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Beware of epistaxis: fatal pseudoaneurysm rupture 30 years after treatment of acromegaly BMJ Case Rep. Pub Date : 2024-04-01 Ana Carreira, Solomon Muna, Ashley B Grossman, Márta Korbonits
We present a fatal complication of treatment in a patient with early-onset acromegaly, treated with two transsphenoidal operations, radiotherapy, radiosurgery and pegvisomant. He was diagnosed in his 30s, and controlled from his 40s, with stable residual tumour within the left cavernous sinus. In his 60s, 30 years after surgery/radiotherapy and 14 years after radiosurgery, he developed recurrent episodes
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Herpes zoster of posterior division of mandibular branch of trigeminal nerve BMJ Case Rep. Pub Date : 2024-04-01 Tulasi Karanth, Neetu Lal
Herpes zoster is a disease caused by the reactivation of dormant varicella zoster virus present in the sensory root ganglion. It presents with a vesicular rash on an erythematous base similar to that seen in classical varicella, however, with only a single dermatomal distribution. The rash is usually seen throughout the affected dermatome as the dorsal root ganglia for each dermatome are clustered
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From endometrium to fingernail bed: histological evaluation of a rare cutaneous metastasis BMJ Case Rep. Pub Date : 2024-04-01 Simona A Alomary, Robert A Schwartz, W Clark Lambert, Albert Alhatem
In the dermatological spectrum of oncologic manifestations, cutaneous metastases from endometrial carcinoma stand as a rarity, given the tumour’s predilection for neighbouring uterine regions. We present an exceptional case of a patient in her mid-50s, whereby an endometrial carcinoma, defying conventional pathways, manifested on the skin and nail of her distal fourth finger, an unusual site for cutaneous
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Bowel perforation with generalised peritonitis secondary to recurrent primary fallopian tube carcinoma after 17 years BMJ Case Rep. Pub Date : 2024-04-01 Mei Jing Ho, Lee S Kyang, Steven Schlichtemeier
We describe a case of bowel perforation secondary to a recurrence of primary fallopian tube carcinoma treated more than a decade ago. A woman in her 70s presented to a rural centre with an acute abdomen. An abdominal CT showed a perforated ileum secondary to a pelvic mass. Emergency laparotomy identified the pelvic mass that was adherent to the side wall and invading the ileum at the site of perforation
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Preoperative three-dimensional modelling and virtual reality planning aids nephron sparing surgery in a child with bilateral Wilms tumour BMJ Case Rep. Pub Date : 2024-04-01 Avijit Banerjee, Ramesh Babu, Dhaarani Jayaraman, Srinivas Chilukuri
Bilateral Wilms tumour (BWT) is a surgically challenging condition. Virtual reality (VR) reconstruction aids surgeons to foresee the anatomy ahead of Nephron Sparing Surgery (NSS). Three-dimensional (3D) visualisation improves the anatomical orientation of surgeons performing NSS. We herewith report a case of BWT where VR planning and 3D printing were used to aid NSS. Conventional imaging is often
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Benign multinodular goitre presenting as acute decompensated type two respiratory failure BMJ Case Rep. Pub Date : 2024-04-01 Abdullah Khalil, Sampath Liyanage, Hazeera Ishaq, Anoop Babu
Acute airway obstruction is a life-threatening complication of benign goitre mostly occurring in cases of known progressing goitres. The index presentation of goitre with decompensated type two respiratory failure is an exceedingly rare and a diagnostically challenging presentation. We discuss the case of a woman in her 50 s, who had been diagnosed with asthma by her general practitioner, but during
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Congenital pterygium with anterior segment dysgenesis: rare ocular manifestation in Rubinstein-Taybi syndrome BMJ Case Rep. Pub Date : 2024-04-01 Dewang Angmo, Tanmay Thulkar, Ekta Shaw, Nitika Beri
Pterygium is a benign, wing-shaped fibrovascular overgrowth of subconjunctival tissue that can encroach over the cornea. This condition usually occurs in individuals aged 20–40 years but is rarely seen in children. We report a case of an infant with Rubenstein-Taybi syndrome presenting with nebulo-macular corneal opacity and congenital pterygium. On examination under anaesthesia, bilateral infero-nasal
