MyMedR

Base of tongue tuberculosis: a case report

Hussaini J, Mutusamy S, Omar R, Rajagopalan R, Narayanan P

Acta Med Iran, 2012;50(2):151-2.

We report a rare case of base of tongue tuberculosis following pulmonary tuberculosis. Patient presented to us with chief complaints of sore throat and pain on swallowing for period of 3 months. On examination with 70 degree telescope, we observed an ulcer on right side of base of tongue. The edges of the ulcer appeared to be undermined with whitish slough at the centre of the ulcer. Examination of neck showed a multiple small palpable middle deep cervical lymph nodes on right side of neck. Biopsy of the ulcer was taken, which showed granulomatous inflammation, suggestive of tuberculosis. Laboratory investigations revealed a raise in erythrocyte sedimentation rate, sputum for acid fast bacilli was strongly positive. Chest X ray was performed for patient showed multiple areas of consolidation. Patient was referred to chest clinic for further management of tuberculosis and was started on anti-tuberculous drugs. In conclusion tuberculosis of oral cavity is rare, but should be considered among one of the differential diagnosis of the oral lesions and biopsy is necessary to confirm the diagnosis.

Matched MeSH terms: Diagnosis, Differential

Basilar invagination: A mimicker of bulbar-onset amyotrophic lateral sclerosis

Tan JSH, Lee S, Hiew FL

eNeurologicalSci, 2021 Mar;22:100321.

PMID: 33553704 DOI: 10.1016/j.ensci.2021.100321

Amyotrophic lateral sclerosis (ALS) is characterized by progressive onset motor deficits with heterogenous presentations ranging from dysarthria to foot drop. Approximately 20% of the patients present with focal bulbar symptoms, in which some may remain restricted to bulbar region (isolated bulbar palsy), and the remaining eventually spreads to involve other body regions (classical ALS). Without accompanying upper and lower motor neurons signs elsewhere, differential diagnoses for isolated bulbar symptoms are extensive, include ALS variants as well as potentially treatable mimics. Therefore, it is important to take heed on every possible aetiology that may disrupt the hypoglossal nucleus, nerve, or lingual muscle itself. Herein, we illustrated a rare presentation of Group A basilar invagination, which mimicked bulbar-onset ALS.

Matched MeSH terms: Diagnosis, Differential

Fulltext Benign Lymphoepithelial Cyst: An Unusual Cause of Parotid Swelling in Two Immunocompetent Patients

Thong HK, Athar PPSH, Mustaffa WMW

Open Access Maced J Med Sci, 2019 Jul 15;7(13):2142-2145.

PMID: 31456841 DOI: 10.3889/oamjms.2019.577

BACKGROUND: Lymphoepithelial cysts, which are benign and slow-growing tumours, usually involve the head and neck regions. Benign lymphoepithelial cysts (BLECs) are the most common cause of parotid swelling in human immunodeficiency virus (HIV)-positive patients and are less common in immunocompetent patients.

CASE PRESENTATION: Here, we present two cases of immunocompetent patients with long-standing, progressively enlarging parotid swelling. Postoperative histopathological examination of these patients revealed features of BLEC.

CONCLUSION: Wide surgical excision is the gold standard for treatment and recurrences is rare. These cases are of particular interest because of the rarity of BLEC in HIV-negative patients and highlight an important differential diagnosis of parotid swelling.

Matched MeSH terms: Diagnosis, Differential

Benign chondroid syringoma of the orbit: an atypical location

Yap JF, Madatang A, Hanafi H

Orbit, 2020 Apr;39(2):135-138.

PMID: 31023118 DOI: 10.1080/01676830.2019.1604766

A 31-year-old male with no known medical illness presented with painless left eye protrusion for the past 2 years. Radiographic features were of an extraconal superior orbital mass with no invasion of adjacent structures. The patient underwent an excisional biopsy of the left superior extraconal mass a week later. The histopathological examination revealed a well-circumscribed lobulated mass with chondroid and myxoid stroma enveloping benign bland-appearing epithelial and myoepithelial cells. These pathological features were consistent with benign chondroid syringoma of the orbit. The patient had an uneventful recovery with no active ocular complaint post-operatively.Despite chondroid syringoma of the orbit being a rare tumour, it should be considered in the differential diagnosis of periorbital masses. Excision of the tumour remains the treatment of choice with histopathological examination as the gold standard of diagnosis. Regular follow-up is warranted in view of possible local recurrence or metastasis.

