Rare Clinical Manifestation Research Articles

Rectal prolapse in a 30-year-old bladder stone male patient: A case report

Rectal prolapse occurs most commonly in children and middle-aged and elderly women and is relatively rare in young men and is occasionally caused by bladder stones. Severe rectal prolapse, bilateral hydronephrosis, and renal insufficiency caused by bladder stones are rare in a 30-year-old man. We report the case of a 30-year-old male patient with cerebral palsy who presented with a large bladder stone that resulted in severe rectal prolapse, bilateral hydronephrosis, and renal insufficiency. Following a definitive diagnosis, the bladder stone was successfully removed, and his kidney function returned to normal. We assessed the patient's nutritional status and stone composition and concluded that the main cause was malnutrition. Rectal prolapse is a rare clinical manifestation of bladder stones, particularly in young adults. Cerebral palsy patients are a vulnerable group in society because of their intellectual disabilities and communicative impairments. Accordingly, besides taking care of their daily diet, abnormal signs in their bodies should receive the doctors' attention in a timely manner.

Asystole, A Rare Cardiac Complication of Lateral Medullary Infarction: Case report and Literature Review. (P2-5.010)

<h3>Objective:</h3> We report a case of lateral medullary infarction leading to asystole, and we discuss the diagnosis, management, and prognosis of patients with this rare complication. <h3>Background:</h3> Clinical presentations of lateral medullary stroke vary. Wallenberg syndrome is the most common presentation, which includes vertigo with nystagmus, ataxia, ipsilateral sensory deficits in the face, bulbar muscle weakness, and ipsilateral Horner’s syndrome. The nucleus tractus solitarius, the dorsal vagal nucleus, and the nucleus ambiguous in the lateral medulla oblongata play a critical role in autonomic regulation and have centers for respiratory, cardiac, and vasomotor reflexes. Despite this, cardiac arrhythmias such as asystole are a rare clinical manifestation of lateral medullary stroke. <h3>Design/Methods:</h3> Case report and literature review. <h3>Results:</h3> A 64-year-old man with hypertension, previously involved in a motor vehicle accident, presented with acute onset dysphagia, left facial droop, and left eye ptosis. CT of the head did not show any acute stroke or hemorrhage. CT angiography of the head and neck showed left vertebral artery (V3/V4 segment) occlusion. He received IV thrombolysis. Post thrombolysis, he had bradycardia evolving to asystole and brief cardiac arrest. MRI of the brain revealed acute left posterior lateral medullary stroke and MR angiography showed left vertebral artery dissection. Cardiac work-up was unrevealing, and he eventually required placement of a dual-chamber pacemaker. Given the absence of respiratory factors and structural heart disease, the bradycardia and asystole were attributed to the lateral medullary stroke. <h3>Conclusions:</h3> Despite the recognized role of the lateral medulla in autonomic regulation, cardiac arrhythmias are rarely associated with lateral medullary infarction. Precise mechanisms are yet to be elucidated, but it remains important to recognize them as a potential complication of this stroke. <b>Disclosure:</b> Dr. Gutierrez Quiceno has nothing to disclose. Dr. Gowda has nothing to disclose. Dr. Kakadia has nothing to disclose.

CHANTER Syndrome: A Rare Cause of Encephalopathy and Ischemic Lesions (P2-5.017)

