This is an RSS newsfeed from BioMed Central It is intended to be used with an RSS reader. For more information about RSS newsfeeds from BioMed Central, visit http://www.biomedcentral.com/info/about/rss/ http://www.jmedicalcasereports.com The latest articles from Journal of Medical Case Reports (ISSN 1752-1947) published by BioMed Central IntroductionCommunity-acquired pneumonia is the most common manifestation in primary coccidioides infections (Coccidioides immitis, C. posadasii). It is essential that this endemic dimorphic fungus be considered in order to proceed with the most appropriate diagnostic tools and therapy. Case presentationWe present a rare case of primary pleural coccidioides and a review of the current literature for optimal diagnostic methods and therapeutic strategies. Conclusions: With increased domestic and international travel, coccidioidomycosis will likely be encountered in nonendemic regions. Recognition by physicians is critical for a timely diagnosis and therapy. Tissue culture can assist in the diagnosis and polymerase chain reaction analysis shows potential as a possible addition. http://www.jmedicalcasereports.com/content/2/1/291 Kamyar Afshar, Ayana BoydKing and Om P Sharma Journal of Medical Case Reports 2008, 2:291 2008-09-03 doi:10.1186/1752-1947-2-291 Journal of Medical Case Reports 1752-1947 2 291 2008-09-03 IntroductionClear cell neoplasms of the jaw are very infrequent and a review of the literature reports only isolated cases of metastatic renal clear cell carcinoma of the jaw.Case presentationA 68-year-old man presented with an osteolytic lesion of the left hemimandible. The first diagnostic hypothesis was a third molar follicular cyst. Surgical treatment consisted of enucleating the lesion preserving the alveolar nerve and extracting of the retained tooth. Unexpectedly, the lesion presented as a solid. Conclusion: The authors report a case of a clear cell neoplasm involving the jaw in which histopathological exam presented an indeterminate histology. The histological characteristics of this tumor make it unique in the international literature. http://www.jmedicalcasereports.com/content/2/1/290 Giulio Gasparini, Roberto Boniello, Alessandro Moro, Francesco Federico, Federica Castri and Sandro Pelo Journal of Medical Case Reports 2008, 2:290 2008-09-01 doi:10.1186/1752-1947-2-290 Journal of Medical Case Reports 1752-1947 2 290 2008-09-01 IntroductionThe occurrence of cytomegalovirus colitis is well known in immunosuppressed patients, such as neoplastic patients following chemotherapy, although its exact etiology remains unclear. Case presentationWe present a case of cytomegalovirus colitis occurring in a 77-year-old man with vomiting and diarrhea 2 weeks after initial systemic chemotherapy consisting of 5-fluorouracil, leucovorin and irinotecan for a recurrent colorectal cancer. Initial colonoscopy revealed multiple punched-out ulcers in the transverse colon and the diagnosis of cytomegalovirus was based on positive cytomegalovirus antigen detected by indirect enzyme antibody method, although immunohistological examination of tissues biopsied at colonoscopy was negative. The symptoms ceased under ganciclovir and octreotide treatment, and the patient recovered gradually. Conclusions: The most probable cause of the cytomegalovirus colitis in this case was impaired immunity following chemotherapy. Cytomegalovirus infection should be included in the differential diagnosis of gastrointestinal disease in colorectal cancer patients after chemotherapy and, when suspected, the clinician should pursue appropriate diagnostic interventions including colonoscopy. http://www.jmedicalcasereports.com/content/2/1/289 Fuminori Teraishi, Hiroshi Shimamura, Takeo Suzuki, Masako Nakamoto, Akira Chikuba, Masashi Nezu, Shun Kohsaka, Takao Takiue and Hiroshi Chikuba Journal of Medical Case Reports 2008, 2:289 2008-08-28 doi:10.1186/1752-1947-2-289 Journal of Medical Case Reports 1752-1947 2 289 2008-08-28 IntroductionGlioblastoma in the pineal region is extremely rare with only a few cases reported in the literature.Case presentationA 68-year-old man presented with a sudden deterioration manifesting as a headache, vomiting and gait disturbance. A magnetic resonance imaging study revealed a heterogeneously ring-enhanced mass in the pineal region. The mass was subtotally removed through the occipital transtentorial approach, and diagnosed as a glioblastoma. Conclusion: We discuss the clinical course, radiological findings and treatment strategies of pineal glioblastoma with a review of the relevant literature. http://www.jmedicalcasereports.com/content/2/1/288 