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atypical presentation of Prostatic Cancer with Left Axillary and Supraclavicular Lymphadenopathy

Open Journal of Urology 2022年第4期12卷 228-236页

作者： Mohamed Izeldeen Ibrahim Abdulgadir Elsunny Hamadelnil Mutaz Mohamed Rehab Osman Abdelrhman Tamir A. Mahmmoud Ahmed M. Elnour Hala Yagoub Lyla M. Alagab Ahmed Gaper Hamad Department of Urology Prince Osman Digna Referral Hospital Portsudan Sudan Department of Surgery Red Sea University Portsudan Sudan Department of General Surgery Ministry of Health Sudan Department of Radiology Port Corporation Hospital Portsudan Sudan Sudan Medical Specialization Board Khartoum Sudan Prince Osman Digna Referral Hospital Portsudan Sudan

Introduction: The burden of prostatic cancer is rising in Sudan. Usually, they present late in their disease with urinary tract obstruction, hematuria, bony pain, or cachexia because there is no screening program. Here we present a patient with prostatic cancer who presented with left axillary mass as his main concern. Case Description: 82-year-old Sudanese male presented with a left axillary and left supraclavicular lymphadenopathy of a few months’ duration. He underwent a decisional biopsy which showed metastatic adenocarcinoma. Upper and lower GI endoscopy were performed but the latter was complicated by a sigmoid perforation with peritonitis. During laparatomy, multiple enlarged pelvic lymphnodes were encountered and a biopsy result suggested a metastatic prostatic neoplasm. Later, prostatic biopsy confirmed the diagnosis. The patient was treated with bilateral orchidectomy. Clinical discussion: Lymphatic metastasis to axillary lymph nodes is a very rare manifestation of prostate cancer and only a few cases have been reported in the literature. It can cause diagnostic difficulty since prostate cancer typically metastasis to the pelvic lymph node and very rarely involves he supradiaphragmatic lymph node. Conclusion: Metastatic prostatic carcinoma should be considered among the causes of supra-diaphragmatic lymph adenopathy. Careful physical and imaging examinations combined with PSA and pathological analysis are essential in the diagnosis of advanced prostate cancer with unusual presentation.

关键词： Prostatic Cancer Adenocarcinoma Axillary Metastasis Supraclavicular Metastasis atypical presentation

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A Case Report on atypical presentation of Cerebral Venous Sinus Thrombosis, a Young Adult with Recurrent Fall: A Clinical Quandary

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Open Journal of Emergency Medicine 2021年第4期9卷 171-178页

作者： Aishwarya Nandy Sayani Banerjee Rajesh Gupta Department of Emergency Medicine Ramkrishna Care Hospital Raipur India Department of Emergency Medicine Calcutta Medical Research Institute Kolkata India Department of General Medicine Ramkrishna Care Hospital Raipur India

Cerebral Venous Sinus Thrombosis (CVST) is blood clot in draining veins and venous sinuses of brain, causing hindrance in the blood drainage system in brain, disturbing the internal homeostasis of brain, resulting in local oedema, ischemia, venous haemorrhage, damage to brain parenchyma and blood brain barrier. In our case report, we discussed a rare presentation of CVST, a 16-year-old young boy who presented in emergency with history recurrent fall, weakness, tingling numbness. What makes it challenging to diagnose in his unusual presentation without common symptoms and on examination no positive neurological finding. This case brings focus on the importance of knowledge about CVST among emergency physicians. CSVT is considered more commonly as a differential diagnosis of stroke in young age group owning to genetic predisposition, hot humid climate of the state leading to severe dehydration, dietary factors leading to vitamin B12 deficiency & hyper-homocysteinemia etc. Moreover, present COVID-19, inducing a hypercoagulable state among affected individuals gave CVST a new momentous among emergency physicians. An early diagnosis can be very fruitful as it might prevent long term disability and reduce mortality significantly.

