Azarisman Mohd Shah

Fatal perimyocarditis in a migrant worker to the tropics from an unexpected aetiology: a case report

Perimyocarditis is an acute inflammation of the pericardium and myocardium resulting in myocellular damage that may present as acute chest pain, electrocardiographic changes and raised cardiac enzymes. It is most commonly of viral aetiology and is usually asymptomatic with complete resolution expected in most cases. It can however lead to fulminant cardiac failure resulting in death or requiring cardiac transplantation.1 Perimyocarditis is difficult to distinguish from an acute coronary syndrome without the benefit of a good clinical history and evaluation. Equally difficult and no less important is establishing the underlying aetiological pathogen responsible as it may alter the treatment and outcome for the patients involved. This case report presents a case of fatal perimyocarditis in a young migrant worker with positive serology for mumps virus, and a review of the literature. It also highlights the importance of an exhaustive diagnostic work up in order to establish the aetiology of the illness. The patient is a 29-year-old Indonesian migrant worker who had been in Malaysia for the last two years with no past history of any medical illnesses. He presented acutely …

Disseminated histoplasmosis presenting with chronic ulcerative tongue lesions in a patient with diabetes.

We describe a case of chronic tongue ulceration with systemic symptoms in a patient with poorly controlled diabetes. A biopsy of a lesion from the posterior third of the tongue showed features typical of histoplasmosis (figure 1). A CT of the thorax and abdomen revealed a diffuse reticulonodular pattern bilaterally (figure 2A). The intra-abdominal organs were normal. A diagnosis of …