Man Presenting Research Articles

Vascularite leucocytoclasique et néphrite interstitielle aiguë après vaccin à SARS-CoV-2 inactivé

SARS-CoV-2 vaccines are being administered worldwide. Most side effects are mild and self-limiting with few reported cases of severe reactions. We report a case of leukocytoclastic vasculitis with acute kidney failure following aninactivated SARS-CoV-2 vaccine, unique for its dramatic visual presentation and its rapid response to treatment. This is the case of a 58years-old man presenting with fever, arthralgias and vascular purpura on his limbs associated with acute kidney failure requiring hemodialysis nine days after anti-COVID-19 vaccination. Skin biopsy revealed a leukocytoclastic vasculitis and a renal biopsy showed an acute tubulointerstitial nephritis. The vascular purpura resolved 7days after initiating treatment with prednisone but the patient remains in chronic renal failure. The analysis and investigation of the complications and adverse events induced by anti-COVID-19 vaccines could increase our understanding of the underlying pathogenesis.

Isolated sensory impairment of the ear auricle in a patient with cerebral infarction localized to the postcentral gyrus

AbstractPure sensory stroke, a well‐defined clinical entity characterized by sensory symptoms, sometimes causes atypical distributions of sensory impairment. We herein report an 85‐year‐old man presenting with isolated sensory impairment of the right‐sided ear auricle due to postcentral gyrus infarction. The somatotopic representation in the human primary somatosensory cortex that corresponds to the ear has not been elucidated. This case suggests the possible cortical area for the ear.

Cystadenoma of the seminal vesicle – Potential diagnostic pitfall: A case report and literature review

Background: Cystadenomas of the seminal vesicles are benign cystic tumours, currently classified into the group of mixed epithelial-stromal tumours (MEST). Primary tumours arising in the seminal vesicles are quite rare, benign tumours being rarer than malignant ones, with only a few cases reported in the English literature since 1944. Cystadenomas represent a potential diagnostic pitfall, as they can be clinically confused with malignant neoplasms and histologically with non-neoplastic inflammatory lesions or other cystic tumours, even malignant. Objective and methods: We report a case of a 23-year-old man presenting with a cystic mass of the seminal vesicle, clinically suspected to be a malignant neoplasm. On pathological examination, a diagnosis of cystadenoma was made. Diagnostic criteria to make a diagnosis of this tumour are questionable. Therefore, we carried out a literature review in attempt to compare clinico-pathological findings of 28 cases reported in the English literature as cystadenomas of the seminal vesicle. Results: Only 28 cases of cystadenomas of seminal vesicles were reported in the English literature. The available data show the difficulty to rule out malignancy preoperatively in a patient with a solid-cystic mass in the pelvic region, and that morphological findings observed were often reported incompletely. Conclusions: The current classification appears debatable, as well as histopathological criteria to diagnose a cystadenoma of the seminal vesicle. For the proper management of these lesions, a multidisciplinary approach is mandatory. Level of evidence: Not applicable

Fifth lumbar vertebrae solitary osteochondroma arising from the neural arch, a case report

BackgroundOsteochondromas are a benign outgrowth of bone and cartilage and one of the most common bone tumors that usually occur in long bones, with only 1–4% being located in the spine, more frequently in the cervical and upper dorsal region, and rarely the lumbar spine. Here, we report a case of lumbar spine (L5) osteochondroma arising from the neural arch.Case presentationA 30-year-old man presenting with a solid painless mass at the lower lumbar region. No neurological symptoms. Radiological examinations revealed an exophytic lesion in the fifth lumbar articular process, and the spinous process appears to be a solitary osteochondroma. Lumbar spine magnetic resonance imaging showed a bony lesion covered by a 2-mm-thick cartilaginous cap. Surgical en bloc resection of the mass was performed, and the histopathological examination confirmed the diagnosis of osteochondroma. No evidence of recurrence at the end of 4-year follow-up.ConclusionOsteochondromas are benign tumors rarely present in the spine; diagnosis can be made by the typical appearance of the cartilaginous cap over the mass in the magnetic resonance imaging. Surgical excision is the best management option.