Matched MeSH terms: Diagnosis, Differential

Fulltext Benign cystic teratoma in a two-year-old child: a case study

Thavarasah AS, Shanta Krishnamurthi, Gururaj Aithala

Med J Malaysia, 1986 Jun;41(2):170-2.

PMID: 3821615

A case of benign cystic teratoma, sufficiently large to present as an abdominal mass with pressure signs on the right ureter in a two-year old child is presented, the lowest age in this country recorded.

Matched MeSH terms: Diagnosis, Differential

Benign osteoblastoma of the maxilla

Yip WK, Lee HT

Oral Surg. Oral Med. Oral Pathol., 1974 Aug;38(2):259-63.

PMID: 4528442

Matched MeSH terms: Diagnosis, Differential

Fulltext Bertolotti's syndrome: A commonly missed cause of back pain in young patients

Manmohan S, Dzulkarnain A, Nor Azlin ZA, Fazir M

Malays Fam Physician, 2015;10(2):55-8.

PMID: 27099663

Bertolotti's syndrome must be considered as a differential diagnosis for lower back pain in young people. Treatment, whether conservative or operative, is still debatable. In this paper, we report a case of a 20-year-old girl presenting with lower back pain for 8 years. We administered injection with local anaesthetic and steroid injections within the pseudo-articulation; however, the pain was relieved for 3 weeks. Surgical excision of the pseudo-articulation successfully treated her back pain and the sciatica.

Matched MeSH terms: Diagnosis, Differential

Fulltext Biatrial thrombi resembling myxoma regressed after prolonged anticoagulation in a patient with mitral stenosis: a case report

Lu HT, Nordin R, Othman N, Choy CN, Kam JY, Leo BC, et al.

J Med Case Rep, 2016 Aug 10;10(1):221.

PMID: 27510438 DOI: 10.1186/s13256-016-1018-0

BACKGROUND: Many cases of cardiac masses have been reported in the literature, but in this case report we described a rare case of biatrial cardiac mass that represented a challenge for diagnosis and therapy. The differentiation between cardiac masses such as thrombi, vegetations, myxomas and other tumors is not always straightforward and an exact diagnosis is important because of its distinct treatment strategy. Transthoracic/esophageal echocardiography and cardiac magnetic resonance play an important role in establishing the diagnosis of cardiac masses. However, no current noninvasive diagnostic tool has the ability to absolutely diagnose cardiac masses; obtaining a pathological specimen by surgical resection of cardiac masses is the only reliable method to diagnose cardiac masses accurately. Our case report is an exception in that the final diagnosis was affirmed by empirical anticoagulation therapy based on clinical judgment and noninvasive characterization of biatrial mass.

CASE PRESENTATION: We described a 54-year-old Malay man with severe mitral stenosis and atrial fibrillation who presented with a biatrial mass. Transthoracic/esophageal echocardiography and cardiac magnetic resonance detected a large, homogeneous right atrial mass typical of a thrombus, and a left atrial mass adhering to interatrial septum that mimicked atrial myxoma. The risk factors, morphology, location, and characteristics of the biatrial cardiac mass indicated a diagnosis of thrombi. However, our patient declined surgery. As a result, the nature of his cardiac masses was not specified by histology. Of note, his left atrial mass was completely regressed by long-term warfarin, leaving a residual right atrial mass. Thus, we affirmed the most probable diagnosis of cardiac thrombi. During the course of treatment, he had an episode of non-fatal ischemic stroke most probably because of a thromboembolism.

CONCLUSIONS: Noninvasive characterization of cardiac mass is essential in clarifying the diagnosis and directing treatment strategy. Anticoagulation is a feasible treatment when the clinical assessment, risk factors, and imaging findings indicate a diagnosis of thrombi. After prolonged anticoagulation therapy, complete resolution of biatrial thrombi was achievable in our case.

Matched MeSH terms: Diagnosis, Differential

Bickerstaff's brainstem encephalitis with overlapping Guillain-Barré syndrome: Usefulness of sequential nerve conduction studies

Fong CY, Aung HWW, Khairani A, Gan CS, Shahrizaila N, Goh KJ

Brain Dev, 2018 Jun;40(6):507-511.