<h3>Objective:</h3> To present a rare case of Cerebellar Hippocampal and Basal Nuclei Transient Edema with Restricted Diffusion (CHANTER) Syndrome. <h3>Background:</h3> CHANTER syndrome is a recently recognized constellation of clinical and radiologic findings. The clinical features include acutely depressed consciousness with obstructive hydrocephalus secondary to cerebellar edema. MRI findings are restricted diffusion in the cerebellar cortex, hippocampi, and basal nuclei. CHANTER is distinguished from ischemic stroke by lack of distribution in a specific vascular territory or vascular occlusion present on angiographic imaging. Etiology may be a primary metabolic or mitochondrial failure of the gray matter with anoxic injury precipitated by opiates or other drugs of abuse. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> A 70-year-old right-handed hypertensive woman with HIV, end-stage renal failure, and lymphoma in remission was in respiratory distress. Seizures of unclear duration were noted on ambulance arrival and midazolam was administered. She was intubated and loaded with levetiracetam for status epilepticus. Norepinephrine was given during a hypotensive episode. Neurological examination was remarkable for lack of motor response to noxious stimuli and present brainstem reflexes consistent with coma. Opiates were detected in urine. MRI brain showed multiple small foci of restricted diffusion involving bilateral cerebellar hemispheres, hippocampi, basal ganglia, and in the right parietal cortex. MR angiography of the head and neck was normal. Video EEGs showed severe diffuse slowing, generalized periodic discharges that became blunted with triphasic morphology after lorazepam and levetiracetam administration. Cardiac monitoring and echocardiogram were unremarkable. Her alertness improved and withdrew minimally all extremities to painful stimuli. She was discharged to a long-term skilled nursing facility. <h3>Conclusions:</h3> This case highlights a rare clinical manifestation suggestive of CHANTER syndrome. Unlike other cases previously described, the cerebellar lesions were not sufficiently large to cause hydrocephalus. However, the clinical recovery was very limited. Status epilepticus and transient hypotension may have played a role in the poor recovery. <b>Disclosure:</b> Dr. Hiana has nothing to disclose. Dr. Soh has nothing to disclose. Dr. Marchidann has stock in Eli Lilly. Dr. Marchidann has stock in Pfizer. Dr. Marchidann has stock in Merck. Dr. Marchidann has stock in Illumina. Dr. Marchidann has stock in Aeterna Zentaris. Dr. Marchidann has stock in Abbot. Dr. Marchidann has received publishing royalties from a publication relating to health care. Dr. Marchidann has received publishing royalties from a publication relating to health care.

Metabolic Stroke as a Clinical Manifestation of Zhu-Tokita-Takenouchi-Kim (ZTTK) Syndrome: A Case Series (P14-9.010)

<h3>Objective:</h3> To report two individuals with Zhu-Tokita-Takenouchi-Kim (ZTTK) syndrome who presented with a metabolic stroke, which has rarely been described as a clinical manifestation of this syndrome. <h3>Background:</h3> ZTTK syndrome is a rare condition caused by a loss-of-function mutation in the <i>SON</i> gene, which is located in chromosome region 21q22, and there are approximately 60 known cases.¹ The <i>SON</i> gene is involved in cellular and mitochondrial processes, but much is still unknown.^2,5,6 The commonly associated clinical manifestations of this condition are global developmental delay, dysmorphic facial features, musculoskeletal abnormalities, abnormal brain MRI, hypotonia, eye anomalies, seizures, and short stature.¹ Here we report two individuals who presented to our institution with a metabolic stroke, which has rarely been described previously other than a single reported case.³ As ZTTK syndrome remains a rare disease, reports which expand the clinical phenotype will help inform clinicians of previous findings, diagnoses, and management strategies. <h3>Design/Methods:</h3> Case series <h3>Results:</h3> Two female children, 11 and 12-year-old, presented very similarly to our institution with sudden left hemiparesis and right gaze preference. Both girls carried a diagnosis of ZTTK syndrome based on their clinical characteristics and genetic testing. Both girls were found to have a metabolic stroke on their MRI brain after extensive workup. The 12-year-old girl was treated with L-arginine, levocarnitine, and ubiquinone, which has been used to treat metabolic strokes in mitochondrial disorders. The 11-year-old girl did not receive any particular treatment for stroke. Both individuals returned to their previous functional baseline within two weeks. <h3>Conclusions:</h3> Metabolic stroke is a rare clinical manifestation of ZTTK syndrome. It is important to recognize metabolic stroke as an etiology of sudden hemiplegia in ZTTK syndrome as it carries clinical and therapeutic implications. Further studies are needed to determine the cause of metabolic stroke in this syndrome. <b>Disclosure:</b> Dr. Morales has nothing to disclose. Ms. El-said has nothing to disclose. Dr. Rossi has nothing to disclose. Dr. Longani has nothing to disclose.

