MyMedR

Fulltext An unusual case of refractory status epilepticus in a young lady: anti-NMDA receptor encephalitis

Khoo CS, Zulkifli NH, Rahman SSA

Clin Med (Lond), 2017 Oct;17(5):436-438.

PMID: 28974594 DOI: 10.7861/clinmedicine.17-5-436

We describe a case of a young lady with anti-NMDA (N-methyl-D-aspartate) receptor encephalitis, who initially presented with status epilepticus. Her seizures and orofacial dyskinesia were refractory to four anticonvulsants. She received intravenous immunoglobulin and a left ovarian tumour (an associated feature) was resected. However, her outcome was poor because of delayed treatment, autonomic dysfunction and complications of prolonged hospitalisation. This case highlights the importance of an early recognition of this rare but increasingly recognised disease.

Matched MeSH terms: Diagnosis, Differential

Distinguishing features of COVID-19 and non-COVID-19 febrile seizures in hospitalised children

Mahendran S, Ng BH, Lim HY, Zailanalhuddin NE, Chandran Y, Wong WF, et al.

Med J Malaysia, 2024 Jul;79(4):408-413.

PMID: 39086337

INTRODUCTION: Febrile seizures in children can be associated with various underlying conditions, including COVID-19. Differentiating COVID-19 and non-COVID-19 related febrile seizures is crucial for tailored patient management and for implementing appropriate infection control measures to prevent nosocomial transmission. This study aimed to describe the clinical features of children hospitalised for COVID-19 and non-COVID-19 febrile seizures and to identify factors that differentiate between the two groups.

MATERIALS AND METHODS: This retrospective cross-sectional study involved children aged 6 months to 6 years who were hospitalised for febrile seizures in Hospital Tuanku Ja'afar Seremban (HTJS) from January 2021 to June 2022. Descriptive statistics were used to summarise the differences in demographics and clinical presentations. Logistic regression analyses were performed to identify factors associated with COVID-19 and non-COVID-19 febrile seizures.

RESULTS: Of the 345 patients (median age 22 months, IQR 15- 32; 59.7% were males) included in the study, 130 (37.7%) tested positive for COVID-19, while 215 (62.3%) tested negative. There were no significant differences between both groups based on age, comorbidities, history of febrile seizures, seizure types, temperature on arrival, cough and rhinorrhoea. Multivariate analysis revealed that a family history of febrile seizures and leucocytosis were associated with increased odds of non-COVID-19 febrile seizures. In contrast, lymphopenia was associated with decreased odds.

CONCLUSION: The clinical presentation of COVID-19 and non- COVID-19 febrile seizures are remarkably similar, highlighting the importance of including COVID-19 screening in febrile seizures workup. Full blood count readings may be potentially useful for differentiating between these conditions.

Matched MeSH terms: Diagnosis, Differential

Fulltext Chronic hydatid cyst in malaysia: a rare occurence

Suria Hayati MP, Boon Teck Eugene C, Jan Jin B, Mohd Rose I

Malays J Med Sci, 2015 Jan-Feb;22(1):79-83.

PMID: 25892954 MyJurnal

Hydatid cysts are not endemic in Malaysia and are rarely seen. We hereby report a case of hydatid cyst of the liver in a 55-year-old Chinese-Australian lady who presented with a calcified liver cyst and negative hydatid serology. A liver segmentectomy was performed and revealed a well-circumscribed, calcified liver cyst containing only creamy whitish material without the typical daughter cyst. A histological examination revealed different layers of the cyst wall and the presence of loose, calcified scolices without a daughter cyst. The case highlights the importance of considering hydatid cyst in the differential diagnosis of liver cyst even in non-endemic areas, as the ease of travelling and migration allows the condition to be seen outside the endemic region.

Matched MeSH terms: Diagnosis, Differential

Fulltext Gastric duplication cyst in an infant presenting with non-bilious vomiting

G KK

Malays J Med Sci, 2012 Jan;19(1):76-8.

PMID: 22977380 MyJurnal

In an infant presenting with a mass in the abdomen and non-bilious vomiting, duplication cyst needs to be considered in the list of differential diagnoses. Gastric duplication cyst is an uncommon occurrence in children. Diagnosis is based on clinical findings and imaging features. Surgical excision is safe and offers a complete cure. The literature recommends excision even in asymptomatic cases due to isolated reports of malignancy arising in the duplication cyst in later life.

Matched MeSH terms: Diagnosis, Differential

Mid-aortic syndrome presented as dilated cardiomyopathy

Pang KY, Yubbu P, Ali N, Koh GT

BMJ Case Rep, 2024 Jun 19;17(6).

