Year 2022, Volume 6 - Issue 9

Background: Paratesticular fibrous pseudotumors are rare benignant intrascrotal lesions that can often mimic malignancy. They often arise in the scrotal tunic while less common localizations are the epididymis and the spermatic cord. Their diagnosis is challenging and often done post-operatively on definitive histopathology; for this reason, they are often treated with orchiectomy which results in overtreatment.

Case Presentation: We present a case of a 42-year-old male patient that came to our observation for scrotal swelling. Physical exam and ultrasound showed a healthy testis but multiple painless, tender, oval lesions at the level of the epididymis. Laboratory tests and testicular markers were within normal limits, thus we planned explorative surgery with frozen sections that excluded malignancy. We performed testis-sparing surgery with epididymectomy, vasectomy, and resection of the tunica vaginalis. Definitive histopathology revealed a fibrous pseudotumor. To date, at 3 months follow-up, the patient is in good clinical condition with no signs of recurrence and with healthy homolateral testis.

Conclusion: Fibrous pseudotumor can mimic malignancy. A correct diagnosis is pivotal to choosing the correct treatment and avoiding aggressive surgery.

Background: Diabetic ketoacidosis (DKA) is an acute complication of diabetes, a severe metabolic disorder that requires urgent treatment. The aim of this article is to present a case of steroid-induced diabetes with complications.

Case presentation: A young 25-year-old man without any co-morbid, presented to the emergency department with fever, vomiting, coughing, and buttock pain which started 3 days before. On the right gluteus, there was a hematoma approx. 10 × 5 cm with fluctuation. The patient had hyperglycemia (9.1 mmol/l), associated with high anion-gap metabolic acidosis, acute kidney injury (AKI), grossly elevated muscle enzymes, hyperkalemia, hyperphosphatemia, hypoalbuminemia, hypocalcemia and hypomagnesemia, and deranged liver function tests. The urine dipstick was grossly cola-colored and biochemically was positive for glucose, ketones, and proteins. Abscess drainage was performed, and Streptococcus pyogenes was isolated on culture and sensitivity. The patient was treated for DKA, complicated by an AKI and infection. Diabetes is confirmed based on glycosylated hemoglobin.

Conclusion: The risk of ketoacidosis and hyperglycemia should be considered in the course of steroid therapy, even without a diagnosis of diabetes, in patients who abuse steroids or have risk factors for diabetes and obesity.

Background: Anti-GBM disease is a small vessel vasculitis that occurs when circulating antibodies against the glomerular basement membrane develop. It is a relatively rare disease, occurring in less than two cases per million population. The usual presentation is with renal or lung manifestations or with a combination of both. Case Presentation: Our case reports a patient who presented with end-stage renal disease secondary to anti-GBM disease, with no pulmonary manifestations, who later presented with a syndrome suggesting cerebral vasculitis, that responded to immunosuppressive treatment. Conclusion: Cerebral involvement in anti-GBM disease is very rare and to our knowledge, only a few cases have been so far reported.

Background: Distinguishing between a bulla and pneumothorax can sometimes be difficult especially in the absence of preexisting lung disease, leading to inappropriate intervention. Case Presentation: We report the case of a well 32-year-old male who presented with a year's history of insidious onset breathlessness. A routine chest radiograph was thought to show a large pneumothorax. He had chest drains placed with no radiological improvement. A video-assisted thoracic surgery procedure revealed a giant bulla. Conclusion: This case highlights the importance of correlating clinical assessment with radiological findings. Early Computerised Tomography (CT) imaging should be considered prior to pleural intervention in clinically stable patients.

Background: Myxedema crisis is a rare decompensated hypothyroid clinical condition with high mortality if remains unrecognized. Case presentation: We report a case of 36-year old male with a 3 week history of difficulty in breathing and facial puffiness. Periorbital edema, very dry skin, and non-pitting edema of legs was noticed on clinical examination. The patient was commenced on oral thyroxine for abnormal thyroid functions but deteriorated over the next few days. A diagnosis of myxedema crisis was made and was treated with a loading dose of oral thyroxine followed by maintenance dose along with intravenous steroids and intravenous antibiotics. Thyroxine dose was adjusted with serial thyroid functions on alternate days to confirm absorption. The patient clinically improved as thyroid functions advanced toward normalization. Conclusion: Myxedema crisis remains poorly recognized condition due to extremely rare endocrine emergency. Under circumstances where intravenous hormone not available, oral thyroxine with daily or alternate day thyroid hormone level to confirm absorption and to adjust dose is equally effective way of management. Patient must be considered for an adrenal insufficiency unless proven otherwise.