Rare clinical forms of chronic brucellosis

Brucellosis is the most common and severe infectious disease in the group of zoonotic infections. This disease is characterized by a multisysitemic lesion. The difficulties in diagnosing this disease are associated with the pathogenetic features of the development of brucellosis, namely prolonged bacteremia, which causes the development of secondary foci of infection in various organs and tissues, manifested by a variety of clinical manifestations, the erasure of symptoms of the disease, as well as the appearance of rare clinical forms of brucellosis.One of the rare clinical manifestations of chronic brucellosis is the defeat of the cardiovascular system and the defeat of the nervous system. According to the latest literature data, cardiovascular complications of brucellosis in humans account for only 3%, but are the main cause of death in 80%. Damage to the nervous system is rare, with a registered frequency of 3% to 13%.Clinical manifestations of neurobrucellosis are diverse and can mimic many other neurological diseases. The most common manifestations of brucellosis may be meningitis, meningoencephalitis. Despite the rare occurrence, these forms of the disease are severe, lead to disability and mortality with late diagnosis. The article presents clinical cases of brucellosis with lesions of the heart and central nervous system.

Laryngeal edema following remimazolam-induced anaphylaxis: a rare clinical manifestation

BackgroundRemimazolam is an ultra-short-acting intravenous benzodiazepine, which has been used as sedative/anesthetic in procedural sedation and anesthesia. Although peri-operative anaphylaxis due to remimazolam has been reported recently, the spectrum of the allergic reactions is still not fully known.Case presentationWe describe a case of anaphylaxis following remimazolam administration in a male patient undergoing colonoscopy under procedural sedation. The patient presented complex clinical signs including airway changes, skin symptoms, gastrointestinal manifestations and hemodynamic fluctuations. Different from other reported cases, laryngeal edema was the initial and main clinical feature of remimiazolam-induced anaphylaxis.ConclusionsRemimazolam-induced anaphylaxis has a rapid onset and complex clinical features. This case reminds anesthesiologists should be particularly alert to the unknown adverse reactions of new anesthetics.

Wandering Spleen: A Rare Condition with Splenic Torsion and Infarction in an Elderly Patient

Ectopic spleen or wandering spleen is an uncommon presentation in which the spleen's anatomical location is different from its fixed position in the left upper quadrant of the abdomen, due to the absence of the typical peritoneal attachments; the spleen is more mobile inside the abdomen. Congenital or acquired conditions are the cause of this anomaly, which could ultimately result in torsion and splenic infarction. Less than 0.2% of wandering spleen cases are reported annually, making it a rare clinical manifestation. Splenic vascular pedicle torsion can result in complications that can cause symptoms of an acute abdomen as a result of ischemic necrosis of the spleen. Computed tomography and ultrasonography with Doppler or CEUS are essential for accurate diagnosis due to the vague clinical signs and potential complications. This case involves a 70-year-old elderly woman who complained of extreme abdominal pain and vomiting for three days. On physical examination, a tense right lower quadrant lump was palpated, when she visited the emergency room. An urgent CT scan was done for the acute abdomen which revealed torsion of the splenic pedicle in a wandering spleen.

Brown tumor of the mandible - a possible clinical manifestation of primary hyperparathyreoidism

Introduction. One of the possible manifestations of primary hyperparathyroidism (PHPT) is the appearance of a benign bone tumor. We hereby present a case of a young woman whose first clinical manifestation of PHPT was a brown tumor of the mandible. Case report. A 27-year-old female patient was hospitalized at the Clinic for Endocrinology, Diabetes, and Metabolic Diseases due to problems occurring in the form of nausea, exhaustion, the feeling of suffocation, dysphagia, pain in the right ear and the right half of the cheeks, with suspected PHPT. Initial laboratory findings pointed out the high levels of parathyroid (PT) hormone (PTH) and calcium (Ca2+) ions, low levels of vitamin D, and increased parameters of bone metabolism with signs of osteopenia. Cone beam computed tomography revealed the presence of bilateral radiolucent lesions of the mandible. Scintigraphy verified a retrosternal hot focus consistent with PT adenoma. After parathyroidectomy was performed, there was a normalization of PTH values, bone metabolism parameters, and the Ca2+ values. Four months after parathyroidectomy, a significant regression of the mandibular tumefaction was confirmed, clinically and radiologically. Conclusion. Brown tumors are rare first clinical manifestations of PHPT. Owing to their histological similarities with other giant-cell lesions (GCLs), definitive diagnosis is sometimes difficult and is based on a correlation of pathohistological, radiological, and laboratory findings. Due to the spontaneous regression of bone lesions after treatment of the basic cause of PHPT, brown tumors should be considered in the differential diagnosis of any GCLs in order to avoid unnecessary surgical procedures.

