MyMedR

Lateral rectus myositis mimicking an abducens nerve palsy in a pregnant woman

Haslinda AR, Shatriah I, Azhany Y, Nik-Ahmad-Zuky NL, Yunus R

Ophthalmic Plast Reconstr Surg, 2013 3 28;30(1):e13-5.

PMID: 23531952 DOI: 10.1097/IOP.0b013e31828957ae

Myositis is a rare unknown inflammatory disorder of the skeletal muscle tissue. Generalized inflammatory myopathies, polymyositis, and dermatomyositis have been reported during pregnancy. Isolated orbital myositis in pregnancy has not been previously described in the literature. The authors report a case of left isolated orbital myositis in a primigravida at 38 weeks gestation affecting the patient's left lateral rectus muscle. MRI of the orbit was consistent with the diagnosis. She showed remarkable clinical improvement with oral corticosteroids therapy.

Matched MeSH terms: Diagnosis, Differential

Fulltext Extracardiac Rhabdomyoma Mimicking Plunging Ranula

Hakim I, Yunus MRM

Medeni Med J, 2020;35(3):271-275.

PMID: 33110681 DOI: 10.5222/MMJ.2020.88120

Histopathologically adult extracardiac rhabdomyoma is a benign tumour of mature striated muscle. It is a slow- growing tumour with predilection to occur in head and neck region. They appear mainly as a solitary lesion, and about 15% of them can be multicentric. A 56-year-old man presented to us with the floor of mouth swelling persisted for one year and the right neck swelling for three years mimicking a plunging ranula. Radiological imaging revealed enhancing mass at the floor of mouth and submandibular region. The mass represented a nonvascular benign tumour. Subsequently, the patient underwent excision of the mass via transcervical and transoral method. Histopathological examination revealed adult type of extracardiac rhabdomyoma. Adult type of extracardiac rhabdomyoma should be considered in the differential diagnosis for the head and neck masses. A complete excision will reduce the risk of recurrence.

Matched MeSH terms: Diagnosis, Differential

Fulltext A young woman with hypogonadism, hypertension and hypokalaemia

Toh VK, Yung CH

Med J Malaysia, 2009 Sep;64(3):242-3.

PMID: 20527279 MyJurnal

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.

Matched MeSH terms: Diagnosis, Differential

Fulltext Spinal neurocytoma with extensive syringohydromyelia

Hanafiah M, Low SF, Sridharan R, Young B

BMJ Case Rep, 2013;2013.

PMID: 24132448 DOI: 10.1136/bcr-2013-201285

Matched MeSH terms: Diagnosis, Differential

Fine needle aspiration cytology of neuroendocrine carcinoma of the breast--a case report and review of literature

Kadir AA, Iyengar KR, Peh SC, Yip CH

Malays J Pathol, 2008 Jun;30(1):57-61.

PMID: 19108413

Neuroendocrine carcinomas of the breast are uncommon tumors known to occur in the elderly. While focal neuroendocrine differentiation may be noted in many ductal and lobular carcinomas, the term neuroendocrine carcinoma is to be applied when more than 50% of the tumor shows such differentiation. This case report details the cytological features of a neuroendocrine carcinoma that was encountered in our hospital. The fine needle aspiration (FNA) smears showed discohesive polygonal cells with abundant cytoplasm, many of which contained eosinophilic granules located at one pole. Histology of the mastectomy and axillary lymph nodes specimen from this patient showed features of neuroendocrine carcinoma--solid type, with metastasis, confirmed with immunohistochemistry. The patient is disease free seven months after surgery. This case highlights the need to closely observe cytological details to identify this rare tumor that may otherwise appear to be invasive duct carcinoma--not otherwise specified on FNA. The implications of diagnosing neuroendocrine differentiation for prognosis and management are also discussed.

Matched MeSH terms: Diagnosis, Differential

Leiomyosarcoma of the breast: report of a case with fine needle aspiration cytologic, histologic and immunohistochemical features

Jayaram G, Jayalakshmi P, Yip CH

Acta Cytol., 2005 Nov-Dec;49(6):656-60.

