Lung cancer masquerading as a paraneoplastic neurologic syndrome without a primary lung mass: Case report and review of literature.

Paraneoplastic and autoimmune encephalitis (AIE) syndromes describe a range of inflammatory disorders of the brain. "Classic" paraneoplastic encephalitis syndromes occur due to a remote neoplasm and are associated with antibodies that target intracellular neuronal proteins while the more recently described AIE syndromes are not always paraneoplastic and occur in association with antibodies that target cell-surface neuronal receptors (e.g., anti-NMDA receptor, anti-LGI1, anti-GABAB receptor).[1] Diagnosis can be difficult and delayed due to nonspecific clinical, imaging, and laboratory findings, and in those syndromes associated with a neoplasm, the neurologic syndromes often precede the cancer diagnosis. We present a case of a 64-year-old patient diagnosed with anti-GABAB receptor encephalitis that subsequently revealed an underlying small cell lung cancer without a primary lung tumor. This case highlights the clinical challenge in diagnosing immune-mediated encephalitis, its methodical work up, and subsequent management.

Acquired Factor VIII Inhibitor Presenting as Occult GI Bleeding.

An acquired coagulation factor deficiency is characterized by acquired autoantibodies against specific clotting factors in those without diagnosed hemophilia. It is a relatively rare condition with an incidence of approximately one case per million per year. We present a case report of an elderly male who initially presented with an occult GI bleed that was identified with a positive fecal occult blood test result. This is the first case reported to our knowledge of an acquired factor inhibitor deficiency presenting in this manner. We postulate the importance of acquired factor inhibitors in the setting of unexplained anemia given absence of overt clinical symptoms that could contribute to aggravate an established GI bleed, especially in the elderly population.

Conjoined twins: a rare case of thoraco-omphalopagus.

Conjoined twins are a rare entity. Only few cases have been reported in the medical literature. They are a rare and exclusive type of monozygotic twins. They are caused by a faulty division of the embryonic disk. Due to high post-natal morbidity and mortality, an early pre-natal diagnosis is a must. All the monozygotic twins should be carefully screened for conjoinnment and if it is present, the type and the degree of sharing of the foetal organs should be delineated. There are many associated anomalies, of which congenital heart defects are the major prognostic factors. Here, we are reporting a case of thoraco-omphalopagus in which there was sharing of the foetal heart, liver and the intestinal loops.

Autosomal recessive polycystic kidney disease: antenatal diagnosis and histopathological correlation.

Autosomal recessive polycystic kidney disease (ARPKD) is one of the most common inheritable disease manifesting in infancy and childhood with a frequency of 1:6,000 to 1:55,000 births. The patient in her second trimester presented with a history of amenorrhea. Ultrasound examination revealed bilateral, enlarged, hyperechogenic kidneys, placentomegaly, and severe oligohydramnios. The pregnancy was terminated. An autopsy was performed on the fetus. Both the kidneys were found to be enlarged and the cut surface showed numerous cysts. The liver sections showed changes due to fibrosis. The final diagnosis of autosomal recessive polycystic kidney disease was made based on these findings. In this article, we correlate the ante-natal ultrasound and histopathological findings in autosomal recessive polycystic kidney disease.