Unusual presentation of an Epstein barr virus-negative extranodal natural killer/T cell lymphoma: A diagnostic dilemma

Extra-nodal Natural killer/T cell lymphoma (ENKTL) is a well-defined and highly aggressive form of NonHodgkin’s lymphoma with a scarcity of cases reported in literature. The most common primary site of involvement is the nasal cavity followed by skin and the gastrointestinal tract (GIT). Cutaneous involvement is a rarity. More than 95% of cases are usually in association with Epstein Barr Virus (EBV) infection. EBV negative ENKTL can be similar in clinical, pathological, and prognostic characteristics with EBV positive ENKTL. This malignancy is usually characterized by its poor prognosis irrespective of clinical stage and therapy. We describe here, a 58-year-old man presenting with multiple nodular lesions over legs and trunk, had an ileal perforation later, and was diagnosed as ENKTL on the ileal biopsy specimen. This case is being reported in view of the fulminant clinical course of the disease, simultaneous involvement of the GIT and skin without nasal or midline involvement, the usefulness of immunohistochemistry in arriving at a diagnosis, and EBV negativity which is quite rare in the Asian population.

The problem of student youth economic socialization: gender perspective


 
 
 The article deals with the topical issue of personal and professional presentation of young women and men as subjects of their economic socialization. The analysis of the empirical research results of social and psychological determinants of young women and men economic self-presentation, as well as the results of a gender audit is done. A conceptual model of economic behavior of young people in the context of patriarchal / traditional and egalitarian / democratic coordinates is presented. The ambivalence of professional self-realization of young people, in particular, the orientation of girls to economic self-affirmation in the microeconomic environment, and boys - in the macro-society, as well as the commitment of both sexes to traditional gender stereotypes is revealed. The low level of material demands of women, including professional ones, is motivated by the socialized attitude to the financial supremacy of men. In psychological portraits of young men and women who present their professional potential, and hence the economic future, more similarities than differences are observed. Young women show a higher level of subjective general and personal locus of control in professional activities and psychological efforts to defend their beliefs.
 The social roles of men and women are still largely mediated by gender stereotypes, which guide the differentiation of their economic self-expression, predetermining the life scenarios declared by the student youth and vision of material commitments. However, the realities of the economic functioning of the genders have shaped the greater personal potential of women in the development of the traditionally masculine economic space, the trigger mechanism for which will dominate the patriarchal egalitarian ideas of personal professional self-presentation. A number of socio-psychological differences between the genders as a consequence of differentiation of their gender socialization should be taken into account in the process of education of economic culture and psychocorrection of professional skills, namely: young women do not concede to men in social, varieties of communicative competence and assertiveness in achieving professional goals.
 The development of a market economy aims to increase the inclusion of young people, especially women, in professional entrepreneurship, using the potential of positive psychology. Conducting gender audit as a practical tool in the implementation of quality monitoring of gender sensitivity-insensitivity of economic socialization allows to develop and implement innovative, egalitarian and educational technologies in higher education.
 
 

A 48-Year-Old Previously Healthy Man Presenting with Acute Respiratory Distress Syndrome (ARDS), Negative Tests for SARS-CoV-2, and Positive Serology for Parainfluenza Virus Type 3 (PIV-3)

Patient: Male, 48-year-old Final Diagnosis: Acute respiratory distress syndrome (ARDS) • parainfluenza virus infection Symptoms: Dyspnea Medication: — Clinical Procedure: — Specialty: Infectious Diseases • Pulmonology Objective: Rare disease Background:Human parainfluenza viruses (PIVs) belong to the Paramyxoviridae family. PIVs cause lower respiratory tract infections in children and the elderly. In addition, severe pneumonia due to PIVs has been reported in immunocompromised adults. However, no reports have described PIV infections leading to acute respiratory distress syndrome (ARDS) in immunocompetent hosts.Case Report:A 48-year-old otherwise healthy man was transported to our hospital due to worsening dyspnea. On arrival, strong effortful breathing was observed and results of arterial blood gas analysis revealed severe hypoxia. On the basis of the clinical presentation, we intubated the patient for mechanical ventilation. However, mechanical ventilation provided inadequate oxygenation. Finally, veno-venous extracorporeal membrane oxygenation was initiated. Pneumonia was considered to be a cause of the ARDS, based on the patient’s history and blood examination. Repeated reverse transcription-polymerase chain reaction tests for the novel coronavirus were performed, and endotracheal aspirate specimens were cultured for bacteria and fungus; however, the results were all negative. On day 2, the PIV-3-specific antibody titer was elevated. Two weeks later, the PIV-3-specific antibody titer had increased 4-fold. On the basis of these results, we diagnosed pneumonia induced by PIV-3 infection.Conclusions:ARDS can occur because of severe pneumonia induced by PIV-3. In cases of unexplained severe pneumonia or ARDS, PIV infection should be included in the differential diagnosis.

