Journal of Clinical Case Reports

Rapid eye movement (REM) sleep behaviour disorder (RBD) is a parasomnia characterised by REM sleep without atonia, causing dream-enacting behaviours (DEBs) or vocalisation. The aetiology of RBD is largely unknown, likely a result from breakdown of the circuits underlying REM sleep atonia. It is also strongly associated with neurodegenerative disorders. Recent studies suggested that head injury could be a risk factor for RBD. We present a case of new-onset RBD, triggered by mild head injury in a patient with well-managed severe obstructive sleep apnoea (OSA). Our case provides a rare opportunity to examine the link between head injury and RBD.

Burkholderia pseudomallei is the causative agent for melioidosis, severe infection that is associated with high morbidity and mortality. Difficulties in laboratory diagnosis of melioidosis may delay the treatment and as a result, affect disease outcomes. Culture is the mainstay for laboratory diagnosis of the disease followed by further commercial biochemical testing for identification of organism. The whole process may take up to 72 hours. Furthermore, commercial identification system may fail to distinguish between B. pseudomallei and closely related species like B. cepacia. The objective of this study was to compare the efficacy of Francis media against commercial identification system such as API20NE and VITEK2GN for the identification of B. pseudomallei. This study showed that Francis media was 100% reliable in the identification of B. pseudomallei as compared to others. The media also offered fast identification of organism from clinical specimen with total incubation time required of only 18 hours. API20NE was able to correctly identify only 5 (12.5%) within 24 hours and 31 (78%) within 48 hours of incubation. VITEK2GN, identified 95% of the isolates correctly within 9 hours of incubation. However, both methods required an additional sub culturing prior to testing. Molecular method was used as the confirmatory method for identification of the isolate.

Background: The 18p deletion disorder is a chromosomal condition due to the absence or deletion of a short arm or all the chromosome. The symptoms and signs vary among patients which may include mental and post-natal growth retardation that ranged from moderate to severe. The cause of 18p deletion among 85% of cases is due to de novo deletions and unwarranted hereditary transmission of structural rearrangements among the rest of cases.
Case presentation: A 16-years-old male was presented with dysmorphic features and refereed for chromosomal analysis. He was born full term by vacuum assisted vaginal delivery with a birth weight of 4.5 kg with no gestational complications. His gestation was without any complication. The pre-natal ultrasound showed vesico-urethral reflux on the left side and hypocalcemia. He had speech delay at 11 months, alopecia areata at 13-years-old and at age of 14-yearsold was diagnosed with celiac disease. The MRI brain showed normal brain and chromosomal analysis for dysmorphic features showed brachycephaly, ptosis, squint (intorsion). The study revealed Deletion of a segment of the short arm of chromosome 18 at a breakpoint 18p11.2 band. Chromosomal analysis was of patient’s mother revealed normal karyotype 46-XX.
Conclusion: This case is quite variable than other studies reported in literature as that patient showed mild dysmorphic features with normal brain function. The clinical presentation is associated with 18p deletion which need further diagnosis and essential management as the symptoms vary regarding the quantity of chromosomal loss.

Intrauterine catheters have been used widely to prevent intrauterine adhesions and to secure hemostasis after hysteroscopic surgery. The presence of a balloon inside the uterine cavity with the catheter shaft in the vagina may be a risk factor for ascending infections. Urinary bladder infections following catheterization and ureteric stents bacterial colonization have been known for many years. In the current study 57 Foley’s catheter tips were swabbed for microbiological examination after their removal from the uterine cavity 5-7 days after hysteroscopic surgery. Culture for both aerobic and anaerobic bacteria was done as well as sensitivity tests for different antibiotics. 41 cases (71.9%) showed positive bacterial culture; 18 of them proved to be Escherichia coli (43.9%). Other isolated bacteria included Beta hemolytic group B streptococci (10 cases, 24.4%), group D streptococci (5 cases, 12.2%), Klebsiella pneumoniae (3 cases, 7.3%), Pseudomonas aeruginosa and Proteus species (5 cases, 12.2%) and one case of Candida albicans. Resistance to commonly used antibiotics was reported in 39 cultures (95.1%), including all 18 Escherichia coli cases. This small auditing study showed that intrauterine catheters used after hysteroscopic surgery might carry a risk of causing ascending infections. Accordingly, such practice has been halted in our clinic as clinical or even subclinical uterine or tubal infections may reduce the fertility potential of young women who are keen to conceive.

