Seyed Farshad Allameh
Vol 7 No 6 (2022): November-December
Brucellosis is a zoonotic infectious disease which any organ can be involved. Soft tissue lesions are rare manifestations of brucellosis. Brucella breast abscess in animal is not uncommon; involvement of the breast in human brucella is extremely rare. Breast abscess involvement was reported to 0.7% of the patient with brucellosis. We report the microbiological findings of breast abscess due to brucella. A 38-year-old woman living in the rural area of Kerman, Iran, presented with an abscess in the right breast. The sampling of the abscess aspiration and preparation of smears showed inflammatory fluid. Culture and PCR performed from the sample identified the presence of Brucella melitensis. The lesion had diminished in size after 8 weeks of treatment with combined doxycycline and rifampin. The possibility of breast abscess being caused by Brucella should be considered in countries, especially in endemic regions. Besides, isolated Brucella spp from microbiological cultures is important for a definitive diagnosis.
Tuberculosis (TB) is a respiratory disease that primarily affects the lungs. The challenge is to recognize the characteristic of TB disease, including extrapulmonary presentation. TB arthritis is an extrapulmonary TB presentation in the joint, which is frequently neglected and misdiagnosed. A 41-year-old female patient was presented with a major complaint of chronic pain in her left wrist for three months. The patient had a low-grade fever without respiratory symptoms. Local examination revealed swelling, warmth and tenderness. Erythrocyte sedimentation rate (ESR) was increased and chest radiograph demonstrated pulmonary TB. She underwent arthrotomy debridement and culture examination. We initiated adjuvant anti-tuberculous treatment. On the evaluation, she reported relief from pain and showed improvement in general condition. TB arthritis is unique due to its rare incidence and unspecific clinical manifestations. A better understanding of these issues will prevent possible diagnostic errors. Prompt treatment was crucial to maintain joint function and prevent permanent destruction.
Neurological symptoms like headache have been reported in patients infected with tuberculosis (TB) and COVID-19 infection . A high index of suspicions is necessary for diagnosing of COVID-19 and neurologic tuberculous coinfection, particularly in the communities at high risk for TB or in an endemic region. Herein, we report a case of a 60-year-old man diagnosed with acute COVID-19 and tuberculous meningitis coinfection, to emphasize challenges about this coinfection, because underlying lung diseases like latent TB will affect the clinical categorization (for severity) of COVID-19, and then active TB disease may severe illness.
Spontaneous pneumomediastinum (SPM) is a rare clinical entity. In the normal population, it is more likely to occur in people with conditions including chronic obstructive pulmonary diseases and asthma. In the context of COVID-19 few cases of SPM have been reported which most of them were patients with severe lung parenchymal inflammation or patients under mechanical ventilation. In this case, we report a young male with a history of minor childhood asthma who presented with acute dyspnea, forceful coughs, and subcutaneous emphysema. Chest computed tomography had no clues for COVID-19, however, pneumomediastinum and subcutaneous emphysema were obvious. He was primarily diagnosed with acute asthma exacerbation causing SPM but eventually, he tested positive for SARS-COV-2, therefore, he underwent the standard treatment for COVID-19 and the SPM was managed conservatively. Finally, after 12 days of hospitalization, he was discharged in favorable clinical condition.
Most people with toxoplasmosis infection are asymptomatic. Cerebral toxoplasmosis in HIV patient represents poor prognostic determinant, but treatable if early treatment is initiated. A case of delayed diagnosis of cerebraltoxoplasmosis is presented.A 27-year-old man presented with one-sided facial numbness and treated as Bell’s Palsy. Later he developed slurred speech. Contrast enhanced CT brain showed left frontal temporal hypodense lesion, leptomeningeal enhancement and perilesional oedema. Steroid was started. Four days later, he presented with decreased responsiveness. Retroviral was detected and diagnosis changed to opportunistic brain infection. He died after 3 days. Toxoplasmosis IgG antibodies turned out positive.In diagnosing cerebral toxoplasmosis, clinical presentation and examination are as important as laboratory testing and radiological imaging.
Pregnancy in a woman with Wilson disease (WD) can cause pre-eclampsia, miscarriage, and preterm labor and causes hepatic, neurologic, and hematologic complications aside from pregnancy-related difficulties. A 30-year-old female was brought to the emergency room (ER) in her 38th gestational week (GW) with the chief complaint of left foot swelling and weight gain. Aside from a platelet count of about 73000, the rest of the assessment and findings were normal. Regarding the reassurance of the platelet count and holding the medical treatment, throughout the vaginal delivery, a child with Apgar of 9-10 was delivered. WD in pregnancy tends to have complications, thus patient management and how the patient is treated are critical.
