Bushra Siddiqui

Megaloblastic anemia: A common but often neglected cause of pyrexia of unknown origin.

Abstract Objective: The objective was to study megaloblastic anemia as a cause of pyrexia of unknown origin (PUO). Materials and Methods: We conducted a study on 15 patients of megaloblastic anemia associated with fever, attending our hospital clinics over a period of 6 months. Results: While 11 patients had symptoms suggesting foci of infection and responded well to intravenous antibiotics, 4 patients had neither any evidence of infection nor responded with empirical broad spectrum antibiotic treatment. They were treated with vitamin B12/folate therapy which led to marked improvement in fever within 48 h. Presenting complaints of the patients and severity/duration of fever along with other epidemiological data were also studied in each case. Conclusion: The present study led us to conclude that megaloblastic anemia forms an important and reversible cause of fever and should be ruled out in all patients presenting with PUO. This knowledge would help the physicians in adequate and timely management of these patients.

Progression Of Fibroadenoma To Malignant Phyllodes Tumour In A 14-year Female

Phyllodes tumours are uncommon breast tumours which account for less than 1% of all breast neoplasms. High-grade malignant phyllodes tumour is a very rare but aggressive breast malignancy and forms approximately 15-30% of all phyllodes tumours. The transformation of a benign fibroadenoma into a malignant phyllodes tumour in a teenaged female is even rarer. We report here an interesting case of malignant phyllodes tumour in a 14-year female patient who was operated twice previously with the diagnosis of complex fibroadenoma in the same breast. There was a large tumour involving whole of the breast and infiltrating the skin. The patient was operated and total mastectomy was done. Diagnosis was confirmed after histopathological examination and immunohistochemistry of the resected specimen. Patient received adjuvant radiotherapy and there was no recurrence on 6-month follow-up. Owing to the rare occurrence of malignant phyllodes tumour in this age group along with previous operations for complex fibroadenoma, this case is being reported here.

A Rare Form of Major Self-mutilation in a Patient with Delusional Disorder

Self-mutilation is defined as the intentional, direct injuring of body tissue without suicidal intent. In this article we report the case of a 45-year-old male who presented to the emergency department with a history of incising his abdomen and chopping his intestines into pieces. The patient also brought the chopped pieces along with himself. He was operated on, and a resection and anastomosis was done. Postoperative recovery of the patient was uneventful. After a psychiatric assessment was done, it was found that he was suffering from delusional disorder. Owing to such rare presentation of major self-mutilation in a patient with delusional disorder, this case is being reported here.

Port site tuberculosis after laparoscopic cholecystectomy: A rare complication with review of literature

Laparoscopic procedures are routinely performed in most surgical centers today. Surgical site infections at port sites following laparoscopy are not uncommon. However, port site tuberculosis (TB) is a rare complication following a laparoscopic procedure. The possible causes of its development include improper sterilization of instruments, use of tap water containing resistant atypical mycobacteria to clean these instruments before immersion into glutaraldehyde solution; and seeding at the port site due to gall bladder TB. We report here a case of a young female who underwent laparoscopic cholecystectomy outside our hospital and then developed a discharging sinus at the epigastric port site. Three attempts of debridement and wound closure had already been done before and every time there was a recurrence. Sinus tract was excised after getting the sinogram, and the histopathology showed features consistent with TB. The patient was put on anti-tubercular therapy, and she had no recurrence after 3 months of follow-up.

Giant cell tumor of acromion process with secondary aneurysmal bone cyst

Giant cell tumor (GCT) or osteoclastoma develops after attaining physeal closure with the most common sites of involvement being the ends of long bones. It is uncommon in the small bones of hands and feet and extremely rare in the flat bones. GCT is a locally aggressive tumor, but in rare cases, it may metastasize to lungs, ribs, regional lymph nodes, and skull. Secondary aneurysmal bone cyst (ABC) may also develop in some cases. Histopathological appearance is pathognomonic in most of the cases of GCT with secondary ABC formation, and immunohistochemistry is rarely needed for a confirmatory diagnosis. The usual treatment is excision or curettage with an adjuvant such as bone cement, liquid nitrogen, and phenol. Involvement of the acromion process is extremely rare. Here, we report a case of a young male having GCT of the acromion process with secondary ABC, and it is the second case reported in literature.

