Quetiapine-induced hypokalemic periodic paralysis (QIHPP) is a rare condition. Herein, we present the case of a 31-year-old pregnant Malay woman diagnosed with bipolar II disorder and QIHPP. She presented to the casualty department with a 2-day history of bilateral lower limb weakness and numbness. Her renal function tests showed moderate hypokalemia (2.5 mmol/L), whereas other investigations were normal. Quetiapine was suspected to be the cause, prompting a psychiatric referral to manage her acute condition. Balancing the risks of untreated QIHPP against the potential relapse of bipolar symptoms from quetiapine discontinuation or dosage reduction poses a significant treatment challenge for pregnant women with QIHPP. Finally, we reduced the quetiapine dosage after careful consideration, leading to the normalization of potassium levels and symptom resolution. Therefore, clinicians should be aware of this side effect when initiating or continuing quetiapine treatment in women of childbearing age or pregnant women with psychiatric disorders. It is crucial to monitor serum electrolytes, especially potassium, following quetiapine administration and warn patients about its potential side effects.

Hemicrania continua (HC) is an indomethacin-responsive headache, characterized by unilateral and continuous headaches with cranial autonomic symptoms. Various pathologies, including sinus-related conditions, are associated with HC. Here, we report the case of a 62-year-old man with HC and rhinosinusitis. The patient complained of a unilateral continuous headache with ipsilateral cranial autonomic symptoms, conjunctival injection, and eyelid edema for 20 months. HC was identified as a potential diagnosis based on the symptom criteria, and a response to indomethacin confirmed the diagnosis. Trigeminal autonomic cephalalgia should be considered in patients with unilateral headaches and cranial autonomic symptoms.

We report a rare case of high-volume training-related myopericarditis. A male, 18 years old, elite road bicycle racing cyclist with high-volume training of 1,000 km per week for >7 years, presented with progressively worsening exertional breathlessness, reduced effort tolerance, and one episode of cardiac syncope. The symptoms were present prior to the coronavirus disease 2019 pandemic but made worse with the sudden increase in the volume of training after lockdown periods in preparation for competition. He exhibited multiple premature ventricular ectopic beats during his resting electrocardiogram, with a normal echocardiogram and non-elevated cardiac enzyme. The exercise stress test revealed similar multiple premature ventricular beats, warranting further investigation using cardiac magnetic resonance imaging (MRI). The findings of the cardiac MRI were suggestive of myopericarditis. He was instructed to refrain from training and initially started with a short course of colchicine. However, his symptoms deteriorated, and cardiac MRI revealed a decrease in the left ventricular ejection fraction from 59% to 50%. His treatment was escalated to a short course of tapered dose steroid, anti-failure medication and gradual, supervised, return to sports program. This case report highlights the discussion of return to play in athletes with myopericarditis.

The simultaneous development of diabetic ketoacidosis (DKA) and thyroid storm (TS) is a rare but potentially lifethreatening condition that requires immediate and targeted treatment. However, their combined diagnosis poses a serious challenge because of the similarities between their clinical manifestations. To date, only a few dozen cases have been described; most of which have been linked to the progression of thyrotoxicosis or uncontrolled hyperglycemia as contributing factors. We present the case of a 37-year-old woman with type 1 diabetes mellitus and Graves’ disease who presented with both TS and DKA. She was initially admitted to the emergency department as a suspected case of stroke. Severe hypoglycemia significantly lowered her alertness to TS and probably provoked a sharp hyperthyroid decompensation, thereby leading to subsequent DKA development.

Macroamylasemia is a rare condition characterized by the formation of an amylase–globulin complex that is too large to be readily excreted by the kidneys and leads to elevated serum amylase levels. It is a benign condition lacking severe signs and symptoms that does not require treatment. This paper presents a case of a middle-aged man with unexplained elevated serum amylase levels. Despite an initially elevated triglyceride level, clinical findings, laboratory test results, and radiological findings were not suggestive of pancreatitis. The ratio of renal amylase clearance to creatinine clearance was calculated at <1%, consistent with macroamylasemia. No specific treatment was given, and he was monitored periodically. Nevertheless, macroamylasemia is a diagnostic challenge because of the need to differentiate it from other causes of hyperamylasemia to avoid unnecessary tests and treatments.

Citations

• Macroamylasemia versus Hyperamylasemia
  Vitorino Modesto dos Santos, Lister Arruda Modesto dos Santos, Taciana Arruda Modesto Sugai
  Korean Journal of Family Medicine.2024; 45(4): 233.     CrossRef

