Undernutrition remains a major public health concern, especially in developing countries. Despite
being rich in resources, Malaysia is still home to children sufering from severe undernutrition.
Tis paper presents the case of a 5-month-old boy with kwashiorkor stemming from improper
weaning which was overlooked. Tis case highlights the importance of recognizing the early signs of
kwashiorkor to allow for early referrals for proper management and prevent its possible complications.
Introduction: A foreign body (FB) in the upper aerodigestive tract is a fairly common encounter.
Fish bones are the commonest FB seen in adults. The commonest presentation is odynophagia.
Usually, the patient will point at the level of FB on the neck to indicate the location.
Methods: Clinical report.
Results: This case report describes a large FB in an adult with underlying infantile cerebral palsy.
Besides dysphagia, it was associated with drooling of saliva and pain in the throat region.
Conclusion: FB ingestion with complete obstruction of the oesophagus is an emergency. It may
cause total dysphagia as the passage of food is completely blocked.
Foreign body aspiration is commonly described in infants and children. However, recently, a new
high-risk group was identified among young women, especially those from the Muslim population
who wear the traditional hair scarf. This is due to the habit of holding the scarf pin in between the
lips to free hands to adjust the scarf more easily. Talking, laughing, or coughing while fixing the
scarf may result in inadvertent inhalation of the pin into the tracheobronchial tree. We present a
case of scarf pin inhalation and the challenges encountered in managing this patient during the
successful removal of the pin via flexible bronchoscopy under fluoroscopy guidance. This particular
case was technically challenging for us as the sharp tip of the needle was pointing upward and
piercing the bronchial mucosa.
Purple urine bag syndrome (PUBs) is a rare and startling phenomenon of purple discolouration
in the urine or urinary catheter and bag. It is reported in chronically debilitated elderly patients,
mostly in women on long-term urinary catheters. Its prevalence is strikingly more common in
nursing home residents. Several factors contribute to the formation of indigo (blue) and indirubin
(red) pigments from a breakdown of dietary tryptophan, which stains the urine purple. These
factors include constipation, dysmotility of the bowel, bowel bacterial overgrowth, dehydration, and
urinary tract infection. The presence of purple urine may cause undue alarm to both the patient and
the doctor. Thus, we present this case report on an 86-year-old woman, a nursing home resident
on a long-term urinary catheter, who presented to the primary care clinic. Her urine cleared
after antibiotic therapy, replacement of her urinary catheter, and supportive management, which
included hydration and nutrition. In addition to these measures, reducing the time between urinary
catheter changes was recommended to prevent recurrence of this condition.
Steroid-induced glaucoma is the most serious complication of the injudicious use of steroids,
particularly among children affected by allergic conjunctivitis. This condition is steroid-dependent,
and children are commonly being prescribed topical anti-inflammatories, including topical steroids,
by general practitioners. Furthermore, topical steroids are also available over the counter, and this
availability contributes to overuse without proper monitoring by an ophthalmologist. We present
a series of five cases illustrating the devastating effect of unmonitored, long-term use of steroids
among children for vernal keratoconjunctivitis. The medications were prescribed initially by general
ophthalmologists and were continually bought over the counter by parents. At the presentation to
our center, these patients were already compromised visually, exhibiting glaucomatous optic disc
changes and high intraocular pressure. The series highlights the optic nerve damage resulting in
irreversible visual compromises among children on long-term, topical steroids and the importance
of regular monitoring with a low threshold for ophthalmologist referral.
Cervical vagal schwannoma is an uncommon, benign neoplasm. It is usually asymptomatic and
presents as a painless, palpable mass in the neck. However, large schwannomas can cause dysphagia,
dysphonia or dyspnea as a result of compression. We report a case of an extremely rare complication
of vagal schwannoma in which neck palpation induced the patient to cough. As the patient refused
any surgical intervention, conservative management was used.
A 7-year-old boy presented with both of his thumbs flexed (Figure 1), the inability to perform the
‘thumbs-up’ gesture, and difficulties in opposing thumbs and fingers in activities such as holding a
pencil during writing, pincer movements, and picking up small objects. His mother only observed
the deformity for one month after the boy complained of difficulty in writing during class. He
had no prior history of trauma to the thumbs or pain and swelling in other joints. There were no
other birth anomalies noticed by his parents. Upon examination, the boy had flexion deformities
of the interphalangeal joint (IPJ) on both of the thumbs. Passive range of motion of the IPJ was
not possible and both were fixed at 60° of flexion. Power of both thumbs could not be assessed as
there was no motion of the joint. The range of motion of the metacarpophalengeal joints (MCPJ)
of both thumbs and all other finger joints was normal. A 0.5cm x 0.5cm subcutaneous nodule was
palpable at the volar crease of the MCPJ bilaterally. The nodule was tender on palpation; however,
no overlying skin changes were evident. (Copied from article).
We report a case of acute gonococcal conjunctivitis in a 36-year-old woman who presented with
eye redness and a history of discharge for one month. Prior to presenting to us, she was treated for
bacterial conjunctivitis with three courses of local antibiotics by three different clinics after brief
assessments and without improvement. The final diagnosis of gonococcal conjunctivitis was made
after a complete history was elicited and supported by the presence of Neisseria Gonorrhoeae in
the eye swab culture test. She and her sexual partner were treated successfully with intramuscular
Ceftriaxone and oral Azithromycin. This case highlights the importance of complete history taking,
including sexual history, which translates into early recognition and treatment, thus preventing
complications. (Copied from article).
Lemierre’s syndrome is a systemic complication commonly caused by oropharyngeal infection by
Fusobacterium species, which manifests itself as an internal jugular vein thrombosis formation.
It is a rare occurrence nowadays with the availability of broad spectrum antibiotics for treatment.
Most cases in the literature presented with a life-threatening condition. We are reporting a case of
Lemierre’s syndrome that presented with persistent neck pain and swelling, initially diagnosed as
cervical lymphadenitis.
Glomus tympanicum is a tumour classified under the group glomus tumours, and is also known
as paragangliomas. It is thought to commonly occur in women in the fifth to sixth decades of life.
Here, we report a case of a 77-year-old lady with multiple co-morbids and a diagnosis of glomus
tympanicum presenting to us. Her symptoms included pulsatile tinnitus, and reduced hearing,
and the management of the case was done with consideration for her underlying multiple comorbidities. This paper also describes the best modality of treatment for this patient with regard
to her background history. The treatment goal was to improve her quality of life and control the
disease.
Dementia is typically characterized by the deterioration of cognitive abilities and is a common disorder
among the elderly in Malaysia. However, behavioral and psychological symptoms are also present
in approximately 90% of dementia patients.1 We report the manifestation of these symptoms in an
elderly woman with dementia and the treatment thereof.
Cardiovascular symptoms presenting in a patient with dengue fever may post a diagnostic
dilemma. We describe a case of dengue myocarditis mimicking an acute myocardial infarction in a
56-year-old woman.
Kimura disease presents as benign lesion and is commonly present among the Asian population. It
is a disease with a favourable prognosis and a peak age of onset in the third decade. It is a chronic
inflammatory disorder of unknown etiology that involves the lymph nodes and subcutaneous
tissues of the head and neck region. We report a case of a 15-year-old boy with multiple Kimura
lymphadenopathies involving the left posterior auricular region as well as the anterior and posterior
triangles of the neck.