MyMedR

Amelanotic spitzoid melanoma in a prepubescent boy

Goh EH, Zarina AL, Thambidorai CR, Maizaton AA, Siti AM, Somasundram S

Pediatr Surg Int, 2008 Apr;24(4):447-9.

The diagnosis of malignant melanoma (MM) in children is difficult due to its uncommon occurrence as well histological similarities to Spitz nevus. A case of MM of the foot in an 11-year-old boy is reported illustrating the histological overlap between Spitz nevus and MM. In our patient, both the primary foot lesion and the regional inguinal metastases were amelanotic, further increasing the diagnostic difficulty. The literature on MM in children is limited and the documentation of such unusual cases is necessary to improve the knowledge on this disease.

Matched MeSH terms: Diagnosis, Differential

Melioidosis: an uncommon cause of neck abscess

Zulkiflee AB, Prepageran N, Philip R

Am J Otolaryngol, 2008 Jan-Feb;29(1):72-4.

PMID: 18061838 DOI: 10.1016/j.amjoto.2007.02.004

INTRODUCTION: Melioidosis is a life-threatening disease caused by B. pseudomallei. It is endemic in Southeast Asia with a few reports from the Western world. It is transmitted via inhalation, ingestion or direct contact with an open wound. Clinically it may present with local or systemic symptoms. Mortality rate is very high in systemic disease; but local infection is usually mild, which causes delay in seeking medical attention.
CASE REPORT: We report a case of neck melioidosis presenting as a parapharyngeal abscess that was successfully managed with incision and drainage and intravenous ceftazidime and co-trimoxazole for 6 weeks followed by eradication therapy with oral co amoxiclav.
CONCLUSION: Neck melioidosis must be considered one of differential diagnoses for "cold abscesses" of the neck, especially in an endemic area, in Asian migrants, or in those with history of previous visit from the endemic regions.

Matched MeSH terms: Diagnosis, Differential

Acute renal failure after a holiday in the tropics

Guron G, Holmdahl J, Dotevall L

Clin. Nephrol., 2006 Dec;66(6):468-71.

PMID: 17176921 DOI: 10.5414/cnp66468

A 20-year-old, previously healthy woman, presented with high fever, headache and myalgia 3 days after her return from a holiday in Southeast Asia. Laboratory data on admission demonstrated a pronounced increase in plasma creatinine, marked thrombocytopenia and moderately elevated liver aminotransferases. After having ruled out malaria, dengue fever was primarily suspected and supportive intravenous fluid therapy was initiated. Still, 1 day after admission, platelet counts dropped even further and she became anuric although she did not appear hypovolemic. On day 2 after admission, urine production commenced spontaneously and the patient slowly recovered. All laboratory test results had returned to normal approximately 2 months later. Serological analysis for dengue fever was negative. It turned out that the patient had been trekking in the jungle while in Thailand and we, therefore, analyzed serology for Leptospira spirochetes which was clearly positive. The patient was diagnosed with leptospirosis which is a serious condition associated with a high mortality when complicated by acute renal failure. Differential diagnoses in patients with acute renal failure and tropical infections are reviewed. The importance of early recognition of leptospirosis, and prompt treatment with antibiotics in suspected cases, is emphasized.

Matched MeSH terms: Diagnosis, Differential

Epinephrine-secreting pheochromocytoma in a normotensive woman with adrenal incidentaloma

Sukor N, Saidin R, Kamaruddin NA

South. Med. J., 2007 Jan;100(1):73-4.

PMID: 17269532

Pheochromocytomas are rare neuroendocrine tumors that produce, metabolize, and usually secrete catecholamines. Although hypertension is a common presenting feature of pheochromocytoma, the tumors occur (or are present) in only 0.1% of patients with hypertension. The variability of symptoms and rarity of occurrence render these tumors difficult to diagnose; many are discovered incidentally during radiological examination or at autopsy. A patient is presented with a pheochromocytoma that was discovered incidentally when she presented with abdominal pain and a normal blood pressure.

Matched MeSH terms: Diagnosis, Differential

Fulltext Marjolin's ulcer--a near forgotten entity

Tan BC, Horton TC, Sara Ahmad T

Med J Malaysia, 2006 Feb;61 Suppl A:91-3.

PMID: 17042239

We report a case of a 55-year-old man who presented with a 6-month history of a fungating ulcer on the right hand at the site of a previously healed ulcer that had been present for 40 years. Histopathological examination of four-quadrant biopsy specimens showed a moderately differentiated squamous cell carcinoma (SCC). A transradiocarpal amputation with stump closure using radial flap was performed as it was not possible to achieve a functionally and cosmetically acceptable hand after a wide excision with 2 cm tumour-free margin. It is our intention to highlight this rare condition as reminder to consider this entity as a differential diagnosis of chronic non-healing skin ulcer.

