Displaying publications 1 - 20 of 334 in total

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  1. Ngiu CS, Ibrahim NM, Yahya WN, Tan HJ, Mustafa N, Basri H, et al.
    BMJ Case Rep, 2009;2009.
    PMID: 21709844 DOI: 10.1136/bcr.01.2009.1501
    Hashimoto encephalopathy (HE) is a poorly recognised steroid-responsive encephalopathy, with prominent neuropsychiatric features. Diagnosis is often difficult due to its heterogeneous clinical presentation, especially since the thyroid status or anti-thyroid antibody titres may not be related to the disease state. Here, the case of a 23-year-old Malay woman with Graves disease who presented with progressive encephalopathy diagnosed as HE is presented. She responded dramatically to high dose intravenous and then oral corticosteroid. A month after the initiation of treatment, she regained full independency.
  2. Anwar S, Hishamuddin A, Khairul AJ, Shamsul AJ, Razlan H, Said MS
    BMJ Case Rep, 2009;2009.
    PMID: 21687021 DOI: 10.1136/bcr.01.2009.1438
    We would like to report a case involving a 38-year-old woman who presented with knee and ankle swellings 2 weeks prior to admission. There were also multiple painful oral ulcers and a few skin sores on the wrist. She also had associated diarrhoea for 2 weeks. There was also marked loss of weight (6 kg in 2 weeks). Colonoscopy examination showed macroscopic and histopathological findings of Crohn's disease; however, skin histology showed extensive neutrophilic infiltration in the dermis, predominantly in the perivascular region. Her final diagnosis was Sweet's syndrome with Crohn's disease.
  3. Dhanoa A, Singh VA
    BMJ Case Rep, 2009;2009.
    PMID: 21686336 DOI: 10.1136/bcr.12.2008.1401
    This is a presentation of a case of mono microbial necrotising fasciitis due to the unusual organism Salmonella enteritidis. The patient presented with swelling and blistering of the right calf. There are only five other such cases reported in the literature. This was the only case that had positive blood cultures for the organism. Prompt and appropriate treatment was intuited but the patient died because of multi-organ failure.
  4. Tan GC, Yap YP, Shiran MS, Sabariah AR, Pathmanathan R
    BMJ Case Rep, 2009;2009.
    PMID: 21686408 DOI: 10.1136/bcr.11.2008.1221
    Mycobacterial spindle cell pseudotumour (MSCP) has been reported in various sites, including skin, lymph nodes, bone marrow, lung and spleen. Cutaneous lesions are extremely rare and the differential diagnoses include various spindle cell lesions. Literature review shows that this lesion has preponderance for upper limb involvement and occurs largely in immunosuppressed individuals. We report a case of MSCP of the skin due to atypical mycobacterium and discuss the risk of misdiagnosis as a sarcoma.
  5. Yasin FN, Singh VA
    BMJ Case Rep, 2009;2009.
    PMID: 21686368 DOI: 10.1136/bcr.12.2008.1317
    Hip fracture-dislocation is extremely rare in sports and is most frequently seen after road traffic accidents. This injury is associated with considerable long-term disability and rapidly progressive joint degeneration. This case report illustrates two cases of hip fracture dislocation that occurred while playing recreational indoor football (futsal). Futsal is a fast-emerging recreational sport in Malaysia and we are now beginning to see high-impact injuries rarely encountered in recreational sports. Therefore, futsal cannot be taken lightly and it is important to take adequate precautions to prevent serious injuries when participating in such sports.
  6. Kong SS, Taib NA, Mahadeva S
    BMJ Case Rep, 2009;2009.
    PMID: 21686715 DOI: 10.1136/bcr.08.2008.0628
    Intussusception due to small intestinal polyps in Peutz-Jeghers syndrome represents a significant clinical challenge. Neither pure surgical nor endoscopic approaches alone are effective in the long-term management of this problem. We describe a combined approach using both surgery and small bowel endoscopy in the management of this condition, which resulted in both immediate and long-term success. Although not new, we believe this approach remains relevant despite recent technological advancements in this area.
  7. Muniandy M, Singh VA
    BMJ Case Rep, 2009;2009.