Reader Response: Clinical Reasoning: A 70-Year-Old Man With Right Arm and Leg Shaking.

The authors describe a case of a 70-year-old man presenting with increased right arm flexion, right leg extension, and limb shaking ischemic events because of an atypical anterior cerebral artery (ACA) stroke in concurrence with normal vital signs.1 We agree with the concluded localization of the stroke. However, serial focal motor seizures, focal-impaired awareness seizures, or status epilepticus with acute stroke may be more likely explanations of the event than limb shaking ischemic events and an akinetic mutism resulting in seizure mimicry.

Anticoagulation may contribute to antimicrobial treatment of Lemierre syndrome: a case report

BackgroundLemierre syndrome (LS) is characterized by multisystemic infection beginning in the oropharynx, local thrombophlebitis (typically, of the internal jugular vein) and peripheral embolism. No evidence-based guidelines exist for the management of this disease, and the use of anticoagulation therapy remains particularly controversial.Case presentationA 61-year-old man presenting with left neck swelling, odynophagia, and dyspnea underwent emergency surgery and received intravenous antibiotics. The primary infection was controlled on hospital day 5, but on day 6 sudden leukocytosis and hypoxemia were observed. CT angiography revealed an intraluminal filling defect in the pulmonary artery on day 8. LS was diagnosed and anticoagulation therapy was initiated. The WBC count, which had maintained its peak values in the previous 2 days, decreased instantly after initiation, and follow-up controls showed thrombus resolution.ConclusionsOur case supports the notion that anticoagulation therapy may be a valid supplement to antimicrobial therapy in LS, especially in the presence of a possibly young thrombus as suggested by clinical worsening.

Bilateral carotid cavernous fistula after trauma: a case report and literature review

BackgroundCarotid cavernous fistula is a rare complication that is typically associated with head trauma and skull base fractures. The traumatic bilateral carotid cavernous fistula are significantly rarer.Case presentationsWe report a case of a 61-year-old man presenting with unilateral exophthalmos, swollen eyelids, conjunctival congestion, and edema etiologically associated with severe trauma. Thereafter, the patient demonstrated symptoms of contralateral oculomotor nerve injury caused by skull base fracture, such as ptosis of eyelid, dilated pupils, and eye movement disorder, and was diagnosed with bilateral carotid cavernous fistula.ConclusionsThe patient recovered after undergoing endovascular embolization of bilateral cavernous sinus fistulas. The patient demonstrated the classic symptoms of an extremely rare condition known as bilateral carotid cavernous fistula, in only one eye. Reporting and analyzing this case will help us elucidate the underlying mechanisms of this disease.

Clinical Reasoning: A 26-Year-Old Man Presenting with Insomnia

Clinical Reasoning: A 26-Year-Old Man Presenting with Insomnia

Are there differences by sex in lung cancer characteristics at diagnosis? -a nationwide study.

BackgroundLung cancer causes approximately 25% of all cancer deaths. Despite its relevance, few studies have analyzed differences by sex at the time of diagnosis in terms of symptoms, stage, age or smoking status. We aim to assess if there are differences between men and women on these characteristics at diagnosis.MethodsWe analyzed the Thoracic Tumour Registry (TTR), sponsored by the Spanish Lung Cancer Group using a case-series design. This is a nationwide registry of lung cancer cases which started recruitment in 2016. For each case included, clinicians fulfilled an electronic record registering demographic data, symptoms, exposure to lung cancer risk factors, and treatment received in detail. We compared men and women using descriptive statistics.ResultsA total of 13,590 participants took part in this study, 25.6% women. Women were 4 years younger than men (64 vs. 69), and men had smoked more frequently. Adenocarcinoma was the most frequent histological type in both sexes. Stage IV at diagnosis was 50.8% in women compared to 43.6% in men. Weight loss/anorexia/asthenia was the most frequent symptom in both sexes and there were no differences in the number of symptoms at diagnosis. There were no relevant differences in the frequency or number of symptoms by sex when non-small cell lung cancer (NSCLC) and small-cell lung cancer (SCLC) were analyzed separately. Smoking status did not appear to cause different lung cancer presentation in men compared to women.ConclusionsThere seems to be no differences in lung cancer characteristics by sex at the time at diagnosis on stage, specific symptoms or number of symptoms.