Holestatski virusni hepatitis A praćen upornim svrabom koji je uspešno lečen kombinacijom sistema za recirkulaciju molekularnih adsorbenata i kortikosteroida - prikaz slučaja

Introduction. Hepatitis A virus is a major cause of acute viral hepatitis worldwide, with approximately 1.5 million cases annually. Clinical manifestations of the hepatitis A virus infection range from asymptomatic to acute liver failure. Cholestatic viral hepatitis A is a rare clinical manifestation characterized by a prolonged course, refractory pruritus, imminent acute liver failure and generally good prognosis. The treatment of pruritus in cholestatic viral hepatitis A can be challenging because a response to conventional therapy is limited. Case report. We present the effects of a combination of pulse doses of prednisolone and two cycles of MARS (Molecular Adsorbent Recirculating System) in the treatment of a young female patient with cholestatic viral hepatitis A. This treatment option significantly reduced the duration of the disease and the intensity of pruritus and led to full recovery of the patient and normalization of laboratory parameters of cholestasis. Conclusion. This treatment combination has proven to have significant and lasting effects with no relapse of pruritus. Low doses of corticosteroids administered for a short time reduce the risk of side effects. The importance of vaccination of international travellers should be also pointed out here.

Moebius syndrome: A case report from Indonesia

Introduction: Moebius syndrome is a neurological condition characterized by congenital facial uniplegia or diplegia due to peripheral type facial nerve paresis and lateral eye movement paresis due to abducens nerve paresis resulting in strabismus. Incidence of Moebius syndrome is 0.27/100,000 live births and often associated with abortion attempts. The following is a case report of Moebius syndrome in Indonesia of a 14-year-old girl with a history of attempted abortion by her mother. Case Report: A 14-year-old girl came with facial muscle complaints in the form of difficulty in raising both eyebrows and closing the mouth since birth. These complaints cause difficulty in eating and drinking. Complaints accompanied by abnormality of the limbs and the number of finger in toes and hands. The patient’s mother had a history of attempted abortion by taking the chemical disinfectant chloroxylenol 4.8% and other drugs. There was bilateral facial nerve paresis and cognitive impairment. On examination of brain magnetic resonance imaging (MRI), it was within normal limits. The patient was planned for physiotherapy and consulted to orthopedics. Conclusion: Moebius syndrome is a collection of rare neurological clinical manifestations in children. Exposure to chemicals during pregnancy can be the etiology of this syndrome in addition to genetics. Management of Moebius syndrome is limited to supportive and symptomatic approach.

Limb-shaking transient ischemic attack in posterior circulation ischemia: a case report

Limb-shaking transient ischemic attack (LS-TIA) is a rare clinical manifestation of steno-occlusive carotid lesions. Reports of LS-TIA caused by posterior circulation ischemia are rare. Here, the case of a 56-year-old male patient with a history of epilepsy, who presented with dizziness, nausea and vomiting, is reported. Initial brain magnetic resonance imaging (MRI) indicated no signs of acute ischemia, and the patient's symptoms had not relieved despite drug administration to treat dizziness. During a vestibular function test on the next day, he developed sudden left-limb shaking without disturbance of consciousness or facial twitching. Considering a seizure, an anti-epileptic drug was administered, but no improvement was observed. Eight hours later, the patient experienced left-limb paralysis, and re-examination of the MRI indicated brainstem infarction. The patient recovered well with antiplatelet and antiatherosclerotic therapy. While LS-TIA is a rare manifestation of TIA of the carotid arterial system, posterior circulation ischemia may also manifest as LS-TIA. If a patient presents with limb shaking due to postural changes despite a history of epilepsy, LS-TIA should be highly suspected.

MACULAR EDEMA AS UNUSUAL PRESENTATION OF NON-ARTERITIC ISCHEMIC OPTIC NEUROPATHY (NAION)

