Year 2022, Volume 6 - Issue 1

Background: We are continually learning how to best manage patients testing positive for SARS-CoV-2 [coronavirus disease 2019 (COVID-19)]. This is particularly challenging in rare autoimmune conditions, where immune system dysfunction, whether by disease or treatment, has the potential to impact on the course of COVID-19 in several ways. Case Presentation: We present the case of a 52-year-old female with Behcet’s Disease, treated by immunosuppressive drugs, who tested positive for COVID-19 during the first month of the pandemic in the United Kingdom. In this case a multidisciplinary team approach, involving gynecological, rheumatological, microbiological, and respiratory teams was essential in ensuring the best outcome for the patient. Conclusion: Our patient had a favorable outcome; she did not require intensive care admission and has recovered. This case supports the hypothesis that the chronic immunosuppression may confer a degree of protection against severe COVID-19 disease, potentially by mitigating the pro- inflammatory cytokine responsible for the respiratory failure seen in severe cases of the disease.

Background: The malignant transformation of vestibular schwannoma (VS) is a rare identity. We present a case of spontaneous transformation of VS and a short literature review. Case Presentation: A 41-year-old female had presented to us with vertigo, tinnitus, and hearing loss. She was diagnosed with left VS and underwent surgical resection. The initial histology was reported as benign grade 1 schwannoma. She subsequently presented to the hospital with hematoma in the tumor cavity after 4 and 5 months, respectively. Her repeat magnetic resonance imaging (MRI) showed growth of the residual tumor. She underwent a second translabyrinthine excision of the tumor. The histology from the second operation showed components of malignant transformation. One month postoperatively she suffered an acute decline in her conscious level. Repeat MRI demonstrated rapid regrowth of the tumor with further hemorrhage. In view of her rapid decline and perceived futility of further intervention and respecting her premorbid wishes, further escalation of therapy was deemed inappropriate. Conclusion: VS can transform into a malignant tumor even in the absence of radiation therapy. This may be considered in case of rapid regrowth of the tumor.

Background: Type 2 diabetes (T2DM) is becoming more prevalent worldwide and sodium-glucose co-transporter-2 (SGLT2) inhibitors are being increasingly used in its management. However, they have been associated with the serious complication of euglycemic diabetic ketoacidosis (EDKA). Case Presentation: A 51-year-old female on canagliflozin for T2DM presented with a 2-week history of vomiting and abdominal pain. With a blood glucose of 9.0 mmol/l, a diagnosis of diabetic ketoacidosis was at first overlooked and the patient was initially managed for pyelonephritis. However, a diagnosis of EDKA was subsequently reached on day 3 after a blood gas revealed a high anion gap metabolic acidosis with ketones of 3.9 mmol/l. Conclusion: This case demonstrates the diagnostic challenge posed by the atypical presentation of SGLT2 inhibitor-associated EDKA. Furthermore, it underlines the need for patient education concerning stopping these medications during illness and highlights how their association with urinary tract infections may further increase the risk of EDKA.

Background: Umbilical metastasis, also known as Sister Mary Joseph nodule, is a rare pathognomonic clinical sign suggesting the presence of an internal cancer. Case Presentation: We describe two female patients with Sister Mary Joseph nodule. In one case, there was a relapse of cancer. In the other patient, the Sister Mary Joseph nodule was the first and only clinical sign of an abdominal malignancy. We will briefly discuss the association with various internal malignancies as well as the pathogenesis and differential diagnosis. Conclusion: We conclude that Sister Mary Joseph nodule is a sign of intra-abdominal malignancy most frequently associated with gastro-intestinal or gynecological cancer. It can be the first and only clinical sign of abdominal malignancy in an otherwise healthy appearing patient or it can be an indication of oncological progressive disease, tumor relapse. Umbilical lesions should raise suspicion of a Sister Mary Joseph nodule, but a differential diagnosis must be made with other primary umbilical malignancies as well as with benign conditions involving the umbilicus.

Background: The coexistence of metabolic bone disease, such as Paget disease (PD) and malignant tumor is frequently described in patients with breast, prostate, lung, lymphoproliferative, colorectal, and renal neoplasms. Indeed, when evaluating cancer patients, there may be diagnostic dilemma of interpreting some changes in bone involvement, whether they are malignant or metabolic changes, since some radiological features of metabolic bone disease can mimic those of bone metastases. Case Presentation: We report a case of 55-year-old male patient, with diagnosed lung adenocarcinoma, referred to the Nuclear Medicine Department for a bone scintigraphy (BS), for evaluation of presented bone metastasis. The Single photon emission computed tomography (SPECT)/computer tomography (CT) scan revealed intensive metabolic accumulation of the radiotracer in cervical vertebra C7, and thoracic vertebra Th1, Th6, Th11, Th12, as well as lumbar vertebra L4, L5, left sacroiliac joint, both iliac and pubic bones and left proximal femur. The FDG PET/CT showed diffuse, but mildly increased uptake in Тh6, Тh11, L4, L5 and pelvic bones (SUV max = 3.3). The CT revealed destruction of Th11 body with compression fracture. Diagnosis of PD was made based on the findings of BS and PET/CT and further confirmed on bone biopsy and the patient was started with bisphosphonate therapy. Conclusion: BS and SPECT/CT are of great importance in accurate detection of incidental PD in patients with lung cancer.