Have our strictures changed

Introduction: Urethral stricture is a common cause of lower urinary tract symptoms in middle-aged and elderly men. Its presentation and management are closely linked with its etiology and this varies across geographical regions of the world as well as overtime. We hereby review the etiology, characteristics, and presentation of men with urethral strictures in a tertiary hospital in northern Nigeria over a year and compare it with previous studies in the region. Patients and Methods: The study was a prospective study from January-December 2016, all patients with urethral strictures and who consented to the study were enrolled in the study. Data was collected using a structured study proforma and analyzed using SPSS version 23. Results: The mean age was 44.1 years with a range of 13-71 years. The age interval 30 – 39 years accounted for most of the patients 24 (28.6%). 43% of the patients had short segment urethral strictures (<2cm) while 57% had long segment strictures (>2cm). The bulbar urethra was the site of most strictures with a frequency of 65%. Strictures were found in the penile and peno-bulbar urethra in 25% and 21% respectively. Only 10% of patients studied had multiple strictures. The etiology was an infection in the majority of the patients with a frequency of 53.3%. Post-traumatic strictures occurred in 33.3% while iatrogenic and catheter –Induced strictures were seen in 7.1% and 6% respectively. 8.3% had recurrent strictures, 1.2 % had previous dilations and 2.4 % had previous DVIU. 88% had no previous intervention for the stricture before the presentation. The complications from urethral strictures observed in the patients were acute urinary retention in 83.4% urethrocutaneous fistulae in 2.4% and urosepsis in 1.2% of the patients. 11% presented with no complication. 68% of these patients were managed by excision and end to end anastomosis, 15 % had a penile pedicled flap 12%, a buccal mucosa graft urethroplasty and 5% with staged urethroplasty. Conclusion: Though there is a gradual rise in post-traumatic and iatrogenic strictures in our environment, Post-inflammatory strictures still predominate. It is however infrequently accompanied by fistulae as seen decades ago. These strictures are mostly long segments single bulbar strictures.

Short-Segment Type B Interrupted Aortic Arch Presenting With Subarachnoid Hemorrhage With Subsequent Primary Percutaneous Repair

This report describes a young adult man presenting with subarachnoid hemorrhage secondary to an intracranial aneurysm who was found to have a short-segment type B interrupted aortic arch. We describe the clinical presentation, evaluation, and management of this patient and highlight imaging findings and percutaneous repair of the aneurysm and interrupted aortic arch. (Level of Difficulty: Intermediate.)

Middle-aged man presenting with hematochezia and hematuria.

Middle-aged man presenting with hematochezia and hematuria.

Complex auditory impairment with peduncular hallucinosis due to pontine haemorrhage – a case report

Peduncular hallucinosis is a rare syndrome that develops with upper brainstem and diencephalon lesions. Patients complain of vivid hallucinations that usually occur in hypnagogic states but maintain critical appraisal. Pathological disruption of the reticular activating systems partially explains this clinical phenomenon. We report the case of a 47-year-old man presenting with peduncular hallucinosis associated with central auditory disturbance consisting of bilateral hypoacusis and left-sided paradoxical hyperacusis, secondary to a pontine haemorrhage.

