scholarly journals Silent primary ovarian ectopic pregnancy following ovulation induction: diagnostic dilemma

2021 ◽  
Vol 10 (9) ◽  
pp. 3654
Author(s):  
Kalyani Saidhandapani ◽  
Yashaswi Pandey ◽  
Priya Shaunthini
Keyword(s):  
Ovulation Induction ◽  
Diagnostic Challenge ◽  
Diagnostic Dilemma ◽  
Ovarian Pregnancy ◽  
Threatening Condition ◽  
Reproductive Techniques ◽  
Life Threatening ◽  
History Of ◽  
High Index Of Suspicion ◽  
Urine Pregnancy Test

Early diagnosis of an ovarian pregnancy, of all the diagnoses relating to extrauterine gestations, is perhaps a diagnostic challenge faced by an obstetrician and a radiologist. About 0.5% of extrauterine implantations occur in the ovary. Recent studies have demonstrated infertility and Assisted reproductive techniques (ARTs), multiparity, use of intrauterine devices as risk factors for ovarian ectopic. Knowledge pertaining to ovulation induction and risk of ovarian ectopic is even more scant. In this article, we report a case report of ovarian pregnancy following ovulation induction with letrozole. Patient visited with history of missed menstrual period, mild abdominal pain and a weakly positive urine pregnancy test. Provisional diagnosis of right tubal ectopic was made. Diagnosis of ruptured ovarian ectopic was made on explorative laparoscopy which was later confirmed histopathologically. Patient had normal intra and post-operative course. An ovarian ectopic can present as a life-threatening condition and a high index of suspicion can prevent morbidity as well as mortality. Ovarian pregnancy in a primigravida with ovulation induction without an alarming sign, as in this case, is the rarest entity came across till date.

Disseminated genitourinary histoplasmosis in a patient with AIDS with negative urine antigen testing

2021 ◽  
Vol 14 (11) ◽  
pp. e243375
Author(s):  
Candice Theodora Joseph ◽  
Michael Feely ◽  
Nicole Iovine
Keyword(s):  
Histoplasma Capsulatum ◽  
Surgical Pathology ◽  
Rare Presentation ◽  
Persons Living With Hiv ◽  
Pathological Evaluation ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
High Index Of Suspicion ◽  
Living With Hiv

Disseminated histoplasmosis is a life-threatening condition in immunocompromised patients. The majority of healthy persons have benign disease not requiring treatment. However, in persons living with HIV, mortality is high and accurate diagnosis is paramount. We present a case of a 48-year-old HIV-positive woman who presented with haematuria and flank pain. She had a history of recurrent urinary tract infection and nephrolithiasis with obstructive hydronephrosis. During cystoscopy, a bladder lesion was found. Pathological evaluation demonstrated abundant intracellular organisms with apparent budding. Subsequent urine histoplasma antigen was negative. Given the high index of suspicion for histoplasmosis based on the surgical pathology findings and epidemiological history, the patient was started immediately on antifungal therapy. One week later, PCR results of the bladder lesion confirmed the presence of Histoplasma capsulatum. This case highlights a rare presentation of genitourinary histoplasmosis and the utility of surgical pathology evaluation and PCR for diagnosis.

scholarly journals Transient binocular blindness: A rare presentation of aortic dissection

2018 ◽  
Vol 27 (4) ◽  
pp. 236-240
Author(s):  
Abdul Hafiz Shaharudin ◽  
Muhamad Hafiq Ab Hamid ◽  
Rosliza Yahaya ◽  
Nik Ahmad Shaiffudin Nik Him ◽  
Nik Arif Nik Mohamed ◽  
...  
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Carotid Artery ◽  
Aortic Dissection ◽  
Sudden Onset ◽  
Rare Presentation ◽  
Diagnostic Dilemma ◽  
Threatening Condition ◽  
Life Threatening ◽  
High Index Of Suspicion