Post-traumatic fibro-osseous lesions (PTFOL) are a rare and benign tumor that typically affects the ribs and is probably caused by an excessive post-traumatic reactive process. PTFOL primarily affects the sixth, seventh, and eighth ribs. Here, we report a case of a PTFOL with an unusual location and expansion that simulated a malignant chest tumor. A 28-year-old male patient with a history of minor chest trauma presented with pain. Chest radiography revealed a large, well-defined lesion on the left fourth rib, and computed tomography (CT) of the chest revealed a lytic lesion-type IC on the posterior and middle arches of the left fourth rib with a cartilaginous matrix and discontinued periosteal reaction without soft tissue mass extension. Additionally, magnetic resonance imaging of the chest revealed an ovoid, expansive mass with cystic lobules and lobulated contours extending almost over the entire left fourth rib, measuring 134×47 mm in size. This mass has a low signal on T1-weighted images and a heterogeneous intermediate signal on T2-weighted images, with intense enhancement after gadolinium injection suggestive of a malignant chest tumor. A CT-guided bone biopsy confirmed the presence of an intramedullary lesion consisting of fibrous connective tissue with fusiform fibroblastic cells without atypical signs. The lesion was delimited by bone trabeculae with nibbled edges, indicating exaggerated osteoclastic activity compatible with a diagnosis of PTFOL. The patient was treated with simple analgesics, and chest pain was relieved, with an unchanged volume of the lesion at 1 year of follow-up.

Herein, we report a rare case of Tolosa-Hunt syndrome (THS) following coronavirus disease 2019 (COVID-19) vaccine administration. A 64-year-old patient presented with recurrent horizontal diplopia and ipsilateral orbital pain, 2 weeks after being administered the COVID-19 vaccination. A diagnosis of THS was based on the relevant criteria after ruling out the differential diagnoses. The clinical presentation improved with corticosteroid administration. THS must be recognized as a complication of COVID-19 vaccination. This association can be explained by an autoimmune response.

Acute pancreatitis is a sudden inflammation affecting the exocrine region of the pancreatic parenchyma. Infectious etiologies are rare. Here we report an exceptional case of a 44-year-old woman from a rural area who was referred to our hospital with fever and abdominal pain. A physical examination revealed pale skin and epigastric tenderness. Thoracoabdominal computed tomography revealed a Balthazar score of D. Serum laboratory findings revealed hemolytic anemia, hepatic cytolysis, and high C-reactive protein level. Calcium and lipase levels were normal. There was no history of recent trauma, alcohol consumption, or drug intoxication. The diagnosis of “query” pancreatitis was confirmed by serological Coxiella burnetii positivity. Oral doxycycline 200 mg daily was initiated. The clinical evolution was favorable. To our knowledge, no association between acute pancreatitis and hemolytic anemia caused by C. burnetii was reported previously. Q fever must be considered in cases of acute pancreatitis, especially when the patient is from a rural area or has a high-risk profession.

Phytophotodermatitis, a cutaneous reaction caused by direct contact with photosensitive substances in plants and subsequent exposure to ultraviolet light, is commonly caused by psoralens in plants, including citrus fruits. We describe a case of phytophotodermatitis caused by a hand sanitizer containing a blood orange (Citrus sinensis) extract. To our knowledge, this is the first reported case of phytophotodermatitis caused by a hand sanitizer. A 41-year-old woman presented with a 2-week history of pruritic cutaneous eruptions on her right thigh. Approximately 24 hours prior to the onset of her symptoms, she applied a new citrus-based hand sanitizer. Immediately after applying the hand sanitizer, her right thigh was exposed to sunlight for approximately 5 hours. Extracts from oranges are used in many cosmetics, including perfumes and fragrances. With the increased use of hand sanitizers during the coronavirus disease 2019 pandemic, physicians should note that phytophotodermatitis due to scented hand sanitizers may occur more frequently.

Citations

• New Insights Concerning Phytophotodermatitis Induced by Phototoxic Plants
  Cristina Grosu (Dumitrescu), Alex-Robert Jîjie, Horaţiu Manea, Elena-Alina Moacă, Andrada Iftode, Daliana Minda, Raul Chioibaş, Cristina-Adriana Dehelean, Cristian Vlad
  Life.2024; 14(8): 1019.     CrossRef
• Significance of Singlet Oxygen Molecule in Pathologies
  Kazutoshi Murotomi, Aya Umeno, Mototada Shichiri, Masaki Tanito, Yasukazu Yoshida
  International Journal of Molecular Sciences.2023; 24(3): 2739.     CrossRef
• Impacts of hand sanitizer on human health and environment: a review
  Shashi Bala , Faheem Ahamad
  Environment Conservation Journal.2023; 24(2): 413.     CrossRef

Systemic lupus erythematosus (SLE) is a connective tissue disease of unknown etiology that predominantly affects women of childbearing age. We report a case of male systemic lupus erythematous with antinuclear antibodies and typical clinical presentations of multiple skin lesions, polyarticular joint pain, fatigue, anorexia, and hair loss. Full evaluations were used to establish a diagnosis of SLE. The lower prevalence of SLE among males and antinuclear antibody-negative patients poses a great challenge for diagnosis. Therefore, as primary care doctors, we need to have a high suspicion of systemic lupus erythematous even in male and antinuclear antibody-negative patients. Thus, early treatment may help patients improve their quality of life.

