Case Reports in Medicine The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Drug-Induced Rhabdomyolysis with Elevated Cardiac Troponin T Thu, 08 Oct 2015 12:19:20 +0000 The essential role of cardiac troponin in the diagnosis of acute myocardial infarction has led to the development of high-sensitivity assays, which are able to detect very small amounts of myocardial necrosis. The high-sensitivity cardiac troponin T assay, however, is not entirely specific for myocardial injury. This case report describes a 48-year-old woman, who, two years after cardiac transplantation, presented with rhabdomyolysis. During the course of the disease, her troponin T level was elevated on repeated occasions, but other definitive evidence of myocardial injury was not found. Asymptomatic cardiac troponin T elevations during rhabdomyolysis may be due to either cardiac involvement or false positive results stemming from skeletal muscle injury. Gro Egholm and Manan Pareek Copyright © 2015 Gro Egholm and Manan Pareek. All rights reserved. Systemic Levamisole-Induced Vasculitis in a Cocaine User without Cutaneous Findings: A Consideration in Diagnosis Thu, 08 Oct 2015 07:03:24 +0000 Levamisole is a known immunomodulating agent frequently used as a cutting agent in cocaine consumed in the United States today. Numerous cases of anti-neutrophil cytoplasmic antibody (ANCA) vasculitis connected with the use of levamisole-adulterated cocaine have previously been reported in the literature, classically characterized by a retiform purpuric rash. We report a case of a crack-cocaine user without cutaneous abnormalities who developed ANCA-associated glomerulonephritis that progressed to renal failure. This case demonstrates the difficulties in solidifying the diagnosis of levamisole-induced vasculitis in the absence of cutaneous findings and the need to pursue more testing to establish causality in ANCA-associated vasculitis that has potential for severe end-organ damage in patients who continue to use cocaine. Gillian G. Baptiste, Anastasia-Stefania Alexopoulos, Tahsin Masud, and Joanna M. Bonsall Copyright © 2015 Gillian G. Baptiste et al. All rights reserved. Atypical Presentation of Disseminated Zoster in a Patient with Rheumatoid Arthritis Mon, 05 Oct 2015 08:04:46 +0000 Patients with rheumatoid arthritis (RA) have 2-fold increased risk of herpes zoster. In literature, limited information exists about disseminated cutaneous zoster in RA patients. An 83-year-old African-American female with RA presented with generalized and widespread vesicular rash covering her entire body. Comorbidities include hypertension, type II diabetes, and dyslipidemia. Patient was on methotrexate 12.5 mg and was not receiving any corticosteroids, anti-TNF therapy, or other biological agents. The patient was afebrile (98 F) with no SIRS criteria. Multiple vesicular lesions were present covering patient’s entire body including face. Lesions were in different stages, some umbilicated with diameter of 2–7 cm. Many lesions have a rim of erythema with no discharge. On admission, patient was also pancytopenic with leukocyte count of 1.70 k/mm3. Biopsies of lesions were performed, which were positive for Varicella antigen. Subsequently, patient was started on Acyclovir. The patient’s clinical status improved and rash resolved. Our patient presented with “atypical” clinical picture of disseminated cutaneous zoster with no obvious dermatome involvement. Disseminated zoster is a potentially serious infection that can have an atypical presentation in patients with immunocompromised status. High index of suspicion is needed to make the diagnosis promptly and to initiate therapy to decrease mortality and morbidity. Nirav Patel, Davinder Singh, Krunal Patel, Shadab Ahmed, and Prachi Anand Copyright © 2015 Nirav Patel et al. All rights reserved. Asymptomatic Bacteriuria Caused by Chromobacterium violaceum in an Immunocompetent Adult Sun, 04 Oct 2015 16:39:20 +0000 Because of increasing antimicrobial resistance, the treatment of the asymptomatic bacteriuria is not considered except in specific circumstances like during pregnancy or before invasive urologic procedures. We are reporting a first case of asymptomatic bacteriuria caused by Chromobacterium violaceum in a 16-year-old male. With the reporting of the C. violaceum which is notorious for its high propensity for hematogenous dissemination causing