Matched MeSH terms: Diagnosis, Differential

Endometrial and endocervical secretion: the search for histochemical differentiation

Nieuwenhuizen L, Khalil MK, Venkatesh N, Othman NH

Anal. Quant. Cytol. Histol., 2006 Apr;28(2):87-96.

PMID: 16637511

To determine the ideal histochemical stain to differentiate between non-neoplastic and neoplastic endocervix and endometrium.

Matched MeSH terms: Diagnosis, Differential

Carcinosarcoma of the palate: report of a case with a diagnosis of sarcomatoid metastasis by fine needle aspiration cytology

Jayaram G, Elsayed EM

Acta Cytol., 2005 Sep-Oct;49(5):520-4.

PMID: 16334029

BACKGROUND: Carcinosarcoma (sarcomatoid carcinoma) is a rare tumor with a high predilection for the aerodigestive tract. Cytologic diagnosis of metastatic carcinosarcoma has been reported in very few cases.

CASE: An 84-year-old woman presented with a 2-cm-diameter, right cervical lymph node that was referred for fine needle aspiration cytology (FNAC). She had received radiotherapy for a palatal squamous cell carcinoma 2 years earlier. The FNAC smears had a sarcomatoid appearance. Repeat fine needle aspiration was performed, with cytologic and immunocytochemical staining. Careful consideration of the cytologic and immunophenotypic features led to an impression of carcinosarcoma. Histologic sections of the palatal biopsy that had been previously diagnosed as squamous cell carcinoma were reviewed, and a final diagnosis of carcinosarcoma was established.

CONCLUSION: Metastasis of rare lesions, such as carcinosarcoma may be confusing and difficult to diagnose on FNAC, especially when the cytologic sample shows a predominantly sarcomatoid component. The difficulty is compounded when the sarcomatoid component happens to have been overlooked on the initial histologic assessment. With representative cytologic sampling, immunocytochemical staining and review of the histologic material, the correct diagnosis was achieved in this case.

Matched MeSH terms: Diagnosis, Differential

Fulltext An acute pharyngeal-cervical-brachial (PCB) variant of Guillain-Barre syndrome presenting with isolated bulbar palsy

Hamidon BB

Med J Malaysia, 2006 Jun;61(2):245-7.

PMID: 16898323 MyJurnal

Acute Guillain-Barre syndrome (GBS) is characterized by an acute onset of limb weakness and areflexia. There are a few rare variants that have been described and one of them is the pharyngeal-cervical-brachial (PCB) variant (oropharynx, neck, and proximal upper limb muscles). However, in this patient, the only presentation was bulbar involvement with fast recovery within days. This is likely to be the milder form of PCB that has rarely been described before. A 19-year-old Malay lady presented with progressive dysphagia associated with nasal voice for one week duration. There was no limb weakness. Examination showed generalized areflexia. Pharyngeal and palatal muscles were markedly weak. Cerebrospinal fluid (CSF) examination showed raised protein level. Nerve conduction studies revealed generalized demyelinating motor polyneuropathy consistent with GBS. The patient fully recovered within three days and was discharged well.

Matched MeSH terms: Diagnosis, Differential

Fulltext Unbalanced chromosomal translocation: a cause of recurrent spontaneous abortion

Zarina AL, Jamil MA, Ng SP, Rohana J, Yong SC, Salwati S, et al.

Med J Malaysia, 2006 Jun;61(2):260-2.

PMID: 16898328 MyJurnal

Recurrent spontaneous abortion, defined as three consecutive abortions, occurs in approximately 1% to 2% of couples. Although the cause is unknown in up to 50% of cases, about 5% of these couples are found to be a balanced translocation carrier. We report a case in which the mother was identified to be a translocation carrier following the birth of a baby with multiple congenital abnormalities.

Matched MeSH terms: Diagnosis, Differential

Thyrotoxicosis presenting as hypokalaemic paralysis and hyperlactataemia in an oriental man

Al-Jubouri MA, Inkster GD, Nee PA, Andrews FJ

Ann. Clin. Biochem., 2006 Jul;43(Pt 4):323-5.

PMID: 16824287 DOI: 10.1258/000456306777695681

A 35-year-old Malaysian man presented with rapid onset of flaccid quadriparesis associated with nausea and vomiting. General blood tests revealed severe hypokalaemia (serum potassium 1.5 mmol/L) and hypophosphataemia (serum phosphate 0.29 mmol/L) as a potential cause of the flaccid paralysis. Arterial blood gases showed mixed acid base disturbance of respiratory alkalosis and metabolic acidosis with hyperlactataemia. Thyrotoxic periodic paralysis (TPP) was suspected as the underlying cause of this presentation and thyroid function tests showed severe hyperthyroid results (free T4 > 77.2 pmol/L, free T3 19.3 pmol/L, thyroid-stimulating hormone [TSH] < 0.05 mIU/L). Treatment with intravenous potassium and phosphate infusion and oral propranolol resulted in rapid resolution of his symptoms. A discussion of the clinical and pathophysiological features and treatment of TPP (a very rare encounter in UK clinical practice) is presented, and to our knowledge associated hyperlactataemia has not been previously described.

