Background: Rheumatoid arthritis (RA) is a systemic autoimmune disease that commonly presents of inflammatory symmetric polyarthritis in small joints and may also have extra-articular involvement. Early diagnosis and treatment within the first 3 months are important to reduce progression and deformities. In some cases, large joint involvement may also present or initially present in RA, which may lead to lower suspicion of RA at the initial visit and results in delayed diagnosis. Case Presentation: Here we present a case of female, 55 years old with knee joint pain and effusion, which initially thought to be osteoarthritis. The patient had inflammatory arthritis features including morning stiffness, pain worsened at rest, and arthritis also involving hands. Yet, the patient was confirmed as having rheumatoid arthritis based on clinical, serological, and radiological features. In the detailed evaluation of knee radiographic examination, bone erosions were identified at a second look. Conclusion: Inflammatory arthritis involving large... Continue Reading

Background: Ischemia with Non-obstructive Coronary Arteries (INOCA) historically considered benign, is now recognized as a cause of recurrent angina, functional limitation and adverse cardiovascular outcomes. In some patients, it may progress to myocardial infarction with non-obstructive coronary arteries (MINOCA). Recognition in younger individuals remains limited, contributing to delay in diagnosis and treatment. Case Presentation: Patient 1: A 16-year-old previously healthy male presented with paroxysmal palpitations and chest discomfort at rest. Nine months later, recurrent symptoms were accompanied by transient ST-segment depression on serial electrocardiography and elevated high-sensitivity troponin I (614 ng/L). Coronary angiography showed unobstructed epicardial vessels. Cardiac magnetic resonance (CMR) revealed focal subendocardial late gadolinium enhancement in the basal inferolateral wall consistent with vasospasm-induced myocardial infarction. Patient 2: A 34-year-old man reported four months of exertional chest discomfort and dyspnea on exertion with normal serial electrocardiography and troponin. Coronary angiography revealed normal epicardial vessels. Adenosine stress CMR identified diffuse subendocardial... Continue Reading

Background: Diaphragmatic endometriosis (DE) is a rare and often underdiagnosed type of extrapelvic endometriosis. It usually presents with atypical cyclical symptoms of thoracic involvement. Case Presentation: We present three African women with pelvic endometriosis and thoracic symptoms. The first case involved a 32-year-old nulligravida who presented with dysmenorrhea, cyclical hemoptysis, pleural effusions, and subfertility. An MRI showed a right pleural effusion and associated diaphragmatic lesions. Laparoscopic excision provided a diagnosis of DE, and she improved with postoperative treatment of dienogest (Endogest: 2 mg). The second case was a 33-year-old woman with recurrent cyclical dyspnea and right chest pain with a history of pelvic endometriosis. She was urgently admitted and underwent VATS surgery and subsequent pleurodesis. She was treated successfully with a GnRH agonist (11.25mg) and stabilized on this treatment. The third case was a 29-year-old nullipara who presented with cyclical right chest pain. An MRI demonstrated a right diaphragmatic nodule... Continue Reading

Background: Post-emetic purpura is a benign condition characterized by the presence of non-blanchable petechiae or purpura (typically in the distribution of the superior vena cava), usually resulting from a sudden increase in intrathoracic pressure after episodes of vigorous vomiting. Despite its often alarming clinical appearance, which can simulate serious hematologic or infectious diseases, it is a self-limiting occurrence with no systemic implications.Case Presentation: We report the case of a 4-year-old female patient who presented with periorbital purpura after an episode of intense vomiting. Physical examination revealed an erythematous, non-bleachable and bilateral rash that was restricted to the region around the eyes, with no other relevant clinical changes. The condition evolved with spontaneous resolution, without the need for therapeutic interventions.Conclusion: Recognition of post-emetic purpura is essential to avoid additional investigations and reduce anxiety of family members, contributing to a safer and more efficient clinical approach. Continue Reading

Background: Hirschsprung’s disease (HD) is a congenital absence of enteric ganglion cells, leading to distal bowel obstruction, chronic constipation, and progressive proximal colonic dilation. In resource-limited settings, delayed presentation and limited pathology support often necessitate staged procedures, increasing morbidity and caregiver burden. Single-stage transanal endorectal pull-through (TAPT) offers a minimally invasive alternative that avoids laparotomy and colostomy. Methods: This mixed prospective-retrospective case series included eight children (ages 2.5–9 years) with rectosigmoid HD who underwent single-stage TAPT between September 2024 and July 2025. Preoperative optimization involved rectal irrigations, nutritional rehabilitation, intravenous antibiotics, and fluid-electrolyte correction. Diagnosis was confirmed by contrast enema and full-thickness rectal biopsy. TAPT was performed using a Soave-type technique without intraoperative frozen section. Outcomes assessed included stool frequency, continence, enterocolitis episodes, anastomotic complications, weight gain, and quality of life. Results: All patients presented with chronic constipation and abdominal distension. Median length of resected bowel was 20 cm. Time... Continue Reading

Anti-NMDA receptor encephalitis is a severe autoimmune encephalitis characterized by progressive neuropsychiatric symptoms and the presence of Immunoglobulin G antibodies against the GluN1 subunit of NMDA receptors. We report a case of a previously healthy 20-year old woman who developed memory impairment, seizures, and progressive decline in consciousness shortly after first-trimester pregnancy termination. Initial cerebrospinal fluid (CSF) findings showed marked neutrophilic pleocytosis, mimicking bacterial meningitis, leading to delayed diagnosis. Anti-NMDAR antibodies were subsequently detected in the CSF, confirming the diagnosis. The patient required intensive care management, including mechanical ventilation and treatment of refractory status epilepticus. First-line therapy with high-dose corticosteroids and intravenous immunoglobulin resulted in partial improvement, followed by significant recovery after rituximab administration. This case highlights diagnostic challenges related to atypical CSF patterns and suggests that pregnancy termination may represent a temporal association with disease progression in susceptible individuals. Clinicians should consider autoimmune encephalitis in acute neuropsychiatric presentations following... Continue Reading