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Vallecular cyst causing sleep-disordered breathing in an older child BMJ Case Rep. Pub Date : 2024-04-01 Dylan J Cooper, Ron Mitzner, Eric A Gantwerker
Consensus-based recommendations are needed to better guide paediatric otolaryngologists in providing standardised care to children with sleep-disordered breathing (SDB). Here we present a unique case of vallecular cyst found during SDB workup in a patient in their middle childhood (6–12 years old). While the patient underwent successful cyst resection, he was noted to have a suspected recurrence 6 months
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Heyde’s syndrome: a challenging case of severe aortic stenosis and gastrointestinal bleeding BMJ Case Rep. Pub Date : 2024-04-01 Mohamed Abouzid, Ahmed Abdelhakeem, Shorouk Elshafie, Ahmad Ghorab
We present the case of an elderly man with a history of diastolic congestive heart failure, severe aortic stenosis and atrial fibrillation, who presented with fatigue, weakness, coffee ground emesis and black tarry stool. Haemoglobin was 68 g/L. Lactate dehydrogenase was elevated at 1038. Evaluation by cardiology and gastroenterology specialists revealed reflux oesophagitis and a mild hiatal hernia
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Long-term cognitive effects of COVID-19 studied with repeated neuropsychological testing BMJ Case Rep. Pub Date : 2024-04-01 Beverly Matthews, Ashima Datey Chakrabarty, Arindam Chakrabarty
COVID-19 has a wide range of clinical manifestations. Apart from respiratory symptoms, neurological manifestations and cognitive impairment are commonly seen. Due to lack of a clear consensus on the definition of long COVID a pragmatic approach of assessing change from neurological baseline has become prevalent. We present the case of a high functioning woman in her late 40s who had a mild course of
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Aplasia cutis congenita type VII of the lower extremity: a favourable disease course with minimal conservative treatment BMJ Case Rep. Pub Date : 2024-04-01 Kwong Tack Quach, Carolien Wind, Kim van Mierlo, Lydia E Vos
Aplasia cutis congenita (ACC) is a group of rare heterogeneous disorders characterised by absent areas of skin at birth. The majority of cases involve the scalp region. ACC limited to one lower limb is extremely rare. We report an usual case of ACC limited to the left thigh of which healing occurred in utero. The case was managed conservatively and the disease course has been favourable with no limitations
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Novel genetic variant in hereditary spastic paraparesis BMJ Case Rep. Pub Date : 2024-04-01 Kathryn A W Knight, Catriona Barbour-Hastie, Angus Gane, Jonathan O'Riordan
A man in his 30s was referred to neurology with right-sided paraesthesia, tremors, chest pain and lower urinary tract and erectile dysfunction. He had a medical history of left acetabular dysplasia, and subjective memory impairment, the latter being in the context of depression and chronic pain with opioid use. There was no notable family history. On examination, he had a spastic paraparesis. Imaging
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Hypereosinophilic syndrome: a rare cause of ST-elevation myocardial infarction and thrombus formation on the aortic valve BMJ Case Rep. Pub Date : 2024-04-01 Mathias Dyreborg Jørgensen, Ida Ransby Schneider, Gunhild Nynke Thomsen, Jordi Sanchez Dahl
We present a case of a man in his 30s presenting with ST-segment elevation myocardial infarction and eosinophilia. The patient underwent thrombus aspiration and initially echocardiographic evaluation was normal. The patient was discharged after 2 days, but was hospitalised again after 6 days. Echocardiographic evaluation now revealed a thrombus formation on the aortic valve. Laboratory data revealed
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Immune thrombocytopaenic purpura following COVID-19 infection masquerading as senile purpura BMJ Case Rep. Pub Date : 2024-04-01 Yuka Shichijo, Kohei Horiuchi, Joyce Fogel
A woman in her 80s presented to the emergency department with a 3-month history of recurrent bruising and fatigue. She exhibited no evidence of cognitive decline and denied a history of trauma. She was a non-smoker with a medical history significant for hypothyroidism and type 2 diabetes, and the
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Eruptive xanthomas BMJ Case Rep. Pub Date : 2024-04-01 Vikrant Saoji, Bhushan Madke, Jayashri Shembalkar, Kinjal Rambhia
