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Fulltext Pediatric brain abscess with fatal outcome caused by hypervirulent Klebsiella pneumoniae, serotype K2-ST65

En ETS, Ismail N, Nasir NSM, Ismadi YKM, Zuraina NMNN, Hassan SA

J Infect Public Health, 2023 Jul;16(7):1089-1092.
PMID: 37224619 DOI: 10.1016/j.jiph.2023.05.015

Hypervirulent Klebsiella pneumoniae (hvKp) is an emerging pathotype in addition to classical Klebsiella pneumoniae, with its ability to cause life-threatening, community-acquired metastatic infections even in healthy individuals. We presented a case of cerebral abscess preceded by otitis media in a 10-year-old child caused by hvKp. The isolates from blood pus aspirate were later identified as K. pneumoniae capsular serotype K2 and closely related to sequence type (ST65), with multiple hypervirulent genes detected (rmpA, rmpA2, iucA and peg344). She succumbed to death despite surgical drainage and susceptible antibiotic therapy. Clinicians should be cognizant of the rising incidence of hvKp infections in pediatric populations.

Matched MeSH terms: Fatal Outcome
Fulltext Afebrile Plasmodium Knowlesi Severe Malaria With A Fatal Outcome

Chang CY

J Ayub Med Coll Abbottabad, 2023;35(1):186-187.
PMID: 36849407 DOI: 10.55519/JAMC-01-11418
Matched MeSH terms: Fatal Outcome
Adult-onset nasopharyngeal diphtheria: an uncommon but rapidly progressive and potentially fatal infection

Ding CH, Wahab AA, Marina Z, Leong CL, Umur N, Wong PF

Trop Biomed, 2021 Jun 01;38(2):119-121.
PMID: 34172699 DOI: 10.47665/tb.38.2.045

Nasopharyngeal diphtheria is an acute infectious upper respiratory tract disease caused by toxigenic strains of Corynebacterium diphtheriae. We report a case of a young adult who presented to us with a short history of fever, sore throat, hoarseness of voice and neck swelling. He claimed to have received all his childhood vaccinations and had no known medical illnesses. During laryngoscopy, a white slough (or membrane) was seen at the base of his tongue. The epiglottis was also bulky and the arytenoids were swollen bilaterally. The membrane was sent to the microbiology laboratory for culture. A diagnosis of nasopharyngeal diphtheria was made clinically and the patient was treated with an antitoxin together with erythromycin, while awaiting the culture result. Nevertheless, the patient's condition deteriorated swiftly and although the laboratory eventually confirmed an infection by toxin-producing C. diphtheriae, the patient had already succumbed to the infection.

Matched MeSH terms: Fatal Outcome
Case Report: Fatal Human Leptospirosis Caused by Leptospira interrogans Genotype ST149

Rao M, Amran F, Kamaruzaman AA, Hakim Esa HA, Abdul Hameed A, Mohamed Shabery NA

Am J Trop Med Hyg, 2021 01;104(1):216-218.
PMID: 33289472 DOI: 10.4269/ajtmh.20-0267

Leptospirosis is an important zoonotic disease with worldwide distribution and nonspecific clinical manifestation. We report a case of fatal leptospirosis in a previously healthy woman with a causative agent. A young adult Indian woman was brought in dead to the forensic department. Ten days before, she developed fever, dizziness with headache, myalgia, diarrhea, and vomiting. Routine inquest and autopsy were performed on the deceased, revealing hemorrhagic lungs with extensive intra-alveolar hemorrhages, pale liver with dissociation and separation of hepatocyte plates, and edematous brain with histiocyte and lymphocyte infiltration in the parenchyma and meninges. Heart tissue depicts myocarditis and pericarditis inflammatory changes. Cerebrospinal fluid (CSF) was turbid in appearance with mildly elevated leukocytes, predominantly lymphocytes. Real-time PCR targeting lipL32 gene of pathogenic Leptospira was detected in the blood, CSF, brain, kidney, heart, and liver. The genetic profile of the causative agent was ST149 (multi-locus sequence typing Scheme 3). This study illustrates the usefulness of Leptospira PCR assay in postmortem diagnosis and addresses the need for further surveillance to identify the epidemiological link of the disease.

