Cardiac metastasis from a bowel malignancy seldom occurs and there is a limited number of case reports published on this subject. Although colorectal cancer is the third commonest malignancy in Malaysia, the incidence of cardiac metastasis has never been reported. We report a case of an elderly man with recently diagnosed adenocarcinoma of the sigmoid colon, who presented with congestive cardiac failure secondary to mechanical obstruction by a right atrial mass. The intractable shock led to his sudden death before any intervention could be planned. If an intra-cavity cardiac mass is detected in a patient with an underlying metastatic malignancy, cardiac metastasis should be suspected. However, primary cardiac tumour or thrombus could also be the differential diagnosis. In our case, the definitive cardiac pathology remained unsolved as an autopsy was refused.
Tuberculosis (TB) remains a global burden despite extensive efforts to control it. TB arthritis commonly manifest as monoarthritis of weight-bearing joints. We report a rare presentation of osteoarticular TB involving multiple small joints of the hands, which mimicked rheumatoid arthritis (RA). Magnetic resonance imaging showed tenosynovitis. The patient was initially treated for seronegative RA but failed to respond. Subsequently, synovial biopsy led to the diagnosis. Antituberculosis treatment was given for 1 year.
An acardiac twin is rare and the diagnosis is commonly achieved from antenatal ultrasound (US) scans. However there have been cases where the appearances of the acardiac twin can be confusing and mimics a mass or tumour, for example, a teratoma. We experienced a case where the findings were unclear from the antenatal ultrasound scans and we had to resort to Magnetic Resonance Imaging (MRI), where we finally made the correct diagnosis based on the identification of two umbilical cords, supplying the normal fetus and the 'mass' (acardiac twin) respectively.
A 38 year old gentleman presented with fever and right hypochondrial pain. On further evaluation he was detected to have an amoebic liver abscess (ALA) in the right lobe of the liver. The abscess yielded anchovy sauce pus on percutaneous drainage. Following the percutaneous drainage the patient developed tachycardia. Electrocardiogram revealed atrial flutter with rapid ventricular rate and ST elevation in all leads suggestive of pericarditis. The atrial flutter was reverted to sinus rhythm by cardioversion. The patient then had an uncomplicated convalescence. Amoebic pericarditis, though rare, is a serious complication of amoebic liver abscess. Pericardial complications are usually seen with left lobe liver abscess due to its proximity. Both pericarditis and cardiac arrhythmias due to amoebic liver abscess especially from right lobe are very rare.
Churg-Strauss syndrome, a small and medium vessel vasculitis, was first described by Churg and Strauss in 1951. It is characterised by the presence of asthma, prominent tissue and blood eosinophilia, systemic vasculitis, and pulmonary and systemic necrotising allergic granulomas. Involvement of the skin, heart and gastrointestinal tract is well documented, but ocular presentation is unusual. We describe a 40-year-old lady who presented with recurrent upper eyelid swelling due to conjunctival lesions. Although she has chronic asthma, Churg-Strauss syndrome was never suspected. The diagnosis of Churg-Strauss syndrome was only made following histological examination of the conjunctival lesions.
Tuberculous vasculitis is a very rare presentation of tuberculosis. So far this is the second reported case in the literature. The diagnosis of this disorder is based on the clinical presentation as well as blood investigation results. With the ever improvement in modern medicine and improvement in endovascular treatment of such diseases, the morbidity and mortality of these patients have been dramatically reduced with better clinical and survival results. We present a case of endovascular stenting of a stenotic subclavian artery with good results.
Extra nodal NK/T cell lymphoma, 'nasal type' is a rare clinicopathological entity. The prevalence of nasal lymphoma is estimated at 0.17-1.5% for all non -Hodgkin's lymphomas (NHL), of which 45% originate from the NK/T cell. It is more commonly encountered in Asian countries. The main clinical features are nasal congestion and epistaxis due to local aggressive destruction. It has a distinct immunophenotypic profile of CD2+, CD56+ and CD3-. The tumor often shows polymorphic lymphoreticular infiltrates and necrosis. We present a case of a 50-year-old male who presented with lateral nasal wall infection following endoscopic sinonasal surgery and later proven to be extranodal NK/T cell 'nasal type' lymphoma with immunophenotypic features.
Brunner's gland adenoma is a rare benign tumour of the duodenum. It is usually asymptomatic but may occasionally present with gastrointestinal haemorrhage and obstruction. We report a 40-year old lady, presenting with upper gastrointestinal bleeding and was found to have prolapsed and intussuscepted Brunner's gland adenoma of the duodenum, which mimicked the appearance of a tumour in the head of pancreas.
