Lipoblastomas are benign tumours of immature fat cells presenting in infancy. A lipoblastoma within the airway lumen causing airway compromise is an extremely rare occurrence. We present a 6 hours of life girl who had airway compromise due to a lobulated mass at the base of the tongue. The mass was excised after emergency endotracheal intubation.
A 55-year-old woman presented with sudden onset of left-sided body weakness and numbness, which was diagnosed as multifocal cerebral infarct with right thalamic bleed. She had concurrent hypertension, diabetes mellitus and chronic kidney disease. She suffered from central poststroke pain and reactive depression as poststroke complications, for which amitriptyline was prescribed. Unfortunately, she developed symptoms suggestive of mania and psychosis upon initiation of medications, which resolved upon withdrawal of amitriptyline. Amitriptyline is effective for treatment of poststroke pain and particularly useful in concomitant depression. Unexpectedly, this patient developed new psychopathologies after initiation of this medication. This case highlights the development of new psychopathologies that could be due to the antidepressant, underlying bipolar disorder or a complication of the stroke itself. Primary care providers need to actively enquire regarding neuropsychiatric symptoms because they can adversely affect the patient's quality of life as well as impede rehabilitation efforts.
A 13-year-old boy presented with a 2 weeks history of tearfulness, childish behaviour, separation anxiety, hypersomnia, hyperphagia and sexual disinhibition following a brief episode of fever. He had been experiencing the episodes since he was seven. The episodes lasted from a few days to 3 weeks and would normally occur once in a year. Most of the time it started with fever and resolved spontaneously. In the past he described auditory hallucination but not this time. Examination revealed a slightly overweight adolescent male appearing appropriate to his age. During the session he was restless, sleepy and burst into tears frequently. He constantly asked his mother when he could go home to sleep. He was very childish and clung to his mother. He was given a trial of risperidone 1 mg to be taken once a day for 3 days. On follow-up he had completely recovered.
The authors present an interesting case under our follow-up who has had five different forms of tumours with different pathologies throughout his lifetime. He started off with hepatoma, followed by pleomorphic sarcoma of the thigh, adenocarcinoma of the prostate, meningioma and finally schwanoma. He is still alive to this date.
Marjolin's ulcers are malignancies that arise from previously traumatised, chronically inflamed or scarred skin. We present a case with childhood burns, who had repeated irritation of his forearm skin with palm oil thorns that eventually led to malignant change.
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.
Catheter-related bloodstream infection (CRBSI) is one of the common healthcare-acquired infections imposing a high burden of morbidity and mortality on the patients. Non-tuberculous mycobacterium is a rare aetiology for CRBSI and poses challenges in laboratory diagnosis and clinical management. This is a case of a woman in her early 60s with underlying end-stage renal failure, diabetes mellitus and hypertension presented with a 2-week history of high-grade fever postregular haemodialysis, vomiting, lethargy and altered mental status.Blood cultures from a permanent catheter and peripheral taken concurrently yielded Mycobacterium senegalense, identified by matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry, which established the diagnosis of CRBSI atypically presented with concurrent acute intracranial bleeding and cerebrovascular infarction at initial presentation. She was started on a combination of oral azithromycin, oral amikacin and intravenous imipenem, and the permanent catheter was removed. Despite the treatments instituted, she developed septicaemia, acute myocardial infarction and macrophage activation-like syndrome, causing the patient's death.
Dermatomyositis is a rare rheumatic disease which predominantly affects the muscles and skin requiring a protracted course of immunosuppressants which may predispose the patients to opportunistic infections. A 49-year-old lady was diagnosed to have dermatomyositis in August 2010 based on history, significantly raised creatine kinase level and muscle biopsy findings. She had recurrent admissions due to fever, myalgia and muscle weakness. She had spiking temperature despite high dose steroids, broad-spectrum antibiotics and antifungal agents. This prompted extensive investigation which leads us to the additional diagnosis of disseminated tuberculosis involving the lungs, muscles and bones. This case demonstrates the challenge in controlling the disease activity of dermatomyositis with immunosuppressants in the setting of disseminated tuberculosis.
