SARS-CoV-2-related Myelin Oligodendrocyte Glycoprotein Antibody-associated Disease: A Case Report and Literature Review

We herein report a case of myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. A 24-year-old woman developed unilateral optic neuritis 3 weeks after contracting coronavirus disease 2019 (COVID-19), followed by intracranial demyelinating lesions and myelitis. Since serum anti-MOG antibody was positive, we diagnosed MOG antibody-associated disease. Immunotherapy with steroids resulted in the rapid improvement of neurological symptoms. This is a suggestive case, as there are no reports of MOG antibody-associated disease with multiple neurological lesions occurring after COVID-19. The response to immunotherapy was favorable. This case suggests that it is important to measure anti-MOG antibodies in patients who develop inflammatory neurological disease after COVID-19.     

Case Report: Adult Nesidioblastosis A Case Report and Review of the Literature

George F. Laidlaw first described a pancreatic abnormality now known to be the most common cause of persistent hyperinsulinemic hypoglycemia in infants in 1938 (1, 2). The term he coined, nesidioblastosis, is derived from the Greek words for islets (nesidia) and germ (blastos) (3). It accurately describes the characteristic feature of nesidioblastosis, islet cells differentiating and budding from ductal epithelium. In adults, hyperinsulinemic hypoglycemia is rarely caused by nesidioblastosis and is usually caused by insulinoma or exogenous insulin treatment (4, 5). The first case series of adult nesidioblastosis was reported by Harness et al in 1981 (6). Since this case series of six patients, there have been only sporadic literature reports of adult nesidioblastosis, documenting fewer than 20 cases of adult nesidioblastosis over the past 15 years (3, 7-10). This paper presents an adult patient with hyperinsulinemic hypoglycemia due to nesidioblastosis and provides a guide to the diagnosis and treatment of this rare disorder in the adult population.     

Pituitary Lymphoma: A Case Report and Literature Review

We report the case of a B-cell type pituitary lymphoma in a 65 year-old male immunocompetent patient who presented with hypogonadotropic hypogonadism and central hypothyroidism and subsequently developed pulmonary lymphoma. Only three cases of pituitary lymphoma have been previously reported, one in a patient with acquired immunodeficiency syndrome, one case of T-cell lymphoma reported in the Japanese literature, and one case of B-cell lymphoma. The previously reported immunocompetent patients presented with signs and symptoms of optic chiasm compression as contrasted to our patients endocrinologic presentation. B-cell lymphoma of the pituitary gland is a exceedingly rare though distinct clinical entity.     

Rhabdomyolysis after COVID-19 Infection: A Case Report and Review of the Literature

Rhabdomyolysis is a condition in which muscle breaks down potentially leading to renal dysfunction, and often occurs secondary to a precipitating factor. Viral or bacterial infections are common precipitants for initiating rhabdomyolysis. Recently, healthcare systems across the world have been challenged by a pandemic of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causing ‘coronavirus disease 2019’ (COVID-19) disease. SARS-CoV-2 infection is recognized to cause respiratory and cardiovascular compromise, thromboembolic events, and acute kidney injury (AKI); however, it is not known whether it can precipitate rhabdomyolysis, with only a limited number of cases of SARS-CoV-2 infection preceding rhabdomyolysis reported to date. Here, we report the case of a 64-year-old woman who developed rhabdomyolysis shortly after SARS-CoV-2 infection and COVID-19. She initially presented with muscular pain, a creatine kinase level of 119,301 IU/L, and a mild rise in her creatinine level to 92 µmol/L, but successfully recovered with intravenous fluid support. We also review the literature to summarise previously reported cases of rhabdomyolysis precipitated by SARS-CoV-2, highlighting the need to consider this diagnosis in patients presenting with SARS-CoV-2 and myalgia.     