Citations

• Diagnostic Dilemma of ANA-negative Pediatric Systemic Lupus Erythematosus in a South Asian Female
  Qaisar Ali Khan, Tehmina khan, Parsa Abdi, Christopher Farkouh, Michelle Anthony, Faiza Amatul Hadi, Sumaira Iram
  Clinical Medicine Insights: Case Reports.2023;[Epub]     CrossRef
• Unusual presentation of systemic lupus erythematosus in a male child: a case presentation
  Khyati Gupta, Vishal Dnyaneshwar Sawant, Sushma Save
  Egyptian Pediatric Association Gazette.2023;[Epub]     CrossRef

Spinal epidural abscess (SEA) caused by Escherichia coli is an uncommon condition. It usually occurs secondary to urinary tract infection (UTI), following hematogenous propagation. Disruption of spinal anatomic barriers increases susceptibility to SEA. Although rarely, such disruption can take the form of lumbar spine stress fractures, which can result from even innocuous activity. Here, we describe a case of SEA secondary to UTI in a patient with pre-existing stress fractures of the lumbar spine, following use of an automated massage chair. Successful treatment of SEA consisted of surgical debridement and a six-month course of antibiotic therapy.

Citations

• Acute Paraplegia Caused by Spinal Epidural Empyema Following Infectious Cellulitis of the Hand: Case Report and Literature Review
  Breno Nery, Cláudio Brandão Filho, Lucas Nunes, Eduardo Quaggio, Fred Bernardes Filho, Joaquim Alencar Neto, Layssa Rhossana Melo, Anna Carolyne Oliveira, Rafael Rabello, Victoria Rodrigues Durand, Rayssa Rocha Silva, Rafael Emmanuel Costa, José Alencar S
  Journal of Neurological Surgery Reports.2024; 85(02): e29.     CrossRef

Kidney matrix stones are a rare form of calculi, which are challenging to diagnose. Matrix stones consist of a proteinaceous material which has a radiolucent appearance that might be overlooked on imaging. Recently, endourological intervention has been the standard treatment method for matrix stones. We report a case of urinary matrix stones in a patient with type 1 diabetes mellitus and chronic kidney disease, in whom the stones formed into a pure matrix and were not visualized in the computed tomography scan. The stones were found after additional work-up, and they were managed using a transureteral stone basket, not through endourological intervention.

Citations

• Analysis, treatment modality and demographic characteristics of urolithiasis patients visiting Korle-Bu Teaching Hospital in Ghana
  Evans Ametefe Akpakli, Emmanuel Asante, Matthew Yamoah Kyei, Kenneth Klufio, Bernard Toboh, James Edward Mensah
  Journal of West African College of Surgeons.2024; 14(1): 94.     CrossRef

We report the first case of hypoglycemia and lactic acidosis caused by the therapeutic doses of venlafaxine. A 19-year-old female patient had presyncope and she was taking venlafaxine 75 mg once a day because of major depression for a week and she had no history of any other drug use or disease. The blood gas analysis revealed hypoglycemia and lactic acidosis. Patient was treated with dextrose infusion and oral diet. Although hypoglycemia and lactic acidosis have been reported in overdose of venlafaxine in the literature, these effects were observed in therapeutic doses.

Citations

• Venlafaxine-induced serotonin syndrome causing bilateral cerebral strokes: a case report
  Nils Mein, Khadija Mammadli, Felix Luessi, Timo Uphaus
  Frontiers in Stroke.2025;[Epub]     CrossRef
• Seizure, Rhabdomyolysis, and Hypoglycemia in a Patient With Venlafaxine Poisoning
  Akif Yarkaç, Çağri Safa Buyurgan, Ataman Köse, Seyran Bozkurt Babuş
  Journal of Clinical Psychopharmacology.2023; 43(6): 546.     CrossRef
• Dose-related hypoglycemia in venlafaxine poisoning: a retrospective cohort study
  Elias Bekka, Florian Eyer
  Clinical Toxicology.2022; 60(12): 1336.     CrossRef
• Venlafaxine
  
  Reactions Weekly.2021; 1885(1): 501.     CrossRef

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The world is currently challenged to handle this pandemic. The common symptoms of COVID-19 are fever, cough, fatigue, and shortness of breath. There are few reports on the association of SARS-CoV-2 with ocular abnormalities including conjunctivitis. We report a case of a 54-year-old woman who presented solely with conjunctivitis subsequently diagnosed with COVID-19. A lack of full history of her travel abroad was another issue leading to a delay in evaluating her COVID-19 status that increased the infection risk to her managing team. Thus, primary care practitioners should be suspicious of this atypical feature of COVID-19, thus enabling us to identify such patients at entry points. Maintaining safety measures while managing patients is also crucial.