Matched MeSH terms: Fatal Outcome
Fulltext Two variants of uterine leiomyoma in Malaysia's last Sumatran rhinoceros (Dicerorhinus sumatrensis)

Salleh A, Zainuddin ZZ, Mohamed Tarmizi MR, Yap KC, Zamri-Saad M

Vet Q, 2020 Dec;40(1):250-257.
PMID: 33045934 DOI: 10.1080/01652176.2020.1836431

Following its capture in March 2014, an adult female Sumatran rhinoceros frequently showed profuse vaginal bleeding. An ultrasonography suggested the presence of multiple reproductive lesions, including two uterine masses which were suspected to be leiomyomas. Soon after, an open pyometra was confirmed. Later in November 2019, the patient died and necropsy confirmed the presence of two uterine masses; one was located at the cervico-uterine junction and another in the uterine body, with pyometra, and cystic endometrial hyerplasia. Based on histological, special stains, and immunohistochemical examination, it was shown that one of the masses was composed of large, ovoid and polyhedral neoplastic mesenchymal cells with eosinophilic cytoplasm and a few binucleated cells surrounded by collagen fibres. It was tested positive for SMA and vimentin, while negative for desmin, cytokeratin AE1/AE3, EMA, CD34, and S100. The other mass was composed of mesenchymal cells undergoing myxoid degeneration as evidenced by the presence of glycosaminoglycan-rich matrix. It was tested positive for SMA, vimentin, partially positive for desmin, and negative for the other markers. With the aid of human medical nomenclature, these masses were diagnosed as epithelioid leiomyoma and myxoid leiomyoma, respectively. This report provides a clinical presentation, and histologic descriptions of the two variants of leiomyomas that have not been reported in veterinary medicine.

Matched MeSH terms: Fatal Outcome
A fatal twist in childhood: A post-mortem finding of intestinal volvulus with malrotation

Tan RZ, Darwin FL, Anuar Zainun K

Malays J Pathol, 2020 Dec;42(3):477-481.
PMID: 33361732

Gastrointestinal pathology leading to the death in paediatric age group is uncommon. The diseases that encountered were mostly intestinal obstruction, peritonitis and gastrointestinal bleeding. Due to the severe symptoms, most of the patients presented to hospital in time and were treated appropriately. However, with the presence of contributing factors, certain gastrointestinal pathology can progress rapidly leading to the death. We report a rare case of intestinal volvulus in a 3 years old girl where the deceased presented with one day short history of vomiting before her demise. The contributing factors were bronchopneumonia sepsis and underlying intestinal malrotation identified via post-mortem examination.

Matched MeSH terms: Fatal Outcome
Emphysematous gastritis after metastatic malignant melanoma: a radiological surprise

Ng CY, Hayati F, Nadarajan C

BMJ Case Rep, 2020 Sep 09;13(9).
PMID: 32912885 DOI: 10.1136/bcr-2020-235174

Malignant melanoma is cancer of the skin which commonly metastasises to the stomach. There have been no reported cases of emphysematous gastritis secondary to metastasis of malignant melanomas, to date. However, a 61-year-old woman with metastatic malignant melanoma of the left great toe presented to us with symptoms of severe left hypochondrium pain associated with high-grade fever, gross abdominal distension and recurrent vomiting. Two months earlier, metastasis was observed to have spread to the stomach and inguinal lymph nodes. At this stage, the patient opted for traditional medication instead of definitive surgery and chemotherapy. Radiological imaging revealed an emphysematous change to the stomach which was radiologically consistent with gastric malignant melanoma. Unfortunately, the patient succumbed to this rare condition.

Matched MeSH terms: Fatal Outcome
Fulltext Germline TET2 loss of function causes childhood immunodeficiency and lymphoma

Stremenova Spegarova J, Lawless D, Mohamad SMB, Engelhardt KR, Doody G, Shrimpton J, et al.

