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Diagnosis of oesophageal mucormycosis managed with medical therapy alone.

Matthew Ringer, Lauren Pischel, Marwan Mikheal Azar,

Mucormycosis is an invasive mould that can cause aggressive infection, particularly in immunocompromised patients. Though oesophageal mucormycosis is relatively rare, it remains an elusive and devastating manifestation of this disease. The management is also challenging, due to surgical morbidity and contraindications such as thrombocytopenia in immunocompromised hosts. In this report, ... Read more >>

BMJ Case Rep (BMJ case reports)
[2020, 13(10):]

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Undiagnosed fibromuscular dysplasia in a deceased donor kidney transplant successfully treated with angioplasty.

Edward Medeiros, Reginald Gohh, Basma Merhi,

A 41-year-old man with end-stage renal disease received a deceased donor kidney transplant without complication. Maintenance immunosuppression consisted of tacrolimus, mycophenolate and prednisone. Two months after transplantation, his creatinine did not improve beyond 2-2.3 mg/dL, which prompted allograft biopsy. His biopsy showed tubular epithelial injury without rejection, and given concern for ... Read more >>

BMJ Case Rep (BMJ case reports)
[2020, 13(10):]

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Calcifying fibrous tumour torsion: a rare cause of abdominal pain.

Amy Hort, Andy Ze Lin Chen, Alireza Moghadam, Tony Pang,

BMJ Case Rep (BMJ case reports)
[2020, 13(10):]

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Intraoral midline mandibulotomy to improve access for transoral robotic surgery (TORS) base of tongue resection in a retrognathic and microstomic patient.

Daniel Bestourous, Margaret Michel, Christopher Badger, Punam Thakkar, Arjun S Joshi,

A 74-year-old man was referred to a tertiary academic otolaryngology clinic for evaluation of a left-sided neck mass with unknown primary. Nuclear imaging modalities revealed a primary cancer located at the left tongue base. Further investigation revealed the tumour to be a p16 positive squamous cell cancer with metastatic spread ... Read more >>

BMJ Case Rep (BMJ case reports)
[2020, 13(10):]

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Primary acquired melanosis (PAM) without atypia/WHO low-grade conjunctival melanocytic intraepithelial lesion over areas of oculodermal melanocytosis.

Bashar M Bata, Sachin M Salvi, Hardeep Singh Mudhar,

An elderly white man with a history of left oculodermal melanocytosis presented with new onset brown pigmentation of the left bulbar and inferior tarsal conjunctiva. The bulbar conjunctival pigmentation was at the level of the conjunctival epithelium and was overlying areas of typical slate-grey scleral pigmentation characteristic of oculodermal melanocytosis. ... Read more >>

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[2020, 13(10):]

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Non-osseous soft tissue metastasis in the foot from renal cell carcinoma.

Nusrat Jahan, Shabnam Rehman,

Metastatic tumours of the distal extremities, also known as acrometastases, are rare. The majority of the acrometastases involve bones-involvement of the soft tissues of the feet and hands is extremely rare. We report a case of clear cell renal cell carcinoma metastasised to the soft tissues of the foot. The ... Read more >>

BMJ Case Rep (BMJ case reports)
[2020, 13(10):]

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Possible affective cognitive cerebellar syndrome in a young patient with COVID-19 CNS vasculopathy and stroke.

Kai Xin Chia, Sonali Polakhare, Stefania Dafne Bruno,

Early case series suggest that about one-third of patients with COVID-19 present with neurological manifestations, including cerebrovascular disease, reported in 2%-6% of hospitalised patients. These are generally older patients with severe infection and comorbidities. Here we discuss the case of a previously fit and well 39-year-old man who presented with ... Read more >>

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[2020, 13(10):]

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Clinical, pharmacokinetic and economic analysis of the first switch to an extended half-life factor IX (albutrepenonacog alfa, rFIX-FP) in Spain.

Manuel Rodríguez López, Juan Eduardo Megías Vericat, Carmen Albo López, Santiago Bonanad,

Extended half-life of factor IX (FIX) demonstrated clinical benefit and lower treatment burden than standard half-life FIX products in clinical trials. We analysed the impact in efficacy, pharmacokinetics (PKs) and costs of the switch from nonacog alfa (rFIX) to albutrepenonacog alfa (rFIX-FP) in the first patient with haemophilia B (HB) ... Read more >>

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[2020, 13(10):]

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Leukemoid reaction causing arterial thrombus in a patient with lung adenocarcinoma.

