Simultaneous volvulus of the transverse and sigmoid colon. Case report

Introduction. Volvulus of transverse colon is rare when compared to cecal and sigmoid volvulus. Cases involving simultaneous volvulus of the transverse colon and another colonic segment are extremely rare. Case report. We report a rare case of simultaneous sigmoid and transverse colon volvulus in a 82-year-old Caucasian female Conclusion. Volvulus is a well recognized cause of large bowel obstruction. The development of transverse and sigmoid volvulus in the same patient is extremely rare. Though rare this possibility must always be considered in the differential diagnosis, when dealing with recurrent intermittent abdominal pain or acute intestinal obstruction.

Visual results with the use of prismatic lenses in the treatment of congenital nystagmus: a clinical case

Purpose: It is important to establish a differential diagnosis between the different types of nystagmus, in order to give the appropriate clinical approach to every situation and to improve visual acuity. The nystagmus is normally blocked when the eyes are positioned in a particular way. This makes the child adopt a posture of ocular torticollis that reduces the nistagmiformes movements, improving the vision in this position. A way to promote the blocking of the nystagmic movements is by using prismatic lenses with opposite bases, to block or minimize the oscillatory movements. This results in a vision improvement and it reduces the anomalous head position. There is limited research on the visual results in children with nystagmus after using prisms with opposing bases. Our aim is to describe the impact on the visual acuity (VA ) of theprescription prism lenses in a nystagmus patient starting at 3 months of age. Methods: Case report on thirty month old caucasian male infant, with normal growth and development for their age, with an early onset of horizontal nystagmus at 3 months of age. Ophthalmic examination included slit lamp examination, fundus, refractive study, electrophysiological and magnetic resonance tests, measurement of VA over time with the Teller Acuity Cards (TAC ) in the distance agreed for the age. At age ten months, the mother noted a persistent turn to the right of the child’s head, which became increasingly more severe along the months. There’s no oscillopcia. At 24 months, an atropine refraction showed the following refractive error: 0D.: -1,50, OS: -0,50 and prismatic lens adapting OD 8 Δ nasal base and OE 8 Δ temporal base. Results: Thirty month old child, with adequate development for their age, with onset of idiopatic horizontal nystagmus, at 3 months of age. Normal ocular fundus and magnetic ressoance without alterations, sub-normal results in electrophysiological tests and VA with values below normal for age. At 6 months OD 20/300; OE 20/400; OU 20/300. At 9 months OD 20/250; OE 20/300; OU 20/150 (TAC a 38 cm). At 18 months OD 20/200; OE 20/100; OU 20/80 (TAC at 38 cm), when the head is turned to the right and the eyes in levoversão, the nystagmus decreases in a “neutral” area. At 24 month, with the prismatic glasses, OD 20/200 OE 20/100, OU20/80 (TAC at 54 cm, reference value is 20/30 – 20/100 para OU e 20/40 – 20/100 monocular), there was an increase in the visual acuity. The child did visual stimulation with multimedia devices and using glasses. After adaptation of prisms: at 30 months VA (with Cambridge cards) OD e OE = 6/18. The child improved the VA and reduced the anomalous head position. There is also improvement in mobility and fine motricity. Conclusion: Prisms with opposing bases., were used in the treatment of idiopathic nystagmus. Said prisms were adapted to reduce the skewed position of the head, and to improve VA and binocular function. Monitoring of visual acuity and visual stimulation was done using electronic devices. Following the use of prismatic, the patient improved significantly VA and the anomalous head position was reduced.

Revisão de literatura de Leucoplasia Oral

Similar a outras lesões de pele, têm sido identificadas lesões precursoras de carcinoma de células escamosas na mucosa da cavidade oral. Na boca, apresenta-se frequentemente em forma de placa branca, denominada leucoplasia. Na conferência de 2005, a leucoplasia foi definida pela OMS como “uma placa ou mancha branca que não pode ser caracterizada clínica ou patologicamente como qualquer outra doença.” Leucoplasia é, portanto, um diagnóstico clínico de exclusão. A frequência de apresentar displasia epitelial, carcinoma in situ, carcinoma verrucoso ou carcinoma de células de escomosas invasivo na leucoplasia oral varia de 8,6% a 60%. A transformação maligna anual de leucoplasia é de 1% a 5 %. Sendo assim, é de fundamental importância, por parte dos profissionais na saúde e principalmente dos médicos dentistas terem conhecimento da leucoplasia oral para que possam suspeitar, fazer o diagnóstico ou encaminhar a profissionais competentes precocemente para o manejamento dessas lesões.