Objective: Streptococcus thoraltensis is a recently described species, isolated from the intestinal and genital tracts of swine and from rabbit feces. We describe here a case of enterocutaneous fistula complicated by abdominal wall abscess formation attributable to S. thoraltensis. To our knowledge, this is the second reported human infection by this organism.
Clinical features: Our patient is a 44-years-old diabetic female, with a previous history of ovarian mixed germ cell tumor treated with surgery and adjuvant chemoradiotherapy, presenting 18 years later with an enterocutaneous fistula complicated by abdominal wall abscess formation at the site of previous surgery. Culture from the drained pus and fistulous tract revealed Streptococcus thoraltensis.
Outcome: The patient was treated conservatively with broad spectrum antibiotics and total parenteral nutrition. She suffered from disseminated intravascular coagulation and acute liver failure and passed away 4 weeks later.
Conclusion: We report for the second time the isolation of streptococcus thoraltensis associated with a pathological process in humans. The infectious role of this newly identified organism pattern in human diseases is yet to be identified.

Here, we report the patient with Stage IV malignant pleural mesothelioma (MPM), who has reached the remission in 5 months of treatment with experimental targeted product (WO/2017/052419). The remission has been confirmed by PET examination performed in German clinic - as the absence of tumor tissue in primary localization and the absence of the distant metastases. Previous patient’s treatment was not successful. Previous treatments included 6 courses of combined chemotherapy consisted of cisplatin, pemetrexed, and bevacizumab; visceral and parietal pleurectomy combined with hyper-thermic intrathoracic chemotherapy (HITHOC); 6 courses of combined therapy with monoclonal antibodies nivolumab and ipilimumab. All that treatments did not demonstrate necessary clinical effect. The therapy with monoclonal antibodies caused also severe side effects- polyarthritis. Due to all these reasons and significant worsening of patient’s general condition and laboratory parameters, the patient according to his freewill decision started treatment with experimental targeted product (WO/2017/052419) as single anti-tumor agent and in 5 months has reached the remission. General condition improved significantly as well. ECOG score changed from 2-3 points at the therapy start to 0-1 point in 5 months of the treatment. The patient fulfils his routine duties in the office.

Involvement of cranial nerves is unspecific and can occur in inflammation, different types of nerve tumours and in malignancies. Central Nervous System (CNS) dissemination during the Mantle Cell Lymphoma (MCL) is unusual. We report a rare case of a patient followed for mantle cell lymphoma, which brutally instituted multiple cranial nerve palsies, brain imaging showed a bilateral sphenoid sinusitis. Cytology later showed the presence of mantle cells in cerebrospinal fluid analysis. We review literature for the Central Nervous System involvement in Mantle cell lymphoma and we discuss possible change of therapeutic strategies. Although the cranial nerves involvement is extremely rare in Mantle cell Lymphoma, physicians should be aware of such patterns of Central Nervous System (CNS) involvement for the early diagnosis and adequate selection of treatment modality.

Bone cement which can reach temperatures of >100°C, is commonly used to fix the femoral stem in total hip arthroplasty (THA). However, reports on skin burns due to bone cement are rare. The primary purpose of this article is to report these rare cases to prevent these complications. Two cases were simultaneous bilateral THA (case A and B) and two cases were unilateral THA (case C and D) are discussed in this case report. In these cases, the maximum thickness of excessive bone cement was >10 mm.

Syphilis is a sexually transmitted infection with rising incidence in recent years due to increased rates of highrisk sexual behaviors. Often called “the great imitator,” syphilis can have many different presentations in its various stages: latent, primary, secondary and tertiary. One form of secondary syphilis is ulceronodular syphilis, also known as lues maligna. We report a case of a 48-year-old Filipino man who presented with a diffuse, ulcerating, papular rash and was subsequently diagnosed concurrently with both lues maligna and human immunodeficiency virus.