An unusual cause for rings in the brain

ABSTRACT

Hong Kong Med J 2012;18:346–7 | Number 4, August 2012
CASE REPORT
An unusual cause for rings in the brain
Anulekha M John, Natarajan Vasanthi, Abhishek Khurana, Geeta Chacko, Promila Mohanraj, Vedantam Rajshekhar, Nihal Thomas
Department of Endocrinology, Diabetes and Metabolism, Christian Medical College, Vellore, India
 
 
We report the case of a 35-year-old man from North India who presented with generalised tonic-clonic seizures and was found to have ring-enhancing brain lesions. He had a coincident adrenal mass lesion. Cultures from both regions grew Histoplasma capsulatum. He improved on treatment with itraconazole. This case is being reported since cerebral ring-enhancing lesions are rarely associated with histoplasmosis, and coincident adrenal involvement is also a rarity in an immunocompetent individual.
 
Key word: Histoplasmosis
 
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A rare neurological complication due to lithium poisoning

ABSTRACT

Hong Kong Med J 2012;18:343–5 | Number 4, August 2012
CASE REPORT
A rare neurological complication due to lithium poisoning
CH Chan, Anne KH Leung, YF Cheung, Phillip YC Chan, KW Au Yeung, KY Lai
B6, Intensive Care Unit, Queen Elizabeth Hospital, Jordan, Hong Kong
 
 
Lithium salts have been used in treatment of depression and bipolar disorder for more than 50 years. Neurotoxic side-effects such as nystagmus, ataxia, tremor, fasciculation, clonus, seizure and even coma have been well described in the literature. We present a case of generalised peripheral neuropathy following lithium intoxication. It is a rare presentation with delayed onset and characterised by a rapid downhill course. Diagnosis was confirmed by nerve conduction tests, which showed axonal neuropathy. Despite the profound neurological effects of this toxicity, it is readily reversible with supportive care and the prognosis is good.
 
Key words: Bipolar disorder; Giant axonal neuropathy; Lithium compounds; Lithium/poisoning; Peripheral nervous system diseases
 
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Peanut aspiration: an avoidable life-threatening condition

ABSTRACT

Hong Kong Med J 2012;18:340–2 | Number 4, August 2012
CASE REPORT
Peanut aspiration: an avoidable life-threatening condition
Patrick HY Chung, Kenneth KY Wong, Lawrence CL Lan, Paul KH Tam
Division of Paediatric Surgery, Department of Surgery, The University of Hong Kong, Pokfulam, Hong Kong
 
 
Foreign body aspiration is a potentially fatal condition. Yet, an accurate diagnosis may not be easy. Management is also challenging and requires a high level of expertise with proper instruments. In this article, we report our experience in the management of peanut aspiration in two young children by means of a ventilating bronchoscope.
 
Key words: Airway obstruction; Bronchoscopy; Child; Foreign bodies; Respiratory aspiration
 
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Hysterectomy for recurrent postmenopausal bleeding revisited: missed sclerosing stromal ovarian tumour

ABSTRACT

Hong Kong Med J 2012;18:338–9 | Number 4, August 2012
CASE REPORT
Hysterectomy for recurrent postmenopausal bleeding revisited: missed sclerosing stromal ovarian tumour
Jacqueline PW Chung, Eva CW Cheung, SF Yim, SM Mak
Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
 
 
Sclerosing stromal tumour of the ovary is rare. Patients present with menstrual irregularities, pelvic pain, abdominal distension, and presence of a large pelvic mass during their twenties or thirties. We report a rare case of an ovarian sclerosing stromal tumour with an atypical presentation, in that it gave rise to recurrent postmenopausal bleeding.
 
Key words: Ovarian neoplasms; Sclerosis
 
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Primary spinal cord desmoplastic astrocytoma in an adolescent: a rare tumour at rare site and rare age

ABSTRACT

Hong Kong Med J 2012;18:253–5 | Number 3, June 2012
CASE REPORT
Primary spinal cord desmoplastic astrocytoma in an adolescent: a rare tumour at rare site and rare age
Darshana D Rasalkar, Bhawan K Paunipagar, Alex Ng
Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
 
 
We report a case of a non-infantile primary intramedullary spinal cord desmoplastic astrocytoma in an 18-year-old girl who presented with spastic paraparesis. The patient had been unable to run for 1 year. Magnetic resonance imaging of her spine showed an intramedullary solid and cystic heterogeneously enhancing lesion located at T7-T8 level. Partial excision was performed. Histology revealed a desmoplastic astrocytoma. To the best of our knowledge, there is no report on primary desmoplastic astrocytoma of the spinal cord in literature. Nor has such a symptomatic tumour manifesting at the age of 18 years been documented.
 
