pISSN: 2538-2683
eISSN: 2538-2691
Editor-in-Chief:
Shahin Akhondzadeh
Editor-in-charge:
Seyed Farshad Allameh
Vol 2 No 4 (2017): Autumn
Case Report(s)
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Endometrioma (ovarian endometrial cyst) usually occurs in women of reproductive age. We report a rare case of huge ovarian endometrioma that was as large as a watermelon. A 26-year-old woman from Iran complained of abdominal distention over approximately 9 months. Diagnostic imaging revealed a semi solid mass measured about 25 centimeter. After doing laparotomy, an ovarian endometrioma was diagnosed in pathology.
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Swyer syndrome is a very rare cause of primary amenorrhea. Affected individuals have an XY karyotype but their external and internal genitalia are of the female type. The gonads are usually replaced by fibrous streaks. Early diagnosis is vital because of the significant risk of germ cell tumor, and bilateral gonadectomy should be performed. Laparoscopy provides a minimally invasive approach for the management of these cases. These patients can have a normal sexual intercourse and they need hormone replacement therapy for development of breast and prevention of osteoporosis. They can conceive through oocyte donation and artificial reproductive techniques.
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Neurosyphilis is defined as central nervous system involvement by treponema pallidum bacteria. Symptomatic neurosyphilis can be manifested as acute or subacute meningitis (a type of meningitis) that emulates other bacterial infections. Hydrocephalus and cranial nerve paralysis (VII and IX) may occur. In this article, we report a case of congenital hydrocephalus neurosyphilis, with a significant improvement in neurological condition after treatment with penicillin-G. The infant was a 2.5-month-old boy who referred to the emergency department because of fever. On initial examination, the head had been larger than usual. The patient was evaluated with suspicion of sepsis. Cerebrospinal fluid (CSF) analysis was consistent with meningitis and hydrocephalus found in ultrasound. Due to lack of response to antibiotic and anti-tuberculosis (TB) treatments in improvement of CSF analysis, ultimately after positive CSF serology in favor of syphilis, treatment changed into penicillin; then clinical and laboratory findings were improved. The rare manifestation of congenital syphilis as hydrocephalus and the appropriate treatment response to penicillin were interesting points for the introduction of this patient. We presented a case of neurosyphilis, which was characterized by a cognitive and neurological deficits, hydrocephaly, and myoclonus, as well as irritability and hearing loss. Since syphilis is easily diagnosed and treatable, it should be considered and evaluated in patients with cognitive defects and motor disorders. Misdiagnosis of syphilis is a serious medical mistake that may cause long-term consequences.
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Wells syndrome is an uncommon disease that typically presents as edematous erythematous plaques, usually preceded by burning or itching of the skin. Histopathological examination shows dense dermal eosinophilic infiltrates in an edematous dermis at the acute phase of lesions. Some of the identified triggering factors include infection, arthropod bites, hematological malignancies, thimerosal containing vaccines and drugs such as penicillin, lincomycin, tetracycline, minocycline and ampicillin. Here we describe a case of Wells syndrome in a 75-year-old woman that its outstanding feature was its large size. Although this case was resistant to our treatment, the condition improved spontaneously after several weeks without administering any other alternative treatments. On the other hand, despite its large size, this case had no identifiable trigger.
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The objective of this paper is to report a case of a patient with Takayasu arteritis (TA), diagnosed and treated as labyrinthitis for two years, with brief review of the literature. A 36-year-old woman, who presented vertigo, falling on the ground for losing consciousness for a few seconds, and.progressive loss of left vision, was admitted to the emergency with headache and impalpable carotid pulses. The erythrocyte sedimentation rate (ECR) and C-reactive protein (CRP) serological tests were increased; however, the ANF (Antinuclear factor), venereal disease research laboratory (VDRL) and fluorescent treponemal antibody absorption (FT-ABS) were negative. After aortography, she developed convulsive seizures, loss of consciousness, hemodynamic instability, and death. The cause of death was distributive shock.
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Nocardia infections rarely occur among normal population. Nocardiosis typically develops in immunocompromised person. In this paper, we report a case of pulmonary nocardiosis in an immunocompetent man. A 77-year-old man was examined in the emergency department because of cough, sputum, and fever from 10 days before admission. Computed tomography (CT) of the chest revealed air space consolidation, necrosis and cavities. Positive culture for nocardia species was reported. The patient received cotrimoxazole two regular-strength tablets (400/80 mg) "per os" (P.O) every 12 hours, and was discharged. In the follow-up after a month, he was completely well, most of his symptoms were improved, and his chest CT was near normal.
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Cutaneous squamous cell carcinoma (cSCC), which is the second most common malignancy in humans, commonly occurs on sun-exposed skin such as face. Incidence rate of squamous cell carcinoma is found to be higher in old men. Metastatic rate of cutaneous squamous cell carcinoma is approximately 4-5%, and it is higher in men, especially those over the age of 75 years. Risk factors that increase the rate of metastatic SCC include immunosuppression like human immunodeficiency virus (HIV), solid organ transplantation, tumor thickness (> 2 mm), lesion diameter (> than 2 cm), poor differentiation, and perineural invasion. To our knowledge, our case is the first report of squamous cell carcinoma with large size with bilateral lesion extending from the groin to intergluteal region.
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Adult T-cell leukemia (ATL) is the only T-cell lymphoproliferative disease, known to be caused by a virus. While human T-lymphotropic virus type 1 (HTLV-1) is found to cause adult T-cell leukemia, other T-cell neoplastic diseases do not correlate with human T-lymphotropic virus type 1. Adult T-cell leukemia usually demonstrates an aggressive course and poor prognosis. Human T-lymphotropic virus type 1 is transmitted via breast feeding, sexual contact, shared needles, and infected blood products. Moreover, some geographic areas are depicted to be endemic for human T-lymphotropic virus type 1; northeast of Iran is known to be one. Here in, a case of adult T-cell leukemia is discussed who presented by hypercalcemia and paraparesia. Hepatosplenomegaly was detected in physical examination and abdominal sonography revealed multiple paraaortic lymphadenopathy. Whole body bone scan demonstrated multiple hot points in skeleton. Chest computed tomography (CT) scan revealed leukemic infiltrations of both lungs. The leukocyte count of peripheral blood was 34000-50000 per mm3, and excessive amounts of mature lymphocytes were observed in peripheral smear. Flow cytometry of bone marrow aspiration reported adult T-cell leukemia. The titer of human T-lymphotropic virus type 1 antibody was elevated in enzyme-linked immunosorbent assay (ELISA) method. Despite the patient was originated from a non-endemic origin, all members of his family including his spouse and children found to be positive for human T-lymphotropic virus type 1. This manuscript describes the clinical course and diagnosis of a patient with adult T-cell leukemia, and clinical suspicions during the course of the disease.