Use of Poppers (Amyl Nitrite): Unpleasant Side Effects in a Brothel

Introduction: Various agents can lead to an acquired methaemoglobinaemia (MHB) with potentially fatal consequences. There is a lack of literature on the formation of methaemoglobin (MH) in the blood after the intake of poppers (amyl nitrite). Poppers are a popular aphrodisiac agent. Case description: A 56-year-old diabetic called an ambulance after using poppers in a brothel with subsequent associated acrocyanosis, confusion and headache. The paramedics reported tachycardia and blood glucose of 3.8 mmol/l. The arterial blood gas analysis in the Emergency Department (ED) revealed a MHB of 23.1%. MH levels decreased rapidly without antidotal therapy. The patient was discharged the next day free of symptoms. Discussion: This case illustrates the potential risks of taking poppers. A wide spectrum of symptoms were present in our patient. For the differential diagnosis of acquired MHB, poppers should be considered.

Auricular Chondritis in a Postpartum Flare of SLE and APS

Introduction: Auricular chondritis has been occasionally described in patients with systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS). Materials and methods: We report the case of a woman with a previous history of APS who presented with auricular chondritis with onset of SLE symptoms during the postpartum period. Conclusion: SLE and APS should be taken into consideration in the differential diagnosis of auricular chondritis.

An Intriguing Case of Anaemia and Splenomegaly

Objectives: Thrombocytopenia and splenomegaly are common features in several haematological disorders. Gaucher disease (GD) is a rare lysosomal storage disorder frequently characterized by thrombocytopenia and splenomegaly, which represents a clinical challenge for haematologists and internists. Case: We describe the case of a 37-year-old patient with a diagnosis of spherocytosis since childhood, who developed hepatic failure and presented striking features of GD including hepatosplenomegaly, bone fractures and post-partum bleeding. We reconsidered the diagnosis of spherocytosis and investigated Gaucher disease. Conclusion: GD should be considered in the differential diagnosis of thrombocytopenia and splenomegaly.

Bacchus Neumonitis

Objective: Interstitial lung diseases (ILD) are a group of pathologies of undetermined frequency that require a broad differential diagnosis and continue to pose a challenge for clinicians. Observations: We present a clinical case of a 17-year-old male with acute interstitial pneumonitis, lung aspergillosis and foreign body lung granulomatosis after carbon monoxide (CO) intoxication. As far as we know, no similar cases have been reported in the literature. Conclusions: ILD require a broad differential diagnosis, which is of great importance to prognosis.

Haemophagocytic Syndrome in a 19-Year-Old Male with Plasmodium falciparum Malaria

Objectives: Infectious agents triggering haemophagocytic lymphohistiocytosis (HLH) primarily involve the herpes virus group. We report a case of HLH precipitated by Plasmodium falciparum. Materials and methods: Clinical and laboratory findings in a patient presenting with fever were collected. After confirmation of acute malaria, anti-malarial treatment was administered. Results: Despite initial favourable evolution, the patient developed fever again together with a worsening of the haematological parameters and increased ferritin levels. A bone marrow biopsy confirmed the diagnosis of HLH. Conclusion: This case illustrates that HLH should be considered in the differential diagnosis of acute malaria in patients with persisting fever and pancytopenia.

A Rare Cause of Chronic Low Back Pain

Objectives: Autosomal dominant osteopetrosis (ADO) is a rare genetic disease characterized by increased bone mass and density due to defective bone resorption. The aim of this case study is to present the clinical and radiographic features of a 22-year-old male patient with ADO and to serve as a reminder that this rare disease should be considered in the differential diagnosis of chronic low back pain. Materials and methods: A 22-year-old patient with ADO is presented in this case report. Results: Clinical and radiographic features of the patient were consistent with ADO. Conclusions: ADO should be taken into consideration in differential diagnosis of low back pain.

Diagnóstico laboratorial de casos de importação de infeções por vírus Zika

O vírus Zika (Flavivirus) é um arbovírus transmitido sobretudo por mosquitos, mas também, por transmissão materno-fetal e sexual. Existem evidências que as infeções por vírus Zika podem estar associadas à síndrome de Guillian-Barré e a casos congénitos de microcefalia e outras malformações do sistema nervoso central. As infeções por vírus Zika, Dengue e Chikungunya partilham, atualmente, os mosquitos vetores, a sintomatologia e a distribuição geográfica. O Centro de Estudos de Vetores e Doenças Infeciosas do Instituto Nacional de Saúde Doutor Ricardo Jorge no seu Laboratório Nacional de Referência de Vírus Transmitidos por Vetores tem desenvolvido o diagnóstico e estudos epidemiológicos de vírus transmitidos por artrópodes desde o princípio dos anos 90. O diagnóstico de Zika foi desenvolvido e padronizado em 2007. O laboratório desenvolveu testes de diagnóstico molecular e serológico tendo identificado vários casos de importação para o território português e feito o diagnóstico diferencial com Dengue e Chikungunya e o despiste de infeção em grávidas e em casos de transmissão sexual.

