MyMedR

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

Haemolytic anaemia precipitated by dengue fever

Abdullah NH, Mohammad N, Ramli M, Wan Ghazali WS

BMJ Case Rep, 2019 Aug 28;12(8).

PMID: 31466966 DOI: 10.1136/bcr-2018-226760

We reported a case of a woman with no past medical illness who presented with a few days' history of fever, myalgia, arthralgia, hypochromic microcytic anaemia and thrombocytopaenia and who was nonstructural protein 1 antigen (NS1Ag)-positive. Haemolytic anaemia including full blood picture work-up revealed high reticulocyte count and haemolysis with positive direct Coombs test. She was started on prednisolone and was discharged well.

Matched MeSH terms: Diagnosis, Differential

Fulltext Systemic lupus erythematosus and melioidosis

Che Rahim MJ, Mohammad N, Kamaruddin MI, Wan Ghazali WS

BMJ Case Rep, 2019 Jul 01;12(7).

PMID: 31266760 DOI: 10.1136/bcr-2019-229974

We reported a case of a young female patient presented with sepsis and diagnosed with melioidosis and systemic lupus erythematosus (SLE) within the same admission. She presented with 1-week history of productive cough, progressive dyspnoea together with prolonged fever, arthralgia, rashes and oral ulcers. She had septicemic shock, respiratory failure requiring intubation and ventilation in intensive care unit and subsequently developed acute renal failure requiring haemodialysis. Antibiotics and immunosuppressive treatment including low-dose intravenous cyclophosphamide were commenced. She had a remarkable recovery and was discharged after 6 weeks. There was no evidence of active SLE or relapse of melioidosis during clinic follow-ups.

Matched MeSH terms: Diagnosis, Differential

Pyopneumothorax secondary to Streptococcus milleri infection

Che Rahim MJ, Mohammad N, Wan Ghazali WS

BMJ Case Rep, 2016 Nov 23;2016.

PMID: 27881590 DOI: 10.1136/bcr-2016-217537

We report a case of a 46-year-old Malay woman with underlying hypothyroidism post thyroidectomy who presented with worsening breathlessness, orthopnoea, productive cough and left-sided pleuritic chest pain of 3 days duration. Chest X-ray on admission showed left-sided massive hydropneumothorax. Pleural tapping revealed empyema. A chest tube was inserted immediately. The culture of pleural fluid grew Streptococcus constellatus The patient was treated with antibiotics for a total of 6 weeks and underwent open thoracotomy and decortication during admission. Subsequently, her lung condition improved and there was no evidence of recurrence during follow-up.

Matched MeSH terms: Diagnosis, Differential

Eosinophilic granulomatosis with polyangiitis and mononeuritis multiplex responded to induction cyclophosphamide

Mohammad N, Wan Ghazali WS

BMJ Case Rep, 2017 May 27;2017.

PMID: 28551593 DOI: 10.1136/bcr-2016-218252

We report a case of 28-year-old Malay woman who initially presented with multiple joints pain with underlying poorly controlled asthma since her childhood. She was treated as seronegative arthritis. However, the involvement of joints, asthma and high-eosinophil counts raised suspicion of Churg-Strauss syndrome. This disease is undoubtedly rare in Malaysians or even in Asian populations. After appropriate therapy was delivered for the correct diagnosis her clinical condition improved. She is currently receiving maintenance treatment.

Matched MeSH terms: Diagnosis, Differential

Fulltext Intracranial bleeding (ICB) as a catastrophic complication of Streptococcus gordonii infective endocarditis (IE) in an immunocompetent patient

Pairan MS, Mohammad N, Abdul Halim S, Wan Ghazali WS

BMJ Case Rep, 2018 Sep 10;2018.

PMID: 30206067 DOI: 10.1136/bcr-2018-225265

We present an interesting case of late-onset intracranial bleeding (ICB) as a complication of Streptococcus gordonii causing infective endocarditis. A previously healthy young woman was diagnosed with infective endocarditis. While she was already on treatment for 2 weeks, she had developed seizures with a localising neurological sign. An urgent non-contrasted CT brain showed massive left frontoparietal intraparenchymal bleeding. Although CT angiogram showed no evidence of active bleeding or contrast blush, massive ICB secondary to vascular complication of infective endocarditis was very likely. An urgent decompressive craniectomy with clot evacuation was done immediately to release the mass effect. She completed total 6 weeks of antibiotics and had postoperative uneventful hospital stay despite having a permanent global aphasia as a sequel of the ICB.

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

Fulltext A misdiagnosed infection mimicking "tree man disease"

Lim JA, Ismail Z, Ibrahim CN, Chong SE, Wan Abdullah WNH

PLoS Negl Trop Dis, 2017 06;11(6):e0005543.

PMID: 28617806 DOI: 10.1371/journal.pntd.0005543

Matched MeSH terms: Diagnosis, Differential

Fulltext An interesting case of systemic lupus erythematosus presenting with hypercalcemia: A diagnostic dilemma

Abdul Gafor AH, Cader RA, Das S, Masir N, Wahid FA

Am J Case Rep, 2013;14:1-3.