PMID: 38901852 DOI: 10.1136/bcr-2024-259981

Mid-aortic syndrome (MAS) is a rare vascular disease that usually leads to renovascular hypertension. With the predominant manifestations being intractable arterial hypertension and lower extremity arterial insufficiency, it has rarely been associated with dilated cardiomyopathy. We report a young girl with congestive heart failure, where the cause was initially attributed to dilated cardiomyopathy. A repeated echocardiogram 6 months later brought the physician's suspicion of MAS because of the abnormal colour of Doppler from the subcostal view. Further assessment using CT angiography revealed discrete thoracic coarctation at the level of T10, with the narrowest diameter of 2.1 mm, thus confirming the diagnosis. Her inflammatory markers and connective tissue screening were negative. She underwent successful stenting of coarctation of the aorta, which later caused improvement in her cardiac function. We highlighted the importance of looking for treatable causes of dilated cardiomyopathy and vigilant clinical and echocardiogram assessment with high suspicion to diagnose MAS.

Matched MeSH terms: Diagnosis, Differential

Bacille Calmette-Guérin (BCG) osteomyelitis: a rare complication of BCG vaccination

Venugopal V, Ng DC

BMJ Case Rep, 2024 Sep 10;17(9).

PMID: 39256178 DOI: 10.1136/bcr-2024-261058

The BCG vaccine is considered a safe and efficacious vaccine in the prevention of severe forms of tuberculosis. BCG osteomyelitis is a rare complication of the BCG vaccine that occurs in vaccinated young children. We report a case of BCG osteomyelitis in a male toddler, presenting with painful left wrist swelling without preceding fever or systemic symptoms. Radiographic evidence of osteomyelitis in the left wrist was observed. Initial treatment with conventional antibiotics for acute haematogenous osteomyelitis showed no improvement. The diagnosis of Mycobacterium bovis BCG osteomyelitis was confirmed via tissue samples for histopathological examination and mycobacterial cultures. The patient responded well to treatment with oral antituberculous therapy. This case highlights the importance of considering BCG osteomyelitis in the differential diagnosis of unexplained joint swelling in BCG-vaccinated young children.

Matched MeSH terms: Diagnosis, Differential

Fulltext Congenital mature cystic teratoma of the lateral neck presenting as cystic hygroma: a rare case report with literature review

Win TT, Razy N, Hamid S, Ubramanian AB, Ramalinggam G

Turk Patoloji Derg, 2014;30(3):220-4.

PMID: 24715558 DOI: 10.5146/tjpath.2013.01220

Teratoma of the neck is a rare extra-gonadal teratoma. Although it can be seen in adult, most of the cases present in fetal life or early childhood. Grading and classification of teratoma is important for management and prognosis. Decision making between mature and immature teratoma is sometime challenging if it is not composed of extensive unusual neuroectodermal tissue component. We reported a rare case of huge congenital mature cystic teratoma composted of various neuroectodermal tissues in an 8-month-old boy; it was located at the lateral neck and mimicked congenital cystic hygroma. A literature review was done to grade and classify the tumour.

Matched MeSH terms: Diagnosis, Differential*

Fulltext Cecal amebiasis mimicking inflammatory bowel disease

Cheng CW, Feng CM, Chua CS

J Int Med Res, 2020 May;48(5):300060520922379.

PMID: 32475192 DOI: 10.1177/0300060520922379

Amebiasis is a frequently occurring parasitic infection in South East Asia. We present a case of a 54-year-old man with right lower quadrant abdominal pain that persisted for longer than 1 year. He had been diagnosed with inflammatory bowel disease in Indonesia. His abdominal pain persisted, despite therapy, and he visited Malaysia for transnational medical advice. Abdominal ultrasound showed fatty liver, gallbladder polyps, and a small left renal stone. Colonoscopy showed multiple ulcers in the cecum and a histopathological examination confirmed amebic infection of the cecum. The colonic ulcers subsided after anti-amebic treatment. This case highlights the need to consider the differential diagnosis of amebic colitis in patients presenting with manifestations of inflammatory bowel disease, especially in patients who live in or have traveled to endemic areas.

Matched MeSH terms: Diagnosis, Differential*

Differentiating multiple-system atrophy from Parkinson's disease

Ramli N, Nair SR, Ramli NM, Lim SY

Clin Radiol, 2015 May;70(5):555-64.

PMID: 25752581 DOI: 10.1016/j.crad.2015.01.005

The purpose of this review is to illustrate the differentiating features of multiple-system atrophy from Parkinson's disease at MRI. The various MRI sequences helpful in the differentiation will be discussed, including newer methods, such as diffusion tensor imaging, MR spectroscopy, and nuclear imaging.

Matched MeSH terms: Diagnosis, Differential

Fulltext Bertolotti's syndrome: A commonly missed cause of back pain in young patients

Manmohan S, Dzulkarnain A, Nor Azlin ZA, Fazir M

Malays Fam Physician, 2015;10(2):55-8.

