Journal of Clinical Case Reports

Atypical Polypoid Adenomyoma (APA) is a rare uterine polypoid biphasic tumour that is typically seen in fertile age. Patients present with abnormal uterine bleeding. Although considered as a benign tumour the literature review reveals a risk for recurrence when conservatively treated and an association with endometrial hyperplasia and carcinoma. Hence, the current views suggest the possibility that APA might be a localised form of atypical hyperplasia. Cowden syndrome is an often difficult to recognize hereditary cancer predisposition syndrome caused by mutations in Phosphatase and Tensin Homologue Gene (PTEN) located on chromosome-10. Affected individuals are predisposed to hamartomatous growths as well as malignancy in multiple organ systems including female breast, endometrium, thyroid, colon and kidney. We describe a first case of clear cell carcinoma arising on the surface of atypical polypoid adenomyoma in a 26 years old female. The tumour was confined to the surface of atypical polypoid adenomyoma of the lower uterine segment with no underlying myometrial invasion; lymphovascular permeation or distant metastasis. The patient was also suggested as having Cowden syndrome based on the clinical circumstances “age and the previous history of follicular thyroid adenoma”. Molecular (PTEN gene) analysis performed later-on confirmed the clinical diagnosis of PTEN hamartoma tumour syndrome. This is the second reported case of atypical polypoid adenomyoma within the context of Cowden syndrome highlighting the possible association between the two. The additional pathological finding of clear cell carcinoma in our case would imply that coexisting/associated endometrial adenocarcinoma with APA could be of either endometrioid or non-endometrioid histo-type.

Background: Oculo-orbital non-Hodgkin lymphoma is a rare presentation of lymphoma. The objective of our study was to clarify the clinical features of non-Hodgkin's oculo-orbital malignant lymphoma and to establish the place of radiotherapy in the treatment. Case: This is a retrospective study including 9 patients treated at the Salah Azaiez Institute between 2007 and 2018. Results: There were 5 women for 4 men with an average age of 65 years. Four LMNHs were located on the right, three on the left and two bilateral. The time between the appearance of functional signs and the diagnosis was less than 6 months. The diagnosis is confirmed by biopsy, resulting in several histological varieties. A full extension assessment was performed in all patients. Muscle and/or optic nerve extension was noted in 6 patients and bone damage was observed in two patients. Six patients had chemotherapy. The 9 patients were treated with orbital radiotherapy with a dose that varied between 30.6 and 40 Gy. The duration of patient follow-up was from 2 months to 10 years. Seven patients were in complete remission. Two patients had insufficient follow-up and one patient died one month after the end of treatment. Conclusion: The interest of radiotherapy in oculo-orbital LMNH has been clearly demonstrated in several studies, but its place, its methods and its tolerance profile remain to be defined in many situations.

We present a one clinical case of patient with metastasis of squamosa cell non–small-cell lung cancer in pancreas. A 49-year-old Caucasian male patient presented to our Medical Oncology department with obstructive jaundice and severe abdominal pain after the last course of chemotherapy. Six months prior to presentation the patient had undergone right bronchoscopy, due to stage IV, moderate-grade squamous cell lung carcinoma. After the bronchoscopy, the patient receives chemotherapy and radiotherapy. Abdominal computed tomography on admission after the last course of chemotherapy, revealed lesion located at the head of the pancreas, causing biliary obstruction. The abdominal computer tomography reveals also lesion in left adrenal gland. Histological examination reveals and change in grade of the histology from moderate in primary foci in lung to lowgrade in metastasis in pancreas. Due to the severe pain in the abdomen and jaundice of the metastatic disease, surgical resection was proposed, and the patient underwent pancreaticoduodenectomy. Histological examination of the resected specimen from pancreas confirmed a low-grade squamous cell carcinoma forms the lung

We report a case of a Yellow Fever Vaccine-Associated Viscerotropic Disease Adverse Event (YEL-AVD) in a young female, who presented to the emergency ward with fever, jaundice, acute kidney failure and thrombocytopenia. Diagnosis was made based upon diagnostic criteria proposed by The Brighton Collaboration Viscerotropic Disease Working Group. YEL-AVD is a very rare but potentially life-threatening acute infection of liver and other vital organs resembling naturally acquired yellow fever disease. Awareness of this rare complication is pivotal in its diagnosis.

