Journal of Clinical Case Reports

This is a case of a 28-year-old lady, nulliparous lady, with a two year history of primary infertility. She had undergone infertility investigations which revealed an ovulation with low day 21 progesterone assay. Pelvic ultrasound scanning showed a normal uterus and endometrium, bulky left ovary and normal right ovary. Laparoscopy, hysteroscopy and tubal dye test revealed mild to moderate endometriosis, probable chocolate cyst on the left ovary, tortuous and blocked left tube. However, there was a normal and patent right tube. Her husband’s seminal analysis was sub-optimal with a good count of 47 million sperm/ml. However, only 7% normal forms and 4% were with rapid progressive motility. The diagnosis of sub fertility in both partners was made.

Marsupialization is defined as opening a window in the cyst wall which enables integration of the cyst lining with oral mucosa. This helps shrinkage of the cyst and provides more conservative surgical procedure fortotal removal of the lesion. Marsupialization is usually performed prior to enucleation and curettage. However, complete healing of the relatively large cysts in adults only by marsupialization is rare. Here we reported two cases of large radicular cysts of the jaws those treated only by marsupialization.

Crimean-Congo Hemorrhagic Fever (CCHF) is a tick-born disease. It is usually transmitted to man following a tick bite or through contact with the blood of an infected patient or blood-contaminated specimens. The mortality rate of CCHF is up to 30%. Five cases of our 7 cases had contacted with livestock or their products. Malaise was the most frequent complaint and fever placed in the second position. Leukopenia, thrombocytopenia and transaminase increases reported in all seven cases. All patients were treated with oral Ribavirin. Both RT-PCR and ELISA tests on serum samples were positive in all cases. As seen in this study and similar studies contact with livestock and animal products is one of the main factors in the transmission of the disease. So, we can conclude that education and awareness of higher risk groups can play a significant role in reducing the risk of being infected with the virus.

We present an interesting case of spontaneous intramuscular rectus abdominis endometrioma, which is a rare condition in a virgin abdomen. A 38 year old lady was referred with a history of persistent right sided lower abdominal pain for several months associated with tender mass, fixed within the anterior abdominal wall, below and to the right of the umbilicus. There was no other history of relevance. This case report aims to increase awareness of this rare condition, which can pose a diagnostic challenge.

Background: Biopsy-related kidney transplants Arteriovenous Fistulae (AVF) are common. Most resolve spontaneously but rarely are they complicated by graft dysfunction. We describe 2 such cases of AVF occurring post renal allograft biopsy. Case reports: A 33 year old lady had multiple biopsies of her renal allograft due to ongoing rejection. Her renal function worsened and a 1.3 cm AVF was diagnosed on Doppler Ultrasound. The AVF closed spontaneously during angiogram and the patient’s renal function improved. The second case was a 25 year old man who had a biopsy due to acute rise in creatinine 14 weeks post transplantation. The biopsy was complicated by haematuria and an AVF was diagnosed on doppler ultrasound. The AVF enlarged over 3 months. An angiogram and endovascular coiling was performed with good resolution of the AVF. The patient’s renal function normalised. Conclusion: Endovascular coiling can ensure good resolution of renal AVF and is generally well tolerated.

A previously healthy 20-year-old patient presents to the ER with a tonic-clonic seizure. His siblings had been diagnosed with pulmonary tuberculosis, one of them within the previous six months. His chest x-ray shows an image suggestive of tuberculosis but CT scan and lumbar puncture did not supported CNS infection. A contrast-enhanced MRI was then performed, showing pachygyria and absence of corpus callosum, establishing the diagnosis as a neuronal migration disorder.

Anorectal injuries are rare in children. These injuries mostly occur with two major mechanisms; 1) sexual abuse, and 2) penetrating trauma. Coincident injury of rectum and bladder following anorectal trauma has been rarely reported. Here, we describe an anorectal injury in a 15-year-old boy due to falling off a tree leading to anorectal trauma by a stick. After the trauma, the patient experienced hematuria and generalized abdominal pain and tenderness. In anal area inspection, anal sphincter was intact and there were no evidences of trauma. The patient underwent anoscopy and exploratory laparotomy and omentum was extruded. The patient was treated by repair of lacerations and retraction of omentum.

A case of hepatic abscess that developed secondary to a foreign body migration is reported herein. In most published cases, the diagnosis is done after failure of medical treatment or recurrence of the abscess. CT-scan findings may lead to an early diagnosis, like in this case. The patient was treated by percutaneous abscess drainage and adapted antibiotherapy. Because of remarkable co-morbid conditions, no removal surgery was performed. No recurrence of the abscess could be observed after eighteen months of follow up. Foreign body is a rare cause of liver abscess that may not be ignored by clinicians. Although removal surgery is the mainstay of its treatment, a medical approach could be attempted with efficacy.

We herein present a case in which extensive cellulitis occurred following a tube thoracostomy for a gas-forming empyema. A 72- year old man was admitted with a fever and cough. A chest computed tomography revealed a large effusion with an air space in the left pleural cavity. A tube thoracostomy was then performed and purulent fluid was recognized. Administration of flomoxef was started after a tube insertion. On the third hospital day, an area of erythema and tenderness was observed around the chest tube insertion site, and on the following day, this area was seen to spread extensively to the left lateral abdomen and the left leg. Subsequent computed tomography revealed widespread subcutaneous swelling with small amounts of air. Laboratory data suggested that multiple organ failure was in progress due to a severe and extensive cellulitis, and the antibiotic was changed to doripenem. Ten days after, the cellulitis had resolved and the laboratory data showed normal result. He has been followed up in our outpatient clinic with no relapse after six months. Although rare, possible occurrences of cellulitis should be considered as a potential complication resulting from a tube thoracostomy for empyema.

We present a case of pregnancy of unknown location with high serum βhcg levels. This case posed a diagnostic difficulty in the management of pregnancy of unknown location. The patient underwent two laparoscopic procedures to establish the diagnosis. The case highlights the importance of close surveillance of patients who present with pregnancy of unknown location.

Background: Abdominal actinomycosis is a rare chronic infectious disease. There are only a few reports of the disease of chronic appendicitis pattern. We present a case of abdominal actinomycosis mimicking chronic appendicitis. Case: A 29-year old male was admitted with symptoms of right low quadrant pain for a few weeks. An abdominal computed tomography scan revealed a solid mass without a clear border, near the cecum. On colonoscopy, normal colon and terminal ileum were seen, except for mild edema and a few tiny erosions around the appendiceal orifice. The patient received an antibiotic treatment. Three month later, abdominal ultrasound was performed and revealed the appendix enlarged to 9 mm, with thickened and hyperemic wall. Appendectomy was performed. On microscopic examination chronic active appendicitis containing Actinomycotic sulfur granules within inflammatory infiltrate was described. Treatment by Amoxicilline was recommended for 6 months.

Despite evidence supporting various benefits of chocolate, studies have revealed an association between chocolate addiction and depression. However, the causal link remains elusive. Depression is a psychiatric disorder accompanied by various symptoms, including fatigue and apathy. This case illustrates how chocolate addiction decreases the daily push-up performance, both as muscle endurance and motivation to follow the daily push-up routine. As decreased muscle endurance and lack of motivation express fatigue and apathy, respectively, the case suggests a causal link between chocolate addiction and depression. Although the case consists entirely in selfobservation, it used reliable measures as demonstrated by other studies.