fatal sepsis (with reported mortality rate up to 65–80%) if prompt proper treatment is not given, as causative agent of asymptomatic bacteriuria, it is recommended to treat the asymptomatic bacteriuria caused by this organism. Narayan Dutt Pant, Manisha Sharma, and Saroj Khatiwada Copyright © 2015 Narayan Dutt Pant et al. All rights reserved. Hemophagocytic Lymphohistiocytosis Complicating Dengue and Plasmodium vivax Coinfection Sun, 04 Oct 2015 13:59:54 +0000 Hemophagocytic lymphohistiocytosis (HLH) is a rare disorder. Dysfunction of cytotoxic T and natural killer (NK) cells causes uncontrolled activity of lymphocytes and histiocytes which leads to HLH. Infections, malignancies, and autoimmune disorders are associated with development of HLH. Dengue and Plasmodium vivax are rare causes of HLH. We report the first ever case of a young man who developed fatal HLH that complicated Dengue Hemorrhagic Fever (DHF) and Plasmodium vivax infection. Muhammad Khurram, Muhammad Faheem, Muhammad Umar, Asif Yasin, Wajeeha Qayyum, Amna Ashraf, Javeria Zahid Khan, Ali Hasnain Yasir, Yusra Ansari, Muhammad Asad, Iram Khan, Shuja Abbas, Irum Rasheed, Natasha Rasool, and Hamama Tul Bushra Khar Copyright © 2015 Muhammad Khurram et al. All rights reserved. Unusual Paraneoplastic Presentation of Cholangiocarcinoma Thu, 01 Oct 2015 12:19:35 +0000 Introduction. Cutaneous paraneoplastic syndromes are a heterogeneous group of skin manifestations that occur in relation to many known malignancies. Paraneoplastic occurrence of SCLE has been noted but is not commonly reported. SCLE association with cholangiocarcinoma is rare. Case Presentation. A 72-year-old man with a history of extrahepatic stage IV cholangiocarcinoma presented with a pruritic rash. Cholangiocarcinoma had been diagnosed three years earlier and was treated. Five months after interruption of his chemotherapy due to a semiurgent surgery, he presented with explosive onset of a new pruritic rash, arthralgias, and lower extremity edema. Physical exam revealed a scaly erythematous rash on his arms, hands, face, neck, legs, and trunk. It was thick and scaly on sun exposed areas. Skin biopsy revealed vacuolar interface dermatitis. Immunofluorescence revealed IgM positive cytoid bodies scattered along the epidermal basement membrane zone. PET-CT scanning revealed metabolically active recurrent disease in peripancreatic and periportal region with hypermetabolic lymph nodes. Oral steroids and new regimen of chemotherapy were started. Rash improved and steroids were tapered off. Discussion. Paraneoplastic syndromes demonstrate the complex interaction between the immune system and cancer. Treatment resistant SCLE should raise a suspicion for paraneoplastic etiology. Aman Opneja, Sonia Mahajan, Sargam Kapoor, Shanthi Marur, Steve Hoseong Yang, and Rebecca Manno Copyright © 2015 Aman Opneja et al. All rights reserved. The Cutaneous Ciliated Cyst in Young Male: The Possibility of Ciliated Cutaneous Eccrine Cyst Wed, 30 Sep 2015 10:29:41 +0000 Cutaneous ciliated cyst was described as a painless cyst occurring on the lower limbs of women between the ages of 15 and 30 years. The cysts are typically lined by ciliated cuboidal to columnar epithelium with pseudostratified areas and focal squamous metaplasia is occasionally present. Immunohistochemical studies have demonstrated that the cysts are PR and ER positive, similar to the epithelia of the fallopian tubes. However, outliers of cutaneous ciliated cysts, including those in male patients and in unexpected locations such as the scalp, finger, and scapular area, have been reported. Thus, some hypotheses have been proposed including the Mullerian heterotopias, ciliated metaplasia of eccrine sweat glands, and embryonic remnants of the cloacal membrane. We report a rare case of cutaneous ciliated cyst on the left shoulder of a 7-year-old boy and this is the eighth case of cutaneous ciliated cyst in male patients. Moreover, through reviewing the articles, we try to propose the classification of the cutaneous ciliated cysts into the cutaneous Mullerian cysts and the ciliated cutaneous eccrine cysts. Youngjoon Kim and Hyunjung Kim Copyright © 2015 Youngjoon Kim and Hyunjung Kim. All rights reserved. A Case Report of an Atypical Presentation of IgG4-Related Disease and Idiopathic CD4 Lymphocytopenia Mon, 28 Sep 2015 06:13:32 +0000 The IgG4-related disease is a fibroinflammatory