Zena Chahine, Yazan Samhouri, Thejus Jayakrishnan, Dulabh Monga,

A leukemoid reaction is typically defined as white blood cell (WBC) count >50×109/L, predominantly neutrophil precursors, that are not due to tumour involvement in the bone marrow and not derived from clones. Leukemoid reactions associated with malignancy, known as paraneoplastic leukemoid reactions, are less common and are most notably seen ... Read more >>

BMJ Case Rep (BMJ case reports)
[2020, 13(10):]

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Sudden irreversible hearing loss post COVID-19.

Foteini Stefania Koumpa, Cillian T Forde, Joseph G Manjaly,

Sudden onset sensorineural hearing loss (SSNHL) is frequently seen by otolaryngologists. The exact pathophysiology of the disease is still unknown, with the most likely causative factor being following a viral infection. Immediate steroids are the best treatment to improve prognosis. Despite a plethora of papers in the literature describing SSNHL, ... Read more >>

BMJ Case Rep (BMJ case reports)
[2020, 13(11):]

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Granulomatous appendicitis: a perioperative challenge.

Nicola Colucci, Jérémy Meyer, Giacomo Puppa, Christian Toso,

BMJ Case Rep (BMJ case reports)
[2020, 13(10):]

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Complete resolution of arrhythmia-induced hydrops fetalis in utero.

Monisha Narayanan, Sypara Dhuka, Srilatha Alapati, Robert P Kauffman,

A 21-year-old G3P2011 Caucasian woman at 27 weeks' gestation presented with fetal tachyarrhythmia between 240 and 270 beats per minute. Fetal supraventricular tachycardia, abdominal ascites, pleural effusion and pericardial effusion indicated hydrops fetalis. Management with digoxin and flecainide converted the fetus to sinus rhythm and resolved the ascites and pleural ... Read more >>

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[2020, 13(10):]

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Parathyroid cyst: differential diagnosis.

Rita Silva, Daniela Cavadas, Carla Vicente, Jose Coutinho,

Parathyroid cysts are rare lesions of the cervical region and less frequently of the mediastinum. They occur mostly in women and are usually asymptomatic. They generally occur in the fourth and fifth decades of life and mainly are non-functioning. They commonly present as a neck mass that is found incidentally ... Read more >>

BMJ Case Rep (BMJ case reports)
[2020, 13(10):]

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Late presentation of 'Lemierre's syndrome': how a delay in seeking healthcare and reduced access to routine services resulted in widely disseminated Fusobacterium necrophorum infection during the global COVID-19 pandemic.

Fergal Howley, Laura O'Doherty, Niall McEniff, Ruth O'Riordan,

The SARS-CoV-2 outbreak has disrupted the delivery of routine healthcare services on a global scale. With many regions suspending the provision of non-essential healthcare services, there is a risk that patients with common treatable illnesses do not receive prompt treatment, leading to more serious and complex presentations at a later ... Read more >>

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[2020, 13(10):]

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Sclerosing variant of mucoepidermoid carcinoma: a diagnostic challenge.

Usman Rasul, Tom Bradish, Mohammed Talha Bashir, Muhammad Shakeel,

The sclerosing variant of mucoepidermoid salivary gland carcinoma is extremely rare. It is nearly impossible to diagnose this condition preoperatively. We present a case of a 23-year-old woman with a 1-year history of left parotid enlargement with inconclusive fine-needle aspiration cytology results. MRI showed an irregular parotid mass, and subsequent ... Read more >>

BMJ Case Rep (BMJ case reports)
[2020, 13(10):]

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Paraneoplastic leukemoid reaction in a localised squamous cell oesophageal cancer with paracrine G-CSF production.

Omar Azzam, Chandra Hewavitharana Hewavitharana, Soraya Fermoyle, David Prentice,

A 51-year-old-man presented with symptoms and baseline investigations suggestive of an infective process. Most strikingly, there was a pronounced neutrophil predominant leucocytosis. Lack of a clinical and biochemical response to empirical antibiotic therapy, prompted imaging for a deep-seated infective process, incidentally uncovering a gastro-oesophageal junction tumour. Resection of the tumour ... Read more >>

BMJ Case Rep (BMJ case reports)
[2020, 13(10):]

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Oro-facial fibrosis in systemic sclerosis: a reconstructive journey.

