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Pulmonary talc granulomatosis mimicking malignant disease thirty years after last exposure: a case reportIntroductionPulmonary talc granulomatosis is a rare disorder characterized by the development of foreign body granuloma secondary to talc exposure. Previous case reports have documented the illness in current intravenous drug users who inject medications intended for oral use. We present a rare case of the disease in a patient with a distant history of heroin abuse who presented initially with history and imaging findings highly suggestive of malignancy. Case presentationA 53-year-old man reported a 4-month history of increasing dyspnea and weight loss. He had a long history of smoking and admission chest X-ray revealed a density in the right hemithorax. Computed tomography confirmed a probable mass with further speculated opacities in both lung fields suspicious for malignant spread. Biopsies obtained using endobronchial ultrasound-guided aspiration returned negative for malignancy and showed bronchial epithelial cells with foreign body giant cell reaction and polarizable birefringent talc crystals.
Conclusions:
This case demonstrates a rare presentation of talc granulomatosis three decades after the last likely exposure. The history and imaging findings in a chronic smoker were initially strongly suggestive of malignant disease, and we recommend that talc-induced lung disease is considered in any patient with multiple scattered pulmonary lesions and a history of intravenous drug use. Confirmation of the disease by biopsy is essential, but unfortunately there are few successful proven management options for patients with worsening disease.
http://www.jmedicalcasereports.com/content/2/1/225
Suneel Dhand and William S KrimskyJournal of Medical Case Reports 2008, 2:2252008-07-03doi:10.1186/1752-1947-2-225Journal of Medical Case Reports1752-194722252008-07-03Jejunal perforation caused by a feeding jejunostomy tube: a case reportIntroductionPercutaneous endoscopic gastrostomy and feeding jejunostomy are used for providing long-term nutritional support to patients with neurological disorders. Various mechanical complications of these procedures are described.Case presentationWe report a case of a 17-year-old boy with cerebral injury who had a percutaneous endoscopic gastrostomy tube changed to a feeding jejunostomy tube. Twenty-four hours later he developed abdominal pain and became clinically septic. A contrast study through the feeding tube and a subsequent computed tomography scan did not reveal any intra-abdominal pathology. At laparotomy it was discovered that the tip of the feeding tube had perforated through the jejunal wall and was lying outside the lumen. This was successfully treated by re-inserting a feeding jejunostomy tube distally and closure of the perforation and previous FJ site
Conclusion:
We suggest that the threshold for contrast studies and operative intervention should be low in neurologically impaired patients to avoid the delay in treatment of tube-related complications.
http://www.jmedicalcasereports.com/content/2/1/224
Nicholas A Stylianides, Ravindra S Date, Kishor G Pursnani and Jeremy B WardJournal of Medical Case Reports 2008, 2:2242008-06-30doi:10.1186/1752-1947-2-224Journal of Medical Case Reports1752-194722242008-06-30Goodpasture's syndrome with positive C-ANCA and normal renal function: a case reportIntroductionGoodpasture's syndrome consists of a triad of pulmonary hemorrhage,rapidly progressive glomerulonephritis and anti GBM antibodies either in circulation or fixed to the kidney.The absence of renal manifestations is uncommon.we present herewith a case of biopsy proven anti GBM antibody disease with normal renal function mild urinary abnormalities and positive C-ANCA serology.Case presentation44 year old female was treated for repeated episodes of hemoptysis and one episode of respiratory failure requirng ventilatory support.She had minor urinary abnormalities in the form of microcopic hematuria and nonnephrotic proteinuria.She also had positive C-ANCA serology.Her lung biopsy showed evidence of intraalveolar hemorrhage with linear IgG deposits in basement membrane of the alveolar cappillaries.Because of the lung biopsy findings kidney biopsy was done in the patient which showed minimal thickening of the glomerular basement membrane and linear IgG and C3 deposits along the capillary walls consistent with the diagnosis anti GBM disease.Her renal function remained persistently normal.
Conclusion:
Goodpasture's syndrome is a rare disease.Eventhough the classical presentation is that of rapidly progressive glomerulonephritis ,pulmonary hemorrhage and anti GBM antibodies in circulation and kidneys it can rarely present with pulmonary hemorrhage and minor urinary abnormalities.In all the cases of repeated pulmonary hemorrahage the possibility of Goodpasture's syndrome should be considered and investigatd further.
http://www.jmedicalcasereports.com/content/2/1/223
Arunachalam Ramaswami, Thiraviam Kandaswamy, Tholappan Rajendran, Hla Aung, Chakko K Jacob, Shaukat Zinna and Pemasiri Upali TelesingeJournal of Medical Case Reports 2008, 2:2232008-06-30doi:10.1186/1752-1947-2-223Journal of Medical Case Reports1752-194722232008-06-30Long-term survival in a patient with repeated resections for lung metastasis after hepatectomy for ruptured hepatocellular carcinoma: a case reportIntroductionTumor rupture and pulmonary metastasis in patients with hepatocellular carcinoma are both associated with poor prognosis and treatment strategies are controversial. Case presentationHere we report a 50-year-old man with survival of over 90 months after undergoing an extended right lobectomy for a ruptured hepatocellular carcinoma and then repeated resections for pulmonary metastasis during the followup period.