Citations

• Prevalence of SARS-CoV-2 in Conjunctival Swab Samples Among Patients Presenting with Conjunctivitis During the COVID-19 Pandemic
  Sezen Karakus, James Foster, Xi Dai, Anthony Gonzales, Xi Zhu, Charles Eberhart, William Hsu
  Clinical Ophthalmology.2022; Volume 16: 127.     CrossRef
• COVID-19 and the Eye: A Comprehensive Review of the Literature
  Yilin Feng, Stephen T. Armenti, Shahzad I. Mian
  International Ophthalmology Clinics.2021; 61(1): 1.     CrossRef
• A Year of Living Dangerously: Challenges and Recommendations for Safely Performing Ophthalmic Surgery During the COVID-19 Pandemic, from Start to Finish
  Juan Pablo Salica, Constanza Potilinski, Marcia Querci, Ignacio Navarro, Juan Sebastián Rivero, Pablo Daponte, Roberto Pineda ll, Juan E Gallo
  Clinical Ophthalmology.2021; Volume 15: 261.     CrossRef
• Evidence of SARS-CoV-2 Transmission Through the Ocular Route
  Jing-Yu Qu, Hua-Tao Xie, Ming-Chang Zhang
  Clinical Ophthalmology.2021; Volume 15: 687.     CrossRef
• Conjunctivitis as a Sentinel of SARS-CoV-2 Infection: a Need of Revision for Mild Symptoms
  Alexios A. Panoutsopoulos
  SN Comprehensive Clinical Medicine.2020; 2(7): 859.     CrossRef
• Are eyes the windows to COVID-19? Systematic review and meta-analysis
  Rina La Distia Nora, Ikhwanuliman Putera, Dhiya Farah Khalisha, Indah Septiana, Asri Salima Ridwan, Ratna Sitompul
  BMJ Open Ophthalmology.2020; 5(1): e000563.     CrossRef

Malignant otitis externa (MOE) is a rare and potentially life-threatening disease of the ear and temporal bone. Bilateral simultaneous MOE is extremely rare. Due to bilaterally symmetrical facial nerve palsy, it can easily be missed at the initial presentation, causing delay in management. Here, we report a case of bilateral MOE managed aggressively with regular ear toileting, ear packing with a ribbon gauze soaked with topical antimicrobials, and long-term intravenous and oral antibiotics. The patient showed good improvement in pain control, facial nerve status, and ear findings.

Citations

• External Auditory Canal Erosion at the 6 O’clock Spot
  Mounika Naidu Boya, Nicole Blumenstein, Miriam Redleaf
  Otology & Neurotology.2024; 45(8): e581.     CrossRef
• Imaging of Pathologies of the Temporal Bone and Middle Ear: Inflammatory Diseases, Their Mimics and Potential Complications—Pictorial Review
  Christopher Kloth, Annika Beck, Nico Sollmann, Meinrad Beer, Marius Horger, Wolfgang Maximilian Thaiss
  Tomography.2023; 9(6): 2190.     CrossRef

This case illustrates the medical complication of a child that arose as a consequence of parents with intellectual disabilities in a primary care setting. A 9-month-old girl presented with multiple admissions because of recurrent pneumonia and was later diagnosed with failure to thrive based on child neglect resulting from the parents’ disabilities. This exemplifies a failure to thrive case with a complex and undiagnosed psychosocial background that required interdepartmental involvement to mitigate the health problem.

“Rusty pipe syndrome” is a condition that needs to be considered in a primiparous woman who presents with bilateral bloody nipple discharge in the early postpartum period. Its prevalence is low and can occur due to physiological condition that arises primarily in primiparous women with increased alveolar and ductal vascularization associated with the onset of lactation. Here, we report a case of a 29-year-old primigravida who presented with bilateral painless bloody nipple discharge after delivery. Her breast examination showed no signs of infection or structural changes, and breast ultrasound did not reveal any significant observations except for a bilateral simple breast cyst. Six days after the onset of lactation, the bloody nipple discharge ceased and lactation continued on demand.

Citations

• Nursing care for women with rusty-pipe syndrome: About a case
  Lidia Sanz Durán
  Enfermería Clínica (English Edition).2023; 33(6): 438.     CrossRef
• Atención enfermera a la mujer con síndrome de tuberías oxidadas o rusty-pipe syndrome: a propósito de un caso
  Lidia Sanz Durán
  Enfermería Clínica.2023; 33(6): 438.     CrossRef
• Grossly Bloody Colostrum—The Need for Staff Education and Maternal Support
  Katarzyna Wszołek, Stanisław Przewoźny, Adrianna Nowek, Angelika Odor, Paulina Małyszka (Hoffmann), Marcin Przybylski, Jakub Żurawski, Małgorzata Pięt, Maciej Wilczak
  Journal of Clinical Medicine.2023; 12(23): 7326.     CrossRef
• Early recognition of rusty pipe syndrome to avoid disruption of breast feeding
  Jia Ming Low, Zubair Amin, Yvonne Peng Mei Ng
  Archives of Disease in Childhood - Fetal and Neonatal Edition.2022; 107(3): 241.     CrossRef
• Review of Rusty Pipe Syndrome with a Case Report
  Tolga Kalayci, Murat Kartal
  Indian Journal of Surgery.2022; 84(S3): 832.     CrossRef
• Rusty pipe syndrome: a case report and review of the literature
  Huanna Tang, Wenting Zhu, Jianpeng Chen, Dan Zhang
  BMC Pregnancy and Childbirth.2022;[Epub]     CrossRef

Primary cutaneous lymphomas are rare diseases among the general population, and even rarer in children. Mycosis fungoides (MF) is the most commonly diagnosed form in childhood. Several atypical clinical variants of MF have been reported, and pityriasis lichenoides-like MF (PL-like MF) is a recently described subtype. We report about a rare case of PL-like MF in an 11-year-old Malay boy with a 2-year history of multiple scaly erythematous papules associated with progressive and generalized hypopigmentation. This case report illustrates the significant dilemma in the diagnosis of the disease, particularly in the early stages, because its symptoms can mimic those of many common childhood inflammatory skin disorders. Later, the widespread hypopigmentation obscured the characteristic lesions, leading to misdiagnosis. Moreover, due to unfamiliarity of the disease, the diagnosis of PL-like MF was missed and delayed until only 2 years after the onset of the dermatosis. Therefore, primary care practitioners must have a high index of suspicion for this cutaneous neoplasm in children with persistent or worsening skin lesions, not responding to standard therapy, to ensure timely referral, diagnosis, and treatment.

