African Man Research Articles

Fatal Hyperosmolar Hyperglycaemic Syndrome complicated by severe Rhabdomyolysis

A 49-year-old African man, with no known past medical history, presented to the emergency department with three day history of vomiting, lethargy, confusion and drowsiness on a background of two week history of thirst, polyuria with drinking up to 10 pints of water a day. More recently he had been drinking litres of non-diet lemonade in an effort to sustain energy levels. On examination, Glasgow Coma Score was 6 (eyes 4, verbal 1, motor 1). He was severely dehydrated with dry mucous membranes, blood pressure 75/40 mmHg, pulse rate 120 bpm and cool peripheries. He was pyrexial 38.5°C, and hypoxic (oxygen saturations 84% on room air). Cardiovascular and respiratory examination was otherwise unremarkable. On arrival to the emergency department, he was intubated and ventilated due to hypoxaemia and poor conscious level. Baseline investigations are shown in Box 1. Chest radiograph showed patchy consolidation in the right base, suggestive of an aspiration pneumonia. A diagnosis of HHS, acute renal failure and severe mixed metabolic and respiratory acidosis was made. The patient was managed on the intensive care unit (ICU) with careful fluid resuscitation with 0.9% saline, according to central venous pressure. Slow reduction of plasma glucose was an explicit aim, using a maximum of 1 unit per hour of intravenous insulin, aiming to reduce plasma glucose by no faster than 1 mmol/L every 4 hours.1 He was fully anticoagulated in view of his high risk of stroke, and was given broad spectrum antibiotics. On ICU, he required inotropic support to maintain blood pressure, and haemofiltration in view of his acute renal failure and severe acidosis. Box 1 Investigations on admission Sodium 157 mmol/L (136–146 mmol/L) Corrected Sodium 181 mmol/L (136–146 mmol/L) Potassium 3.9 mmol/L (3.5–5.1 mmol/L) Urea 23.7 mmol/L (2.5–6.4 mmol/L) Creatinine 253 µmol/L (62–106 µmol/L) Creatine Kinase 1097 mmol/L (9–168 IU/L) Calcium 2.45 mmol/L (2.15–2.58 mmol/L) Phosphate 1.52 mmol/L (0.74–1.52 mmol/L) Serum osmolality 480 mOsm/kg (280–295 mOsm/kg) Haemoglobin 14.8 g/dl (11.5–16.6) White cell count 17.6 × 109/l (4–11) Platelets 211 × 109/l (150–400) Plasma Glucose 90.3 mmol/L (4–7 mmol/L) pH 6.998 (7.35–7.45) pCO2 5.54 kPa (4.67–6.40 kPa) pO2 (on 100% oxygen) 12.9 kPa (11.1–14.4 kPa) Bicarbonate 14.3 mmol/L (22–26 mmol/L) Lactate 5.6 mmol/L (0.5–1.6 mmol/L) Base Excess −12.3 mmol/L (−3–+3 mmol/L) Chest radiograph Right sided volume loss and patchy consolidation ECG Sinus tachycardia Urinalysis Protein + Ketones trace Blood + + + Leucocytes negative Nitrites negative View it in a separate window His condition did not improve despite full intensive care. Serum creatine kinase continued to increase to a peak of 417,907 IU/L, and a presumptive diagnosis of compartment syndrome leading to muscle infarction and acute rhabdomyolysis was made, which was supported by raised compartment pressures in the thigh and calf muscles. He underwent multiple fasciotomies, which confirmed necrotic muscle. His acidosis did not resolve despite haemofiltration, and oxygenation deteriorated, probably as a result of acute lung injury. He developed uncontrollable bleeding from disseminated intravascular coagulopathy, and after careful discussion with his family, further support was withdrawn, and he died 72 hours after arrival in hospital. Post mortem examination showed a fatty liver, evidence of muscle infarction in the legs, but no evidence of cardiovascular or cerebrovascular events.