PMID: 29459060 DOI: 10.1016/j.braindev.2018.02.001

Bickerstaff's brainstem encephalitis (BBE) is a rare immune-mediated disorder characterized by ophthalmoplegia, ataxia and disturbance of consciousness, which may overlap with Guillain-Barré syndrome (GBS) if there is additional limb weakness. We report a 7-month-old boy presented with ophthalmoplegia followed by a rapidly ascending paralysis of all four limbs and disturbance of consciousness. The initial impression was BBE with overlapping GBS. This was supported by sequential nerve conduction study (NCS) findings compatible with an acute inflammatory demyelinating polyneuropathy (AIDP). He received intravenous pulse methylprednisolone, intravenous immunoglobulin and plasmapharesis with complete clinical recovery after 6 weeks of illness and improved NCS findings from week 16. This is the first case of paediatric BBE with overlapping GBS with an AIDP subtype of GBS. It expands the clinical spectrum of this condition in children. Our case highlights the importance of sequential NCS in paediatric BBE with overlapping GBS for accurate electrophysiological diagnosis and prognosis particularly if the first NCS findings are not informative.

Matched MeSH terms: Diagnosis, Differential

Fulltext Bilateral adrenal histoplasmosis: endoscopic ultrasound-guided fine needle aspiration as a method of diagnosis and assessment

Khairul Azhar J, Jacqueline HSG, Tony LKH, Tan BH, Steven JM

Med J Malaysia, 2011 Dec;66(5):504-6.

PMID: 22390113

We report a case of a healthy 78-year-old indonesian man who presented with chronic weight loss, poor appetite and lethargy. CT abdomen showed bilateral adrenal masses. EUS-guided FNA was performed on the left adrenal gland. Histopathology report was Histoplasma Capsulatum. He recovered well with antifungal treatment without any complication. In this case, we found that the role of EUS -guided FNA was not only limited to diagnosis but also helped in the prognosis of the disease since the method was able to assess the general anatomy of the adrenal gland better than other imaging modalities due to its close proximity and direct visualization.

Matched MeSH terms: Diagnosis, Differential

Fulltext Bilateral epidural extension of thoracic capillary vertebral (intraosseous) hemangioma mimicking spinal meningioma

Kan CH, Saw CB, Rozaini R, Fauziah K, Ng CM, Saffari MH

Med J Malaysia, 2008 Jun;63(2):154-6.

PMID: 18942307 MyJurnal

We describe a rare case of vertebra (intraosseous) hemangioma with bilateral and symmetrical epidural extension causing cord compression in a 24-year-old woman. The epidural component was isointense to cord on both T1 and T2 sequences, and enhanced markedly and homogenously following gadolinium administration. The gradual in onset and progressive nature with the typical enhancing pattern lead the neurosurgeon to the more common diagnosis of spinal meningioma. Epidural extension of vertebral hemangiomas causing cord compression is rarely reported. Review of literatures reveal that cases that have been reported are of unilateral extension into epidural space and of cavernous type. This is the first case report of capillary vertebral (intraossous) hemangioma with bilateral extension through both intervetebral foramen into the epidural space causing myelopathy.

Matched MeSH terms: Diagnosis, Differential

Fulltext Bilateral maxillary sinus cholesterol granuloma: a rare entity

Marina MB, Gendeh BS

Med J Malaysia, 2006 Jun;61(2):226-8.

PMID: 16898317

Cholesterol granuloma in the paranasal sinuses is rare. It is more common in the mastoid antrum and temporal bone air cells in chronic middle ear disease. A case of bilateral maxillary sinus cholesterol granuloma that mimics chronic maxillary sinusitis is reported. This is the first reported case of cholesterol granuloma of the maxillary sinus in the Malaysian Literature.

Matched MeSH terms: Diagnosis, Differential

Fulltext Bilateral spontaneous persistent open pneumothorax with chylothorax

Khajotia R, Raman S

Can Fam Physician, 2012 Jul;58(7):757-60.

PMID: 22859639

Matched MeSH terms: Diagnosis, Differential

Fulltext Bilateral tension pneumothorax after acupuncture

Mohammad N

BMJ Case Rep, 2018 Apr 19;2018.