Kyung-Sub Moon, Shin Jung, Tae-Young Jung, In-Young Kim, Min-Cheol Lee and Kyung-Hwa Lee Journal of Medical Case Reports 2008, 2:288 2008-08-27 doi:10.1186/1752-1947-2-288 Journal of Medical Case Reports 1752-1947 2 288 2008-08-27 IntroductionDysphagia is a common presentation in older people. Diffuse idiopathic skeletal hyperostosis affecting the cervical spine is an uncommon cause of dysphagia and may be overlooked.Case presentationWe present the case of an 88-year-old man with dysphagia and weight loss. Initial investigation with upper gastrointestinal endoscopy was inconclusive. A diagnosis of diffuse idiopathic skeletal hyperostosis as a cause for dysphagia was eventually made using video fluoroscopy. This showed a bony prominence impeding swallow at the level of C3. The patient was unfit for surgical management so a percutaneous endoscopic gastrostomy tube was inserted for feeding. Conclusion: The diagnosis of diffuse idiopathic skeletal hyperostosis involving the cervical spine often goes unrecognised as a cause of dysphagia despite its prevalence in the elderly population. Diagnosis is made using cervical radiographs, barium swallow and computed tomography. There is a risk of perforation with endoscopy in patients who have cervical diffuse idiopathic skeletal hyperostosis. Conservative management includes non-steroidal anti-inflammatory medications and a modified diet. Surgery may be considered in certain patients where conservative management fails. http://www.jmedicalcasereports.com/content/2/1/287 Seema Srivastava, Natalia Ciapryna and Inaki Bovill Journal of Medical Case Reports 2008, 2:287 2008-08-27 doi:10.1186/1752-1947-2-287 Journal of Medical Case Reports 1752-1947 2 287 2008-08-27 IntroductionDisk battery ingestions can lead to serious complications including airway or digestive tract perforation, blood vessel erosions, mediastinitis, and stricture formation. Case presentationWe report a 20-month-old Caucasian child who developed eosinophilic enterocolitis and subsequent protein-losing enteropathy from manganese that leaked from a lithium disk battery. The disk battery was impacted in her esophagus for 10 days resulting in battery corrosion. We postulate that this patient's symptoms were due to a manganese leak from the 'retained' disk battery; this resulted in an allergic response in her gut and protein-losing enteropathy. Her symptoms improved gradually over the next 2 weeks with conservative management. Conclusion: This is the first case report to highlight the potential complication of allergic enterocolitis and protein-losing enteropathy secondary to ingested manganese. Clinicians should be vigilant about this rare complication in managing patients with disk battery ingestions. http://www.jmedicalcasereports.com/content/2/1/286 Muhammad A Altaf, Praveen S Goday and Grzegorz Telega Journal of Medical Case Reports 2008, 2:286 2008-08-27 doi:10.1186/1752-1947-2-286 Journal of Medical Case Reports 1752-1947 2 286 2008-08-27 IntroductionOsteoid osteoma is a benign tumor of the growing skeleton. It presents with pain, which is usually worse at night. The radiographic features consist of a central oval or round nidus surrounded first by a radiolucent area followed by another area of sclerotic bone. In the hand, osteoid osteoma is more commonly located in the phalanges and carpal bones. The metacarpals are the least common sites for osteoid osteoma.Case presentationWe present a case of an osteoid osteoma of the left third metacarpal bone in a 36-year-old woman. The clinical and radiographic findings along with the surgical management of the lesion are presented. The pain disappeared immediately after the operation. At the 2-year follow-up, the patient was pain-free and there was no evidence of recurrence. Conclusions: Physicians should be aware of the unusual presence and the atypical clinical presentation of this benign lesion in the metacarpal bones of the hand. http://www.jmedicalcasereports.com/content/2/1/285 Efstathios Chronopoulos, Fragiskos N Xypnitos, Vassilios S Nikolaou, Nicolas Efstathopoulos and Dimitrios Korres Journal of Medical Case Reports 2008, 2:285 2008-08-27 doi:10.1186/1752-1947-2-285 Journal of Medical Case Reports 1752-1947 2 285 2008-08-27 IntroductionAcquired partial lipodystrophy or Barraquer-Simons syndrome is a rare form of progressive lipodystrophy. The etiopathogenesis of adipose tissue atrophy in these patients is unknown.Case presentationThis is a case report of a 44-year-old woman with acquired partial lipodystrophy. To obtain insight into the molecular basis of lipoatrophy in acquired partial lipodystrophy, we examined