Acute abdominal compartment syndrome complicating a colonoscopic perforation: a case report

IntroductionA perforation occurring during colonoscopy is an extremely rare complication that may be difficult to diagnose. It can be responsible for acute abdominal compartment syndrome, a potentially lethal complex pathological state in which an acute increase in intra-abdominal pressure may provoke the failure of several organ systems.Case presentationWe report a case of acute abdominal compartment syndrome after perforation of the bowel during a colonoscopy in a 60-year-old North African man with rectal cancer, resulting in respiratory distress, cyanosis and cardiac arrest. Our patient was treated by needle decompression after the failure of cardiopulmonary resuscitation. An emergency laparotomy with anterior resection, including the perforated sigmoid colon, was then performed followed by immediate anastomosis. Our patient remains alive and free of disease three years later.ConclusionAcute abdominal compartment syndrome is a rare disease that may occasionally occur after a colonoscopic perforation. It should be kept in mind during colonoscopy, especially considering its simple salvage treatment.

The perils of relying on anti-hepatitis B total core antibody in screening individuals infected with HIV

Co-infection with HIV and hepatitis B virus (HBV) has serious long-term consequences. We describe a case of an HIV-infected heterosexual black African man with a delayed diagnosis of HBV infection. Baseline HBV screening was performed using a sequential testing algorithm starting with a total core antibody (anti-HBc) test, which was negative. He had no evidence of immunity against HBV and subsequently received three unsuccessful courses of HBV vaccination. He had mild but persistent elevation of liver enzymes over a five-year period despite maintaining full suppression of HIV replication on efavirenz, lamivudine and zidovudine; the latter was changed to abacavir due to lipoatrophy. Further testing revealed e-antibody positive chronic HBV infection with undetectable anti-HBc reactivity. High-grade HBV viraemia associated with L180M and M240V drug-resistance mutations was confirmed. He was subsequently switched to a tenofovir-based regimen, which achieved HBV suppression. Adopting effective HBV screening strategies in HIV-infected patients is recommended.

Hypertrophy of the feet and ankles presenting in primary hypertrophic osteoarthropathy or pachydermoperiostosis: a case report

IntroductionPachydermoperiostosis or primary hypertrophic osteoathropathy is a rare genetic disease with autosomal transmission. This disorder, which affects both bones and skin, is characterized by the association of dermatologic changes (pachydermia or thickening of the skin) and rheumatologic manifestations (periostosis and finger clubbing). Here, we report a new observation of pachydermoperiostosis.Case presentationA 20-year-old North African Tunisian Caucasian man presented with hypertrophic osteoarthropathy. On a clinical examination, we found morphologic abnormalities of his face and extremities associated with skin changes. The laboratory findings were normal. A work-up disclosed no organic etiology. The final diagnosis consisted of pachydermoperiostosis syndrome.ConclusionPachydermoperiostosis is a rare entity that should be differentiated from secondary hypertrophic osteoarthropathy and chronic rheumatic diseases.

Squamous-cell carcinoma in situ in a patient with oculocutaneous albinism

A 36-year-old African man from Guinea with a history of albinism presented with a many-year history of scaling and erythema of the face, neck, and arms. The patient had light eyes, hair, and skin. Physical examination showed extensive photodamage. A skin biopsy specimen from the posterior aspect of the lower leg showed a squamous-cell carcinoma in situ. The most common types of oculocutaneous albinism (OCA), OCA 1 and OCA 2, are autosomal recessive disorders of pigmentation that commonly affect the skin, hair, eyes, and ears. Photodamage and skin cancers plague patients with albinism. In Africa, where albinism is prevalent, albinos face a myriad of social and medical issues. Skin cancer surveillance is an important consideration for albinos, and sun protection is paramount.