A male in his mid-30s presented with multiple asymptomatic yellowish skin lesions on both the palms, elbows and buttocks for the past year. He reported that skin lesions first started appearing on the elbows, and over the next few months, similar lesions were noted on both palms. He had no
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Dedifferentiated liposarcoma of the spermatic cord BMJ Case Rep. Pub Date : 2024-04-01 Eric James Panther, Hannah Lyons, Andrew Jacob Shychuk
A man in his 60s presented to an outside hospital with persistent groin pain and a scrotal mass which was thought to be a recurrent hernia. Three months after initial presentation, the patient was found to have dedifferentiated liposarcoma (LPS) of the spermatic cord. LPS of the spermatic cord is a rare entity; however, clinicians should have LPS on the differential diagnosis especially in men with
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Fertility-sparing approach in concurrent gliomatosis peritonei and growing teratoma syndrome in a young woman BMJ Case Rep. Pub Date : 2024-04-01 Siti Nawwal Ahmad Nasfy, Habibah Abdul Hamid, Azalea Md Khairuddin, Maryam Kameelah Mohamad Fauzi
Gliomatosis peritonei (GP) and Growing Teratoma Syndrome (GTS) are rare and clinically significant conditions often associated with ovarian teratomas. GP involves the development of benign glial implants on the peritoneal surface, while GTS is characterised by the growth of benign, yet enlarging peritoneal implants following chemotherapy for malignant germ cell tumours. These implants are typically
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Breast cryoablation for the palliative treatment of indolent subtype of multicentric triple-negative breast cancer BMJ Case Rep. Pub Date : 2024-04-01 Monica L Huang, Deanna L Lane, Hannah Bomar, Henry Kuerer
Breast cryoablation for palliative and curative treatment of breast cancer has been performed for decades. Although there is a recent resurgence of interest in breast cryoablation with curative intent for unifocal, hormone receptor-positive, human epidermal growth factor receptor 2-negative breast cancer, this report highlights the essential role that cryoablation can play in the palliative treatment
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Haemophilus parainfluenzae infective endocarditis complicated by multiorgan septic emboli BMJ Case Rep. Pub Date : 2024-04-01 Jarred Bowden, Molly Hunt, Jason Harhay, Tejal Patel, Neena Thomas-Gosain
Infective endocarditis (IE) caused by Haemophilus parainfluenzae is a rare but serious condition if not diagnosed and treated promptly. In this article, we describe a patient with H. parainfluenzae IE who initially presented with non-specific symptoms but subsequently developed multiple sequelae of IE. The diagnosis of IE was made based on clinical, echocardiographic, radiological and microbiological
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Serotonin syndrome presenting as acute dizziness with supine hypertension and orthostatic hypotension BMJ Case Rep. Pub Date : 2024-04-01 Sanjay Prakash, Ravisha Gupta, Maitree M Raval, Charu Tibrewal
Serotonin syndrome (SS) is a drug-induced clinical syndrome characterised by a combination of cognitive, neuromuscular and autonomic dysfunctions. The symptoms may include mild non-specific symptoms such as tremors and diarrhoea to coma and sudden death. Herein, we describe a case of SS in which acute dizziness was associated with supine hypertension and orthostatic hypotension. A man in his mid-30s
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Juvenile trabecular ossifying fibroma of the inferior turbinate BMJ Case Rep. Pub Date : 2024-04-01 Milind Sagar, Prahlad Dharmavaram Rajasekhar, Chirom Amit Singh, Hena Khandkar
Nasal obstruction is a commonly reported issue in the Otorhinolaryngology Outpatient Department. In this case, an early adolescent boy with a long-standing problem of right-sided nasal obstruction since childhood sought consultation. Diagnostic nasal endoscopy revealed a deviation of the nasal septum to the left, coupled with right inferior turbinate hypertrophy, all overlying healthy mucosa. A CT
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Gram-negative sepsis caused by a rare pathogen Phytobacter ursingii BMJ Case Rep. Pub Date : 2024-04-01 Samuel Choice, Ashten Sherman, Katherine Holder, Elaine Harrington
This case reviews the clinical course of an elderly woman on chronic total parenteral nutrition who developed sepsis secondary to a rare, newly described gram-negative rod known as Phytobacter ursingii . The patient noticed a leak in her Hickman catheter when infusing her nutrition. 24 hours after a new catheter was replaced, the patient developed fevers, chills and weakness. She presented to the hospital