关键词： Cerebral Venous Sinus Thrombosis Acute Neurological Emergency atypical presentation

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An Incidental Finding and Unusual presentation of atypical Coccidioidomycosis in a 72-Year-Old Man: A Case Report

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Case Reports in Clinical Medicine 2023年第9期12卷 357-361页

作者： Alise Haddad Ethan Dimock Joseph Hanna Rafi Haddad Michel Hanna Stephen Galens William Beaumont School of Medicine Oakland University Rochester USA St. George’s University Grenada USA Faculty of Medicine and Medical Sciences University of Balamand Balamand Lebanon Division of Infectious Disease Department of Internal Medicine Corewell Health William Beaumont University Hospital Royal Oak USA

This case report presents an unusual and challenging diagnostic scenario involving a 72-year-old man who recently returned from a trip to Maui, Hawaii. While in Maui, the patient presented with a fever and fatigue that resolved spontaneously. However, he had an observable rash on his head and was given a steroid injection to resolve the rash. Later on his trip, the patient experienced a dry, nonproductive cough which resolved with a five-day course of prednisone. While visiting Michigan, the patient began to experience neck pain and visited Troy Beaumont Hospital for further treatment. Meningitis tests were negative. Vancomycin was given due to the detection of gram positive coccidioidomycosis in the culture, but this was later proven to be a contaminant. Coccidiomycosis does not initially have specific symptoms. Despite negative coccidioidomycosis antigen tests, the patient exhibited features more consistent with blastomycosis and cryptococcus, highlighting the complexities of diagnosing fungal infections with atypical presentations. The case emphasizes the importance of considering alternative fungal pathogens native to endemic regions and pursuing comprehensive diagnostic measures to establish an accurate diagnosis. Lastly, the discussion about recommendations for antifungal therapy and preventative measures for individuals at risk of respiratory fungal infections is critically important for the advancement of early detection of fungal infections.

关键词： Coccidioidomycosis Blastomycosis Cryptococcus Fungal Infections Diagnostic Challenges atypical presentation

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atypical presentations of COVID-19

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Advances in Infectious Diseases 2020年第3期10卷 136-142页

作者： Deepthi Jayasekara Suranjith L. Seneviratne Arindra Jayasekara Ishan De Zoysa Department of Infectious Diseases Western University Pomona USA Emanate Health West Covina USA Department of Surgery University of Colombo Colombo Sri Lanka Department of Clinical Immunology Royal Free Hospital London UK Tulane University New Orleans USA

Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, emerged in Wuhan, China in December 2019. It has now spread to all parts of the world and as of 26th July 2020, more than 16 million cases and over 600,000 deaths have been reported. The commonest presentation is respiratory in nature with non-productive cough, fever and shortness of breath. Some COVID-19 patients have had atypical or unusual presentations involving the neurological, metabolic, gastrointestinal, renal, haematological, cutaneous and cardiovascular systems. In this mini-review, we have outlined the main atypical or unusual clinical presentations of COVID-19.

关键词： COVID-19 SARS-CoV-2 atypical presentation

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Co-Occurrence of COVID-19 Infection and Intracerebral Hemorrhage in an Older Adult: A Case Report

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Case Reports in Clinical Medicine 2022年第4期11卷 106-115页

作者： Malarkodi Suppamutharwyam Tiong Ing Khieng Department of Internal Medicine Sarikei General Hospital Sarikei Malaysia Geriatric Unit Sarawak General Hospital Kuching Malaysia

Coronavirus disease 2019 (COVID-19) often has multifaceted presentations, even in young adults, which poses a significant challenge to clinicians who are caring for older adults. Older patients often present with subtle atypical manifestations, and failure to recognize these may lead to a cascade of negative events. Age-related immune system changes, comorbidities, and atypical presentations often make early diagnosis of COVID-19 difficult. Here, we report a case of an 82-year-old moderately frail male patient who presented with generalized body weakness and tested positive for COVID-19. On the second day of admission, he developed unilateral body weakness and aphasia, and computed tomography of the brain revealed acute right frontal spontaneous intracerebral hemorrhage with no vascular anomaly. He did not have any traditional risk factors for intracerebral hemorrhage and was not on any anticoagulants. The course of this case illustrates the delicate balance between the atypical presentations of COVID-19, the importance of a comprehensive geriatric assessment, and the management of older adults during the COVID-19 pandemic.

关键词： Advance Care Planning atypical presentation Comprehensive Geriatric Assessment COVID-19 Intracerebral Hemorrhage

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COVID-19 presenting with persistent hiccup and myocardial infarction in a peritoneal dialysis patient:A case report

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World Journal of Virology 2022年第4期11卷 198-203页

作者： Dimitra Bacharaki Panagiotis Giannakopoulos Konstantinos Markakis Christos Papas Aikaterini Theodorou Vasiliki Zoi Georgios Tsivgoulis Sophia Lionaki Department of Nephrology Attikon University HospitalChaidari 12462Greece Department of Internal Medicine Attikon University HospitalChaidari 12462Greece Department of Cardiology Attikon University HospitalChaidari 12462Greece Second Department of Neurology National and Kapodistrian University of AthensAttikon University HospitalAthensGreece