Giant colonic ulcer and pseudopolyps in an immunodepressed patient

We read with interest the case report by Colaiacovo et al. describing a case of disseminated histoplasmosis in an immunodepressed patient [1]. We had a similar case of a 55-year-old African man who was evaluated for leucopenia and a persisting inflammatory syndrome. He had received a cadaveric renal allograft 2 years earlier because of glomerulonephritis, after which he had been treated with an immunosuppressive regimen of prednisone, tacrolimus, and mycophenolate mofetil. He had 1-month history of intermittent rectal bleeding, abdominal pain, and weight loss. Physical examination was unremarkable. Blood, urine, and stool cultures, chest radiograph, and testing for Clostridium difficile toxin, cytomegalovirus (CMV), Epstein–Barr virus, HIV, and parvovirus B19 infection were all negative. Abdominal computed tomography (CT) scan revealed a 5-cm thickened, stenotic segment of the right colon and enlarged mesenteric lymph nodes suggestive of carcinoma ([Fig. 1]).

Squamous cell carcinoma (Marjolin's ulcer) in an orocutaneous fistula of a large mandibular ameloblastoma: a case report

IntroductionAmeloblastomas are rare lesions constituting 1% of all jaw tumors. Oral squamous cell carcinomas are common lesions; these constitute about 90% of all oral cancers. Concurrent tumors consisting of ameloblastoma and squamous cell carcinoma are extremely rare.Case presentationThis case report describes a 35-year-old African man who presented with a large mandibular tumor with an orocutaneous fistula that was found to be an ameloblastoma on histopathological examination, with concurrent squamous cell carcinoma histology within the fistula. This presentation was consistent with a Marjolin's ulcer within an ameloblastoma.ConclusionAmeloblastomas and Marjolin's ulcers require different management strategies. Careful histopathological examination of surgical specimens is key to patient outcome, as treatment of these patients depends on an accurate diagnosis.

Prolapsed sigmoid intussusception per anus in an elderly man: a case report

BackgroundIntussusception in pediatrics is widely documented and well described. On the basis of the literature, however, adult intussusception is a rare entity with a prevalence of from 1% to 5%. The majority of adult patients with intussusception have an underlying pathology that needs to be identified by performing a proper physical examination and a wide array of investigations.Case presentationWe present a case of a 66-year-old African man who presented to our emergency department with a mass protruding per anus with obstipation. During laparotomy, we found that the sigmoid colon had intussuscepted into the rectum and out from the anus. Other abdominal viscera were normal and without any obvious mesenteric lymphadenopathy. Sigmoid colectomy and spectacle colostomy were performed. Grossly, the excised bowel looked normal, but the histologic results showed features of necrosis and chronic inflammation.ConclusionWhile 70% to 90% of cases of adult intussusception have an identifiable cause or lesion, most pediatric intussusceptions are idiopathic. The presentation in an adult described herein was of an uncommon idiopathic type with no identifiable cause found on the basis of the history, physical examination, or histological findings.

Radiology Quiz Case 3

A 31-YEAR-OLD NORTH AFRICAN MAN PREsented with a 4-month history of headache. He reported several attacks of massive epistaxis, which had stopped spontaneously. His medical history was unremarkable, and he had no history of trauma. Fiberoptic examination showed an asymmetry of the roof of the rhinopharynx. The overlying mucosa was normal. No arterial beating was visualized on fiberoptic examination. There was no palpable cervical node. The findings of the rest of the head and neck examination were normal. The patient underwent standard computed tomography (Figure 1) and magnetic resonance imaging (Figure 2). What is your diagnosis?