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Acute diverticulitis of the appendix BMJ Case Rep. Pub Date : 2024-04-01 Ahmed Abdelrahim, Yusuf Yusuf, Omer Ali, Haytham Abudeeb
Acute diverticulitis of the appendix (ADA), though uncommon, often presents similarly to acute appendicitis but carries a higher risk of complications such as perforation and malignancy. We report the case of a male patient in his 50s with acute right iliac fossa abdominal pain, diagnosed via CT scan with ADA. Urgent laparoscopic appendicectomy was performed, and the patient was discharged without
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Mycoplasma hominis peritonitis after oocyte donation BMJ Case Rep. Pub Date : 2024-04-01 Pablo Mendoza Cediel, David Garcia Teruel, Esther Viedma Moreno, Maria Teresa Perez Pomata
We report the case of a young, immunocompetent, non-pregnant woman diagnosed with acute abdomen 3 weeks after an ultrasound-guided transvaginal oocyte retrieval (TVOR). Peritoneal fluid, obtained during exploratory laparoscopy, yielded Mycoplasma hominis as the sole pathogen. The patient’s symptoms and signs improved after 24-hour treatment with intravenous clindamycin, ampicillin and gentamycin. Complete
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Clinicoradiological features of probable chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) syndrome BMJ Case Rep. Pub Date : 2024-04-01 Deepa Susan John, Shreyas Reddy Kankara, Sunitha Palasamudram Kumaran, Adnan Sarfaraz Hussain
Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a recently described chronic inflammatory central nervous system disease. This case report describes a young female patient presenting with weakness in bilateral upper and lower limbs and tinnitus for 2 months. A neurological examination revealed signs of brainstem and cerebellar involvement
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Extramedullary relapse of multiple myeloma presenting as space-occupying lesion in liver treated with daratumumab, pomalidomide, dexamethasone and bendamustine BMJ Case Rep. Pub Date : 2024-04-01 Sarthak Wadhera, Arihant Jain, Suvradeep Mitra, Pankaj Malhotra
Extramedullary relapse in patients with multiple myeloma (MM) is often associated with loss of biochemical response and the appearance of measurable residual disease in the bone marrow. Fever is an unusual presenting manifestation of MM. Treatment of extramedullary relapse in patients progressing on proteasome inhibitors, anti-CD38 monoclonal antibodies and immunomodulatory drugs is challenging, as
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Pleisiomonas shigelloides bacteremia after catfish injury BMJ Case Rep. Pub Date : 2024-04-01 Catherine Glatz, Asad Arastu, Meghan K Train
This case of Pleisimonas shigelloides bacteremia resulting after a catfish barb injury highlights an unusual presentation of a common condition that requires alternative therapy for successful treatment. An otherwise healthy male in his early 40s presented to the emergency department with sepsis and rapidly spreading cellulitis shortly after a catfish injury at a freshwater lake. His broad-spectrum
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Tele-ICU enabled management of an organ donor in an under-resourced setting BMJ Case Rep. Pub Date : 2024-04-01 Prudhvi Dasari, Maheeja Reddy, Dileep Singh Parmar, Carl Britto
A man in his 30s was involved in a road traffic crash in a small town in India, not equipped to deal with cases of brainstem death. He was declared brain-dead after a few hours. The patient’s information was forwarded to organ specialists across the country, with the goal of preserving the patient’s organs for donation via a tele-ICU model. The team comprising bedside doctors and remote intensivists
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Megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS): challenges in diagnosis and management BMJ Case Rep. Pub Date : 2024-04-01 Keerthika Murali, Anjan Kumar Dhua
Megacystis microcolon intestinal hypoperistalsis syndrome (MMIHS) is a rare, congenital functional intestinal obstruction, characterised by megacystis (bladder distention in the absence of mechanical obstruction), microcolon and intestinal hypoperistalsis (dysmotility). We are reporting a case of a female child with normal antenatal course who presented with recurrent episodes of abdominal distension
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Atypical parathyroid adenoma with severe bone manifestations in early adolescence BMJ Case Rep. Pub Date : 2024-04-01 Ana Rachel Teixeira Batista Carvalho, Paula Hollanda de Araújo, Flaviene Alves do Prado Romani, Betânia Bisinoto Barra
