Flushing and diarrhea, and less frequently, heart failure, vomiting and bronchoconstriction

alkiviadis.1961 shared this article with you from Inoreader Management of refractory hypoglycaemia in a metastatic neuroendocrine tumour co-secreting serotonin and insulin Via BMJ Case Reports Last 6 Issues A 27-year-old otherwise healthy man of African descent presented to the hospital with initial symptoms of carcinoid syndrome that later evolved into symptoms of hyperinsulinemic hypoglycaemia. Investigations revealed a metastatic neuroendocrine tumour (NET), co-secreting both serotonin and insulin. Management involved a multimodal approach in an attempt to reduce tumour burden and achieve euglycaemia, which proved to be a significant challenge in the face of refractory hyp oglycaemia despite the administration of multiple prohyperglycaemic agents in combination. Unfortunately, given the burden of metastatic disease and multiple medical complications that ensued, the patient passed away. This case highlights the clinical history of a NET co-secreting serotonin and insulin, the use of combination therapy in the treatment of refractory hypoglycaemia in a metastatic insulin-producing tumour and emerging therapeutic modalities in the treatment of these rare malignancies. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Management of refractory hypoglycaemia in a metastatic neuroendocrine tumour co-secreting serotonin and insulin

alkiviadis.1961 shared this article with you from Inoreader Management of refractory hypoglycaemia in a metastatic neuroendocrine tumour co-secreting serotonin and insulin Via BMJ Case Reports Last 6 Issues A 27-year-old otherwise healthy man of African descent presented to the hospital with initial symptoms of carcinoid syndrome that later evolved into symptoms of hyperinsulinemic hypoglycaemia. Investigations revealed a metastatic neuroendocrine tumour (NET), co-secreting both serotonin and insulin. Management involved a multimodal approach in an attempt to reduce tumour burden and achieve euglycaemia, which proved to be a significant challenge in the face of refractory hyp oglycaemia despite the administration of multiple prohyperglycaemic agents in combination. Unfortunately, given the burden of metastatic disease and multiple medical complications that ensued, the patient passed away. This case highlights the clinical history of a NET co-secreting serotonin and insulin, the use of combination therapy in the treatment of refractory hypoglycaemia in a metastatic insulin-producing tumour and emerging therapeutic modalities in the treatment of these rare malignancies. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Management of inferior dislocation of a StopLoss Jones tube after conjunctivodacryocystorhinostomy

alkiviadis.1961 shared this article with you from Inoreader Management of inferior dislocation of a StopLoss Jones tube after conjunctivodacryocystorhinostomy Via BMJ Case Reports Last 6 Issues Persistent epiphora significantly worsens one's quality of life. A commonly known method of treatment of complete obstruction of the lacrimal canaliculi is conjunctivodacryocystorhinostomy with placement of a glass Jones tube. Unfortunately, the use of such a prosthesis of the lacrimal tract often results in certain complications, the most frequent of which include extrusion or superior and inferior migration. For the last several years, a modified version of the Jones t ube—the StopLoss Jones tube (SLJT)—has been available. It almost eliminates the possibility of extrusion. However, inferior migration still remains an important problem. When that happens, it is necessary to proceed surgically. In this paper, we describe an endoscopically-guided technique of management of an inferiorly dislocated SLJT. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Every loin swelling in an infant is not a renal mass: rare presentation of psoas abscess in an infant

alkiviadis.1961 shared this article with you from Inoreader Every loin swelling in an infant is not a renal mass: rare presentation of psoas abscess in an infant Via BMJ Case Reports Last 6 Issues Primary iliopsoas abscess (IPA) in infants is an uncommon condition. It presents as inguinal or thigh swelling with limitation of movements on the affected side. Early detection and timely drainage of the abscess can prevent serious complications related to the dissemination of infection. We report a case of primary IPA due to methicillin-sensitive staphylococcal infection presenting as a left lumbar mass in an immune-competent infant. The abscess was detected in time, dra ined surgically and treated with cloxacillin for 4 weeks, thereby preventing serious complications. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Epiglottic aplasia in an infant with Joubert syndrome

alkiviadis.1961 shared this article with you from Inoreader Epiglottic aplasia in an infant with Joubert syndrome Via BMJ Case Reports Last 6 Issues Congenital aplasia of the epiglottis is a rare condition with variable presentation ranging from respiratory distress requiring surgical airway to an asymptomatic finding. Epiglottic aplasia is presumed to be caused by arrest of development of laryngeal structures and is most commonly associated with syndromic conditions, though isolated episodes of aplasia of the epiglottis do exist. In this report, we present a term infant with multiple congenital anomalies who was noted to have a hoarse cry prompting laryngoscopy. This showed complete absence of the epiglottis. Subsequent genetic testing showed mutations in the CPLANE1 gene that is associated with Joubert syndrome. Our patient was able to be discharged home on a thickened formula diet and is eating and gaining weight appropriately. Here, we present a review of the currently available literature of other cases of congenital epiglottic aplasia or hypoplasia discussing the presentation, management and outcomes in these cases. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Lung injury from e-cigarette use: a foul and pestilent congregation of vapours