The authors report a case of a 6-year-old girl who developed subacute intestinal obstruction after a trivial blunt trauma to her abdomen. Her normal vital signs masked the presence of intestinal bleeding. An incidental finding at surgery of a haematomatous polypoid vascular growth of the ileum was subsequently confirmed to be cavernous haemangioma of the small bowel. Surgical resection was curative in this patient.
Data from the WHO state that up to 85% of cases of human schistosomiasis are from Africa. The common sites of this parasitic infection are the intestine and bladder. Testicular schistosomiasis is extremely rare but the number of reported cases worldwide has doubled over the past decade. The authors report a case of testicular schistosomiasis of a Myanmar immigrant in Malaysia who presented with a 6-month history of progressively enlarging left testicular swelling. His biochemical markers and cultures were not suggestive of an ongoing infection. Hence, a testicular malignancy was strongly suspected, for which, he underwent a left orchidectomy. Our clinical suspicion was proven wrong when the histopathology of the removed left testis revealed schistosomal eggs with granulamatous tissue formation. Subsequently, the patient was treated with praziquantel.
Sporotrichosis is a mycosis caused by a saprophytic dimorphic fungus named Sporothrix schenckii. Infections occur following traumatic inoculation of fungus from plants and infected cat bites and scratches. We report a case of a farmer who presented with a solitary subcutaneous nodule initially diagnosed as a soft tissue tumour. A history of agricultural activity and feline contact should draw the clinician's attention to sporotrichosis, as the diagnosis can be easily missed in atypical cases. The diagnosis, microbiology and management of the case are discussed.
Children with occipital seizures often have ictal autonomic symptoms such as pallor and vomiting and lack motor manifestations. This has lead to misdiagnosis of occipital seizures in children. The following case report highlights the clinical features of a child with occipital epilepsy misdiagnosed as having migraine. The aetiology of symptomatic occipital epilepsy will be discussed.
We report a case of a 16 years old girl who presented sequentially with primary amenorrhoea, hypertension and hypokalaemia. Eight years later, she was finally diagnosed with 17alpha-hydroxylase deficiency congenital adrenal hyperplasia. Previous antihypertensive medications were stopped. Hydrocortisone alone successfully maintained normotension and normokalaemia.
The authors describe recurrent lens dislocation into the anterior chamber in a young girl with homocystinuria. The patient's 12-year-old sister died after a cerebrovascular accident caused by the same disease. This report highlights the importance of early dietary restrictions and treatment.
Even though the World Health Organization criteria's for classifying the dengue infection have been used for long time, recent studies declare that several difficulties have been faced by the clinicians to apply these criteria. Accordingly, many studies have proposed modified criteria to identify the risk in dengue patients based on statistical analysis techniques. None of these studies utilized the powerfulness of the self-organized map (SOM) in visualizing, understanding, and exploring the complexity in multivariable data. Therefore, this study utilized the clustering of the SOM technique to identify the risk criteria in 195 dengue patients. The new risk criteria were defined as: platelet count less than or equal 40,000 cells per mm(3), hematocrit concentration great than or equal 25% and aspartate aminotransferase (AST) rose by fivefold the normal upper limit for AST/alanine aminotransfansferase (ALT) rose by fivefold the normal upper limit for ALT. The clusters analysis indicated that any dengue patient fulfills any two of the risk criteria is consider as high risk dengue patient.
Dural metastasis is a rare entity in clinical practice. We report a case of dural metastasis secondary to thyroid carcinoma, which on both preoperative CT and MRI and at surgery had the typical appearance of a meningioma. Histopathological findings confirmed metastatic follicular thyroid carcinoma as a primary site. Although rare, dural metastases can mimic a meningioma. Our experience in this case has led us to consider metastasis as a differential diagnosis even when a meningioma is suspected. We believe that reporting of the case of dural metastasis mimicking a meningioma may help clinicians in future.
Follicular dendritic cell sarcomas (FDCS) are rare neoplasms that involve lymph nodes or extranodal sites. They show varied histological features and thus can be mistaken for carcinoma or sarcoma. Correct identification is important for further management. A 43-year-old Indian female presented with a three-month history of progressive swelling at the right inguinal region. It was excised completely and was reported as lymph node with metastatic poorly differentiated carcinoma based on Haematoxylin and eosin (H&E) stain findings. Computerized tomography (CT) scans of thorax, abdomen and pelvis were normal and did not reveal a primary site. Following this, the case was referred to one of the authors. The slides were reviewed and a variety of immunocytochemical markers were done. The tumour cells were negative for epithelial, melanocytic, neural, leucocyte and soft tissue tumour markers. They were immunopositive for CD21, CD35 and negative for CD68. Based on the immunocytochemical findings, a final diagnosis of FDCS was made. This case highlights the histological and immunophenotypical profile of a rare tumour which requires a high index of suspicion for diagnosis.