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The clinical history, histology and cross-sectional imaging is complementary in securing a diagnosis.Follow-up imaging and endoscopic evaluation can be useful in monitoring response to treatment.Subclavian vein access is still one of the most favoured access options for cardiac implantable electronic device (CIED) implantation. For the physician, the technique is reasonably familiar and easy to carry out. However, this has several potential complications. check details In this case, we present a late complication of subclavian access. The patient presented with intermittent loss of pacemaker output, which caused him to experience several syncopal events. In the acute setting, we changed the lead polarity and achieved a good outcome. Further management of this situation consisted of removal and replacement of the damaged lead.
Subclavian vein access is still one of the most favoured access options for cardiac device implantation.Intermittent loss of output can be a sign of pacemaker malfunction due to subclavian crush syndrome.Damaged lead extraction may be difficult to perform.
Subclavian vein access is still one of the most favoured access options for cardiac device implantation.Intermittent loss of output can be a sign of pacemaker malfunction due to subclavian crush syndrome.Damaged lead extraction may be difficult to perform.Testicular adrenal rest tumour (TART) is a known entity in patients with congenital adrenal hyperplasia. An adult patient presenting with testicular enlargement raises a concern for malignancy and this creates a diagnostic dilemma between non-malignant conditions such as TART versus testicular malignancy. We describe a case where the patient underwent orchiectomy due to clinical concern for malignancy but, retrospectively, this outcome could have been prevented by medical treatment. This case emphasises the need to learn from errors. There is a need to increase awareness of the condition among medical professionals to reduce the chances of unnecessary surgical intervention.
To recognize testicular adrenal rest tumour (TART) as cause of testicular enlargement in adult patients with congenital adrenal hyperplasia.To differentiate TART from other types of testicular malignancy.Consider medical treatment with exogenous glucocorticoid and mineralocorticoid replacement to prevent unnecessary surgical intervention.
To recognize testicular adrenal rest tumour (TART) as cause of testicular enlargement in adult patients with congenital adrenal hyperplasia.To differentiate TART from other types of testicular malignancy.Consider medical treatment with exogenous glucocorticoid and mineralocorticoid replacement to prevent unnecessary surgical intervention.Aortoenteric fistula (AEF) is a rare condition with a high mortality rate. AEFs are classified according to their primary and secondary causes, the former being less frequent. Primary AEFs occur in a native aorta and their causes include aneurysms, foreign bodies, tumours, radiotherapy and infection. The classic triad of aortoesophageal fistulas, a subtype of AEFs, are mid-thoracic pain and sentinel haemorrhage, followed by massive bleeding after a symptom-free interval. We present the case of a 41-year-old male patient who presented in the emergency room after successive episodes of abundant haematemesis. He was hypovolemic, hypothermic and acidotic at presentation. His medical history included an emergency room visit the week before with chest pain but no relevant anomalies on work-up, active intravenous drug use and chronic hepatitis. Esophagogastroduodenoscopy (EGD) showed a bulging ulcerated lesion suspicious for aortoesophageal fistula, confirmed by computed tomography (CT) angiography, which revealed amultiple comorbidities, even in the presence of a normal electrocardiogram and chest x-ray.
Aortoesophageal fistula is a rare cause of severe upper gastrointestinal haemorrhage with a high mortality rate.Computed tomography angiography is diagnostic in most cases but a high level of suspicion is essential.Chest pain, a characteristic clinical symptom of aortoesophageal fistula, cannot be disregarded in a patient with multiple comorbidities, even in the presence of a normal electrocardiogram and chest x-ray.Acquired haemophilia (AHA) is a rare autoimmune disorder caused by circulating autoantibodies that inhibit the activity of factor VIII (FVIII). Acquired inhibitors against FVIII are rarely seen, with a reported incidence of approximately 1 case per million/year. Clinical conditions and contexts associated with AHA include autoimmune diseases, lymphoproliferative malignancies, drug treatment, pregnancy and infections. An association with urticarial vasculitis is even more rare. Here, we report a case of a 59-year-old woman presenting with cutaneous and muscle haematomas secondary to AHA in association with urticarial vasculitis, who was successfully treated with factor eight inhibitor bypassing activity (FEIBA) and prednisolone.
Acquired haemophilia (AHA) is a rare autoimmune disease.AHA predisposes to severe, potentially life-threatening haemorrhage.An association with urticarial vasculitis is even more rare.
Acquired haemophilia (AHA) is a rare autoimmune disease.AHA predisposes to severe, potentially life-threatening haemorrhage.An association with urticarial vasculitis is even more rare.
Coccidioidomycosis is an endemic disease in the Americas. No cases have been reported in Africa.
A 23-year-old HIV seronegative Ugandan man was referred to Mulago National Referral Hospital in Kampala, Uganda with a 10-month history of haemoptysis and difficulty breathing, and a 6-month history of localized swellings on the extremities. He had associated weight loss and drenching sweats, but no fevers. He had taken anti-tuberculosis medicine for 2 months with no improvement. He had never travelled out of Uganda. On physical examination, he had cystic swellings and ulcerated lesions on the extremities. He had tachypnoea, crackles in the chest and mild hepatomegaly. Bronchoscopic examination showed two masses occluding the right main bronchus. Bronchoscopic biopsy showed findings consistent with coccidioidomycosis. The patient improved with antifungal treatment and was discharged.
We report the first case of disseminated coccidioidomycosis with pulmonary and cutaneous manifestations in Africa.
Coccidioidomycosis is an endemic disease in the Americas and may now be present in Africa.