Intraepithelial Giardia Intestinalis: A Case Report and Literature Review

The giardiasis is a neglected parasitic disease. The WHO has estimated more than 280 million of human infections each year; however, intraepithelial giardiasis is a rare entity, there are only 5 reports showing invasive giardiasis.A pediatric female patient with chronic abdominal pain, diarrhea, or pasty stools, without fever, was seen in the Gastroenterology and Nutrition Service. The stool studies were negative for pathogens and lactose hydrogen breath test was positive. The presumptive clinical diagnosis was giardiasis and the patient was empirically treated with nitazoxanide. But, the patient persisted with abdominal pain and pasty stools.Endoscopy was indicated to search for Helicobacter and Giardia. Guardian and patient gave written informed consent. Hematological profile was normal. The endoscopy was performed under general anesthesia and the biopsies and duodenal aspirate were obtained. The microscopic analyses of duodenal fluid showed Giardia trophozoites. Electron microscopic analysis was negative for Helicobacter pylori, but Giardia trophozoites with a typical crescent shape within the tissue were found.The patient was treated with tinidazole, subsequent tests showed that lactose absorption was normal, stool examinations were negative for Giardia and abdominal pain had stopped.This case suggest that intraepithelial giardiasis could be a common entity but unseen because the giardiasis diagnosis is usually made on fecal samples. Future studies are necessary to determine the role of intraepithelial trophozoites in giardiasis pathogenic mechanisms     

Case Report: Aortoesophageal Fistula Case Report and Review of the Literature

Dubrueil (1) described the first case ofaortoesophageal fistula in 1818. Chiari (2) in 1914described the syndrome of aortoesophageal fistula as atriad of: midthoracic pain or dysphagia followed by a herald hemorrhage and fatalhematemesis. Carter et al (3), in an autopsy review of24 cases of aortoesophageal fistula, found that 80% hada sentinal hemorrhage prior to fatal exsanguination. Wereport a case of an aortoesophageal fistula due to asaccular aneurysm of the descending aorta and review thecauses, clinical manifestations, diagnostic modalities,and treatment options of this uncommon but often fatal cause of upper gastrointestinalhemorrhage.     

Coronary Stent Infections: A Case Report and Literature Review

Although rare, coronary artery stent infections are associated with a high mortality rate. Since the introduction of coronary stents in 1987, only 16 cases of infection have been reported. We report a new case in a 66-year-old woman who had undergone a difficult percutaneous coronary intervention procedure, during which 3 overlapping stents were implanted in the mid portion of the right coronary artery. Twenty-two days after the procedure, the patient died. Autopsy revealed the cause of death to be pericardial tamponade due to rupture of the right ventricular myocardium. The stented portion of the right coronary artery was enveloped by an abscess, and purulent material completely occluded the stents. Cultures of the myocardium were positive for methicillin-resistant Staphylococcus aureus. We conducted a review of the literature on coronary artery stent infections. Data suggest that early-onset infections (<10 days after stent implantation) are potentially amenable to medical therapy alone, but late-onset infections (≥10 days after implantation) or major complications necessitate combined surgical and medical therapy. Medical therapy consists of broad-spectrum antibiotics. Surgical intervention includes stent removal if possible, and abscess drainage or perforation repair when indicated.Key words: Blood vessel prosthesis implantation/adverse effects, coronary stent infections, prosthesis-related infections/complications/diagnosis/therapy, stents/adverse effects, Staphylococcus aureusCoronary artery stents have been in use for more than 2 decades. Stent infections are rare, hard to treat, and potentially devastating. Our treatment of a patient with a coronary stent abscess prompted us to review the literature. From our experience and the evaluation of previously reported cases,^1–14 we propose an approach for diagnosing and treating these infections.     

Primary Gastric Tuberculosis: A Case Report and Literature Review

Gastric tuberculosis is a rare entity; it usually occurs secondary to another lesion(s), mainly in the lungs. Only a few cases of primary gastric tuberculosis have been reported in the literature. Most commonly, gastric tuberculosis lesion(s) is located in the lesser curvature of the antrum and prepylorus, so the clinical picture is similar to that of peptic ulcer, in addition to the constitutional symptoms seen in tuberculosis in general. We report a case of a young man presented with abdominal pain acute gastric outlet obstruction due to a large mass in the lesser curvature of the antrum and the pylorus. The histological examination revealed caseating granuloma with the presence of acid-fast bacilli. Partial gastrectomy with Bilroth II reconstruction was performed and the patient was put on antituberculosis medications. There was no evidence of the tuberculous lesion anywhere else. Patient's follow-up observation in the clinic was uneventful.     