PMID: 27099663

Bertolotti's syndrome must be considered as a differential diagnosis for lower back pain in young people. Treatment, whether conservative or operative, is still debatable. In this paper, we report a case of a 20-year-old girl presenting with lower back pain for 8 years. We administered injection with local anaesthetic and steroid injections within the pseudo-articulation; however, the pain was relieved for 3 weeks. Surgical excision of the pseudo-articulation successfully treated her back pain and the sciatica.

Matched MeSH terms: Diagnosis, Differential

Fulltext Giant epidermal cyst with intramuscular extension: a rare occurrence

Low SF, Sridharan R, Ngiu CS

BMJ Case Rep, 2015 Feb 06;2015.

PMID: 25661748 DOI: 10.1136/bcr-2013-202534

An epidermal cyst is the most common type of cyst to occur in subcutaneous tissue. When its size is greater than 5 cm, it is recognised as a giant epidermal cyst. A subcutaneous giant epidermal cyst with intramuscular extension is extremely rare. The authors report a case of a 74-year-old man who presented with a painless, slow-growing left gluteal mass of 6-month duration. Examination revealed a large left gluteal mass that was fixed to the underlying structures. A small epidermal cyst with visible punctum was noted at the medial aspect of the mass. MRI demonstrated a large, lobulated left gluteal lesion measuring 20 cm×16 cm×10 cm. The lesion was partly within the gluteal maximus muscle and partly within the subcutaneous tissue. MRI and ultrasound features of the lesion were consistent with a giant epidermal cyst with intramuscular extension. The lesion was excised and histology confirmed the diagnosis.

Matched MeSH terms: Diagnosis, Differential

Melkersson-Rosenthal syndrome with involvement of masticatory muscles

Kuok SS, Ramli N, Tan CT, Goh KJ

Clin Neurol Neurosurg, 2015 Mar;130:8-10.

PMID: 25562719 DOI: 10.1016/j.clineuro.2014.12.003

Matched MeSH terms: Diagnosis, Differential

Combined Spline and B-spline for an improved automatic skin lesion segmentation in dermoscopic images using optimal color channel

Abbas AA, Guo X, Tan WH, Jalab HA

J Med Syst, 2014 Aug;38(8):80.

PMID: 24957396 DOI: 10.1007/s10916-014-0080-7

In a computerized image analysis environment, the irregularity of a lesion border has been used to differentiate between malignant melanoma and other pigmented skin lesions. The accuracy of the automated lesion border detection is a significant step towards accurate classification at a later stage. In this paper, we propose the use of a combined Spline and B-spline in order to enhance the quality of dermoscopic images before segmentation. In this paper, morphological operations and median filter were used first to remove noise from the original image during pre-processing. Then we proceeded to adjust image RGB values to the optimal color channel (green channel). The combined Spline and B-spline method was subsequently adopted to enhance the image before segmentation. The lesion segmentation was completed based on threshold value empirically obtained using the optimal color channel. Finally, morphological operations were utilized to merge the smaller regions with the main lesion region. Improvement on the average segmentation accuracy was observed in the experimental results conducted on 70 dermoscopic images. The average accuracy of segmentation achieved in this paper was 97.21 % (where, the average sensitivity and specificity were 94 % and 98.05 % respectively).

Matched MeSH terms: Diagnosis, Differential

Intermittent midline suprasternal neck mass caused by superior herniation of the thymus

Su SC, Hess T, Whybourne A, Chang AB

J Paediatr Child Health, 2015 Mar;51(3):344-6.

PMID: 25266888 DOI: 10.1111/jpc.12744

Neck masses in infants and children have a wide differential diagnosis. However, neck masses apparent only during raised intrathoracic pressure are rare with a limited number of causes, including superior herniation of the normal thymus, apical lung herniation, jugular phlebectasia and laryngocoele. These conditions can easily be differentiated from one another by imaging. We present an infant with intermittent suprasternal neck mass visible only during increased intrathoracic pressure, produced either by crying or straining. Diagnosis of superior herniation of the thymus into the neck was confirmed by ultrasonography with the characteristic sonographic appearances of the normal thymus as well as its shape, size and location. Ultrasonography should be the first imaging modality of choice. Management of superior herniation of the thymus into the neck should be conservative as the thymus naturally involutes with increasing age. Awareness of the differential diagnosis of neck swelling present only on Vasalva manoeuvre or increased intrathoracic pressure is important to prevent unnecessary tests, avoid radiation, biopsy and surgery.

Matched MeSH terms: Diagnosis, Differential

Black hairy tongue in older edentulous individuals

Kannan S, Muthusamy S, Chandrasekaran B, Gopal D, Sidhu P

J Am Geriatr Soc, 2014 May;62(5):992-4.