Key words: Adolescent; Astrocytoma; Spinal cord
 
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A sarcoma of 23 years' duration: symptom duration is not a reliable parameter to exclude malignancy

ABSTRACT

Hong Kong Med J 2012;18:250–2 | Number 3, June 2012
CASE REPORT
A sarcoma of 23 years' duration: symptom duration is not a reliable parameter to exclude malignancy
YL Lam, WY Ho, TP Ng, Amanda Kan, Tony WH Shek
Department of Orthopaedics and Traumatology, Queen Mary Hospital, Pokfulam, Hong Kong
 
 
This report describes a 31-year-old woman with a 23-year history of a right buttock mass that was otherwise asymptomatic, but was proven to be a low-grade fibromyxoid sarcoma (a fully malignant soft tissue tumour with a potential for distant metastasis). This case illustrates that a long-standing tumour does not necessarily imply a benign pathology. A vigilant approach should be taken for any tumours that are of significant size (larger than 5 cm).
 
Key words: Fibrosarcoma; Sarcoma; Soft tissue neoplasms
 
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Rhabdomyolysis associated with Mycoplasma pneumoniae pneumonia

ABSTRACT

Hong Kong Med J 2012;18:247–9 | Number 3, June 2012
CASE REPORT
Rhabdomyolysis associated with Mycoplasma pneumoniae pneumonia
Fahmi Y Khan, Hassan Sayed
Department of Medicine, Hamad General Hospital, Doha, Qatar
 
 
We report a case of rhabdomyolysis associated with Mycoplasma pneumoniae pneumonia in a 37-year-old Sri Lankan man who presented to the emergency department with complaints of feverishness, shortness of breath, cough, and generalised muscle pain. He had a serum creatinine kinase of 14 220 U/L, serum myoglobin of 1822 ng/mL, and serum creatinine of 195 µmol/L. His chest X-ray revealed bibasilar interstitial infiltrates. The antimycoplasma antibody titre was high. The patient was successfully treated with aggressive intravenous fluid replacement and azithromycin. The outcome was rapidly favourable, allowing us to discharge the patient 12 days after admission. On discharge, the serum creatinine kinase was 924 U/L and the creatinine was 126 µmol/L; the chest examination was unremarkable.
 
Key words: Mycoplasma pneumoniae; Pneumonia, mycoplasma; Rhabdom
 
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A pale Chinese boy with recurrent painful digital swelling

ABSTRACT

Hong Kong Med J 2012;18:163-5 | Number 2, April 2012
CASE REPORT
A pale Chinese boy with recurrent painful digital swelling
Frankie WT Cheng, WK Leung, Vincent Lee, Margaret HL Ng, Winnie CW Chu, KF Huen, MK Shing, CK Li
Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong
 
 
Thalassaemia is the most common haemoglobinopathy in the Chinese population. However, recurrent painful digital swelling is not a typical manifestation of this well-known hereditary condition. We describe a case of co-inheritance of beta-thalassaemia and sickle cell trait in a Chinese family and a child who suffered from sickle cell/beta-thalassaemia with recurrent dactylitis. This report highlights awareness of this rare condition in the Chinese population, since acute manifestations can be life-threatening and mimic other emergency conditions. Prompt management can prevent further complications and avoid unnecessary interventions due to delay in diagnosis. A detailed family history and examination of the patient's peripheral blood smear is crucial to reach a correct diagnosis.
 
Key words: Anemia, sickle cell; beta-Thalassemia
 
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Acute torsion of a wandering spleen

ABSTRACT

Hong Kong Med J 2012;18:160-2 | Number 2, April 2012
CASE REPORT
Acute torsion of a wandering spleen
Y Lam, Kenny KY Yuen, LC Chong
Department of Surgery, United Christian Hospital, Kwun Tong, Hong Kong
 
 
The 'wandering spleen' is a rare condition due to extreme laxity or absence of ligaments that fix the organ in its normal anatomical position within the left upper quadrant. Without early surgical intervention, wandering spleen can lead to torsion and subsequent splenic infarction or rupture. Clinical suspicion plus urgent investigation and intervention are important, so as to salvage the spleen and prevent complications. We present a case of torsion of a wandering spleen in a 21-year-old young woman, who presented with a painful pelvic mass. We also reviewed the literature on this entity.
 
Key words: Pelvis; Spleen; Splenic diseases; Tomography, X-ray computed; Torsion; Wandering spleen
 
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Intrapleural injection of OK-432 as the primary in-utero treatment for fetal chylothorax

ABSTRACT

Hong Kong Med J 2012;18:156-9 | Number 2, April 2012
CASE REPORT
Intrapleural injection of OK-432 as the primary in-utero treatment for fetal chylothorax
Viola KT Leung, Stephen SH Suen, YH Ting, LW Law, TK Lau, TY Leung
Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
 
 
Chylothorax is a rare congenital condition associated with significant perinatal mortality and morbidity. Previous treatments with repeated thoracocentesis or thoracoamniotic shunting were technically demanding, and associated with significant procedure-related complications and neonatal complications. Here we report the first successful case in Hong Kong treated by a simple and effective intervention, namely pleurodesis with OK-432, in a fetus presenting at 20 weeks of gestation with bilateral pleural effusion.
 
Key words: Chylothorax; Picibanil; Pleural effusion
 
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