International Journal of Case Reports

Introduction: Renal stones are endemic in low income countries among children below 15 years old. This should not be underestimated due to high association with other morbidity and highly recurrence rate when compared with adults. Objective : To explore the Effectiveness of Extracorporeal Shock Wave In Pediatric Renal Stones. Methodology: Study the case of a child girl reported with renal stone, clinical and laboratory data were obtained , Radiological investigations as US and CT were done, The patient underwent dj stent, then patient received one session of Extracorporeal Shock Wave 4000 us guided storz eswl Lithotripsy for urinary Stones then uralyt-u pediatric dose and allpourinol 100 mg once daily then start to passing stones gravels Results: Follow up by CT for the patient after 3 months revealed no stone, renal scan split function from 12 to 18%. Conclusion: Renal stones could be presented even among pediatric group even with negative family history. Ultrasound is the first choice imaging modality for diagnosis of suspected renal stones , CT could be used for follow up. Dihydroxyadenine stones could be missed during routine diagnosis of renal stones so imaging is mandatory and stones analysis should be done.

A 7-month-old girl with congenital cytomegalovirus (CMV) infection underwent an immune assessment in anticipation of Transfer Factor therapy. She had been symptomatic since birth, with jaundice, rhinorrhea, diarrhea, pneumonia, hepatosplenomegaly, chorioretinitis, hydrocephalus (for which she was shunted), motor retardation, and failure to thrive. Her sputum and urine cultures were positive for CMV and her IgM anti-CMV antibody titer was positive at 1:16-1:32 dilutions. Her baseline immune assessment was normal except for a failure of her peripheral blood mononuclear cells to produce migratory inhibitory factor in response to CMV antigen. Treatment with transfer factor prepared from CMV seropositive donors resulted in clinical improvement, clearance of the virus, normal migratory inhibition factor responses to CMV antigen, and subsequent development of normal growth and development parameters.

Pharyngeal perforation is a rare serious finding with fatal outcomes if not diagnosed and managed promptly(1). The main cause is an iatrogenic injury during pharyngeal instrumentation and commonly present with neck pain, swelling, and subcutaneous emphysema. Many predisposing factors played a major role like difficult instrumentation, pharyngeal infection and old age(2). In our case, we present a patient with prostate cancer who underwent radical prostatectomy and was found to have mediastinal and surgical emphysema.

BACKGROUND Salmonella infection is common in tropical countries including Malaysia. It is invasive in immunocompromised and those of extreme ages. It typically presents with gastrointestinal symptoms such as diarrhea, abdominal pain or vomiting. Extra-intestinal manifestations are seen in 30% of salmonellosis cases. These atypical manifestation leads to difficulty and delay diagnosis thus poorer outcome. Pericardium involvement is estimated to be less than 2% of all cases and has mortality rate as high as 50%1. As high as 70% of pericarditis cases were identified to be immunosuppressed2; these include chronic immunosuppressant usage, autoimmune disease, end stage renal failure, malignancy and etc. Herein, we report a fatal case of pyogenic pericardial effusion by Salmonella enteritidis in an immunocompetent adolescent. CASE PRESENTATION A 16-years-old Malay boy was referred from GP to our centre in April 2015 with CXR finding suggestive of pericardial effusion. He had prolonged cough for 8 months, associated with breathlessness and failure symptoms. He had on and off fever but denied gastrointestinal symptom. He had multiple visits to private practitioners and was investigated for Tuberculosis, which yielded negative result. His condition continued to deteriorate. Of note, he had no significant medical and surgical illness. There was no history of contact with tuberculosis patients, recent travelling history or high risk behaviour. Upon admission, he was tachypnea and in shock. His blood pressure was 90/56mmHg with a pulse rate of 102bpm. His JVP was raised and heart sound was muffled. Lung examination revealed reduced breath sound bilaterally with generalized rhonchi. Initial blood investigations revealed leukocytosis with predominant neutrophils (16 x 109/L). ABG showed type 1 respiratory failure. ESR was raised, 100mm/hour. Chest X-ray showed a congested lung field consistent with pulmonary oedema. Bedside echocardiogram revealed a large pericardial effusion with diastolic right atrium and ventricle collapsed, indicating temponade effect. Emergency pericardialcentesis drained…

A 40-year-old male presented to the emergency department with the complaint of a sudden, painful left eye and swelling after episodes of sneezing. A day earlier, he had sustained a blunt trauma to the left orbit as the result of a fall from motorcycle. The initial examination showed subcutaneous and subconjunctival emphysema. Visual acuity in the left eye was 20/40 (0.50), the pupils were reactive with no relative afferent pupillary defect, and there were limitations in levoduction, dextroduction, infraduction and supraduction. A slit-lamp examination revealed normal anterior and posterior segments with an intraocular pressure of 24mmHg. An orbital computed tomography scan showed orbital, subconjunctival, and subcutaneous emphysema associated with a small fracture of medial wall of the left eye. Following conservative management with broad-spectrum oral antibiotics, a topical antiglaucoma drug, low dose systemic steroid drug, and lubricating eye drops, the patient improved dramatically within one week.