Introduction: Aortic dissection is a clinical chameleon that can have variable presenting features that require a careful history and physical examination. A non-specific presentation of this life-threatening condition causes a diagnostic dilemma among clinicians especially in the emergency department leading to grave consequences. Case Presentation: We present a case of aortic dissection that presented as an acute bilateral blindness that was associated with a sudden onset of loss of consciousness and central chest pain. Bedside carotid ultrasound showed a double lumen carotid artery suggesting an intraluminal flap. Computed tomography angiography revealed extensive dissection of the entire length of the aorta. Discussion: This case illustrated the need for a high index of suspicion to diagnose patients with aortic dissection especially as the patient presented with an acute binocular visual loss and chest pain. Conclusion: A bedside carotid artery ultrasound in the emergency department was found useful in screening and diagnosing a carotid artery–related pathology.

scholarly journals A rare acute presentation of intestinal malrotation in the elderly

2020 ◽  
Vol 7 (10) ◽  
pp. 3432
Author(s):  
Abidemi A. Adesuyi ◽  
Oladele O. Situ ◽  
Cephas S. Batta
Keyword(s):  
The Elderly ◽  
Intestinal Malrotation ◽  
Age Group ◽  
Midgut Volvulus ◽  
Diagnostic Challenge ◽  
Rare Presentation ◽  
Diagnostic Dilemma ◽  
Acute Presentation ◽  
History Of ◽  
High Index Of Suspicion

Intestinal malrotation, a congenital anomaly of the midgut, typically presents in pediatrics age group with the most feared complication of midgut volvulus and its catastrophic sequelae. Midgut volvulus secondary to intestinal malrotation is a rare presentation in adults more so in the elderly. Its rarity portends a diagnostic dilemma for both the surgeon and radiologist. We report a 65-year-old man admitted following a referral with a 12-hour history of acute abdomen with an initial diagnosis of acute pancreatitis but later had laparotomy with intraoperative findings of a midgut volvulus and gangrenous ileal segment secondary to intestinal malrotation. This case emphasizes the importance of early diagnosis to prevent the disastrous complication of this disease. The rarity of this condition portends a formidable diagnostic challenge in adults hence the awareness of its possibility and a high index of suspicion is crucial in diagnosis.

scholarly journals Haemophagocytic lymphohistiocytosis in Adult- A Case Report and Literature Review

2016 ◽  
Vol 33 (3) ◽  
pp. 166-176
Author(s):  
Syeda Fahmida Hossain ◽  
Nazmul Kabir Qureshi ◽  
Zahid Mahmud ◽  
Md Iqbal Hossain
Keyword(s):  
T Lymphocytes ◽  
Age Groups ◽  
Vascular Diseases ◽  
Haemophagocytic Lymphohistiocytosis ◽  
Diagnostic Challenge ◽  
Laboratory Findings ◽  
Collagen Vascular Diseases ◽  
Threatening Condition ◽  
Life Threatening ◽  
High Index Of Suspicion

Haemophagocytic lymphohistiocytosis (HLH) is a rare but potentially fatal disease of normal but overactive histiocytes and lymphocytes that commonly appears in infancy, although it has been seen in all age groups. The disease may be inherited or acquired due to infections, collagen vascular diseases and malignancies. The pathological hallmark of the syndrome is uncontrolled activation of T lymphocytes and macrophages, together with an impaired cytotoxic function of NK cells and CD8+ T lymphocytes, resulting into massive cytokine release (e.g., interferon ”, TNF á, interleukin[IL]-6, 8,10,12,18 etc) from these cells and overwhelming inflammation. Lymphocytes and macrophages, sometimes with haemophagocytic activity accumulate in bone marrow, spleen, liver, or lymph nodes. This immune dysregulatory disorder is characterized by fever, hepatosplenomegaly, lymphadenopathy, skin rash, cytopenias, hepatitis, coagulopathy, neurological symptoms. We report a case of 65 years old male presenting with fever and erythroderma who developed typical clinical and laboratory findings consistent with diagnosis of HLH according to HLH-2004 guidelines. Despite receiving etoposide based chemotherapy, the patient succumbed rapidly from progressive HLH. This case high lightened the diagnostic challenge and the need for keeping a high index of suspicion for promptly diagnosis and treatment of this potentially life threatening condition as clinical features and laboratory investigations are non specific.J Bangladesh Coll Phys Surg 2015; 33(3): 166-176

scholarly journals Wandering airway foreign body in early infancy

2020 ◽  
Vol 7 (8) ◽  
pp. 1798
Author(s):  
Rajkumar M. Meshram ◽  
Nilesh Nagdive ◽  
Vishal S. Gajimwar ◽  
Parameshappa N. Nandikoppa ◽  
Suraj P. Gondase
Keyword(s):  
Foreign Body ◽  
Male Infant ◽  
Tracheobronchial Tree ◽  
Respiratory Passage ◽  
Impacted Foreign Body ◽  
Threatening Condition ◽  
Life Threatening ◽  
History Of ◽  
Appropriate Therapy ◽  
High Index Of Suspicion

