Adult-onset Still Disease (AOSD) is a rare rheumatologic condition with unrecognized etiology. Spiking fevers, joint involvement (arthralgia or arthritis), rashes, lymphadenopathy, abnormal liver function test data, and leukocytosis are the main features of this disease. Yamaguchi’s criteria with the sensitivity and specificity of 96.2% and 92.1%, respectively, is the most beneficial tool for the diagnosis of AOSD, as a rare disease. The uncommon features of the still disease remain confusing for clinicians. about the present study reported a 27-year-old patient who was referred to our hospital with an unknown diagnosis, because of the rare features of Still disease. The explored characteristics of rashes, fever, and para-clinical data, as well as laboratory and imaging data, are described in detail; such features have led to long hospitalization to confirm the diagnosis in this patient. The positive family history of the rheumatologic disease and dramatic response to low dose corticosteroids were other outstanding features of our case. This report highlighted the necessity of conducting randomized clinical trials to address the management of AOSD. Besides, the present study signified the need for providing further awareness among clinicians to prevent long hospitalization.
Primary gallbladder cancer is a rare malignancy and it is difficult to be diagnosed because there are no specific signs and symptoms at the initial stage. The most important risk factors include female gender, the age of more than 65 years, and having large gallstones. The authors present a rare and unusual case of adenocarcinoma of the gallbladder because the reported case is a male patient from Asia and had acalculous cholecystitis.
An 81-year-old woman with symptoms of upper Gastrointestinal (GI) obstruction but with no supporting evidence for obstruction in previous endoscopies was studied with a solid-liquid gastric emptying scintigraphic examination. There was evidence of accumulation of the tracer in a part of the stomach in the thorax before filling the stomach. The paraesophageal hiatal hernia was suspected. The diagnosis was not confirmed by other modalities and the patient passed away after upper GI bleeding a month later.
How Shall We Proceed After Inserting an Unsterile Device for Fracture Fixation: ReTENing or Retaining? A Case Report
Background: Limited information is available on how to properly manage to implant nonsterile devices in the medical literature. To the best of our knowledge, there is no guideline for managing nonsterile medical devices implanted inadvertently.
Case Presentation: A 3.5-year-old boy was operated on because of femur fracture malunion. After the completion of the operation and discharging the patient, we were informed that the nail has not been sterilized. The parents were immediately informed about the complication and the patient was re-admitted to the hospital. The situation and its complication were thoroughly discussed with the family. By active involvement of the parents, infectious specialist, and the orthopedic surgeon, a shared decision was made to treat the complication. The patient was closely observed. In a radiograph obtained at the 4th week after the index surgery, the sign of callus formation was observed. At this time, we decided to remove the Titanium Elastic Nail (TEN) and continue casting for another two weeks.
Conclusion: The primary “take-away” lesson of this case report is that honest disclosure of our mistake facilitated the additional necessary treatment. One single case is not enough for making a recommendation or offer a guideline for this kind of error during or after an orthopedic procedure; however, this case presents a successful method. Although the consequences of infection could be dire, it is prudent to take “not-to-harm” as the first step in benefiting.
Cryptococcal infection is a chronic opportunistic infection in patients with the Human Immunodeficiency Virus (HIV). A rare case of cryptococcal lymphadenitis is presented here in a 27-year-old woman with an enlarged cervical lymph node. Fine needle aspiration from the involved lymph nodes showed variable-sized, rounded yeast cells surrounded by halos with a prominent capsule. Early diagnosis by fine-needle aspiration is essential and reduces morbidity and mortality.
Fractures in Corticosteroid- and Bisphosphonate-Treated Subjects With Longstanding Rheumatoid Arthritis and Systemic Lupus Erythematosus
Background: Bisphosphonates are the most widely prescribed agents for the treatment of postmenopausal osteoporosis and other metabolic bone diseases. Atypical femoral fractures in bisphosphonate-treated patients have raised concerns regarding the long-term safety of this class of medications.
Case Presentation: In this study, we report two patients suffering from fractures while receiving biphosphonates; a postmenopausal patient with rheumatoid arthritis and a history of long-term use of bisphosphonates and glucocorticoids presenting with multiple fractures as case one and another 52-year-old female patient diagnosed with Systemic Lupus Erythematosus (SLE) who suffered from a femoral shaft fracture without any history of prior traumatic incidents as case two.
Conclusions: Considering the low risk for atypical femoral fractures, further careful screening for these types of fractures should be undertaken. In addition, in order to lower the rate of fractures in patients on long-term bisphosphonate therapy, assessment of patients’ contralateral side should be considered to prevent further fractures, especially in patients with prodromal pain
Extensive Intracranial Calcification in aCase of Hypoparathyroidism Which Presented With Generalized Tonic-Clonic Seizure: A Case Report
Hypoparathyroidism is an endocrine disorder that can be congenital or acquired. Generally, hypoparathyroidism is characterized by hypocalcemia, hyperphosphatemia, and low or abnormal levels of Parathyroid Hormone (PTH). It can be asymptomatic or symptomatic. The symptoms include seizures, paresthesia, depression, psychosis, extrapyramidal manifestations, and increased intracranial pressure. In this case study, we reported a 40-year- old male patient who was admitted to the emergency department with generalized tonic- clonic movements and urine incontinency. Laboratory investigations revealed hypocalcemia, hyperphosphatemia, and low parathyroid hormone levels and in paraclinical studies, including Electroencephalography (EEG) and brain CT-scan, despite normal EEG, extensive intracranial calcification involving the basal ganglia, thalamus, white matter of the cerebral hemispheres, and subcortical area of the frontal and parietal lobes were observed on CT-scan.
Burkitt lymphoma, as the most common non-Hodgkin Bcell lymphoma of childhood, is rarely detected in the gastrointestinal tract. Intussusception secondary to Burkitt’s lymphoma is an uncommon presentation. We describe an unusual case of intestinal Burkitt’s lymphoma in a four and the half-year-old girl who presented with intermittent colicky pain three times. Imaging studies were suggestive of intussusception. The patient was subjected to the surgery of bowel resection, which revealed a creamy-gray oval-shaped mass. Histopathology through immunohistochemistry study confirmed the Burkitt lymphoma. Owing to rather nonspecific clinical and radiological features, the preoperative diagnosis of Burkitt lymphoma remains a challenging task for pediatric surgeons and radiologists. Therefore, in case of any clinical suspicion, further examinations, such as CT scan in children are recommended.
Introduction: Periductal Stromal Sarcoma (PSS), especially spindle and epithelioid types, is a rare subtype of the malignant fibroepithelial tumor with benign ductal elements and a sarcomatous stroma composed of spindle cells. The therapeutic management of PSS is based on wide surgery with free margins, and adjuvant therapies are not required.
Case Presentation: This report describes a 37-year-old woman who presented to Shariati hospital with a right breast mass for review and a second opinion pathology report. The patient had undergone a radical mastectomy in another hospital three months previously. Histological and immunohistochemical examinations revealed PSS and all dissected lymph nodes were free of tumor. Based on the diagnosis, the patient received no adjuvant treatment (such as chemotherapy or radiotherapy). After nine months of close follow-up examinations, no recurrence was observed.
Conclusion: PSS is an extremely rare disease with low-grade sarcomatous behavior, which may evolve into a phyllodes tumor or an entity of breast cancer. Therefore, frequent follow-up examinations are required.