This is a case of primary hyperparathyroidism in a female teenager with multiple fractures and severe bone manifestations. The histopathology revealed atypical parathyroid adenoma, an exceedingly rare form of hyperparathyroidism; its main differential diagnosis is parathyroid carcinoma, as it shares both clinical and histological characteristics with it, in addition to its still uncertain malignant
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Dermoscopic features of lichen nitidus BMJ Case Rep. Pub Date : 2024-04-01 Naveen Kumar Kansal, Shivani Vasisht, Riti Bhatia
A woman in her middle childhood, with Fitzpatrick skin phototype IV, presented with mildly itchy, tiny, skin-coloured lesions around the right eye for four months. Her mother gave a history of recurrent seasonal allergies (colds), suggesting an atopic diathesis. On examination, the right
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Optic nerve sheath diameter as a noninvasive adjunct tool in the evaluation of intracranial pressure BMJ Case Rep. Pub Date : 2024-04-01 Mallanagouda M Patil, Deepti S Joshi, Apoorva Gayatri Abbadi, Cauvery B Shethe
An infant presented with the abrupt onset of esotropia of the left eye, followed by an esotropia of the right eye over the subsequent 48 hours. Physical examination revealed bilateral papilledema, and apart from esotropia of both eyes ([figure 1][1]), the neurological assessment was unremarkable.
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Dermatofibrosarcoma protuberans of the breast BMJ Case Rep. Pub Date : 2024-04-01 Muskaan Qadir, Saira Fatima, Safdar Shaikh, Sana Zeeshan
Dermatofibrosarcoma protuberans (DFSP) of the breast is an infrequent soft tissue sarcoma that usually affects young to middle-aged women. Our case report describes a unique occurrence of DFSP of the breast in an adolescent girl, which was initially being managed as a keloid for 2 years under dermatology despite being refractory to treatment. Once the diagnosis of DFSP was confirmed through punch biopsy
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Transient severe haemodynamic disturbance during radical nephrectomy: a probable catecholamine surge BMJ Case Rep. Pub Date : 2024-04-01 Sripriya Ramalingam, Parthasarathy Srinivasan
Catecholamine surge and haemodynamic derangements are normally expected during the surgery for pheochromocytoma and benign functioning adrenal tumours. This male patient in his 50s underwent radical nephrectomy for renal cell carcinoma. The patient had no comorbidities. Three hours into the surgery, during electrocauterisation of the upper pole of the kidney, the patient’s blood pressure unexpectedly
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Tattoo-associated sarcoidosis with hepatic and ophthalmic involvement BMJ Case Rep. Pub Date : 2024-04-01 Maya Thrasher, Hannah Blaikie, Alex Thompson, Barbara Demediuk
A woman in her 20s presented to an eye hospital with a 3-month history of eye redness, pain and blurred vision ([figure 1][1]). During this time, her tattoos (the first of which had been done 7 years earlier and the last of which had been done 8 months earlier) had become itchy and indurated ([
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Percutaneous biliary stent removal for benign biliary stricture post hepaticojejunostomy BMJ Case Rep. Pub Date : 2024-04-01 Arsalan Nadeem, Aliaksei Salei
This case report presents the percutaneous extraction of a biliary stent in a patient with a history of liver transplant and Whipple procedure, suffering from benign biliary stricture post hepaticojejunostomy. After failed management with conventional benign biliary protocol, a fully covered WallFlex biliary stent was percutaneously placed and later removed using a balloon catheter technique. The procedure
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Vertebral artery dissection as the underlying cause of ventral spinal epidural haematoma BMJ Case Rep. Pub Date : 2024-04-01 Joana Tavares, Inês Freire, Cristina Branco, Ana Luís
Spontaneous spine epidural haematoma is a rare occurrence, with an incidence of 0.1/100 000 inhabitants/year. The anterior location of the haematoma is very uncommon since the dural sac is firmly attached to the posterior longitudinal ligament. Vertebral artery dissection as its underlying cause is an exceptionally rare event, with only two documented cases. This article presents the case of young
