Rare Symptom Research Articles

Clinical features of Omicron variant infection in 445 patients with coronavirus 19 disease.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) can mutate frequently and many new strains have emerged thus far. The clinical and epidemiological characteristics differ with each dominant strain. Obtain an understanding of the clinical characteristics of patients infected with the Omicron variants of the SARS CoV-2. Retrospective cohort SETTINGS: Teaching hospital in China. Data on sociodemography, signs/symptoms, hospital stay, viral shedding period, comorbidities, treatment options and final outcome were retrieved from hospital electronic medical record. We collected nasopharyngeal samples, laboratory data, and clinical data from patients admitted to the hospital with SARS CoV-2. Clinical characteristics of the patients infected with Omicron variant of SARS CoV-2. 445 patients RESULTS: The median age was 43.0 years with a range from 2 to 75 years. Two-thirds of the participants were male and one-third were female. Almost half of the participants (51.9%) had no symptoms, whereas 48.1% had at least one symptom. Of symptomatic patients, 26.7% had mild symptoms and 21.3% had moderate symptoms. No patients were admitted with severe or critical symptoms. All patients discharged from the hospital after complete recovery without any serious complications or death. The most common symptom was cough followed by sore throat and fever. Less common symptoms were having sputum, stuffy nose, and muscle pain. Rare symptoms were weakness, headache, diarrhea, hemoptysis and nausea/vomiting. All patients had mild to moderate symptoms. Shortness of breath was not a common symptom among the study group. No patients needed invasive oxygen therapy in this cohort. Single center and retrospective design. None.

Neurobrucellosis Presenting With Isolated Intracranial Hypertension (P3-10.005)

<h3>Objective:</h3> To indicate that isolated intracranial hypertension can be the only symptom of neurobrucellosis. <h3>Background:</h3> Neurobrucellosis is a frequent infection in the Mediterranean countries but it is under-diagnosed because of its clinical polymorphism. Clinical manifestations are very different in relation to meningeal, parenchymal or vascular involvement. Isolated intracranial hypertension is a rare symptom. <h3>Design/Methods:</h3> We report the case of a young man with neurobrucellosis who presented with isolated intracranial hypertension without other systemic symptoms of brucellosis. <h3>Results:</h3> A 32-year-old man with no medical history was referred to our department for headache and binocular diplopia evolving for 1 month. There was no history of drug use, consumption of raw milk, or weight gain or loss. Clinical examination showed bilateral stage II papilledema with a left VI nerve palsy. The patient had no meningeal syndrome or organomegaly. There was no fever. An intracranial hypertension was suspected and the patient was hospitalized. Cerebral magnetic resonance imaging was normal. The opening cerebrospinal fluid (CSF) pressure was 45 cmH₂O. Microscopic examination of the CSF revealed 113 cells/mL with lymphocytic predominance and negative culture. Protein level was 1.19 g/l, glucose level was 0.54 mmol/l (ratio at 0.09). Wright test was positive at 1/5120 titer in serum. The patient was diagnosed with neurobrucellosis and was treated with Doxycycline and Rifampicin with good clinical evolution. <h3>Conclusions:</h3> The incidence of neurobrucellosis ranges between 1.7–10%. Chronic meningitis with intracranial hypertension has been rarely described as the initial manifestation of neurobrucellosis. The evolution is favorable in more than 50% of cases after appropriate antibiotic therapy. Early diagnosis and appropriate management are important. <b>Disclosure:</b> Nesrine Charfi has nothing to disclose. Sawsan Daoud has nothing to disclose. Nadia Bouattour has nothing to disclose. Salma Sakka has nothing to disclose. khadija maalla has nothing to disclose. mariem damak has nothing to disclose. Prof. Mhiri has received personal compensation for serving as an employee of Hikma. Prof. Mhiri has received personal compensation for serving as an employee of Sanofi Genzyme. Prof. Mhiri has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Prof. Mhiri has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche.

