Epithelioid haemangioendothelioma – A rare cause of pleural effusion

We present the case of a 44-year-old patient, with a history of lymphatic tuberculosis, diagnosed with a pleural effusion associated with pulmonary consolidations. Pleural effusions are frequent in the general population, presenting an incidence of 3–4 cases/1000 people. The etiological diagnosis can be difficult, as they can be secondary to a variety of diseases. Numerous extrapulmonary disorders can explain fluid accumulations in the pleural space with elevated protein level (exudates). However, more frequently they are the result of pulmonary diseases – inflammatory, infectious or neoplastic. The case entailed a differential diagnosis between pulmonary and pleural tuberculosis and neoplastic diseases. Despite receiving antituberculous treatment, the patient’s initial symptoms worsen, the patient starts presenting new signs and symptoms, and the fluid’s characteristics change – expression of an unfavourable evolution. Establishing the diagnosis proved to be difficult as invasive procedures were necessary. We diagnosed an extremely rare tumour, of vascular origin as the cause of the pleural effusion. Epithelioid haemangioendothelioma (EHE) presents an incidence of 1 in 1 million people. In conclusion, when treating a patient for pleural effusion, the lack of improvement entails reconsidering the initial diagnosis and performing more extensive tests.

Autoimmune glial fibrillary acidic protein astrocytopathy presented as ataxia, myoclonus and bulbar syndrome: a case report and review of the literature

ObjectiveTo describe an atypical case of autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy.ResultsA patient in his 60s presented with 6 months of progressive ataxia, proximal myoclonus and bulbar symptomatology. Cerebrospinal fluid (CSF) analysis showed monocytic pleocytosis, elevated protein level and elevated adenosine deaminase (ADA) level. CSF microbiological studies were negative and brain and cervical MRI showed no significant findings. We tested for nuclear, cytoplasmatic and synaptic neural autoantibodies as well as anti-GFAP antibodies. While awaiting these results, the patient was commenced on methylprednisolone boluses (1 g/day for 5 days), noting rapid neurological improvement. Eventually, CSF tests were positive for anti-GFAP antibodies.ConclusionWe report atypical manifestations of GFAP astrocytopathy. Further research is needed to fully understand the spectrum of neurological manifestations of this autoimmune disease and facilitate timely diagnosis.

Case Report: Histiocytic Necrotizing Lymphadenitis (Kikuchi–Fujimoto Disease) Concurrent With Aseptic Meningitis

Kikuchi–Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare, benign, self-limiting disease characterized by local lymphadenopathy. Central nervous system involvement in KFD is extremely rare and remains a diagnostic challenge. Only 41 cases of aseptic meningitis associated with KFD have been reported worldwide, with just four cases (including our case) of KFD with meningitis as the first symptom. We report a case of KFD accompanied by aseptic meningitis with severely high intracranial pressure (400 mmH2O), increased white blood cell count (56 × 106/L), and moderately elevated protein level (0.52 g/L). This case is unique in the delayed appearance of lymphadenopathy. After 1 month of treatment with steroids, fever, headache, and lymphadenopathy gradually disappeared, and the result of cerebrospinal fluid examination gradually became normal. In conclusion, based on our case findings and our literature review on KFD with aseptic meningitis, a diagnosis of KFD should be considered when delayed appearance of lymphadenopathy is observed in patients with aseptic meningitis.

New-Onset Seizure With Possible Limbic Encephalitis in a Patient With COVID-19 Infection: A Case Report and Review

With the outbreak of COVID-19 (coronavirus disease 2019) as a global pandemic, various of its neurological manifestations have been reported. We report a case of a 54-year-old male with new-onset seizure who tested positive for severe acute respiratory syndrome coronavirus 2 from a nasopharyngeal swab sample. Investigative findings, which included contrast-enhancing right posterior temporal lobe T2-hyperintensity on brain magnetic resonance imaging, right-sided lateralized periodic discharges on the electroencephalogram, and elevated protein level on cerebrospinal fluid analysis, supported the diagnosis of possible encephalitis from COVID-19 infection. The findings in this case are placed in the context of the existing literature.

ACUTE TRANSVERSE MYELITIS AS A NEUROLOGICAL COMPLICATION OF COVID-19: A CASE REPORT

We aim to report a COVID-19-related case of acute myelitis that has not been associated with any other viral infections. A 23-year-old student was admitted to the hospital within a month from the time of loss of smell and taste with features of acute-onset non-compressive myelitis with paresthesia on both sides from the Th9 level. Complex neurological, clinical, laboratory, and neuroimaging examination was performed within 24 hours of admission. MRI of the spine showed a segment of increased T2 signal in the center of the spinal cord at Th11-Th12. Elevated protein level and lymphocytic pleocytosis were detected in the cerebrospinal fluid. A serologic blood test for SARS-CoV-2 showed recent infection. PCR for other viral infections was negative. The patient was treated with injectable steroids and showed full recovery. Specific neurological features of acute myelitis associated with COVID-19 were reported, described, and analyzed. Patient was treated and recovered.

Outbreak of bacterial meningitis after spinal anaesthesia in Bangladesh

Iatrogenic meningitis following spinal anaesthesia is very rare. Recently we have experienced severe headache, vomiting, fever, restlessness, nuchal rigidity and altered level of consciousness 5-6 hours after spinal anaesthesia in one hundred and nineteen patients diagnosed as iatrogenic bacterial meningitis during the period of September 2008 to March 2009. Patients were successfully treated with Inj. Ceftriaxone 2gm BID for 14 days, Inj. Dexamethasone 20mg daily in four divided dose for five days. Purulent CSF, high cell count (1570mm-3), elevated protein level (269mg/dl) and normal glucose (57mg/dl) levels in CSF were noted. There were 5 (4.2%) cases of mortality. No causative organisms were isolated from CSF, blood of the affected patients and anaesthetic agent used for the block. In conclusion, the cause of meningitis was diagnosed as bacterial in origin though no organism was isolated. DOI: http://dx.doi.org/10.3329/jbsa.v22i1.18084 Journal of BSA, 2009; 22(1): 5-11

An Unusual Case of Subclinical Peripheral Neuropathy and Cervical Spondylosis in Atopic Myelitis

Many cases of atopic myelitis have been reported in Japan; however very few were described in western countries. An 82-year-old woman with a past medical history of atopic dermatitis and asthma presented with progressive paresthesia (tingling) of both hands and tetraparesis. Before the onset of neurological symptoms, she complained of ichthyosis of both legs for 5 weeks. Magnetic resonance imaging demonstrated multisegmental degenerative arthritis, degenerative disc disease, and abnormal spinal cord signal intensity over several cervical segments, suggesting the diagnosis of myelitis. Total serum IgE level was elevated. Nerve conduction studies revealed asymmetric axonal sensorimotor neuropathy. The cerebrospinal fluid specimen showed lymphocytic pleocytosis and elevated protein level. Based on clinical, imaging, and laboratory findings, atopic myelitis was diagnosed. The diagnosis of atopic myelitis should be considered in myelopathy patients with history of atopy and elevated serum IgE levels.