Extensively drug-resistant Salmonella typhi causing rib osteomyelitis: A case report

Rationale: Salmonella (S.) typhi is a rare cause of osteomyelitis in immunocompetent adults. Extensive drug resistance (XDR) may lead to more complicated cases of S. typhi osteomyelitis. Patient concern: A 55-year-old female presented with a persistent low-grade fever and a swelling on her lower left chest with a sinus discharging purulent fluid for the past 8 months. Her symptoms had been unresponsive to previous anti-microbial therapy. Diagnosis: Rib osteomyelitis caused by XDR S. typhi. Interventions: Surgical wound debridement, left 7th-9th rib resection and intravenous IV meropenem were done. Outcome: Fever resolved and left-sided swelling resected without recurrence. Lessons: The prevalence of XDR S. typhi is growing in South Asia and should be considered as the differential diagnosis of chronic osteomyelitis.

Cough, hemoptysis and hair expectoration: an intrapulmonary teratoma

Teratomas can be found in different organs of the body and may involve gonads, saccrococcygeal region, mediastinum and other sites. Intrathoracic teratomas always occur in mediastinum and less often arise within the lung. As teratomas mostly involve sex organs [gonads], they rarely occur as extra-gonadal tumors accounting for only 3% of all the cases and very small percentage of such tumors occur in mediastinum. We reported an interesting case of middle aged male who presented to us with symptoms of cough, hemoptysis and trichoptysis [hair expectoration]. We found that patient had intrapulmonary teratoma that was initially being treated as case of pulmonary tuberculosis. He underwent surgical resection of his cavitatory lesion and diagnosis of intrapulmonary teratoma was confirmed by histopathology as well. The patient made remarkable recovery with complete disappearance of his symptoms. From Pakistan no such case has ever been reported. Although it is very unusual but in patient with cavitatory lesion, intrapulmonary teratoma should always be kept in mind as differential diagnosis

Bronchial carcinoid presenting as multiple lung abscesses

Bronchial carcinoid tumours is a rare group of pulmonary malignant neoplasm that is derived from neuroendocrine system. Bronchial carcinoid usually present with hilar masses, atelactasis, bronchiectasis, or post-obstructive pneumonia. This case describes a very unusual presentation of bronchial carcinoid tumour with multiple lung abscesses involving the whole lung. This report is of an adult lady who presented with multiple lung abscesses involving her whole of the right lung. She was found to have an endo-bronchial lesion in her right main bronchus which eventually turned out to be carcinoid tumour. She responded to resection and antibiotic therapy

Aneurysm of sinus of Valsalva

Aneurysm of sinus of Valsalva is a rare cardiac abnormality with congenital origin in most of the cases. If it is located in the right coronary sinus, it usually ruptures into a right heart chamber and frequently a ventricular sepctal defect [VSD] co-exists with this condition. Early diagnosis and immediate surgical treatment can save the patient's life in most cases. All the 3 cases reported in this series had aneurysm of right sinus of Valsalva with associated VSD and mild degree of aortic regurgitation [AR]. Two of the cases ruptured aneurysm into the right ventricle. Trans-esophageal echocardiography was used to confirm the diagnosis and all three showed good results with surgery

Giant multiple intra-abdominal hydatid cysts

Hydatid disease is endemic in the cattle grazing areas. It is a parasitic infection caused by the Echinoccocus Granulosus. Dogs are the definitive host and humans get infected either by contact with the definitive host or by consuming hydatid ova contaminated vegetables. A 42 yr old lady presented with shortness of breath on exertion, orthopnea and progressively increasing abdominal distention. She had past history of hydatid disease and had progressively increasing abdominal distention three laparatomies and a right thoracotomy, in the past five years. On physical examination, she had a distended, non-tender abdomen. Her routine laboratory investigations were normal. Echinococcus antibody titres were 1:64 [Normal 1:32]. Computed Tomography [CT] scan revealed multiple, well defined cysts throughout the abdomen. Laparotmy and right thoracotomy was planned. Patient refused to undergo any further surgical procedure. She was discharged from the clinic with a prescription of Albendazole 400 mg twice a day for an indefinite period. Symptomatic or large cysts should be surgically treated. In cases suspected of having peritoneal spillage, antihelminthic drugs should be administered. In addition, small asymptomatic cysts, some daughter cysts, and peritoneal secondary cysts and splenic cysts may also be effectively treated with Albendazole

Primary mediastinal germ cell tumor successful curative resection following chemotherapy a case report

Primary mediastinal germ cell tumours are relatively rare and account for only a small portion of all the mediastinal tumours. We present a case of a primary mediastinal germ cell tumour in a 14 years old Afghani boy

Intra cardiac burkitt's lymphoma mimicking acute pulmonary embolism

Primary cardiac lymphoma is a rare clinical entity with poor prognosis and delayed diagnosis is often due to variable and non-specific clinical presentation. The case of an elderly male is reported with multiple co-morbidities, who had undergone a spinal laminectomy two weeks prior to presentation, later presented to the emergency room [E.R.] with acute chest pain, dyspnea and hypoxemia. A diagnosis of intracardiac thrombus was made, based on the clinical picture and echocardiography findings but per-operatively, he was found to have an extensive, non-resectable cardiac tumor

Successful pulmonary venous channeling in a case of Scimitar syndrome

A young girl child with recurrent pneumonias, failure to thrive and dextroposed heart was diagnosed with and surgically treated for scimitar syndrome. Early diagnosis and treatment of this syndrome prevents serious morbidity