BACKGROUND Persistent hiccups,lasting more than 48 h,have been described as an atypical presentation of coronavirus disease 19(COVID-19)in the general *** the best of our knowledge,this is the first report of persistent hiccups and non-ST elevation myocardial injury(NSTEMI)as an atypical presentation of COVID-19 in a peritoneal dialysis(PD)*** SUMMARY A 70-year old man,who had been on PD for 3 years with a history of ischemic heart failure and reduced ejection fraction,presented for a scheduled radionuclide myocardial *** arrival,he complained of anorexia,nausea for 5 d,and unremitting hiccups for the previous 48 *** and laboratory examinations revealed an NSTEMI plus a positive nasopharyngeal reverse transcriptase polymerase chain reaction testing for severe acute respiratory syndrome coronavirus ***-19 lung involvement was mild and was resolved without specific *** injury was managed by coronary catheterization and stenting,while hiccups responded only to baclofen per *** Persistent hiccups and NSTEMI can be atypical presentations of COVID-19 in peritoneal dialysis patients,which may be due to involvement of the central nervous system and myocardial injuries.

关键词： COVID-19 Peritoneal dialysis atypical presentation Hiccup Myocardial infarction Baclofen Case report

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Leukemoid reaction in a patient with COVID-19 infection: A case report

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Journal of Acute Disease 2022年第3期11卷 120-122页

作者： Prabhat Agrawal Ashish Gautam Anjana Pandey Harendra Kumar Nikhil Pursnani Departments of Medicine S.N.Medical CollegeAgraIndia Departments of PathologyS.N.Medical CollegeAgraIndia

Rationale:COVID-19 usually presents with flu-like symptoms and signs,but some rare presentations like leukemoid symptoms cannot be ***’s concerns:A 37-year-old female presented to the outpatient department with flu-like ***:The RT-PCR test for SARS-CoV-2 infection was positive,while complete blood cell and peripheral blood smear showed leukemoid ***:Paracetamol and fexofenadine for flu-like symptoms and leukemoid ***:On the 10th day,the patient was asymptomatic and RT-PCR was *** the patient was discharged and leukemoid presentation subsided after clearance of viral ***:COVID-19 has a myriad of presentations,and unusual symptoms/signs especially in this pandemic could be induced by COVID-19 infection.

关键词： COVID-19 Leukemoid reaction atypical presentation Abnormal total leucocyte count Leukocytosis

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Heavily calcified gastrointestinal stromal tumors:Pathophysiology and implications of a rare clinicopathologic entity

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World Journal of Gastrointestinal Oncology 2017年第3期9卷 135-141页

作者： Massimiliano Salati Giulia Orsi Luca Reggiani Bonetti Fabrizio Di Benedetto Giuseppe Longo Stefano Cascinu Department of Medical and Surgical Sciences for Children and Adults Division of Medical OncologyUniversity Hospital of Modena and Reggio Emilia Department of Diagnostic Medicine and Public Health Division of PathologyUniversity Hospital of Modena and Reggio Emilia Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit University Hospital of Modena and Reggio Emilia Azienda Ospedaliero-Universitaria Policlinico di Modena

Gastrointestinal stromal tumors(GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract, and are characterized by a broad spectrum of clinical, histological and molecular features at presentation. Although focal and scattered calcifications are not uncommon within the primary tumor mass, heavy calcification within a GIST is rarely described in the literature and the clinical-biological meaning of this feature remains unclear. Cases with such an atypical presentation are challenging and may be associated with diagnostic pitfalls. Herein, we report a gastric GIST with the unusual presentation of prominent calcifications that was identified incidentally on imaging during a post-trauma diagnostic work-up. The patient underwent laparoscopic surgery with a radical resection of the mass, which was subsequently characterized by histological analysis as spindle-shaped tumor cells, positive for CD117/c-KIT, CD34 and DOG1, and with calcified areas. Given the intermediate risk of recurrence, no adjuvant therapy was recommended andthe patient underwent regular follow-up for 22 mo, with no evidence of relapse. Our case can be considered of interest because of the rarity of clinical presentation and the uniquely large size of the GIST at diagnosis(longest diameter exceeding 9 cm). In closing, we discuss the pathophysiology and clinical implications of calcifications in GISTs by reviewing the most up-to-date relevant literature.

关键词： Gastrointestinal stromal tumor Calcification Stomach atypical presentation Computed tomography

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