Журнал клинических случаев

Pityriasis lichenoides (PL) is an uncommon acquired skin disease of unknown etiology. The disease is speculated to be an inflammatory disease triggered by infectious agents, an inflammatory response to T-cell dyscrasia, or an immune complex mediated hypersensitivity. We report the first case of PL et variolifomis acuta (PLEVA) occurring after tetanus vaccination.

57-year-old man with past medical history of diabetes, hypertension and depression who was evaluated for obstructive jaundice, and was found on CT scan of abdomen to have a hypoenhancing 2.6 x 2.1 cm mass within the posterior and medial aspect of the pancreatic head which abutted the common bile duct and superior pancreatic duodenal branch from the common hepatic artery highly suspicious for pancreatic adenocarcinoma.

A 3-year-old girl with chronic kidney insufficiency (CKI) due to left kidney dysplasia and right multicystic kidney presented decoy cells due to polyomavirus BK (BKV) in the fresh and unstained urine sediment observed by phase-contrast microscopy.

A 57-year-old man kidney transplant recipient was admitted to the hospital for severe headache and respiratory symptoms. During routine urinalysis, yeasts were seen in the urine sediment and these were regarded as probable Candida species. Since the laboratory was informed by the attending clinician that the patient was immunosuppressed, urine was stained with China ink and revealed the presence of budding yeast-like capsular organisms, consistent with Cryptococcus sp.

Balantidium coli is a ciliated protozoa which can infect humans. Although the infection is uncommon, it tends to be more frequent in the tropics and subtropical regions. It is often asymptomatic but may present with gastrointestinal symptoms. Few cases of urinary balantidiasis have been reported but faecal contamination could cause diagnostic dilemma.

Infection with hepatitis A virus can cause severe or even fatal illness in patients with chronic liver disease. Here we describe a ten-year-old girl who presented as acute liver failure and was diagnosed with Wilson’s disease and later with coexistent hepatitis E infection. Wilson’s disease was demonstrated on the basis of Kayser Fischer ring, low ceruloplasmin, and high urinary copper excretion. Hepatitis E was diagnosed serologically with a positive anti HEV IgM titers. Our case suggests that acute hepatitis E may play a part in the acute decompensation seen in some cases of unrecognized Wilson’s disease. The patient gradually deteriorated and died in a period of 3 months.

Multiple myeloma is an immunoproliferative monoclonal disorder of plasma cells, characterized by an expansion of atypical cells, which produce monoclonal immunoglobulin. This neoplasm has several clinical presentations: solitary osseous plasmacytoma, plasmocytic leukemia or extramedullary plasmocytoma. Plasmocytoma are rare in the gastrointestinal tract. This case present a histologically confirmed case of primary gastric plasmocytoma.

The study aimed at demonstration of the effect of cupping therapy in ischemic myocardial conditions. Despite advances in treatment of myocardial infarction, the mortality rate is still high. In spite of the efficacy and safety of coronary stenting, the overall adverse cardiac events after stent insertion is also high; 8.1%. Accumulation of toxic mediators in the body is a documented fact. These substances can induce vascular spasm and other effects on vascular endothelium. Impairment of the vascular endothelial function is involved in the pathogenesis of wide variety of cardiovascular diseases and hence is considered a therapeutic target. Production of ischemic metabolites within the myocardium due to lack of proper perfusion constitutes a toxic element which can contribute to progression of the coronary heart disease. Elimination of these toxic elements from the targeted tissues and circulation is a challenge that would definitely help to correct an underlying micro-circulatory error. Withdrawal of these ischemic tissue metabolites, being interstitial, is only feasible via superficial scratching on the skin and suction by the traditional therapeutic cups; a maneuver which could lead to correction of an associated spastic ischemic situation at the microcapillary level. Three male patients aged between 61-65 years with history of two coronary stents insertion, have developed chest tightness few months after coronary stenting. They hesitated towards undergoing further coronary procedures. They were scheduled for basic cupping therapy on the upper back and front of the chest. All patients demonstrated dramatic symptomatic relief and documented clinical recovery. Cupping therapy is promising in relieving ischemic myocardial conditions via elimination of inflammatory mediators that compromise the microcirculation.