disease characterized by tumefactive lesions, a dense lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, storiform fibrosis, and, often but not always, elevated serum levels of IgG4. Idiopathic CD4 lymphocytopenia is a heterogenic and rare syndrome characterized by the detection of a persistent absolute CD4 T cells count <300 cells/mm3 (or <20% of total T cells) in more than one occasion and no evidence of HIV infection in absence of immunodeficiency or therapy associated with depressed levels of CD4 T cells. We report the case of a 50-year-old man with a multiorgan IgG4-related disease presenting in a temporal association with a profound and symptomatic idiopathic CD4 lymphocytopenia. Both clinical pictures improved after steroid treatment. Idiopathic CD4 lymphocytopenia has been associated with a number of autoimmune conditions but, to the best of our knowledge, this is the first case in which an association with the IgG4-related disease is reported. Francesco Rapisarda, Luca Zanoli, Grazia Portale, Salvo Scuto, and Pietro Castellino Copyright © 2015 Francesco Rapisarda et al. All rights reserved. Diffuse Large B Cell Lymphoma with Extensive Cutaneous Relapse Sun, 20 Sep 2015 14:19:51 +0000 Herein, we aimed to report a diffuse large B cell lymphoma (DLBCL) case that had extensive cutaneous relapse with no skin involvement previously. A 59-year-old man presented to hospital in April 2014 with fatigue, anorexia, fever, and anemia. Cervical lymph node biopsy revealed CD20+, BCL2+, MUM1+, BCL6+ high grade B lymphoproliferative neoplasm. After FISH investigation, he was diagnosed as DLBCL. He was given 7 cycles of R-CHOP and achieved remission. However, in November 2014, he had emerging skin lesions that cover nearly all of his body. A control PET-CT revealed diffuse cutaneous involvement. CD20+, BCL2+, MUM1+, BCL6+ high grade B cell lymphoma infiltration was detected with skin biopsy. He was diagnosed as relapse lymphoma, so 2 cycles of R-DHAP were given. There was no treatment response; therefore, R-ICE regimen was started. The patient had achieved second complete remission and his skin lesions were completely regressed. The involvement of skin with CD20+ cells after 7 cycles of rituximab therapy favors that there is a rituximab resistant disease which tends to involve the skin. To conclude, DLBCL may relapse extensively with cutaneous involvement and the best treatment option in these patients is salvage chemotherapy followed by autologous peripheral blood stem cell transplantation. Umit Yavuz Malkan, Gursel Gunes, Okan Yayar, and Haluk Demiroglu Copyright © 2015 Umit Yavuz Malkan et al. All rights reserved. Diagnosis and Management of Cornu Cutaneum of Nasal Vestibule: A Rare Case Report Sun, 20 Sep 2015 14:02:04 +0000 Cornu cutaneum is a relatively uncommon projectile, irregular, hyperkeratotic nodule that can be seen in places such as scalp, forehead, eyelids, ear, nose, lips, and upper extremities which are subjectable to sunlight. Treatment is surgery with radical margins. Excisional biopsy is enough for treatment of the lesion on head and face. However, there is only little literature about cornu cutaneum on the nasal vestibule. We present an 82-year-old male patient with a necrotic, irregular shaped lesion with pedicle on the left nasal vestibule excised and diagnosed as cornu cutaneum. Hande Ezerarslan, Mustafa Mert Basaran, and Sefik Halit Akmansu Copyright © 2015 Hande Ezerarslan et al. All rights reserved. Trichobezoar Causing Airway Compromise during Esophagogastroduodenoscopy Thu, 17 Sep 2015 13:45:47 +0000 Objectives. (1) Report the case of a 5-year-old female with trichotillomania and trichophagia that suffered airway compromise during esophagogastroduodenoscopy for removal of a trichobezoar. (2) Provide management recommendations for an unusual foreign body causing extubation and partial airway obstruction. Methods. Case report of a rare situation of airway compromise caused by a trichobezoar. Results. A 5-year-old patient underwent endoscopic retrieval of a gastric trichobezoar (hairball) by the gastroenterology service under general endotracheal anesthesia in a sedation unit. During removal, the hairball, due to its large size, dislodged the endotracheal tube, effectively extubating the patient. The bezoar became lodged at the cricopharyngeus muscle. Attempts to remove the bezoar or reintubation were unsuccessful. The