Erosion of nails following thallium poisoning: a case report

This case report describes a patient with thallium poisoning caused by repeated exposure to low doses of thallium. Alopecia and nail changes were the most prominent features of this case. There was dystrophy of nails in the form of whitish lunular stripes. This is the first report of complete erosion of proximal parts of nails following thallium poisoning. This case is the first report of thallium poisoning from India occurring from repeated low dose exposure.     

Severe acute respiratory syndrome--Singapore, 2003

The Singapore Ministry of Health (MOH), with assistance from the World Health Organization (WHO), has been investigating an outbreak of severe acute respiratory syndrome (SARS). This is a novel condition caused by the SARS-associated coronavirus (SARS-CoV) and is characterized by both an atypical pneumonia and efficient nosocomial transmission. This report summarizes epidemiologic features of this outbreak in Singapore, including the influence of super spreaders and the national prevention and control strategy.     

Reiter's syndrome in an adolescent female with systemic sequelae

Reiter's syndrome (RS) generally affects adult white males. It occurs infrequently in adolescents. This condition is characterized by a triad of symptoms: arthritis, urethritis, and ocular abnormalities, and it usually has a benign course. We report an atypical case of RS in a black adolescent female who developed articular and ocular sequelae. Despite aggressive medical therapy, one year after diagnosis her condition has deteriorated and she is confined to a wheelchair. Although RS is believed to be a brief illness predominantly affecting the joints of the lower extremity, this condition may have severe systemic manifestations with chronic sequelae.     

Bacteremia and endocarditis caused by a Gordonia species in a patient with a central venous catheter

We report the first case of endocarditis caused by a Gordonia species genetically related to G. sputi but exhibiting some atypical biochemical features in a 31-year-old woman with a central venous catheter. This unusual pathogen may be a new cause of opportunistic infections in patients with severe underlying diseases.     

Atypical Sweet's syndrome in a neutropenic patient with acute myeloid leukemia, secondary to a RAEB-T, simulating thrombophlebitis

We report a rare case of a patient with acute myeloid leukemia following refractory anemia with excess of blasts transformed (RAEB-T) who presented a clinical picture suggestive of thrombophlebitis. The ultrasonographic procedure and the response to corticosteroid treatment suggest that this condition was compatible with an atypical Sweet's syndrome.     

Bulimia nervosa in an elderly male: a case report

OBJECTIVE: There is increasing knowledge regarding demographics, comorbid psychiatric disorders, and symptoms characteristic of males suffering from eating disorders. METHOD: The current case report describes the history, symptom progression, and successful treatment of an elderly bulimic male whose presentation was atypical. RESULTS: This case underscores the need to consider the presence of an eating disorder regardless of age and gender, when a patient complains of unexplained nausea, abdominal pain, or vomiting.     

Intracranial hemorrhage in the setting of posterior reversible encephalopathy syndrome: two case reports and a review

Posterior reversible encephalopathy syndrome (PRES) is clinically characterized by seizures, changes in vision, altered mental status, and headache, with associated radiologic changes on brain imaging. Intraparenchymal hemorrhage is a rare complication of PRES and an atypical initial presentation of this condition. In this report, we discuss two patients who presented with multifocal cerebral hemorrhages that were later attributed to PRES. We further expand on the pathophysiology, management, and prognosis on patients with hemorrhagic PRES. Increased awareness of this complication of PRES is important in guiding prognostication and treatment.     

Fatal case of unsuspected pertussis diagnosed from a blood culture--Minnesota, 2003

Pertussis (i.e., whooping cough) is a prolonged cough illness caused by the bacteria Bordetella pertussis and associated typically with an inspiratory "whoop," paroxysmal cough, and posttussive vomiting. B. pertussis can cause severe illness or death, especially in infants who have not completed their pertussis vaccination series. Adolescents (i.e., persons aged 13-17 years), adults, and recently vaccinated persons often report atypical symptoms, resulting in delay of recognition and creation of infectious reservoirs for further transmission. In 2003, the Minnesota Department of Health (MDH) investigated a fatal case of unsuspected B. pertussis infection in an elderly adult. This report summarizes the case investigation, which documents the rare isolation of B. pertussis from blood and underscores the need for clinicians to consider pertussis infection in adolescents and adults who have a prolonged cough illness.     

Suspected brucellosis case prompts investigation of possible bioterrorism-related activity--New Hampshire and Massachusetts, 1999

Brucella species, particularly B. melitensis and B. suis, are potential agents of biological terrorism (1,2). This report describes the public health and law enforcement assessment of a suspected case of brucellosis in a woman, in which the atypical clinical presentation and suspicious circumstances surrounding the case raised the possibility of biological terrorism. Although the investigation did not identify evidence of biological terrorism, the safe resolution of the case illustrates the value of integrated clinical, public health, and law enforcement biological terrorism preparedness and response.     

Hypertrophic cardiomyopathy with shared morphology in identical twins: a case report

We report the case of identical twin sisters, both with hypertrophic cardiomyopathy, and both found to have similar echocardiographic appearances in the form of asymmetric septal hypertrophy. This is unusual, in that published reports commonly describe the heterogeneous expression of this condition in twins.     

