A 45-year-old Malay lady who presented with intermittent abdominal pain and a left hypochondrial mass was found to have a 10 x 8 x 5 cm duodenal tumour without local invasion at laparotomy. En bloc resection of the tumour with adequate margin of clearance was done and histopathological diagnosis of low grade leiomyosarcoma was made. Fourteen months later, she returned with multiple metastases in the liver and needed palliative chemotherapy for pain relief. Duodenal leiomyosarcomata are very rare tumour. Their prognostic indicators include biological grading, tumour size and presence of metastases. Recognition of its high malignant potential calls for close surveillance calls even after apparent curative surgery.
A case of carotid body tumour is presented. Pathology, diagnostic investigations, modalities of treatment and prognosis are discussed. With greater awareness of this condition and improvement in diagnostic investigations and surgical techniques, the outlook in managing this condition should be better.
Two cases of oral speckled leukoplakia with differing behaviour are presented. This precancerous lesion of unknown aetiology requires early diagnosis for proper management. Candida albicans are frequently found in these lesions. The significance of epithelial dysplasia in relation to treatment is discussed. Surgical removal is the treatment of choice.
A rare case of gestational trophoblastic disease (GTD) in a 54-year old Malay woman is described. A total abdominal hysterectomy with bilateral salphingo-oopherectomy was done. She was given methotrexate therapy as she had persistent high levels of serum B hCG.
Animal inflicted wounds, left untreated may result in chronic bacterial or fungal infection. Clinical features of these infections may overlap leading to a delay in diagnosis and treatment. We report a case of chronic non-healing cat bite wound treated with several antibiotics without improvement. Later patient developed the classical "sporotrichoid spread" and a presumptive diagnosis of sporotrichosis was made. Laboratory investigation for fungal culture and skin biopsy failed to identify the underlying pathogen. A trial of oral antifungal agent resulted in complete recovery of the lesions implicating fungus as the causative pathogen. Physicians should have a high index of suspicion for fungal infections when managing animal inflicted wounds.
Chikungunya virus (CHIKV) is a mosquito-borne alphavirus which causes fever, rash, and arthralgia. In the past, life-threatening complications were very rarely reported. However, during the recent worldwide outbreaks, there have been several reports of unusually severe complications and deaths. Malaysia is experiencing a nationwide outbreak of CHIKV, with over 10 000 patients affected since April 2008. We report the first case of culture-confirmed CHIKV-associated death in Malaysia, in a patient with fever, rash, acute exacerbation of pre-existing heart failure, rhabdomyolysis, and multiple organ failure. CHIKV infections may cause atypical, severe or fatal presentations.
Autonomic dysreflexia (AD) is not an uncommon clinical condition and it is usually detected in patients with complete spinal injuries at or above thoracic 6th vertebral level (T 6). This condition is reported to occur in 48- 60% of cases of spinal cord injury at or above the level of T6. But AD due to injury below T6 is rare. The basic mechanism is thought to be due to excessive, uncontrolled activation of sympathetic system. In the present case, we discuss a persistent AD in 55-yr-old tetraplegic patient with C5 American Spinal Injury Association (ASIA) grade A lesion due to a fall from 10 metre height. MRI examination showed C5 and C6 bi-facets fracture and dislocation with canal compromise. Wiring and fusion was performed but recurrent mucous plugging and aspiration pneumonia and urinary tract infection happened during the hospital stay. Three months later, he was re-admitted with multiple pressure sores, pneumonia, sepsis and high blood pressure. He was administered with nifedepine but the blood pressure kept fluctuating. The present study highlights how the precipitating factors like concomitant urinary tract infection, decubitus ulcers, spasticity triggered the AD attack. The knowledge of the AD and its proper diagnosis and management may be beneficial to all clinicians and the present article attempts to highlight such.
Although all types of tumour and tumour-like conditions have been described to occur in the clavicle, they only contribute to less then 0.5% of all skeletal tumours. The incidence of primary chondrosarcoma of the clavicle is extremely rare. To our knowledge it has not been reported in Malaysia. We would like to highlight the possibility of chondrosarcoma as a differential diagnosis for a clavicular lesion.
A 60 year old male presented with pruritus, excoriations and enlargement of several groups of lymph nodes associated with constitutional symptoms following the intake of an aspirin preparation. Lymph node biopsy established the diagnosis of angioimmunoblastic lymphadenopathy. The need to be aware of this condition is highlighted when patients present with clinical features suspicious of lymphoma.
child and two elderly females with benign migratory glossitis (BMG) are presented. The aetiology is unknown, but emotional stress, mechanical and chemical trauma are important in the production of pain in an initially asymptomatic BMG. Treatment consists of reassurance, avoidance of hot, spicy and highly-seasoned foods. Any underlying reactive depression must be treated.
Central nervous system involvement in melioidosis is rare. We describe a 48 year old woman who developed septicaemia and a brain abscess due to Pseudomonas pseudomallei. Since there is a continuing practical problem in bacteriological confirmation of the aetiological agent, diagnosis of melioidosis has to be made on clinical suspicion.