Conclusions:
This case report shows that surgical resection can be an effective treatment for patients with both ruptured hepatocellular carcinoma and pulmonary recurrences.
http://www.jmedicalcasereports.com/content/2/1/222
Kai-Lun Shih, Yang-Yuan Chen, Tsung-Han Teng and Maw-Soan SoonJournal of Medical Case Reports 2008, 2:2222008-06-30doi:10.1186/1752-1947-2-222Journal of Medical Case Reports1752-194722222008-06-30Sweet's Syndrome in a patient with Crohn's disease: a case reportBackground:
Sweet's syndrome, also known as acute febrile neutrophilic dermatosis, has been associated with malignancy, autoimmune disease and collagen vascular disease. The association of Crohn's disease and Sweet's syndrome is rare. We report a case of Sweet's syndrome in a patient with Crohn's disease. Case presentationA 63-year-old man with a history of Crohn's disease presented with one-week duration of abdominal pain, diarrhea and hematochezia. He also noticed eruption of painful skin rashes all over his body at the same time. Colonoscopy and esophagogastroduodenoscopy (EGD) showed inflammation involving different parts of the gastrointestinal tract consistent with Crohn's disease. Punch biopsy of the skin lesion was consistent with Sweet's syndrome, which has a rare association with Crohn's disease.
Conclusion:
Crohn's disease should be excluded in patients presenting with Sweet's syndrome and diarrhea. Alternatively, Sweet's syndrome should be considered as a diagnosis when a patient with Crohn's disease develops skin lesions.
http://www.jmedicalcasereports.com/content/2/1/221
Nadia M Mustafa and Mark LavizzoJournal of Medical Case Reports 2008, 2:2212008-06-28doi:10.1186/1752-1947-2-221Journal of Medical Case Reports1752-194722212008-06-28A reversible lesion of the corpus callosum splenium with adult influenza-associated encephalitis/encephalopathy: a case reportIntroductionInfluenza virus-associated encephalitis/encephalopathy is a severe childhood illness with a poor prognosis. Adult case reports are rare and, to date, there have been no reports of adults with a mild subcortical encephalopathy with reversible lesions of the corpus callosum splenium.Case presentationA previously healthy 35-year-old man presented with acute progressive tetraplegia, transcortical motor aphasia and a mild decrease in his consciousness during his recovery after receiving oseltamivir phosphate treatment, and influenza type A antiviral medication. The initial magnetic resonance imaging study at day 1 showed symmetrical diffuse lesions in the white matter and a lesion on the central portion of the corpus callosum splenium. These findings had resolved on follow-up studies at day 8 and day 146. His neurological deficits mostly recovered within 12 hours following methylprednisolone pulse therapy. The levels of interleukin-6 and interleukin-10 in his blood and cerebrospinal fluid were initially elevated, but rapidly decreased to normal levels by day 8.
Conclusion:
It is important for clinicians to recognize that even in adulthood, the subcortical encephalopathy observed during the therapeutic treatment for influenza type A infection can occur in conjunction with a reversible lesion of the corpus callosum, which may recover quickly. In addition, the cytokine storm in the blood system and the corticospinal cavity may play an important role in the etiology of the disease process.
http://www.jmedicalcasereports.com/content/2/1/220
En Kimura, Sadahisa Okamoto, Yuji Uchida, Tomoo Hirahara, Tokunori Ikeda, Teruyuki Hirano and Makoto UchinoJournal of Medical Case Reports 2008, 2:2202008-06-28doi:10.1186/1752-1947-2-220Journal of Medical Case Reports1752-194722202008-06-28Cystitis due to the use of ketamine as a recreational drug: a case reportIntroductionKetamine is a derivative of phencyclidine and is a dissociative anaesthetic. Its use as a recreational drug is on the increase among young adults attending clubs and parties.Case presentationWe describe the case of a 20-year-old man who presented with a 7-month history of urinary frequency, nocturia, urgency, suprapubic discomfort during micturition and episodes of severe haematuria shortly after commencing weekly recreational ketamine use. Complementary examinations were negative except for a thickened bladder wall on ultrasound examination and mild inflammatory changes on cystoscopy. So far only nine cases of ketamine-associated ulcerative cystitis have been described.