PMID: 29674395 DOI: 10.1136/bcr-2017-221550

Acupuncture is an ancient complementary medicine which is currently used worldwide. Many serious adverse events have been reported which include a spectrum of mild-to-fatal complications. However, the level of awareness with regard to complications is still low both to physicians and patients. We report a 63-year-old who presented with acute shortness of breath 2 hours after having had acupuncture. On examination, there was absent breath sound heard on the left lung and slightly reduced breath sound on the right lung. She had type 1 respiratory failure. Urgent chest radiograph confirmed bilateral pneumothorax which was more severe on the left with tension pneumothorax and mediastinal shift. Chest tubes were inserted bilaterally after failed needle aspiration attempts. Subsequently, the pneumothoraces resolved, and she was discharged well. The bilateral pneumothoraces caused by acupuncture were curable but could have been potentially fatal if diagnosis was delayed. This case report adds to the limited current literature on the complications of acupuncture leading to bilateral pneumothoraces.

Matched MeSH terms: Diagnosis, Differential

Fulltext Biliary cystadenoma - computed tomography findings

Ariff A, Hassan H, John G

Malays J Med Sci, 2002 Jan;9(1):49-51.

PMID: 22969318

Biliary cystadenoma is a rare neoplasm of the biliary ductal system. Surgical management yields an excellent result. We present a case of recurrent biliary cystadenoma in the left lobe of the liver. The cyst was successfully treated with hepatic segmentectomy. The lobulated smoothly marginated septated cystic lesion noted on computed tomography (CT) were highlighted and the other imaging studies, differential diagnosis and management were reviewed.

Matched MeSH terms: Diagnosis, Differential

Biliary cystadenoma: A rare occurrence

Peh KH, Eugene Chan BT

Med J Malaysia, 2020 05;75(3):307-308.

PMID: 32467552

Biliary cystadenoma is a rare benign tumour with the potential to transform into malignant carcinoma of the biliary ductal system. There is difficulty in differentiating a benign one from a malignant biliary cystadenoma, and therefore these lesions should always be completely resected. We report a case of biliary cystadenoma which underwent a complete resection.

Matched MeSH terms: Diagnosis, Differential

Fulltext Bimaxillary concomitant hypohyperdontia in a 10-year-old child

Kariya PB, Singh S, Kulkarni N, Arora A

BMJ Case Rep, 2017 Aug 10;2017.

PMID: 28798243 DOI: 10.1136/bcr-2017-220683

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.

Matched MeSH terms: Diagnosis, Differential

Biofluid Markers of Equine Neurological Disorders Reviewed From Human Perspectives

Mayaki AM, Abdul Razak IS, Noraniza MA, Mazlina M, Rasedee A

J Equine Vet Sci, 2020 03;86:102907.

PMID: 32067661 DOI: 10.1016/j.jevs.2019.102907

Neurological disorders (NDs) are often fatal to horses. Thus, symptoms of equine NDs commonly indicate euthanasia. Current diagnostic approaches for equine NDs is based on clinical signs, differential diagnoses, analysis of cerebrospinal fluid (CSF), assessment of histopathological lesions, and imaging. However, advances in biofluid biomarkers in the diagnosis of human neurological diseases can potentially be applied to equine NDs. In this review, we described the established human blood and CSF neurobiomarkers that could potentially be used to diagnose equine NDs.

Matched MeSH terms: Diagnosis, Differential

Black hairy tongue in older edentulous individuals

Kannan S, Muthusamy S, Chandrasekaran B, Gopal D, Sidhu P

J Am Geriatr Soc, 2014 May;62(5):992-4.

PMID: 24828937 DOI: 10.1111/jgs.12813

Matched MeSH terms: Diagnosis, Differential

Fulltext Bladder outflow obstruction masquerading as pelviureteric junction (PUJ) obstruction

Teh CL, Lei CC, Khairullah A

Med J Malaysia, 1996 Mar;51(1):156-8.

PMID: 10968001

We report a case of bladder outflow obstruction presenting with upper tract dilatation mistaken initially as pelviureteric junction (PUJ) obstruction. The lower tract obstruction ought to be dealt with first before upper tract obstruction is assessed because the renal pelvic pressure is significantly affected by vesical filling and high bladder pressure.

Matched MeSH terms: Diagnosis, Differential

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