MyMedR

Fulltext Septic arthritis of lumbar facet joint with co-existing spondylolisthesis - a case report

Khoo C, Thevarayan S, Rengsen P, Deepak AS

Malays Orthop J, 2010;4(2):48-50.

MyJurnal

We report a rare case of septic arthritis of the lumbar facet joint (SALFJ) with co-existing spondylolisthesis of the L5 on S1 vertebra and discuss possible differential diagnoses, diagnostic difficulties and management of this condition.

Matched MeSH terms: Diagnosis, Differential

Fulltext Cystic teratoma mimicking recurrent pleural effusion, complicated by Mycobacterium abscessus infection

Mohd Esa NY, Mohd Radzi AA, Bakar NS, Mohd Khalid MS, Ismail AI, Abdul Rani MF

Respirol Case Rep, 2016 May;4(3):e00155.

PMID: 27516884 DOI: 10.1002/rcr2.155

Teratomas of anterior mediastinum are rare. They are often slow growing, asymptomatic, and detected incidentally on chest imaging. Mycobacterium abscessus (M. abscessus) is an acid-fast bacillus that is classified as a pathogenic "rapid growing" non-tuberculous mycobacteria. It is an uncommon cause of human pathology, which may cause skin and soft tissue infection after skin injury following inoculation, minor trauma, and surgery. Here, we present an unusual case of benign cystic teratoma mimicking recurrent pleural effusion, which was subsequently complicated by M. abscessus infection following thoracotomy. Cystic teratoma is rare, but it needs to be considered whenever clinical and investigative work-up fails to provide a convincing diagnosis. A combined clinical, radiological, surgical, and histopathological assessment is important to arrive at the correct diagnosis. Rapidly growing mycobacteria needs to be included in the differential diagnosis of patients with non-resolving infected post-thoracotomy wound and who do not respond to broad-spectrum antibiotics.

Matched MeSH terms: Diagnosis, Differential

Fulltext Classical trigeminal neuralgia, purely paroxsymal with vascular compression - a case report

B, Elamathi, R, Vijaya, V, Valliappan, A, Ramanathan

Ann Dent, 2014;21(1):33-37.

MyJurnal

According to the 3rd edition of the international
classification of headache disorders (ICHD3 2013),
Trigeminal Neuralgia (TN) is classified into two types:
1. Classical TN, purely paroxysmal 2. Classical TN
with concomitant persistent facial pain. In this article,
the authors describe a 47 year-old, male with unilateral,
severe, recurring, electric shock-like pain involving left
lower jaw, teeth and gingiva. Diagnosis of classical TN
of the left 3rd division of the trigeminal nerve was made.
The patient was treated with pharmacotherapeutic agents
but without relief. Magnetic resonance imaging (MRI)
of the brain showed medial vascular compression of left
trigeminal pontine root entry zone caused by superior
cerebellar artery. A microvascular decompression (MVD)
surgery was done at the left trigeminal pontine root entry
zone resulting in good relief of pain. This article highlights
the differential diagnoses to be considered with TN and
also emphasize the difference between the two types of
the TN according to ICDH3 (2013). It also highlights the
difference between classical TN purely paroxysmal with
and without vascular compression by imaging techniques
and their differing treatment modalities, which therefore
should be reflected in future ICDH classification.

Matched MeSH terms: Diagnosis, Differential

Fulltext Chronic heel pain: It could be tuberculosis

Muhamad Effendi F, Ibrahim MI, Rozali KN, Miswan MF

Malays Fam Physician, 2016;11(2-3):20-23.

PMID: 28461854 MyJurnal

INTRODUCTION: Heel pain is a common presentation at a primary care setting. The majority of these cases are benign and self limiting in nature. Common differential diagnoses include plantar fasciitis and peroneal muscle sprains. However, certain conditions-if undetected early-may cause significant morbidity to the patient. A high index of suspicion and early referral for further investigations are needed to prevent long-term morbidities.

METHODS: A clinical review of a patient with chronic left heel pain was performed. Blood parameters and imaging investigations indicated chronic infection of the calcaneum. Histopathological examination was highly suggestive of tuberculosis.

RESULT: The patient responded well to antituberculous therapy. She was pain free and showed no signs of recurrence at final follow-up.

CONCLUSION: Here, we report a case of chronic heel pain, which was later diagnosed as tuberculosis of the calcaneum and successfully treated with antituberculous therapy.

Matched MeSH terms: Diagnosis, Differential

Epiploic Appendagitis: An uncommon surgical diagnosis

Michael A, Zakry Y, Hanif H

Med J Malaysia, 2017 04;72(2):128-129.

