BMJ Case Reports最新文献

We report a term baby who presented soon after delivery with bilateral tender scrotal swelling with skin discolouration, which was subsequently diagnosed as rapidly progressive cellulitis. The scrotal swelling was treated as cellulitis with a broad spectrum of antibiotics, covering anaerobes, considering the absence of signs and ultrasonographic features of testicular torsion. He also had meconium aspiration pneumonia, complicated by pulmonary hypertension, and required non-invasive oxygen supplementation and intravenous antibiotics. The swelling slowly improved over 2 weeks without complications. In conclusion, early diagnosis and proper antibiotic treatment are essential to prevent the spread of infection and serious complications. .

A woman in her late 40s presented with a cystic lesion in the left lacrimal gland for 1 year and associated pain in the past 3 months. On examination, the patient had cystic lesion in the left lacrimal gland region without any signs of inflammation. An initial provisional diagnosis of simple dacryops of the left eye was made, and the lesion was observed. On review at 1 month, the patient complained of persistent swelling and dull pain in the left eye. Excisional biopsy of the lesion was planned. Intraoperatively, the cyst ruptured during surgery, and yellowish, granule-like concretions were noted within the cyst. The cyst wall along with contents was excised and sent for histopathological examination and microbiology analysis. Microbiological analysis revealed fungal filaments (Aspergillus fumigatus). Histopathological examination confirmed cyst wall with fungal colonies. Postoperatively, the patient is doing well without any evidence of recurrence at a follow-up period of 6 months.

A male patient with pectus carinatum and spine scoliosis deformity presented with a 7-day history of recurrent episodes of nausea, vomiting and abdominal distention. He reported a weight loss of about 10 kg in the last 6 months and an altered eating habit. The contrast-enhanced CT of the abdomen revealed a significant compression of the third part of the duodenum, reduced the aortomesenteric distance and left renal vein compression between the abdominal aorta and superior mesenteric artery. A diagnosis of superior mesenteric artery syndrome with nutcracker syndrome was made. The patient's symptoms persisted on conservative management, and surgical correction was planned where a side-to-side anastomosis of the second part of the duodenum and jejunum was performed. The nutcracker syndrome was managed conservatively with ongoing surveillance. The patient did well postoperatively and was discharged without any complications. Until 4 months of follow-up, his weight improved, and urine examination did not show haematuria.

Herpes simplex virus (HSV) is a double-stranded DNA virus, whose primary target is epithelial cells. It is disseminated by hematogenous spread. HSV type 2 (HSV-2) usually causes genital infection with mucocutaneous lesions or it may be asymptomatic. HSV-2 is also an important cause of meningitis either during primary infection or by (recurrent) reactivation of dormant virus within the central nervous system. The authors present the case of a nulliparous woman in her mid-20s presenting to the emergency department at 22 weeks' gestation with acute onset of headache. CT of the head and magnetic resonance angiography (MRA) were unremarkable. She received broad-spectrum antimicrobial therapy for suspected meningitis. Her cerebrospinal fluid culture detected HSV-2. She denied a history of oral or genital herpes. She commenced treatment with intravenous acyclovir 10 mg/kg 8 hourly for 7 days. She responded clinically and her headache resolved. There remains a relative dearth of cases of HSV-2 meningitis reported in the literature hence making pregnancy management and delivery planning challenging for obstetricians. This case demonstrates the importance of the multidisciplinary team involvement of genitourinary medicine and sexual health physicians, obstetricians and neonatologists with formal documentation of a birth and postnatal care plan.

Combination targeted therapy with vemurafenib and cobimetinib has proved effective for metastatic melanoma. However, severe cutaneous adverse reactions have been reported, most frequently not only drug rash with eosinophilia and systemic syndrome but also rare Stevens-Johnson syndrome and toxic epidermal necrolysis (TEN) cases. We report a case of life-threatening episode of TEN following metastatic melanoma targeted therapy with vemurafenib and cobimetinib, with a long but successful patient recovery.

