Microangiopathic hemolytic anemia/Acquired Thrombotic Thrombocytopenic Purpura as a first presentation of pancreatic cancer
Thrombotic thrombocytopenic purpura (TTP) is a rare life-threatening hematologic disorder. It is mainly characterized by thrombocytopenia, microangiopathic hemolytic anemia (MAHA), fever, renal impairment and neurological abnormality. Plasmapheresis and steroids are the standard of care. MAHA/TTP can be the initial presentation of solid organ malignancies especially gastrointestinal tumors. We report a 56-year-old female patient who presented with progressive back pain, tiredness, easy bruising, fever and weight loss. Laboratory results showed anemia, thrombocytopenia, and schistocytes in the peripheral smear. An initial diagnosis of thrombotic thrombocytopenic purpura (TTP) was made on the basis of clinical presentation and lab findings. She was treated with corticosteroids and plasma exchange but with no major response. CT abdomen and PET CT were suggestive of pancreatic carcinoma with extensive lymph nodal, organs and bone metastases. Supraclavicular lymph node biopsy was compatible with metastatic adenocarcinoma. As a result, the diagnosis of pancreatic cancer was established and the decision was for palliative treatment. This case highlights the need to consider malignancy in patients with MAHA/TTP especially if it does not respond to plasmapheresis. Hence, the treatment of MAHA/TTP could be directed to the underlying malignancy if available.
Oral Lesion like Mucous Membrane Pemphigoid under Carboplatin-induced Hemolytic Anemia and Pancytopenia as Hypersensitive Reactions in a case with Maxillary Sinus Cancer: A Case Report
Here we report the first case of fatal carboplatin induced immune hemolytic anemia in a patient with head and neck malignant neoplasms followed by onset of multi-organ failure. While carboplatin is an effective agent used to treat many kinds of malignant tumorigenic lesion, a number of reports about allergic side effects are present. A 64-year-old male patient diagnosed as maxillary sinus cancer was treated by radiation therapy associated with weekly intravenous infusions of carboplatin. After five times of carboplatin infusion, white blood cell and platelet counts and hemoglobin value gradually decreased, and reached to almost bottom level. Both direct and indirect coombs tests were negative. Reticulocyte count and the value of platelet-associated IgG were high level, and oral lesion-like mucous membrane pemphigoid appeared on tongue and hard plate. Recognition of the particular oral abnormality in the early stage could allow for correct diagnosis and a potentially effective therapy. Funding: This study was supported in part by JSPS KAKENHI Grant Number 18K09885.
Invasive Haemophilus influenzae disease in Northwestern Ontario First Nations communities: Case Series
We present clinical and microbiological data of 5 pediatric cases of invasive Haemophilus influenzae disease, which occurred over a period of 10 months in the service area of a regional hospital of Northwestern Ontario. Four cases of invasive H. influenzae type a (Hia) disease presented either as meningitis, non-complicated and complicated pneumonia, or soft tissue infection in children between 7 months and 6 years of age. Although the cases were from different communities with no known common exposure, the Hia isolates demonstrated similar phenotypic and genotypic characteristics. One case of invasive disease due to nontypeable H. influenzae (NTHi) presented as chorioamnionitis in an adolescent. The data emphasize the significance of Hia and NTHi as a cause of serious disease in Indigenous communities.
Vascular neoplasms are the most common primary nonhematopoietic tumors of the spleen. They include hemangiomas, littoral cell angiomas, splenic hamartomas, lymphangiomas, hemangioendotheliomas, angiosarcomas, and Sclerosing Angiomatoid Nodular Transformation (SANT)1. SANT is a rare and benign lesion arising from the red pulp of the spleen 2.Martel et al first described the disease entity in 2004 in middle aged- adults with slight female preponderance , the etiology and pathogenesis are still not clear3, SANT poses diagnostic clinical and radiological challenges4, we present this case report with review of the literature.
Colo-renal fistula following percutaneous radiofrequency ablation of a renal tumor. A case report and review of treatment options
Background: Colo-renal fistula formation is a very rare complication following percutaneous radiofrequency ablation (RFA) in the management of renal cell carcinoma. In this paper we describe the management of a patient with a left colo-renal fistula occurring after renal tumor RFA. Additionally, we present a thorough literature review of reported cases of colo-renal fistulae after percutaneous RFA to further highlight their treatment challenges. Summary: Two weeks after undergoing percutaneous RFA of an incidental 3cm left renal mass, a 67-year-old male was re-admitted to the hospital with a symptomatic colo-renal fistula. Patient ultimately failed conservative management with broad spectrum antibiotics and ureteral stent placements, and subsequently underwent segmental colonic resection and renorrhaphy, with complete renal preservation. Conclusion: Although complications after RFA of renal tumors are rare, iatrogenic colo-renal fistula formation is a significant complication requiring a multi-disciplinary approach with a trial of non-operative management prior to surgical intervention.