PMID: 16450908

BACKGROUND: Leiomyosarcoma of the breast is a rare neoplasm. We present a case of primary leiomyosarcoma of the breast in a middle-aged female in whom fine needle aspiration cytologic features suggested sarcoma.

CASE: A 55-year-old female presented with a rapidly growing breast lump of 1 month's duration. On examination, an ulcerating, 12 x 10 cm tumor was seen involving the lower medial and lateral quadrants of the right breast. Fine needle aspiration cytology showed variably sized, dissociated and loosely clustered polygonal, plump and spindle cells with pale blue cytoplasm and vesicular nuclei that were round, oval or irregular. Occasional giant forms and nucleolated and mitotic cells were present. A single cluster of benign ductal cells was seen. The tumor cells did not express immunocytologic reactivity to estrogen receptor protein. A cytologic diagnosis of sarcoma was given with differential diagnoses of metaplastic carcinoma and malignant phyllodes tumor. Histologic study established the diagnosis of leiomyosarcoma. Leiomyosarcoma of the breast shows fine needle aspiration cytologic features of sarcoma, but specific tumor typing may not be possible, especially when the cytologic material is inadequate for ancillary staining required to distinguish leiomyosarcoma from metaplastic carcinoma and malignant phyllodes tumor.

Matched MeSH terms: Diagnosis, Differential

Fulltext The role of 99mtechnetium (Tc) diethyl-iminodiacetic acid (EHIDA) hepatobiliary scintigraphy in the diagnosis of a rare cause of obstructive jaundice

Lai FM, Paramsothy M, George J, Yip CH

Singapore Med J, 1996 Jun;37(3):261-3.

PMID: 8942223

This paper illustrates the role of 99m-Technetium(Tc) diethyl-iminodiacetic acid (EHIDA) hepatobiliary scintigraphy in a patient who developed obstructive jaundice as a result of afferent loop syndrome, which is a rare occurrence. The computed tomographic (CT) and ultrasonographic findings are also described.

Matched MeSH terms: Diagnosis, Differential

Granulomatous pulmonary zygomycosis in a patient without underlying illness. Computed tomographic appearances and treatment by pneumonectomy

Majid AA, Yii NW

Chest, 1991 Aug;100(2):560-1.

PMID: 1864139

Pulmonary zygomycosis rarely occurs in the absence of underlying disease. We report a patient with granulomatous pulmonary zygomycosis without underlying disease who presented with a pulmonary mass. We present the computed tomographic findings that we believe have not been described previously. We also report the successful treatment by pneumonectomy.

Matched MeSH terms: Diagnosis, Differential

Visual Dermatology: Scalp Involvement in Pemphigus Vegetans

Huei LT, Yee EYW

J Cutan Med Surg, 2020 05 22;25(3):329.

PMID: 32442016 DOI: 10.1177/1203475420928927

Matched MeSH terms: Diagnosis, Differential

Fulltext Tuberculosis or systemic lupus erythematosus? A diagnostic and therapeutic dilemma

Mohd A, Goh EM, Chow SK, Looi LM, Yeap SS

Southeast Asian J. Trop. Med. Public Health, 2003 Jun;34(2):361-4.

PMID: 12971563

The diagnosis of patients with fever of unknown origin (FUO) is often problematic because the range of possible differential diagnoses is broad. We report on a case in which a patient presented with FUO and was subsequently found to have both a collagen vascular disease and an intercurrent infection. Treatment for the collagen vascular disease with corticosteroids exacerbated the intercurrent infection. The problems in the diagnosis and management of such cases are discussed.

Matched MeSH terms: Diagnosis, Differential

Fulltext Cerebral infarction and cerebral salt wasting syndrome in a patient with tuberculous meningoencephalitis

Loo KL, Ramachandran R, Abdullah BJ, Chow SK, Goh EM, Yeap SS

Southeast Asian J. Trop. Med. Public Health, 2003 Sep;34(3):636-40.

