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Objective: To characterize the clinical presentation, diagnostic challenges, neuroimaging findings, and treatment response in patients with seronegative autoimmune encephalitis (AIE) presenting as new-onset refractory status epilepticus (NORSE) and to assess the utility of fluorodeoxyglucose positron emission tomography (FDG-PET) and electroencephalogram (EEG) in diagnosis
and disease monitoring.
Background: NORSE is a life-threatening condition that often arises in the setting of AIE. While seropositive AIE has established diagnostic criteria, seronegative AIE remains a diagnostic challenge due to the absence of autoantibodies and non-specific findings on conventional investigations.
Methods: This is a prospective case series of four patients with seronegative AIE presenting as NORSE. Clinical history, cerebrospinal fluid (CSF) findings, magnetic resonance imaging (MRI), EEG, and FDG-PET results were analyzed. Immunotherapeutic interventions included intravenous immunoglobulin, corticosteroids, plasma exchange, rituximab, and tocilizumab.
Results: We present four patients with NORSE, characterized by challenging diagnoses due to negative antibodies in serological and CSF analyses. All patients exhibited normal MRI brain results. FDG PET revealed patterns of hypermetabolism or hypometabolism in sequential imaging. Therefore, indicating the potential function of FDG PET as an imaging biomarker in seronegative AIE.
Conclusion: Seronegative AIE presenting as NORSE remains a diagnostic and therapeutic challenge. Conventional MRI and CSF studies may be inconclusive, whereas FDG-PET and EEG provide valuable insights into disease activity. Early and aggressive immunotherapy can improve seizure control and clinical outcomes. Further research is needed to refine diagnostic criteria and treatment strategies for seronegative AIE.

Background: Parathyroid adenoma is a frequent cause of hyperparathyroidism. Its association with D hypovitaminosis can complicate this pathological state, especially in case of delayed surgical intervention. 

Case presentation: This case report presents a 77-year-old female patient with a complex medical history including dyslipidemia, hypertension, who developed primary hyperparathyroidism due to a parathyroid adenoma. The persistent hypercalcemia, elevated parathyroid hormone (PTH), and parathyroid scintigraphy led to the diagnosis, but the low 25-hydroxyvitamin D level complicated the picture. Due to personal decisions and the COVID-19 pandemic, surgery was delayed for six years, resulting in complications such as vitamin D deficiency-induced immunosuppression and osteoporosis. Post-surgical outcomes were favorable, with normalization of biochemical markers and stabilization of comorbid conditions. 

Conclusion: This case highlights that timely multidisciplinary management is essential in primary hyperthyroidism, as surgical delay worsens complications, yet parathyroidectomy can still reverse outcomes even after years of progression. 

Background: Pyomyositis is uncommon in temperate regions and is usually caused by Staphylococcus aureus. Infections due to group A Streptococcus (GAS) are rare but can progress rapidly.

Case Presentation: A healthy 50-year-old man presented with a three-day history of left-calf pain and swelling two days after minor blunt trauma. He was tachycardic but normothermic. Work-up for thrombosis and cellulitis showed leukocytosis (24.9 × 10^9/L) and C-reactive protein 436 mg/L; Doppler leg ultrasonography and chest computed tomography (CT) were unremarkable. Within 18 hours, the limb became tense with new blisters and systemic instability. Urgent limb CT revealed extensive subcutaneous edema and fascial fluid. Fasciotomy identified intramuscular abscesses without necrotizing fasciitis. Cultures grew GAS sensitive to penicillin. Broad-spectrum intravenous antibiotics were streamlined to benzyl-penicillin, meropenem, and metronidazole; two weeks of intravenous therapy followed by two weeks of oral co-amoxiclav achieved near complete recovery.

Conclusions: GAS pyomyositis can transform mild limb discomfort into sepsis within hours, even in immunocompetent adults. Disproportionate tachycardia, rapidly spreading swelling or blistering, and escalating inflammatory markers warrant early cross-sectional imaging, multidisciplinary review, and prompt operative exploration. Vigilant reassessment and decisive intervention were critical to the favorable outcome in this case and may reduce morbidity in similar rapidly progressive infections.

Background: Mature ovarian cystic teratomas (MOCT) are the most common benign ovarian tumours. They are mainly asymptomatic (60%) but can in rare cases (<1%) complicate by forming a fistula into adjacent structures such as the bowel. Patients with fistulating ovarian teratomas are typically managed surgically, most often requiring laparotomy.

Case Presentation: We report a case of an 18-year-old woman who presented with vague abdominal and gynaecological symptoms. She expelled a mass with hair and teeth per rectum which was later confirmed as a MOCT.  We managed her conservatively as a collaboration with colorectal and gynaecology teams. At one-year follow-up, she remained asymptomatic with no radiological evidence of a residual fistula.

Conclusion: This case highlights the diagnostic challenges in MOCT with a bowel fistula. We demonstrate that conservative management may be a viable option in select patients.

Background:

Capnocytophaga canimorsus is a fastidious, zoonotic Gram-negative bacillus that can cause rapidly fatal septicaemia. Delays in microbiological diagnosis due to slow growth are common, reducing survival chances. This case uniquely highlights both an atypical gastrointestinal presentation and the resolution of a diagnostic impasse through extended CO₂ incubation triggered by astute clinical suspicion.

Case Presentation:

A 57-year-old male, recently tapered off corticosteroids for inflammatory arthritis, presented with diarrhoea, vomiting, and hypotensive collapse. He rapidly developed disseminated intravascular coagulation and multi-organ failure. Empirical piperacillin–tazobactam and gentamicin failed; cultures flagged positive at 72 hours with no initial growth. Only after clinicians alerted the laboratory, extended incubation under CO₂ enabled growth of C. canimorsus by day seven, confirmed via MALDI-TOF. Switching to meropenem led to recovery, although amputations of the necrotic tissues, including both toes and digits from his right hand were necessary due disseminated intravascular coagulation.

Conclusion:

This case demonstrates that C. canimorsus infection may initially mimic gastroenteritis and progress rapidly to fulminant sepsis. Early clinical suspicion, timely communication with microbiology for adapted incubation protocols, and prompt escalation to effective antimicrobial therapy are critical for survival.

Background: Mucosa-associated lymphoid tissue (MALT) lymphoma is a rare variant of extranodal marginal zone B cell lymphoma occurring at mucosal sites. Gastric MALT lymphoma is well-described, but non-gastric MALT lymphomas, particularly small intestinal, ceacal, and appendiceal MALT lymphoma, are rare and present diagnostic problems. Intestinal MALT lymphoma is frequently diagnosed late and can be associated with nonspecific symptoms in patients.
Case presentation: A 69-year-old female with diabetes mellitus, hypertension, and hypothyroidism, admitted to the emergency room for 24 hours with colicky lower abdominal pain and vomiting, without bowel movements. Abdominal distension and right iliac fossa tenderness were noted on clinical examination. Imaging, however, suggested a closed-loop obstruction of a twisted segment of the ileum. A laparoscopic right hemicolectomy with resection and anastomosis was carried out on the patient. Extranodal marginal zone lymphoma of MALT type arising from the terminal ileum, cecum, and appendix with ischemic changes
was identified by histopathological analysis of the resected specimen.
Conclusion: The importance of considering MALT lymphoma in the elderly with bowel obstruction, without an established chronic inflammatory or autoimmune condition, is emphasized in this case. Mechanical obstruction requires surgical resection, but systemic therapy is the treatment of choice for disseminated disease. Future research should address the role of molecular diagnostics and targeted therapies in non-gastric MALT lymphoma to enhance early detection and management programs.