Orthostatic Hemifacial Spasm, Trigeminal Paresthesias, and Pulsatile Tinnitus in the Setting of Idiopathic Intracranial Hypertension (P11-4.003)

<h3>Objective:</h3> N/A <h3>Background:</h3> Hemifacial spasm and trigeminal paresthesias are rarely seen in idiopathic intracranial hypertension (IIH), with no previous documentation of their cooccurrence in this condition. In this unique case, we treated a patient with IIH with symptoms of hemifacial spasm, trigeminal paresthesias, and pulsatile tinnitus. Symptoms appeared only upon standing and remitted with sitting. <h3>Design/Methods:</h3> A 46 year old woman with a six year history of IIH presented with pulsatile tinnitus, painless hemifacial spasm, and paresthesias isolated to her right lower face (V3) that occurred exclusively when moving from a sitting to a standing position. Episodes occur several times daily, last for 60 seconds, and remit immediately upon sitting. VA was 20/20; optic discs were swollen, confirmed by optical coherence tomography. Head MRI and IAC MRI with special attention to the posterior fossa were unremarkable. <h3>Results:</h3> N/A <h3>Conclusions:</h3> Orthostatic hemifacial spasm, trigeminal paresthesias, and pulsatile tinnitus together in the setting of IIH have not been previously reported. This case adds to the spectrum of occult symptoms occurring in IIH, thus improving rare symptom recognition and patient outcomes. The dynamics of anatomic shift and volume redistribution in the context of these symptoms will be discussed. <b>Disclosure:</b> Ms. Patrick has nothing to disclose. Miss Kleinbart has nothing to disclose. Miss Gilbert has nothing to disclose. Mr. Postma has nothing to disclose. Miss Trokthi has nothing to disclose. Charles Maitland has nothing to disclose.

Homoeopathy in the management of headache and migraine – A narrative review

Background: Homeopathy appears scientifically implausible and is one of the most contentious CAM therapies. The purpose of this review is to summarise the treatment effects of homoeopathy in migraine. There will be no disease if there is no definite cause. The disease's nature will follow the cause, and the effect will make the person sick. The effects and the sick person will be treated in a straightforward and understandable manner. Migraine is the result of the cause, and the well-known Homoeopathic medicine can produce better results on this ailment when used in conjunction with the presence of the symptoms. This study is to search the well-known, rare medicine and its efficacy in such condition which is described in different literature as well as different research study. There are wide ranges of Homoeopathic medicines considered as rare remedies on the basis of paucity of symptoms and large number of medicine with rare symptoms representing the uniqueness when selected on the basis of totality. During practising Homoeopathic physician requires well-known medicine as well as rare medicine that helps to management of migraine.&#x0D; Methods: Relevant studies were identified by a comprehensive literature search in electronic databases, reference list of relevant papers, and contacts with experts. Randomized controlled trials comparing individualized homeopathic treatment strategy with placebo were eligible. Information on patients, methods, interventions, outcomes, and results was extracted in a standardized manner and quality was assessed using a checklist and scoring system.&#x0D; Results: Six papers met criteria for inclusion. Three out of the six papers studied migraine headache, two studied cervicogenic and tension type headache, and one included all types of headaches. Four studies were randomized clinical trials, and two were prospective observational studies. Validity scores ranged from 25.0% to 63.4%. Homeopathy was superior to placebo in one randomized clinical trial and equal to placebo in three randomized trials. In no study was homeopathy less effective than placebo in treating headache, or harmful. Two prospective observational studies demonstrated improvement in patients receiving homeopathic care.&#x0D; Conclusion: There is insufficient evidence to support or refute the use of homeopathy for managing tension type, cervicogenic, or migraine headache. The studies reviewed possessed several flaws in design. Given these findings, further research is warranted to better investigate the effectiveness of homeopathic treatment of headaches. (J Chiropr Med 2004; 3:45–52)

The TSC2 c.2742+5G>A variant causes variable splicing changes and clinical manifestations in a family with tuberous sclerosis complex.