PMID: 28473679 MyJurnal

Epiploic appendagitis or appendices epiploicae, is a rare cause of abdominal pain in patients with mild signs of abdominal pathology. It mimics diverticulitis or appendicitis clinically as there are no pathognomonic features. It is a surgical diagnosis presenting with localised, sharp, acute abdominal pain, not associated with symptoms like nausea, vomiting, fever or suggestive laboratory values. With the availability of abdominal CT scans and ultrasound, it will frequently be a differential diagnosis preventing unnecessary surgery for patients. However, it may be erroneous and therefore clinical judgement is of paramount importance. This report highlights this rare presentation and identifies management guidelines.

Matched MeSH terms: Diagnosis, Differential

Granulomatous peritonitis due to Ascaris eggs

Ahluwalia HS

Med J Malaya, 1965 Jun;19(4):316-7.

PMID: 4220859

Matched MeSH terms: Diagnosis, Differential

Fulltext Primary adenocarcinoma of the fallopian tube mimicking pelvic inflammatory disease

Tamby, M.R., Juliana, M.B., Wan Hamilton, W.H., Masir, N., Hemlata, K.G.

Medicine & Health, 2011;6(2):139-142.

MyJurnal

Primary fallopian tube carcinomas are rare and are difficult to diagnose preoperatively.
We describe a fallopian tube carcinoma in a 50-year-old lady who presented with symptoms of pelvic inflammatory disease. Ultrasound examination showed bilateral hydrosalphinx. However, CT scan showed features suggestive of a malignant ovarian tumour. At surgery, a markedly dilated left fallopian tube was found and histopathological examination confirmed the presence of a primary serous adenocarcinoma. The uterus and both ovaries were free of tumour. This report highlights that carcinoma of the fallopian tube should be considered as a differential diagnosis in females who present with lower abdominal pain.

Matched MeSH terms: Diagnosis, Differential

Fulltext Masquerade syndrome: an ocular involvement of lung cancer

Umi Kalthum, M. N., Wan Haslina Wah

Medicine & Health, 2013;8(1):47-51.

MyJurnal

We report a case of a 37-year-old smoker who presented with painless and sudden onset of loss of upper field vision of the right eye, associated with one month history of dry cough which was unresponsive to antibiotic and subsequent anti- tuberculosis therapy. Visual acuity at presentation was counting finger. There was bullous retinal detachment on examination. Radiological imaging revealed multiple lung opacities, involving the brain and the right orbit. Bronchoscopy and biopsy confirmed the diagnosis of adenocarcinoma of the lung. This case illustrates masquerade syndrome of which a lung carcinoma harbours behind a seemingly innocent retinal detachment. It also highlights the importance of entertaining lung carcinoma as a differential diagnosis in suspected tuberculosis among heavy smokers.

Matched MeSH terms: Diagnosis, Differential

Fulltext A rare case of traumatic bilateral sixth cranial nerve palsy

Hamidon, B.B., Md Shariful, H.S., Nasaruddin, M.Z.

International Medical Journal Malaysia, 2012;11(2):50-52.

MyJurnal

Traumatic bilateral sixth cranial nerve palsy is a rare condition which is typically associated with additional intracranial, skull, and cervical spine injuries. We describe a case of complete bilateral sixth nerve palsy in a 28-year-old female patient after an alleged motor vehicle accident. She had altered level of consciousness but no intracranial lesion or associated skull or cervical spine fracture was detected. In this case, we discussed the differential diagnoses, initial workup, and possible treatment options in cases of traumatic 6th nerve palsy.

Matched MeSH terms: Diagnosis, Differential

Fulltext Oral and maxillofacial pathologic lesion: retrospective studies on prevalence and sociodemographic features

Nurhayu Ab Rahman

Archives of Orofacial Sciences, 2014;9(2):65-75.

MyJurnal

The aim was to study the prevalence and sociodemographic features of odontogenic, non-odontogenic and salivary glands lesions among patients seen in Hospital Universiti Sains Malaysia. This information is essential to assist clinician in formulating reliable differential diagnosis of such lesion. Data on patient demographics, lesion location, tissue of origin and microscopic diagnosis were extracted from the Laboratory and Diagnosis record registries for biopsy specimen accessioned from year 2000 to 2012. This data was subsequently analyzed based on World Health Organization Classification of Head and Neck Tumours (2005). A total of 748 cases were included in the study. Out of the total number of cases, 367 cases were males and 377 cases were females. Ninety seven cases (13%) were of odontogenic origin, while 90 cases (12%) and 197 cases (26%) were of non-odontogenic and salivary gland origin respectively. Forty five percent of cases involved oral mucosal lesions. The most prevalent odontogenic lesion reported within the twelve years period was radicular cyst and ameloblastoma. Non-odontogenic bone lesion was rarely encountered with it making up less than two percent of total cases reported. Pleomorphic adenoma was the most prevalent benign salivary glands neoplasm reported within similar time period.

