1/17. Erdheim Chester disease: a rare cause of knee and leg pain.A case of Erdheim Chester disease in a 51-year-old Turkish patient is described. Erdheim Chester disease is a rare form of lipoid granulomatosis. knee and leg pain are the most common symptoms, and physicians working in orthopaedics and traumatology are the first to be consulted. Our patient demonstrated a typical bilateral, symmetric sclerosis of the metaphyseal region of long bones of the lower extremity, histologic examination revealed foamy, lipid-loaded histiocytes. The patient also suffered from arterial hypertension, diabetes insipidus and exophthalmos of the left eye. The diagnosis was confirmed by a bone biopsy, and the patient was treated with non-steroidal anti-inflammatory drugs, corticosteroids and vincristine.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/17. Pulmonary granuloma caused by pseudomonas andersonii sp nov.Pulmonary granuloma is a common lesion for which gram-negative bacteria are rarely implicated as a cause. Hence, most physicians are unaware of this etiology. We isolated a gram-negative bacterium from a surgically resected pulmonary granuloma in a 42-year-old, nonimmunocompromised woman. Within the necrotizing granuloma, numerous organisms also were demonstrated by Gram stain, suggesting a cause-disease relationship. Characterization of the bacterium by sequence analysis of the 16S ribosomal gene, cellular fatty acid profiling, and microbiologic studies revealed a novel bacterium with a close relationship to pseudomonas. We propose a new species for the bacterium, pseudomonas andersonii. These results suggest that the differential diagnosis of a lung granuloma also should include this gram-negative bacterium as a potential causative agent, in addition to the more common infections caused by acid-fast bacilli and fungi. This bacterium was shown to be susceptible to most antibiotics that are active against gram-negative bacteria.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/17. Is it Crohn's disease? A severe systemic granulomatous reaction to sulfasalazine in patient with rheumatoid arthritis.BACKGROUND: sulfasalazine is a widely used anti-inflammatory agent in the treatment of inflammatory bowel disease and several rheumatological disorders. Although as many as 20% of treated patients may experience reversible, dose-dependent side effects, less frequent but potentially severe, systemic reactions have also been reported. CASE PRESENTATION: A severe systemic reaction to sulfasalazine developed in a 21-year old female with rheumatoid arthritis characterized by eosinophilia, granulomatous enteritis and myelotoxicity, cholestatic hepatitis, and seizures. The clinical course and management of this patient are presented as well as a review of the incidence and outcome of severe systemic reactions to sulfasalazine. CONCLUSIONS: Granulomatous myelotoxicity and enteritis developed in a 21 year old female within 3 weeks of initiating sulfasalazine for rheumatoid arthritis. Following a short course of corticosteroids, the patient had resolution of her cholestatic hepatitis, rash, eosinophilia, and gastrointestinal symptoms with no residual manifestations at 7 months follow-up. Although severe reactions to sulfasalazine are rare and unpredictable, practicing physicians should be aware of unusual clinical presentations of toxicity when prescribing sulfasalazine.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/17. Atypical presentation of intramedullary spinal cord lesion.We report a patient who presented with atypical clinical manifestations including worsening abdominal pain from an intramedullary spinal cord lesion. It is important to consider non-abdominal causes of abdominal pain for patients with an atypical presentation. The described case demonstrates the challenges facing the physician with the early diagnosis of acute abdominal pain. spinal cord lesions, although uncommon, remain a potentially disabling and life-threatening cause of abdominal pain.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/17. Crohn's disease of the appendix presenting as acute appendicitis.A patient is reported who initially presented with findings simulating acute appendicitis and who was subsequently found to have Crohn's disease isolated to the appendix. Although the hazard of appendectomy in Crohn's disease is well known, it is interesting that none of the known patients with isolated appendiceal Crohn's disease has developed a fistula. Three of the 15 reported cases of Crohn's disease solely involving the appendix developed granulomatous changes involving other regions of the bowel as long as four years following the initial diagnosis. Because of the rarity of this condition, however, specific conclusions regarding the likehood of future recurrence cannot be drawn. We stress increased physician awareness of this entity in order to emphasize long-term follow-up for such patients.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/17. Video-assisted thoracic surgical procedure: management of a solitary pulmonary nodule.Solitary pulmonary nodules continue to challenge all diagnostic skills. Herein we describe video-assisted thoracic surgical intervention, a new, minimally invasive technique that aids physicians in obtaining a definitive histologic diagnosis in a select group of patients with an indeterminate solitary pulmonary nodule.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/17. Peritoneal schistosomiasis: an unusual laparoscopic finding.Laparoscopic surgery is now a common procedure for the cure of appendicitis. Unexpected other laparoscopic findings can be a diagnostic challenge. The authors present a case in which, in addition to typical appendicitis, multiple whitish nodules were found diffusely on the peritoneal surfaces suggesting a differential diagnosis including miliary tuberculosis and carcinoma metastases. The final diagnosis of schistosomiasis, made by histology and serology, had not been suspected. This uncommon and rare presentation deserves to be reported, especially to physicians of nonendemic areas, in an era in which people travel extensively.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/17. Oral presentation of Kaposi's sarcoma in a patient without severe immunodeficiency.Primary oral Kaposi's sarcoma of the "traditional type" (non-African, non-acquired immunodeficiency syndrome, nonimmunosuppressed) is a rare disorder. Presentation of this disorder at this site has not been well documented in the surgical pathology literature. This report describes a primary oral Kaposi's sarcoma in an older man without evidence of the acquired immunodeficiency syndrome or overt immunosuppression; this sarcoma recurred three times before a correct diagnosis was made. The case illustrates the importance of including Kaposi's sarcoma in the differential diagnosis. The lesions can easily be confused with pyogenic granuloma if the physician is unaware that primary Kaposi's sarcoma can occur at this site.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/17. Atypical mycobacterial cervicofacial lymphadenitis in children: a disease as old as mankind, yet a persistent challenge.The diagnosis of atypical cervicofacial lymphadenitis is often not readily clinically apparent. parents may bring a child to the physician's attention long before the development of the classic findings. When assessing the child with acute-onset cervicofacial lymphadenitis, there are 2 imperative clinical determinations: Is the lymphadenitis of viral, bacterial, or mycobacterial etiology? If of mycobacterial etiology, is it an atypical or tuberculous mycobacterial process? The goal in management is to avoid misdiagnosis and lengthy duration of symptoms before appropriate therapy is instituted. This paper includes a case study-based review of the evaluation, diagnosis, and management of cervicofacial lymphadenitis in children due to atypical mycobacterial organisms.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/17. cholesteatoma vs. cholesterol granuloma of the petrous apex.Lesions involving the petrous apex are rarely encountered in clinical practice. This directly affects the ability of the otolaryngologist to diagnose and effectively treat these lesions. Greater physician awareness and increased technologic capability are leading to more effective management of pathologic conditions involving this area of the temporal bone.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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