Infective Endocarditis Secondary to Mycoplasma pneumoniae.

Mycoplasma pneumoniae (MP) is a gram-positive bacterium most commonly associated with community-acquired pneumonia in adults. It can also involve other systems of the body. Cardiovascular complications include pericarditis, myocarditis, congestive cardiac failure, and, rarely, infective endocarditis. We report a case of infective endocarditis secondary to MP infection in an adult. We treated our patient with doxycycline, which showed significant improvement.

Posterior Reversible Encephalopathy Syndrome Secondary to Varicella Encephalitis.

Posterior reversible encephalopathy syndrome (PRES) is a rapidly progressive neurologic condition presenting with typical symptoms including headache, nausea, vomiting, altered mental status, and visual defects. Neuroimaging profile, particularly magnetic resonance imaging (MRI), is the most important tool for diagnosis. The most commonly reported etiological factors include hypertensive emergency and renal disease. We describe a 67-year-old lady who developed clinical and radiological characteristics of PRES secondary to Varicella encephalitis.

Association of two single nucleotide polymorphisms rs10407022 and rs3741664 with the risk of primary ovarian insufficiency in a sample of Iraqi women.

Primary ovarian insufficiency (POI) can be a devastating disease impacting women below the age of forty. This involves a major decrease in the amount and quality of oocytes, or ovarian reserve in a woman. The distribution of single-nucleotide polymorphisms, rs10407022 and rs3741664, in Iraqi people and its association with primary ovarian insufficiency is the main objective of this study. The mean of FSH and LH levels of patients with POI was higher than control, while the mean of AMH levels of patients was lower compared to control. For rs10407022, the GT and TT genotypes were positively associated with the risk of POI. For the rs3741664, the AG genotype was negatively associated with the risk of POI. The results lead to the main conclusion that rs10407022 and rs3741664 polymorphisms may significantly affected the serum levels of AMH and FSH and thus affect POI etiology.

Sigmoid volvulus: a rare but unique complication of enteric fever.

We present a case of sigmoid volvulus in a young male patient with culture-proven Salmonella Typhi in the blood which was sensitive to Meropenem and Azithromycin only, presented with fever, vomiting, loose stools, hematochezia, abdominal distention and tenderness with no signs of perforation on erect chest x-ray. Further, radiological imaging showed signs of sigmoid volvulus. An urgent colonic decompression with untwisting of the mesentery was performed. In our case, it can be said that sigmoid volvulus was developed as a complication of multiple drug-resistant strains of Salmonella Typhi. The resistance is acquired by alteration in the genome sequence. Currently, it is important to control such an unknown outbreak of multiple drug-resistant strains of Salmonella Typhi as it is a serious health care issue of disease control and prevention in Pakistan.

Microscopic polyangiitis: an incidental finding in a patient with stroke.

Microscopic polyangiitis (MPA) is a primary systemic vasculitis characterized by inflammation of small-sized vessels associated with the presence of anti-neutrophilic cytoplasmic antibodies. We report a case of a 39-year-old female diagnosed with microscopic polyangiitis as an incidental finding who presented with signs and symptoms of a stroke at a young age. Usually, it presents with fever, malaise, skin rash, weight loss, mononeuritis multiplex, and arthralgia/myalgia. Very rarely, it can involve meninges to cause meningeal vasculitis which can present as a febrile seizure. The most frequent neurological manifestation is peripheral neuropathy. Cerebral infarction or hemorrhage as an isolated finding is very rarely observed in the patient with MPA as was seen in our patient.

Escherichia coli: a rare cause of meningitis in immuno-competent adult.

A 35-year-old male of Asian ethnicity presented with complaints of high-grade fever, severe headache, vomiting, generalized seizures, deteriorated conscious level and neck stiffness. After all baseline workup Computed Tomography (CT) scan of the brain was done, which turned out to be unremarkable. CT scan was then followed by lumbar puncture (LP) and Cerebrospinal fluid (CSF) detailed report was sent, which was highly suggestive of bacterial meningitis with the predominance of polymorphonuclear leukocytes. Later on, CSF culture and sensitivity report showed growth of Escherichia coli, which is one of the rare causes of meningitis in immunocompetent adults without any history of craniocerebral trauma, neurosurgical intervention, urinary or gastrointestinal tract infections, and an immunocompromised state. Abbreviations: CSF: Cerebrospinal fluid; LP: Lumbar puncture; CT: Computerized tomography; E-coli: Escherichia coli; GCS: Glasgow coma scale; COPD: Chronic Obstructive Pulmonary Disease; HTLV1: Human T-Lymphotropic virus -1; PCR: Polymerase chain reaction.

