A challenging diagnosis of chronic osteomyelitis in a child with congenital insensitivity to pain: a case report.

Introduction: Congenital insensitivity to pain (CIP) is a rare condition where individuals are born with an inability to perceive pain. This can lead to various complications in the skin, skeletal system, and other bodily systems. Chronic osteomyelitis is one of the possible manifestations of CIP, which can be difficult to diagnose and treat due to the lack of pain as a diagnostic criterion. Presentation: A 5-year-old boy with CIP developed chronic osteomyelitis in his right leg, presented with fever, claudication, swelling, and local heat for 2 months. He had a history of CIP since birth, diagnosed at 18 months of age. He also had a family history of CIP. He had previously suffered a shoulder fracture and had taken asthma medication for 1 year. He had experienced tonsillitis 2 months ago. On examination, he had hepatomegaly, enlarged lymph nodes in the groin, and a minor swelling on the right knee. He had an audible snapping sound during knee flexion. Blood tests showed increased inflammatory markers. Imaging studies confirmed presence of osteomyelitis, and bone biopsy revealed infection with Staphylococcus aureus. Treatment included vancomycin and cefotaxime. Clinical discussion: Genetic factors behind CIP were discussed, highlighting challenges in diagnosis. Manifestations of CIP, diverse and age-related, include orthopaedic issues, ophthalmological effects, and thermoregulation disturbances. The patient's case is presented with unique features, necessitating a comprehensive diagnostic approach. Conclusion: This case highlights the challenges faced in diagnosing osteomyelitis among CIP patients and emphasizes the need for other diagnostic criteria apart from pain.

Modified compression sutures for treatment of asymptomatic uterine arteriovenous malformation in a low-resource setting: A case report.

INTRODUCTION AND IMPORTANCE: Uterine arteriovenous malformation (UAVM) can be present at birth or acquired later, often after trauma like cesarean delivery. It can cause severe vaginal bleeding but may have no symptoms. What makes our case special, other than being a rare condition, is the surgical technique used. CASE PRESENTATION: A 24-year-old woman came in with abdominal pain at 38 weeks pregnant. She had a cesarean delivery 13 months before. She had an uncomplicated repeat cesarean but bled heavily after from uterine atony. A 5 × 7 cm asymptomatic uterine AVM was found incidentally in the right uterine horn. After the transfusion, B-Lynch sutures were used to treat the atony and AVM. The patient recovered well after the sutures. Follow-up ultrasound showed the AVM got much smaller and no more bleeding. CLINICAL DISCUSSION: While conventional approaches advocate hysterectomy or uterine artery embolization (UAE), our case, situated in a low-income setting, necessitated innovative strategies. With embolization unavailable, and surgery carrying inherent risks, the B-lynch Procedure emerged as a pragmatic choice. CONCLUSION: Uterine AVM with no symptoms can happen after cesarean delivery. In low-resource settings, modified compression sutures can effectively treat heavy bleeding after delivery and shrink AVM size, avoiding hysterectomy.

Thrombocytopenia with absent radii syndrome with delayed presentation of thrombocytopenic episodes: a case report.

Bilateral radii aplasia with the presence of both thumbs and episodes of low platelets count are the main characteristics of thrombocytopenia with absent syndrome, which is an unusual birth disorder, with an incidence of 0.42\100 000 population. Case presentation: The authors reported a case of a 6-month-old baby girl who experienced thrombocytopenia at the age of 6 months for the first time, as a result of cow's milk being introduced for 45 days with chronic diarrhea and growth failure. She had a deviation of the axis of the hand laterally, and a bilateral absent of radii with the presence of both thumbs. In addition, she had abnormal psychomotor development, marasmus case manifestations. Conclusions: Our aim in publishing the current case report is that clinicians caring for patients with thrombocytopenia with absent syndrome will be aware of the myriad of complications, which may occur in the other organ systems so that they can promptly diagnose and treat any associated abnormalities.

A case report of a bullet in the breast of a woman for four years without any complications.

INTRODUCTION AND IMPORTANCE: A bullet stabilized in a breast for more than 4 years without causing any complication due to its presence is not a common case. Sometimes breast isolated injury could be seen without symptoms like pain, or palpable mass, or it could present with abscess formation and fistula. In addition, the bullet - if it's small - could mimic calcifications seen in malignancy when performing mammography. CASE PRESENTATION: We report a case of a 46-year-old well-being female who came to resect a superficial gunshot she got in her left breast in one of the armed conflict areas in Syria. The bullet has been settled there for more than 4 years without causing any inflammation-related signs at the wound's site and without causing any symptoms or complications. CLINICAL DISCUSSION: The tissue damage caused by the gunshot is associated with several factors such as the bullet caliber, speed, range of shooting, and energy flux. Frequently, gunshot injuries are most serious in friable solid organs like the liver and brain, whereas dense tissues such as bones and loose tissues like subcutaneous fat are more tolerant and resistant to that kind of insult. When a foreign body (bullet) enters the body without causing tremendous tissue damage and settles there for enough period of time we expect seeing signs of inflammation (heat, swelling, pain, tenderness, and redness). CONCLUSION: Such cases must be taken into consideration and not be neglected without intervention due to the increased risk of many fearful complications including Squamous Cell Carcinoma.