IJCR (2022), Volume 6

Sjögren’s Syndrome (SS) is a chronic autoimmune disease characterized by exocrinopathy, with xerophthalmia and xerostomia. Patients with SS may exhibit extra-glandular features such as neurologic symptoms. Peripheral neuropathy is the most common neurological complication of primary SS (pSS). We report a case of a 71-year-old female with pSS admitted to the Internal Medicine ward due to sensorimotor symptoms and petechiae. From the extensive study carried out, emphasis is given to elevation of inflammatory markers and to nerve conduction study compatible with mononeuritis of multiple nerves. The diagnosis of mononeuropathy multiplex (MM) secondary to pSS was made. She was started on corticosteroid therapy, which allowed complete regression of the petechiae as well as symptomatic and functional improvement. However, new sensorimotor deficits were noted a few days later. The decision was made to start cycles of cyclophosphamide in association with corticosteroid and physical therapies, leading to deficit improvement. Currently, the patient is in remission with low-dose corticosteroid therapy.

Ectopic prostate tissue (EPT) is an uncommon presentation and has been found mainly in the male urinary tract, such as the bladder, urethra, seminal vesicles, and testis. There have been extremely few cases of EPT observed out of the genitourinary tract. The present article describes one rare case of a 78-year-old male with an incidental finding of a rectal submucosal tumor, which was completely resected with a pathological diagnosis of EPT.

Background: Bronchopleural fistula (BPF) following percutaneous lung mass biopsy is a very rare but challenging complication. We describe percutaneous fibrin injection as safe and successful in the treatment of BPF. Additionally, we present a thorough literature review of the reported treatment options of iatrogenic BPF. Summary: A 68-year-old man with a lung cancer, COPD, and multiple other comorbidities underwent an image-guided percutaneous biopsy of an enlarging right-upper lobe lung nodule that was complicated by a large iatrogenic right-sided pneumothorax requiring an image-guided placement of a drainage catheter. Four days after the catheter placement, he was diagnosed with a BPF after developing a continuous air leak, pneumomediastinum, and extensive subcutaneous emphysema. Because patient wished to avoid placement of a chest tube, endobronchial interventions, or any other invasive procedures for management of his BPF, he underwent an image-guided, percutaneous fistula closure by injection of fibrin sealant in the fistula tract. Conclusion: BPF represents a significant challenge requiring a multidisciplinary approach. Percutaneous fibrin injection in the fistula tract represents a less invasive option for patients who have small fistulae, are not operative candidates, or wish to avoid the morbidity of a major surgical interventions.

Babinski-Nageotte Syndrome (BNS) is a rare variant of lateral medullary infarction, and only a few cases have been reported. In this case, a 52-year-old African-American gentleman presented with acute onset weakness on the left side of the body. On examination, there was a palpable right supraclavicular lymph node. Neurological examination showed right-sided gaze-evoked nystagmus and left hemiparesis with grade 3/5 power. Reflexes were normal except for extensor plantar responses on the left. MRI showed a subacute right-sided lateral brainstem infarct just below the pontomedullary junction with minimal progression in a repeat MRI after 24 hours. Workup for supraclavicular adenopathy with CT chest and CT abdomen and pelvis revealed neither neoplastic nor metastatic disease. Biopsy of supraclavicular lymph node was planned as an outpatient but was deferred as it was presumed to be reactive. He was conservatively managed with daily physiotherapy, aspirin, atorvastatin, and optimal blood pressure control. Babinski-Nageotte syndrome includes all symptoms of the Wallenberg syndrome with contralateral hemiparesis due to a spread of the lateral lesion to the pyramidal tract. Atherosclerotic occlusion and lipohyalinosis of the vertebral artery and posterior inferior cerebellar artery have been identified as the most common causes.

This case report could be considered very useful to show to the surgical residents how to obtain a correct diagnosis utilizing logically both clinical signs and diagnostic tools. Twenty days after a right hemicolectomy for colon cancer this patient presented a right sided colic pain in the lumbar region with irradiation to the groin and a CT showing a dilated right ureter. The anamnesis of the recent surgery was suggestive for iatrogenic ureteral lesion. Through the comparison of pre-operative and postoperative CT, however, it has been realized that a stone present in the right pelvis before surgery had been gone down to the ureter just immediately after surgery. Iatrogenic ureteral lesions after colorectal surgery are rare but should be considered a potential event during colorectal surgery. However, the correct and complete evaluation of anamnesis, clinical history, and diagnostic tools should be always done in order to reach a correct diagnosis. During the surgical residency, the residents should be encouraged to reason and think carefully, without any haste, to obtain a valid diagnostic solution.