child was able to be mask ventilated while the otolaryngology service was called. Direct laryngoscopy revealed a hairball partially obstructing the view of the glottis from its position in the postcricoid area. The hairball, still entrapped in the snare from the esophagoscope, was grasped with Magill forceps and slowly extracted. The patient was then reintubated and the airway and esophagus were reevaluated. Conclusions. Trichobezoar is an uncommon cause of airway foreign body. Careful attention to airway management during these and similar foreign body extractions can prevent inadvertent extubations. Erica Y. Kao, Nicholas J. Scalzitti, Gregory R. Dion, and Sarah N. Bowe Copyright © 2015 Erica Y. Kao et al. All rights reserved. Treatment of Phthiriasis Palpebrarum and Crab Louse: Petrolatum Jelly and 1% Permethrin Shampoo Tue, 15 Sep 2015 10:14:09 +0000 Phthiriasis palpebrarum is an uncommon cause of blepharoconjunctivitis in which Pthirus pubis infest the eyelashes. We report a case of unilateral phthiriasis palpebrarum with crab louse. A 45-year-old man presented with conjunctival hyperaemia and moderate itching associated with irritation, and crusty excretions of the eyelashes in the left eye. Careful slit-lamp examination revealed many lice and nits in left eye and mild conjunctival hyperaemia. No abnormality was found in the right eye. On dermatologic examination, only one louse was found at the pubic area. The patient was treated effectively with petrolatum jelly (Vaseline) and 1% permethrin shampoo (Kwellada 1% shampoo). At the end of the first week no louse or nit was present on eyelashes and pubic area. Yunus Karabela, Gurkan Yardimci, Isik Yildirim, Eray Atalay, and Semsi Nur Karabela Copyright © 2015 Yunus Karabela et al. All rights reserved. First Autochthonous Coinfected Anthrax in an Immunocompetent Patient Tue, 15 Sep 2015 08:53:10 +0000 Cutaneous anthrax has a mortality rate of 20% if no antibacterial treatment is applied. The clinical manifestations of cutaneous anthrax are obviously striking, but coinfection may produce atypical lesions and mask the clinical manifestations and proper laboratory diagnosis. Anthrax is known to be more common in the Middle East and Iran is one of the countries in which the zoonotic form of anthrax may still be encountered. We report a case of a 19-years-old male who used to apply Venetian ceruse on his skin. Venetian ceruse (also known as Spirits of Saturn) is an old cosmetic product used for skin whitening traditionally made from sheep’s spinal cord. The patient referred to the Referral Laboratory, Mazandaran University of Medical Sciences, Sari, Iran, with atypical dermatosis, pronounced pain, and oedema of the affected tissue. It was confirmed by both conventional and molecular analysis that culture was a mixture of Bacillus anthracis and Trichophyton interdigitale. The patient was initially treated with ceftriaxone (1000 mg/day for two weeks), gentamicin (1.5–2 mg/kg/day), terbinafine (200 mg/week for one month), and 1% clotrimazole cream (5 weeks) two times per day which resulted in gradual improvement. No relapse could be detected after one-year follow-up. Anthrax infection might present a broader spectrum of symptoms than expected by clinicians. These unfamiliar characteristics may lead to delayed diagnosis, inadequate treatment, and higher mortality rate. Clinicians need to be aware of this issue in order to have successful management over this infection. Parvaneh Afshar, Mohammad Taghi Hedayati, Narges Aslani, Sadegh Khodavaisy, Farhang Babamahmoodi, Mohammad Reza Mahdavi, Somayeh Dolatabadi, and Hamid Badali Copyright © 2015 Parvaneh Afshar et al. All rights reserved. An Unusual Course of Segmental Renal Artery Displays a Rare Case of Hilar Nutcracker Phenomenon Sun, 13 Sep 2015 11:25:21 +0000 Nutcracker phenomenon or renal vein entrapment is classically seen as a compression of renal vein in between abdominal aorta and superior mesenteric artery with patients being asymptomatic or clinically manifested in the form of nutcracker syndrome as proteinuria, hematuria, flank pain, pelvic congestion in women, and varicocele in men. In this report, we are presenting a case of rare variant of nutcracker phenomenon along with brief review of anatomy, pathophysiology, public health, and clinical significance of nutcracker syndrome. On a routine dissection of an adult male