http://www.jmedicalcasereports.com The latest research articles published by Journal of Medical Case Reports 2013-06-18T00:00:00Z IntroductionAn infection by herpes zoster virus is a common and important cause of encephalitis. Herpes zoster virus encephalitis if not treated promptly can result in significant morbidity and mortality. The diagnosis of herpes zoster virus encephalitis is based on clinical history, examination, neuroradiological imaging (magnetic resonance imaging and/or computed tomography scan), cerebrospinal fluid analysis and identification of the pathogen in cerebrospinal fluid by polymerase chain reaction amplification and/or anti-herpes zoster virus immunoglobulin G antibody in cerebrospinal fluid. Although ischemic intracerebral infarcts in patients with herpes zoster virus encephalitis or vasculopathy are reported in the literature, multiple intracerebral hemorrhages as a complication of herpes zoster virus encephalitis in an immunocompetent individual are extremely rare.Case presentationA 40-year-old Indian man presented with an acute history of four episodes of seizures, fever, headache, drowsiness, focal neurological deficits and vesicular eruptions over the abdomen in a typical dermatomal distribution. His head computed tomography scan revealed multiple cerebral hemorrhages. Investigations (positive ratio between the cerebrospinal fluid/serum quotients for anti-herpes zoster virus immunoglobulin G and total immunoglobulin G antibodies) established its infective origin due to herpes zoster virus. He developed bilateral pneumonia during the hospital course. He had an excellent recovery following a 2 weeks' course of intravenous acyclovir. Conclusion: Herpes zoster virus encephalitis or vasculopathy is a rare cause of multiple intracerebral hemorrhages and must be considered in the differential diagnosis of patients presenting with an acute history of fever, altered consciousness, and focal neurologic deficits with history of a typical herpetic rash. Its prompt recognition and treatment could alter the course of illness. http://www.jmedicalcasereports.com/content/7/1/155 Amrish Saxena Benjamine Khiangte Iadarilang Tiewsoh Ulhas Jajoo Journal of Medical Case Reports 2013, null:155 2013-06-18T00:00:00Z doi:10.1186/1752-1947-7-155 /content/figures/1752-1947-7-155-toc.gif Journal of Medical Case Reports 1752-1947 ${item.volume} 155 2013-06-18T00:00:00Z PDF IntroductionExtraosseous uptake of 99mTc-hydroxymethylene diphosphonate is a common situation of variable clinical relevance.Case presentationA 52-year-old Caucasian woman presented to our department for breast cancer staging. A 99mTc-hydroxymethylene diphosphonate bone scan was performed and showed focal pelvic hyperfixation that disclosed intrauterine device migration into the anterior wall of the bladder on single photon emission computed tomography with computed tomography. Conclusion: This observation confirms the major role of single photon emission computed tomography with computed tomography in achieving an exact diagnosis. http://www.jmedicalcasereports.com/content/7/1/154 David Morland Carole Mathelin Arnaud Wattiez Izzie Namer Journal of Medical Case Reports 2013, null:154 2013-06-10T00:00:00Z doi:10.1186/1752-1947-7-154 /content/figures/1752-1947-7-154-toc.gif Journal of Medical Case Reports 1752-1947 ${item.volume} 154 2013-06-10T00:00:00Z PDF IntroductionAggressive angiomyxoma is a rare myxedematous mesenchymal tumor that mainly occurs in the female pelvis and perineum. The principle of treatment for aggressive angiomyxoma is surgical excision. The tumor can be removed by local excision alone when it occurs locally on the perineum. However, it cannot be completely excised by a perineal approach alone when it passes through the perineum and pelvic bone to extend into the retroperitoneal space.Case presentationA 34-year-old Asian woman presented with a rapidly growing left perineal mass and swelling in the left gluteal region. The swelling was associated with a mild, dull pain in the left gluteal region. In the present case of bulky aggressive angiomyxoma extending to the perineum and retroperitoneal space, the authors made an inverted Y incision through the buttock, removed the coccyx and lower portion of the sacrum, and excised the retroperitoneal mass and perineal lesion through a perineal approach. Conclusion: The inverted Y incision and trans-sacral approach can provide easy access to deep retroperitoneal aggressive angiomyxoma