PMID: 23569551 DOI: 10.12659/AJCR.883849

BACKGROUND: Hypercalcemia is common in primary hyperparathyroidism malignancies and even in tuberculosis. Interestingly, systemic lupus erythematosus (SLE) rarely presents with hypercalcemia.
CASE REPORT: We describe an interesting case of SLE in a patient who was otherwise thought to have either tuberculosis or a malignancy. The patient initially presented with feeling unwell, with generalized lymphadenopathy, bilateral pleural effusion, and bilateral corneal calcium deposits secondary to severe hypercalcemia. The diagnosis of SLE was made based on positivity of antinuclear antibodies (ANA) and anti-dsDNA, the presence of serositis, lymphadenopathy, autoimmune hemolytic anemia, and constitutional symptoms. She was treated with steroids, with tremendous improvement in her general well-being, resolution of lymphadenopathy and pleural effusion, and normalization of her hemoglobin and serum calcium. The atypical presentation of SLE with hypercalcemia with pleural effusion is discussed.
CONCLUSIONS: SLE should be one of the differential diagnoses in patients presenting with severe hypercalcemia.
KEYWORDS: atypical presentation; hypercalcemia; systemic lupus erythematosus

Matched MeSH terms: Diagnosis, Differential

Colon carcinoma with endobronchial metastasis masquerading as bronchial asthma causing ball valve effect

Kho SS, Yong MC, Chan SK, Tie ST, Voon PJ

Med J Malaysia, 2018 12;73(6):403-404.

PMID: 30647213

Malignant central airway obstruction (CAO) with ball valve effect (BVE) in the lung is rare. We discuss a case of metastatic colon cancer who presented with asthma like symptoms which thoracic computed tomography and bronchoscopy revealed an intraluminal tumour obstructing the left main bronchus in a ball valve manner. Airway patency was restored urgently with immediate alleviation of symptoms. This illustrates the importance of recognizing subtle features of central airway obstruction to allow expedition of appropriate investigations and therapy.

Matched MeSH terms: Diagnosis, Differential

Case 263: Malaysian Charm Needles (Susuk)

Martin JL, Vlachou PA

Radiology, 2019 03;290(3):843-847.

PMID: 30789811 DOI: 10.1148/radiol.2019162113

History A 58-year-old woman was seen in the rheumatology clinic for bilateral wrist and knee pain that was unresponsive to physiotherapy and intra-articular steroid injections. Remote fracture of the left tibia from a motor vehicle collision was reported and was previously treated with conservative management. Serologic work-up for inflammatory disease was negative. The patient reported no prior surgical or medical history. Social history revealed remote immigration from Malaysia. Radiographs of the hands and knees were obtained.

Matched MeSH terms: Diagnosis, Differential

Fulltext Spinal cryptoccoma mimicking a spinal cord tumor complicated by cryptococcal meningitis in an immunocompetent patient

Carol L, Tai MS, Yusoff SM, Rose N, Rafia MH, Viswanathan S

Neurol India, 2018 7 25;66(4):1181-1183.

PMID: 30038119 DOI: 10.4103/0028-3886.237012

Matched MeSH terms: Diagnosis, Differential

Localization and prediction of malignant potential in recurrent pheochromocytoma/paraganglioma (PCC/PGL) using 18F-FDG PET/CT

Fikri AS, Kroiss A, Ahmad AZ, Zanariah H, Lau WF, Uprimny C, et al.

Acta Radiol, 2014 Jun;55(5):631-40.

PMID: 24037430 DOI: 10.1177/0284185113504330

To our knowledge, data are lacking on the role of 18F-FDG PET/CT in the localization and prediction of neuroendocrine tumors, in particular the pheochromocytoma/paraganglioma (PCC/PGL) group.

Matched MeSH terms: Diagnosis, Differential

Fulltext The clinical spectrum of ocular bartonellosis: a retrospective study at a tertiary centre in Malaysia

Tey MS, Govindasamy G, Vendargon FM

J Ophthalmic Inflamm Infect, 2020 Nov 16;10(1):31.

PMID: 33191467 DOI: 10.1186/s12348-020-00224-0

BACKGROUND: Cat scratch disease (CSD) is a systemic illness caused by the gram-negative bacillus, Bartonella henselea, which can occasionally involve the ocular structures. The objective of this study is to evaluate the various clinical presentations of ocular bartonellosis at our institution. A retrospective review of the clinical records of 13 patients (23 eyes) with ocular manifestations of Bartonella infections over a 3-year period between January 2016 to December 2018 was undertaken at our institution.