Citations

• Febrile Ulceronecrotic Mucha-Habermann Disease Associated With Hemophagocytic Lymphohistiocytosis: A Case Report and Review of the Literature
  Caroline Chen, Lauren M. Fahmy, Celine M. Schreidah, Cynthia M. Magro, Larisa J. Geskin
  The American Journal of Dermatopathology.2024; 46(4): 238.     CrossRef
• Pityriasis Lichenoides-Like Mycosis Fungoides: A Case Report
  Lily Park, Claudia Green, Derrek M Giansiracusa, Penelope Hirt, Carlos Ricotti, Francisco Kerdel
  Cureus.2023;[Epub]     CrossRef
• Mycosis fungoides in pediatric population: comprehensive review on epidemiology, clinical presentation, and management
  Rohit Kothari, Jacek C. Szepietowski, Martine Bagot, Sunmeet Sandhu, Anant Patil, Stephan Grabbe, Mohamad Goldust
  International Journal of Dermatology.2022; 61(12): 1458.     CrossRef
• Pityriasis Lichenoides Chronica-like CD8-Positive Mycosis Fungoides
  Thilo Gambichler, Ekaterina Heinzer, Carlo Hendricks, Nicole Duschner, Stefanie Boms
  Dermato.2022; 2(4): 121.     CrossRef

Pancytopenia represents a unique challenge for primary care doctors and its etiological causes encompass various specialties, including hematology and rheumatology. Despite the existence of effective tests such as bone marrow biopsy and immunoassays to rule out the potential causes of pancytopenia, it is often difficult to pinpoint the exact diagnosis. In this case report, we have described such a ‘gray zone’ patient, who presented with pancytopenia, neutropenia, and splenomegaly, and was being treated for fungal pneumonia before being transferred to Severance Hospital (department of family medicine). As the patient had a 10-year history of multiple, long-term hospital admissions that were having a severely debilitating impact on the quality of life, we performed a partial splenic embolization as a potential cure for the symptoms. Although this induced acute blood count recovery, it failed to prevent eventual mortality from septic shock.

Lucio phenomenon is a potentially fatal leprosy reaction seen in pure, primitive, and diffuse form of lepromatous leprosy. It is a globally restricted phenomenon that occurs in Mexico and Costa Rica; however, sporadic cases have been reported elsewhere. We report a rare case of a 50-year-old Indonesian, who resided in Malaysia for the past 33 years, which presented with extensive ulcers on all four limbs for 3 weeks, as well as a 16-year history of skin changes and alopecia. Full evaluation established the diagnosis of lepromatous leprosy with Lucio phenomenon. Delay in diagnosis leads to significant disabilities and disease transmission within the community. Therefore, primary care practitioners, even in non-endemic countries, should be wary of this atypical feature of leprosy to prevent complications since it is a highly curable disease.

Citations

• Rare Variant of Leprosy Reaction (Lucio Phenomenon): A Case Series
  Luh Made Mas Rusyati, Herman Saputra, Made Sanitca Indah, Ni Kadek Setyawati
  The International Journal of Mycobacteriology.2024; 13(1): 105.     CrossRef
• Leprosy reactions: Unraveling immunological mechanisms underlying tissue damage in leprosy patients
  Héctor Serrano-Coll, Eric L Wan, Lina Restrepo-Rivera, Nora Cardona-Castro
  Pathogens and Disease.2024;[Epub]     CrossRef
• The economic burden of leprosy treatment to households in Ghana: A cross-sectional study in the Volta Region of Ghana
  Maxwell Ayindenaba Dalaba, Alfred Kwesi Manyeh, Mustapha Immurana, Martin Amogre Ayanore, Isaiah Agorinya, James Akazili, Patricia Akweongo, Benedict Okoe Quao
  SAGE Open Medicine.2024;[Epub]     CrossRef
• Lucio phenomenon: A case report
  Priyanka Dilipbhai Bodar, Jalpa Kailashbhai Patel, Devna Subramonia Pillai, Rita Vipul Vora
  Indian Journal of Dermatology, Venereology and Leprology.2023; 91: 91.     CrossRef
• Lucio Phenomenon and APLA in Hansen's Disease: A Rare Phenomenon
  Jayanta Sharma, Sudipto Chakroborty, Kisholoy Karan, Parthajit Das
  Bengal Physician Journal.2022; 9(2): 44.     CrossRef
• Dermatopatología de la oclusión intraluminal vascular: parte I (trombos)
  M.J. Beato Merino, A. Diago, Á. Fernández-Flores, J. Fraga, A. García Herrera, M. Garrido, M.Á. Idoate Gastearena, M. Llamas-Velasco, C. Monteagudo, J. Onrubia, Y.C. Pérez-González, N. Pérez Muñoz, J.J. Ríos-Martín, E. Ríos-Viñuela, J.L. Rodríguez Peralto
  Actas Dermo-Sifiliográficas.2021; 112(1): 1.     CrossRef
• Clinical and Histopathologic Characteristics of the Main Causes of Vascular Occusion — Part I: Thrombi
  M.J. Beato Merino, A. Diago, A. Fernandez-Flores, J. Fraga, A. García Herrera, M. Garrido, M.A. Idoate Gastearena, M. Llamas-Velasco, C. Monteagudo, J. Onrubia, Y.C. Pérez-González, N. Pérez Muñoz, J.J. Ríos-Martín, E. Ríos-Viñuela, J.L. Rodríguez Peralto
  Actas Dermo-Sifiliográficas (English Edition).2021; 112(1): 1.     CrossRef
• Lucio’s phenomenon in untreated advanced leprosy
  Nurwahyuna Rosli
  Human Pathology: Case Reports.2020; 21: 200413.     CrossRef