and reduce damage to neighboring organs. http://www.jmedicalcasereports.com/content/7/1/153 Dae Hong Gun Chong Young Cho Il Park Ji Park Yoon Lee Journal of Medical Case Reports 2013, null:153 2013-06-10T00:00:00Z doi:10.1186/1752-1947-7-153 /content/figures/1752-1947-7-153-toc.gif Journal of Medical Case Reports 1752-1947 ${item.volume} 153 2013-06-10T00:00:00Z PDF IntroductionReplication of the human immunodeficiency virus involves an obligatory step of reverse transcription of the viral ribonucleic acid genome into a double-stranded deoxyribonucleic acid, and subsequent integration of the deoxyribonucleic acid into the human chromatin to form the proviral deoxyribonucleic acid. This proviral human immunodeficiency virus deoxyribonucleic acid is a critical marker for the diagnosis of acute infections, mother-to-child transmissions and for the confirmation of indeterminate serological reactions. We describe a case of a human immunodeficiency virus positive woman, naive to antiretroviral treatment, who was persistently negative for human immunodeficiency virus proviral deoxyribonucleic acid polymerase chain reaction. This observation, to the best of our knowledge, is the first time that it has been described in Africa.Case presentationA 28-year-old Gabonese woman living in Cameroon requested a human immunodeficiency virus diagnosis in our laboratory. She had an unprotected heterosexual contact 6 months earlier while on vacation in Gabon. The request for a human immunodeficiency virus test was as a result of apprehensions developed after the exposure episode. Human immunodeficiency virus serological examinations were ambiguous and confirmatory tests (including human immunodeficiency virus proviral deoxyribonucleic acid polymerase chain reaction) were carried out. Apart from the human immunodeficiency virus proviral deoxyribonucleic acid polymerase chain reaction that was persistently negative, all other polymerase chain reactions carried out were positive. The deoxyribonucleic acid sequences have been submitted to the GenBank database with accession numbers: KC626022, KC626023 and KC626024 for the protease, reverse transcriptase and gp41 genes respectively. Conclusion: The persistently negative human immunodeficiency virus proviral deoxyribonucleic acid polymerase chain reaction in a person with a confirmed human immunodeficiency virus infection is of immense importance in the human immunodeficiency virus diagnostic field. This could highlight the fact that cases of false negative human immunodeficiency virus proviral deoxyribonucleic acid polymerase chain reactions exist especially with the high genetic variations observed with human immunodeficiency virus. The challenges presented by such false negative tests in the identification of acute infections, mother-to-child transmissions and the confirmation of indeterminate serological reactions are daunting. These data therefore would be invaluable especially to clinicians in Africa where non-B human immunodeficiency virus subtypes circulate. http://www.jmedicalcasereports.com/content/7/1/152 Anfumbom Kfutwah Valerie Ngono Paul Alain Ngoupo Richard Njouom Journal of Medical Case Reports 2013, null:152 2013-06-10T00:00:00Z doi:10.1186/1752-1947-7-152 /content/figures/1752-1947-7-152-toc.gif Journal of Medical Case Reports 1752-1947 ${item.volume} 152 2013-06-10T00:00:00Z PDF IntroductionLeukoencephalopathy, brain calcifications and cysts, known as Labrune syndrome, is a rare syndrome. The etiology is unknown; in some cases it is difficult to differentiate from Coats plus syndrome and diagnosed as cerebroretinal microangiopathy with calcifications and cysts. We present the case of a patient with adult leukoencephalopathy, brain calcifications and cysts and discuss recently described entities in view of the relevant literature.Case presentationA previously healthy 19-year-old Chinese man presented with weakness of his right limbs that rapidly worsened over a short interval. Computed tomography and magnetic resonance imaging showed numerous low-density cysts, calcifications, and abnormal signal change of white matter. A visual field examination showed irregular visual field defects in both eyes. A neuro-ophthalmologic examination did not find evidence of Coats retinopathy. A larger excisional biopsy was carried out and a diagnosis of leukoencephalopathy, brain calcifications and cysts was confirmed. Conclusions: We present an example of adult-onset leukoencephalopathy, brain