PMID: 15115143

A 38-year old female with underlying systemic lupus erythematosus was admitted with tuberculous meningoencephalitis. After an initial good response to anti-tuberculous treatment, she developed cerebral infarction and profound hyponatremia. This was due to cerebral salt wasting syndrome, which has only previously been described in 2 cases. The difficulties in diagnosis and management of this case are discussed.

Matched MeSH terms: Diagnosis, Differential

Fulltext Current diagnostic approaches to detect two important betacoronaviruses: Middle East respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Chong ZX, Liew WPP, Ong HK, Yong CY, Shit CS, Ho WY, et al.

Pathol Res Pract, 2021 Sep;225:153565.

PMID: 34333398 DOI: 10.1016/j.prp.2021.153565

Middle East respiratory syndrome coronavirus (MERS-CoV) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are two common betacoronaviruses, which are still causing transmission among the human population worldwide. The major difference between the two coronaviruses is that MERS-CoV is now causing sporadic transmission worldwide, whereas SARS-CoV-2 is causing a pandemic outbreak globally. Currently, different guidelines and reports have highlighted several diagnostic methods and approaches which could be used to screen and confirm MERS-CoV and SARS-CoV-2 infections. These methods include clinical evaluation, laboratory diagnosis (nucleic acid-based test, protein-based test, or viral culture), and radiological diagnosis. With the presence of these different diagnostic approaches, it could cause a dilemma to the clinicians and diagnostic laboratories in selecting the best diagnostic strategies to confirm MERS-CoV and SARS-CoV-2 infections. Therefore, this review aims to provide an up-to-date comparison of the advantages and limitations of different diagnostic approaches in detecting MERS-CoV and SARS-CoV-2 infections. This review could provide insights for clinicians and scientists in detecting MERS-CoV and SARS-CoV-2 infections to help combat the transmission of these coronaviruses.

Matched MeSH terms: Diagnosis, Differential*

Fulltext Isolated Bilateral Pinna Swelling: A Rare Initial Presentation of Leprosy

Yusuf SYM, Ismail IA, Hamid RA, Jamil NA, Yasin MM

Open Access Maced J Med Sci, 2019 Jun 15;7(11):1815-1817.

PMID: 31316665 DOI: 10.3889/oamjms.2019.481

BACKGROUND: Leprosy or Hansen disease is a chronic infectious disease that causes social stigma due to its deforming bodily appearance and physical disability. It has a wide spectrum of presentation affecting diagnosis.

CASE REPORT: A 21-year-old man who presented with chronic isolated bilateral pinna swelling as a result of leprosy is reported. The bilateral pinna swelling started as multiple shiny papules with an erythematous background and progressively became hyperpigmented and lobular over two years. This rare presentation of leprosy poses initial diagnostic difficulties, leading to misdiagnoses by various health care professionals. Diagnoses ascribed include eczema, insect bite and perichondritis. A suspicion of leprosy was raised when hyperaesthetic hypopigmentation of skin started to appear on the body after two years, with worsening of the pinna swellings. This was confirmed by identification of Mycobacterium leprae in slit skin smear test and skin biopsy.

CONCLUSION: Isolated involvement of pinna in a patient without lesions in other body parts is an unusual initial presentation of leprosy. However, leprosy should be kept as a rare differential diagnosis of isolated lesions on the ear in patients not responding to conventional treatment.

Matched MeSH terms: Diagnosis, Differential

Acute septicaemic melioidosis: a report of seven cases

Puthucheary SD, Lin HP, Yap PK

Trop Geogr Med, 1981 Mar;33(1):19-22.

PMID: 7245336

A report is presented of seven patients with acute septicaemic melioidosis seen at the University Hospital, Kuala Lumpur, Malaysia, during 1976-1979. All had associated disorders which rendered them more susceptible to infection. As prognosis depends on early diagnosis it is important that this disease be considered in the differential diagnosis of a septicaemic illness in such patients from endemic areas. The treatment of choice is a combination of tetracyclines and chloramphenicol, initially used in massive doses, and continued for at least six month to prevent relapses.

