ABSTRACT
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Subject(s)
Humans , Male , Middle Aged , Aortic Aneurysm/complications , Aortic Dissection/complications , Cardiac Tamponade/complications , Pericardial Effusion/complicationsSubject(s)
Bone Neoplasms/secondary , Carcinoma, Hepatocellular/pathology , Liver Neoplasms/pathology , Antineoplastic Agents , Biopsy, Fine-Needle , Bone Neoplasms/diagnostic imaging , Bone Neoplasms/drug therapy , Bone Neoplasms/pathology , Carcinoma, Hepatocellular/diagnostic imaging , Carcinoma, Hepatocellular/drug therapy , Clavicle/diagnostic imaging , Clavicle/injuries , Fatal Outcome , Fractures, Bone/diagnostic imaging , Humans , Liver Neoplasms/diagnostic imaging , Liver Neoplasms/drug therapy , Male , Middle Aged , Niacinamide/analogs & derivatives , Phenylurea Compounds , SorafenibABSTRACT
Haematological toxicity due to antiepileptic drugs is uncommon, but the increased risk of aplastic anaemia has been reported. Few case reports have been published regarding pancytopenia associated with levetiracetam treatment, and its intrinsic pathogenesis is still unknown. We describe the case of a woman aged 77â years who presented with abdominal pain and loss of appetite. She had been taking valproic acid, due to a previous episode of epileptic seizures, and presented with drowsiness and dizziness. Valproate was discontinued and therapy with levetiracetam was initiated. 2â days later, we observed severe anaemia, leucopenia and thrombocytopenia, which were attributed to levetiracetam. Although she recovered soon after the treatment was discontinued, it took 2â weeks for cell counts to return to normal.
Subject(s)
Epilepsy/drug therapy , Pancytopenia/chemically induced , Piracetam/analogs & derivatives , Aged , Anticonvulsants/adverse effects , Anticonvulsants/therapeutic use , Female , Humans , Leukocyte Count , Levetiracetam , Pancytopenia/blood , Piracetam/adverse effects , Piracetam/therapeutic useABSTRACT
Clostridial soft tissue infections are infrequent, but can be life-threatening when associated with certain underlying conditions, such as immunosuppression or malignancy. When bacteraemia occurs, it can be accompanied by haemolysis. Only surgical removal of the focus of infection and early onset of antibiotic therapy can prevent a very poor outcome. We describe the case of a man aged 65â years who presented with sepsis, haemolysis and rapid worsening. The identification of a gas-forming liver abscess, the early percutaneous drainage and the prompt initiation of antibiotic treatment were the key factors in the outcome of this patient.
Subject(s)
Bacteremia/complications , Clostridium Infections/complications , Clostridium perfringens , Liver Abscess/microbiology , Sepsis/microbiology , Soft Tissue Infections/complications , Aged , Bacteremia/microbiology , Clostridium Infections/microbiology , Hemolysis , Humans , Male , Soft Tissue Infections/microbiologyABSTRACT
Chordoid gliomas are rare tumours. Despite being considered low-grade neoplasms, recent reviews have reported generally poor prognosis due to complications involving severe hypothalamic symptoms. We report a patient aged 30â years with chordoid glioma. What makes this case report interesting is the presence of neurogenic fever, which was already present before the final diagnosis of the brain tumour and also several months after the surgical removal. Since the patient underwent a subtotal resection of the tumour, it remains unclear whether the fever was due to hypothalamic dysfunction or remnants of the tumour. We also performed temperature logging with a continuous-monitoring recording device.
Subject(s)
Cerebral Ventricle Neoplasms/diagnosis , Fever/etiology , Glioma/diagnosis , Hypothalamic Diseases/etiology , Hypothalamus , Third Ventricle/pathology , Adult , Body Temperature Regulation , Humans , Magnetic Resonance Imaging , MaleABSTRACT
Kimura disease is a benign rare chronic inflammatory disorder of unknown aetiology. This disease is mainly endemic in Asia, although cases have also been reported in Europe and America. We describe a case in a 34-year-old Chinese man presenting with severe eosinophilia and multiple lymphadenopathy. Since our initial aim was to rule out the diagnosis of lymphoma, and given the limitations of our laboratory, we decided to perform an excision of one of the cervical lymph nodes. The histological diagnosis was consistent with Kimura disease. We review the epidemiology, the aetiology and clinical features of this entity.
Subject(s)
Angiolymphoid Hyperplasia with Eosinophilia/diagnosis , Adult , Angiolymphoid Hyperplasia with Eosinophilia/drug therapy , Anti-Inflammatory Agents/therapeutic use , Diagnosis, Differential , Humans , Lymph Nodes/pathology , Male , Prednisone/therapeutic use , Rare Diseases/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
We describe cases of two previously healthy women presenting with progressively worsening breathlessness for 1-2 months. In both cases, physical examination was suggestive of a left-sided pleural effusion, confirmed by chest X-ray. Analysis of aspirated fluid showed a lymphocytic exudate, but cytological analysis was negative for malignancy in both patients. CT scan revealed malignancies as the underlying cause of the effusions. Both patients were managed with intercostal drainage in order to collect a sufficient amount of pleural fluid to perform a new technique in our hospital: cell block. This proved to be extremely useful in assessing the definitive diagnosis and management of both women. We briefly discuss the approach to a malignant pleural effusion and the aid of this not-so-new technique.
Subject(s)
Cytological Techniques/methods , Exudates and Transudates/cytology , Pleural Cavity/pathology , Pleural Effusion, Malignant/diagnosis , Adult , Aged , Female , Humans , Pleural Cavity/cytology , Pleural Effusion, Malignant/cytology , Tomography, X-Ray ComputedABSTRACT
A 56-year-old patient was admitted to our hospital, presenting with dysphagia as the only symptom. He was very concerned about this difficulty in swallowing. Diseases of the upper digestive tract were suspected, but further investigations revealed a neurological disorder. He had suffered a brain stem stroke and, as a consequence, developed an aspiration pneumonia. What seemed a digestive disorder was indeed a brain stem stroke, therefore we had to deal with the diverse impacts of this condition.
Subject(s)
Brain Stem Infarctions/complications , Deglutition Disorders/etiology , Pneumonia, Aspiration/etiology , Brain/diagnostic imaging , Brain Stem Infarctions/diagnosis , Brain Stem Infarctions/diagnostic imaging , Diagnosis, Differential , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Neuroimaging , Tomography, X-Ray ComputedABSTRACT
Unknown primary tumour refers to a group of cancers for which the anatomical site of origin remains occult after detailed investigations. Thanks to sophisticated imaging, immunohistochemical testing and molecular-profiling tools, there is a more accurate approach to unknown primary cancer. Metastasis to bone is not a rare phenomenon, because any tumour can metastasise to bone, so it is a common clinical scenario. The role of clinical history, physical examination, laboratory tests, radiographic studies and immunohistochemistry is critical for a successful diagnostic strategy. Subsets of unknown primary cancers can be identified primarily on the basis of histopathological findings, the pattern of spread and serum markers. New immunohistochemical markers and tissue-of-origin profiles may establish presumable primary sites to unknown primary cancer on the basis of immunohistochemical and molecular patterns. We present a case of a 57-year-old woman without a cancer history, who had primary bone metastasis as the first manifestation of an occult primary tumour.