Prasit Phowthongkum

Spindle cell pseudotumor of the brain associated with Mycobacterium haemophilum and Mycobacterium simiae mixed infection in a patient with AIDS: the first case report

BACKGROUND Spindle cell pseudotumors may occur due to mycobacterial infection, especially in immunocompromised hosts including those with AIDS. They have been reported from many body sites; the lymph nodes are predominantly involved, most frequently associated with Mycobacterium avium complex infection. To the best of our knowledge, Mycobacterium-associated spindle cell pseudotumors have not been previously described in the brain stem and in association with mixed mycobacterial infection. CASE REPORT We describe a man with AIDS who presented with right hemiparesis and truncal ataxia. Magnetic resonance imaging revealed enhancing nodular lesions at the cerebral peduncle and medulla. A mycobacterial spindle cell pseudotumor was diagnosed on surgical specimens. Blood and brain tissue cultures grew Mycobacterium haemophilum and Mycobacterium simiae. CONCLUSIONS To our knowledge, this is the first case of spindle cell pseudotumor of the brain associated with M. haemophilum and M. simiae mixed infection.

Familial aortic dissection and congenital iris flocculi with hypertension.

Familial clusters of aortic dissection without connective tissue diseases are rare. We report a family with aortic dissection, congenital iris flocculi and hypertension in the young. This suggests that this combination of an uncommon familial phenotype may have a common etiology.

Spontaneous coronary artery dissection following a preeclampsia pregnancy

1. IntroductionSpontaneous coronary artery dissection (SCAD) is an uncommoncause of acute myocardial infarction. The dissection of tunica intima ormedia,formingofhematomaunderneatharterialwallandcompressingthe true coronary lumen leads to myocardial infarction of distal cardiactissue. Thehigh suspiciousindexshouldmakein young female withoutany cardiovascular risk, especially in peripartum period. Emergent cor-onaryangiogramfollowedbyintravascularultrasoundisrecommendedfor diagnosis; however optimal treatment is still inconclusive [1].

Sigmoid volvulus: is it related to Marfan syndrome?

To the Editor, We report a case of a 65-year-old male, who presented with abdominal distention for 1 day, with past medical history of diabetes, hypertension, atrial fibrillation, cerebrovascular accident with residual right hemiparesis, and mild expressive aphasia. He reported of having diffuse abdominal distention, feeling nauseated with multiple episodes of non-bilious vomiting. He was afebrile with normal blood pressure. Abdominal exams showed distended abdomen with tympanic note on percussion. Rectal examination revealed emptied rectal vault. Abdominal X-ray showed marked dilatation of sigmoid loop, extending from the pelvis into the right upper quadrant, with coffee-bean appearance. Due to a high suspicionofsigmoidvolvulus,immediaterigidsigmoidoscopywas

Malignant pleural effusion: is CT pulmonary angiogram needed?

We have read an interesting article from Zarogoulidis et al. (1), “Malignant pleural effusion and algorithm management”, which give us the excellent guideline for managing oncologic patient with malignant pleural effusion. In oncologic patients, malignant pleural effusion is a common cause of dyspnea, however pulmonary embolism is a frequent complication which also might present with pleural effusion. The question is “do we have to rule out pulmonary embolism in all oncologic patients who presented with shortness of breath and pleural effusion?”

Acute aortic dissection mimics acute inferoposterior wall myocardial infarction in a Marfan syndrome patient

A 30-year old man with acute chest pain was diagnosed with acute inferoposterior wall myocardial infarction following electrocardiography. After a failed coronary angiography, an echocardiogram revealed an aortic intimal flap after which acute aortic dissection was diagnosed. The patient received a successful Bentall operation without immediate complication. Retrospective examination then confirmed the diagnosis of Marfan syndrome. This case demonstrates acute aortic dissection may mimic acute myocardial infarction.