Chronic apical periodontitis associated with dental pulp necrosis is the main cause of odontogenic extraoral cutaneous sinus openings. These tracts are often initially misdiagnosed unless the treating clinician considers a dental aetiology. This case report of a 19-year-old woman describes the diagnosis and treatment of an extraoral cutaneous sinus tract of odontogenic origin. Non-surgical conservative endodontic therapy was opted as the involved teeth were restorable. One month after the completion of obturation, there was closure of the sinus tract. One year follow-up showed complete resolution of the sinus tract with minimal scar formation.
A 25-year-old gravida 2 para 1 with 12-week amenorrhoea presented a second time for recurrent vomiting in pregnancy. She was diagnosed to have a missed miscarriage following absent fetal heart seen in an early scan. She opted for conservative management. However, on the third presentation, her vomiting continued. Repeated transvaginal ultrasound scan showed a fetus with a crown rump length of 19 mm, which is equivalent to 8 weeks and 4 days, with absence of fetal heart pulsation. Thyroid function tests and β human chorionic gonadotropin were then requested. Results showed that the patient's serum β human chorionic gonadotropin level was markedly raised to 147,000. A molar pregnancy was suspected. Her thyroid function tests came back normal. Suction curettage was performed and histopathology confirmed a partial molar pregnancy. On follow-up, the β human chorionic gonadotropin level was normal by 7 weeks after the curettage.
A 2-year-old boy was presented with symptoms of chest infection. The chest radiograph showed a large mediastinal mass, which led to further investigations including biopsy of the tumour. Histopathological analysis revealed a diagnosis of lipoblastoma. We highlight the imaging appearance of the lesion. Although histopathological analysis is required for the confirmation of the diagnosis, cross-sectional imaging is useful in evaluating the extent of the tumour for surgical planning.
Numerical anomalies, either addition or deletion, are quite a common findings in human dentition. However, it is extremely rare to find both hypodontia and hyperdontia simultaneously in the same individual. This condition is referred as concomitant hypohyperdontia (CHH). Aetiology of this condition is still obscure. The prevalence of CHH has been reported to be between 0.002% and 3.1%. This case report highlights a rare occurrence of bimaxillary CHH represented by the absence of both mandibular central incisors and presence of two supernumerary teeth in the maxillary anterior segment. The rarity of such condition of mixed hypodontia as well as hyperdontia in single human dentition prompted the author to report the case.
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.
Wolff-Parkinson-White (WPW) syndrome is an extremely rare congenital cardiac conduction disorder. It is due to an aberrant pathway between the atrium and ventricle. This manuscript entails a man with an underlying WPW who was posted for an elective orchidectomy. We discussed the important perioperative precautions to prevent the precipitation of acute cardiac events.
We report a case of a 46-year-old woman who has presented to a peripheral hospital with progressive exertional dyspnoea and chest discomfort. The resting ECG showed features of left-sided ventricular hypertrophy. The initial chest radiograph was reported as cardiomegaly. Initial echocardiography revealed left atrial dilatation and 'left ventricular' hypertrophy with normal ejection fraction. She was treated as possible coronary artery disease and was subsequently referred to our centre for CT coronary angiography. Findings from the CT scan were consistent with congenitally corrected transposition of the great arteries (ccTGA). This report describes the radiological features of ccTGA, its associated cardiovascular anomalies, pathophysiology and potential complications.
Penetrating foreign body in the head and neck can be catastrophic from injury to the constellation of vascular and neural structures in the neck. Early recognition and prompt surgical intervention is imperative to save lives. Herein, we present an unusual case of iatrogenic foreign body-a coiled guidewire embedded in the deep neck space. The complications, radiological investigation and multidisciplinary surgical management are further discussed.