Background: Stroke is a rare but serious complication of malaria, especially with Plasmodium falciparum infection as a result of cerebral vessels obstruction by the parasitized red blood cells. Prompt recognition in malaria patients presenting with neurological symptoms is essential for effective management. Case Presentation: A 32-year-old male with no prior cardiovascular risk factors developed acute neurological symptoms after treatment for confirmed malaria. Brain imaging showed multifocal ischemic infarcts. Comprehensive investigations excluded common causes of stroke, including hypertension, diabetes, coagulopathies, and cardiac sources of embolism as well as vasculitis. The close timing between malaria infection and strokes, along with the absence of alternative explanations, supported a diagnosis of malaria-associated ischemic stroke. The patient continued antimalarial therapy and received supportive care including physiotherapy. Over subsequent day, neurological deficits gradually improved with rehabilitation. Conclusion: Malaria-induced stroke, though uncommon, should be considered in young patients presenting with acute neurological deficits in endemic areas. Early diagnosis and... Continue Reading

Background: Bladder leiomyoma is an uncommon, benign, smooth-muscle neoplasm that can closely resemble a urachal remnant when located at the anterior bladder or dome. Imaging findings may overlap substantially with urachal remnants or other lesions and definitive diagnosis often requires surgical excision, especially in symptomatic patients or when malignancy cannot be excluded. Bladder leiomyoma arising at the bladder dome is particularly uncommon and may radiographically mimic urachal pathology, creating diagnostic uncertainty and affecting preoperative decision-making. Case Presentation: A 45-year-old woman presented with approximately six months of suprapubic discomfort and progressive stress-predominant urinary incontinence. Pelvic MRI demonstrated a 3 cm anterior/dome lesion favored to represent a urachal remnant. Cystoscopy showed an invaginating dome mass with intact mucosa, limiting the utility of transurethral biopsy. Given persistent symptoms, non-diagnostic imaging, and the inability to exclude a urachal remnant, the patient underwent robotic-assisted partial cystectomy with en bloc excision of the dome lesion and a... Continue Reading

Background: Amoxicillin, a commonly used broad-spectrum antibiotic, can crystallize in renal tubules when administered at high doses, causing acute amoxicillin-induced crystal nephropathy (AICN). This condition typically presents with acute kidney injury (AKI) and macroscopic hematuria. Risk factors include high dosage, rapid infusion, dehydration, and low urinary pH. Although urine microscopy can confirm amoxicillin crystals, it is underutilized, contributing to underrecognition of AICN. Case Report: We present the case of a 75-year-old woman with fever and cellulitis, diagnosed with native aortic valve endocarditis due to Streptococcus dysgalactiae. She was treated with high-dose intravenous amoxicillin (6 × 2 g/day). On day two, she developed macroscopic hematuria and progressive AKI, eventually requiring temporary hemodialysis. Urine microscopy revealed elongated amoxicillin crystals, confirming the diagnosis of AICN. Amoxicillin was discontinued and replaced with continuous penicillin G infusion. Renal function recovered markedly within one week, allowing discontinuation of dialysis. Discussion: This case highlights the importance of... Continue Reading

Not available Continue Reading

Background: Recurrent Hypocalcemic Tetany in children is an important clinical feature of pseudohypoparathyroidism encompassing a spectrum of rare endocrine disorders characterised by end-organ resistance to parathyroid hormone (PTH).Case presentation: We report a case of a 10-year-old girl with genetically confirmed PHP Type 1a and 1c, presenting with classical features including recurrent hypocalcemic tetany, short stature, and mild intellectual delay. Notably, the child exhibited additional findings of primary hypothyroidism, celiac disease, positive autoimmune markers (ANA, SSA/Ro, Ro-52), congenital heart disease (ventricular septal defect), and Müllerian duct anomalies - features rarely reported in conjunction with pseudohypoparathyroidism.Conclusion: The co-existence of autoimmune endocrinopathy, congenital cardiac defect, and Müllerian anomaly in our patient raises the possibility of an expanded phenotypic spectrum or dual genetic pathology. The constellation of findings in this child may suggest either an represent coincidental conditions or a blended/dual genetic diagnosis. Continue Reading

Background: Croup is a common pediatric respiratory illness characterized by a barking cough, inspiratory stridor, and hoarseness resulting from upper airway narrowing. While most cases are of viral etiology, spasmodic croup can be triggered by non-infectious factors such as allergy, gastroesophageal reflux disease, or psychological stress.Case Presentation: We describe a previously healthy with no significant past medical history 10-year-old girl, with multiple presentations to the emergency department with persistent hiccups accompanied by inspiratory stridor with the classic “steeple sign”. Her clinical course suggested overlapping mechanisms, including reflux-related and stress-related functional triggers, as her symptoms improved with proton-pump inhibition and corticosteroids. Conclusion: This case illustrates an unusual presentation of recurrent spasmodic croup with persistent hiccups, likely multifactorial in origin. Awareness of atypical features may help in early identification and improve patient outcomes. Continue Reading

Background: Kikuchi–Fujimoto disease (KFD) has been reported more frequently in Asian countries. Its clinical course is usuallytransient, with spontaneous resolution within 1 to 4 months.Case Presentation: An 18-year-old male with a history of febrile seizures in childhood presented with 1 month of persistent fever, malaise, rash, and generalized painful lymphadenopathy. On admission, he was tachycardic, febrile, and exhibited significant pancytopenia. Infectious studies were negative, while acute-phase reactants were elevated. Computed tomography imaging revealed systemic lymphadenopathy and hepatosplenomegaly. A lymph node biopsy was performed, demonstrating necrotizing lymphadenitis consistent with KFD. Only after histopathologic confirmation and due to the known association with systemic lupus erythematosus (SLE), immunologic testing was expanded, revealing elevated anti–double-stranded DNA antibodies and positive European Alliance of Associations for Rheumatology/American College of Rheumatology criteria, confirming KFD secondary to lupus. Immunosuppressive therapy was initiated, resulting in clinical and hematologic improvement, and the patient was discharged with follow-up in Rheumatology.Conclusion: The... Continue Reading