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Objective: To characterize the clinical presentation, diagnostic challenges, neuroimaging findings, and treatment response in patients with seronegative autoimmune encephalitis (AIE) presenting as new-onset refractory status epilepticus (NORSE) and to assess the utility of fluorodeoxyglucose positron emission tomography (FDG-PET) and electroencephalogram (EEG) in diagnosis
and disease monitoring.
Background: NORSE is a life-threatening condition that often arises in the setting of AIE. While seropositive AIE has established diagnostic criteria, seronegative AIE remains a diagnostic challenge due to the absence of autoantibodies and non-specific findings on conventional investigations.
Methods: This is a prospective case series of four patients with seronegative AIE presenting as NORSE. Clinical history, cerebrospinal fluid (CSF) findings, magnetic resonance imaging (MRI), EEG, and FDG-PET results were analyzed. Immunotherapeutic interventions included intravenous immunoglobulin, corticosteroids, plasma exchange, rituximab, and tocilizumab.
Results: We present four patients with NORSE, characterized by challenging diagnoses due to negative antibodies in serological and CSF analyses. All patients exhibited normal MRI brain results. FDG PET revealed patterns of hypermetabolism or hypometabolism in sequential imaging. Therefore, indicating the potential function of FDG PET as an imaging biomarker in seronegative AIE.
Conclusion: Seronegative AIE presenting as NORSE remains a diagnostic and therapeutic challenge. Conventional MRI and CSF studies may be inconclusive, whereas FDG-PET and EEG provide valuable insights into disease activity. Early and aggressive immunotherapy can improve seizure control and clinical outcomes. Further research is needed to refine diagnostic criteria and treatment strategies for seronegative AIE.

Background: Mature ovarian cystic teratomas (MOCT) are the most common benign ovarian tumours. They are mainly asymptomatic (60%) but can in rare cases (<1%) complicate by forming a fistula into adjacent structures such as the bowel. Patients with fistulating ovarian teratomas are typically managed surgically, most often requiring laparotomy.

Case Presentation: We report a case of an 18-year-old woman who presented with vague abdominal and gynaecological symptoms. She expelled a mass with hair and teeth per rectum which was later confirmed as a MOCT.  We managed her conservatively as a collaboration with colorectal and gynaecology teams. At one-year follow-up, she remained asymptomatic with no radiological evidence of a residual fistula.

Conclusion: This case highlights the diagnostic challenges in MOCT with a bowel fistula. We demonstrate that conservative management may be a viable option in select patients.

Background: Mucosa-associated lymphoid tissue (MALT) lymphoma is a rare variant of extranodal marginal zone B cell lymphoma occurring at mucosal sites. Gastric MALT lymphoma is well-described, but non-gastric MALT lymphomas, particularly small intestinal, ceacal, and appendiceal MALT lymphoma, are rare and present diagnostic problems. Intestinal MALT lymphoma is frequently diagnosed late and can be associated with nonspecific symptoms in patients.
Case presentation: A 69-year-old female with diabetes mellitus, hypertension, and hypothyroidism, admitted to the emergency room for 24 hours with colicky lower abdominal pain and vomiting, without bowel movements. Abdominal distension and right iliac fossa tenderness were noted on clinical examination. Imaging, however, suggested a closed-loop obstruction of a twisted segment of the ileum. A laparoscopic right hemicolectomy with resection and anastomosis was carried out on the patient. Extranodal marginal zone lymphoma of MALT type arising from the terminal ileum, cecum, and appendix with ischemic changes
was identified by histopathological analysis of the resected specimen.
Conclusion: The importance of considering MALT lymphoma in the elderly with bowel obstruction, without an established chronic inflammatory or autoimmune condition, is emphasized in this case. Mechanical obstruction requires surgical resection, but systemic therapy is the treatment of choice for disseminated disease. Future research should address the role of molecular diagnostics and targeted therapies in non-gastric MALT lymphoma to enhance early detection and management programs.