Gallbladder torsion is a rare but potentially catastrophic presentation to an acute surgical unit. It was first described by Wendel in 1898 where this presentation was labelled as a ‘floating gallbladder’, with a high propensity for perforation1. Since then approximately 500 cases have been reported in the literature2. Anatomically, gallbladder torsion occurs where the gallbladder rotates along its mesentery causing vascular compromise and obstruction to biliary drainage. This leads to subsequent necrosis and perforation3. Shaikh A. et al have reiterated that the entire aetiological sequence of gallbladder torsion continues to remains a debated topic although, generally, a redundant mesentery is required for torsion to occur4. In most reported cases, the gallbladder has been shown to undergo a clockwise rotation 5. As described later, this presentation has predominantly been reported in elderly females suggesting that age plays a role in anatomically predisposing to torsion. Factors hypothesised for this include decrease in visceral fat and liver atrophy making free movement of the gallbladder and ultimately volvulus more likely to occur6. The symptoms of gallbladder torsion are in keeping with those of cholecystitis, typically presenting with right upper quadrant pain, nausea and vomiting 2. Clinical examinations of previously reported cases have documented abdominal distention, right upper quadrant pain and localised peritonitis2. These non-specific signs can make this specific phenomenon a challenge to diagnose in clinical practice. It has been documented that a partial volvulus can present with intermittent symptoms, similar to those seen in biliary colic, although the majority of cases will present acutely with signs described above 3. Due to the relatively low numbers reported in the literature it is difficult to determine the most appropriate investigations in patients where this is expected. Classically, patients presenting with right upper quadrant pain will likely receive an abdominal ultrasound on admission. From the cases…
Background: Schwannoma is a rare mesenchymal tumor, that arise from the Schwan cells of the nerve sheath. Schwannoma in the gastrointestinal tract is a very uncommon finding, with the stomach being the most common location. Preoperative diagnosis is difficult due to the wide variety of other mesenchymal tumors, definitive diagnosis is after histopathological examination and immunohistochemical staining of the specimen. Case presentation: We are presenting a rare case of stomach schwannoma, in a 50-year-old male who presented with urological complaints. He had a CT scan that incidentally showed a polypoidal gastric mass. Discussion: Schwannomas generally present asymptomatically; however, in some cases they can cause abdominal discomfort, pain or digestive symptoms. The definitive diagnosis of gastric schwannomas is determined by pathological examination of the surgically removed specimen. Conclusion: Schwannoma usually runs a benign course with excellent prognosis, yet there are very few reported cases of Malignant GI schwannoma. Benign or malignant, until now the treatment of choice is surgical excision with free margin.
We present a case of an 81-year-old asthmatic female with a left foot drop and an incidental finding of hypereosinophilia with an initial differential diagnosis of Eosinophilic Granulomatosis with Polyangiitis (EGPA). However, after extensive investigations, all causes of hypereosinophilia were excluded and the left foot drop was secondary to a radiculopathy. This led to a diagnosis of Idiopathic Hypereosinophilic Syndrome (IHES), a diagnosis of exclusion. This is the first case report where hypereosinophilia and a left foot drop where unrelated conditions occurring simultaneously thus posing a diagnostic dilemma. Therefore, this case report aims to highlight the importance of a systematic approach in the investigation of hypereosinophilia, to ascertain the cause and to rule out organ damage as this will affect the management and the outcome.
Recurrences of Graves’ disease (GD) after total thyroidectomy (TT) are uncommon, with few cases reported in literature. This article describes the case of a 58-year-old man who was treated with TT due to GD over 15 years ago. A progressive reduction of levothyroxine treatment was observed due to persistent subclinical hyperthyroidism. Thyroid-stimulating hormone receptor antibodies were detected in blood analysis and in the imaging test, a lesion was identified in the upper left anterolateral cervical region. A histopathological study of the lesion revealed colloid goiter. The patient was diagnosed with GD recurrence in a thyroid remnant and was remitted to an otorhinolaryngologist to remove the lesion. The histopathological study showed diffuse thyroid hyperplasia. The objective of this clinical case report is to highlight this unusual recurrence to better treat and improve long-term outcomes in patients treated with TT.
Diverticulae are uncommonly encountered in the stomach. They can be congenital or acquired- the latter variety being the less frequent of the two. This article details one such rare case from Lagos, Nigeria and discusses certain aspects of its clinical and endoscopic presentation. We present a 59-year old with a background history of non-steroidal anti-inflammatory drugs abuse presented with hematemesis and melena and was in hemorrhagic shock. After stabilization, the gastroscopy findings were of a gastric diverticulum (GD) in the anterior prepyloric wall. There was a Forrest IIb ulcer in the GD’s wall with surrounding erythema and edema. The patient was successfully managed medically and conservatively and with good long term results.