Matched MeSH terms: Diagnosis, Differential

Chikungunya infection in Malaysia: comparison with dengue infection in adults and predictors of persistent arthralgia

Mohd Zim MA, Sam IC, Omar SF, Chan YF, AbuBakar S, Kamarulzaman A

J Clin Virol, 2013 Feb;56(2):141-5.

PMID: 23201456 DOI: 10.1016/j.jcv.2012.10.019

Chikungunya virus (CHIKV) and dengue virus (DENV) co-circulate in areas endemic with the Aedes mosquito vectors. Both viruses cause similar illnesses which may be difficult to distinguish clinically. CHIKV is also associated with persistent arthralgia.

Matched MeSH terms: Diagnosis, Differential

Cannon's disease: clinical and diagnostic implications: a case report

Ram S, Siar CH

Dent Update, 2004 Nov;31(9):557-9.

PMID: 15612463

Cannon's disease or white sponge naevus is a relatively rare genetically determined skin disorder. It is inherited as an autosomal dominant trait that displays a high degree of penetrance and expressivity. This article describes cases of Cannon's disease in a mother and her son.

Matched MeSH terms: Diagnosis, Differential

Fulltext Granulomatous reaction secondary to intramammary silicone injection

Majedah S, Alhabshi I, Salim S

BMJ Case Rep, 2013;2013.

PMID: 23417932 DOI: 10.1136/bcr-2012-007961

Matched MeSH terms: Diagnosis, Differential

A decision tree for differentiating multiple system atrophy from Parkinson's disease using 3-T MR imaging

Nair SR, Tan LK, Mohd Ramli N, Lim SY, Rahmat K, Mohd Nor H

Eur Radiol, 2013 Jun;23(6):1459-66.

PMID: 23300042 DOI: 10.1007/s00330-012-2759-9

OBJECTIVE: To develop a decision tree based on standard magnetic resonance imaging (MRI) and diffusion tensor imaging to differentiate multiple system atrophy (MSA) from Parkinson's disease (PD).

METHODS: 3-T brain MRI and DTI (diffusion tensor imaging) were performed on 26 PD and 13 MSA patients. Regions of interest (ROIs) were the putamen, substantia nigra, pons, middle cerebellar peduncles (MCP) and cerebellum. Linear, volumetry and DTI (fractional anisotropy and mean diffusivity) were measured. A three-node decision tree was formulated, with design goals being 100 % specificity at node 1, 100 % sensitivity at node 2 and highest combined sensitivity and specificity at node 3.

RESULTS: Nine parameters (mean width, fractional anisotropy (FA) and mean diffusivity (MD) of MCP; anteroposterior diameter of pons; cerebellar FA and volume; pons and mean putamen volume; mean FA substantia nigra compacta-rostral) showed statistically significant (P < 0.05) differences between MSA and PD with mean MCP width, anteroposterior diameter of pons and mean FA MCP chosen for the decision tree. Threshold values were 14.6 mm, 21.8 mm and 0.55, respectively. Overall performance of the decision tree was 92 % sensitivity, 96 % specificity, 92 % PPV and 96 % NPV. Twelve out of 13 MSA patients were accurately classified.

CONCLUSION: Formation of the decision tree using these parameters was both descriptive and predictive in differentiating between MSA and PD.

KEY POINTS: • Parkinson's disease and multiple system atrophy can be distinguished on MR imaging. • Combined conventional MRI and diffusion tensor imaging improves the accuracy of diagnosis. • A decision tree is descriptive and predictive in differentiating between clinical entities. • A decision tree can reliably differentiate Parkinson's disease from multiple system atrophy.

Matched MeSH terms: Diagnosis, Differential

Fulltext Bronchiolitis obliterans organising pneumonia: a treatable condition

Hooi LN

Med J Malaysia, 2005 Jun;60(2):222-5.

PMID: 16114165

Bronchiolitis obliterans organising peumonia BOO) is an uncommon inflammatory lung condition involving the terminal bronchioles and alveoli, which is responsive to treatment with corticosteroids. Patients usually present with dyspnoea, cough and fever. Two cases are described here; both had haemoptysis and were initially treated as community acquired pneumonia. Diagnosis was made on lung biopsy and there was rapid resolution after a course of prednisolone.

