseases are highlighted. An early distinction of disease flares or drug reactions from sepsis is difficult. Risk-benefit ratio consideration of continuing successful treatments in pregnancy is acknowledged.

Background: Ameloblastoma, one of the most common odontogenic tumors, although classified as benign yet shows strong predilection for local infiltration. This leads to the recurrence of the tumor after surgical resection (more so when treated conservatively). Recurrent cases may progress toward malignant transformations on rare occasions, thus repeated attempts of conservative surgery in these should be avoided. Case Presentation: We present two cases of ameloblastoma that recurred after limited resection. One of them was showing focal area of cellular atypia denoting its path toward malignant transformation. Both the cases were managed with aggressive radical resection and suitable reconstruction. Conclusion: Tumor histology, anatomical location, and adequacy of tumor resection with safety margins are various factors which influence the recurrence of tumor and thus are to be considered along with the possibility of malignant transformation while formulating a treatment plan for revision cases. An individualized decision-making approach should be adopted for every case and long-term follow-up is necessary to avoid unacceptable morbidity due to extensive recurrences.

Background: Suppurative or phlegmonous gastritis is an uncommon but serious disease, which can be fatal if untreated. The treatment is conservative at first with antibiotic therapy, but a total gastrectomy might be required if the patient is unresponsive to medical treatment and the clinical conditions deteriorate. Case presentation: We present a case of acute suppurative gastritis, the second in the literature to our knowledge not to be fatal in a pregnant woman, caused by group A Streptococcus pyogenes, treated conservatively after an exploratory laparoscopy. The delivery was uncomplicated and the patient recovered well after a long cycle of targeted antibiotic therapy. Conclusion: The rarity of suppurative gastritis may be associated with the difficulty of a prompt diagnosis and high mortality as a result. The aim of this case report is to raise awareness about the importance of an early diagnosis, and it is crucial to avoid treatment delays. The emergency physician, radiologist, and surgeon should be aware of this entity.

Background: Behcet’s disease is a systemic vasculitis with unusual thrombosis, especially in children. Intracardiac localization is rare. The site of choice is the right ventricle. It may be isolated, but must necessarily seek other vascular attacks, in particular an aneurysmal pathology of pulmonary arteries. Its clinical expression is not specific. Case Presentation: An 8-years-old boy was hospitalized for an isolated prolonged fever with marked inflammatory state. No infectious symptoms were identified. Electrocardiogram showed a right branch block and negative T waves in V1-V3 leads. Transthoracic echocardiography revealed multiple right ventricular masses, associated with minimal pericardial effusion. These masses have various sizes and are lining right side of interventricular septum and pulmonary infundibulum without right ventricular outflow tract obstruction. Thoracic computerized tomography scan and cardiac magnetic resonance imaging confirmed that cardiac masses were multiples thrombi filling right ventricle and pulmonary artery. Thrombophilia panel assessment and eye fundus examination were normal. The patient was not a carrier of the HLA B51 gene. Juvenile Behcet’s disease was the final diagnostic. Treated by anticoagulant and corticotherapy, the clinical and ultrasound course of the patient was favorable. A 3-year follow up didn’t show a recurrence of these thrombi. Conclusion: Regression of thrombus under anticoagulant, of fever and inflammatory syndrome under corticosteroid therapy, is a good retrospective diagnostic criterion.

Background: Gall bladder perforation presents in various forms with the most common being peritonitis. The most common causes include gall stones obstructing the cystic duct and necrosis of gall bladder due to ischemia. Case Presentation: A 19-year-old female presented to the emergency department of East Surgical Ward of Mayo Hospital Lahore, Pakistan, with a history of abdominal distension for 4 months for which she was counseled because of pregnancy. She gave birth to healthy baby 1 month prior, but abdominal distension did not resolve. On examination, she had a distended and tender abdomen with visible striae. She was tachycardiac with a pulse rate of 124 per minute and blood pressure of 110/80 mmHg. Fluid cytology showed negative for malignant cells and total leukocyte count of 17 × 109 /l. Abdominal ultrasound showed a huge thick-walled cystic area with internal echoes measuring 31 × 19 × 19 cm with total amount of fluid volume in the cyst was approximately 5 l arising from the right hypochondrium. On opening the abdomen, a huge cyst was encountered extending from the epigastrium to the pelvis with dense adhesions. The cyst was opened and fluid aspirated. Communication between cyst was found with gall bladder in the epigastrium. The cyst wall was excised partially, and cholecystectomy carried out. The patient was discharged on 5th post-operative day. Conclusion: The development of thick-walled huge cyst within abdominal cavity after gall bladder perforation is a rare entity, especially when the patient had gone through full-term pregnancy with the presence of the cyst.

Background: Wandering spleen is an unusual condition characterized by hypermobility of the spleen. Excessive mobility can cause torsion of the vascular pedicle with subsequent complications such as ischemia and necrosis. Clinical manifestations can vary from asymptomatic to abdominal emergency and treatment is often surgical. Case Presentation: We presented a case report of splenic torsion in a 24-year-old woman with complaints of upper abdominal pain associated with mild left hypochondrial tenderness. Laboratory testing and ultrasound were completely negative making the diagnosis difficult. A computed tomography (CT) scan was carried out due to worsening symptoms and it demonstrated a splenic torsion with involvement of the distal part of the pancreatic tail. Surgery was performed by laparoscopic splenectomy. No signs of pancreatitis were found. Conclusion: Splenic torsion is a rare but important differential diagnosis in patients with an acute abdomen and CT is often necessary to achieve the correct diagnosis and exclude possible complications.

Background: Combined autoimmune neutropenia (AIN) and immune thrombocytopenia (ITP) is a rare disease that can present as extremely low neutrophil count and platelet count, respectively [1]. Case Presentation: We describe the first case, to the authors’ knowledge, of the novel SARS CoV-2 infection and combined AIN and ITP in a healthy 27-year-old male. Conclusion: Viruses have been known to trigger autoimmune diseases in people with genetic predisposition. We speculate that the patient’s selective IgM deficiency predisposed him to have autoimmune cytopenia, and SARS-COV-2 triggered him to acquire combined AIN and ITP. Our hypothesis is supported by a lack of evidence of malignancy, a normal morphology on the smear, and an immediate response to IVIG infusion with significant improvement in platelet and neutrophilic count.

Background: Traumatic acetabulum fractures are common injuries and are often associated with cardiopulmonary injuries such as hemothorax or pneumothorax. Aortic transection is a well-described cause of death, particularly after a deceleration injury. However, late dissection on arcus aorta level is rare. Case Presentation: We describe the late presentation of an aortic transection case with acetabular fracture caused by a motor vehicle accident treated with thoracic endovascular aortic repair procedure and discuss the possible mechanism of injury. Conclusion: In high-energy traumas, such as acetabular fractures, one should be alert for traumatic aortic injuries, especially if the patient has a chest trauma.