Background: Enteric duplication cysts are rare congenital malformations. Cases in adults are rare, often asymptomatic and diagnosed incidentally. Enteric duplication cysts in adults could present abdominal pain, distention, mass and dysphagia. The preoperative diagnosis is difficult, radiological images, even an abdominal Computed Tomography scan could not show a bowel duplication. Malignant transformation is rare. Case presentation: We present a case of a 67 year-old man admitted in Our Surgery Unit for several episodes of bowel obstruction. After an ileal resection the anatomopathological exam diagnosed an Enteric duplication cysts. Conclusion: A diagnosis before surgery is difficult. Only surgery and a precise anatomopathological exam can discover this malformation.

Reversible cerebral vasoconstriction syndrome (RCVS) is a coined term to express conditions that manifest narrowing of the cerebral arteries. The most common manifestation of a patient with RVCS is severe headache that is thunderclap in presentation, however, some may present with focal neurologic deficits related to the site of edema or vascular occlusion and even cortical manifestation such as seizure. The current treatment for RCVS is still observational, which includes use of calcium channel blockers and intra-arterial vasodilation. In this case report, Cilostazol, a phosphodiesterase 3 inhibitor with a myosin light chain kinase enzyme inhibitor, can be used as a treatment for recanalization of constricted cerebral arteries.

Background: The purpose of this case report is to illustrate the clinical course of an extremely rare case of Congenital Pulmonary Lymphangiectasia (CPL) presenting as an early pulmonary interstitial emphysema (PIE) complicating respiratory distress syndrome, in an extremely low gestational age neonate (ELGAN) along with a short review of the literature. Case presentation: This 24 weeks ELGAN male with radiologic changes consistent with pulmonary interstitial emphysema (PIE) complicating respiratory distress syndrome which later progressed to bilateral cystic lung changes, expired at 23 days of age. Maternal history was complicated by E. coli urinary tract infection and Group-B Strep chorioamnionitis. The infant remained intubated throughout the hospital course and received antibiotics initially and terminally. His tracheal aspirate cultures also grew Mycoplasma hominis, and Ureaplasma urealyticum, treated with azithromycin. An autopsy revealed diffuse bilateral congenital lymphangiectasia. Postmortem blood and lung tissue cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA). Conclusion: Despite its extreme rarity, the authors recommend considering congenital pulmonary lymphangiectasia in the differential diagnosis, in an extremely preterm neonate, presenting with early pulmonary interstitial emphysema (PIE), and respiratory failure refractory to surfactant, antibiotic therapy, and complex ventilator management.

Bockdalek hernia is a rare type of congenital diaphragmatic hernia which was firstly described by Vincent Alexander Bockdalek in 1848.[1] The hernia sac is more commonly located on the left due to protection of the right side of the diaphragm by the liver, and contents can include spleen, small bowel, liver, colon or kidney.[1] Bockdalek hernia with intra-thoracic kidney is extremely rare and the reported incidence is less than 0.25%.[2] During embryogenesis the developing kidney which is located in the pelvis migrates upwards to fuse with the adrenal glands. Sometimes, this upward migration of the developing kidney does not stop at its designated point and thus the kidney reaches into the thorax. [3] Treatment options for Bockdalek hernia may include open or laparoscopic surgical repair, which involve the reduction of the herniated organs and closure of diaphragmatic defect with or without prosthetic mesh.[4] Herein we report a rare case of recurrent Bockdalek hernia including an intra-thoracic left kidney in a 59 year old lady with a past history of a Bockdalek hernia that was repaired at the age of 3, who presented to our hospital with severe lower abdominal pain and vomiting.

Few cases of ankle tuberculosis have been reported in the literature. We describe two cases of tuberculosis of ankle presented to Orthopaedics OPD at Rajindra Hospital, Patiala. Case one was a 34 year male with complain of swelling of the left ankle since 3 years and a discharging sinus at the tip of the old healed scar on the left ankle for 6 months. The patient was an old case of Pulmonary Tuberculosis treated with anti-tubercular therapy 6 years back. On laboratory evaluation, CBC, ESR and CRP were normal. Ankle X-Ray showed a lytic lesion in both malleoli. The patient was admitted and debridement of the left ankle was done, and the tissue specimen CB-NAAT was positive. The patient was subsequently put on anti-tubercular therapy for 11 months. His follow-up visits were uneventful. Case two was a 31 old year female presented to us with complaint of pain at right ankle since 5 months. Pain was followed by swelling which progressed over a period of time of one month. MRI was done which showed bone defect with erosions Tissue sample were sent for histopathological examination and CBNAAT.CBNAAT result came to be positive. Patient was put on ATT. Patient improved after ATT. Ankle TB is a rare entity ,must be considered in the differential diagnosis of a swelling of the foot and ankle., requiring a high index of suspicion. As the disease is progressive and promotes degenerative changes of the articular cartilage, early identification is critical for successful treatment and to avoid permanent functional disability.