Matched MeSH terms: Diagnosis, Differential

Meigs' syndrome: a case report and review of the literature

Fook CW

Med J Malaya, 1970 Sep;25(1):58-60.

PMID: 4250313

Matched MeSH terms: Diagnosis, Differential

Hydatidiform mole: problems in early diagnosis

Yusof K

Med J Malaysia, 1973 Jun;27(4):275-9.

PMID: 4270785

Matched MeSH terms: Diagnosis, Differential

Fulltext The relationship between alvarado score and pain score in managing adult acute appendicitis in the Emergency Department

Ahmad, K.I., Shamsul, A.S., Ismail, M.S.

Journal of Surgical Academia, 2011;1(1):15-24.

MyJurnal

Acute appendicitis is one of the most common differential diagnoses for acute abdominal pain made by emergency doctors. Suspected cases require surgical referral for observation or definitive intervention to prevent complications. A high index of suspicion and good clinical skills with the aid of scoring systems allows early decision making, which includes optimal pain control. The objective of this study was to identify the pain score and is relationship to the cut-off points of the Alvarado scoring system so that justifies early surgical referral or discharge for suspected acute appendicitis from the Emergency Department of Universiti Kebangsaan Malaysia Medical Centre (UKMMC). This was a cross sectional study of acute abdominal pain from June 2007 to September 2008. All patients who fulfilled the criteria and consented to the study were assessed for Alvarado score, verbal numerical pain score (VNRS) and their subsequent management. Patients with an Alvarado score of ≥7 were likely to have acute appendicitis (80.1% sensitivity and 52.63% specificity) and those with the score of ≤3 were unlikely to have acute appendicitis. The median pain score was 7.00 (IQR: 5.00-8.50) but 72.5% did not receive any analgesia. There was no direct relationship between the pain score with Alvarado score. Oligoanalgesia in patients with acute appendicitis still exist in Emergency Department of UKMMC.

Matched MeSH terms: Diagnosis, Differential

Fulltext Solitary Skull Metastasis as Initial Manifestation of Hepatocellular Carcinoma - A Case Report

Ellyda, M.N., Mohd Shafie, A.

International Medical Journal Malaysia, 2009;8(2):47-52.

MyJurnal

Metastatic spread of tumors to the skull is quite unusual and often represents diagnostic and therapeutic issues. Skull involvement can be observed in various neoplasms of epithelial origin and are most often due to lung, breast, thyroid, kidney and prostate cancers. However, skull metastases from hepatocellular carcinoma (HCC) have been rarely reported. The prognosis for patients with hepatocellular carcinoma is so poor that treatment of such distant metastatic lesion cannot be achieved before death occurs due to the primary malignancy. Therefore, the clinical manifestations of cranial metastasis prior to that of primary hepatocellular carcinoma have rarely been reported. This case illustrates a rare case of skull metastasis as an initial manifestation of hepatocellular carcinoma. Although a solitary skull metastasis prior to the diagnosis of HCC demonstrates rare metastatic behavior for HCC, especially in Asia, skull metastases from HCC should be included in the differential diagnosis of skull tumors, even if the patient is asymptomatic of liver cirrhosis.

Matched MeSH terms: Diagnosis, Differential

Bronchography and selective bronchoscopy in diagnosis of lung malignancy: a case report

Galanti A, Wong Wai Kwan, Choy T

Med J Malaya, 1970 Dec;25(2):152-4.

PMID: 4251136

Matched MeSH terms: Diagnosis, Differential

Gangrenous giant Meckel's diverticulitis masquerading acute appendicitis: a surgical conundrum

Teng WW, Yeap BT, Azizan N, Hayati F, Chuah JA

ANZ J Surg, 2019 09;89(9):E379-E380.

PMID: 29695030 DOI: 10.1111/ans.14503

Matched MeSH terms: Diagnosis, Differential

Fulltext A Diabetic Elderly Man with Finger Ulcer

Mohamad N, Badrin S, Wan Abdullah WNH

Korean J Fam Med, 2018 Mar;39(2):126-129.

PMID: 29629046 DOI: 10.4082/kjfm.2018.39.2.126

Fixed cutaneous sporotrichosis is a differential diagnosis that can be considered in diabetic patients who present with a poorly healing ulcer. Although its prevalence is low, it can occur in patients with immunocompromised status. Here we report a case of a 70-year-old man with diabetes mellitus who presented with a 1-month history of an unhealed ulcer over the tip of his left middle finger. He experienced a cat bite over his left middle finger 1 month prior to the appearance of the lesion. A skin biopsy revealed the presence of Sporothrix schenckii. Oral itraconazole 200 mg twice daily was started empirically and the patient showed marked improvement in the skin lesion after 2 months of therapy.

