Spontaneous pneumomediastinum mimicking angioedema in an asthmatic teenager

Spontaneous pneumomediastinum [SPM] often presents with chest pain, cough, and/or dyspnea. The presentation with facial swelling is less frequently mentioned and may be misinterpreted as angioedema. A palpable subcutaneous crepitus, an audible mediastinal crunch, and subcutaneous or mediastinal air in chest X-ray should be carefully sought. We present a boy with an asthma exacerbation and bronchopneumonia who developed facial swelling following an antibiotic injection. Careful scrutiny of the Chest X-ray for an evidence of subcutaneous air would have negated an initial thinking of angioedema. SPM should be included in the differential diagnosis of acute swelling of the face during asthma exacerbations

Central pontine myelinolysis in the hyperosmolar hyperglycaemic state

To report a rare association of central pontine myelinolysis [CPM] with hyperosmolar hyperglycaemic state [HHS]. A diabetic female presented with HHS and prolonged severe hypernatraemia. The metabolic derangement was adequately treated with proper correction of both hyperglycaemia and hypernatraemia. Lack of improvement in the presenting confusional state and the development of a fresh neurological deterioration led to the suspicion of CPM that was confirmed with magnetic resonance imaging. She fully recovered after 4 weeks with no specific medical treatment. This case report showed that osmotic demyelination was linked to hypernatraemia and that CPM could result from severe hypernatraemia of HHS

Hypothermia with pneumonia: a rare presentation of brucellosis

To report a very rare form of brucellosis presenting with hypothermia and pneumonia. Clinical Presentation and Intervention: A 41-year-old male shepherd presented with a depressed level of consciousness. Clinically, his rectal temperature was 29.5°C, and he was cold, apathetic, hyporeflexic, and hypotensive, with atrial fibrillation. He had clinical and radiological evidence of bilateral bronchopneumonia. Blood culture and serologic testing were positive for Brucella melitensis. The patient recovered completely after proper management of the hypothermia and treatment of the brucellosis with antibiotics [doxycycline 100 mg orally twice daily for 6 weeks and streptomycin 1 g i.m. daily for 21 days]. This case shows that brucellosis should be considered in the differential diagnosis of septicemic patients presenting with hypothermia