Blood, 2020 Aug 27;136(9):1055-1066.
PMID: 32518946 DOI: 10.1182/blood.2020005844

Molecular dissection of inborn errors of immunity can help to elucidate the nonredundant functions of individual genes. We studied 3 children with an immune dysregulation syndrome of susceptibility to infection, lymphadenopathy, hepatosplenomegaly, developmental delay, autoimmunity, and lymphoma of B-cell (n = 2) or T-cell (n = 1) origin. All 3 showed early autologous T-cell reconstitution following allogeneic hematopoietic stem cell transplantation. By whole-exome sequencing, we identified rare homozygous germline missense or nonsense variants in a known epigenetic regulator of gene expression: ten-eleven translocation methylcytosine dioxygenase 2 (TET2). Mutated TET2 protein was absent or enzymatically defective for 5-hydroxymethylating activity, resulting in whole-blood DNA hypermethylation. Circulating T cells showed an abnormal immunophenotype including expanded double-negative, but depleted follicular helper, T-cell compartments and impaired Fas-dependent apoptosis in 2 of 3 patients. Moreover, TET2-deficient B cells showed defective class-switch recombination. The hematopoietic potential of patient-derived induced pluripotent stem cells was skewed toward the myeloid lineage. These are the first reported cases of autosomal-recessive germline TET2 deficiency in humans, causing clinically significant immunodeficiency and an autoimmune lymphoproliferative syndrome with marked predisposition to lymphoma. This disease phenotype demonstrates the broad role of TET2 within the human immune system.

Matched MeSH terms: Fatal Outcome
Mesenchymal chondrosarcoma - A rare cause of pleural effusion

Cheo SW, Abraham AD, Madatang A, Low QJ

Med J Malaysia, 2020 07;75(4):458-460.
PMID: 32724019

Mesenchymal chondrosarcoma is a malignant neoplasm arising from cartilaginous bone or soft tissue. It is uncommon yet devastating. Our patient was a 21-year-old man who presented with pleuritic chest pain and weight loss. His chest radiograph showed left pleural effusion. His pleural effusion analysis was consistent with exudative pleural effusion. Tuberculosis workup was negative. Pleural fluid cytology did not yield malignant cells. Subsequently, his computed tomography of thorax showed left rib sclerotic lesion with soft tissue component. Biopsy of the soft tissue eventually confirmed the diagnosis of mesenchymal chondrosarcoma. He succumbed to his illness before the diagnosis was confirmed. We hope that through this case report, we are able to provide some insight into this rare condition.

Matched MeSH terms: Fatal Outcome
Dilemma in the management of methanol poisoning at a district hospital in Malaysia

Low QJ, Lee KT, Lim TH, Siaw C, Cheo SW, Tan NE, et al.

Med J Malaysia, 2020 07;75(4):442-444.
PMID: 32724013

There are increasing reports of methanol poisoning (MP) incidence worldwide. In Malaysia, the largest first methanol poisoning was reported in Selangor in 2013 with a total of 41 patients and cluster of cases been reported from the country since then. Often MP involved adulterated alcohol containing more than the legal permissible concentration of methanol. Methanol is rapidly absorbed and metabolised into formic acid which causes variable symptoms of the central nervous system such as blindness, seizure, coma and gastrointestinal disturbances. Mortality could reach up to 83% as reported using the coma state, pH and pCO2 level in the worst-case scenario.

Matched MeSH terms: Fatal Outcome
Delayed diagnosis of Ewing's sarcoma in a young patient presented with left knee monoarthritis

Lim CH, Lim YH, Radzi M

BMJ Case Rep, 2020 Mar 19;13(3).
PMID: 32198224 DOI: 10.1136/bcr-2019-232193

A 19-year-old girl presented to the rheumatology clinic for left knee monoarthritis for the past 4 months. She also had constitutional symptoms with significant weight loss. On physical examination, she appeared cachexic, her left knee was swollen and tender. MRI of the left knee showed a soft tissue swelling extending into the knee joint. Left knee synovial fluid showed small round cells. Histopathology results were compatible with Ewing's sarcoma. Due to the delay in seeking medical advice, she succumbed to the disease 1 week after the diagnosis was made. Soft tissue/bone tumour causes monoarthritis is not common. A careful history taking, physical examination and investigations should be done in order to identify a sinister cause of monoarthritis such as Ewing's sarcoma. Early treatment should be initiated to ensure a better outcome.