Giant condyloma acuminatum of the scrotum in a man with AIDS: a case report

IntroductionGiant condyloma acuminatum, also called a Buschke-Löwenstein tumor, first described in 1925, is a slow-growing, locally aggressive, destructive tumor of the ano-genital region. Scrotal tumors are rare. Reports on giant condyloma acuminatum lesions in patients with HIV and AIDS are surprisingly even rarer.Case presentationIn this report, we present the case of a 42-year-old African man with AIDS who was undergoing anti-retroviral therapy. He was found to have a giant condyloma acuminatum of the scrotum. Wide surgical excision and scrotal reconstruction with a pedicled anterolateral thigh flap was performed, significantly improving his quality of life.ConclusionDecision making regarding the goals of surgical intervention in the terminally ill is a complex process. The options include conservative medical palliation or palliative excision versus a curative excision that has the potential for significant morbidity. Wide surgical excision with local flap reconstruction significantly improved the quality of life of the patient described herein. The challenges presented by emerging or unusual presentations of surgical pathology secondary to HIV and AIDS in patients who are on anti-retroviral therapy provide an opportunity for research and the establishment of guidelines for the use of adjuvant chemotherapy in these patients.

Lives: Whole and Otherwise by H Nigel Thomas (review)

JulyAugust 2011 169 to domestic comicbooksfeaturing much lower production values. Thoughmanycreators worked and continue toworkin thealbum form, fewmastered it so gracefullyand tosuchentertaining effect as Jacques Tardi. This recent release from Fantagraphics, entitled TheExtraordinary Adventures ofAdeleBlanc-Sec, collects thefirst twoofTardi's Adele adventures into something that could easilybe mistaken fora graphic novel. Inthis popular storyline, Tardi explores fin-de-siecle Paris with a mixture ofgothic imagery andludicrous plottwists, propelled bya droll heroinewith a penchant for entangling her elaborate schemes with the ineptitude ofbuffoons. Firstpublishedin the 1970s, Tardi'sworkhereis truly timeless, rendering hischaracters in Herge's ligneclairestyle but embedding thebackground witha virtuoso's attention todetail. Thisisimportant becausethestorydrawsso heavily upon thesetting - Parisin the latenineteenth century - to give it a depththatallows the workto transcend its oftenridiculous plot devices.In the firststory,"PterrorOver Paris,"Adele's quest to recover stolengoods (forherown gain) becomesbound up in the unlikely appearance ofa pterodactyl thatbeginsassaulting thecitizens ofParis. While the fundamental elementsof thepterodactyl storyline arebrought toa closebythealbum's end,Adele'sowninterests continue on intothenextstory, "TheEiffel TowerDemon."Thisestablishes a precedent by whichthe readeris abletogaina senseofclosure from each individualstorywhilebeing invitedto followthe largerstory concerns on intothenext.Thereis something silly aboutthewayTardi weavespetty crime and supernaturalhoo -ha tocreate these stories, and yethis delivery makesthereader feellikehe orsheis inon thejoke, rather than thebutt ofit. It is tempting, fromthisdistance intime andplace,tohopethat Tardi'sworkhereis representative ofthegeneral quality ofFrench BD fromthisperiod.Tardi was then and remains todayoneofthegreat masters ofhisartform. Very little of thenon-Tardi bande dessinee contemporary totheAdeleBlanc-Sec stories holdsup withthesamepoise,both to his creditand our disappointment . Readersinterested in some ofthebestofwhatFrench BD hasto offer shouldseize thisopportunity