Severe hypercalcemia complicated by acute pancreatitis revealing generalized bone lysis metastasis: Case report and review

Malignant hypercalcemia is a frequent metabolic complication of osteophilic tumors, exceptionally revealing cavitary cancer, but its prognosis remains poor despite early and adequate management. We report the case of a young patient, smoker without any previous history, admitted for the management of a digestive symptoms made of abdominal pain with food vomiting. The patient had an electrocardiogram withchest computed tomography scan and BBC evoking PA on malignant hypercalcemia. An etiological investigation was conducted to confirm the tumoral origin of the hypercalcemia. We put the patient on hyperhydration with corticotherapie and biohosphonates with a good clinical and biological improvement. Malignant hypercalcemia affects about 10%-20% of patients with cancer including nasopharyngeal carcinoma. Its clinical presentation varies according to the extent and speed of onset, responsible for multivisceral involvement including kidney, heart, neuropsychiatric system, which may engage the patient''s vital prognosis. The therapeutic management is based on 4 main principles; hyperhydration, increase of urinary calcium excretion by loop diuretics, decrease of bone resorption by biphosphonates and extrarenal purification which remains the ideal choice in case of life-threatening severe hypercalcemia. Acute hypercalcemic pancreatitis as a mode of revelation of cavum cancer has almost never been described in the literature     

Cardiac hydatid cyst: 2 case reports

Hydatidosis is a parasitic disease that is still prevalent in regions that rear farm animals, notably along the Mediterranean coast. The liver and lungs are most commonly involved. Cardiac hydatidosis has been reported infrequently even in countries in which hydatid disease is endemic. This entity must be known because when undiagnosed and untreated, the risk of fatal complications increases. We report 2 cases of cardiac echinococcal cysts in young men. The first case is an incidentaloma in a patient admitted for pancreatitis. The second case is about a patient admitted for dyspnea. CT scan and MRI were performed showing intraventrucular cystic mass with a calcified wall which was very suggestive of a hydatid cyst diagnosis. We would like to emphasize the relevance of imaging in this context and shade some light on imaging diagnostic tools.     

Retroperitoneal desmoid tumor in a patient with familial adenomatous polyposis: A case report

Desmoid tumors are benign fibroblastic neoplasms, with locally invasive features and a tendency of recurrence. They are considered an aggressive non-metastatic fibromatosis. The retroperitoneal location is extremely rare. Their exact mechanism of occurrence is still controversial, but could be related to a genetic predisposition, hormonal factors or traumatic factors, including surgery. This entity faces management difficulties due to its rarity, the variable circumstances of its discovery, and the non-specific clinical manifestations. Their sensitivity to chemotherapy and radiotherapy is limited and surgery remains the only curative treatment in symptomatic cases, however observational waiting could consist the most appropriate management in selected asymptomatic patients, moreover it could avoid unnecessary morbidity from surgery or radiotherapy, which makes the management of this condition a multidisciplinary decision and should be adapted to fit the patients individually. We report a case of a retroperitoneal desmoid tumor in a 31-year-old woman with a history of familial adenomatous polyposis, through which we will discuss this extremely rare neoplastic entity.     

Primary hyperparathyroidism presenting as a brown tumor in the mandible: A case report

A brown tumor is a non-neoplastic lesion resulting from an abnormality of bone metabolism in the context of hyperparathyroidism.We report the case of a 51-year-old woman who initially consulted for edentulism and a growing mandibular mass. She benefited from a radiological and biological assessment which made the diagnosis of primary hyperparathyroidism combined with a parathyroid adenoma.We remind through this observation the difficulty to establish a correct diagnosis in patients with an osteolytic process of the maxilla and the necessity to look for hyperparathyroidism in front of a giant cell lesion given the insidious character of this endocrinopathy.     

Concomitant acute myopericarditis and multiple systemic arteriovenous thrombosis as a rare manifestation of post-COVID-19 syndrome

Initially recognized as a respiratory system disease, COVID-19 has been found to be more of a systemic illness with multiorgan involvement. Recently, there are increasing reports of persistent and prolonged effects after acute COVID-19 infection, mainly on the cardiovascular system. Here, we report the case of a young man with myopericarditis and multiple systemic arteriovenous thrombosis developing several weeks after flu-like symptoms, with antigens indicating a past COVID-19 infection. This case highlights the multisystemic involvement of SARS-CoV-2, raising the possibility of concomitant myopericarditis and multiple systemic thrombosis after a COVID-19 non-severe infection. To our knowledge, there are no previous reports of such a case.     

Reversible splenial lesion syndrome (RESLES): Two patients as study cases

Reversible splenial injury syndrome (RESLES) is a rare clinicoradiological entity that defines a reversible lesion in the splenium of the callosum in magnetic resonance imaging.RESLES may be of infectious iatrogenic or metabolic origin. We report 2 cases of drug induced RESLES in our training.The presence of an isolated lesion of the corpus callosum in a context of polymedication by psychotropic drugs and the regression in less than 4 weeks suggests a toxic origin, in particular medicinal.The pathophysiology of these reversibles lesions of the splenium of callosum is not very clear, most often it is a phenomenon of vasogenic edema that is evoked, the clinical symptoms are very varied and nonspecific, and the prognosis is generally good in the absence of underlying disorder.     

Primary leiomyosarcoma of the sigmoid colon: Case report and review of literature

Leiomyosarcomas of the sigmoid colon are aggressive and extremely rare tumors representing less than 0.1% of all colorectal malignancies. Few cases have been reported in the literature and their imaging features need to be more detailed. We report the case of a 70 year old male patient, smoker, with a history of arterial hypertension, admitted for abdominal pain and hypogastric mass. Computed tomography has shown a voluminous heterogeneously enhancing tumor process with a necrotic center, attached to the sigmoid wall, with multiple secondary peritoneal and hepatic masses. The anatomopathological examination of the biopsy sample with immunohistochemistry allowed the diagnosis of leiomyosarcoma of the sigmoid colon. Clinical presentation and radiological features of leiomyosarcomas are non-specific, and the definitive diagnosis is only established after an anatomopathological examination.     

Brainstem stroke: A fatal thromboembolic event after new onset atrial fibrillation during covid-19 infection: A case report and literature review

Coronavirus disease (COVID-19) disease is a serious pandemic that put the world on an exceptional sanitary alert. It is a multifaceted disease, since it can affect the lung, the cardiovascular system and the central nervous system at the same time. A 66-year-old man, diabetic, hypertensive, admitted to the emergency room for medical management of acute dyspnea, diagnosed with COVID-19 infection. The evolution is marked by respiratory distress as well as new onset atrial fibrillation and a severe ischemic stroke of the brainstem. COVID-19 disease is associated with very serious thromboembolic complications of high incidence, and this is explained by the coagulopathy secondary to the alteration of the microcirculation after the hyper-inflammatory state. Ischemic stroke is one of these complications. The occurrence of new onset atrial fibrillation during COVID-19 infection makes the incidence of ischemic stroke very high and the prognosis more severe. The treatment is mainly based on antithrombotic therapy. Thromboembolic complications remain a real problem to manage in COVID-19 patients given the several mechanisms that promote this situation.