PMID: 24828937 DOI: 10.1111/jgs.12813

Matched MeSH terms: Diagnosis, Differential

Giant retinal tears

Shunmugam M, Ang GS, Lois N

Surv Ophthalmol, 2014 Mar-Apr;59(2):192-216.

PMID: 24138895 DOI: 10.1016/j.survophthal.2013.03.006

A giant retinal tear (GRT) is a full-thickness neurosensory retinal break that extends circumferentially around the retina for three or more clock hours in the presence of a posteriorly detached vitreous. Its incidence in large population-based studies has been estimated as 1.5% of rhegmatogenous retinal detachments, with a significant male preponderance, and bilaterality in 12.8%. Most GRTs are idiopathic, with trauma, hereditary vitreoretinopathies and high myopia each being causative in decreasing frequency. The vast majority of GRTs are currently managed with a pars plana vitrectomy; the use of adjunctive circumferential scleral buckling is debated, but no studies have shown a clear anatomical or visual advantage with its use. Similarly, silicone oil tamponade does not influence long-term outcomes when compared with gas. Primary and final retinal reattachment rates are achieved in 88% and 95% of patients, respectively. Even when the retina remains attached, however, visual recovery may be limited. Furthermore, fellow eyes of patients with a GRT are at higher risk of developing retinal tears and retinal detachment. Prophylactic treatment under these circumstances may be considered but there is no firm evidence of its efficacy at the present time.

Matched MeSH terms: Diagnosis, Differential

Upper lateral neck swelling: rare but important differential diagnosis

Mohamad I, Nik Hassan NF

Ann Acad Med Singap, 2013 Aug;42(8):422-3.

PMID: 24045382

Matched MeSH terms: Diagnosis, Differential

Fulltext Solid variant of papillary thyroid carcinoma in a 14-year-old girl

Abdul Rahman WF, Md Hashim MN, Win TT, Bakrin IH

BMJ Case Rep, 2013;2013.

PMID: 23749834 DOI: 10.1136/bcr-2013-010001

Solid variant of papillary thyroid carcinoma (PTC) is a rare, poorly characterised variant and predominantly reported in children with a history of radiation exposure. This variant has a high propensity for extra-thyroidal extension and cervical lymph node metastases. A 14-year-old Malay girl who had no history of radiation exposure, presented with multiple cervical lymphadenopathy and it was clinically suspicious for tuberculosis or lymphoma. An incisional biopsy revealed a metastatic PTC. The patient underwent total thyroidectomy with bilateral lateral neck dissection and histopathology report was solid variant of PTC. Whole-body I(131) scan was performed which revealed an intense tracer uptake in the neck. She was planned for radioactive iodine ablation and now on regular follow-up for monitoring of possible tumour metastasis.

Matched MeSH terms: Diagnosis, Differential

Fulltext The importance of considering sebaceous gland carcinoma in presumed chalazia in South Asian patients?

Sagili S, Malhotra R

Br J Gen Pract, 2013 Feb;63(607):74.

PMID: 23700655

A 51-year-old Malaysian female was referred with a left lower eyelid lesion noticed 4 years ago. She consulted her GP a year ago and was diagnosed to have a chalazion. Her GP requested funding for treatment. The primary care trust (PCT) considered this a low-priority procedure and declined funding. One year later she approached her GP again and was referred to a hospital for management of this eyelid lesion (Figure 1). She underwent a biopsy and the histology was suspicious of a squamous cell carcinoma. She was referred to our unit. On examination, she had a left lower eyelid, firm 4mm nodule with thickening and distortion of tarsal conjunctiva. With a clinical suspicion of sebaceous gland carcinoma (SGC), a wedge excision of the lesion was performed. Paraffin section histology confirmed complete excision of SGC. Delayed repair required a Tenzel flap. She remains asymptomatic at 5-month follow-up.

Matched MeSH terms: Diagnosis, Differential

Fulltext Non-invasive investigation of chronic stable angina--a practical overview for medical practitioners

Jayasinghe R, Weerasooriya S, Kapadia N

Med J Malaysia, 2012 Apr;67(2):236-9; quiz 240.

PMID: 22822658

How does one decide on the best non-invasive test to investigate stable coronary ischaemia? This is a very common question faced by many medical practitioners. Chronic stable angina is a common presentation encountered in general practitice. Upon clinical assessment and risk stratification the patient needs to be investigated further to confirm the diagnosis. The first investigational modality involves a non-invasive test. It is important that practitioners possess a practical knowledge of the array of different tests that are available so that the best suited one for each patient can be chosen. This article aims to compare the efficacy and accuracy and the practical utility of the different non-invasive tests for coronary ischaemia and aid the practitioner in making sound decisions in this regard.

Matched MeSH terms: Diagnosis, Differential

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