The pharmacist plays a crucial role in ensuring optimal patient outcomes, by working with the healthcare team as well as educating the patient. This study focuses on two major aspects that affect patient outcome: pharmacist intervention during the provision of healthcare and patient compliance. Case presentation: YT is a 42 year old Malay male who was referred for the presentation of back and axilla carbuncles 3 days before admission. The patient has a history of diabetes mellitus, hypertension and hyperlipidemia since 2008. He has undergone saucerization surgery for the removal of the carbuncles and has responded well to therapy. His diabetes and hypertension are uncontrolled while his hyperlipidemia status is unknown due to lack of lipid profile data. Clinical evaluation: Patient’s main issue is non-compliance of drug regimen leading to poorly controlled disease states. Insufficient dose of medication also contributed to poor control. There were also a number of lab data, such as prothrombin time, INR value and lipid profile data that were not addressed during admission. Pharmacist’s Intervention is crucial in ensuring optimal patient outcomes.

Large-scale MeHg poisoning occurred in Niigata, Japan in the 1960s. Hair mercury levels were measured early in the epidemic of MeHg poisoning. The severe prenatal exposure cases with conditions resembling cerebral palsy, i.e., congenital Minamata disease are well-known, although severe prenatal and postnatal MeHg exposure cases who did not develop such severe symptoms are not well-known. We conducted follow-up neurologic examinations and interviews of four participants with a history of prenatal and postnatal MeHg exposure who had-along with their mothers undergone hair mercury measurement in June 1965. We describe their development and subjective symptoms in childhood and neurologic signs in adulthood. The hair mercury levels of the four participants ranged from 63.0 to 111.0 ppm in 1965, and maternal levels ranged from 58.0 to 275.0 ppm. Although the four participants had high prenatal and postnatal MeHg exposures, they did not develop severe symptoms resembling cerebral palsy. They had symptoms such as poor concentration and poor memory which are thought to be neuropsychological dysfunction, as well as MeHg poisoning in childhood. One was intellectually impaired (Total IQ, 79). Nearly 50 years after prenatal and postnatal MeHg exposure, they had neurologic signs such as sensory disturbances of the bilateral distal extremities and blurred vision. There are several limitations such as a possibility of selection bias, etc. in the present study. 4 cases had various signs and symptoms possibly due to prenatal and postnatal MeHg exposure such as neurologic signs and neuropsychological dysfunction during lifetime.

Indroduction: Lipomas are relatively common and are the most prevalent benign soft-tissue neoplasm. The transformation of lipomas into malignant liposarcomas is relatively rare, and the precise etiology and pathogenesis of lipomas are not well understood. Few published studies or case reports of post-traumatic lipomas have been described in the medical literature, and the pathological link between blunt trauma and formation of lipomas remains controversial. Case presentation: 46 year-old male presented to the clinic complaining of right knee swelling and the presence of a leg mass. The patient reported that he previously sustained blunt leg trauma during a basketball game at the site of his leg mass. After increased growth of his leg mass on imaging, he sought medical and surgical evaluation. The patient decided to pursue surgical resection with pathologic specimen review. The patient underwent surgical resection of the right thigh mass and the final pathologic diagnosis was a lipoma. Conclusion: When evaluating a patient with a lipoma, physicians should ascertain whether or not the patient has sustained previous trauma at the site of the mass lesion. It appears from this case report that blunt trauma during sports may be a risk factor for the future development of soft tissue lipomas. Further epidemiologic research is necessary to clearly ascertain this pathologic link.

Functional dyspepsia is a clinical syndrome defined by chronic or recurrent pain or discomfort in the upper abdomen of a variable origin. A general agreement exists on the irrelevant role played by Helicobacter pylori in the pathophysiology of most cases of functional dyspepsia worldwide.

In this case report, we show a case of 21-year-old woman who presented amenorrhea, a blind vagina, a bilateral Nuck channel herniation. After initial examination, it was thought that she had the Testicular Feminization Syndrome. After follow-up, it was observed that she presented uterovaginal agenesis and ovary and uterine tubes hernia of the Nuck channel.

Hidradenoma papilliferum (HAP) is known since the nineteen century. The vast majority of cases occur on genital and perianal regions of women. Tumors found in other areas of the body are considered to be “ectopic”. The lacrimal caruncle is a vestigial skin structure with a diverse histology including hair. To our knowledge, the presence of HAP on the caruncle was referred only once in a series of cases published in a gynecological journal. We report for the first time in the ophthalmic literature a case of a caruncular hidradenoma papilliferum (HAP) as an unusual benign tumor of apocrinic differentiation.