cadaver, we noticed an unusual arrangement of the structures at the hilum of the left kidney showing entrapment of renal vein between left anterior inferior and posterior segmental renal arteries. The variation in the course of left anterior inferior segmental renal artery leads to compression of left renal vein at renal hilum. Therefore, we have named this rare abnormal anatomical entity as hilar nutcracker phenomenon. The structures in the right renal hilum are normal. The objective of this paper is to report an unusual but important variant of nutcracker phenomenon and also give collective knowledge of such anatomical variations in renal vasculature that will help in diagnosing and treating such rare renal disorder. Devendra A. Sawant and Thomas F. Moore Copyright © 2015 Devendra A. Sawant and Thomas F. Moore. All rights reserved. Pulmonary Silicosis Presents with Pleural Effusion Mon, 07 Sep 2015 06:52:31 +0000 Silica and silicate mineral dust inhalation can cause a variety of histopathological changes in the lungs and pleura. These include pulmonary silicotic nodules, interstitial infiltrate, fibrosis, and pleural thickening. Pleural effusion is an extremely rare presentation of silicosis. To our best knowledge, there have been only 2 cases of silicosis with pleural effusion reported in medical literature. Herein, we describe a case of a 77-year-old male with almost 50 years’ history of occupational silica exposure. He presented with a 4-week history of exertional shortness of breath. He is a lifetime nonsmoker, with no known other significant pulmonary disease. He had chest X-ray which showed a right lung infiltrate and bilateral pleural thickening and effusion. Chest CT showed moderate-sized bilateral pleural effusion and thickening with multiple bilateral intrapulmonary nodules seen. He had undergone extensive workup and was diagnosed with silicosis. Mohsin Salih, Tarake Aljarod, Mohamed Ayan, Melnick Jeffrey, and Bobby H. Shah Copyright © 2015 Mohsin Salih et al. All rights reserved. New-Onset Myocarditis in an Immunocompetent Adult with Acute Metapneumovirus Infection Wed, 02 Sep 2015 11:55:56 +0000 Introduction. A number of viruses have been implicated in viral myocarditis; however, there has been no previous report of human metapneumovirus (hMPV) causing this condition. Discovered in 2001, hMPV is typically associated with upper respiratory illness, mainly affecting children. Case Presentation. We report the case of a 25-year-old man with acute systolic heart failure from viral myocarditis secondary to the hMPV. The patient was initially admitted to the general medical ward but developed increasing oxygen requirements resulting in transfer to the cardiac intensive care unit. Cardiac magnetic resonance imaging was used to help confirm the diagnosis. He was treated with intravenous diuretics, and afterload and preload agents, and he was subsequently discharged home after seven days of hospitalization. Discussion. hMPV is typically a respiratory pathogen; however, it was associated with in myocarditis in our patient. Due to the recent ability to detect this virus, we may see more cases of this, particularly during peak months of infection. Conclusion. This is the first case description of myocarditis associated with hMPV infection. Mark A. Weinreich, Ahmad Y. Jabbar, Nagina Malguria, and Robert W. Haley Copyright © 2015 Mark A. Weinreich et al. All rights reserved. Bilateral Spontaneous Perirenal Hemorrhage due to Initial Presentation of Polyarteritis Nodosa Tue, 01 Sep 2015 06:51:25 +0000 Spontaneous perirenal hemorrhage (SPH) is uncommon but can be a life-threatening condition which is associated with flank or abdominal pain and hypovolemia. The etiologies of SPH include tumor, vascular disease, and infection. Among the vascular diseases, polyarteritis nodosa (PAN) is common cause of the SPH. However, patients with PAN usually complain of nonspecific symptoms and the incidence of PAN is relatively rare. So, diagnosis is difficult even though tissue biopsy and angiography help to confirm the PAN. Particularly bilateral perirenal hemorrhage is very rare complication in patients with PAN. We reported a case of bilateral perirenal hemorrhage in the patients with PAN who have continued to take exogenous sex hormone. Hyung-Il Choi, Yang-Gyun Kim, Se-Yun Kim, Da Wun Jeong, Ki-Pyo Kim, Kyung-Hwan Jeong, Sang-Ho Lee, and Ju-Young Moon