Matched MeSH terms: Diagnosis, Differential

Fulltext Tarsal tunnel syndrome caused by ganglion

Ng WM, Chan KY

Med J Malaysia, 2004 Dec;59 Suppl F:69-71.

PMID: 15941169

We report a case of delayed diagnosis of tarsal tunnel syndrome caused by a ganglion arising from the talo-calcaneal joint. Unusually the symptoms were mainly due to the lateral planter nerve compression with a positive Tinel's sign. A surgical decompression was successful in relieving the dysaesthesia in spite of a 7 years history.

Matched MeSH terms: Diagnosis, Differential

Fulltext Kikuchi's lymphadenitis (necrotizing lymphadenitis) and systemic lupus erythematosus: a case report

Fernandez SH

Malays J Pathol, 2000 Jun;22(1):25-9.

PMID: 16329534

A 26-year-old Indian lady was admitted for lower abdominal pain, diarrhoea, vomiting, fever and cough. The initial diagnosis was that of peritonitis secondary to ruptured or perforated viscus with lobar pneumonia. On laparotomy, she was found to have necrotizing or Kikuchi's lymphadenitis of the abdominal lymph nodes. The initial two antinuclear antibody (ANA) results came back negative. She was diagnosed to have systemic lupus erythematosus (SLE) when the third sample for ANA came back positive and the double-stranded DNA (dsDNA) antibody test was homogenously positive. This case illustrates a need to be aware that necrotizing lymphadenitis can precede the onset of systemic lupus erythematosus.

Matched MeSH terms: Diagnosis, Differential

Fisher's unique variant in Stocker's type II congenital cystic adenomatoid malformation of the lung: a case report

Darnal HK, Ibrahim H, Mutum SS

Malays J Pathol, 2000 Jun;22(1):31-5.

PMID: 16329535

An eight-week-old infant presented with dyspnoea two months after an uneventful normal vaginal delivery. Radiologically, a sharply outlined radiolucent area surrounded by atelectasis was seen in the upper lobe of the left lung. A left upper lobectomy was performed with the clinical impression of congenital pulmonary emphysema. The resected specimen displayed multiple cysts 2 to 6 mm in diameter. Microscopically, intracystic papillary mesenchymal ingrowths lined by respiratory epithelium were present. Based on both the gross and microscopical features, a diagnosis of Fisher's variant of type II congenital cystic adenomatoid malformation (CAM) was made. The postoperative follow-up showed excellent recovery and normal development of the child.

Matched MeSH terms: Diagnosis, Differential

Fulltext Malignant melanoma of the gastrointestinal tract presenting as a bleeding gastric ulcer

Noraidah M, Jasmi AY

Malays J Pathol, 2003 Jun;25(1):57-61.

PMID: 16196379

Malignant melanoma involving the gastrointestinal tract is diagnosed antemortem in only a small percentage of patients with the disease. Presenting symptoms are often non-specific, causing a diagnostic problem. The vast majority of such melanomas are metastatic from a cutaneous primary, however there is evidence that the tumour can arise de novo in the gastrointestinal system. We report a 74-year-old man with malignant melanoma with an unusual presentation simulating a symptomatic gastric ulcer. He presented with epigastric pain, haematemesis and melaena. Explorative laparotomy revealed a large ulcerated tumour with several pigmented satellite nodules in the proximal stomach, multiple ileal nodules and widespread nodal and liver metastases. Proximal gastrectomy and limited small bowel resection was performed. Histology revealed the tumour to be composed of nests of epithelioid cells with melanin pigment. The tumour cells showed immunohistochemical positivity for S100 protein and HMB45 antibodies. This report emphasizes that melanoma should be a diagnostic consideration in patients with gastric ulcer.

Matched MeSH terms: Diagnosis, Differential

Fulltext Clinical evaluation of dengue and identification of risk factors for severe disease: protocol for a multicentre study in 8 countries

Jaenisch T, Tam DT, Kieu NT, Van Ngoc T, Nam NT, Van Kinh N, et al.

BMC Infect Dis, 2016 Mar 11;16:120.

PMID: 26968374 DOI: 10.1186/s12879-016-1440-3

The burden of dengue continues to increase globally, with an estimated 100 million clinically apparent infections occurring each year. Although most dengue infections are asymptomatic, patients can present with a wide spectrum of clinical symptoms ranging from mild febrile illness through to severe manifestations of bleeding, organ impairment, and hypovolaemic shock due to a systemic vascular leak syndrome. Clinical diagnosis of dengue and identification of which patients are likely to develop severe disease remain challenging. This study aims to improve diagnosis and clinical management through approaches designed a) to differentiate between dengue and other common febrile illness within 72 h of fever onset, and b) among patients with dengue to identify markers that are predictive of the likelihood of evolving to a more severe disease course.

Matched MeSH terms: Diagnosis, Differential

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