Avascular necrosis, or osteonecrosis of the femoral head, is a debilitating condition which leads to the destruction of the hip joint due to an interruption in the blood supply to the bony region and is most commonly due to trauma. The case discussed here has been highlighted as it presented as non-traumatic osteonecrosis of the femoral head with an absence of risk factors in a healthy adult male. A 37-year-old male presented with a 4-month history of recurrent left hip pain, which worsened with initiation of movement and weightbearing on the affected side. The patient was overweight but normotensive with a full range of movement of the hips bilaterally. There were no abnormalities detected on initial X-ray images of the left hip. However, due to the persistent pain and sclerotic changes in a subsequent X-ray, a magnetic resonance image of the bilateral hips was obtained, leading to the diagnosis of osteonecrosis of the bilateral femoral heads. Due to the lack of improvement with physiotherapy and analgesia, the patient was subjected to conservative surgery of the symptomatic left hip with concurring evidence of avascular necrosis based on intraoperative anatomical biopsy. This case emphasizes the importance of identifying underlying issues during history taking and physical examination in adults without risk factors. The early diagnosis of osteonecrosis assists in preventing joint collapse and can delay the requirement of joint replacements. High levels of suspicion are necessary to instigate investigation in persistent cases without the presence of risk factors.

Clival chordoma is a rare malignant tumor of the brain that typically occurs in older adults. It has a high local recurrence rate and is hence associated with poor prognosis. Here, we report a case of an adolescent who presented with a 1-month history of worsening headache and blurring of vision, as well as a 6-month history of left-sided facial and body numbness. Clinical findings were consistent with left upper motor neuron lesion of the seventh cranial nerve with involvement of the fifth cranial nerve. He was also found to have a sixth cranial nerve palsy demonstrated by diplopia upon lateral gaze with no evidence of papilledema. Magnetic resonance imaging of the brain suggested clival chordoma. He was subsequently referred to the neurosurgical team, and he successfully underwent an endoscopic trans-sphenoidal surgery to excise the lesion. He recovered well, continued his follow-ups with the neurosurgical team, and showed good progress. He also attended regular follow-ups with his primary care physician to ensure ongoing psychosocial support and monitoring of his overall health status. This case demonstrates the importance of prompt identification and treatment of clival chordoma in an adolescent. Long-term follow-ups and shared care between primary and secondary care physicians are essential to monitor recurrence of tumor and to provide psychosocial support.

Citations

• Fungal skull base lesion masquerading as malignancy: a diagnostic dilemma. Illustrative case report
  Kodeeswaran M, S. Muthuchitra, Noorul Hidhaya S, Vishaal P, P.B. Janakiraman, Tamilarasan P, K.P. Priyadharshan, Jamila Alagarsamy, Gaurav R. Dhoka, Bipin Chaurasia
  Annals of Medicine & Surgery.2025; 87(2): 929.     CrossRef
• Diagnosis and management of a rare case of clival chordoma in a young male patient
  Federica Masino, Manuela Montatore, Marina Balbino, Giuseppe Maria Andrea D'Arma, Gianmichele Muscatella, Rossella Gifuni, Giuseppe Guglielmi
  Radiology Case Reports.2024; 19(9): 3683.     CrossRef
• A Case Report of Chordoma Presenting as a Sphenoid Sinus Mass: A Diagnostic Challenge
  Sushma Bharti, Jyotsna Naresh Bharti
  Current Medical Imaging Reviews.2023;[Epub]     CrossRef

We report a case of steroid withdrawal syndrome in a 74-year-old woman who was suspected of having an occult exogenous Cushing’s syndrome secondary to prolonged traditional complementary medicine use. She presented with non-specific symptoms of lethargy, malaise, and poor oral intake with weight loss for 1 month, and investigations showed suboptimal 9 AM cortisol level. She has responded well to steroid replacement.