gene expression in adipose tissue from this patient newly diagnosed with acquired partial lipodystrophy. A biopsy of subcutaneous adipose tissue was obtained from the patient, and DNA and RNA were extracted in order to evaluate mitochondrial DNA abundance and mRNA expression levels. Conclusions: The expression of marker genes of adipogenesis and adipocyte metabolism, including the master regulator PPARg, was down-regulated in subcutaneous adipose tissue from this patient. Adiponectin mRNA expression was also reduced but leptin mRNA levels were unaltered. Markers of local inflammatory status were unaltered. Expression of genes related to mitochondrial function was reduced despite unaltered levels of mitochondrial DNA. It is concluded that adipogenic and mitochondrial gene expression is impaired in adipose tissue in this patient with acquired partial lipodystrophy. http://www.jmedicalcasereports.com/content/2/1/284 Jordi P Guallar, Ricardo Rojas-Garcia, Elena Garcia-Arumi, Joan C Domingo, Eduardo Gallardo, Antoni L Andreu, Pere Domingo, Isabel Illa, Marta Giralt and Francesc Villarroya Journal of Medical Case Reports 2008, 2:284 2008-08-27 doi:10.1186/1752-1947-2-284 Journal of Medical Case Reports 1752-1947 2 284 2008-08-27 IntroductionInsulin allergy may occur in patients treated with subcutaneous applications of insulin preparations. Besides additives in the insulin preparation such as protamine, cresol, and phenol, the insulin molecule itself may be the cause of the allergy. In the latter case, therapeutic options are rare.Case presentationA 68-year-old man with poorly controlled type 2 diabetes mellitus received different insulin preparations subcutaneously while on oral medication. Six to eight hours after each subcutaneous application, he developed pruritic plaques with a diameter of >15cm at the injection sites that persisted for several days. Allergologic testing revealed positive reactions against every insulin preparation and against protamine. Investigation of serum samples demonstrated IgG antibodies against human and porcine insulin. We treated the patient with human insulin using an ultra-rush protocol beginning with 0.004 IU and a rapid augmentation in dose up to 5 IU. Therapy was accompanied by antihistamine therapy. Subsequent conversion to therapy with glargine insulin (6 IE twice daily) was well-tolerated. Conclusion: As reported in this case, desensitization with subcutaneously administered human insulin using an ultra-rush protocol in patients with an insulin allergy may present an easy form of therapy that is successful within a few days. http://www.jmedicalcasereports.com/content/2/1/283 Claudia Pfohler, Cornelia SL Muller, Dirk O Hasselmann and Wolfgang Tilgen Journal of Medical Case Reports 2008, 2:283 2008-08-26 doi:10.1186/1752-1947-2-283 Journal of Medical Case Reports 1752-1947 2 283 2008-08-26 IntroductionWe present the case of a 49-year-old woman with a seronegative rheumatoid arthritis who developed pustular psoriasis whilst on etanercept and subsequently developed disseminated herpes simplex on infliximab. Case presentationOur patient presented with an inflammatory arthritis which failed to respond to both methotrexate and leflunomide, and sulphasalazine treatment led to side effects. She was started on etanercept but after 8 months of treatment developed scaly pustular lesions on her palms and soles typical of pustular psoriasis. Following the discontinuation of etanercept, our patient required high doses of oral prednisolone to control her inflammatory arthritis. A second biologic agent, infliximab, was introduced in addition to low-dose methotrexate and 15mg of oral prednisolone. However, after just 3 infusions of infliximab, she was admitted to hospital with a fever, widespread itchy vesicular rash and worsening inflammatory arthritis. Fluid from skin vesicles examined by polymerase chain reaction showed Herpes Simplex Virus type 1. Blood cultures were negative and her chest X-ray was normal. Her infliximab was discontinued and she was started on acyclovir, 800mg five times daily for 2 weeks. She made a good recovery with improvement in her skin within 48 hours. She continued for 2 months on a prophylactic dose of 400mg bd. Her rheumatoid arthritis became increasingly active and a decision was made to introduce adalimumab alongside acyclovir. Acyclovir prophylaxis has been continued but the dose tapered so that she is taking only 200mg of acyclovir on alternate days. There has been no recurrence of Herpes Simplex Virus lesions despite increasing adalimumab to 40mg weekly 3 months after starting treatment. Conclusions: We believe this to be