Case report on bilateral emphysematous pyelonephritis in a non-diabetic male: A complex treatment journey.

INTRODUCTION: Emphysematous pyelonephritis is a severe kidney infection characterized by gas formation, predominantly affecting diabetic women. Symptoms include fever, pain, and nausea, requiring urgent and accurate management due to its potentially fatal nature. CASE PRESENTATION: This article reports a successful management of a case of bilateral emphysematous pyelonephritis complicated with perinephric, retroperitoneal collection and urosepsis. DISCUSSION: Emphysematous pyelonephritis (EPN) is a severe kidney infection characterized by acute necrotizing infection in the renal tissue and nearby structures. While EPN typically affects individuals with risk factors such as diabetes, obstructive uropathy, and hypertension, this case is unique because the patient lacks these common risk factors but hails from a region where EPN is more prevalent. The management of EPN has evolved over the years, with recent advances in imaging, antibiotics, and drainage techniques leading to a shift from invasive surgical procedures to more conservative approaches, resulting in improved outcomes and reduced mortality rates. CONCLUSION: Emphysematous pyelonephritis demands urgent intervention to prevent high mortality rates. Swift, tailored treatment, including antibiotics and possible surgical interventions, is crucial, involving a multidisciplinary approach for improved patient outcomes.

Surgical management of a giant parotid gland pleomorphic adenoma in Northern Sri Lanka: A case report.

INTRODUCTION: Pleomorphic adenoma is the most common benign tumour of the parotid gland. It is commonly observed in middle-aged women. Usually, pleomorphic adenomas are asymptomatic with a slow-progressing tendency. There is a substantial risk of malignant transformation if left untreated. Imaging modalities and fine needle aspiration cytology are highly valuable preoperative diagnostic tools and aid in selecting therapeutic interventions. Surgical technique is chosen based on clinical grounds. PRESENTATION OF CASE: A 48-year-old woman presented with a painless extensive mass in the left-sided face. A provisional diagnosis of the benign parotid tumour was made based on clinical evaluation. Imaging studies and cytological assessment suggested pleomorphic adenoma of the left parotid gland, and left-sided total parotidectomy with facial nerve dissection was performed. DISCUSSION: Pleomorphic adenoma involving the deep lobe of the parotid gland is rare. It typically grows slowly. If left untreated, it can present as a giant mass, as in our case. The extensive tumour mass can also involve adjacent structures, including facial nerve. Therefore, surgical dissection must be involved facial nerve and adjacent muscles. CONCLUSION: Surgical dissection of giant pleomorphic adenoma is challenging and often leads to significant deformities postoperatively. Early intervention will improve surgical outcomes and quality of life.

A case report: A rare case of icteric variant of Stauffer's syndrome.

INTRODUCTION: Stauffer's syndrome is a rare paraneoplastic non metastatic hepatic dysfunction related to renal cell carcinoma. It is characterized by elevated alkaline phosphatase, erythrocyte sedimentation rate, a-2-globulin, y-glutamyl transferase, thrombocytosis, prolongation of prothrombin time and hepatosplenomegaly, in the absence of hepatic metastasis. A rare variant of it with cholestatic jaundice is described in four cases so far in literature. CLINICAL PRESENTATION: We present a case of a patient presented with features of cholestatic jaundice who was found to have a left sided renal cell carcinoma in the work up. DISCUSSION: This case illustrates the importance of considering paraneoplastic syndromes in mind when working up for patients presenting with hepatic dysfunctions without identifiable causes. CONCLUSION: This may result in early identification and intervention which will result in better outcome and prolong survival rate.

A young patient with prostatic carcinoma with testicular metastasis.

Prostate cancer is one of the most frequent cancers in males and commonly a disease of the older population, but it is increasingly seen among older adolescents and young adults. The common sites of metastasis of prostatic carcinoma are bones and regional lymph nodes. Testicular metastasis from prostatic carcinoma is an infrequent presentation. We report a case of a young patient with prostatic carcinoma and multiple metastases, including bilateral testis. A 40-year-old male presented with lower urinary tract voiding symptoms and back pain for three months. His prostate-specific antigen level was elevated at 13.98 ng/ml. A magnetic resonance imaging of the prostate revealed two PIRADS V lesions and metastases in multiple bones and regional lymph nodes. On follow up, the patient complained of bilateral testicular swelling and ultrasound scan of the testes revealed bilateral testicular metastasis. Fine needle aspiration cytology of right-side testicular lesion revealed malignant cells compatible with metastasis from prostate cancer. Later involvement of multilevel vertebral and skull metastases was identified by magnetic resonance imaging. A T3bN1M1c staging of prostate cancer was made, androgen deprivation therapy followed by chemo and radiotherapy was instituted, following extensive discussion with the patient. Unfortunately the patient succumbed to the illness during the course of treatment. This case report is of a patient with rare presentation of bilateral testicular metastasis with prostate cancer in young age.