Background: High-energy fractures of the distal tibia associated with soft tissue defects represent a significant therapeutic challenge due to the high risk of infection and non-union.  We demonstrate an effective treatment of such a fracture using S53P4 bioglass. Case Report: We present the case of a 53-year-old male patient who sustained a comminuted distal metaphyseal fracture of his tibia and fibula, complicated by extensive burns in vicinity and a bone defect. Following initial stabilization and soft tissue management, the bone defect was treated with plate osteosynthesis and filled with S53P4 bioactive glass. At the 9-month follow-up, the fracture had healed with a good functional outcome and no signs of infection. Conclusion: S53P4 bioactive glass is an effective alternative to autologous bone grafts in high-risk environments due to its osteoinductive and antimicrobial properties. Continue Reading

Background: Hypercalcemia is a common electrolyte abnormality with varied etiologies and clinical manifestations. Although primary hyperparathyroidism and malignancy account for the majority of cases, less common causes may present diagnostic challenges. Case Presentations: We report three unusual cases of hypercalcemia secondary to disseminated tuberculosis, sarcoidosis and acute lymphoblastic leukemia. The first case involved a 44-year-old woman presenting with fever and altered sensorium. Laboratory investigations revealed severe anemia, acute kidney injury, pancreatitis and PTH independent hypercalcemia. Cerebrospinal fluid analysis was normal but chest imaging and lymph node biopsy confirmed disseminated tuberculosis. After initiation of antitubercular therapy, she developed drug-induced hepatitis followed by progressive multiorgan dysfunction, culminating in death. The second case involved a 48-year-old woman presenting with generalized body aches and a past history of cervical cancer. Malignancy-related hypercalcemia was initially suspected. However, further evaluation established a diagnosis of sarcoidosis. Management with intravenous hydration and corticosteroids led to normalization of serum... Continue Reading

Background: The purpose of this article is to highlight the importance of in a case of peripheral arterial disease (PAD) with suspected microembolization, through the presentation of a complex clinical case involving a patient with a mechanical heart valve, anemia, and heart failure. The aim is also that of emphasizing the importance of the multidisciplinary approach to treating comorbid conditions, such as type 2 diabetes, in patients with PAD. Case Presentation: A 48-year-old diabetic and hypertensive man presented with rest pain and left forefoot gangrene. He was diagnosed with advanced PAD (Fontaine stage IV) with multiple comorbidities. Endovascular revascularization and optimized multidisciplinary management were performed, resulting in clinical improvement, increased walking distance, and regression to Fontaine stage IIA. Conclusion: This case emphasizes that advanced PAD requires prompt multidisciplinary management and strict control of comorbidities, highlighting also that poor adherence to anticoagulation therapy and risk factor management may contribute to complications... Continue Reading

Background: Large urinary bladder (UB) calculus is now rare in urological clinical practice. UB stone presents with obstructed urinary flow, increased urinary frequency, and lower abdominal and perineal or penile pain. Male patients are affected more. Hot environmental condition, poor water intake, benign prostatic enlargement, urethral stricture, and prolonged urethral catheterization are some of the contributory factors for bladder stone formation. Herein, we have tried to highlight importance and need of open cystolithotomy in five cases of large UB calculus presented to outpatient department (OPD) with their clinical presentation, history, and investigations with probable causes and review of literature.Case series: Five consecutive patients were evaluated, diagnosed, and operated for giant UB calculus by open cystolithotomy. Patients were discharged with suprapubic catheter (SPC) and per-urethral catheter (PUC) in situ. SPC and PUC were sequentially removed after 3 weeks of surgery. All five patients had intact UB stone removal except one where... Continue Reading

Background: Lemierre syndrome is a rare but potentially life-threatening condition classically characterized by recent oropharyngeal infection, septic thrombophlebitis of the internal jugular vein, and septic embolization. However, severe deep neck infections may occasionally present with clinical features that mimic Lemierre syndrome, even when internal jugular vein thrombosis, septic embolization, and positive cultures are absent.Case Presentation: A 21-year-old previously healthy man presented to the emergency department with altered mental status following a two-week history of sore throat. Fever, chills, dyspnea, and confusion had developed within the previous 24 hours. On admission, he was febrile, tachypneic, confused, and poorly cooperative. Laboratory investigations revealed neutrophilic leukocytosis and elevated inflammatory markers. Contrast-enhanced neck computed tomography demonstrated a right-sided peritonsillar/parapharyngeal abscess measuring 18 × 28 × 54 mm with obliteration of the parapharyngeal fat planes. However, no evidence of internal jugular vein thrombosis or septic pulmonary embolism was identified. The patient was admitted to the... Continue Reading

Background: Ferric carboxymaltose can cause fibroblast growth factor 23-mediated renal phosphate wasting; neurological presentations may delay recognition. Case Presentation: A 76-year-old woman presented after a 2-minute focal seizure one month after receiving a single 1 g intravenous ferric carboxymaltose infusion for iron-deficiency anemia. Computed tomography of the head and electroencephalography showed no acute intracranial or epileptiform cause. Extended testing demonstrated severe hypophosphatemia (0.23 mmol/L) and hypomagnesemia (0.52 mmol/L), with recurrent phosphate decline despite replacement. Fibroblast growth factor 23 was inappropriately normal (35 pg/mL) for the preceding severe hypophosphatemia, supporting ferric carboxymaltose-associated phosphate wasting. Concurrent pantoprazole use likely contributed to hypomagnesemia. After phosphate and magnesium replacement and pantoprazole discontinuation, electrolytes stabilized by day 12 and no further seizure occurred. Conclusion: Ferric carboxymaltose-induced hypophosphatemia should be considered in patients presenting with unexplained seizures after intravenous iron exposure. Continue Reading