Tuberous sclerosis complex (TSC) is a genetic, variably expressed, multisystem disease characterized by benign tumors. It is caused by pathogenic variants of the TSC complex subunit 1 gene (TSC1) and the TSC complex subunit 2 gene (TSC2). Genetic testing allows for early diagnosis, genetic counseling, and improved outcomes, but it did not identify a pathogenic variant in up to 25% of all TSC patients. This study aimed to identify the disease-causing variant in a Han-Chinese family with TSC. A six-member, three-generation Han-Chinese family with TSC and three unrelated healthy women were recruited. A comprehensive medical examination, a 3-year follow-up, whole exome sequencing, Sanger sequencing, and segregation analysis were performed in the family. The splicing analysis results obtained from six in silico tools, minigene assay, and patients' lymphocyte messenger RNA were compared, and quantitative reverse transcription PCR was used to confirm the pathogenicity of the variant. Two affected family members had variable clinical manifestations including a rare bilateral cerebellar ataxia symptom. The 3-year follow-up results suggest the effects of a combined treatment of anti-epilepsy drugs and sirolimus for TSC-related epilepsy and cognitive deficits. Whole exome sequencing, Sanger sequencing, segregation analysis, splicing analysis, and quantitative reverse transcription PCR identified the TSC2 gene c.2742+5G>A variant as the genetic cause. This variant inactivated the donor splice site, a cryptic non-canonical splice site was used for different splicing changes in two affected subjects, and the resulting mutant messenger RNA may be degraded by nonsense-mediated decay. The defects of in silico tools and minigene assay in predicting cryptic splice sites were suggested. This study identified a TSC2 c.2742+5G>A variant as the genetic cause of a Han-Chinese family with TSC and first confirmed its pathogenicity. These findings expand the phenotypic and genetic spectrum of TSC and may contribute to its diagnosis and treatment, as well as a better understanding of the splicing mechanism.

Clinical Features of Pituitary or Parasellar Tumor Onset with Cranial Nerve Palsy: Surgical Intervention Considerations

This study aimed to clarify the symptoms of pituitary or parasellar tumor onset with cranial nerve palsy (CNP) and to improve our knowledge of this rare symptom and its most appropriate treatment. Among 1281 patients with pituitary or parasellar tumors surgically treated from 2003 to 2020, 30 cases (2.34%; 15 men and 15 women; mean age: 55.6years, range: 6-83years) first presenting with CNP were reviewed to evaluate the neurological symptoms, histological diagnosis, interval from onset to surgery, and time before complete CNP recovery. Pathological diagnoses comprised 17 pituitary adenomas, including 10 pituitary apoplexies and 4 adrenocorticotropic hormone-positive adenomas, and 13 other tumors, including 3 chordomas, 2 xanthogranulomas, 2 malignant lymphomas, 2 metastatic tumors, 1 Rathke cleft cyst, 1 plasmacytoma, 1 craniopharyngioma, and 1 neuroendocrine carcinoma. The mechanisms causing CNP were pituitary apoplexy (n= 10), cranial nerve compression or involvement (n= 17), and inflammatory changes (n= 9). As the first manifestation, 20 (66.7%) patients presented with oculomotor nerve palsy, 2 (6.7%) with trochlear nerve palsy, and 13 (43.3%) with abducens nerve palsy. Full recovery of CNP was obtained in 25 patients (83.3%) after surgery alone and in 2 patients (6.7%) after adjuvant therapy. Early surgery provided no significant difference in full recovery rates although it reduced the time to reach full recovery. It is critical to determine the mechanisms of CNP and intervene surgically to improve symptoms, shorten the duration of the disorder, prevent relapses, and obtain the correct pathological diagnosis to select the proper adjuvant therapy.

Stubborn Cough; A Rare Symptom Due to Pacemaker Lead Perforation

Cardiac perforation by pacemaker (PM) lead is a rare but potentially life-threatening complication. The clinical presentation is highly variable. Patients may be asymptomatic or present with chest pain, dyspnea or tamponade. In this case, we report a patient with pacemaker implantation who developed a stubborn cough secondary to lead perforation.

Implementing Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome management system by hospital pharmacists in Samutsakhon Hospital, Thailand.