Teenage pregnancy is when a young female between 13 and 19 years old carries a child. It is even more worrisome for teenagers who live in child-headed households because they are vulnerable and at risk of becoming pregnant. A qualitative research technique was employed to conduct the research. There were 40 participants between 13 and 19 years old. These participants lived alone. Usually, the eldest teenager had become the household head. A questionnaire was administered to find out reasons for teenage pregnancy in child-headed households. The questions were based on participants’ sexual health behavior, knowledge about and use of contraceptives and drug and alcohol use. A qualitative investigation was adopted. Out of the 40 cases, the researcher found that 31 participants reported to have at least one child. These were lack of parental supervision or role models, unwillingness to approach outsiders for advice and information, misconception of socially constructed ideologies of relationships, fear of losing a source of income, influence of drug and alcohol use, actual intercourse against pornography and masturbation, poverty, peer pressure, sexual abuse, incorrect knowledge and use of contraceptives, low selfesteem, entering into early, unsupervised relationships, and lack of a plan or achievable dreams. Teenagers who live in child-headed households are more vulnerable to becoming pregnant due to external factors such as poverty, lack of parents, and sexual abuse. However, they also have other contributing factors, such as their abuse of drug and alcohol, that make them even more vulnerable and at risk of getting pregnant. However, it can be recommended that a special policy needs to be implemented for child-headed household; concerned officials must visit the village at least once a month; and follow-up care, a secure home, and strong, quality health education must be provided to teenagers who live in child-headed households

Introduction: Pheochromocytomas are rare catecholamine secreting tumors that arise from the chromaffine tissue of the adrenal medulla. Rarely, these tumors are associated with cardiomyopathy. We herein present a patient with pheochromocytoma presenting initially with congestive heart failure and hypertensive emergency.

Case presentation: A 62-year-old female with no past medical history presented to the emergency department for dyspnea and lower extremity edema of 2 weeks duration. The patient was tachycardic at 120 BPM, hypertensive at 197/90 mmHg. She had decreased breath sounds bilaterally. Electrocardiogram showed sinus tachycardia. Chest x-ray revealed bilateral pulmonary infiltrates and effusions. Laboratory testing demonstrated a white blood cell count of 18.06 TH/mm3 , platelet count of 693 TH/mm3 , D-dimer of 540 ng/ml, and a brain natriuretic peptide of 888pg/ml. A lower extremity duplex was negative for venous thromboembolism. Computed tomography scan of the chest ruled out pulmonary embolism. An Echocardiogram showed diffuse hypokinesis, and an estimated ejection fraction of 35 percent. Thyroid stimulating hormone, Urine and plasma metanephrines and renal artery duplex were done as part of the workup. Renal ultrasound and arterial Doppler were negative for renal artery stenosis, but revealed a right upper pole partially solid mass. An MRI of the abdomen confirmed a mass in the upper pole of the right kidney. Initial laboratory tests showed elevated plasma Metanephrines at 8065 pg/ml and urine metanephrines at 1594 mcg/g. The patient was started on Phenoxybenzamine. Surgical resection with histo-pathological examination performed 4 weeks later confirmed the diagnosis of pheochromocytoma.

Discussion: Pheochromocytomas are rare tumors, associated with a number of cardiovascular complications. The acute onset of severe congestive heart failure secondary to catecholamine overproduction is a rare entity, and is associated with a poor prognosis.This case teaches us, that in patients presenting with heart failure with no obvious cause, the diagnosis of pheochromocytoma should always be contemplated.

A successful example of use of a new regenerative substance BP-C2 in a patient with advanced inoperable pancreatic cancer before, during and after chemotherapy is described. The patient was subjected regularly to medical history review, physical examination, serum biochemistry, complete blood picture, computed tomography of the abdomen, and Quality-of-Life questionnaires (QoL). BP-C2 treatment was started and subsequently the condition of the patient improved. During this 26 weeks long treatment period, the patient tolerated FOLFIRINOX treatment well without any adverse effects (AE) and with improvement of her functional status. During the treatment with FOLFIRINOX and BP-C2 the sum diameter of the target lesions was reduced by 34.8%, the sum of non-target lesions were reduced by 86.2% and the number of non-target lesions fell from 4 to 1 and the AEs disappeared. C - reactive protein (CRP) was normalized and CA 19-9 reduced by 88% from baseline. QoL variables improved substantially. No neutropenia was observed after week 18 and all biochemical parameters were normalized at week 25. After discontinuation of BP-C2, recurrence of the tumors and AEs occurred A 19-9 and as well as QoL variables returned to baseline level. BP-C2 is a promising adjuvant treatment to the toxic chemotherapy regimens used in inoperable pancreatic cancer patients.

Previous case reports on autocastration have focused mostly on psychiatric and surgical (urology) interventions since most of such individuals appear overtly psychotic and require serious medical involvement due to the nature of their trauma. The importance of psychological support after stabilization has been largely overlooked. This paper describes an adolescent who was followed up for 2 years after an act of autocastration emanating from a religious based ordering hallucination.