BMJ case reports
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Epidermolysis bullosa acquisita is a rare, acquired, autoimmune subepidermal blistering disease of the skin, characterised by blisters and erosions, especially in trauma-prone sites and extensor skin surface, scarring with formation of milia, skin fragility and nail dystrophy. Epidermolysis bullosa acquisita is extremely rare in childhood and it has been reported to be frequently associated with Crohn's disease. ⋯ We report a case of a 17-year-old boy affected by Crohn's disease who presented with milia on infiltrated erythematous plaques over the back of the hands. The diagnosis of epidermolysis bullosa acquisita was confirmed by histopathology, direct and indirect immunofluorescence analysis and ELISA.
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Tuberculosis caused by Mycobacterium tuberculosis presents a major health challenge in endemic countries and spares no organ in the human body. This infection is a mimicker of various disease processes such as metastasis, lymphoproliferative diseases, and other granulomatous conditions such as sarcoidosis and fungal infections. The most challenging and important differential is metastasis, especially in the disseminated form of tuberculosis. We present a histopathologically proven case of isolated hepatosplenic tuberculosis that was provisionally diagnosed as lymphoma due to its unusual, restricted involvement of the liver and spleen.
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We present a case where a C-MAC video laryngoscope was used to remove a duodenal stent that was inadvertently dislodged in the patient's proximal oesophagus during an interventional radiology procedure, causing upper airway obstruction. Using the C-MAC and a pair of Magill forceps, we were able to successfully remove the stent. Video feed allowed for further communication between us and the ENT (ear, nose and throat) surgeons.
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Case Reports
An atypical presentation of a typical pulmonary pathogen in an immunosuppressed patient.
We describe a case of a 38-year-old, HIV-positive asthmatic man with a history of intravenous methamphetamine substance misuse who presented with worsening dyspnoea, wheeze, productive cough without haemoptysis and deteriorating exercise tolerance. His chest X-ray was clear and subsequent CT scanning demonstrated multilobar, patchy consolidation and ground glass change in the lung parenchyma. His CD4 count was 864 cells/mm(3) (n=500-1500 cells/mm(3)) and viral load 863 IU/mL. ⋯ The differential diagnosis also included a methamphetamine-induced pulmonary haemorrhage, given the multiple small foci of ground glass change. The patient's sputum cultured Haemophilus influenzae, which was somewhat surprising, given his unusual CT findings. He recovered with antibiotic therapy and a follow-up CT scan at 6 weeks revealed complete resolution of the radiological findings.
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Case Reports
Dysphagia, dysphonia and sore throat following cerebral infarction: an unexpected cause.
A 75-year-old woman presented with left-sided weakness. There was no speech disturbance or reported swallowing difficulties. CT of the head revealed infarction in the territory of the right middle cerebral artery. ⋯ Seven days later a plastic item, later identified as the patient's denture, was expectorated. Following this, the dysphagia, dysphonia and sore throat rapidly resolved. The case highlights the importance of considering foreign body in the differential, and oral cavity examination in the assessment of a patient with dysphagia and sore throat is essential.