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Wasp sting-induced bilateral thalamic and midbrain infarction BMJ Case Rep. Pub Date : 2024-04-01 Megha Priyadarshi, Ranveer Singh Jadon, Naval Kishore Vikram, Stanzin Spalkit
A male patient in his early 40s presented to the emergency department with an acute onset of respiratory distress and facial oedema, indicative of anaphylaxis. These symptoms emerged 2 hours subsequent to a wasp sting on the left side of his face. Despite initial stabilisation, the patient’s state deteriorated into somnolence and disorientation. Notably, he denied any history of seizures, sensory or
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Acute primary CMV infection complicated by pneumonitis and ITP in young immunocompetent woman in a regional Queensland Hospital BMJ Case Rep. Pub Date : 2024-04-01 Emma Roberts, Wei Yao Ng, Maduka Sanjeewa, Janath De Silva
We present the first published case of simultaneous pneumonitis and immune thrombocytopenic purpura secondary to primary cytomegalovirus (CMV) infection in an immunocompetent patient. Treatment with oral valganciclovir for 2 weeks successfully led to complete clinical recovery. CMV is traditionally associated with infection in immunocompromised patients and neonates; however, evidence of severe CMV
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Tracheal Schwannoma Presenting as Subcutaneous Emphysema and Pneumomediastinum BMJ Case Rep. Pub Date : 2024-04-01 Rayan Mohamad, Salwa A Koubaissi, Pierre Bou Khalil, Pierre Sfeir
Primary tracheal schwannomas are rare benign tumours. This is a case report, and therefore, no specific methods or results are applicable. We here report a case of a tracheal schwannoma in an early adolescent girl presenting with subcutaneous emphysema and symptoms of airway obstruction. Tracheal resection and reconstruction by primary anastomosis were performed. Pathology confirmed the diagnosis of
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Severe DRESS with myocarditis secondary to naproxen/esomeprazole BMJ Case Rep. Pub Date : 2024-04-01 Sarah O'Mahony, Ann-Marie Tobin, Teresa Mary Donnelly
A man in his 60s presented with a widespread erythematous rash and associated chills, paraesthesia and haematuria. He had recently commenced naproxen/esomeprazole. Blood tests showed hypereosinophilia (0.73×109/L) and moderate acute kidney injury. Histology revealed parakeratosis, mild spongiosis with eosinophils. He developed acute coronary syndrome with rapid atrial fibrillation. Coronary angiogram
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Total pancreatectomy, splenectomy and remnant gastrectomy for invasive intraductal papillary mucinous neoplasm (IPMN) after prior Roux-en-Y gastric bypass BMJ Case Rep. Pub Date : 2024-04-01 Joanna T Buchheit, Isha Joshi, Matthew E Dixon, June S Peng
A female patient in her 50s presented with abdominal pain, nausea and jaundice. She had a history of prior Roux-en-Y gastric bypass and her body mass index was 52.5 kg/m2. Biochemical testing revealed a total bilirubin level of 14.3 mg/dL (normal<1.2 mg/dL) and carbohydrate antigen 19–9 of 38.3 units/mL (normal<36.0 units/mL). CT demonstrated a 3.2 cm pancreatic head mass, biliary and pancreatic duct
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Spontaneous branch retinal artery occlusion secondary to a retinal arterial macroaneurysm BMJ Case Rep. Pub Date : 2024-04-01 Alan Baltazar Treviño-Herrera, Vishakh Padmakumar, Bhavik Panchal, Avinash Pathengay
A man in his late 70s presented with a sudden-onset, painless, diminution of vision lasting 5 hours. The best-corrected visual acuity (BCVA) in both eyes was 20/20. Slit lamp biomicroscopy showed intraocular lenses in both eyes with the remainder of the anterior segment being unremarkable
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Ocular manifestations suggest osteogenesis imperfecta in a previously undiagnosed adult following polytrauma BMJ Case Rep. Pub Date : 2024-04-01 Christopher P Bunting, James F Green
A man in his 40s was brought to a major trauma centre by ambulance after falling 2 m from scaffolding and sustaining several bony injuries. On primary survey, he had a clinical left-sided flail segment (broken ribs disconnected from the thoracic cage due to fractures in two or more places),
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Metastatic mediastinal hepatoid adenocarcinoma BMJ Case Rep. Pub Date : 2024-04-01 Gayle Caruana, Robert Cachia, Sara Micallef, Matthew Sammut, Josephine Psaila