Brachial plexitis: an unusual presentation in sickle cell disease.

Brachial plexitis is defined as an inflammation of the brachial plexus. There are two entities of the disease: idiopathic, which is generally considered to be immune-mediated, and genetic. The disease manifests as the acute onset shoulder pain, weakness of the involving arm ± sensory loss. Brachial plexitis is also known as Parsonage-Turner syndrome and hereditary neuralgic amyotrophy. Diagnosis is made with the help of history, physical exam, and imaging. Conservative management is the mainstay of treatment. There has not been any proven treatment for the condition though some cases have been treated empirically with steroids. We present a case of 61-year-old woman with sickle cell anemia who presented with right upper extremity weakness and MRI findings of brachial plexitis.

Cold autoimmune hemolytic anemia: a rare association with triple-positive breast cancer.

A 45-year-old Asian woman was presented with fever, easy fatigability, shortness of breath, cervical and axillary lymphadenopathy and other signs and symptoms of anemia. After all the baseline work-up, the patient was investigated for Mono-coombs C3d levels, which were elevated, suggesting the diagnosis of Cold autoimmune hemolytic anemia (Cold AIHA). An Ultrasound-guided true-cut biopsy was done to determine the primary cause associated with it, which showed the presence of tumor cells arranged in cords and clusters. They have dark staining cells with mitotic activity, suggestive of breast carcinoma as an association of Cold AIHA. Estrogen receptor (ER), progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2) were sent, which came out to be positive. So, the patient was diagnosed with Cold AIHA in association with triple-positive breast cancer.

Cytomegalovirus infection in the setting of occult ulcerative colitis: case report and review of the literature.

CMV can infect a variety of organs including gastrointestinal tract, meninges, eyes and other organs depending upon the nature of immune system but it can also manifest as a flare-up in ulcerative colitis patients. It usually presents as loose stools, bright red blood in the stool and weight loss in the patient. In the setting of an Immunocompetent patient, CMV colitis has been diagnosed in patients with occult inflammatory bowel disease. It is usually diagnosed on histology secondary to endoscopic biopsy. We herein report a case of a 73 years old female with CMV colitis found to have underlying ulcerative colitis.

Recurrent spontaneous pneumothorax in pregnancy - a case report and review of literature.

Spontaneous pneumothorax in pregnancy is a rare and life-threatening condition. In this report, a case of spontaneous pneumothorax occurring at 34 weeks' gestation in a healthy 34-year-old primigravida is described. She had typical complaints of chest pain and dyspnoea and diagnosis was made by chest X-ray which showed an extensive pneumothorax in the right side. Pneumothorax recurred twice over approximately three weeks. A caesarean section secondary to small pelvic parameters was scheduled with the chest tube in situ and a healthy 2.5 kg female infant was delivered. We discuss spontaneous pneumothorax during pregnancy and review the literature.

Rosai-Dorfman Disease: Rare Presentation as Isolated Mediastinal and Hilar Lymphadenopathy.

Rosai-Dorfman disease (RDD) is a rare, benign, and predominantly nodal disease that most commonly presents as bilateral, painless cervical lymphadenopathy; although inguinal, axillary, mediastinal, and hilar lymphadenopathy has also been reported. Apart from nodal involvement, RDD has extranodal manifestations involving bone, soft tissue, and liver as well as constitutional symptoms of fever, night sweats, and weight loss, which make it reasonable to rule out the infectious, autoimmune, and malignant conditions as the differential diagnosis. We herein report a case of RDD affecting only the mediastinal and hilar region in an 83-year-old woman.

Association of Hypertrophic Obstructive Cardiomyopathy with Rheumatoid Arthritis.

Our article refers to a 50-year-old woman with previously diagnosed rheumatoid arthritis (RA) who presented with symptoms of dyspnea on exertion and dizziness. An echocardiogram revealed a 17-mm asymmetric interventricular septum hypertrophy and systolic anterior motion of the anterior mitral valve leaflet. Association of hypertrophic obstructive cardiomyopathy (HCM) with connective tissue diseases has been well documented. For RA the human leukocyte antigen (HLA) system, particularly HLA-DR4, may possibly be a link between the two entities, as it is associated with both RA and HCM. Therefore, a patient with RA and suggestive history should be investigated for cardiac involvement. Further studies are needed to elucidate a more accurate association between the above diseases.