Aim & Purpose: To report a new case of herpes zoster in an immunocompetent pediatric patient. Case report: A previously healthy 6-year-old boy which the medical history revealed no anterior vaccination against VZV but a maternal varicella during the pregnancy. He Consults on our Emergency Department for a diffuse vesicular skin eruption, particularly covering the left forehead, a blurry vision, photophobia and a left-sided Headache. The clinical examination revealed a sub-febrile temperature (38.5°C), a thick layer of necrotizing crusts covering the left forehead, a upper eyelid, vesicles and pustules with an erythematous base on the left zygoma extending to the left lateral canthus, a bilateral eyelid edema particularly on the left and the Hutchinson's sign, a predictor of ocular inflammation and corneal sensory denervation, was present. The best visual Acuity was 10/10 in the right eye and 7/10 on the left. The slit lamp examination noted in left eye a conjunctival hyperemia with a pseudo dendritic epithelial keratitis, a diffuse fluorescein staining of the corneal epithelium, and secretions. The right eye was normal. The laboratory investigations revealed white blood cells at 5.1 × 103 cells/μL, the basic immunological tests (Immunoglobulines; C3 and C4 levels) were normal and the HIV serology was negative. A clinical diagnosis of herpes zoster was made, and the patient was started on intravenous Acyclovir (10 mg/kg/dose every 8 hours) associated to topical Gancyclovir, eye wash solution, topical antibiotic, lubricating eye drops and Dermatologic ointments daily for 1 week. The evolution was marked by a complete remission without sequelea. Discussion and Conclusion: The peculiarity of our observation is the occurrence of shingles in an immunocompetent child, without notion of previous chickenpox and the ophthalmic localization which remains a rare form in children. Clinicians must be vigilant in their evaluation of vesicular lesions in children even without known varicella exposure.

Brucellosis is a multi-system infectious disease that exhibits various manifestations and complications. Neurobrucellosis is a rare but serious presentation of brucellosis that can be discovered in every stage of the disease. Laboratory tests, physical examination, and patient history are generally the basis for diagnosing the disease. It has both insidious and prolonged clinical course of the disease and long-term therapies. Also, the most common pattern of the exhibition is sub- acute or chronic. We reported a case of a young female who had a history of painless weakness in the right lower limb (proximal and distal) that started gradually and had progressed over time, and after a month she felt weakness in the left lower limb with the same pattern. Lumbosacral Magnetic Resonance Imaging (MRI) with and without contrast was shown evidence of enhancement thickening of caudal equina ventral roots. Brucella agglutination test was positive, the result was 1/160. And other clinical tests were normal. The patient was treated with Intravenous Injection (IV) Rifampicin and Intravenous Cotrimoxazole. The patient was discharged with good health and continuing all two medications for 5 months. The decision was taken to report this case as a result of the entire response in the patient’s illness after an enduring disease. Neurobrucellosis is a treatable disease in which it would be better to consider a high indication of suspicion. If ignored, it may cause significant morbidity and mortality

The cholecystocolic fistula is a rare complication, usually of a chronic cholecystitis. The clinic presentation is variable and non-specific and common with other abdominal pathologies. Because of the abdominal anatomy, the most frequent fistula is the cholecysto-duodenal (70%), followed by the cholecystocolic (10-20%) and the least common is the cholecystogastric fistula.

Thumb hypoplasia occurs in a variety of forms, which are often categorized using Blauth classification and its modifications. In 1991, Manske et al. suggested a type IIIA variation characterized by first web space narrowing, underdeveloped or absence of thenar muscles, thumb extrinsic and metacarpophalangeal joint instability. Here we present a 5-year-old female patient who visited our clinic due to a small thumb and inability to flex the interphalangeal joint since birth. Her medical history showed an esophageal atresia surgery which was performed when she was a neonate. She then underwent a first web space release using four-flap Z-plasty and exploration of the flexor pollicis longus tendon. We found that the extensor pollicis longus and flexor pollicis longus tendon were interconnected along the radial border of the thumb, traction on either tendon tends to abduct the thumb at the metacarpophalangeal joint. Tenolysis was performed and the patient showed significant improvements in opposition movements and precision grip post-operation. We proposed that ultrasound is as reliable as magnetic resonance imaging to examine the flexor tendon and performing a wrist incision to confirm the recovery of the thumb opposition motion can save unnecessary tendon transfer.

Psychiatric symptoms in patients with structural brain anomalies may be very hard to manage. A patient with Behçet Disease associated neurological signs was consulted to a consultation-liaison psychiatrist for evaluation and treatment of coprophagia. Little is known about the etiology and treatment of coprophagia. We’ll review what is known about this disorder as well as treatment options.

Idiopathic pulmonary hemosiderosis is a chronic respiratory disorder characterized by repeated episodes of alveolar hemorrhage. Patients with
this disorder have a risk for acute exacerbation and life threatening respiratory failure. To date, it has not been well elucidated whether patients
with idiopathic pulmonary hemosiderosis can safely undergo cardiac valve surgery. Here we describe a case of successful transcatheter aortic
valve replacement for severe symptomatic aortic stenosis in a 75-year-old man with idiopathic pulmonary hemosiderosis. Since a wide range of
physiological alterations resulting from cardiopulmonary bypass have the potential to trigger life-threatening alveolar hemorrhage, it is prudent
to avoid conventional valve replacement surgery in these patients. To maximize patient safety, transcatheter aortic valve replacement is an
acceptable alternative.