International Journal of Case Reports

  • Successful experiments with Salvia officinalis and Salvia microphylla and COVID19

    This paper presents results of the author on Salvia officinalis and Salvia microphylla and COVID19. The results were achieved with dried Salvia officinalis leaves and with fresh Salvia microphylla leaves. The properties of fresh leaves appear with the taste as being much richer in antiviral agents, drying reduces the antiviral activity. The experiments presented in this paper are on the author himself, do not involve biosampling to confirm in laboratory but existing data in the published literature confirms the excellent efficiency of Salvia officinalis against COVID19 and a large array of other diseases. The self-experiments were very successful against COVID19, opening a path for natural treatment.

  • Epithelial-myoepithelial carcinoma of floor of mouth: A case report of double clear cell variant with immunohistochemical correlation

    Epithelial-myoepithelial carcinoma (EMC) is a rare biphasic low-grade malignancy accounting for only 0.5% of all salivary gland tumors. Commonly, EMC affects parotid gland (70%) and rarely affecting other salivary glands. Clearing of both, epithelial and myoepithelial cell types, is rare and gives an impression of a monocellular neoplasm. Case report: A 42-year-old male reported to Oral and Maxillofacial Surgery Department in Faculty of Oral and Dental Medicine, Misr International University with a painless growth in the floor of mouth since 5 years. The soft tissue window of computerized tomography (CT) revealed a well-circumscribed swelling in the sublingual space. The provisional diagnosis was pleomorphic adenoma. Results: The histopathological examination showed solid sheets of rounded to polyhedral clear cells forming lobes and lobules separated by connective tissue mucoid septa. A thin fibrous capsule, invaded with some tumor cells was also present. The presented pattern of clear cells together with the encapsulation of the tumor provides an impression of clear cell variant of monocellular neoplasm. Conclusion: The presented case relates to an epithelial-myoepithelial carcinoma originating from the sublingual salivary gland, which is a rare site for this lesion. Based on immunohistochemical staining, differentiation between the double clear cell types was confirmed using S-100 protein and SMA for the myoepithelial nature of the outer cells while the epithelial nature of the inner cells was confirmed by CK-19 and EMA. Thus, the diagnosis of double clear cell variant of EMC was given.

  • Hormone Receptor Expression in Non Cancer Breast Lesions

    Background Estrogen receptors (ER), Progesterone receptors (PR) expression is seen in non cancer breast lesions like juvenile fibroadenomas and phyllodes tumour. Materials and Methods This is a prospective study on a study population that comprised fibroadenomas and phyllodes tumor. Results While a few studies indicate that ER/PR expression correlates with a more benign outcome ,we did not see the same in our population. Ki 67 proliferation was greater in the stromal component of phyllodes tumours,compared to fibroadenomas.

  • Pseudo-endocarditis secondary to ruptured posteromedial papillary muscle with anatomical variation: A Case Report

    Myocardial infarction is the leading cause of papillary muscle rupture. This complication occurs in up to 5% of cases post MI and although rare, it constitutes a cardiac emergency if left untreated. On this basis, a 59-year-old male presented with low-grade fever and atypical chest pain with raised inflammatory markers and troponin levels. He was treated for infective endocarditis after echocardiography revealed a mass on the mitral valve, which was presumed to be a mitral valve vegetation and so he completed a 6-weeks course of antibiotics followed by elective mitral valve replacement surgery. During surgery, it was discovered that there was no endocarditis. Instead an unusually small muscle head of one of the posteromedial papillary muscle groups had ruptured secondary to an inferior myocardial infarction. This ruptured muscle head was highly mobile and mimicked a mitral valve vegetation. The mitral valve was successfully repaired, and the right coronary artery grafted. He made a full recovery but developed new-onset atrial fibrillation for which he is awaiting elective cardioversion. One should have a high index of suspicion for diagnosing papillary muscle rupture as it may mimic valvular vegetation on echocardiography, especially if the papillary muscle involved is an anatomical variant.

  • Secondary hyperparathyroidism and symptomatic hypercalcemia: overlooked complications of chronic liver disease

    A 71-year-old female with biopsy-proven liver cirrhosis was brought to the ER due to confusion for 5 days. She was diagnosed with acute decompensated liver disease and hepatic encephalopathy. Investigations also revealed PTH-dependent hypercalcemia. Both of these entities could be causing her symptoms. Neck ultrasound did not reveal any parathyroid lesions. Alteration in mental status persisted even after the management and resolution of hepatic encephalopathy. Symptomatic resolution occurred after normalization of her calcium levels which required normal saline, cinacalcet as well as calcitonin over the course of 7 days. Hypercalcemia secondary to chronic liver disease should be considered in the differential diagnosis of patients with liver cirrhosis presenting with an altered mental status. Hypercalcemia of chronic liver disease is not always transient and managed with normal saline as previously reported; It could necessitate more aggressive therapy with calcitonin and cinacalcet as reported in this case.

