Pituitary apoplexy: Case report with review of literature

A fifty five year old gentleman was admitted with uncontrolled hypertension. Within 24 hours, he became drowsy and later on started complaining of visual deterioration. Neuro-imaging identified pituitary tumor with bleed. He was treated for pituitary apoplexy. He underwent emergency trans-sphenoid decompression of pituitary tumor. He had a very turbulent post operative course and required aggressive management of Diabetes Insipidus with up to 10 liters of IV fluids infusion per day which was later controlled with desmopressin puffs. He was discharged once the condition was brought under control but returned ten days later with upper GI bleeding. He had been on replacement steroids all this time with proton pump inhibitors. He was found to have two superficial non bleeding ulcers in first part of duodenum. He was managed with blood transfusion and high dosage of proton pump inhibitors. Vision gradually improved and has reached almost normal. He has remained symptom free now and being treated medically for his pan-hypopituitarism. Management of pituitary apoplexy is discussed in the light of available literature

Lymph node involvement in plasmacytoma

A case of plasmacytoma of the spine with multiple sites of involvement at presentation is reported. The sites involved were T4, T5, T9 levels and the jugular foramen. The patient had no evidence of bone marrow involvement or paraprotein either in the serum or urine. Resections of the tumour from T4 and T5 levels was performed, followed by radiation therapy. The patient developed a recurrence seven and half years after the initial presentation. The recurrence occurred at the right clavicle and in the soft tissue around it. This was followed by multiple recurrences at the same site with involvement of the supraclavicular lymphnodes inspite of aggressive chemotherapy, radiation therapy and autologous stem cell transplant. Fine Needle Aspiration cytology and histology showed a typical plasma cell neoplasm with characterstic nuclear features, immunohistochemistry was compatible with a plasmacytoma

Actinomycotic lung abscess with review of literature

A case of lung abscess due to a rare cause -Actinomycosis is presented. The patient presented with signs and symptoms of pneumonia and failed to respond to antibiotic therapy. CT findings and various modes of treatment are described. CT guided FNAC helped in the final diagnosis where the aspirated material showed several eosinophilic cotton wool colonies of filamentous microorganism consistent with actinomycosis. Due to the thick walled abscess and surrounding unresolved pneumonia the patient was treated with intercostals tube drainage

Kimuras disease of the external ear canal

Review of a case of kimuras disease in the external Auditory canal in a non-Bahraini Asian patient who had a total local excision of the lesion, we reviewed the literature which stated that this a rare vascular skin lesion which involves the Head and Neck region in mostly adult patients1.The lesion histologically composed of two component: vascular endothelium and lymphoid follicles, with inflammatory infiltrate.the most effective treatment is local surgical excision to avoid recurrence and to restore function2