To study the process of implementing the DRESS management system by pharmacists and its results, during 2016-2020. Operational Research, starting from the process of implementing the DRESS management system by the pharmacy department of Samutsakhon Hospital and reporting the results to the Pharmacy and Therapeutic Committee in patients diagnosed with DRESS according to the RegiSCAR criteria, collecting data from an electronic medical records database. The main DRESS management system implementation process is: 1) listing the High alert drugs which may cause an adverse reaction and preparation of pharmacists in DRESS; 2) Using RegiSCAR for patient assessment; 3) Suggesting a genotyping test before the patient receives the drug, starting with carbamazepine and allopurinol; 4) Using a Computerized Decision Support System (CDSS) to facilitate the screening alert. 5) Proposing to the Pharmacy and Therapeutic Committee for approval on gene testing. As a result, a total of 184 patients were sent for genotyping testing, and 92 of the drug allergy genes were identified, making the prevention or monitoring of patients more effectively. 31 patients were diagnosed with DRESS, and 54.84% were male. The 4 drug items with the highest incidence were phenytoin 28.95%, nevirapine 10.53%, rifampicin 7.89%, and pyrazinamide 7.89%. Clinical symptoms were rash 100.00%, fever 90.32%, lymphadenopathy 6.45%, at least one dysfunction in the internal organ system 74.19%, liver dysfunction 80.65%, and eosinophilia 58.65%. Phenytoin had a statistically significant induced eosinophil (p=0.044), which could be used as a factor in the CDSS drug surveillance. Even DRESS is a rare adverse drug reaction symptom but causes life-threatening. Continuous system management by pharmacists is significant with a huge effect. In the drug items, the highest incidence was phenytoin. Implementing a system to monitor patients' drug use, could reduce DRESS, and prevent the recurrence of drug allergies.

Diagnosis and Management of Choledochal Cyst in One Year-Old Baby: A Case Report

Background: Choledochal cysts (CC) are rare congenital anomalies of the biliary tract. The classic triad of jaundice, abdominal pain, and right upper quadrant mass are rare symptoms, mainly in children and adolescents. This study aimed to present the diagnosis and management of choledochal cyst cases in a baby girl.&#x0D; Case presentation: A 1-year-old girl, domiciled outside the city of Padang, was brought to the hospital by her parents with complaints of repeated vomiting for 1 day before being admitted to the hospital. This complaint has been accompanied by yellowish eyes and body, pale bowel movements, and dark brown urine since 3 months ago. The patient was never brought to the doctor for treatment. Since 1 month ago, the patient often feels pain in the abdomen and has a lump in the upper right abdomen. On the abdomen area, there was no distention, hepar was ¼-1/4 sharp edge, tenderness at the epicondrium area, no rebound tenderness, turgor was decreased, and no palpable mass. Abdominal ultrasonography presented a choledochal duct cyst with biliary obstruction. Abdominal CT scan with contrast revealed intrahepatic and extrahepatic biliaryectasis et causa suggestive of the choledochal cyst (Todani IVA) and hepatomegaly. The patient was consulted by the pediatric surgery division for further management and was advised to undergo surgery with the Roux En-y procedure. Follow-up after the patient underwent surgery showed clinical improvement. Symptoms of jaundice in the eyes and skin begin to decrease, as brownish stools and light brown urine.&#x0D; Conclusion: Surgical treatment with the Roux-en-Y procedure is the definitive treatment for choledochal cysts in this patient.

Incomplete Kawasaki Disease with Peripheral Facial Nerve Palsy and Lung Nodules: A Case Report and Literature Review

The diagnosis of Kawasaki disease (KD) is challenging and often delayed mainly in case of young infants and in presence of an incomplete disease and atypical features. Facial nerve palsy is one of the rare neurologic symptoms of KD, associated with a higher incidence of coronary arteries lesions and may be an indicator of a more severe disease. Here, we describe a case of lower motor neuron facial nerve palsy complicating KD and perform an extensive literature review to better characterize clinical features and treatment of patients with KD-associated facial nerve palsy. The patient was diagnosed at the sixth day of disease and presented extensive coronary artery lesions. A prompt treatment with intravenous immunoglobulins, aspirin and steroids obtained a good clinical and laboratory response, with resolution of facial nerve palsy and improvement of coronary lesions. The incidence of facial nerve palsy is 0.9-1.3%; it is often unilateral, transient, more frequent on the left and seemingly associated with coronary impairment. Our literature review showed coronary artery involvement in the majority of reported cases (27/35, 77%) of KD with facial nerve palsy. Unexplained facial nerve palsy in young children with a prolonged febrile illness should prompt consideration of echocardiography to exclude KD and start the appropriate treatment.

Case series of drug-induced open bite: Extrapyramidal symptoms related to psychotropic medications.

