A severe case of toxic epidermal necrolysis which started with agep-like features: Does a new clinical type of drug eruption?
Acute generalized exanthematous pustulosis (AGEP) and toxic epidermal necrolysis (TEN) are adverse cutaneous reactions. Despite the fact that these 2 cutaneous reactions differ in presentation, prognosis, pathologic features, and treatment, overlap can exist between them, creating a diagnostic challenge. It has rarely been reported that AGEP overlaps or mimics TEN, while TEN which starting by multıple pustules like AGEP has not been reported. The present study reports a rare case of a 14-year-old male patient with the clinical manifestations of multiple purulent bullae caused by amoxycillin ingestion. On 3. day dermatological examination revealed flaccid bullae and epidermal splitting with positive Nikolsky’s sign on right pectoral area, erosions on oral and anogenital mucosa. Histopathologic examination showed a massive inflammatory infiltration and epidermal necrosis indicated Steven Johnson syndrome. Later on added systemic symptoms with haemodynamic, respiratory imbalance and the patient was exitus. The case is discussed to reveal whether a new clinical pattern of drug eruption has been identified. We describe a patient with TEN who presented initially with clinical features of acute generalized exanthematous pustulosis (AGEP). To the best of our knowledge, one report drug eruption with purulent bulla and epidermal necrolysis has previously been documented, and therefore the present study is the second case report of its kind. Because the initial presentation of such adverse drug reactions may vary, diagnosis is difficult and dermatologists must careful the possibility of mimics among adverse cutaneous reactions.
COVID-19 infection was first described in Wuhan, China after an increasing spread of atypical pneumonia of unknown pathogen. Unfortunately, this novel virus continues spreading causing a pandemic. Thalassemia considered one of the most common hemoglobinopathies. Beta thalassemia is the commonest type with a variety in clinical picture due to the deference in homozygous. A lot of vulnerable categories were at high risk of getting infected with the coronavirus and more even its complication. Despite the conflicting data and ongoing research on this topic, thalassemia patients were categorized among the high-risk population. Here we present a case series describing the clinical progression of two splenectomised patients who has transfusion dependent beta thalassemia major.
Takotsubo syndrome (TTS) is characterised by transient regional wall motion abnormalities of the left or right ventricles often associated with new ECG changes (including ST-segment elevations, ST-segment depressions, T-wave inversions and QTc prolongation) in the absence of a culprit atherosclerotic artery which could explain the ventricular dysfunction. In this article we present an unusual case of recurrent TTS following electrical cardioversion in a 61 year old female patient who was admitted to our unit.
Metastatic pancreatic adenocarcinoma to the urinary bladder is extremely rare and has only been reported 4 cases worldwide. We describe such a case presented with hematuria and dysuria after ten months of the initial diagnosis. Immunohistochemistry helped to confirm the diagnosis of metachronous metastasis. Six months after being diagnosed with the bladder metastasis, progression with severe right hydronephrosis and mild dilatation of the left pyelocaliceal system palliated with an UventaTM metallic ureteral stent and a double J ureteric catheter.
CML is a chronic myeloproliferative disorder associated with activating mutations in tyrosine kinases forming a BCR-ABL fusion gene, causing hyperproliferation of neoplastic myeloid progenitors [1,2]. The incidence of CML peaks in the fourth and fifth decades of life . In the United States, nearly 4,500 cases are diagnosed annually . The onset of the disease is insidious due to the nonspecific initial “B symptoms,” such as increased fatigability, weight loss and weakness. The natural history of CML is slow with a median survival of three years if untreated [3,4]. The current treatment is targeted therapies to the BCR-ABL tyrosine kinase using imatinib or nilotinib and hydroxyurea. Although B symptoms are common, priapism can be an initial presentation of CML in 1-5% of cases . Priapism is a urological emergency defined by a sustained erection of four or more hours. Hyperviscous blood in leukemias, such as CML, prevents appropriate venous drainage of the corpora cavernosa, resulting in failure of detumescence . This case reports highlights priapism as a presenting sign of CML and reviews the pathophysiology between the association.