Hepatoid adenocarcinoma (HAC) of the mediastinum is a rare extrahepatic tumour that pathologically and morphologically resembles hepatocellular carcinoma. Extrahepatic HACs primarily occur in the stomach, ovaries, lung, gallbladder, pancreas and uterus. Patients with mediastinal HAC tend to be male smokers over forty years of age. Clinical symptoms of HAC are non-specific and varied in nature; therefore
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Weight loss with GLP-1 analogues in preparation for transplantation BMJ Case Rep. Pub Date : 2024-04-01 Marissa O'Callaghan, Carel Le Roux, Aurelie Fabre, Cormac McCarthy
This case describes a woman in her 20s with a 6-month history of progressive exertional dyspnoea and cough. Examination revealed hypoxia on room air, sinus tachycardia, finger clubbing and bibasal inspiratory crackles. Inflammatory markers were mildly elevated and empirical antimicrobial therapy was commenced. A multidisciplinary discussion consensus diagnosis of acute interstitial pneumonitis was
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Reactive perforating collagenosis: dermoscopic aspects and differential diagnosis BMJ Case Rep. Pub Date : 2024-04-01 Keshavmurthy A Adya, Arun Inamadar
Reactive perforating collagenosis (RPC) is a chronic remitting and relapsing disorder among the primary perforating dermatoses that is clinically characterised by keratotic papules and nodules and histologically by transepidermal elimination of altered dermal elements. Dermoscopic features of RPC
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Role of physical therapy intervention in acute disseminated encephalomyelitis BMJ Case Rep. Pub Date : 2024-04-01 Sanjay Tejraj Parmar, Charulata Deshpande, Dipti Sambhajirao Kadam
We reported a case of a school-going child, diagnosed with acute disseminated encephalomyelitis (ADEM) who presented with symptoms such as high fever, acute hemiplegia and ataxia and was referred for physiotherapeutic intervention. This case report aims to document the assessment and management of ADEM from the intensive care unit to the home setting by physical therapy. Also, the child developed
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Synchronous subarachnoid haemorrhage and ischaemic stroke as a result of complete internal carotid artery occlusion BMJ Case Rep. Pub Date : 2024-04-01 Aysha Gomaa, Chemindra Biyanwila, Mansi Jantre
A previously healthy man in his 60s presents with a one-day history of insidious onset headache and ‘walking into doors’. He reported transient right arm pain and tingling but no weakness. A CT brain showed a right middle cerebral artery (MCA) infarct as well as a synchronous right frontal lobe convexal subarachnoid haemorrhage (cSAH). An arch to vertex CT angiogram demonstrated right MCA occlusion
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Gastric emphysema with massive hepatic portal venous gas BMJ Case Rep. Pub Date : 2024-04-01 Tomiharu Niida, Mitsuhiro Takeuchi, Kosuke Kataoka, Kikuo Isoda
A woman in her 70s who had been admitted to our hospital for the treatment of heart failure vomited severely. CT of the abdomen ([figure 1][1]: axial image (left) and coronal image (right)) demonstrated massive hepatic portal venous gas (HPVG) and air scattered within the gastric wall (arrows). On
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Encountering the corona mortis vessel during laparoscopic totally extraperitoneal mesh hernioplasty and its significance BMJ Case Rep. Pub Date : 2024-04-01 Vikram Saini, Sonali Alla, Himanshi Verma, Umesh Chhabra
Corona mortis (CM) is an anastomotic vessel between the inferior epigastric or external iliac vessels and the obturator or internal iliac vessels. The Latin meaning of it is ‘crown of death’ which corresponds to massive haemorrhage caused by injury to this vessel during surgery. The incidence of this vessel is around 50% in the hemipelvis. We are presenting an intraoperative video of a right laparoscopic
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The use of rotational thromboelastometry to guide management following Bitis nasicornis envenoming BMJ Case Rep. Pub Date : 2024-04-01 Charles Nye, David Griffith Lalloo, Timothy Hooper
A man in his thirties presented following Bitis nasicornis envenoming. His coagulation was assessed using rotational thromboelastometry (ROTEM). It identified a subtle abnormality, not detected using standard laboratory assessments of coagulation, and influenced ongoing management. The abnormality resolved following treatment with antivenom. There are few documented cases of using ROTEM to assess patients
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Denosumab and sclerotherapy for recurrent spinal aneurysmal bone cyst in a child BMJ Case Rep. Pub Date : 2024-04-01 Raj Singh, Sreekumar Madasswery, Matt Colman, Paul McKeegan Kent