Copyright © 2015 Hyung-Il Choi et al. All rights reserved. Sinus of Valsalva Aneurysm: A Rare Cause of Dyspnea Mon, 24 Aug 2015 07:36:58 +0000 Sinus of Valsalva aneurysm (SOVA) is a rare clinical entity. Clinical manifestations can vary from an incidental finding on an imaging study to a life-threatening emergency. We report a case of a 51-year-old female with a large symptomatic left SOVA. Echocardiogram and computed tomography angiography (CTA) of the chest revealed marked dilatation of the left sinus of Valsalva, measuring 7.5 cm. This resulted in superior displacement of the left main coronary artery. Surgical repair of the aneurysm with reimplantation of the right and left coronary arteries was performed in addition to aortic valve replacement (Bentall procedure). The patient had an uneventful postoperative course and remains asymptomatic at the three-month follow-up visit. Aiman Smer, Osama Elsallabi, Mohamed Ayan, Haitam Buaisha, Hamza Rayes, Yazeid Alshebani, Hamza Tantoush, and Mohsin Salih Copyright © 2015 Aiman Smer et al. All rights reserved. Mandibular Brown Tumor of Secondary Hyperparathyroidism Requiring Extensive Resection: A Forgotten Entity in the Developed World? Wed, 19 Aug 2015 09:46:22 +0000 Brown tumor of hyperparathyroidism (BTHPT) is rare in the United States and not frequently seen in clinical practice. This is likely because early diagnosis and prompt treatment of this disease process prevent the progression and development of BTHPT. Conversely, BTHPT is more common in underdeveloped countries where fewer patients have access to health care and hyperparathyroidism (HPT) goes untreated. It has been reported that the incidence of BTHPT in underdeveloped countries can be as high as 58 to 69 percent in patients with primary HPT. We present a case report of a patient in the United States with a large mandibular BTHPT requiring an extensive resection in the setting of secondary HPT. Despite being rare in this country, it is important for nephrologists, primary care physicians, and oral health care providers to be able to recognize this entity, so that intervention may be rendered early. Mohammed Qaisi, Matthew Loeb, Lindsay Montague, and Ron Caloss Copyright © 2015 Mohammed Qaisi et al. All rights reserved. Diffuse Calcifications of the Spleen in a Woman with Systemic Lupus Erythematosus Mon, 17 Aug 2015 08:47:58 +0000 Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease, which affects a wide variety of organs including the spleen. Splenic involvement in SLE includes conditions such as splenomegaly, hyposplenism, infarction, and spontaneous rupture. However, only a few cases of splenic calcifications in patients with SLE have been reported. Herein, we present a case of a 24-year-old female diagnosed with SLE, in which we found diffuse splenic calcifications. The unique pattern of splenic calcifications in SLE contributes to the differential diagnosis from other conditions such as infections and other connective tissue diseases, which also cause calcifications in the spleen. Aristeides G. Vaiopoulos, Meletios A. Kanakis, Kyriaki Katsouri, Stavroula Kyriazi, George A. Vaiopoulos, and Phaedon Kaklamanis Copyright © 2015 Aristeides G. Vaiopoulos et al. All rights reserved. Cooccurrence of Multiple Sclerosis and Idiopathic Basal Ganglia Calcification Sun, 16 Aug 2015 11:14:38 +0000 Multiple sclerosis (MS) is a chronic inflammatory demyelinating and neurodegenerative disease of central nervous system that affects both white and gray matter. Idiopathic calcification of the basal ganglia is a rare neurodegenerative disorder of unknown cause that is characterized by sporadic or familial brain calcification. Concurrence of multiple sclerosis (MS) and idiopathic basal ganglia calcification (Fahr’s disease) is very rare event. In this study, we describe a cooccurrence of idiopathic basal ganglia calcification with multiple sclerosis. The association between this disease and MS is unclear and also maybe probably coincidental. M. Abedini, N. Karimi, and N. Tabrizi Copyright © 2015 M. Abedini et al. All rights reserved. Inflammatory Pseudotumor of the Liver with Escherichia coli in the Sputum Wed, 12 Aug 2015 11:13:00 +0000 Inflammatory pseudotumor is a nonmalignant lesion that mimics malignant lesions and has been reported to occur at various sites throughout the body. Though it has been reported as a reaction to infection, the