Accidental impaction of objects in the respiratory passage is a life-threatening condition. A 9-month-old male infant was admitted with fever, cough and respiratory distress without history of choking. He was treated as wheezy bronchitis with appropriate therapy but, did not show response. HRCT showed an impacted foreign body in the trachea which caused a partial luminal compromise. Two attempts to remove foreign body by rigid bronchoscope failed, and tracheostomy was performed due to fall in oxygen saturation. After stabilization, again saturation was falling and air entry was absent on right hemithorax. Considering the possibility of movement of foreign body in right bronchus, bronchoscope was reintroduced and foreign body was removed in piecemeal. This process was complicated with cardiorespiratory arrest, twice from which the patient was revived. Postoperative period was uneventful. So, high index of suspicion is required to diagnose such a foreign body of the tracheobronchial tree to prevent morbidity and mortality.      

Intraorbital Abscess: A Rare Cause of Orbit Compression

FACE ◽  
2021 ◽  
pp. 273250162110050
Author(s):  
Samuel Ruiz ◽  
Rizal Lim
Keyword(s):  
Pediatric Population ◽  
Rare Complication ◽  
Disease Process ◽  
Rare Condition ◽  
External Drainage ◽  
Direct Extension ◽  
Life Threatening ◽  
History Of ◽  
High Index Of Suspicion ◽  
Prompt Diagnosis

Introduction: Intraorbital abscess is a rare complication of rhinosinusitis that affects most commonly the pediatric population. It is thought to be caused by direct extension or venous spread of infections from contiguous sites and can lead to life-threatening complications, like permanent visual loss and cerebral abscesses. Objectives: Intraorbital abscess is a rare condition that requires prompt diagnosis and treatment to avoid serious complications. Our objectives are to provide an overview of this rare disease process and its management including our successful treatment experience. Case Description: We present a 2 case report of a 13-year-old pediatric male and a 66-year-old male with history of chronic sinusitis who presented with a right intraorbital abscess successfully treated with external drainage with decompression of the orbit. Conclusion: When intraorbital abscess is encountered, a high index of suspicion is needed to allow prompt and accurate diagnosis for this infrequent condition. Timely surgical drainage of the abscess is needed to prevent the development of fatal complications.

scholarly journals A Rare Case of Autoimmune Polyglandular Syndrome Type 2 in a Child With Persistent Fatigue

2019 ◽  
Vol 6 ◽  
pp. 2333794X1984507 ◽  
Author(s):  
Ryan Kenneth Smith ◽  
Peter M. Gerrits
Keyword(s):  
Adrenal Insufficiency ◽  
Autoimmune Polyglandular Syndrome ◽  
Threatening Condition ◽  
Viral Illness ◽  
Persistent Fatigue ◽  
Life Threatening ◽  
Local Emergency Department ◽  
Autoimmune Polyglandular Syndrome Type ◽  
High Index Of Suspicion

Adrenal insufficiency is a rare, potentially life-threatening condition whose diagnosis requires a high index of suspicion. Adrenal insufficiency may be primary, secondary, or tertiary with varied etiologies. Primary insufficiency may be part of a cluster of autoimmune diseases, referred to as autoimmune polyglandular syndrome(s) (APS). We describe a case of a 15-year-old male who presents to a local emergency department complaining of fatigue, fever, abdominal pain, nausea, and vomiting for a few days with a preceding viral illness. The patient was hyponatremic and hyperkalemic with skin hyperpigmentation, raising concern for adrenal insufficiency. Laboratory workup confirmed autoimmune primary adrenal insufficiency, with subsequent laboratory studies revealing autoimmune thyroiditis and celiac disease. Concomitant Addison’s and Hashimoto’s diseases led to a diagnosis of APS type 2. The patient was started on steroid replacement with rapid clinical improvement.