Aneurysmal bone cyst (ABC) is a non-malignant, locally destructive, blood-filled lesion in the bone that tends to grow aggressively. A young girl presented with a rapid recurrence after aggressive surgery of a large symptomatic sacral-spinal ABC. After a multidisciplinary tumour board, she was successfully treated with sclerotherapy and monthly intravenous denosumab. The patient has maintained asymptomatic
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Scalp necrosis following preoperative endovascular embolisation of the superficial temporal artery for meningioma BMJ Case Rep. Pub Date : 2024-04-01 Harsimran Panesar, Mai Hatazaki, Yevgenia Shekhtman
A woman in her late 50s with a left frontal lobe convexity meningioma underwent an elective endovascular embolisation of the left middle meningeal artery and distal branches of the left superficial temporal artery prior to surgical resection of the tumour. On postoperative day 46, she developed scalp necrosis, leading to poor wound healing requiring wound debridement and a complex plastic surgery reconstruction
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Case of subconjunctival dirofilariasis BMJ Case Rep. Pub Date : 2024-04-01 Khushi Sunil, Teena Mariet Mendonca, Anooja Sasikumar, Rajesh Nayak
A woman in her third decade presented to the ophthalmology clinic with redness, pain and foreign body sensation in the left eye for 1 day. There was no history of trauma or foreign body deposition in the eye, fever, sore throat, recent travel or contact with pet animals. On examination, her visual
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Spontaneous bowel evisceration through umbilical hernia in an adult non-cirrhotic patient BMJ Case Rep. Pub Date : 2024-04-01 Niccolo Grappolini, Matteo Zanchetta, Davide Inversini, Giuseppe Ietto
Few cases of spontaneous bowel evisceration (SBE) through umbilical hernias (UHs) in adult patients have been reported in the literature. Interestingly, the spontaneous rupture of the hernia sac is a rare complication usually seen in adult cirrhotic patients with persistent ascites or in patients with congenital wall defects. A man in his early 50s was admitted to our emergency department with SBE
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Listeriosis in pregnancy: a challenge in diagnosis BMJ Case Rep. Pub Date : 2024-04-01 Nurul Iftida Basri
Listeriosis is a rare foodborne infection caused by Listeria monocytogenes . It has been reported to be commonly found among the obstetric population, immunocompromised group and elderly, presumably due to the lower immunity status in these populations. Presentation in pregnancy is usually non-specific like fever, diarrhoea, respiratory tract symptoms and preterm rupture of membrane. These make the
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Non-tuberculous mycobacterial pulmonary infection presenting in a patient with unilateral pulmonary artery agenesis BMJ Case Rep. Pub Date : 2024-04-01 Seemab Paul, Andrew MacNair, Vasileios Lostarakos, Richard Capstick
People who have structural or developmental lung disease are more likely to develop non-tuberculous mycobacterial infections. We present the case of a young man in his 30s who had unilateral pulmonary artery agenesis on the right side and presented with a 6-month history of productive cough and fever. His CT scan showed nodular and cavitating lesions on the right side, and sputum analysis confirmed
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Atypical chest pain and haemoptysis as the initial presentation of spindle rhabdomyosarcoma in elderly smoker man BMJ Case Rep. Pub Date : 2024-04-01 Diego Bernal, Kenneth Nugent, Mahmoud Abdelnabi
A man in his 60s who used to smoke at least one pack a day for at least 40 years with no significant medical history presented a several-week history of intermittent haemoptysis and severe sharp chest pain worsened by cough and inspiration. His physical examination was significant for left chest
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Alarming medication error with prostaglandin E1 (PGE1) in a term neonate with critical congenital heart disease BMJ Case Rep. Pub Date : 2024-04-01 Saikat Patra, Prachi Patwal, Chinmay Chetan, Girish Gupta
An outborn full-term female newborn with birth weight 2.45 kg was admitted to our centre at 24 hours of life with respiratory distress and cyanosis. The baby had tachycardia and oxygen saturation (SpO2) 40% at admission to neonatal intensive care unit (NICU). She was mechanically ventilated on