Synchronous supratentorial and infratentorial oligodendrogliomas with incongruous IDH1 mutations, a case report

Infratentorial oligodendrogliomas, a rare pathological entity, are generally considered metastatic lesions from supratentorial primary tumors. Here, we report the case of a 23-year-old man presenting with a histopathologically confirmed right precentral gyrus grade 2 oligodendroglioma and a concurrent pontine grade 3 oligodendroglioma. The pontine lesion was biopsied approximately a year after the biopsy of the precentral lesion due to disease progression despite 4 cycles of procarbazine-CCNU-vincristine (PCV) chemotherapy and stable supratentorial disease. Histology and genetic analysis of the pontine biopsy were consistent with grade 3 oligodendroglioma, and comparison of the two lesions demonstrated common 1p/19q co-deletions and TERT promoter mutations but distinct IDH1 mutations, with a non-canonical IDH1 R132G mutation identified in the infratentorial lesion and a R132H mutation identified in the cortical lesion. Initiation of Temozolomide led to complete response of the supratentorial lesion and durable disease control, while Temozolomide with subsequent radiation therapy of 54 Gy in 30 fractions resulted in partial response of the pontine lesion. This case report supports possible distinct molecular pathogenesis in supratentorial and infratentorial oligodendrogliomas and raises questions about the role of different IDH1 mutant isoforms in explaining treatment resistance to different chemotherapy regimens. Importantly, this case suggests that biopsies of all radiographic lesions, when feasible and safe, should be considered in order to adequately guide management in multicentric oligodendrogliomas.

A case report of spontaneous biliary peritonitis with accessory liver lobe: rare presentation of a rare pathology

Spontaneous intrahepatic bile duct perforation with associated accessory liver lobe is an exceedingly rare condition with very few cases reported in the literature. Here we report a case of 76 years old man presenting with severe pain, abdominal distension since 3 days having jaundice and signs of peritonitis. Having undergone an exploratory laparotomy, 1 liter of bilious peritoneal fluid was seen with a perforation of left intra hepatic bile duct with a presence of an accessory lobe of liver. The gall bladder was contracted with multiple stones. Extrahepatic biliary duct was found normal intraoperatively. A cholecystectomy with resection of the accessory liver lobe was done. Post operatively patient had persistence of jaundice for which a magnetic resonance cholangiopancreatography was done, revealing a distal common bile duct calculus. Patient underwent endoscopic retrograde cholangiopancreatography with stone extraction on post operative day 10 relieving the symptoms. Patient is on regular follow up with no further complications. Awareness of such unusual occurrences is necessary for early diagnosis and instituting the appropriate treatment thereby reducing the mortality.

Clinical Reasoning: A Middle-aged Man With Progressive Gait Abnormalities

Progressive spastic paraplegia is the core symptom of hereditary spastic paraplegias (HSPs), a group of monogenic disorders characterized pathologically by degeneration of the corticospinal tract and dorsal column and leading to irreversible neurologic deficits. However, acquired causes, such as structural, vascular, inflammatory, infectious, metabolic, toxic, neurodegenerative, and iatrogenic causes, can also cause acquired spastic paraplegia. We describe the case of a middle-aged man presenting with progressive spastic paraplegia combined with ataxia and parkinsonism. No mutation of HSP genes was detected. After a comprehensive diagnostic workup, hyperintensities in the bilateral basal ganglia, mesencephalon, pons, and cerebellum on T1-weighted images were found, which demonstrated hypointensity on susceptibility-weighted imaging. Furthermore, an increased blood ammonia level and diffuse slow-wave activity in EEG were detected. The patient had a 7-year history of hypertension, alcoholic liver cirrhosis, and transjugular intrahepatic portosystemic shunt operation 2 years before the onset of spastic paraplegia symptoms. Current workup combined with patient history resulted in a diagnosis of acquired hepatocerebral degeneration and hepatic myelopathy.. This case provided a detailed diagnostic approach for progressive spastic paraplegias and exhaustive differential diagnoses of basal ganglia deposits. The take-home message from this case was that acquired causes, especially curable causes, should always be excluded first when dealing with patients with progressive spastic paraplegia.

Tertiary Syphilis Involving the Larynx: A Rare Case Report

Abstract Syphilis is one of the most common sexually transmitted diseases. In recent years, a resurgence of syphilis has been described in the literature, with a 71.4% increase in documented cases in the United States from 2014 to 2018. Tertiary syphilis remains rare in developed countries. We report a case of tertiary laryngeal syphilis in a middle-aged man presenting with cervical lymphadenopathy and an oropharyngeal mass with clinical features suggestive of malignancy. Precise pathologic examination with laboratory testing revealed the final diagnosis. We review the imaging and pathologic findings to emphasize the importance of taking syphilis into consideration in the differential diagnosis of oropharyngeal masses.