Background: Felty's syndrome is a rare condition affecting 1–3% of patients with rheumatoid arthritis. It typically arises after a prolonged course of RA. Although rheumatic fever and RA may share overlapping features, they are distinct entities; their co-occurrence in a patient is rare and considered coincidental. Case presentation: A 27-year-old woman with childhood rheumatic fever and mitral stenosis presented with low-grade fever and inflammatory arthritis. Three years earlier, she had developed pancytopenia and hepatosplenomegaly, and she was recently diagnosed with seropositive rheumatoid arthritis. Her earlier cytopenias and organomegaly were retrospectively attributed to Felty’s syndrome, likely preceding RA onset. Treatment with corticosteroids and hydroxychloroquine led to significant improvement, and methotrexate was added for maintenance and relapse prevention. Conclusion: Careful medical history and clinical examination, as well as thorough other investigations, should be performed to exclude other causes of neutropenia.   Continue Reading

Background: Pleomorphic carcinoma of the breast is a rare and aggressive histologic variant of invasive breast carcinoma characterized by the presence of highly atypical, bizarre, pleomorphic giant cells. It typically portends a poor prognosis and poses diagnostic challenges due to its undifferentiated morphology. Case Presentation: We report the case of a 39-year-old woman who presented with a 5-month history of a progressively enlarging left breast mass. Imaging revealed a large, irregular lesion without overt metastatic disease. Histopathology demonstrated a high-grade pleomorphic undifferentiated epithelioid neoplasm, with triple-negative receptors expression. Immunohistochemistry suggested an undifferentiated epithelioid neoplasm requiring exclusion of metastasis. Modified radical mastectomy was performed, and PET <AQ1>-CT excluded other primary sources, confirming this as a primary breast malignancy. Conclusion: Primary undifferentiated pleomorphic carcinoma of the breast is rare and diagnostically challenging. Multimodal imaging, expert histopathological analysis, and exclusion of metastasis are essential for diagnosis and management. This case underscores the need... Continue Reading

Background: The 15q11.2–q13 duplication syndrome (OMIM: 608636) is a rare autosomal dominant neurodevelopmental disorder caused by genomic rearrangements within a highly unstable chromosomal region prone to low-copy repeat–mediated duplications. This region contains imprinted genes involved in Angelman and Prader–Willi syndromes, making the parental origin relevant to its pathogenicity. Clinically, affected individuals present with autism spectrum disorder, intellectual disability, developmental and speech delays, seizures, and hypotonia. To date, no case has been reported in Morocco. Case Presentation: We report an eight-year-old girl referred to our genetics department for global developmental delay, absence of speech, intellectual disability, autism spectrum disorder, and facial dysmorphia. Neurological examination revealed motor delay, including tiptoe walking and incontinence, while EEG, thyroid function, and auditory evoked potentials were normal. Whole exome sequencing revealed a heterozygous 9.0 Mb duplication at 15q11.2–q13.3 encompassing imprinted genes such as UBE3A, SNRPN, and GABRB3, consistent with 15q11–q13 duplication syndrome (OMIM: 608636). Conclusion: Most... Continue Reading

Background Horner syndrome (HS), defined by the triad of ptosis, miosis, and facial anhidrosis, arises from disruption of the oculosympathetic pathway at any point along its course. The most frequently documented causes include trauma, neoplasms, and iatrogenic injury. Conversely, cervical myelopathy resulting from disc herniation is an uncommon etiology of HS. Case Presentation We describe an unusual presentation of HS in a 64-year-old woman with a large C5–C6 central disc herniation causing severe stenosis and cord compression. Conclusion This case highlights the importance of considering HS as a potential clinical indicator of cervical myelopathy. Prompt recognition and timely referral for surgical decompression are essential, as the recovery is influenced by both the duration and severity of sympathetic fibre compression. Continue Reading

Background: Antimicrobial resistance (AMR) is a growing global health crisis driven by inappropriate antibiotic use, prolonged treatment, and inadequate documentation of prescribing rationale. Optimizing antimicrobial use through hospital-based stewardship interventions is a clinical priority to improve outcomes and curb resistance. This audit evaluated whether structured pharmacist–microbiologist interventions could enhance compliance with local antimicrobial-prescribing standards on a busy medical ward in a United Kingdom district general hospital. Aim: To measure compliance with Trust antimicrobial-prescribing standards and assess the effect of pharmacist–microbiologist interventions on prescribing quality. Methods: Two nine-week audit cycles were undertaken on medical ward. Each cycle included a four-week baseline review, a four-week stewardship intervention, and a one-week post-intervention re-audit. Data were extracted from the electronic prescribing system. Results: In Cycle 1, baseline compliance was 63 % (guideline), 79 % (indication), and 83 % (duration), rising post-intervention to 83 %, 92 %, and 94 %. In Cycle 2, baseline rates... Continue Reading