Matched MeSH terms: Fatal Outcome
Case series: Fulminant community-acquired Acinetobacter pneumonia

Tonnii S, Chua HH

Med J Malaysia, 2020 03;75(2):186-188.
PMID: 32281608

Acinetobacter infection, especially the drug-resistant strain, is a common cause of nosocomial infection. However, community-acquired Acinetobacter infection is uncommon. We reported three cases of community-acquired Acinetobacter pneumonia. All three cases had histories of regular home-brewed alcohol consumption presented with severe acute respiratory symptoms requiring ventilatory support and had low total white cell count. They succumbed to the illness within 2 to 10 days of admission. They had positive blood or endotracheal aspirate cultures of sensitive-strain Acinetobacter sp. which was only sensitive to high dose sulbactam. Early recognition and correct antibiotic can help reduce mortality.

Matched MeSH terms: Fatal Outcome
Sudden death due to infective endocarditis caused by Streptococcus constellatus: A case report

Zamasry MS, Hilmi Z, Mohd Yusof MYP, Razali HSA, Nawawi H, Mahmood MS

Trop Biomed, 2019 Dec 01;36(4):845-849.
PMID: 33597456

Infective endocarditis (IE) is a relatively uncommon disease, but has been challenging to diagnose over the years. With the increasing incidence, variety of causative agents and the resistance of microorganisms towards antibiotics, there is still an occurrence of sudden death due to undiagnosed IE. The most common microorganism causing IE is Staphylococcus aureus. However, there is increasing prevalence of other microorganisms causing IE. This case report highlights a case of sudden death due to IE caused by a rare pathogen, Streptococcus constellatus which belongs to the Streptococcus anginosus group (Milleri group). A study noted the crude incidence of IE in 6 world regions ranged between 1.5 and 11.6 cases per 100,000 people. To date, there has been no previous report on sudden death due to IE caused by Streptococcus constellatus in Malaysia, neither in the forensic nor clinical setting. This case report underlined the characteristics and pathological features of this microorganism. The increasing incidence and variety of causative organisms in IE are important public health issues. It is vital for future studies to examine the risk factors of IE related to Streptococcus constellatus, to enhance better understanding, insight and awareness regarding the course of this disease. This in turn may facilitate preventive measures to avoid morbidity and mortality from this condition.

Matched MeSH terms: Fatal Outcome
Fatal anaphylaxis of ranitidine injection : have we not learnt the lesson yet?

Chuah YY, Lee YY, Lin LF, Kuo CJ

Acta Gastroenterol Belg, 2019 10 1;82(3):449-450.
PMID: 31566338
Matched MeSH terms: Fatal Outcome
"Fleshy" Skin Cellulitis: A Triggering Factor for ANCA Associated Vasculitis

Yang SC, Mustafar R, Kamaruzaman L, Wei Yen K, Mohd R, Cader R

Acta Med Indones, 2019 Oct;51(4):338-343.
PMID: 32041918

A 59-year-old lady with underlying hypothyroidism presented with acute contact dermatitis progressed to cellulitis with superimposed bacterial infection and acute kidney injury. She responded to initial management with antibiotics, but a week later, she had cutaneous and systemic vasculitis. Her skin biopsy consistent with immune-mediated leuko-cytoclastic vasculitis and her blood test was positive for cytoplasmic-anti-neutrophil cytoplasmic antibody (c-ANCA). A diagnosis of ANCA-associated vasculitis was made and she was treated with immunosuppressant with plasmapheresis and hemodialysis support for her kidney failure. Despite aggressive measures, the patient succumbed to her illness. This case report demonstrates that soft tissue infection could trigger the development of ANCA-associated vasculitis whilst a background of hypothyroidism serves as a predisposing factor as both condition were reported separately in a couple of case studies before.

Matched MeSH terms: Fatal Outcome
Fulltext LeHeR, a simple novel approach for difficult airway in non-trauma patients

Yezid NH, Poh K, Md Noor J, Arshad A

BMJ Case Rep, 2019 Aug 10;12(8).
PMID: 31401573 DOI: 10.1136/bcr-2019-230201

Managing the difficult airway presents a great challenge to anaesthesiologists and emergency physicians. Although there are many methods and scoring systems available to predict and anticipate difficult airway, the dictum in emergency airway is to always expect the unexpected. We have encountered a novel simple method of improving laryngoscopic view in difficult airway. We report four cases of difficult airway encountered in our district hospital from November 2017 to December 2018, in which intubation was performed using a simple manoeuvre called supine left head rotation (LeHeR). In all these cases, LeHeR manoeuvre has proven to be successful after more than a single attempt at intubation using various methods. The manoeuvre improves drastically the laryngoscopic view of Cormack-Lehane from 3B and 4 to 1 and 2.