Q fever is an endemic zoonotic infection in Australia cause by Coxiella burnetii. It has been recognised in other parts of the world, especially among livestock rearing occupations, stock yard and abattoir workers. Majority (65%) of patients infected with C.burnetti are asymptomatic while symptoms similar to those of respiratory and hepatitis are the most common making diagnosis difficult in the early stages. We report a case of a young man who was exposed to and infected with Q fever as an occupational hazard. He presented in an unusual way with the predominant initial symptoms of abdominal pain, fever, hepatitis and sterile peritonitis necessitating an emergency surgical procedure to explore a suspected surgical abdomen. Respiratory involvement ensued only several days later. The diagnosis of Q fever was confirmed with positive convalescent serology phase II IgM and IgG antibodies to Coxiella burnetii. A marked clinical response to doxycycline pending serological confirmation was supportive of this highly suspected diagnosis in an at-risk patient.

AnIn knee arthritis with extra-articular deformity of the femur, total knee arthroplasty becomes more challenging. Simultaneous femoral deformity correction and TKA can be a complex procedure. We present a case in which TKA and femoral osteotomy for varus femoral deformity were performed simultaneously. Non-union in the osteotomy portion occurred after the operation. Teriparatide therapy and low intensity pulsed ultrasound therapy was administered after a diagnosis of non-union. Bony union was partially obtained at 29 months after surgery.

An emergency presentation of a paraoesophageal hernia with acute respiratory distress and an acute abdomen is a rare presentation. Hereby, we are presenting a 73year old female who presented with an acute dyspnoea and acute bowel obstruction, the imaging revealed large paraoesophageal hernia almost collapsing the right lung, she had an emergency surgery, an anterior gastropexy was performed since she was unstable. Despite subsequent surgeries e.g Collis gastroplasty and mesh cruroplasty, patient developed recurrent hiatal hernia. Unfortunately, the patient ultimately passed away from a vancomycin resistant enterococci (VRE) bacteraemia and due to overwhelming medical comorbidities. As presentation of paraoesophageal hernia with acute dyspnea and acute abdomen is a rare incidence, we discuss this and its management options through a case report.

Primary lymphoma of the bone (PLB) primarily arising from the medullary cavity is an extremely rare entity, with only limited number of studies and sporadic cases reported in the literature. The current study presents one case of PLB presented with unique presentation and treated with chemotherapy only. A 66 year old male presented with severe pain in the left hip that persisted for two months. Initial laboratory work up showed anemia, hypercalcemia and increase in free light chains kappa to lambda ratio, a diagnosis of multiple myeloma was suspected, magnetic reso¬nance imaging of the vertebral spine extensive involvement of bone marrow of the vertebrae. An 18F fluorodeoxyglucose positron emission tomography computed tomography (FDG PET CT) scan showed widely scattered moderate to intense uptake in multiple lytic of skeleton, Impression was : Image compatible with extensive multiple myeloma, No extra osseous involvement was found. Bone marrow examination was performed confirmed a diagnosis of extensive bone marrow involvement by High grade B-cell neoplasm with areas of bone marrow necrosis. The patient received six cycles of R-CHOP regimen (Rituximab, cyclo-phosphamide, Anthracycline, vincristine and prednisone) and achieved a complete response, as confirmed by FDG PET CT. At present, the patient is in a good condi¬tion.so this patient presentation mimicking multiple myeloma, which represent diagnostic dilemma. Primary lymphoma of the bone is rare disease entity, there is no strong evidence supporting some diagnostic and therapeutic decisions, and therefore, case presentation of the rare disease may facilitate treatment of similar diseases. A review of the literature to elucidate the clinical, radiological, pathological phenotype and optimal treatment of PLB done.

Primary central nervous system (CNS) lymphomas are tumours localised only in the brain, spinal cord, and rarely, the eyes (i.e. involving only the CNS). These can be detected by imaging modalities, namely computed tomography (CT) and magnetic resonance imaging (MRI), in which they appear as lesions, most often with surrounding enhancement (i.e. peripherally-enhancing or ring-enhancing lesions). However, similar lesions can be seen in a variety of other conditions and differentiating these diagnoses by imaging alone is difficult. We report a case of primary CNS lymphoma in a 21-year old gentleman who was misdiagnosed as and treated for neurocysticercosis and brain tuberculomas due to misleading investigation results, in addition to the relative unlikelihood of CNS lymphoma in this patient compared to other similar individuals. Fortunately, appropriate management was initiated as soon as CNS lymphoma was confirmed by biopsy of the brain lesion, with good treatment response.