Matched MeSH terms: Diagnosis, Differential

The challenge of improving the diagnostic yield from metanephrine testing in suspected phaeochromocytoma and paraganglioma

Samsudin I, Page MM, Hoad K, Chubb P, Gillett M, Glendenning P, et al.

Ann. Clin. Biochem., 2018 Nov;55(6):679-684.

PMID: 29660998 DOI: 10.1177/0004563218774590

Background Plasma-free metanephrines (PFM) or urinary fractionated metanephrines (UFM) are the preferred biochemical tests for the diagnosis of phaeochromocytoma and paraganglioma (PPGL). Borderline increased results should be followed up to either exclude or confirm diagnosis. Methods We extracted all PFM and UFM results reported by our laboratory over a six-month period from the laboratory information system. We categorized patients with borderline increased results according to whether follow-up testing had been performed as suggested in the initial laboratory report. Questionnaires were then sent to all requesting doctors and medical notes reviewed where available. Results Two hundred and four patients with borderline increased PFM or UFM were identified. Sixty-five (38.5%) of 169 patients with borderline increased PFM had a repeat test out of which 36 were normal and 29 did not normalize. Of 35 patients with borderline increased UFM, 17 (48.6%) had subsequent PFM measurement, out of which 15 were normal. Questionnaires were returned to 106 (52%) patients. Of these, the most frequent indication for testing was hypertension ( n = 50); 15 patients had an incidental adrenal mass and two of these patients were diagnosed with a phaeochromocytoma. Conclusion Only 38% of patients with borderline increased PFM had a repeat PFM measurement. This was not significantly higher when compared with the 28% in a previous audit that we reported in 2010 ( P = 0.10). Forty-nine per cent of patients with a borderline increased UFM had a repeat UFM or PFM measurement. There remains a substantial possibility of missed detection of PPGL.

Matched MeSH terms: Diagnosis, Differential

Congenital Midline Tongue Base Mass in An Infant: Lingual Hamartoma

Fadzilah N, Azman M, See GB

J Clin Diagn Res, 2016 Sep;10(9):MD01-MD03.

PMID: 27790477

Lingual hamartoma is a rare finding of congenital midline posterior tongue mass. The lesion may be seen as a single anomaly or maybe associated with syndrome especially the Oral Facial Digital Syndrome (OFDS). Here, we report an otherwise normal and healthy two-month-old boy with a congenital midline base of tongue mass presented with snoring and episodic vomiting since the age of 1 month. Tumour excision from the area of foramen of caecum recovered a pinkish pedunculated tumour. Histopathology examination confirmed the diagnosis of leiomyomatous lingual hamartoma. Differential diagnosis, especially for midline tongue mass and other paediatric tongue lesions are discussed. We also discuss the epidemiology, histopathologic features, treatment and prognosis of lingual hamartoma based on the literature review.

Matched MeSH terms: Diagnosis, Differential

Erythema nodosum

Leung AKC, Leong KF, Lam JM

World J Pediatr, 2018 Dec;14(6):548-554.

PMID: 30269303 DOI: 10.1007/s12519-018-0191-1

BACKGROUND: Erythema nodosum can be associated with a number of systemic diseases. There is, however, a paucity of information in the pediatric literature on this condition. The purpose of this article is to familiarize pediatricians with the evaluation, diagnosis, and treatment of erythema nodosum.

DATA SOURCES: A PubMed search was completed in Clinical Queries using the key terms "erythema nodosum".

RESULTS: Clinically, erythema nodosum presents with a sudden onset of painful, erythematous, subcutaneous nodules mainly localized to the pretibial areas. Lesions are usually bilateral and symmetrical, ranging from 1 to 5 cm in diameter. Erythema nodosum may be associated with a variety of conditions such as infection, medications, sarcoidosis, pregnancy, inflammatory bowel disease, vaccination, autoimmune disease, malignancy, and miscellaneous causes. The condition is idiopathic in approximately 50% of cases. The diagnosis is mainly clinical with biopsy reserved for atypical cases. To evaluate for the underlying cause, some basic laboratory screening studies are worthwhile in most cases and include a complete blood cell count, erythrocyte sedimentation rate and/or C-reactive protein, throat swab culture, antistreptococcal O titers, and a chest radiograph. Other tests should be individualized, guided by the history and physical examination results. Most cases of erythema nodosum are self-limited and require no treatment. Bed rest and leg elevation are generally recommended to reduce the discomfort. Nonsteroidal anti-inflammatory drugs are the first-line treatment for pain management.

CONCLUSIONS: As erythema nodosum is often a cutaneous manifestation of a systemic disease, a thorough search should be performed to reveal the underlying cause.

Matched MeSH terms: Diagnosis, Differential

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