Histoplasmose em Portugal: infeção rara?

O Histoplasma capsulatum é o agente etiológico da histoplasmose, apresenta duas variedades com caraterísticas epidemiológicas diferentes var. capsulatum e var. duboisii endémicas no continente americano e no continente africano, respetivamente. Nas últimas décadas têm sido descritos casos de histoplasmose na Europa e em países asiáticos como a China, onde esta infeção não é considerada endémica. A facilidade de movimentação das populações tem contribuído para alterar o padrão epidemiológico desta infeção. Este trabalho tem como objetivo analisar o número de casos registados em Portugal e chamar a atenção para a importância de melhor se conhecer a epidemiologia desta infeção no nosso país. A histoplasmose não é uma doença de declaração obrigatória, os casos de histoplasmose existentes resultam de diagnósticos clínicos observados no âmbito dos internamentos hospitalares. O número médio de episódios de internamento hospitalar referenciados nos Base de dados de Grupos de Diagnóstico Homogéneo durante o período de 2009 a 2014 foi de 23 episódios/ano. No mesmo período foram descritos na literatura dez casos de Histoplasmose em Portugal, tratando-se sobretudo de apresentações clínicas de interesse científico em que algumas se referem a casos com período de latência de 40 anos após exposição. Apesar de ser considerada uma doença rara na Europa, clínicos e microbiologistas devem estar em alerta e aumentar o seu conhecimento sobre a patogenicidade, os métodos de diagnóstico diferencial, o tratamento e a evolução do padrão epidemiológico desta e de outras infeções fúngicas.

Immune-Mediated Necrotizing Myopathy: An Often Misdiagnosed Entity

Immune-mediated necrotizing myopathies (IMNM) are recognized as a subgroup of idiopathic inflammatory myopathies (IIM). IMNM are defined based on a combination of clinical presentation and laboratory studies, requiring a specific myopathological pattern on muscle biopsy for diagnosis. The authors describe a case of a patient with necrotizing myopathy, thought to be immune mediated, highlighting the challenge of its differential diagnosis. As clinical assessment and diagnostic tools sometimes fail to determine whether a necrotizing myopathy is immune mediated, leading to misdiagnosis and a compromise of the optimal therapeutic approach, distinguishing between IMNM and other myopathies is crucial.

Epigastric Pain in Acute Renal Infarction: The Forgotten Presentation

Epigastric pain is a manifestation of several medical and surgical conditions. However, when persistent epigastric pain is associated with microscopic or frank haematuria and elevated lactate dehydrogenase (LDH), especially in patients with increased risk of thromboembolic events, acute renal infarction (ARI) should be considered. We report the case of a 77-year-old male patient who presented with sudden persistent epigastric pain and elevated LDH who was found to have atrial fibrillation. The patient was diagnosed with ARI. ARI is not usually a typical differential diagnosis in patients with persistent epigastric pain and elevated LDH in whom the risk of thromboembolic events is high. Thus, physicians should perform a contrast-enhanced CT scan as early as possible to rule out or confirm renal infarction.

A Young Woman with Fever and Cervical Lymphadenopathy

Kikuchi-Fujimoto's disease is a self-limiting and rare disorder of unknown aetiology. The typical presentation includes fever, cervical lymphadenopathy and night sweats. Consequently, it is part of the differential diagnosis of infectious, lymphoproliferative and connective tissue diseases. Histology demonstrates necrotizing histiocytic lymphadenitis. Treatment is symptomatic with non-steroidal antiinflammatory agents, although there are reports of corticosteroid use in complicated cases. We present the case of a 23-year-old woman admitted to hospital for fever and cervical lymphadenopathies, and diagnosed with Kikuchi-Fujimoto's disease.

Hepcidin and Ferritin Levels in Fever of Unknown Origin: Is There a New Biomarker?

Background and objectives: Significantly elevated serum ferritin levels are associated with both iron overload and some inflammatory conditions. Hepcidin is a protein that interferes with iron absorption in inflammatory states and acts as an acute-phase reactant. Materials and methods: Here we report the case a 33-year-old patient who presented with high fever, skin lesions and arthralgia lasting for 2 weeks. His ferritin level was 13,800 µg/l and his hepcidin level was 61 ng/dl. Results: The final diagnosis was adult onset Still's disease. The condition evolved satisfactorily with steroid treatment, but after several weeks the patient presented with an unexpected recurrence. Conclusions: Hepcidin is a good inflammatory marker that could be useful in the differential diagnosis of hyperferritinaemia.