Drug-induced open bite is one of the extrapyramidal symptoms with abnormal tonus of muscles and is rarely recognized in dentistry. This is a retrospective case study to investigate clinical characteristics including detailed complaints in patients with drug-induced open bite. Of the outpatients who first visited the psychosomatic dental clinic at the Tokyo Medical and Dental University Hospital between September 2013 and September 2022, the patients diagnosed with drug-induced open bite were involved in this study. The clinical characteristics including sex, age, detailed complaints, duration of illness, abnormal findings, psychotropic medications, and other medications that were taken at the first examination, psychiatric comorbidities, the duration of psychiatric diseases, and other medical histories were collected retrospectively by reviewing their medical chart. Drug-induced open bite was found in 11 patients [women: 7, men: 4, median of age: 49 (36.5, 53) years old]. Difficulty in eating especially chewing was the major complaint (9/11, 81.6%) with the duration of illness as 48.0 (16.5, 66) months. Various degrees of open bite were observed. While some showed no occlusal contact on frontal teeth, some showed occlusal contact only on the second molars; moreover, the jaw showed a horizontal slide in a few patients. Three cases could be followed up for prognosis; while in one case the drug-induced open bite improved with 6 months of follow-up, two cases did not improve, and one showed extrusion of molars. All of them had psychiatric comorbidities with the most common diagnosis being schizophrenia (n = 5) and depression (n = 5) followed by insomnia (n = 1) and autism spectrum disorder (n = 1) including duplicated diagnosis. Nine patients (81.6%) had been undergoing treatment with antipsychotics of which three patients were also taking antidepressants. Although a drug-induced open bite is a rare symptom, prudent medical interviews about symptoms, psychiatric comorbidities, and psychotropic medication history besides oral assessment are necessary to provide a precise diagnosis and appropriate management in collaboration between dentists and psychiatrists.

Evaluation of patients admitted to the emergency department after Coronavac (Sinovac) vaccination?

To evaluate the symptoms and laboratory parameters of patients admitted to the emergency department after CoronaVac (Sinovac) vaccination. Complaints, demographic characteristics, laboratory tests, interventions, and outcomes of patients admitted to the emergency department within seven days of receiving the CoronaVac (Sinovac) were all evaluated. Pain at the injection site, swelling, redness, and pain in the injected arm were expected side effects of the vaccination. In this study, a total of six people had syncope following the vaccination, one of whom developed an allergic reaction. The most common adverse events in non-geriatrics were fatigue, headache, fever, and abdominal pain, while in geriatric patients’ fatigue, headache, chest pain, and dyspnea were most common, with fever falling in the last place. Rare symptoms following vaccination included syncope and urticaria. It is necessary to be prepared for the side effects that may occur during mass vaccination against COVID-19. In this study, the body’s response to the vaccine in geriatric patients was atypical in vital signs and laboratory values.

Medication safety and rare side effect of carbamazepine: A case report

Introduction: Medicines are the most widely used interventions in health care, and adverse drug reactions alone are responsible for 5-10% of hospitalizations in elderly patients. Carbamazepine is an anticonvulsant drug, and skin rash is one of its rare symptoms. It requires immediate medical attention and is sometimes life-threatening.&#x0D; Case Report: This case report is about a 72-year-old woman who witnessed the interaction of rivaroxaban and carbamazepine and the side effects of carbamazepine simultaneously.&#x0D; Conclusion: Patient participation and patient-centered tools are needed to promote patient safety.&#x0D;

Massive Intramedullary Ependymoma: A Case Report

Introduction: Intramedullary ependymoma (IE) is adults' most common intramedullary spinal tumor. Tumors usually extend one to eight segments in the cervical region. In this case report, we reported a patient with massive IE spanning from the fourth ventricle to the T4 segment of the spinal cord, which surgically treated with laminectomy from occiput to T4 Case Presentation: A 42-year-old man who is a known case of IE with progressive upper extremities paraesthesia and gait disturbance. Four years ago he refused surgery and presented with dysphagia. The patient's MRI demonstrated an intramedullary spinal cord tumor extending from the fourth ventricle to T4. Conclusions: massive spinal ependymoma is a rare, benign, slow-growing tumor, and patients present symptoms years before diagnosis. Upon confirmation of the diagnosis, the tumor must be surgically removed.