Conclusion:
We expect that in the future an increasing number of cases of cystitis caused by ketamine use will be seen in young adults.
http://www.jmedicalcasereports.com/content/2/1/219
Britt Colebunders and Peter Van ErpsJournal of Medical Case Reports 2008, 2:2192008-06-26doi:10.1186/1752-1947-2-219Journal of Medical Case Reports1752-194722192008-06-26Mucinous cystadenoma of the appendix misdiagnosed as cystic hydatid disease of the liver: a case reportIntroductionPrimary neoplastic lesions presenting with a mucocele of the appendix are very rare and can be divided into benign variants of mucinous adenomas or cystadenomas, mucinous tumours of uncertain malignant potential or mucinous cystadenocarcinomas. Most of these tumourous mucoceles are asymptomatic and are found incidentally. The major complication of neoplastic mucinous appendiceal tumours is the development of a pseudomyxoma peritonei due to spreading of mucin-producing cells within the abdominal cavity.Case presentationA 44-year-old man presented with a history of non-specific symptoms of right upper abdominal pain. Abdominal ultrasound and computed tomography scan identified a cystic mass consistent with the morphological characteristics of an echinococcal hydatid cyst. After completing systemic albendazole therapy, an explorative laparotomy revealed a cystic tumour of the appendix. Ileocaecal resection was performed and pathology reports confirmed the diagnosis of a mucinous cystadenoma of the appendix. The postoperative course was uneventful.
Conclusion:
Here we present the case of a man with a mucinous cystadenoma of the appendix mimicking cystic hydatid disease. We discuss the importance of re-evaluation and differential diagnostic reflections in cases of appendiceal mucocele.
http://www.jmedicalcasereports.com/content/2/1/218
Andreas Krieg, Jan Schulte am Esch, Ludger W Poll, Stefan Braunstein and Wolfram T KnoefelJournal of Medical Case Reports 2008, 2:2182008-06-25doi:10.1186/1752-1947-2-218Journal of Medical Case Reports1752-194722182008-06-25Response of pulmonary artery intimal sarcoma to surgery, radiotherapy and chemotherapy: a case reportIntroductionPulmonary artery intimal sarcoma is a rare disease with no characteristic symptoms. It is difficult to diagnose early and is frequently misdiagnosed as a pulmonary embolism.Case presentationHere we report a case of pulmonary artery intimal sarcoma in a 54-year-old woman presenting with complaints of shortness of breath on exertion. Echocardiography and a computed tomography scan showed that the right pulmonary artery trunk was blocked by a low-density mass. The patient was diagnosed with pulmonary artery intimal sarcoma by pathology and a complete mass resection was performed. After experiencing 10 months of disease-free survival, she was re-admitted because of the recurrence and metastasis of the tumor. Radiotherapy and chemotherapy were performed; however, only limited success was achieved. The patient died 15 months after the initial onset of symptoms.
Conclusion:
Some patients with intimal sarcoma of the pulmonary artery can benefit from radiotherapy and chemotherapy as well as surgery.
http://www.jmedicalcasereports.com/content/2/1/217
Hong-qing Long, Qin Qin and Cong-hua XieJournal of Medical Case Reports 2008, 2:2172008-06-25doi:10.1186/1752-1947-2-217Journal of Medical Case Reports1752-194722172008-06-25Factitious lymphoedema as a psychiatric condition mimicking reflex sympathetic dystrophy: a case reportIntroductionReflex sympathetic dystrophy can result in severe disability with only one in five patients able to fully resume prior activities. Therefore, it is important to diagnose this condition early and begin appropriate treatment. Factitious lymphoedema can mimic reflex sympathetic dystrophy and is caused by self-inflicted tourniquets, blows to the arm or repeated skin irritation. Patients with factitious lymphoedema have an underlying psychiatric disorder but usually present to emergency or orthopaedics departments. Factitious lymphoedema can then be misdiagnosed as reflex sympathetic dystrophy. The treatment for factitious lymphoedema is dealing with the underlying psychiatric condition. Case presentationWe share our experience of treating a 33-year-old man, who presented with factitious lymphoedema, initially diagnosed as reflex sympathetic dystrophy.
Conclusion:
Awareness of this very similar differential diagnosis allows early appropriate treatment to be administered.
http://www.jmedicalcasereports.com/content/2/1/216
Nnamdi Nwaejike, H A.P Archbold and Darrin S WilsonJournal of Medical Case Reports 2008, 2:2162008-06-24doi:10.1186/1752-1947-2-216Journal of Medical Case Reports1752-194722162008-06-24