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  • ISSN: 2373-9819
    Volume 2, Issue 2
    March/April 2014
    Case Report
    Maria João Pereira1*, Joana Raposo2, Zita Romão1 and Carlos Sofia1
    Abstract: Strongyloides stercoralis is an intestinal parasite that could be found in tropical regions. Usually infects the small intestine. The gastric involvement is a rare phenomenon. The asymptomatic chronic infection can persist for years. In pathological conditions associated with immunosuppression, the reactivation can occur in a disseminated form, associated with gastrointestinal, pulmonary or cutaneous symptoms, and with a high mortality rate.
    The authors describe the case of a immunocompromised patient with advanced lung cancer, with involvement of gastric mucosa by Strongyloides stercoralis. Because the clinical symptons and endoscopic findings are nonspecific, a high level of suspicion is required for diagnosis, highlighting the importance of endoscopic biopsies of any anomaly detected.
    Matthew Arneill1*, Richard Arneill2 and Nicola Maiden1
    Abstract: Adult Onset Still’s disease (AOSD) is a systemic inflammatory disorder of unknown aetiology. Rarely, it may be complicated by Macrophage Activation Syndrome (MAS), a multisystem inflammatory syndrome caused by massive cytokine release from activated lymphocytes and macrophages.
    We report the case of a 31 year old female who presented with a 3 week history of arthralgia, myalgia, fever and sore throat. Adult Stills Disease (ASD) was diagnosed and the patient commenced on oral Prednisolone. The patient was readmitted 7 days later with significant deterioration in symptoms and was systemically unwell. Macrophage Activation Syndrome (MAS) was diagnosed. The patient was successfully treated with supportive therapy, IV Methylprednisolone, Cyclosporine and Anakinra. This case highlights the fact that active ASD and MAS can mimic sepsis. MAS is rare, and is most commonly seen secondary to underlying inflammatory disease. It is important that MAS is promptly recognised and treated, given its high mortality rate, despite treatment.
    Anam Hameed1, Melissa W. Taggart2 and Mehnaz A. Shafi1*
    Abstract: Langerhans cell histiocytosis (LCH) is a rare disorder of unknown pathogenesis. It is characterized by abnormal proliferation and dissemination of Langerhans cells derived from the bone marrow. The disease most commonly affects the bones and the skin. Involvement of the gastrointestinal (GI) tract is extremely rare. We report the case of a 49 year old woman who presented to the clinic with complains of abdominal bloating and change in bowel habits. She was scheduled for a diagnostic colonoscopy. On colonoscopy, three diminutive polyps were seen at the splenic flexure that was removed with cold biopsy polypectomy. On histology, one of the polyps showed an ovoid collection of atypical cells within the submucosa. The cells were intermediate in size with eosinophilic cytoplasm and ovoid nuclei. The nuclei were variably convoluted with few reniform shapes and some grooves. No cytoplasmic inclusions were identified. The atypical cells extended into the lamina propria. Immunohistochemical staining showed the cells to be strongly positive for CD1a and S100 which confirmed the diagnosis of LCH. On follow up as outpatient, extensive clinical workup showed mild eosinophilia with no evidence of disseminated LCH. Review of published literature showed only a handful of cases of colonic involvement with LCH in the adult population. Most patients have focal disease detected on screening colonoscopy. Systemic involvement is uncommon.
    Siddharth S. Das, Musharraf Husain*, Ashraf Bhat, and Firdoos F. Hajini
    Abstract: Phytobezoar presenting as acute intestinal obstruction is extremely rare in clinical practice and causing terminal ileum obstruction is still rarer. We report a case of middle aged female who presented with intestinal obstruction due to impacted phytobezoar in terminal ileum. Emergency exploratory laparotomy was performed and large phytobezoar found impacted in terminal ileum, which was compressed manually, tried to break and narrowed, subsequently milked to caecum. Though most of the time enterotomy is required for the removal of impacted bezoars, compression and milking of the content to caecum should be tried first. This will release the intestinal obstruction without peritoneal contamination. Enterotomy should be reserved for failed cases only.
    Sabina Khan1, Musharraf Husain2* and Ansari MM3
    Abstract: Sebaceous gland tumors are rare and their presence should alert the physician to search for internal malignancies. These malignancies may appear before, concomitantly or even few years after the appearance of cutaneous lesions. We are reporting a case of sebaceous gland adenoarcinoma who clinically presented with infected sebaceous cyst and final diagnosis of adenocarcinoma was made on histopathological examination. This patient is put on close surveillance for the detection of internal malignancies.