  • Miller Fisher syndrome associated with respiratory failure

    Miller Fischer syndrome (MFS) is a rare clinical variant of Guillain-Barre syndrome. The diagnosis suspected primarily on clinical trial of areflexia, ophtalmoplegia and ataxia, is confirmed by the mandatory presence of antiganglioside antibodies (anti GQ1b). An acute onset is typical of MFS, beginning with neurological symptoms following a respiratory or digestive infectious illness. The therapeutic options are either the plasmapheresis or the administration of intravenous immunoglobulin (IVIG). Although rare, in certain cases the patients present with respiratory symptoms needing intensive care. We report the case report of a patient which presented with the classical triad of MFS but also with rapid progressive respiratory failure due to bilateral vocal cords palsy and general muscle weakness. He needed respiratory mechanical support. The patient received a treatment by IVIG without any improvement in symptomatology. Eventually he completely recovered and he was discharged from the hospital 3 month later.

  • Tuberculosis Mimicking a Testicular Tumor

    Genitourinary tuberculosis is a challenging clinical entity which can affect the entire male genital tract. Seventy-five- year old male presented with a testicular lump masquerading a testicular malignancy. Histological and microbiological examination of testicular biopsy specimens established the diagnosis of tuberculosis. Isolated testicular tuberculosis is rarely reported. High degree of clinical suspicion and histological sampling are paramount important in the process of diagnostic evaluation.

  • Conditional Dysosmia: a Very Unpleasant Symptom Causing Severe Anorexia and Breathing Problems in Covid-19: a Case Report

    The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new coronavirus that is highly contagious and responsible for the ongoing pandemic disease; coronavirus disease (COVID-19). The disease was first identified in December 2019, and the World Health Organization declared the pandemic on the 11th of March 2020. Although individuals infected with SARS-CoV-2 may be asymptomatic, the disease can present as an upper respiratory tract illness. In the majority of the cases, it is of a mild type, however, some patients experience severe viral pneumonia that leads to respiratory failure, and, in some cases to death. A COVID-19 diagnosis is confirmed by viral RNA detection in nasopharyngeal swab specimens; nonetheless, in some countries, COVID-19 tests are not available for screening and are only used to diagnose severe cases. Since 31 December 2019 and as of 17 October 2020 and in accordance with the applied case definitions and testing strategies in the affected countries 39 400 032 cases of COVID-19 have been reported, including 1 105 353 deaths [1]. The main way to control the spread of COVID-19 is to prevent human-to-human transmission, which can be achieved through a combination of public health measures, including the rapid identification and isolation of infected people [1]. Diagnostic suspicion is based on nonspecific symptoms, such as fever, odynophagia, head- ache, and dry cough which are present in almost all acute respiratory virus cases [2]. Anosmia, which may be associated with the loss of taste, has been initially observed in European cases and seems to be a more specific symptom of COVID-19. Thus, during the pandemic, individuals with these symptoms should be tested for COVID-19; when tests are not available, isolation of the patient is indicated [3]. It should also be noted that olfactory dysfunction significantly influences the physical well-being, quality of life, safety, and…

  • Fatal diffuse pleural calcification due to Tuberculosis- An unexplained entity

    Diffuse pleural thickening has many causes and often need to be diagnosed early as delay in treatment can be lethal. Diffuse pleural thickening can be due to calcifications and may occur as a result of chronic infections including Tuberculous effusion. Primary pleural calcification due to Tuberculosis is extremely rare. A 28 year old patient was presented with exertional dyspnea, chronic cough and pleuritic type chest pain for a period of 4 months. CXR showed left sided diffuse pleural calcifications and ultrasonography showed calcified pleura with thick echogenic material suggestive of an empyema. Further evaluation with a CECT showed left sided diffusely calcified, septated pleura with empyema and contralateral early pleural and peritoneal calcification. Pleural aspiration showed a hemorrhagic exudative lymphocytic effusion with high ADA titer. Cytology did not reveal malignant cells. His serum calcium level was normal. He was diagnosed to have extra-pulmonary tuberculosis and was treated with standard anti TB treatment with an intercostal tube drainage. Despite TB treatment he passed away due to respiratory distress caused by pleural thickening. This case highlights the importance of timely initiation of anti TB treatment and the capacity of Tuberculosis to cause diffuse pleural calcification which can be fatal in an untreated setting.

  • Successful non-operative management of extensive pneumomedia- stinum and pneumoperitoneum

    Background: A 70 year old male presented with acute left flank pain and was found to have extensive free air in both the mediastinal and peritoneal cavities. He was managed successfully without surgery. Case: A 70 year old male presented with left flank pain that began an hour prior to arrival. He had a history of obstructive sleep apnea that had been treated with continuous positive airway pressure therapy (CPAP) at home for many years. His vital signs, physical exam, and laboratory testing were all unremarkable. However, imaging findings were impressive for massive pneumoperitoneum and pneumomediastinum. Given his clinical stability, operative exploration was deferred, and he was admitted for observation and bowel rest. He was discharged less than 48 hours after admission without incident. His history of home CPAP therapy was the only attributable cause for the ominous findings seen on his imaging. Recognizing that this was a case of benign free air saved this patient from the morbidity and potential for death that comes with an unnecessary operative exploration. Conclusion: Continuous positive airway pressure therapy can result in benign free air within the mediastinal and peritoneal cavities. Evaluating the complete clinical scenario will allow for recognition of similar cases in which these grim findings are not indicative of surgical disease, thus avoiding the iatrogenesis of unnecessary surgery.