Citations

• Glucocorticoid-Induced Side Effects Cause Oral Lesions in Systemic Lupus Erythematosus: A Case Report
  Zulfa Pranadwista, Novia Hasanah, Tenny Dewi, Wahyu Hidayat
  International Medical Case Reports Journal.2024; Volume 17: 919.     CrossRef
• A patient with a bronchial carcinoid presents with Cushingoid symptoms due to an atypical and potentially dangerous supplement
  Tomas Morales, Shanika Samarasinghe
  Journal of Clinical and Translational Endocrinology: Case Reports.2023; 30: 100157.     CrossRef

The presence of erythrocytosis along with the diagnosis of chronic obstructive pulmonary disease (COPD) may veer a primary care clinician in a busy clinic towards attributing the erythrocytosis to hypoxia secondary to COPD; however, this is not always the case. This case highlights the importance of investigation and the significance not excluding a primary cause in COPD patients with erythrocytosis. A 57-year-old male, presenting with chronic cough, was subsequently diagnosed with COPD clinically and confirmed by spirometry. Erythrocytosis was also incidentally noted. The patient did not have any symptoms of polycythemia or hepatosplenomegaly. Therefore, the erythrocytosis was initially thought to be caused by hypoxia secondary to COPD. However, the JAK2 V617F gene mutation was detected and hence the diagnosis of polycythemia vera was made. Although the erythrocytosis was initially attributed secondary to the underlying pulmonary disease, investigations proved it to be primary in origin. This case report highlights the importance of investigating the underlying cause and to confirm the diagnosis of erythrocytosis as primary and secondary polycythemia differ in their management approach. This will avoid inappropriate diagnosis, treatment, and undesirable outcomes.

Citations

• Secondary polycythemia and venous thromboembolism: a systematic review
  Amelia Panjwani, Venkata Sathya Burle, Rhea Raj, Sneha Thomas, Vasavi Gorantla
  F1000Research.2023; 12: 758.     CrossRef
• Screening for latent polycythemia vera in chronic obstructive pulmonary disease-associated erythrocytosis
  Stephen E. Langabeer
  Respiratory Medicine and Research.2022; 81: 100914.     CrossRef

Olfactory impairment occurs in patients with Alzheimer’s disease, and olfactory function tests are performed for the diagnosis of Alzheimer’s disease. However, the diagnosis and patient status are not currently outlined for vascular dementia, and many physicians do not consider concurrent vascular dementia in patients complaining of olfactory dysfunction. Here, we report a case of vascular dementia with no symptoms of dementia other than olfactory dysfunction. This case suggested that the olfactory function test is helpful not only for the diagnosis of Alzheimer’s disease but also for the early diagnosis of vascular dementia.

Citations

• Odor Intensity Shift Keying (OISK) and Channel Capacity of Odor-Based Molecular Communications in Internet of Everything
  Aditya Powari, Ozgur B. Akan
  IEEE Transactions on Molecular, Biological, and Multi-Scale Communications.2024; 10(3): 396.     CrossRef
• Inflammation and olfactory loss are associated with at least 139 medical conditions
  Michael Leon, Emily T. Troscianko, Cynthia C. Woo
  Frontiers in Molecular Neuroscience.2024;[Epub]     CrossRef
• Olfactory loss is a predisposing factor for depression, while olfactory enrichment is an effective treatment for depression
  Michael Leon, Cynthia C. Woo
  Frontiers in Neuroscience.2022;[Epub]     CrossRef

A 50-year-old man was found to have purple discoloration of the urine. He was on long-term urinary catheterization. He was asymptomatic, and urinalysis did not suggest a urinary tract infection. Purple urine bag syndrome resolved with a change of the urinary catheter and bag. He was prescribed regular laxatives and passed stools regularly.

Citations

• Violet discoloration of urine: A case report and a literature review
  Muthanna Saraireh, Sahem Gharaibeh, Mohammad Araydah, Sarah Al Sharie, Fadi Haddad, Arqam Alrababah
  Annals of Medicine and Surgery.2021; 68: 102570.     CrossRef

We present the case of a 14-year-old Malay girl with an ependymoma of the conus medullaris who presented to multiple general practitioner clinics with a 24-month history of chronic low back pain. The pain was symptomatically managed as a simple musculoskeletal pain and sciatica. Further imaging to aid diagnosis was delayed until the appearance of severe pain with neurological deficits. Magnetic resonance imaging revealed an enhancing spinal mass at L1 through L3, and histopathological investigations confirmed the grade II ependymoma according to the World Health Organization classification. She underwent gross resection of the tumor. After the surgery, she developed neurogenic urinary bladder and bowel, which required intermittent self-catheterization, intermittent enema use, and intensive physical therapy.

Citations

• Bilateral Lumbar Radiculopathy Secondary to Myxopapillary Ependymoma: A Case Report
  Joseph C. D'Angiolillo, Nitesh V. Patel, R. Nick Hernandez, Simon Hanft
  Journal of Chiropractic Medicine.2021; 20(3): 170.     CrossRef

Disulfiram has been used for the treatment of alcohol dependence for nearly 65 years and is approved by the Food and Drug Administration. It causes negative reinforcement by accumulating toxic acetaldehyde due to irreversible inhibition of aldehyde dehydrogenase. Disulfiram has very few side effects when taken without alcohol. Epileptic seizure induction is a rare side effect in therapeutic doses, and its mechanism is unknown. We present a patient with a single epileptic seizure which was thought to be due to disulfiram used in the treatment of alcohol dependence. We did not find it ethical to administer disulfiram again because the patient discontinued alcohol use and was afraid of epileptic seizures.