Macroamylasaemia (MA) is a biochemical disorder characterised by elevated serum amylase activity, resulting from the circulation of a macromolecular complex of amylase bound to a serum component, often an immunoglobulin. The increased molecular weight of this complex prevents the normal renal excretion of the enzyme. A few cases of adult patients with coeliac disease (CD) and MA have been reported, in which the biochemical disorder resolved after treatment with a gluten-free diet. However, in other cases, this resolution did not occur. Here, we report a case of CD masquerading as recurrent pancreatitis due to the presence of MA.

Fetus in fetu (FIF) is a rare anomaly of embryogenesis in which a malformed parasitic twin is found within the body of the normally developed host twin. It has a reported incidence of 1 per 500 000 births with a 2:1 male predominance. The authors present a unique case of FIF, where autopsy investigation played a pivotal role in identifying this exceptionally rare anomaly, rarely documented in the literature. A primigravida woman in her early 20s was diagnosed with FIF at 13+3 weeks of gestation. She opted for medical termination of her pregnancy. The postmortem examination confirmed the diagnosis of FIF. Malformations in both fetuses, namely, partial urorectal septum malformation in the parasitic twin and heterotaxy syndrome in the host twin, were unmasked by fetal autopsy.The significance of autopsy examination in FIF cases is underscored by our case, as it facilitates the diagnosis of this rare entity and the reporting of congenital anomalies in the aforementioned.

One of the extremely rare locations for an ectopic pregnancy is myometrium. Intramyometrial ectopic pregnancy is characterised by an unusual form of implantation wherein the gestational sac is situated deep in the myometrium, separated from the endometrial cavity and fallopian tubes. It accounts for <1% of all ectopic pregnancies. The preoperative diagnosis based on ultrasound findings may mimic a degenerated leiomyoma, thereby posing further diagnostic challenges. We report a case of a woman in her late 20s presenting with abnormal uterine bleeding diagnosed ultrasonographically as posterior wall fibroid. Histopathological evaluation of the myomectomy specimen revealed chorionic villi lined by trophoblastic cells, thereby confirming the diagnosis. This case report aims to increase the awareness about the possibility of this potentially life-threatening rare entity even with normal serum beta-human chorionic gonadotropin levels.

A woman in her 70s with a past history of breast cancer in remission presented with several months of dyspnoea, skin tightness and Raynaud's phenomenon. Physical examination was significant for hypertension, hypoxaemia, sclerodactyly, diffuse crackles on auscultation and mild respiratory distress. Work-up revealed elevated serum creatinine, elevated right ventricular systolic pressure on echocardiography and nuclear bone scan findings of osseous metastatic disease. Captopril was initiated with concern for scleroderma renal crisis. The scleroderma panel was positive for RNA polymerase 11 and 155. Vertebral biopsy was diagnostic of recurrent breast cancer. Through multidisciplinary discussion, rituximab was initiated, and malignancy treatment was deferred; however, the patient developed several complications and ultimately elected to pursue inpatient hospice. In the setting of recurrent breast cancer, this case is suggestive of paraneoplastic scleroderma. The presence of underlying malignancy is an important consideration in new cases of scleroderma, and multidisciplinary management is key to determining treatment preference.

Acute generalised exanthematous pustulosis (AGEP) is a rare cutaneous adverse reaction which is caused due to drugs or other triggers in children. We report a very rare case of AGEP after introduction of oral cefixime for a female child who presented with complaints of fever, cough and cold for 6 days. It was noted that she developed a rash over the face within 24 hours and within the following few hours, it spread over the neck, in the axilla and over the groin. The patient has no history of allergy and had no history of similar reaction in the past. On examination, the patient was vitally stable with no sign of shock or any other significant systemic findings. The rash was characterised by erythematous base with multiple pinpoint pustules and culture of those was sterile. Haemogram was suggestive of mild leucocytosis with normal liver and renal functions. Treatment included stopping the triggering medication, that is, syrup cefixime and starting the child on oral corticosteroids along with antihistamines. The child started improving within 48 hours of medication, and rashes recovered with desquamation. AGEP is an adverse reaction which is rarely noted in children. It is treated with oral corticosteroids and supportive care of the local lesions.