Postoperative pulmonary complications (PPCs) are associated with a significant morbidity and mortality; prevention and management strategies depend greatly on the patients’ comorbid conditions. Chronic Obstructive Pulmonary Disease (COPD) is a well-known risk factor for PPCs, but controlled Asthma does not appear to be so. On the other hand, the role of Asthma-COPD Overlap Syndrome (ACOS) as a risk for PPCs is yet to be studied. While there is a guidance for the perioperative risk reduction and management of COPD and Asthma, specific guidance for ACOS is also lacking. As a consequence, physicians tailor their management by considering both the components. We present a case of a 74-year-old man with ACOS, diagnosed with invasive bladder carcinoma. He was taken for laparoscopic radical cystectomy and ileal conduit. Although he had an uneventful surgery, we lost him on the seventh postoperative day due to multiple complications, including PPCs. The case highlights the need for considering the ACOS separately as a risk and calls for a specific roadmap for perioperative management. 1. Asthma-COPD Overlap Syndrome patients appear to be at high risk of PPCs2. There is a lack of evidence-based guidance and literature to tailor the management of such patients to reduce the perioperative risks for PPCs3. It is high time to delineate the ACOS patients from Asthma and COPD, study them in context to PPCs and perioperative outcome so that specific guidance can be developed.
Case presentation: We present a case of a 74-years-old man with ACOS, diagnosed with invasive bladder carcinoma. He was taken for laparoscopic radical cystectomy and ileal conduit. Although he had an uneventful surgery, we lost him on the seventh postoperative day due to multiple complications, including PPCs.
Conclusion: The case highlights the need for considering the ACOS separately as a risk and calls for a specific roadmap for perioperative management.
Redo syndrome or acute hematometra is a rare complication after abortion or cesarean section.A-32- year-old woman with previous cesarean section, term pregnancy, and labor pain referred to hospital.She delivered a healthy baby with a good Apgar score and discharge 2 days later without complications after a cesarean section. She came back to the hospital with the severe abdominal pain, weakness, without abnormal bleeding, at 6 days postpartum. Abdominopelvic sonography showed a large hematometra in the uterus. She took misoprostol 200 μg intra vaginal and 200μg sublingual, plus serum oxytocin and cefazolin. After about 1.5 hours, she passed a large hematoma, her pain gradually relieved, and she was discharged three days later. This report show that misoprostol is useful in the management of acute hematometra.
Neuromyelitis Optica Spectrum Disorder (NMOSD) is an autoimmune rare disorder that involves the endfeet of astrocytes. The role of genetics in the disease is not well known. Rare cases of familial NMOSD were reported worldwide. In this report, first, we presented a young man with myelitis and his cousin who suffered from this disease. Then we reviewed some reports around the world about familial NMO. The prevalence of familial NMO is nearly 3%. First cases are reported from East Asia. Its characteristics are similar to the sporadic type. Recent data suggest genetics play role in NMO.
This article presents a case of portal vein thrombosis accompanied by a large uterine fibroma. A 37-year-old virgin woman presented with vaginal bleeding, abdominal mass, fever, dyspnea and lower limbs edema. In past medical history, she did not have any systemic diseases. She had menometrorrhagia from four years ago. She was admitted with diagnosis of a large uterine fibroma and was suspected of COVID 19 pneumonia or thrombophlebitis. The final diagnosis was a large uterine fibroma with chronic portal vein thrombosis. Although uterine fibromas are benign tumors, they may make serious life-threatening complications like thrombosis. The cause of thrombosis is the pressure effect of fibroma and/ or transfusion to treat anemia. Although there may be other unknown etiologies for thrombosis in these patients. We suggest that existence of a large uterine myomas should be known as a risk factor for thrombosis ( like IBS, Covid 19 and etc.) and be given a score in Caprini Score system, to start anticoagulation before and after any surgical intervention.
Rituximab is a CD20 depleting agent, widely used as an off-label disease- modifying treatment (DMT) in treating multiple sclerosis (MS). The present study aimed to report the first case of rhino-sino-cerebral mucormycosis in a patient with secondary progressive MS (SPMS), treated with rituximab.The patient was a 38-year-old man with a history of SPMS treated with rituximab, who developed subacute left vision loss and impaired ocular movement. He also mentioned a concomitant severe headache and cheek swelling. Based on the brain and orbital magnetic resonance imaging (MRI) findings, rhino-sino-cerebral mucormycosis was suspected. Subsequent endoscopic examination confirmed the diagnosis. He underwent medical treatment with amphotericin B liposomal and surgical debridement leading to a significant clinical recovery. He was eventually discharged home with a solid recommendation to discontinue rituximab. The present report indicates a case of SPMS treated with rituximab, who developed rhino-sino-cerebral mucormycosis.
Seyed Farshad Allameh
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