Primary hydatid disease of the breast clinically masquerading as a galactocele: A case report

Abstract We report a rare case of a 30-year-old breastfeeding woman who presented to our surgical outpatient department with complaints of a gradually enlarging lump in her left breast for the last 2 months. She also complained of difficulty in breastfeeding for 1 week. On examination, the right breast was normal but there was a 4 cm × 4 cm retroareolar soft lump in her left breast. Examination of the bilateral axilla was normal. A provisional diagnosis of galactocele was made and the patient was subjected to ultrasonic mammography and fine needle aspiration cytology (FNAC). Ultrasonic mammography of the left breast showed a heterogeneous, hypoechoic lesion with thick septations and internal echoes suggestive of a complex cystic lesion, leading to a differential diagnosis of either hydatid cyst or breast abscess. On FNAC, the aspirate was not milky and cytological examination was performed, which revealed hydatid scolices, hooklets, foamy macrophages and granular debris, leading to the final diagnosis of hydatid cyst of the breast. The patient was investigated further but there were no cysts at any other site. Chemotherapy with albendazole was started and surgery was performed after 1 month. Histopathology further confirmed the diagnosis. Owing to the rarity of presentation, this case is being reported here.

A case of coexisting carcinoma and tuberculosis in one breast

Abstract Coexistent carcinoma and tuberculosis in a breast is a rare entity. It poses problems right from the diagnosis and staging of carcinoma to treatment and patient compliance. Proper clinical examination and investigations should be performed in such cases as both carcinoma and tuberculosis are major diseases with no definite symptoms or signs to distinguish the two. Herein, we report the case of a 45-year-old female who presented with complaints of a lump and pain in left breast, weight loss and weakness for the past 4 months. Fine needle aspiration cytology from the breast lump showed clusters of malignant cells along with many loose clusters of epithelioid cells on a background showing caseous necrosis. A diagnosis of coexisting breast carcinoma and tuberculosis of the breast was made and antitubercular treatment was started. The patient was operated and histopathology confirmed the diagnosis.

Challenges in the diagnosis and management of spontaneous bile duct perforation: A case report and review of literature.

We report a case of 14-year-old male, who presented to us with complaints of severe pain in abdomen, vomiting, and inability to pass feces and flatus. He was diagnosed as a case of peritonitis after careful history, examination, and investigations. The exact cause of peritonitis was not known. Exploratory laparotomy was done, and it was found that there was perforation of the right hepatic duct about 1 cm proximal to its confluence with the left hepatic duct. Perforation was closed around the T-tube. Postoperative T-tube cholangiogram was done after 3 weeks which confirmed the free passage of dye into the duodenum, and there was no leakage of dye. T-Tube was removed 4 weeks after the operation, and the patient was discharged in satisfactory condition. Postoperative follow-up was done for 3 months, and it was uneventful.

Trichogranuloma of the external auditory canal mimicking aural polyp: A rare case report

We report a case of an 18-year-old male who presented to us with complaints of decreased hearing, ear discharge, and fullness in the right ear for last 2 months. Examination revealed a swelling of 0.5 cm × 0.5 cm in the inferior part of the external acoustic canal, tympanic membrane was found to be normal. Patient was advised antibiotic and steroids ear drops after making a provisional diagnosis of aural polyp. Surgical excision of the swelling was done when conservative treatment was unsuccessful. The excised polyp was sent for histopathological examination which revealed presence of foreign body giant cells and mixed inflammatory infiltrate around the fragments of hair shafts which confirmed the diagnosis of trichogranuloma in the external auditory canal. Owing to the rarity of such location of trichogranuloma, this case is being reported here.

Amyand's hernia masquerading as a strangulated inguinal hernia: A case report and literature review

We report a rare case of a 62-year-old male who presented to surgical emergency department with the complaints of sudden onset pain and swelled in the right inguinal region with nausea, vomiting and abdominal distension. There was a history of a reducible swelling in the right inguino-scrotal region for the last 1 year. Based on history, clinical examination and investigations a provisional diagnosis of right-sided strangulated inguinal hernia was made and patient was planned for an emergency surgery. On the exploration, the hernial sac revealed a gangrenous vermiform appendix and the diagnosis of Amyands hernia was made. Appendectomy was performed through the same incision, and hernial repair was done using a polypropylene mesh.