Journal of Clinical Case Reports

Optimal management of severe early fetal growth restriction presents one of the greatest challenges in obstetrics. At present, a combination of several different monitoring modalities is used, including arterial and venous Doppler ultrasonography plus assessment of short-term fetal heart rate variation, without consensus on which of these should trigger the decision to deliver. Pathological Doppler waveforms in the ductus venosus (DV) have been found to be associated with adverse out come. However it is not clear how long a fetus in utero can withstand changes in presence of altered flussimetry and which are , specifically, the effects related to them during extrauterine life. Optimal management of severe early fetal growth restriction presents one of the greatest challenges in obstetrics. At present, a combination of several different monitoring modalities is used, including arterial and venous Doppler ultrasonography plus assessment of short-term fetal heart rate variation, without consensus on which of these should trigger the decision to deliver.

Background: Hyponatraemia is a recognised, but underreported complication of the peripartum period. This presentation endeavours to bring to light the susceptibility of labouring women and their babies to hyponatraemia by presenting an overview of sodium metabolism, in addition to a case report and review of the current literature. Case study: A 33 years multiparous lady in spontaneous labour developed confusion four hours postnatal and was found to have serum sodium of 114mmol/L. She had not received oxytocin or intravenous fluid supplementation intrapartum, and reports consumption of 2.5 litres of water in the preceding six hours of labour. Conclusion: There are a number of factors which predispose the pregnant woman to a dilutional hyponatraemia, including the elevated fluid volume, iatrogenic fluid supplementation, “encouraged” polydipsia and alterations in Anti Diuretic Hormone (ADH).

Chronic necrotizing pulmonary aspergillosis is characterized by a pulmonary infiltration with cavitation in patients with chronic pulmonary disease, slight immunodeficiency or healthy patients. A 57-year-old man with non-small cell carcinoma who has had radiotherapy was admitted with a history of left side pleuritic chest pain, non-productive cough, fever and dyspnea. Aspergillus fumigatus was found in his mycological exams of BAL fluid. Serum examination presented positive galactomannan. Final diagnosis was semi-invasive pulmonary aspergillosis treated with voriconazole.

Broad ligament pregnancy also termed as interligamentous pregnancy is a rare form of ectopic pregnancy. Incidence is reported as 1 in 300 ectopic pregnancies. A broad ligament pregnancy usually results from trophoblastic penetration of tubal pregnancy through the tubal serosa and into the mesosalpinx, with secondary implantation between the leaves of broad ligament. It can also occur if a uterine fistula develops inbetween.

We present here a case report of a 27 year old man, who presented with high grade fever and swelling in the neck region. Peripheral blood smear showed both normocytic normochomic as well as microcytic hypochromic blood picture. Hemoglobin was 6.2 g%, TLC was 2100/mm3, DLC was: L65, N30, E05, platelet count was 69000 (i.e. pancytopenia was documented). FNAC of the cervical lymph nodes revealed reactive hyperplasia, with no evidence of caseating or non-caseating granulomas. A differential diagnosis of aplastic anemia was made. However, bone marrow examination revealed acid fast bacilli (AFB) on ZN staining. A revised diagnosis of bone marrow tuberculosis was made and the patient was put on ATT. There was a dramatic response clinically and thepancytopenia reverted after treatment.

Tumor Lysis Syndrome (TLS) results from massive necrosis orapoptosis of large proliferating tumors and is characterized by marked hyper uricemia, hyperkalemia, and hyper phosphatemia secondaryto cell lysis and the metabolism of excessive nucleic acids. Clinically significant TLS, with end-organ compromise, occurs in approximately5% of all patients with hematologic malignancies and in up to 25% of highrisk patients, including those with T-cell acute lymphoblasticleukemia and Burkitt’s lymphoma. TLS is a phenomena frequently occurs after the initiation of therapy, while spontaneous TLS occurringin the absence of chemotherapy, is rare but might portend a worse prognosis. We present a case of spontaneous TLS treated successfullywith continuous renal replacement therapy and increasing-dosegradually chemotherapy in a boy with T-cell lymphoblastic lymphoma/leukemia.

Solitary fibrous tumor is a rare neoplasm of mesenchymal origin that usually arise within the pleura. Its origin in abdominal wall is extremely rare, with only 15 cases described in the English literature.
We report the case of a 55-year-old woman presented with a mass located at the left lower quadrant of the
abdominal wall. Microscopic studies revealed histologic and immunohistochemicalfeatures consistent with a SFT. Eighteen months after surgical excision of the mass followed by adjuvant radiotherapy, the patient is alive and disease-free. The authors discuss the clinicopathological features of SFTs, differential diagnosis and treatment options.

Intestinal tuberculosis (TB) is an uncommon manifestation of tuberculosis, especially in Western countries, and is most often seen in immigrant and immunosuppressed patients The incidence of intestinal TB has not been well documented for liver transplant patients in Western countries. This case report discusses the complications of intestinal TB in a liver transplant patient and addresses the importance of identifying the necessity for and timing of surgery. Given the immunosuppressed state of these patients, the expedient diagnosis and treatment of this potentially fatal condition is critical.

We report a case of 55 years-old female with colorectal adenocarcinoma and metastasis to skin and breast tissue. Most common site of metastases of colorectal carcinoma is lung and liver. Cutaneous metastases are rare and account for only 4-6.5% of such cases. Often skin metastasis is to the postsurgical scars as observed as in our case. After a careful review of literature less than 30 cases have been found to have metastasis from colon adenocarcinoma to breast. To have two uncommon sites metastatic in one patient to best of our knowledge is not being described. Prognosis is poor because it is usually indicative of disseminated disease.

Maternally inherited diabetes and deafness (MIDD), also called mitochondrial diabetes mellitus, is a rare form of diabetes that comprises 0.5-2.8% of the diabetic population. Most cases of MIDD are associated with a point mutation in the mitochondrial DNA (mtDNA) at position 3243 of the leucine tRNA gene (A3243G) . Patients with MIDD are characterized by 1) young onset of diabetes, 2) absence of obesity, 3) neurosensory hearing loss, 4) maternal family history of diabetes and 5) progressive insulin secretory defect. In most cases of MIDD, diabetes is non-insulin dependent at onset, but progresses to require insulin therapy thereafter. However, to our knowledge, few cases with MIDD show complete loss of C-peptide level during the course of the disease

Neuromuscular choristomas are rare tumors that usually occur in the first decade of life. They most commonly involve large nerves such as the sciatic and brachial plexus. We report a case of a 4 year old girl with a neuromuscular choristoma of the cervical region with significant pain secondary to the tumor. This is a unique region for this tumor and the persistant pain secondary to this tumor not frequently reported.