Journal of Clinical Case Reports

Background: Posterior Reversible Encephalopathy Syndrome (PRES) refers to a clinico-radiological syndrome characterized by headache, altered mental function, visual disturbance, seizures and transient posterior changes on neuro-imaging. Case report: We present a case of a 38 year old female who presented with sudden onset behavioural change, visual disturbance and subsequent witnessed generalized tonic-clonic seizure. A cerebral MRI showed extensive signal abnormality consistent with vasogenic oedema in the cerebellar hemispheres and subcortical white matter of the occipito-parietal lobes consistent with a neuro-radiological diagnosis of Posterior Reversible Encephalopathy Syndrome (PRES). Conclusion: We describe a case of a dramatic first presentation of Systemic Lupus Erythematosus (SLE) with neurological manifestations of PRES, occurring in the absence of accompanying evidence of lupus nephritis, cerebritis or other usual causative factors, such as immunosuppression.

Hypertrophic Osteoarthropathy (HOA) is a disease of the joints and bones characterized by advanced clubbing that is bulbous enlargement of the ends of one or more fingers or toes; proliferation and oedema of connective tissue resulting loss of the normal angle between the skin and nail, excessive sponginess of the nail base of the digits of the hands and feet. There is painful periosteal proliferation of long bones such as the radius, ulna, or tibia in clubbing, and the periostitis is often associated with mild fever and arthralgia or joint effusion. There are two accepted types of HOA, primary and secondary. The former is usually inherited and hereditary (idiopathic), while the secondary type seen as a concurrent manifestation of another diseases. Herein, we present a 23-year-old man diagnosed with primary HOA and had only smoking history. After examining the patient, we have concluded that there is possibility of relationship between the HOA and smoking history.

Carcinoma of endometrium is among the most common female pelvic malignancies. The mean age at diagnosis is 61 years. However, 5-30% of women are aged younger than 50 years at the time of diagnosis. This tumor is rare in patients less than 30 years of age. We present a case of carcinoma of endometrium in 20 year female with review of literature.

Adrenal myelolipomas are rare neoplasms. They are benign in nature comprising mainly of adipose and myeloid tissues. Majority of these adrenal gland tumors are hormonally inactive. In view of their rarity, they are usually detected incidentally or misdiagnosed. Misdiagnosis is quite common and can lead to difficulty in management. We wish to report a case of adrenal myelolipoma that was misdiagnosed which fortunately did not result in a major issue. With the availability of advanced imaging techniques and minimally invasive procedures, these situations can easily be avoided. The main reason for highlighting this patient is to create awareness among both the surgeons and the radiologists.

Follicular lymphoid hyperplasia of the hard palate is a reactive lymphoid proliferation which closely simulates the palatal lymphomas, both clinically and histologically. It is therefore imperative that the pathologist be familiar with the features that separate these two conditions. It reported a case of FLH in a 70-year-old white woman, showing a nodular lesion in right posterior soft palate, reddish, soft, asymptomatic. Histopathological analysis revealed lymphoid aggregates with discrete lobular appearance in the lamina propria of connective tissue showing numerous lymphocytes in the periphery with scanty cytoplasm and homogeneously basophilic nuclei and central areas of germinal centers showing tingible-body macrophages and occasional mitotic figures. In order to distinguish Follicular Lymphoma (FL) from Follicular Hyperplasia (FH), immunohistochemical staining method for bcl-2 was used showing positivity in the mantle zone and absence of immunostaining in the cellular elements within the follicle centres.

Epidermoid and dermoid cysts are malformations observed in the oral cavity, represent less than 0.01% of all oral cavity cysts. Histologically, they can be further classified as epidermoid, dermoid or teratoid. The cysts can be defined as epidermoid when the lining presents only epithelium dermoid cysts when skin adnexa are found and teratoid cysts when other tissue such as muscle, cartilage, and bone are present. We report a case in which a 15-year-old boy developed a dermoid cyst presented at our clinic with complaints of increasing dysphagia and globus sensation about 5 years. On examination, the patient revealed a massive swelling of the floor of the mouth, which had displaced the tongue cranially. MRI imaging showed the lesion to be a homogeneous, cystic lesion, clearly at a distance from the
surrounding mucous tissue. Surgery was performed, and the tumor was resected completely. Histologic examination of the resected tissue was consistent with an epidermoid cyst located in the floor of the mouth. The patient did well postoperatively, and no recurrence was noticed at the 6-years of follow-up. Although epidermoid cysts are rarely located in the oral cavity, it should be included in differential diagnosis. Surgery is the treatment of choice.

Introduction: Hydatid cyst is a zoonosis caused by Echinococcus granulosus. It may affect any organ and tissue in the body, in particular the liver and Lung. Musculoskeletal or soft tissue hydatidosis accounts for about 0.5 – 5% of all echinococcal infections in endemic areas, and is almost secondary to the hepatic or pulmonary disease.
Case presentation: We report an unusual case of primary subcutaneous hydatidosis in the left supraclavicular region of the neck. A 53 year old female patient was admitted with three months history of pain and gradually growing mass located in the left supraclavicular region. Physical examination revealed a moderately hard, painful and erythamatous mass. The blood cell count was normal. Computed tomography demonstrated, a multilocular cystic lesion with thin borders, thin wall. The mass is binocular and extend to the scapula. CT showed no involvement of the lung. From these signs the patient was diagnosed as having abscess (bacterial infection or tuberculosis). The diagnosis of Echinococcus granulosus infection was made preoperatively after visualization of the cyst wall and
the daughter cysts. Following irrigation of cystic cavity with hypertonic saline solution, the cyst wall was excised along with a portion of surrounding tissue. Histopathogical examination of the specimen confirmed the hydatid origin. Hemagglutination tests for Echinococcus and ELISA were negative. Ultrasound of the abdomen was normal. The patient received albendazole (400 mg/day) for 8 weeks postoperatively. No sign of recurrence could be detected by physical examination and imaging (CT) at 4-month follow-up.
Conclusion: The case illustrate that echinococcal disease should be considered in the differential diagnosis of every cystic mass in every anatomic location, especially when they occur in endemic areas.

Background: Depression is mostly reported psychiatric disorders in children with epilepsy.
Aim: To investigate prevalence of depression among Nigeria children and adolescents with epilepsy and explore associated variables.
Methods: Study involved 57 participants between 7-18years, diagnosed of epilepsy in a Nigeria mental-healthinstitution. Depression and illnesses-perception were assessed using Child-Attitude-towards-Illness-Scale and Center-for-Epidemiology-Study-Depression-Scale respectively. Data was analysed using Spearman’s Correlation Coefficients and multiple regression (p < 0.05).
Results: Participants were aged 13.8 ± 3.3years with onset of seizure between 1-17 years (mode = 9years) and presentation in the clinic between 2-17 years (mode = 11years). About 40% were diagnosed of depression. About 44% had varied educational problems. There was significant correlation between depression and each of educationallevel and seizure frequency at presentation. Seizure frequency predicted depression and felt-stigma. Parent’s socioeconomic status predicted seizure frequency.
Conclusion: There is high prevalence of depression in Nigeria children and adolescents with epilepsy. Epilepsy has negative impact on the psycho-social status of its sufferers.