Faith Hyun Kyung Jeon, Michelle Griffin, Jajini Varghese, Peter Edward Michael Butler,

Oro-facial fibrosis presents a significant disease burden in patients with systemic sclerosis, but there remains no established treatment modality. Autologous fat grafting is a minimally invasive surgical procedure that is now increasingly recognised for its regenerative capacity, propagating an expansion of heterogeneous indications beyond volume restoration, including fibrotic diseases such ... Read more >>

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[2020, 13(10):]

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Novel homozygous missense mutation in ABCA3 protein leading to severe respiratory distress in term infant.

Naveen Parkash Gupta, Anil Batra, Ratna Puri, Varun Meena,

The term baby presented with respiratory distress with X-ray pictures consistent as hyaline membrane disease (HMD). Baby was ventilated and treated with surfactant. Because of the persistence of high ventilation needs with X-ray pictures consistent with HMD with a transient response to surfactant every time, the possibility of an inherited ... Read more >>

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[2020, 13(10):]

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Manifestation of metastatic lung adenocarcinoma as Gerstmann syndrome.

Albert Jang, Tameka A Smith, Steven Trainor, Peter C Caldwell,

BMJ Case Rep (BMJ case reports)
[2020, 13(10):]

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Placental site trophoblastic tumour: the rarest subtype of gestational trophoblastic disease.

Mariana M Chaves, Tiago Maia, Teresa Margarida Cunha, Vera Furtado Veiga,

Placental site trophoblastic tumour (PSTT) is a very rare form of gestational trophoblastic disease that grows slowly, secretes low levels of beta-subunit of human chorionic gonadotropin (β-hCG), presents late-onset metastatic potential and is resistant to several chemotherapy regimens. Here, we report a case of PSTT in a 36-year-old woman who ... Read more >>

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[2020, 13(10):]

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Severe hypophosphataemia following oral bisphosphonate treatment in a patient with osteoporosis.

Louise Wulff Bagger, Per Kim Dyhr Hansen, Peter Schwarz, Barbara Rubek Nielsen,

A 76-year-old woman was treated with oral bisphosphonate, alendronate, for osteoporosis in an outpatient clinic. Routine blood tests 4 months after alendronate prescription surprisingly revealed severe hypophosphataemia. The patient was hospitalised and treated with intravenous and oral phosphate supplements. Alendronate was later reintroduced as treatment for osteoporosis and the patient ... Read more >>

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[2020, 13(10):]

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An unusual ischaemic presentation of thrombosed intracranial mycotic aneurysm with subsequent subarachnoid haemorrhage.

Patrick Brown, Daniel Fulks,

We present an unusual case of acute ischaemic stroke secondary to thrombosed mycotic aneurysm with subsequent early aneurysmal rupture and subarachnoid haemorrhage, successfully treated with endovascular coil embolisation of the thrombosed segment. Imaging correlates are presented demonstrating successful endovascular management despite vessel occlusion precluding angiographic visualisation of the aneurysmal segment. ... Read more >>

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[2020, 13(10):]

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Aphasia and confusion - influenza encephalopathy: atypical presentation of influenza.

Reiichiro Obata, Kristina Ernst,

Influenza encephalopathy, a rare manifestation of influenza infection in the adult population which is not widely recognised, can present with confusion and focal neurological symptoms, including aphasia. The aim of this report is to illustrate the unique presentation of influenza encephalopathy and discuss the need for close attention to and ... Read more >>

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[2020, 13(10):]

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Left ventricular aneurysm complicating apical hypertrophic cardiomyopathy.

Liam Toner, Anoop Koshy, Omar Farouque, John Cotroneo,

BMJ Case Rep (BMJ case reports)
[2020, 13(10):]

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Prolonged euglycemic diabetic ketoacidosis triggered by a single dose of sodium-glucose cotransporter 2 inhibitor.

Maki Miwa, Mikio Nakajima, Richard H Kaszynski, Hideaki Goto,

A 45-year-old woman was admitted for diabetic ketoacidosis (DKA). Aggressive rehydration and continuous intravenous insulin resulted in improved blood glucose levels; however, metabolic acidosis persisted. One day prior to admission, the patient took a single dose of a sodium-glucose cotransporter 2 (SGLT2) inhibitor and this likely contributed to the prolonged ... Read more >>

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[2020, 13(10):]

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