Heterotopic pregnancy; case report

2019 ◽  
Vol 7 (05) ◽  
Author(s):  
Vipul R. Khandagale
Keyword(s):  
Risk Factors ◽  
Ectopic Pregnancy ◽  
Adnexal Mass ◽  
Heterotopic Pregnancy ◽  
Free Fluid ◽  
Threatening Condition ◽  
Life Threatening ◽  
Ectopic Pregnancies ◽  
High Index Of Suspicion ◽  
Low Risk Women

Heterotopic pregnancy is a rare clinical condition in which intrauterine and extrauterine pregnancies occur at the same time. It can be a life threatening condition and easily missed with the diagnosis. We present the case of a 37 year old patient who was treated for a heterotopic pregnancy with live intrauterine gestation and ruptured left adnexal gestation.The ectopic pregnancy was not suspected at her initial presentation. A high index of suspicion is needed in women with risk factors for an ectopic pregnancy and in low risk women who have free fluid with or without an adnexal mass with an intrauterine gestation.It is difficult to estimate exactly the incidence of ectopic pregnancies, but on an average it is approximately 1:300 normal pregnancies worldwide.

scholarly journals Pompe Disease: Cyanosed Hypotonic Infant with Normal Respiratory Rate

2017 ◽  
Vol 13 (2) ◽  
pp. 172-174 ◽  
Author(s):  
S. Koirala ◽  
A. Poudel ◽  
R. Basnet ◽  
K. Subedi
Keyword(s):  
Respiratory Rate ◽  
Pompe Disease ◽  
Clinical Findings ◽  
Diagnostic Challenge ◽  
Floppy Infant ◽  
History Of ◽  
Infantile Pompe Disease ◽  
High Index Of Suspicion ◽  
To Receive ◽  
Remote Part

Infantile hypotonia or floppy infant is a diagnostic challenge when it presents with other presenting complaints such as fever, cough or diarrhea. Many times the hypotonia goes unnoticed when other symptom covers the hypotonia and child continues to receive the treatment for other symptoms. We report a rare case from Nepal of infantile Pompe disease who presented with the history of fever and cough in the recent earthquake disaster camp at remote part of Sindhupalchowk, Nepal. He was being treated as a case of pneumonia.Pompe disease can be diagnosed clinically by taking detailed history and correlating the clinical findings during the presentation with other symptoms. In our case the normal respiratory rate, reduced Spo2 and presence of crackles dominated the hypotonia and was mistreated as pneumonia. High index of suspicion is necessary in diagnosing Pompe disease.

scholarly journals Diffuse infiltrating retinoblastoma: A diagnostic conundrum

2021 ◽  
Vol 7 (2) ◽  
pp. 204-206
Author(s):  
Harsha Bhattacharjee ◽  
Aditi Mehta ◽  
Dipankar Das ◽  
Kasturi Bhattacharjee ◽  
Manabjyoti Barman ◽  
...  
Keyword(s):  
Family History ◽  
Multimodal Imaging ◽  
Positive Family History ◽  
Neovascular Glaucoma ◽  
Exudative Retinal Detachment ◽  
Imaging Features ◽  
Diagnostic Challenge ◽  
Progressive Loss ◽  
History Of ◽  
High Index Of Suspicion

Diffuse infiltrating retinoblastoma (DIR) is characterized by absence of intraocular mass, lack of calcification. It may mimic inflammatory uveitis or exudative retinopathy. An eight-years-old boy presented with progressive loss of vision in left eye. Clinical evaluation revealed neovascular glaucoma with a yellow–gray fundal glow, exudative retinal detachment, subretinal exudation and telangiectatic vessels. The presentation was consistent with exudative retinopathy (Coat’s disease) but for the presence of a family history of retinoblastoma in the younger sibling. Despite the absence of an intraocular mass or calcification on multimodal imaging, the enucleation was done on the basis of clinical suspicion of retinoblastoma. Histopathology confirmed a diagnosis of DIR.: DIR can pose a diagnostic challenge due to its non-characteristic clinical and imaging features and atypical presentation. A high index of suspicion along with a positive family history was key to diagnosis in our case; histopathology was confirmatory.

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