Matched MeSH terms: Diagnosis, Differential

Cutaneous larva migrans in Hospital Kuala Lumpur, Malaysia: rate of correct diagnosis made by the referring primary care doctors

Yap FB

Trans R Soc Trop Med Hyg, 2011 Jul;105(7):405-8.

PMID: 21600621 DOI: 10.1016/j.trstmh.2011.04.002

A retrospective study was undertaken to determine the clinical features of cutaneous larva migrans (CLM) seen in the Department of Dermatology, Hospital Kuala Lumpur (Kuala Lumpur, Malaysia) and to assess the rate of correct diagnosis made by the referring primary care doctors. Clinical records of all 31 patients with CLM seen between January 2006 and June 2010 were retrieved. The majority of patients were male. The mean age was 32.2 years. Pruritus was reported in 83.9% of cases and serpiginous tracts in 100%. The mean lesion count was 4.4 and the mean duration of disease before presentation was 3.1 weeks. The majority of skin lesions were on the buttock and lower extremities. Only 45.2% of patients had the correct diagnosis made by the referring primary care doctors. Older age of patients and lower number of lesions were associated with a higher rate of correct diagnosis. The low rate of correct diagnosis made by the referring primary care doctors to the dermatologists in this study warrants the need for education of not only primary care doctors but also future primary care providers, consisting of medical students, house officers and junior medical officers.

Study site: Department of Dermatology, Hospital Kuala Lumpur

Matched MeSH terms: Diagnosis, Differential

Fulltext Chromoblastomycosis

Yap FB

Int J Infect Dis, 2010 Jun;14(6):e543-4.

PMID: 19889559 DOI: 10.1016/j.ijid.2009.07.005

Matched MeSH terms: Diagnosis, Differential

Fulltext Delirium acutum -- an uncommon life-threatening psychiatric emergency

Chew PH, Leong LC, Yao SK

Med J Malaysia, 1982 Dec;37(4):370-2.

PMID: 7167091

Matched MeSH terms: Diagnosis, Differential

Fulltext Prolonged conjugated hyperbilirubinaemia--evaluation using duodenal fluid inspection for bile

Halim AJ, Yakin F

Med J Malaysia, 1983 Dec;38(4):327-30.

PMID: 6599993

Eight infants between the ages of one and three months with prolonged conjugated hyperbilirubinaemia had duodenal aspirations performed to differentiate between biliary atresia and neonatal hepatitis. Four infants had bile-stained aspirates and in all of them the jaundice subsided completely by eight months of age. We have found duodenal aspiration a safe, inexpensive and simple procedure to undertake in helping us make a rapid differentiation between patients with conjugated hyperbilirubinaemia requiring urgent laparotomy and those that do not require surgery. This approach appears to be reliable although further studies need to be undertaken.

Matched MeSH terms: Diagnosis, Differential

Fulltext It's aneurysmal, it's stenotic, it's tuberculosis

Guru K, Yahya M

Med J Malaysia, 2011 Dec;66(5):515-6.

PMID: 22390117 MyJurnal

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.

Matched MeSH terms: Diagnosis, Differential

Comparative study of cytologic and colposcopic findings in preclinical cervical cancer

Maziah AM, Sharifah NA, Yahya A

Malays J Pathol, 1991 Dec;13(2):105-8.

PMID: 1823091

Seventy-seven patients who had PAP smear cytology and colposcopic examination in a 2-year period between 1988 and 1989 were reviewed. Those with findings indicative or suspicious of malignancy were subjected to biopsy. All 50 patients thus biopsied were confirmed to have preclinical cancer on histological examination. Compared against histology, PAP smear cytology gave an accuracy rate of 90% (5 false negatives) and colposcopy gave an accuracy rate of 94% (3 false negatives). These results demonstrate that the two techniques are useful as screening tests for preclinical cervical cancer. The results are improved if they are used complementarily. However, there was poor specificity in the categorisation of cervical cancer by both methods. This was probably due to the subjectiveness of the two procedures. The study also raised the possibility of a higher incidence of preclinical cervical cancer in the Chinese ethnic group.

Matched MeSH terms: Diagnosis, Differential

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