    PMID: 21686602 DOI: 10.1136/bcr.09.2008.0846
    A 68-year-old woman presented with a gradually increasing left gluteal swelling that she had first noted 2 years previously. The results of both clinical and radiological examinations were consistent with soft tissue sarcoma, but the final diagnosis after resection was haematoma.
  8. Bastion ML
    BMJ Case Rep, 2010;2010.
    PMID: 22242074 DOI: 10.1136/bcr.10.2009.2398
    The use of 0.5 mg/0.05 ml of ranibizumab intracamerally, to induce regression of iris neovascularisation in a non-diabetic patient, is reported. A 55-year-old Malay man presented with left eye rubeosis and hyphaema secondary to ischaemic remnant retinal flap in his silicone filled pseudophakic eye. Regression of rubeosis and resolution of hyphaema was noted within 4 days of injection of intracameral ranibizumab, allowing repeat vitrectomy to be performed without much bleeding, thus facilitating removal of his intraocular lens and laser to remaining flap. One month postoperatively he remained comfortable with counting fingers vision similar to the pre-hyphaema period.
  9. Hee LW, Singh VA, Jayalakshmi P
    BMJ Case Rep, 2010;2010.
    PMID: 22400059 DOI: 10.1136/bcr.09.2009.2266
    Gout is a disease where an abnormal collection of uric crystals (gouty tophi) can often be found in the foot and ankle. Occasionally such tophies are found at unusual sites and this can pose a challenge to the clinician where diagnosis and treatment is concerned. We describe a patient who presented to our oncology department with a swelling on his right thigh which was clinically diagnosed to be a soft tissue sarcoma, but after further investigations it turned out to be a gouty tophi. The purpose of this case report is to emphasise the variable presentation of gout and the challenges that can be faced by clinicians in diagnosing a soft tissue swelling.
  10. Peyman M, Ong MJ, Iqbal T, Subrayan V
    BMJ Case Rep, 2010;2010.
    PMID: 22802477 DOI: 10.1136/bcr.08.2010.3266
    Iris mammillations are dark brown, smooth, mound- or dome-shaped protuberances that are typically found on the anterior iris surface and are presumed to be congenital in origin. This congenital anomaly is usually unilateral and can be hereditary or sporadic. Lisch nodules in neurofibromatosis, tapioca melanoma of the iris, inflammatory iris granulomata and Cogan-Reese syndrome should be considered in the differential diagnosis. In this case report, the authors present a case of a bilateral iris mammillations in two siblings with congenital adrenal hyperplasia (CAH). To our knowledge, this is the first case where bilateral iris mammilations have been found to be associated with a systemic condition. Iris mammillations can be considered as one of the clinical signs in CAH in view of the pathogenesis discussed. Detailed ocular examination in CAH may reveal an increased incidence.
  11. Mahmod M, Nor IF, Maskon O
    BMJ Case Rep, 2010;2010.
    PMID: 22448190 DOI: 10.1136/bcr.02.2009.1549
    While selective non-steroidal anti-inflammatory drugs, namely cyclo-oxygenase-2 (COX 2) inhibitors, are known to be associated with acute myocardial infarction, little is known about the cardiovascular safety of the non-selective non-steroidal anti-inflammatory drugs. We report the case of a 44-year-old man who developed anaphylactic reaction and acute inferior myocardial infarction following ingestion of a non-selective anti-inflammatory drug, diclofenac sodium. Coronary angiography revealed a large thrombus in the right coronary artery which was partially removed by intracoronary catheter aspiration. Complete resolution of the remaining thrombus was achieved after treatment with an oral anticoagulant.
  12. Ngiu CS, Said MS, Periyasamy P, Low SF
    BMJ Case Rep, 2010;2010.
    PMID: 22778377 DOI: 10.1136/bcr.11.2009.2421
    Rituximab is a B-cell-depleting monoclonal anti-CD20 antibody. It is widely used in haematology and rheumatology. However, usage of rituximab in immunosupressed patient has been associated with various opportunistic infections. The authors reported a case of refractory rheumatoid arthritis treated with rituximab, which later presented with non-resolving pneumonia with pulmonary nodule. Percutaneous computer tomogram guided lung biopsy was arranged to confirm the suspicion of tuberculosis, but did not yield conclusive results. Later, she presented left-chest abscess and underwent incision and drainage. The pus culture and sensitivity confirmed pulmonary nocardiosis with chest wall dissemination. She was treated with 2-week course of trimethoprim sulfamethoxazole and responded. The authors also reviewed published cases of nocardiosis post-rituximab.