Background: Flail arm syndrome (FAS) is an uncommon variant of amyotrophic lateral sclerosis (ALS) characterized by progressive, predominantly lower motor neuron weakness confined mainly to the upper limbs. Because structural cervical disease is common in older adults, its diagnosis may be delayed or misattributed to compressive or peripheral nerve disorders. Case Presentation: A 69-year-old man developed progressive asymmetric upper limb weakness over two years, evolving into bilateral brachial diplegia with preserved lower limb function. Neurological examination showed marked upper limb atrophy, fasciculations, and extensor plantar responses, without sensory deficits. MRI showed no significant cervical compression, while electromyography revealed multisite denervation, supporting the diagnosis of flail arm syndrome as a phenotype of ALS. Multiple alternative diagnoses, including cervical myelopathy, multifocal motor neuropathy, and myopathy, were systematically excluded. Conclusion: This case highlights the importance of recognizing flail arm syndrome within the ALS spectrum. Electrophysiological evidence of multisite motor neuron involvement is crucial... Continue Reading

Background: Intracranial calcifications are a common radiological finding, but their significance varies widely depending on the pattern and distribution. While Fahr's disease is often considered in such cases, it typically presents with bilateral and symmetrical involvement. Unilateral, extensive calcifications, especially when associated with cerebral atrophy, should prompt a broader differential. Case Presentation: We describe a 43-year-old man with no significant medical history who presented with his first-ever seizure. He was found unresponsive by his wife, with tongue biting and post-ictal confusion. By the time he arrived in the emergency department, he had returned to baseline, and his neurological examination was completely normal. Initial CT imaging revealed extensive right-sided subcortical calcifications with associated cerebral atrophy, raising the possibility of Fahr’s syndrome. However, further imaging told a different story. MRI indicated dilated convoluted signal-void formations with post-contrast enhancement, and SWI confirmed widespread blooming matching the calcifications. At the right MCA bifurcation, CT... Continue Reading

Background: Historically, the term myxedema madness has been used to describe neuropsychiatric manifestations of advanced hypothyroidism. First documented in 1888 by the Clinical Society of London, it encompasses a spectrum of mental disturbances including delusions, hallucinations, melancholia, and paranoia. Although autoimmune hypothyroidism is common in clinical practice, its presentation with acute psychosis and suicidal behavior remains rare. Case Presentation: This paper presents a compelling case of a 28-year-old male migrant worker in Qatar with no prior psychiatric history, who was admitted following a serious suicide attempt. The patient exhibited florid psychotic symptoms, including hallucinations, religious delusions, and overwhelming guilt, culminating in self-injurious behavior. Laboratory investigations revealed profound hypothyroidism with markedly elevated thyroid-stimulating hormone (TSH) and anti-thyroid peroxidase (anti-TPO) antibodies, confirming autoimmune etiology. The episode was later attributed to severe hypothyroidism. Prompt multidisciplinary intervention; comprising levothyroxine replacement and antipsychotic therapy led to rapid resolution of psychiatric symptoms and full clinical remission.... Continue Reading

Background: Bilateral multiple microcystic pulmonary lesions highly suspicious for metastasis are a rare radiological manifestation of lung adenocarcinoma, and have seldom been reported in young adults. Such lesions are easily misinterpreted as infectious or cystic lung diseases, potentially leading to delayed diagnosis and inappropriate management. We report a case of lung adenocarcinoma in a young welder with multifactorial risk factors who presented with bilateral multiple microcystic lesions and achieved a sustained response to osimertinib, aiming to improve recognition and timely management of this rare presentation. Case presentation: A 35-year-old Chinese male welder presented with cough and blood-streaked sputum. Chest CT revealed a left lower lobe mass, mediastinal and left supraclavicular lymphadenopathy, and bilateral multiple microcystic lesions highly suspicious for metastasis. Despite anti-infective therapy, the pulmonary lesions persisted,and biopsy confirmed lung adenocarcinoma harboring an EGFR exon 19 deletion and a somatic TP53 co-mutation (PD-L1 TPS 10%). Osimertinib 80 mg daily achieved... Continue Reading

Background: Notalgia paresthetica is a chronic sensory neuropathy characterized by localized pruritus and associated dysesthesias. There exists no definitive treatment for the disease to date. Here we report a novel concept of dopaminergic treatment in a female patient with chronic itching due to a probably hereditary form of notalgia paresthetica. Case Presentation: We describe a 76-year-old female patient suffering from severely distressing notalgia paraesthetica. Here, itching occurred mainly during the cold season in the area medial to the left scapula. Notably the patient’s mother, uncle and cousin were also affected by the disease. Low dose treatment with levodopa 50 mg combined with benserazide 12.5 mg per day significantly reduced itching with additionally alleviating the compulsive urge to scratch. Conclusion: The neurobiological difference between A11 and A10 dopaminergic (DAergic) neurons may explain the efficacy of levodopa at low dosages. Absence of the dopamine transporter system (DAT) in A11 DAergic neurons, contrasted... Continue Reading

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