tomakethisandother Tardibooks now availablein Englishpart of their library. RobVollmar University ofScience & Arts ofOklahoma HNigel Thomas. Lives: Whole andOtherwise . Toronto. TSAR. 2010.146pages. Can$20.95. isbn 978-1-894770-61-3 Inhisnewcollection ofstories, Lives: Whole andOtherwise, H NigelThomas (author ofSpirits intheDarkand Return to Arcadia) continues hisexploration ofthelivesofCaribbean immigrants livingin Montreal. Already knownforhisCaribbean-Canadian chronicling, Thomas's characters struggle toliveina hyphenated state betweenmultipleworlds - prostitute , outsider, agendapusher, homosexual .It'stohiscredit that Thomas is abletowrite skillfully aboutsuch complicated lives. In "Maude,"Thomastakesaim at multiplepowers - the Catholic Church,the Canadian government - as a powerful prostitute outlinesherproposedmemoir . Aging Nota Bene Benjamin Kwakye The Other Crucifix Ayebia Thethird novel ofBenjamin Kwakye, The Other Crucifix chronicles thelife ofprotagonist JojoBadu, a Ghanaian native studying inanelite liberal arts college in America. The novel raises important questions about identity andbelonging as it discusses both Badu's individual struggles andthemore generalized experience of the modern African man. Martin Malone The Only Glow ofthe Day New Island Based or? Rosanna Night Walker, aradio play byMalpne, this novel details thedifficult situation, of"wren woman" Rosanna Doyle, who lived intheharsh Curragh grasslands during the winter of 1863, hoping toreunite with her lover. Thehistorical events were documented byjournalist Richard Tone, who was commissioned by Charles Dickens. yetcunning, shelistskeyfigures in order toinfluence political powerto herfavor. A young, biracial woman atthecenter of"Shaky attheKnees" wrestles tofind inner strength after growing up in an unstable householdwhereherwhitemother and blackfather constantly flung racial insultsat each other.In "Graduations ," animmigrant mother andher stern employer constantly fight with theimmigrant's adolescent son;but whenhe finally receives hisgraduationcertificate , botharesurprised tofindoutthetrueresults oftheir battle. Inoneofthestrongest stories of thecollection, "Percy'sIllness," a womanrecounts her friendship witha troubled youngimmigrant, beginning withtheir sharedsexual miscueandprogressing tohisseriousmental illness stemming from an identity crisis. Ifthere's one complaint about thecollection, it's thatthe stories tendtobe tooshort. Thisis meant to be a compliment: one wishes Thomaswould spend moretime exploring thefascinating liveshe's created. Yearsfilled withrichemotionsand eventsareoften abbreviatedintoshortparagraphs . Where writers such as Edward P. Jones and DeborahEisenberg willspend pages exploring pivotalmoments in a character's life, Thomastends tocompress. As a result, hisstories leaveemotional surface dents where theymighthave leftcraters. But theseare minorcomplaints. Lives: Whole andOtherwise does an admirable jobofinvestigating liveslived insecrets andhonesty, complication andsimplicity. Armando Celayo Norwich , United Kingdom DavidFoster Wallace. ThePale King. NewYork. Little, Brown. 2011.x+ 548 pages.$27.99. isbn 978-0-316-07423-0 LateinDavidFoster Wallace's Infinite Jest (1996),seventeen-year-old Hal Incandenza contemplates a Sisphyean future: walking downhisdormitory hallway againandagain, eating and excreting "dayafter dayafter day." Day-after-day-after-day becamethe stuff ofWallace's2005Kenyon Collegecommencement address, which spokeof making a meaningful life in thefaceof working-world routine . Thataddress, we cannowsee, has a strong relation to thisunfinishednovel :routine, itsdiscontents andrewards...