the first reported case of widespread cutaneous herpes simplex virus type 1 infection following treatment with infliximab. We discuss the clinical manifestations of herpes simplex virus infections with particular emphasis on the immunosuppressed patient and the use of prophylactic acyclovir. Pustular psoriasis is now a well recognised but uncommon side effect of antitumour necrosis factor therapy and can lead to cessation of therapy, as in our patient's case. http://www.jmedicalcasereports.com/content/2/1/282 Elizabeth Ann Justice, Sophia Yasmin Khan, Sarah Logan and Paresh Jobanputra Journal of Medical Case Reports 2008, 2:282 2008-08-26 doi:10.1186/1752-1947-2-282 Journal of Medical Case Reports 1752-1947 2 282 2008-08-26 IntroductionDermal sinus tracts are rare congenital lesions located in the midline characterized by a cutaneous pit or dimple. They occur all along the midline neuroaxis, from the nasion and occipital area down to the lumbar and sacral regions, most frequently in the lumbar and lumbosacral region.Case presentationHere we report a 5-year-old girl who presented with occasional headache. There were two dimples, one on the dorsal aspect of her head and another on her neck. Conclusion: Dermal sinuses are almost always singular and the co-existence of double dermal sinuses has not been reported previously. http://www.jmedicalcasereports.com/content/2/1/281 Mostafa El Khashab, Farideh Nejat and Abolhasan Ertiaei Journal of Medical Case Reports 2008, 2:281 2008-08-26 doi:10.1186/1752-1947-2-281 Journal of Medical Case Reports 1752-1947 2 281 2008-08-26 IntroductionFibroepithelial polyps of the ureter are benign tumors arising from the mesodermal tissue in the ureteral wall. Their etiology remains unknown. Hematuria and obstructive urinary symptoms are the most common findings. The treatment of choice is endoscopic resection, and the prognosis for patients with these lesions is excellent.Case presentationWe present three cases of fibroepithelial polyps associated with calculi in the distal part of the ureter. The patients were all women, aged 20, 45 and 52 years. Two patients were suffering from flank pain and dysuria while one patient was asymptomatic at the time of diagnosis. The patients were fully treated with endoscopic resection. To the best of our knowledge, this is the fourth report of adult ureteral fibroepithelial polyps associated with ureteral calculi in the English literature. The etiology, clinical features, diagnosis, and management of fibroepithelial polyps are discussed in this report. Conclusion: Whenever polypoid lesions are detected especially at the distal part of the ureter, benign fibroepithelial polyps should be kept in mind for differential diagnosis. Additionally, although rarely seen, the co-existence of ureteral calculi with fibroepithelial polyps should be borne in mind. http://www.jmedicalcasereports.com/content/2/1/280 Tahsin Turunc, Baris Kuzgunbay and Tuba Canpolat Journal of Medical Case Reports 2008, 2:280 2008-08-26 doi:10.1186/1752-1947-2-280 Journal of Medical Case Reports 1752-1947 2 280 2008-08-26 IntroductionPrimary hepatic lymphoma is an unusual form of non-Hodgkin's lymphoma that usually presents with constitutional symptoms, hepatomegaly and signs of cholestatic jaundice. Diffuse hepatic infiltration is uncommon and presentation with acute hepatic failure even more rare. The presence of markedly elevated ferritin levels can complicate the evaluation process and suggest alternative diagnoses. Case Presentation We present the case of a middle-aged woman exhibiting pancytopenia, hyperferritinemia and rapidly deteriorating to develop acute hepatic failure. Her initial clinical picture led to a working diagnosis of adult onset Still's disease with probable hemophagocytic syndrome before her worsening liver function necessitated a percutaneous liver biopsy and establishment of the final diagnosis of primary hepatic lymphoma. Conclusions: Primary hepatic lymphoma is an uncommon malignancy and its manifestation as progressive hepatitis or acute fulminant hepatic failure can be difficult to diagnose. The presence of constitutional symptoms, pancytopenia and high ferritin levels can complicate the evaluation process. A liver biopsy early in the course of liver dysfunction may establish the diagnosis without a higher risk of bleeding complications seen once liver failure sets in. http://www.jmedicalcasereports.com/content/2/1/279 Fyeza S Haider, Robert E Smith, Sharif Khan and Omar Rahman Journal of Medical Case Reports 2008, 2:279 2008-08-19 doi:10.1186/1752-1947-2-279 Journal of Medical Case Reports 1752-1947 2 279 2008-08-19