    Verma Shraddha*, Kanojia Ravi P, Samujh Ram, and Rao K L N
    Abstract: Y-shaped sigmoid duplication is very rare congenital anomaly. Only few cases have been reported in English literature. Our patient, 19 days female, presented with abdominal distension, constipation and bilious vomiting. She was asymptomatic for initial 9 days of life. The abdomen was grossly distended and a large lump was palpable. Plain X-ray abdomen showed a large air collection. On exploration, Y-shaped duplication was found arising from mid sigmoid. The other end was communicating with a large cyst filled with fecal matter. Duplicated segment was excised with simple closure of sigmoid.
    Thanuja G. Pradeep1,2, Sushma K Rajashekara2, Sureshbabu Gangasagara2, Ramesh TK2 and Raviprakash D2
    Abstract: We report a case of unusual presentation of calotropis induced keratitis where a patient presented with peripheral ulcerative keratitis following accidental splash of calotropis sap into his eye. The review of literature revealed cases of toxic keratoconjunctivitis, corneal abrasion, iridocyclitis and endothelial toxicity. But no case of ulcerative keratitis has been reported so far.
    Arun Kannan*, Sweta Chandra, Jose Lizcano, Christie Murphy
    Abstract: Warfarin Induced Skin Necrosis is a well-known and dreaded complication in patients who is being started on warfarin without adequate bridging with other anticoagulants. The mechanism is thought to be due to protein C deficiency acquired after initial exposure to warfarin. We present a rather unusual cause of protein C deficiency due to sepsis resulting in warfarin induced skin necrosis. 43 year old lady who has been on chronic warfarin therapy secondary to anti phospholipid syndrome was admitted to the hospital for acute ischemic cerebellar stroke. Warfarin was held due to acute thrombocytopenia. She was discharged to a facility after restarting the warfarin at the same dose. She presented back to the hospital with septic shock due to pneumonia. She was found to have multiple necrotic areas consistent with skin necrosis. Unfortunately, patient died due to multi organ failure despite goal directed therapy. This case demonstrates the importance of recognizing the sepsis as an acquired cause of protein C deficiency.
    Andrea Wenner1,2, Jose Aceves1,2, Diana Mungall2, Richard Castillo3 and Batool F Kirmani2,4*
    Abstract: Vagal nerve stimulation is approved for medically refractory partial epilepsy in children older than 12 years of age. However, it has been shown in the literature that vagal nerve stimulation is also quite efficacious in children younger than 12 with generalized epilepsy and brain malformations. We report a case series of children younger than 12 who responded well to vagal nerve stimulation. A retrospective review was conducted at our institution for pediatric patients from 1997 to 2013 who were younger than 12 years of age and had pharmacoresistant epilepsy and brain anomalies resulting in static encephalopathy. Our hospital’s institutional review board approved the study. The variables included epilepsy type, current anticonvulsants, failed anticonvulsant, epilepsy type, imaging data, other comorbidities and effect of vagal nerve stimulation on seizure frequency. Three patients were identified who received vagal nerve stimulator were between 6-9 years of age. Two of these patients were diagnosed with generalized epilepsy and one with Lennox-Gastaut syndrome. The etiologies included lissencephaly, cortical dysplasias and asymmetry of the cerebral hemispheres, respectively. They were taking an average of 2-3 anticonvulsants and had failed treatment with at least 2 anticonvulsants. The patients showed marked decrease in the seizure frequency during the 6-month and 1-year follow-up. Vagal nerve stimulation was found to be efficacious in this subgroup of difficult pediatric patients with pharmacoresistant generalized epilepsy and epileptic encephalopathy.
    Khurram Tariq* and Nilmarie Guzman
    At the beginning of the HIV/AIDS epidemic in the 1980s, the medical community learned about a subset of patient population who presented with opportunistic infections, had severely depressed CD4 T cell counts, but to everyone’s surprise these patients did not have HIV infection and there was no other explanation to account for their immunodeficiency [1-5]. Emergence of these anomalous findings lead to a review of 230,179 cases in the Center for Disease Control and Prevention (CDC) AIDS Reporting System from 1980s to the early 1990s and found 47 cases of Idiopathic CD4+ T cell lymphocytopenia (ICL) [6]. To our knowledge these 47 cases represent the largest pool of ICL patients and who were then studied prospectively between 1992 through 2006 to define the natural history of the disease [6-7]. Most of our understanding of the rare ICL syndrome comes from the findings obtained from these 47 patients [7].
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