alkiviadis.1961 shared this article with you from Inoreader Lung injury from e-cigarette use: a foul and pestilent congregation of vapours Via BMJ Case Reports Last 6 Issues A 62-year-old man presented with worsening dyspnoea, haemoptysis and reduced exercise tolerance. He was found to be hypoxaemic with bilateral basal opacification on chest imaging, but inflammatory markers, respiratory virus PCR and sputum culture demonstrated no signs of infection. The patient reported having initially mild, yet progressive, symptoms since he started vaping 14 months previously. He was treated with oxygen therapy, supportive care and cessation of vaping. C hest imaging at discharge showed marked improvement of previous bilateral opacification and the patient returned to baseline exercise tolerance, with no oxygen requirement. Vaping is becoming more common in the UK and this case demonstrates the importance of considering electronic vaping-associated lung injury in cases of non-infective lung injury. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Secondary sclerosing cholangitis in critically ill patients: a rare disease precipitated by severe SARS-CoV-2 infection

alkiviadis.1961 shared this article with you from Inoreader Secondary sclerosing cholangitis in critically ill patients: a rare disease precipitated by severe SARS-CoV-2 infection Via BMJ Case Reports Last 6 Issues A previously well 59-year-old man required a prolonged intensive care unit stay due to severe COVID-19 symptoms. During the admission, he developed a cytokine storm, also known as secondary haemophagocytic lymphohistocytosis, and multiorgan failure. Despite recovering from his other organ failures, his liver function continued to deteriorate. Magnetic resonance cholangiopancreatography and subsequent endoscopic retrograde cholangiopancreatography revealed extensive intrahe patic duct dilatation with 'beading' but common bile duct sparing. Given the patient had no primary liver disease prior to admission, we considered secondary causes of cholestatic liver injury; this led us to an unusual diagnosis of secondary sclerosing cholangitis in critically ill patients. This case demonstrates a rare disease that has developed specifically in the context of SARS-CoV-2 infection. A review of current literature and the underlying pathophysiology for this rare disease are discussed, particularly in relation to COVID-19. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Salmonella Typhi: a rare cause of parotid abscess

alkiviadis.1961 shared this article with you from Inoreader Salmonella Typhi: a rare cause of parotid abscess Via BMJ Case Reports Last 6 Issues The incidence of extraintestinal infection caused by Salmonella spp has been increased during the past decade. Here we report a case of a parotid abscess caused by Salmonella enterica subspecies enterica serotype Typhi (S. Typhi) in an individual without any significant abnormality of the parotid gland. A 68-year-old man presented to the surgical department with high-grade intermittent fever associated with painful swelling over the right side o f the face, extending into the neck. An ultrasound of the neck revealed an abscess of the right parotid gland. S. Typhi was isolated from the pus drained from the parotid gland. The patient was treated with intravenous followed by oral cephalosporin for a period of 7 days. This case gives an insight into one of the rarer aetiological agents causing parotid abscess. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Incidentally detected primary corneal squamous neoplasia in an elderly man presenting with cataract

alkiviadis.1961 shared this article with you from Inoreader Incidentally detected primary corneal squamous neoplasia in an elderly man presenting with cataract Via BMJ Case Reports Last 6 Issues Primary corneal neoplasia (PCN) is a rare cancerous lesion of cornea usually encountered in elderly. The clinical symptoms are generally non-specific, with ocular irritation, redness, cosmetic disfigurement and varying degrees of visual disturbances depending on visual axis involvement. Corneal neoplasia is usually associated with surrounding conjunctival lesions and incidentally detected PCN is rarely encountered in clinical practice. Presently, we report a case of isolat ed unilateral PCN diagnosed incidentally in an elderly man presenting with cataract. In vivo confocal microscopy aided in its diagnosis after impression cytology was repeatedly negative. Cataract surgery was deferred and the patient was administered three cycles of mitomycin C 0.04% 4 times/day. The tumour margins receded as evident on clinical examination and on anterior segment optical coherence tomography. We discuss the role of various corneal imaging modalities in diagnosis and management of PCN besides highlighting importance of comprehensive slit-lamp examination in patients planned for cataract surgery. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Hyperplastic thyroid nodule masquerading as parathyroid adenoma in a patient with tubercular lymphadenitis induced hypercalcaemia

alkiviadis.1961 shared this article with you from Inoreader Hyperplastic thyroid nodule masquerading as parathyroid adenoma in a patient with tubercular lymphadenitis induced hypercalcaemia Via BMJ Case Reports Last 6 Issues Serum intact parathyroid hormone (iPTH) levels are high or high normal in patients with parathyroid adenoma. Rarely these patients can have normal or low serum iPTH values. With sandwich immunometric assays, an exceptionally high serum iPTH level can lead to falsely low measurement due to the 'hook effect'. Here, we describe the case of a 66-year-old female patient with PTH-independent hypercalcaemia which mimicked parathyroid adenoma. A multidisciplinary team approach helped in the diagnosis and management leading to complete recovery. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Optic nerve compression due to allergic fungal rhinosinusitis

alkiviadis.1961 shared this article with you from Inoreader Optic nerve compression due to allergic fungal rhinosinusitis Via BMJ Case Reports Last 6 Issues View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.

Post phacoemulsification wound infection by Nocardia cyriacigeorgica: a rare acid-fast organism

alkiviadis.1961 shared this article with you from Inoreader Post phacoemulsification wound infection by Nocardia cyriacigeorgica: a rare acid-fast organism Via BMJ Case Reports Last 6 Issues Tunnel infection is one of the most dreaded infections, post phacoemulsification. Most cases reported till now are caused by Gram-positive and Gram-negative bacteria or fungi and very few cases by the acid-fast organisms. Ocular infections by Nocardia usually have poor prognosis. Here, we report a case of tunnel infection, its management and microbiological identification of cause behind it, that is, Nocardia cyriacigeorgica a rare acid-fast microorganism. View on the web Inoreader. Take back control of your news feed. Follow us on Twitter and Facebook.