Diabetes mellitus associated with atypical antipsychotic medications: new case report and review of the literature.

BACKGROUND: Since the introduction of atypical antipsychotic medications, beginning with clozapine in 1990, several case reports in the psychiatric literature have suggested that they might be associated with new onset of diabetes mellitus as well as with diabetic ketoacidosis. METHODS: We report the case of a 38-year-old patient with schizophrenia who suddenly developed diabetes mellitus and ketoacidosis 12 months after starting olanzapine. Similar cases in the literature were found through a MEDLINE-assisted search using the key words "schizophrenia," "diabetes mellitus," "ketoacidosis," and "adverse drug reaction." RESULTS: Including this case, 30 patients have been reported in the literature to have developed diabetes or have lost diabetic control after starting clozapine, olanzapine, or quetiapine. Twelve of these 30 developed diabetic ketoacidosis. Two limited quantitative studies have added evidence toward this association. CONCLUSION: Although a causal relation has not been definitively proved, the number of cases reported in the literature suggests there might be an association between atypical antipsychotic medications and diabetes mellitus. Primary care physicians who care for patients with schizophrenia should be aware of this possible association.     

合并维生素D缺乏儿童原发性甲状旁腺功能亢进症一例循证病例报告

儿童原发性甲状旁腺功能亢进症为罕见疾病,合并维生素D缺乏时更增加了诊治难度。本文结合国内外相关文献检索和复习,总结基于循证的临床特点,报告1例以维生素D缺乏性佝偻病表现就诊的原发性甲状旁腺功能亢进症男童,发现儿童甲状旁腺功能亢进症症状比成人严重,血钙水平更高,甲状旁腺激素偏低,病理与成人相似,以单个腺瘤最多,手术治愈率高。合并骨软化时可使血钙降至正常范围,但临床表现骨骼病变更严重。     

Aleukemic leukemia cutis preceding acute monocytic leukemia: a case report

Aleukemic leukemia cutis is an extremely rare clinical presentation in patients who eventually develop acute leukemia, usually of monocytic lineage. This condition is associated with a very poor prognosis and is often difficult to diagnose. We report a case of a 33 years old female with leukemia cutis preceding the onset of acute monocytic leukemia by four months. The patient received induction and consolidation chemotherapy followed by allogeneic bone marrow transplant and has been free of disease for six years. To our knowledge, this is the first documented case in Puerto Rico with the diagnosis of leukemia cutis preceding acute monocytic leukemia.     

肝移植术后并发急性侵袭性真菌性鼻窦炎1例

肝移植术后真菌感染在临床比较常见,但急性侵袭性真菌性鼻窦炎在肝移植术后患者中极为少见,在耳鼻喉科也较为少见,该类患者病情凶险,预后极差。本文通过总结分析我院收治的1例肝移植术后并发急性侵袭性真菌性鼻窦炎患者的病史、临床表现、影像学特征及治疗经验,探讨肝移植术后急性侵袭性真菌性鼻窦炎的临床特点、诊断标准、治疗原则。     

肺部中、高分化腺癌1例

肺部中高分化腺癌非常多见,典型病例诊断也不难。但该例患者早期很不典型。通过此病例,让我们对早期不典型中高分化腺癌有进一步认识,也提醒我们,对年龄较大的患者,肺部有大片炎症时,治疗后及时的随访非常必要。     

多西环素治疗急性Q热失败1例

Q热是由伯氏考克斯氏体引起的一种世界范围内高致病性的人畜共患疾病。Q热临床表现不典型,常规实验室及影像学检查缺乏特异性,多数患者症状轻微且可自愈。Q热不是我国法定传染病,国内缺乏相关的诊治指南,是一种长期以来被忽视和诊断不足的疾病。本文报告1例病例,通过血液宏基因组二代测序(mNGS)诊断为急性Q热,经14 d多西环素治疗发热不退,后经米诺环素治疗3 d病情好转,旨在提高临床医生对急性Q热的认识,缩短疾病诊治时间。     

Probable Crohn's colitis mimicking ischaemic colitis in a young adult

The features on barium enema of ischaemic colitis is characteristic and the radiological sign of "thumb printing" thought to be almost pathognomonic of the condition. We report a case of inflammatory bowel disease, probably Crohn's disease mimicking these radiological features. This has not to our knowledge been previously documented.     

Spontaneous rupture of the oesophagus: case report of a delayed diagnosis and subsequent management.

Spontaneous rupture of the oesophagus is a rare but potentially fatal condition. Initially described by Boerhaave in 1724, this condition remained a pathological curiosity until a subsequent case was reported by Barrett in 1946. The diagnosis is often difficult and, thus, the appropriate management is delayed. An oesophageal disruption may occur within the mediastinum or between the mediastinum and the visceral lung pleura, resulting in an oesophago-pleural fistula. We report a case of a spontaneously occurring oesophageal disruption which was successfully managed with minimum surgical intervention.     

A case of spontaneous hypothermia.

It is important to recognise any condition, however rare, which can be cured. We report a case of chronic hypothermia and its dramatic response to treatment.