  13. Bastion ML
    BMJ Case Rep, 2010;2010.
    PMID: 22791576 DOI: 10.1136/bcr.03.2010.2867
    To describe an unusual case of vitreomacular traction syndrome spontaneously resolving prior to elective pars planar vitrectomy demonstrated on optical coherence tomography.
  14. Bastion ML, Zahidin AZ
    BMJ Case Rep, 2010;2010.
    PMID: 22750927 DOI: 10.1136/bcr.11.2009.2497
    An unusual case of disciform keratitis developing in a patient with silicone oil-filled eye following vitrectomies for posterior globe rupture.
  15. Bastion ML
    BMJ Case Rep, 2010;2010.
    PMID: 22736756 DOI: 10.1136/bcr.11.2009.2488
    This report describes the rapid progress of a case of unilateral acute retinal necrosis (ARN) that led to formation of a macular hole rhegmatogenous retinal detachment with advanced proliferative vitreo-retinopathy (PVR) changes over the space of 2 weeks. This necessitated primary vitrectomy with circumferential scleral buckle placement, which facilitated reattachment of the retina.
  16. Bastion ML, Qader AM
    BMJ Case Rep, 2011;2011.
    PMID: 22696753 DOI: 10.1136/bcr.02.2011.3889
    The authors would like to present an unusual case of unilateral retinal detachment, phacodonesis, dense cataract and ocular coloboma in a 7-year-old Indian Muslim boy with Noonan syndrome. He underwent lensectomy, 23G pars planar vitrectomy, air fluid exchange, endolaser and silicone oil injection which successfully reattached the retina. His best corrected visual acuity was 6/24 6 months after the surgery and oil removal.
  17. Nimir AR, Ibrahim R, Ibrahim IA
    BMJ Case Rep, 2011;2011.
    PMID: 22689601 DOI: 10.1136/bcr.04.2011.4096
    The authors report a case of a 6-week-old baby girl who was admitted to the paediatric ward due to a high fever for 2 days. The patient experienced three fits which took place while in the ward. A brain sonogram showed subdural heterogeneous collection consistent with focal empyema; however, no hydrocephalus or infarction was detected. An urgent Burr hole procedure was performed to remove the collected pus. Both blood and cerebrospinal fluid (CSF) culture grew Salmonella species which remain sensitive to some antibiotics. This strain was sent to the institute of medical research (IMR) for serotyping. The patient was treated with intravenous combination of ceftriaxone and ciprofloxacin for 3 weeks. One week later, IMR sent results that identified the strain as Salmonella enterica serotype Houtenae. Following antibiotic treatment, repeat ultrasound illustrated an improvement of the subdural empyema, and the gram stain of the CSF specimen failed to isolate bacteria.
  18. Chew HB, Ngu LH, Keng WT
    BMJ Case Rep, 2011;2011.
    PMID: 22715259 DOI: 10.1136/bcr.02.2010.2706
    A rare syndrome of rapid-onset obesity with hypothalamic dysfunction, hypoventilation and autonomic dysregulation (ROHHAD) has been recently described. We report the first patient with this syndrome in Southeast Asia and review reported cases to date. Our patient was good health with normal development until the age of 2. He then developed hyperphagic obesity, hypersomnolence, seizures, alveolar hypoventilation, central hypothyroidism, sodium and water dysregulation, gastrointestinal dysmotility, strabismus, disordered temperature and irregular heart rate, altered sweating, delayed puberty, mental retardation and recurrent respiratory tract infections. The cardiomyopathy with heart failure and abnormal cerebral spinal fluid (CSF) neurotransmitter analysis present in our patient have not been reported previously. Tumours of the sympathetic nervous system are known to be associated with this syndrome but had not been found in our patient at the time of reporting. We highlight the difficulty of achieving the diagnosis of ROHHAD syndrome and its overlap with other well-established disease entities. The mortality and morbidity resulting from the high incidence of cardiorespiratory arrest may be prevented by early ventilatory support.
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