Seyed Farshad Allameh
Vol 3 No 4 (2018): Autumn
In this case report, we present a 16-year-old athlete woman with the history of dyspnea, especially during exercise with vitamin D deficiency that was diagnosed by cardiopulmonary exercise test.
Enchondroma is a kind of bone hamartoma and a benign hyaline cartilage tumor. Although it is the most common benign tumor of bone, it is quite rare in the spine, especially the lumbar spine. We report a case of chondroma that was located in the lumbar spine, which extended from L2 to L5 in a 4.5-year-old child. He visited our clinic with a complaint of spine deformity and limping for 3 years. Surgical resection of large ossified mass was performed and pathologically confirmed to be a benign hamartoma of hyaline cartilage with enchondral ossification. Resection of mass released the tethering effect and balanced the growth speed of spine bilaterally. It is suggestive of a congenital developmental malformation with hamartomatous features and reactive changes.
We report a 25-year-old man who was initially presented with Rapidly Progressive Glomerulonephritis (RPGN) in Shahid Modarress Hospital, Tehran, Iran. His diagnosis was Anti-Glomerular Basement Membrane (Anti-GBM) disease that was confirmed by kidney biopsy, as his serum Anti-GBM antibody was undetectable. Although the patient was on cyclophosphamide and high dose prednisolone, he developed Thrombotic Thrombocytopenic Purpura (TTP). We initiated treatment with a high dose of prednisone and plasmapheresis. Because of his poor response, rituximab was administered. After that, the patient’s hematologic criteria and clinical symptoms improved to an acceptable level. Our case is a unique form of negative serum Anti-GBM antibody disease which was complicated with TTP and responded to treatment with rituximab
In the last couple of years, with the advancement of imaging methods, the diagnosis of gray matter heterotopia has been more promising. Gray matter heterotopia is a rare disorder in the general population, but recent attention to its psychiatric aspects encouraged us to introduce a patient with a form of gray matter heterotopia, who suffers from the anatomical abnormalities with a variety of psychiatric disorders. Our patient is a 25-year-old woman, who presented a variety of organogenesis disorders such as imperforate anus and rectovaginal fistula with the presence of gray matter heterotopia and history of refractory mood and psychotic disorders during 9 past years. Because of the various clinical manifestations of the disease, syndromic attention to this disease seems to be helpful in diagnosing and treating its various aspects.
Myosteatosis is a pathological infiltration of fat in skeletal muscle reflecting an impairment in normal synthesis and elimination of triglyceride. Myosteatosis is associated with aging, type 2 diabetes, insulin resistance, and vitamin D deficiency. It is inversely related to loss of muscle strength and consequent disability. Lumbar paraspinal muscles are located on each side of the lumbar spine, attached to the vertebrae, providing necessary levels of trunk stability and trunk movement. We report a 65-year-old woman with vitamin D deficiency, type 2 diabetes, and laboratory findings of secondary hyperparathyroidism. Her physical examination indicated dominantly pronounced walking difficulties due to the weakness of the paraspinal and pelvic muscles and the instability of the lower part of the vertebral column. Characteristic radiological features of expressive myosteatosis of paraspinal muscles were determined by magnetic resonance. The treatment of vitamin D, calcium and physical therapy over the course of one year did not block her progressive mobility disorder.
Ankylosing Spondylitis (AS) is a chronic inflammatory disease of the skeleton manifested by back pain and progressive stiffness of the spine. In AS, the inflammation starts around the enthesis (the site of ligament insertion into bone) and typically affects young men with a peak age of onset of 20 to 30 years. Although classically thought as a spinal disease, it can involve other organs such as eyes, lungs, and heart. We present a 49-year-old man with pleural effusion and history of recent pericardial effusion but his fluid studies of pleura and pericardium did not lead us to a clear diagnosis. Then we noticed his thoracic kyphosis, severe restriction of lumbar movements and sacroiliac joint inflammation on MRI which are suggestive of AS. We started prednisolone 50 mg daily for one week and the pleural effusion resolved spontaneously after one week. Then, we tapered prednisolone and the patient remained well off any medication. Isolated pleural and or pericardial effusion may be seen in patients with AS without a simultaneous apical fibrobullous involvement of the lungs and it responds well to corticosteroid.
During the recent years, paradoxical embolism and Patent Foramen Ovale (PFO) have drawn great attention because of their strong correlation with cryptogenic stroke in young patients. The coexistence of pulmonary and paradoxical embolism is even rarer. Awareness of this complication with prompt recognition and treatment could prevent significant disability and death. We presented a 51-year-old man with evidence of concomitant pulmonary embolism and overload due to Pulmonary Thromboembolism and stroke, which suggests the presence of Patent Foramen Ovale. He was successfully treated with anticoagulation and PTO closure was performed.