Introduction: Non-arteritic Ischemic Optic Neuropathy is the most common type of ischemic optic neuropathy. Nearly half of NAION patients presented with 20/30 or better visual acuity. Central vision is often preserved relative to the visual field loss.Macular edema in NAION patient is rare, and its occurrence may confuse to other disease and lead to unnecessary treatment. Case Report: We identified a NAION patient presented with macular edema. The patient age was above 40 and had diabetes mellitus (DM). He had clinical findings consistent with NAION with poor visual acuity at the early presentation. Optical coherence tomography examination was performed, and the patient had prominent subretinal fluid. Intravitreal antiVEGF injection was done on our patient and he showed a significant improvement of macular edema. Discussion: Macular edema is a rare clinical manifestation that may contribute a visual deterioration in NAION. The incidence of macular edema in NAION patients is difficult to measure since OCT of macula is not routinely performed. In our report, we encountered a case of NAION complicated by macular edema that underwent a different approach in therapy. Spontaneous regression of subretinal fluid was seen during observation without any treatment given. Our patient achieved a stable visual acuity and visual field defect. This finding is under the literature that spontaneous recovery will be observed during the natural course of acute NAION. Conclusion: Macular edema is an unusual but self-limiting presentation of NAION. Therefore, a comprehensive examination is needed to prevent any unnecessary treatment.

Case report: Undifferentiated sarcoma with multiple tumors involved in Lynch syndrome: Unexpected favorable outcome to sintilimab combined with chemotherapy

Patients with Lynch syndrome are at an increased risk of developing simultaneous or metachronous tumors, while sarcomas have been occasionally reported. Sarcomas are generally not considered part of the common Lynch syndrome tumor spectrum. However, more and more studies and case reports suggested that sarcoma could be a rare clinical manifestation of Lynch syndrome, leading to new treatment strategies for sarcoma. We report the case of a 74-year-old male patient with Lynch syndrome who had rectal mucinous adenocarcinoma and prostate adenocarcinoma and then developed undifferentiated sarcoma of the left neck two years later. Mismatch repair deficiency (dMMR) was confirmed by immunohistochemical staining for the mismatch repair proteins MSH2, MSH6, MLH1 and PMS2. The result of polymerase chain reaction (PCR) microsatellite instability (MSI) testing of sarcoma showed high-level microsatellite instability (MSI-H). Additionally, a pathogenic germline mutation in MSH2 (c.2459-12A>G) was detected by next-generation sequencing (NGS). Taking into account HE morphology, immunohistochemical phenotype, MSI status, NGS result, medical history and germline MSH2 gene mutation, the pathological diagnosis of left neck biopsy tissue was Lynch syndrome related undifferentiated sarcoma with epithelioid morphology. The patient has been receiving immunotherapy (sintilimab) combined with chemotherapy (tegafur, gimeracil and oteracil potassium capsules) and currently has stable disease. We also reviewed the literature to understand the association between sarcoma and Lynch syndrome. Sarcoma may now be considered a rare clinical manifestation of Lynch syndrome. Attention and awareness about the association between Lynch syndrome and sarcoma need to be increased. Therefore, timely detection of MMR proteins and validation at the gene level for suspicious patients are the keys to avoiding missed or delayed diagnosis and to identifying patients suited for immunotherapy, which may also help to provide appropriate genetic counseling and follow-up management for patients.

Trombosis portal en Síndrome antifosfolipídico: Reporte de caso

Antiphospholipid syndrome (APS) is a systemic autoimmune disorder characterized by arterial, venous, or small vessel thrombosis and recurrent early pregnancy loss, fetal loss, or pregnancy morbidity in the context of persistent antiphospholipid antibodies. Characterized by the development of multiple thrombotic manifestations, simultaneously or within a short period of time; being portal vein thrombosis (DVT) a rare and serious clinical manifestation and a predictor of poor prognosis.The case of an elderly patient with abdominal pain and portal vein thrombosis associated with APS with antithrombotic treatment and analgesics of favorable evolution is presented.

CLOT IN TRANSIT: THE ROLE OF POINT-OF-CARE ULTRASOUND IN EARLY DIAGNOSIS AND IMPROVED OUTCOMES

CLOT IN TRANSIT: THE ROLE OF POINT-OF-CARE ULTRASOUND IN EARLY DIAGNOSIS AND IMPROVED OUTCOMES

Total spleen calcification - a rare clinical manifestation in systemic lupus erythematosus

Splenomegaly, infarction, spontaneous rupture and hyposplenism are among the frequently manifestations of splenic involvement in systemic lupus erythematosus (SLE) patients. Exceptionally, extensive splenic calcifications are found in SLE. This aspect is due to the periarterial thickening in an “onion-skin” model. Discrete, small, circular and diffuse nodules that are distributed at the level of the parenchyma, but that are missing at the capsular and subcapsular level, are the main characteristics of these calcifications. The aim of this report is to present the case of a SLE patient with this rare splenic calcifications association.