It is well known in the literature that adult ptosis can be induced or worsen by cataract surgery even with modern sutureless clear cornea phacoemulsification. [1, 2, 3, 4,5,6,7,8] We are presenting this unusual case was the opposite. The ptosis resolved after cataract surgery. A possible effect from the successful management of dry eye disease before cataract surgery is explained. Drooping of the unilateral upper eyelid is unilateral ptosis. Ptosis may be myogenic, neurogenic, and aponeurotic from healthy aging, injury, eye diseases. [9, 10] Ptosis also can be associated with hard contact lens wear, immunological, degenerative, or hereditary disorders, tumors, or infections.  Patients with ptosis often present with a lower position of the upper eyelid, complain of a tired appearance, and defect in their superior visual field even blurred vision. The levator muscle controls the position of the eyelid and is innervated by the oculomotor nerve. The Mueller muscle also controls partially by providing sympathetic innervation. The deficiency of these two muscles may cause ptosis.  Hering’s law of motor correspondence of a ptosis lid can affect the contralateral lid position [5, 7] as the levator muscles work in synchrony with each other. Therefore, unilateral ptosis can induce a retraction of the contralateral lid or a pseudo retraction. When ptosis is causing visual field defects, the innervation input to both eyelids will increase to reduce the ptosis. There will be a compensatory elevation of eyebrow to reduce the amount of ptosis.  These phenomena need to be considered in the evaluation of unilateral ptosis for surgery. Another essential examination, such as Margin Reflex Distance 1 (MRD1), is the crucial measurement for ptosis besides levator function and palpebral fissure. MRD1 is the distance from the margin of the upper lid to the central corneal reflex (normal is between 4.0-4.5 mm)….
The patient is a 15-year-old girl who presented with a 4-day history of fever, a persistent cough, and x-ray evidence of a right middle lobe pneumonia. On day 10 of her illness, at a time when she was afebrile and her pneumonia had cleared, she developed a severe headache and within hours lapsed into coma. Cerebral spinal fluid analysis and serological tests were diagnostic of a post-infectious meningoencephalitis due to Mycoplasma pneumoniae.
Evaluation of laboratory risk indicator for necrotizing fasciitis (Lrinec) scoring system for diagnosis of necrotizing fasciitis in patients presenting with soft tissue infection
Necrotizing soft tissue infection represents a diverse process; the term itself encompasses a continuum ranging from pyoderma to life threatening infections (clostridial gas gangrene with myonecrosis, anaerobic cellulitis, and severe, necrotizing vibrio infections). These can occur in any anatomical area but the commonest site is the extremities. Necrotizing fasciitis is often underestimated because of the lack of specific clinical findings in the initial stages of the disease. The paucity of specific cutaneous signs to distinguish necrotizing fasciitis from other soft tissue infections such as cellulitis makes the diagnosis extremely difficult. The first and most important consideration for an accurate, prompt diagnosis is to have a high index of suspicion. It has been shown by numerous studies in the past that early recognition and surgical intervention at the earliest is the sole factor in preventing the morbidity and mortality in patients with necrotizing fasciitis [1-3]. So a scoring system which is easy to follow and cost effective with high positive and negative predictive value is required. One such scoring system is the LRINEC scoring system devised by Wong et al  in 2005 which claims to have a positive predictive value of 92.0% and negative predictive value of 96.0%. The mortality in necrotizing fasciitis is as high as 34%.  We evaluated LRINEC scoring system in patients presenting with symptoms and signs suggestive of soft tissue infection that progresses to necrotizing fasciitis in Sri Ramachandra Medical College and Hospital, Porur, Chennai over a period of two years.
Intra Cholecystic Papillary Tubular Neoplasm – A Case Report Of A Rare Differential Diagnosis Of Carcinoma Gall Bladder
We present a case report of a 57 year old lady who presented with complaints of right sided upper abdominal pain. The patient was initially diagnosed with carcinoma gall bladder(CAGB) by CECT Abdomen and PET CT imaging studies. Intra cholecystic papillary tubular neoplasm of the gall bladder(ICPN) was diagnosed after histopathological examination of the radical cholecystectomy specimen. ICPN can be managed with a cholecystectomy if the diagnosis is known pre operatively as the prognosis for ICPN is much better as compared with that for gallbladder adenocarcinoma.
Case report: The patient is a 36-year-old woman who was referred to our allergy-immunology clinic by her primary care physician to be assessed for a possible allergic disorder. The patient states that since early teenage she has had frequent bouts of sneezing generally preceded by nasal itching and often occurring when she first goes outdoors. She denies having a chronic cough or wheezing and has no symptoms suggestive of allergic conjunctivitis or sinusitis. She has not had urticaria or anaphylactoid reactions. Her mother and 29-year-old sister have similar complaints but have never been assessed for possible allergies. The patient’s medical history is otherwise unremarkable. On physical examination her vital signs were within normal limits. Her conjunctivae were not inflamed or edematous and she had no edema or pallor of her nasal mucosa and no tenderness of her paranasal sinuses. Her lungs were clear to auscultation and free of wheezes on deep breathing. The remainder of her exam was unremarkable. Laboratory assessment revealed a normal complete blood count and metabolic panel. Skin testing to 66 regional allergens was negative, and her serum IgG, IgA, IgM, IgD, and IgE levels were within normal limits. Because she was suspected as having ACHOO, she was dark adapted and then exposed to a bright light which instantaneously precipitated her nasal itching and sneezing, confirming the diagnosis.