Cervical Intradural Disc Herniation Causing Progressive Quadriparesis After Spinal Manipulation Therapy: A Case Report and Literature Review

Cervical intradural disc herniation (IDH) is an extremely rare condition, comprising only 0.27% of all disc herniations. Three percent of IDHs occur in the cervical, 5% in the thoracic, and over 92% in the lumbar spinal canal. There have been a total of 31 cervical IDHs reported in the literature. The pathogenesis and imaging characteristics of IDH are not fully understood. A preoperative diagnosis is key to facilitating prompt intradural exploration in patients with ambivalent findings, as well as in preventing reoperation. The purpose of reporting our case is to remind clinicians to consider the possibility of cervical IDH during spinal manipulation therapy in patient with chronic neck pain.The patient signed informed consent for publication of this case report and any accompanying image. The ethical approval of this study was waived by the ethics committee of Chonbuk National University Hospital, because this study was case report and the number of patients was <3.A 32-year-old man was transferred our emergency department with progressive quadriparesis. He had no history of trauma, but had received physical therapy with spinal manipulation for chronic neck pain over the course of a month. The day prior, he had noticed neck pain and tingling in the bilateral upper and lower extremities during the manipulation procedure. The following day, he presented with bilateral weakness of all 4 extremities, which rendered him unable to walk. Neurological examination demonstrated a positive Hoffmann sign and ankle clonus bilaterally, hypoesthesia below the C5 dermatome, 3/5 strength in the bilateral upper extremities, and 2/5 strength in the lower extremities. This motor weakness was progressive, and he further complained of voiding difficulty.Urgent magnetic resonance imaging (MRI) of the cervical spine revealed large, central disc herniations at C4–C5 and C5–C6 that caused severe spinal cord compression and surrounding edema. We performed C4–C5–C6 anterior cervical discectomy and fusion.The patient''s limb weakness improved rapidly within 1 day postoperatively, and he was discharged 4 weeks later. At his 12-month follow-up, the patient had recovered nearly full muscle power.We presented an extremely rare case of cervical IDH causing progressive quadriparesis after excessive spinal manipulation therapy. The presence of a “halo” and “Y-sign” were useful MRI markers for cervical IDH in this case.     

Emphysematous Pyelonephritis: A Case Report and Review of the Literature

Emphysematous pyelonephritis is a rare and life-threatening suppurative infection of renal parenchymal and perirenal tissues, characterized by spontaneous gas production. Although uncommon (76 cases in the literature), it occurs almost exclusively in diabetic patients (87 % of the cases). We describe a recent case of a diabetic woman with emphysematous pyelonephritis due to E. coli, successfully managed with unilateral nephrectomy. Symptoms, diagnostic approach and management are discussed and related to the previously reported series.     

Neuroleptic-Induced Dysphagia: Case Report and Literature Review

Neuroleptic medication may cause extrapyramidal symptoms (EPS) that can affect swallowing as well. This report describes a case of drug-induced dysphagia in a 53-year-old man receiving haloperidol for treatment of schizophrenia. The diagnosis was established by fiberoptic endoscopic evaluation of swallowing. After changing medication to fluphenazin, dysphagic symptoms resolved. The literature on EPS-related dysphagia, its demographic features, typical symptoms, diagnostic modalities, clinical course, and treatment options is reviewed. Rainer Dziewas and Tobias Warnecke contributed equally to this work.     

Endobronchial Lipoma: Case Report and Literature Review

Endobronchial lipomas are rare benign tumors that can cause bronchial obstruction resulting in significant symptoms and post-obstructive parenchymal damage. Accurate diagnosis and treatment are essential to avoid unnecessary morbidity and mortality in these patients. We describe one case of endobronchial lipoma at our institution and include a literature review of endobronchial lipoma cases reported during the time period 2003–2018. Treatment has shifted towards bronchoscopic management and away from surgery for the majority of patients; 64.3% of patients in this review had their lipoma resected bronchoscopically, compared to 30% or less in reviews as recent as 2003. Notably, in cases reported since 2010, 72.7% of cases were managed bronchoscopically. Recurrence rates are low following both bronchoscopic and surgical resection.     

Granulomatous Gastritis: A Case Report and Review of the Literature

A 69-yr-old white female presented to her physician with a 3-yr history of epigastric pain. Gastric biopsies revealed noncaseating granulomas in the mucosa and submucosa. No definite etiological factor could be detected. A diagnosis of idiopathic granulomatous gastritis was made. In the past, this condition has prompted surgery. Steroids have also been advocated. Our patient was managed successfully with symptomatic treatment, without the use of steroids or surgical intervention. She remains well 4 yr later.     

Syphilitic Hepatitis: A Case Report and Review of the Literature

Although recognized for more than 400 yr hepatic complications of syphilis are uncommon and frequently overlooked as explanations for acute liver dysfunction. We describe a case of acute hepatitis during the course of relapsing secondary syphilis, with additional confirmation of the diagnosis by lymph node biopsy demonstrating Treponema pallidum.