calcifications and cysts and have expanded the clinical spectrum of features associated with this syndrome. Previous reports have not, to the best of our knowledge, previously reported visual field defects. Based on the latest findings, we believe that leukoencephalopathy, brain calcifications and cysts and Coats plus syndrome are genetically distinct entities. http://www.jmedicalcasereports.com/content/7/1/151 Yaming Wang Gang Cheng Chao Dong Jianning Zhang Yuhong Meng Journal of Medical Case Reports 2013, null:151 2013-06-06T00:00:00Z doi:10.1186/1752-1947-7-151 /content/figures/1752-1947-7-151-toc.gif Journal of Medical Case Reports 1752-1947 ${item.volume} 151 2013-06-06T00:00:00Z PDF IntroductionTetralogy of Fallot is one of the most common forms of cyanotic congenital heart disease and in the absence of surgical correction it has an elevated early mortality, with most patients dying in childhood.The authors reported this case because of the unusual course of an uncorrected tetralogy of Fallot. There are only a few reports of patients with an uncorrected tetralogy of Fallot who reach an advanced age and to the best of our knowledge this is the first case report of a possible endocarditis in a patient with an uncorrected tetralogy of Fallot who is older than 70 years.Case presentationThe authors present a case of a 72-year-old Caucasian woman with uncorrected tetralogy of Fallot who was admitted with fever and heart failure to our Cardiology Department with possible infective endocarditis. Conclusions: The longevity of this patient is probably due to the association between a large ventricular septal defect, a balanced subpulmonary stenosis and to the presence of systemic hypertension. After empiric antibiotic therapy, the patient was discharged and no surgical intervention was performed due to her previous benign evolution. http://www.jmedicalcasereports.com/content/7/1/150 Pedro Sousa Walter Santos Nuno Marques Pedro Cordeiro Rui Ferrinha Salomé Pereira Ana Almeida Ilídio Jesus Journal of Medical Case Reports 2013, null:150 2013-06-02T00:00:00Z doi:10.1186/1752-1947-7-150 /content/figures/1752-1947-7-150-toc.gif Journal of Medical Case Reports 1752-1947 ${item.volume} 150 2013-06-02T00:00:00Z XML IntroductionAcute leukemia is rare in pregnancy. The importance of promptly diagnosing and treating this disease in pregnancy stems from its life-threatening potential, both to the mother and fetus.Case presentationWe report a case of relapse of acute myeloid leukemia at 23 weeks of pregnancy in a 24-year-old Albanian woman. Our patient categorically refused chemotherapy treatment, and in her 35th week of gestation, severe hemorrhagic diathesis rapidly developed. The manifestation and course of this life-threatening complication posed therapeutic challenges for the attending medical team. Conclusion: Based both on our experience and the results of other gynecological studies, there exists a strong indication that the earlier a patient’s chemotherapy treatment begins, the better the maternal outcome. We support chemotherapy for patients who are pregnant presenting with such illness. The present case report testifies that refusal of chemotherapy by such patients is a high-risk decision. http://www.jmedicalcasereports.com/content/7/1/148 Syheda Hoxha Vlora Ibishi Ahmet Brovina Mynevere Hoxha Shefqet Lulaj Journal of Medical Case Reports 2013, null:148 2013-05-31T00:00:00Z doi:10.1186/1752-1947-7-148 /content/figures/1752-1947-7-148-toc.gif Journal of Medical Case Reports 1752-1947 ${item.volume} 148 2013-05-31T00:00:00Z XML IntroductionPleural effusions are a common clinical problem and affect about one million people in the United States and United Kingdom each year. Over 60 causes of pleural effusion have been identified; establishing the definitive aetiology can be difficult, and often requires invasive procedures. Guidelines state that macroscopic examination of the fluid should be the first step in determining the aetiology of a pleural effusion. Papillary thyroid carcinoma is an uncommon cause of malignant pleural effusion, with only 10 cases reported in the literature, their physical characteristics and composition having been rarely described. We describe for the first time a distinctive brown colour of the malignant effusion (despite centrifugation) from a rare case of metastatic papillary thyroid cancer to the pleura, associated with a high pleural fluid iodine content. Such a characteristic may be