true etiology of the lesion is unknown. In this report, we present the case of a patient with a liver lesion of unknown origin. Through a series of imaging studies, we were able to observe the locally aggressive nature of this lesion as it rapidly eroded into the lung. Sputum cultures showed growth of E. coli, indicating E. coli infection as a possible etiology of this lesion. Pathology was consistent with inflammatory pseudotumor. Sreenath Narayan, Ashwini Nayak, and Chris L. King Copyright © 2015 Sreenath Narayan et al. All rights reserved. Diffuse Alveolar Hemorrhage Associated with Warfarin Therapy Wed, 12 Aug 2015 07:15:49 +0000 Diffuse alveolar hemorrhage (DAH) is a life-threatening clinical pathologic syndrome caused by a variety of diseases. We report a case of DAH related to therapy of warfarin use. In this case report, we present the diffuse alveolar hemorrhage case as a rare and life-threatening complication of warfarin. Bülent Kaya, Ibrahim Yildiz, Reshat Mehmet Baha, Neslihan Ebru Eryaşar Zeytun, and Azize Yetisgen Copyright © 2015 Bülent Kaya et al. All rights reserved. Reconstruction of Elbow by Free Fibular Graft in a Case of Osteoclastoma of Proximal Ulna: A Rare Case Report Wed, 12 Aug 2015 06:30:33 +0000 Giant cell tumour is a benign aggressive bone tumour. Most commonly, it is seen in epiphysiometaphyseal region around knee and distal radius. Proximal ulna is a rare location for giant cell tumour. According to reports, only 4 such cases have been reported in English literature. We report one such case of giant cell tumour of proximal ulna. Patient presented with painless, progressive swelling around right elbow since 4 months. Proximal ulna along with tumour was resected and elbow was reconstructed using nonvascularized free fibular graft. At two years of follow-up, patient is tumour-free and has functional range of movement in elbow. We are reporting the case because of its rare location and for the indigenous treatment modality of using free fibular graft for elbow reconstruction. Kiran Kalaiah, S. G. Thejaswi, and Marula Siddappa Copyright © 2015 Kiran Kalaiah et al. All rights reserved. Pulmonary Embolism in a Sarcoidosis Patient Double Heterozygous for Methylenetetrahydrofolate Reductase Gene Polymorphisms and Factor V Leiden and Homozygous for the D-Allele of Angiotensin Converting Enzyme Gene Tue, 11 Aug 2015 11:35:06 +0000 Sarcoidosis is a multisystem granulomatous disease of unknown etiology and pathogenesis. It presents in patients younger than 40 years of age. The lungs are the most commonly affected organ. Till the present day, there is no single specific test that will accurately diagnose sarcoidosis; as a result, the diagnosis of sarcoidosis relies on a combination of clinical, radiologic, and histologic findings. Patients with sarcoidosis have been found to have an increased risk of pulmonary embolism compared to the normal population. MTHFR and factor V Leiden mutations have been reported to increase the risk of thrombosis in patients. We hereby present a case of a middle aged man with sarcoidosis who developed a right main pulmonary embolism and was found to be double heterozygous for methylenetetrahydrofolate reductase gene polymorphisms and factor V Leiden and homozygous for the D-allele of the angiotensin converting enzyme gene. Nadim El-Majzoub, Rami Mahfouz, and Nadim Kanj Copyright © 2015 Nadim El-Majzoub et al. All rights reserved. A Fetus with Iniencephaly Delivered at the Third Trimester Thu, 06 Aug 2015 11:26:49 +0000 Iniencephaly is an uncommon neural tube defect, having retroflexion of the head without a neck and severe distortion of the spine. Iniencephaly is classified into two groups, iniencephaly apertus (with encephalocele) and iniencephaly clausus (without encephalocele). Incidence ranges from 0.1 to 10 in 10.000 pregnancies and it is seen more frequently in girls. Most of the fetuses with this defect die before birth or soon after birth, while those with the milder forms may live through childhood. Recurrence risk is around 1–5%. Family should be offered termination to reduce maternal risks and counseled for folic acid supplementation before the next planned pregnancy. Here we present a rare case of iniencephaly clausus which was diagnosed at 18th week of gestation by ultrasonography and delivered in the third trimester of pregnancy due to rejection of termination. Esra Cinar