Segmental testicular infarction

We report a case of segmental testicular infarction occurring in a 24-year-old African Malian man who presented with a complaint of sudden and severe left testicular pain for 4 days. Scrotal ultrasound showed a hypoechoic mass in the left testicle. The hypoechoic area demonstrated no blood flow in colour Doppler mode. The patient underwent a left testicular exploration. A partial orchiectomy was performed with complete excision of the lesion. Pathological evaluation revealed a segmental testicular haemorrhagic infarction.

Kaposi-Sarkom des Magens als ungewöhnliche Erstmanifestation einer HIV-Infektion (AIDS)

Ein aus Afrika (Liberia) stammender 47-jähriger Mann stellt sich mit seit einem Jahr bestehenden epigastrischen Schmerzen vor. In den wiederholt ambulant durchgeführten Gastroskopien zeigen sich diffuse derb-indurierte Ulzerationen im Korpus, welche auch nach erfolgreicher Helicobacter-pylori-Eradikationstherapie bestehen bleiben. Histologisch findet sich zunächst eine erosive Entzündung mit foveolärer Hyperplasie. Zur weiteren Diagnostik und Therapie wird der Patient stationär aufgenommen. Endosonografisch stellt sich im gesamten Magen herdförmig eine echo­arme Verdickung der Mukosa und Submukosa mit vermehrter Vaskularisation dar. Es erfolgt die endoskopische Rugektomie (endoskopische Schlingenabtragung). Histologisch ließ sich erst nach wiederholter Biopsie der Nachweis erbringen, dass der stets vordergründigen Erosionen ein ­mesenchymaler Tumor der Magenwand zu­grunde lag, bei dem es sich immunhistochemisch nicht um den zunächst favo­risierten GIST (gastrointestinaler Stromatumor) handelte, sondern um ein Kaposi-Sarkom, das im Zusammenhang mit der inzwischen geklärten Grunderkrankung als HIV-assoziiertes Sarkom des Magens anzusehen ist.

Testicular tuberculosis presenting with metastatic intracranial tuberculomas only: a case report

IntroductionIntracranial tuberculomas are a rare complication of tuberculosis occurring through hematogenous spread from an extracranial source, most often of pulmonary origin. Testicular tuberculosis with only intracranial spread is an even rarer finding and to the best of our knowledge, has not been reported in the literature. Clinical suspicion or recognition and prompt diagnosis are important because early treatment can prevent patient deterioration and lead to clinical improvement.Case presentationWe present the case of a 51-year-old African man with testicular tuberculosis and multiple intracranial tuberculomas who was initially managed for testicular cancer with intracranial metastasis. He had undergone left radical orchidectomy, but subsequently developed hemiparesis and lost consciousness. Following histopathological confirmation of the postoperative sample as chronic granulomatous infection due to tuberculosis, he sustained significant clinical improvement with antituberculous therapy, recovered fully and was discharged at two weeks post-treatment.ConclusionThe clinical presentation of intracranial tuberculomas from an extracranial source is protean, and delayed diagnosis could have devastating consequences. The need to have a high index of suspicion is important, since neuroimaging features may not be pathognomonic.

Discourses from without, discourses from within: women, feminism and voice in Africa

Discourses of development, education, gender, feminism and critical linguistics arrive in Africa from usually well-meaning but often opportunistic agents from other contemporary socio-political and economic contexts. Each of these forms a new layer that veils the earlier discourses and practices. Simultaneously, people in Africa are (re-)positioned as inarticulate; without literacy, literary traditions or education; living in poverty; and thus dependent upon the more ‘developed world’. Women are further positioned as subject to unmediated cultural or religious practices of the African man. Since women clearly lack voice and agency, they need ‘to be spoken for’ or require the intellectual assistance of development agencies, followed soon after by feminist scripts of the centre. These are most often in the international languages of wider communication, which for most women in Africa are at once alluring but impenetrable or undelivering of promised socio-economic or political capital. In this article, counter-hegemonic voice, agency and assertion of linguistic and other forms of citizenship demonstrate that the discourses from without lack the temporal and spatial subtlety required to gauge the business of women in Africa. Often unwittingly, they contrive instead to re-marginalise women.

The appropriation of linguistic forms for better cognitive comprehension of the Nigerian pragmatic literature

The propensity of the English language to absorb native nuances by the African writers should be seen as a worthwhile stylistic device, despite the position of English language. Its adaptability to natural flavours should therefore be aimed at the writers’ intention to reach a wider audience. This also means that the attempt by writers to decolorize through literature the polluted African culture god through the use of appropriate notions and local nuances. The technique has, however, been to put on record traditional ways of life, the peoples’ customs, communal activities such as festivals, ceremonies, rituals, myths, folktales, proverbs, music, dance, songs, etc. in order to remind the African reader about the importance of these crucial aspects of the tradition in addition to the appropriation of language use. Hence most African writings can be said to have their foundations in the cultural heritage of their various groups. through the use of what one may call technically implanted African English, African coinages, direct translation, proverbs, local idioms transfers of mother tongues, local insertions/ect. Hence it is not enough to use the sociological and residual approaches to literature. The formalist and pragmatic approaches should also be considered paramount in the writing of African literature. For the choice of diction, narrative technique and the entire pragma-aesthetic implications of the African man’s speech is important to the reader of African literature, if he is to understand the theme