Citations

• Disulfiram-Associated Generalized Tonic–Clonic Seizures
  Sivapriya Vaidyanathan, Sudharshan Raghunathan, Suma T. Udupa, Ravindra Neelakanthappa Munoli, Malkonahalli Srikanta Manjushree, Samir Kumar Praharaj
  American Journal of Therapeutics.2024; 31(4): e422.     CrossRef
• Anticancer Effects of New Disulfiram Analogs
  Omeima Abdullah, Christopher A. Beaudoin, Ziad Omran
  Biological and Pharmaceutical Bulletin.2024; 47(11): 1804.     CrossRef
• Disulfiram-induced epileptic seizures
  Violeta Nogueira, Mafalda Azevedo Mendes, Inês Pereira, Joana Teixeira
  BMJ Case Reports.2021; 14(3): e236296.     CrossRef

Anxiety disorders are the most prevalent psychiatric disorders in the general population. The relationship between dyspepsia and particularly gastroesophageal reflux disease (GERD) and psychiatric comorbidity such as anxiety is poorly defined. However, GERD was noted to be strongly associated and often coincident in onset with generalized anxiety disorder in the community. In this paper, we report the case of an adult man who presented with severe weight loss and underlying GERD, and was later found to have an anxiety disorder as the cause of both.

Mammary Paget’s disease is clinically defined as skin inflammation of the nipple area and is an adenocarcinoma of the epidermis of the nipple. The pathogenesis of mammary Paget’s disease is relatively unknown; nonetheless, there are two popular theories that support the underlying carcinoma and de novo carcinogenesis. For the attending medical practitioner, mammary Paget’s disease poses a diagnostic and therapeutic dilemma, especially in the absence of a clinically palpable breast mass. We report a rare case of a 48-year-old Malay woman who presented at Hospital Universiti Sains Malaysia, Kelantan, Malaysia with the symptom of skin erosion on the left nipple and unresponsiveness to multiple topical treatments. A full evaluation and assessment of the patient were conducted, and mammary Paget’s disease was diagnosed.

Citations

• Diagnostic imaging challenges of mammary Paget's disease presenting with subtle clinical and imaging features: A case report
  Sawitri Darmiati, Andre Elton Heryanto, Primariadewi Rustamadji
  Radiology Case Reports.2025; 20(4): 1925.     CrossRef
• Paget's disease of the breast: Presentation, treatment, and outcomes in a modern cohort
  Dorsa Mousa-Doust, Rebecca Warburton, Jin-Si Pao, Carol Dingee, Amy Bazzarelli, Jieun Newman-Bremang, Elaine McKevitt
  The American Journal of Surgery.2024; 231: 18.     CrossRef
• A revised modified LICAP flap as a novel oncoplastic breast-conserving surgery technique for Mammary Paget’s disease
  Timothy Nario, Joseph Do Woong Choi, Sara Wu, Thomas Oh, Jeremy Hsu
  Surgery Case Reports.2024; 2: 100020.     CrossRef
• Mammary Paget's Disease Mimicking Benign and Malignant Dermatological Conditions: Clinical Challenges and Diagnostic Considerations
  Renee Scott-Emuakpor, Setareh Reza-Soltani, Sana Altaf, Kaushik NR, Faustyna Kołodziej, Susana Sil-Zavaleta, Monica Nalla, Muhammad Naqib Ullah, Maha R Qureshi, Yasmin Ahmadi, Ali Rezvani, Humza F Siddiqui
  Cureus.2024;[Epub]     CrossRef
• An Overview of Clinical Manifestations of Dermatological Disorders in Intensive Care Units: What Should Intensivists Be Aware of?
  Ali Al Bshabshe, Wesam F. Mousa, Nashwa Nor El-Dein
  Diagnostics.2023; 13(7): 1290.     CrossRef
• Mammary Paget’s Disease of Young Females: Case Reports and Comparison With Middle-Aged and Elderly Patients
  Chun-yan Lv, Xian-kui Cheng, Zhong-Yue Guo, Li Liu, Jian Cai, Tao Lei, Yan Tang
  Clinical Pathology.2023;[Epub]     CrossRef
• Descripción de un caso de adenomatosis erosiva del pezón: tratamiento quirúrgico
  Marcelo Chávez Díaz, Gonzalo Ziegler Rodríguez, Jaime Montes Gil
  Revista de Senología y Patología Mamaria.2023; 36(4): 100526.     CrossRef
• Mammary Paget’s Disease: An Update
  Sione Markarian, Dennis R. Holmes
  Cancers.2022; 14(10): 2422.     CrossRef
• An unusual case of longstanding mammary Paget disease presenting with reticulated skin changes
  S. K. Dhariwal, E. Rytina, J. C. Sterling
  Clinical and Experimental Dermatology.2021; 46(4): 748.     CrossRef

• Erosive Adenomatosis of the Nipple: A Clinical Diagnostic Challenge

  
  Shuni Ying, Hong Fang, Jianjun Qiao
  Clinical, Cosmetic and Investigational Dermatology.2020; Volume 13: 587.     CrossRef