Tanriverdi, Ilhan Bahri Delibas, Zeynep Kamalak, Berrin Goktug Kadioglu, and Rukiye Ada Bender Copyright © 2015 Esra Cinar Tanriverdi et al. All rights reserved. Gabapentin Treatment for Neuropathic Pain in a Child with Sciatic Nerve Injury Tue, 04 Aug 2015 11:20:23 +0000 There are a restricted number of studies about usage of gabapentin for neuropathic pain treatment of pediatric patients. We shared a 12-year-old male case with severe neuropathic pain that hindered the rehabilitation programme for the loss of muscle power and movement limitation. Neuropathic pain developed after peripheral sciatic damage due to firearm traumatisation did not respond to other medical treatments but healed nearly completely after gabapentin usage. Halil Ekrem Akkurt, Haluk Gümüş, Hamit Göksu, Ömer Faruk Odabaşı, and Halim Yılmaz Copyright © 2015 Halil Ekrem Akkurt et al. All rights reserved. Serotonin Syndrome in the Setting of Lamotrigine, Aripiprazole, and Cocaine Use Mon, 03 Aug 2015 06:07:40 +0000 Serotonin syndrome is a potentially life-threatening condition associated with increased serotonergic activity in the central nervous system. It is classically associated with the simultaneous administration of two serotonergic agents, but it can occur after initiation of a single serotonergic drug or increasing the dose of a serotonergic drug in individuals who are particularly sensitive to serotonin. We describe a case of serotonin syndrome that occurred after ingestion of higher than prescribed doses of lamotrigine and aripiprazole, in addition to cocaine abuse. The diagnosis was established based on Hunter toxicity criteria and severity was classified as mild. The features of this syndrome resolved shortly after discontinuation of the offending agents. Serotonin syndrome is characterized by mental status changes, autonomic hyperactivity, and neuromuscular abnormalities along a spectrum ranging from mild to severe. Serotonin syndrome in our patient was most likely caused by the pharmacokinetic and pharmacodynamic interactions between lamotrigine, aripiprazole, and cocaine leading to increased CNS serotonergic activity. Anupam Kotwal and Sarah L. Cutrona Copyright © 2015 Anupam Kotwal and Sarah L. Cutrona. All rights reserved. Histopathologic Finding of Both Gastric and Respiratory Epithelia in a Lingual Foregut Cyst Thu, 30 Jul 2015 11:25:34 +0000 Foregut cysts are uncommon, mucosa-lined congenital lesions that may occur anywhere along the gastrointestinal or respiratory tract and typically present within the first year of life. Although infrequent, these cysts may generate feeding or respiratory difficulties depending on the size and location of the lesion. Foregut cysts of the oral cavity are rarely seen and of those cases localized to the tongue are even more uncommon. We describe a 4-month-old girl with a foregut cyst involving the floor of mouth and anterior tongue. Subsequent histologic analysis demonstrated a cyst lined with both gastric and respiratory epithelia. This case represents an extremely rare finding of both gastric and respiratory epithelia lined within a single cystic structure in the tongue. Although a very rare finding, a foregut cyst should be on the differential diagnosis of any lesion involving the floor of mouth or tongue in an infant or child. Yangfan Luo, Nick Shillingford, and Jeffrey A. Koempel Copyright © 2015 Yangfan Luo et al. All rights reserved. First Case of Tricuspid Valve Endocarditis Caused by Gemella bergeri Thu, 30 Jul 2015 09:44:33 +0000 Gemella bergeri is a Gram-positive cocci species arranged in pairs and composes the normal flora of oral cavity, digestive and urinary tract. Several species of Gemella are known to cause endocarditis. Here, we report the first case in Thailand of G. bergeri endocarditis whose blood culture was negative using routine methods but was positive by PCR identification of bacteria in the affected valve. A 37-year-old male presented with prolonged fever, weight loss, and dyspnea on exertion. By transthoracic echocardiography, he was suspected of having infective endocarditis of the tricuspid valve. The patient underwent tricuspid valve repair and vegetectomy. Routine hospital blood cultures were negative but G. bergeri was identified by PCR/sequencing of the heart valve tissue. Orathai Pachirat, George Watt, and Burabha Pussadhamma Copyright © 2015 Orathai Pachirat et al. All rights reserved.