useful in expediting diagnosis of a malignant pleural effusion in the appropriate clinical context.Case presentationWe present the case of a 71-year-old Caucasian man with metastatic papillary thyroid cancer; a large, long-standing, right-sided pleural effusion and a 83-fold higher pleural thyroglobulin level compared to corresponding serum, supporting this malignancy as the cause of the patient’s effusion. The pleural fluid had a distinctive pigmentation similar to iodine-containing antiseptic preparations. Biopsy during medical thoracoscopy confirmed metastatic papillary thyroid carcinoma. Analysis of pleural fluid showed a pleural thyroglobulin level over 80 times that of serum levels (29,000μg/L versus 350ug/L). Pleural fluid iodine content was 23,000ug/L and may account for the fluid’s distinctive pigment, as iodine is an essential component in thyroglobulin and thyroid hormone synthesis. Conclusions: Pleural fluid pigmentation may aid diagnosis in the appropriate clinical setting. A distinctive iodine-like brown colour of pleural fluid may represent elevated iodine content and should raise consideration of metastatic thyroid cancer as a cause for a pleural effusion. http://www.jmedicalcasereports.com/content/7/1/147 Andrew Rosenstengel Ee Lim Michael Millward YC Lee Journal of Medical Case Reports 2013, null:147 2013-05-31T00:00:00Z doi:10.1186/1752-1947-7-147 /content/figures/1752-1947-7-147-toc.gif Journal of Medical Case Reports 1752-1947 ${item.volume} 147 2013-05-31T00:00:00Z XML IntroductionBoth the isolated distal femoral epiphysiolysis and the isolated proximal tibial epiphysiolysis are the least common epiphyseal injuries. Even though they are uncommon, they have a high incidence rate of complications.Case presentationWe present a case with Gustilo-Anderson grade 3b open and Salter-Harris type 1 epiphysiolysis of the distal femur and proximal tibia caused by a farm machinery accident. The patient was a 10-year-old boy, treated by open reduction and internal fixation. Conclusion: Although distal femoral and proximal tibial growth plate injuries are rarely seen benign fractures, their management requires meticulous care. Anatomic reduction is important, especially to minimize the risk of growth arrest and the development of degenerative arthritis. However, there is a high incidence of growth arrest and neurovascular injury with these type of fractures. http://www.jmedicalcasereports.com/content/7/1/146 Deniz Gulabi Mehmet Erdem Guven Bulut Cem Avci Murat Asci Journal of Medical Case Reports 2013, null:146 2013-05-31T00:00:00Z doi:10.1186/1752-1947-7-146 /content/figures/1752-1947-7-146-toc.gif Journal of Medical Case Reports 1752-1947 ${item.volume} 146 2013-05-31T00:00:00Z XML IntroductionCrystal violet was commonly used for the treatment of oral and vaginal candidiasis or for sterilization during operations up to the 1960s. Because crystal violet is potentially toxic to mucosal membranes, it has been replaced with other disinfectants, and crystal violet is rarely used. We report a case of chemical cystitis due to intravesical instillation of crystal violet dye.Case presentationCrystal violet dye was instilled into the bladder of a 47-year-old Japanese woman to confirm the presence of a vesicovaginal fistula. Our patient developed symptoms of gross hematuria, frequent urination and lower abdominal pain. Computed tomography showed thickening of her whole bladder wall with spotted high-density lesions. Cystoscopy demonstrated desquamated epithelial cells and a hemorrhagic bladder wall. We treated our patient conservatively with nonsteroidal anti-inflammatory drugs and glucocorticoids. During follow-up, magnetic resonance images showed that the detrusor muscle of her bladder was normal. Our patient’s symptoms gradually improved and she completely recovered within six months. Conclusion: Considering the severe side effect of crystal violet, it would be better not to use this dye to examine conditions such as a vesicovaginal fistula. Magnetic resonance imaging may help to evaluate the level of damage in the bladder wall of patients with chemical cystitis. http://www.jmedicalcasereports.com/content/7/1/145 Takeshi Hashimoto Makoto Ohori Takeshi Kashima Hidenobu Yamamoto Masaaki Tachibana Journal of Medical Case Reports 2013, null:145 2013-05-31T00:00:00Z doi:10.1186/1752-1947-7-145 /content/figures/1752-1947-7-145-toc.gif Journal of Medical Case Reports 1752-1947 ${item.volume} 145 2013-05-31T00:00:00Z XML