<i>Penicillium marneffei</i> infection in an African man

Penicilliosis is a systemic fungal infection caused by Penicillium marneffei. The infection is most commonly seen in Southeast Asia, Southern China, Hong Kong, and Taiwan. It is rarely seen among individuals of African descent. Here, we report a case of penicilliosis in an African man from Namibia who was studying in Malaysia. He presented with multiple umbilicated papules associated with cough, fever, loss of appetite, and weight. He also had urethral discharge and admitted to unprotected sexual intercourse with multiple partners. Histopathological examination of a skin papule showed the presence of multiple 2 to 4 microm intracellular yeast cells. Culture of the papule revealed Penicillium marneffei. The serology for human immunodeficiency virus (HIV) was positive. This case illustrates the need to recognize penicilliosis in any individuals staying or travelling to Southeast Asia and the need to look for underlying HIV infection in adults with umbilicated papules.

Colonic adenocarcinoma revealing Crohn's disease: a case report

IntroductionThere is growing evidence from epidemiological studies and clinicopathological data obtained from case reports that Crohn's disease is associated with an increased risk of carcinoma of the large bowel.Case presentationA 70-year-old Arabic African man with undiagnosed Crohn's disease presented with acute abdominal obstruction due to an occlusive carcinoma of the sigmoid. At laparotomy, the colonic tumor was excised with continuity restored by end-to-end anastomosis.ConclusionThe risk of colonic carcinoma in Crohn's disease is increasing. Several case reports actually support the possibility that a genuine association between these two conditions exists.

Appendicular peritonitis in situs inversus totalis: a case report

IntroductionSitus inversus is a congenital anomaly characterized by the transposition of the abdominal viscera. When associated with dextrocardia, it is known as situs inversus totalis. This condition is rare and can be a diagnostic problem when associated with appendicular peritonitis.Case presentationWe report the case of a 20-year-old African man who presented to the emergency department with a 4-day history of diffuse abdominal pain, which began in his left iliac region and hypogastrium. After examination, we initiated a surgical exploration for peritonitis. We discovered a situs inversus at the left side of his liver, and his appendix was perforated in its middle third. A complementary post-operative thoracic and abdominal tomodensitometry revealed a situs inversus totalis.ConclusionAppendicular peritonitis in situs inversus is a rare association that can present a diagnostic problem. Morphologic exploration methods such as ultrasonography, tomodensitometry, magnetic resonance imaging, and laparoscopy may contribute to the early management of the disease and give guidance in choosing the most appropriate treatment for patients.

Plasmodium falciparum malaria and Parvovirus B19; a case of acute co-infection

BackgroundCo-infection with Plasmodium falciparum malaria and Parvovirus B19 in adults is an extremely rare occurrence and, apparently, only one case has been previously reported. Herein we describe a case of acute co-infection with severe anemia and renal failure.Case presentationThe patient was a 34-year-old African man presenting myalgia, fatigue, headache, anemia and hepatosplenomegaly. A thin peripheral smear showed Plasmodium falciparum trophozoites and the patient was treated with oral mefloquine. After an initial amelioration, fever, fatigue and myalgia reappeared, the anemia worsened and there was evidence of acute renal failure. No malarial parasites were found with a blood smear. A bone marrow aspiration showed marked erythroid hypoplasia. Parvovirus B19-specific IgM and IgG and viremia were positive. The patient was treated with steroids and blood cell transfusions. After ten days, anemia and renal failure progressively decreased. When last seen, the patient was asymptomatic and the blood values were within the normal range.ConclusionsThe diagnosis of Parvovirus B19 acute infection should be considered in any case of persistent severe anemia and/or renal failure, even in clinical conditions that are well-known causes of anemia and renal failure, such as malaria.