Macular Edema as Unusual Presentation of Non-Arteritic Ischemic Optic Neuropathy (NAION)

Introduction: Non-arteritic Ischemic Optic Neuropathy is the most common type of ischemic optic neuropathy. Nearly half of NAION patients presented with 20/30 or better visual acuity. Central vision is often preserved relative to the visual field loss. Macular edema in NAION patient is rare, and its occurrence may confuse to other disease and lead to unnecessary treatment.&#x0D; Case Report: We identified three NAION patients presented with macular edema. The patients' age was above 40 and had diabetes mellitus (DM). Our patients had clinical findings consistent with NAION with poor visual acuity at the early presentation. Optical coherence tomography examination was performed, and all patients had prominent subretinal fluid. Intravitreal anti-VEGF injection was done on our first patient and no treatment was given to our second and third patient. All patients showed a significant improvement of macular edema.&#x0D; Discussion: Macular edema is a rare clinical manifestation that may contribute a visual deterioration in NAION. The incidence of macular edema in NAION patients is difficult to measure since OCT of macula is not routinely performed. In our report, we encountered three cases of NAION complicated by macular edema that underwent a different approach in therapy. Spontaneous regression of subretinal fluid was seen during observation without any treatment given. Our patients achieved a stable visual acuity and visual field defect. This finding is under the literature that spontaneous recovery will be observed during the natural course of acute NAION.&#x0D; Conclusion: Macular edema is an unusual but self-limiting presentation of NAION. Therefore, a comprehensive examination is needed to prevent any unnecessary treatment.

Treatment and Prevention of Anti-Glomerular Basement Membrane Disease a Tertiary Care Hospital Study

Patients with anti-glomerular basement membrane (anti-GBM) disease have Type IV collagen antigens in their glomerular and alveolar basement membranes. GN or alveolar bleeding develops quickly. Genetically vulnerable people may be activated by environmental factors. There isn't enough evidence to indicate a causal relationship between SARS- cov-2 and COVID-19. One in ten crescentic kidney disease patients has anti-GBM sickness. Early identification of circulating antibodies, increased awareness of rare and challenging clinical manifestations, and immunosuppressive and plasma exchange therapy have improved patients' prognoses. Anti-GBM disease is rare, but new medications and treatments are coming.

Multiple Myeloma with Histiocytosis.

Myeloma is a disease characterized by abnormal clonal plasma cells that produces paraprotein. The coincidence of myeloma and histiocytosis is a rare clinical manifestation. This case report describes a 50-year-old female with back pain, anemia, increased globulin and hypercalcemia due to multiple myeloma. Bone marrow cytomorphology revealed an increased number of plasmocytes and histiocytosis.

Cardiac Diseases During Systemic Inflammatory Diseases in the Internal Medicine and Medical Oncology Department of NTHC-HKM of Cotonou

Systemic inflammatory diseases are characterized by multivisceral involvement at some point in their evolution. This involvement can concern almost all organs, including the heart. Each systemic condition has a unique cardiac expression. The target of this study is to determine the frequency of cardiac involvement in systemic inflammatory diseases. This study is a cross-sectional, descriptive, and analytical study that was conducted within 07 months. The aim was to screen 23 patients followed for systemic inflammatory diseases for cardiac involvement. The mean age was 44 (±12) years old with a minimum of 24 and a maximum 64 years. Most of patients were women with a sex ratio (M/F) of 0.09. An echocardiographic abnormality was found in 26.1% of patients and 73.1% had an ECG abnormality. They included left atrial hypertrophy (43.4%), left ventricular hypertrophy (30.4%), right axial deviation (26.1%), low voltage (21.7%), right atrial hypertrophy (8.6%), S1Q3 appearance (8, 6%), pulmonary hypertension (8.6%), repolarization disorders (8.6%), sinus tachycardia (8.6%), middle tricuspid insufficiency (4.3%), middle pulmonary insufficiency (4.3%), and pericarditis (4.3%). Patients with systemic inflammatory diseases had cardiac disorders with rare clinical manifestations but with an incidental discovery either on ECG or on cardiac echodoppler. Hence, a systematic cardiac exploration in these patients was essential.