Matched MeSH terms: Fatal Outcome
Phenotypic variation among siblings with arrhythmogenic right ventricular cardiomyopathy

Oon YY, Koh KT, Khaw CS, Mohd Amin NH, Ong TK

Med J Malaysia, 2019 08;74(4):328-330.
PMID: 31424042

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is primarily a familial disease with autosomal dominant inheritance. Incomplete penetrance and variable expression are common, resulting in broad disease spectrum. Three patterns of phenotypic expression have been described: (1) "classic" subtype, with predominant right ventricle involvement, (2) "left dominant" subtype, with early and dominant left ventricle involvement, and (3) "biventricular" subtype, with both ventricles equally affected. Genotypephenotype associations have been described, but there are other genetic and non-genetic factors that can affect disease expression. We describe two different phenotypic expressions of ARVC in a family.

Matched MeSH terms: Fatal Outcome
Fulltext Post-transplant lymphoproliferative disorder presenting as T-prolymphocytic leukemia: a case report

Kasinathan G, Kori AN, Azmie NM

J Med Case Rep, 2019 Jul 22;13(1):223.
PMID: 31327318 DOI: 10.1186/s13256-019-2164-y

INTRODUCTION: Post-transplant lymphoproliferative disorder is a serious disorder which occurs post hematopoietic stem cell transplant or solid organ transplantation. T-prolymphocytic leukemia is a T cell type monomorphic post-transplant lymphoproliferative disorder which accounts for only 2% of all mature lymphocytic leukemias in adults over the age of 30.
CASE PRESENTATION: A 59-year-old man of Chinese ethnicity presented to our hematology unit with headache, lethargy, and exertional dyspnea for the past 1 month. He underwent an uneventful cadaveric renal transplant 20 years ago for chronic glomerulonephritis-induced end-stage renal disease. He had been on long-term immunosuppressants since then consisting of orally administered prednisolone 10 mg daily and orally administered cyclosporine A 50 mg twice daily. On examination, he was pale with a palpable liver and spleen. He had a functioning renal graft. Marrow flow cytometry confirmed T-prolymphocytic leukemia with lymphocytes expressing CD2, CD3, CD7, CD52, and TCL-1. His human T-cell lymphotropic virus and Epstein-Barr virus serology and deoxyribonucleic acid (DNA) were negative. He was treated with one cycle of cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy to which he failed to respond. In view of his renal allograft, he was not suitable for alemtuzumab due to the risk of nephrotoxicity. He was given orally administered venetoclax but he died on day 17 due to severe auto tumor lysis syndrome.
CONCLUSION: The place of immunophenotyping in the diagnosis and treatment of this disorder is of significant importance. More research needs to be carried out to further comprehend the pathophysiology and treatment modalities for this disorder.

Matched MeSH terms: Fatal Outcome
Fulltext A rare extrapyramidal manifestation in a patient with primary central nervous system lymphoma

Tee TY, Khoo CS, Ibrahim NM, Osman SS

Neurol India, 2019 3 13;67(1):297-299.
PMID: 30860142 DOI: 10.4103/0028-3886.253620
Matched MeSH terms: Fatal Outcome
Melioidosis mimicking miliary tuberculosis

Tan RZ, Mohd Nor F, Shafie S, Tan LJ

Forensic Sci Med Pathol, 2019 03;15(1):151-154.
PMID: 30293222 DOI: 10.1007/s12024-018-0026-3

Melioidosis is an infectious disease caused by Burkholderia pseudomallei, a gram-negative intracellular bacillus. Tuberculosis, also an infectious disease, is caused by Mycobacterium tuberculosis, an acid fast bacillus. In both diseases, patients commonly present with fever and respiratory symptoms due to sepsis which might lead to respiratory failure or sudden death if left untreated. Not only are these two entities similar in clinical presentation, but the autopsy findings may mimic each other, giving rise to difficulties in determining the cause of death. We report a case of melioidosis and compare it to a typical case of miliary tuberculosis. Similarities between the cases on gross and histopathological examinations are discussed. In such circumstances, microbiological culture of bodily fluids and internal organs should be performed to ascertain the correct cause of death.

Matched MeSH terms: Fatal Outcome

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