RESULTS: The diagnosis was made based on clinical findings and in addition, with the support of the evidence of Bartonella hensalae IgG and/or IgM. Small retinal white lesions were the most common ocular findings in this series of patients (82.6% of eyes, 76.9% of patients). Neuroretinitis was the second most common finding (47.8% of eyes, 69.2% of patients), followed by exudative retinal detachment involving the macula (34.8% of eyes, 53.8% of patients) and Parinaud's oculoglandular syndrome (17.4% of eyes, 23.1% of patients). Other findings like isolated optic disc oedema without macular star (8.7% of eyes, 15.4% of patients) and vitritis (4.3% of eyes, 7.7% of patients) were also observed. Ten patients (76.9%) had bilateral ocular involvement. Most of the patients were young, immunocompetent and had systemic symptoms like fever prior to their ocular symptoms. The visual acuity (VA) at initial presentation ranged from 6/6 to hand movement (mean, 6/20), and at final visit 6/6 to 6/60, (mean, 6/9). 91.7% of patients were treated with antibiotics. Only 2 patients received oral corticosteroids together with antibiotics due to very poor vision on presentation. The visual prognosis of ocular bartonellosis is generally good with 16 (88.9%) of 23 eyes having VA of 6/12 or better at final follow-up visit.

CONCLUSION: Small foci of retinal white lesions were the most common manifestation of ocular bartonellosis in this series, followed by neuroretinitis, though an array of other ocular findings may also occur. Therefore, we should consider bartonella infection as a possible differential diagnosis in those patients.

Matched MeSH terms: Diagnosis, Differential

Fulltext Problem based review: The patient with a pyrexia of unknown origin

Woolley AK, Hedger NA, Veettil RP

Acute Med, 2013;12(2):107-10.

PMID: 23732136

Pyrexia of unknown origin (PUO) is a frequent presentation to the Acute Medical Unit, and is a source of significant morbidity, both the psychological burden of an uncertain diagnosis and prognosis and untreated complications of the underlying pathology. We present a problem based review of the management of PUO, illustrated by a patient who recently presented to our unit with fever and systemic malaise after returning from abroad and in whom no cause could be found for more than two months. We describe a structured approach making use of complex modern techniques such as Positron Emission Tomography-Computed Tomography (PET-CT) which ultimately provided the diagnosis for our patient.

Matched MeSH terms: Diagnosis, Differential

Ocular myasthenia gravis and idiopathic orbital inflammatory disease: double the trouble!

Sharudin SN, Govindasamy G, Mohamad NF, Kanesalingam R, Vasudevan SK

Can J Ophthalmol, 2018 04;53(2):e55-e58.

PMID: 29631841 DOI: 10.1016/j.jcjo.2017.07.024

Matched MeSH terms: Diagnosis, Differential

Fulltext Optic disc swelling in a patient with tuberculous meningitis: a diagnostic challenge

Zuhaimy H, Leow SN, Vasudevan SK

BMJ Case Rep, 2017 Aug 09;2017.

PMID: 28794092 DOI: 10.1136/bcr-2017-221170

We discuss the diagnostic challenge in an adult patient presented with purely ocular symptoms diagnosed with tuberculous meningitis (TBM). A 38-year-old woman presented with bilateral painless blurring of vision. There were bilateral sixth cranial nerve palsy and bilateral optic disc swelling. Optic nerve function tests were normal. Patient was lucid with no signs of meningism. Brain imaging were normal. She had a positive Mantoux test, high erythrocyte sedimentation rate but no clinical evidence of active pulmonary tuberculosis infection. Her Quantiferon-TB Gold in-tube test was negative. Cerebrospinal fluid analysis revealed a high opening pressure but no biochemical parameters to suggest TBM, hence she was treated as idiopathic intracranial hypertension. A diagnosis of TBM was finally made following a positive PCR for Mycobacterium tuberculosis Her vision improved with reduction in optic disc swelling following antituberculous treatment.

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

Fulltext Aerodigestive amyloidosis presenting as acute asthma

Sreetharan SS, Prepageran N, Razak A, Valuyeetham KA

Med J Malaysia, 2003 Jun;58(2):290-3.

PMID: 14569753

Aerodigestive amyloidosis is a rare disorder characterized by fibrillar protein deposition in the aerodigestive tree. We present a case of a 19-year-old Chinese gentleman whose diagnosis was initially missed as he presented with features suggestive of severe bronchial asthma and was intubated and ventilated. He subsequently presented 2 years later with severe stridor and required emergency tracheostomy. Current literature is reviewed for the histopathology, common clinical features, radiological findings and treatment options for aerodigestive amyloidosis.

Matched MeSH terms: Diagnosis, Differential

The masquerades of female pelvic tuberculosis: case reports and review of literature on clinical presentations and diagnosis

Chow TW, Lim BK, Vallipuram S

J Obstet Gynaecol Res, 2002 Aug;28(4):203-10.

PMID: 12452262

In this review, tuberculosis of the genital tract was diagnosed retrospectively in 11 females over 15 years. The presentations of nine cases are described. Seven of the nine cases presented with ascites, vague abdominal distension, weight loss and were misdiagnosed as ovarian carcinoma. Eight women had no relevant past history. A review on clinical presentations and diagnosis of pelvic tuberculosis is presented. We conclude that although the incidence of tuberculosis is uncommon in developed countries, its prevalence appears to be increasing worldwide. Therefore, clinicians should consider tuberculosis as a differential diagnosis when encountering clinical presentations of pelvic mass and ascites.

Matched MeSH terms: Diagnosis, Differential

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