WUNDERLICH'S SYNDROME IN A PATIENT WITH ADVANCED TUBEROUS SCLEROSIS COMPLEX WITH LARGE ANGIOMYOLIPOMA

Wunderlich's syndrome, or spontaneous non-traumatic retroperitoneal hemorrhage, can be a life-threatening event. Renal angiomyolipoma is a rare benign tumor that can occur sporadically, or in association with tuberous sclerosis. A case of spontaneous retroperitoneal hemorrhage in a patient with tuberous sclerosis and renal angiomyolipoma is presented. Tuberous sclerosis complex is a rare symptom complex and may have varied presentations.We present a case of hypovolemic shock due to spontaneous rupture of large angiomyolipoma in a 24-year-old male patient with tuberous sclerosis complex (TSC).The hemodynamic instability of our patient leads to an urgent surgery and right nephrectomy was done for the angiomyolipomas. Spontaneous hemorrhage in renal angiomyolipoma in a case of tuberous sclerosis and management are discussed.

Ramsay Hunt Syndrome: An Introduction, Signs and Symptoms, and Treatment.

Ramsay Hunt syndrome is the complication of the virus varicella-zoster and the infection caused by it, which shows apparent geniculate ganglion involvement. This article discusses the etiology, epidemiology, and pathology of Ramsay Hunt syndrome. Clinically it may be presented as a vesicular rash on the ear or even in the mouth, pain in the ear, and facial paralysis. Some other rare symptoms may also be present, which are also discussed in this article. Skin involvement is also seen in some cases as patterns due to anastomoses between cervical and cranial nerves. This article provides an overview of how the varicella-zoster virus causes facial paralysis and other neurological symptoms. Knowing about this condition and its clinical features is essential to make an early diagnosis and, thus, provide a good prognosis. A good prognosis is required to reduce the nerve damage, prevent further complications, and start an early therapy of acyclovir and corticosteroid. This review also presents a clinical picture of the disease and its complications. The incidence of Ramsay Hunt syndrome has gradually decreased over time because of the development of the varicella-zoster vaccine and better health facilities. The paper also talks about how the diagnosis of Ramsay Hunt syndrome is made and the various treatment options available. Facial paralysis in Ramsay Hunt syndrome presents differently than Bell's Palsy. If not treated for too long, it may cause permanent muscle weakness and may also cause a loss of hearing. It may be confused with simple herpes simplex virus outbreaks or contact dermatitis.

The most common persistent symptoms in patients with COVID-19 who were evaluated in the Internal Medicine polyclinic

Objectives: To identify continuing symptoms of individuals in the post-COVID period. To begin with our study was planned to research the most common persistent symptoms in the post-COVID period, and additionally to research whether or not there were differences between the most frequent initial symptoms in the 1st, 2nd and 3rd waves of the pandemic. Methods: Cases attending the internal medicine clinic infected with COVID-19 who were minimum 120 days past the infection were included in the study. The study was shaped by responses of cases to open-ended questions. Results: From a total of 2,802 clinical attendances, 1,005 cases were included in the study. Of cases, 9.3% required clinical monitoring and 1.7% required intensive care during infection. The mean number of persistent symptoms was 1.38, with the most common persistent symptoms being 11.2% fatigue/tiredness, 6.1% shortness of breath, and 4.6% back and low back pain. Mean number of initial symptoms was 1.63, with the most common initial symptoms being 21.2% fatigue, 19.4% fever and 19.1% headache. Persistent chest pain was most common among those infected in the 1st wave, while there were no other significant differences observed between pandemic waves. Conclusions: The most common persistent symptoms were consistent with the general literature data; however, our condition of minimum 120 days past infection allowed a range of symptoms to ameliorate. Our results are more realistic in this way. A range of rare persistent symptoms emerging in our results were not encountered in the literature, while our study is unique as there is no other study comparing pandemic periods.

Guillain–Barré Syndrome in a patient with systemic lupus erythematosus with underlying pituitary carcinoid: A rare presentation

Background: Guillain-Barré syndrome (GBS) is a rare neuropsychiatric symptom of systemic lupus erythematosus (SLE). GBS in individuals with SLE has distinct features than those without SLE. There is much heterogeneity in the treatment and clinical outcome. Even though GI carcinoids have been related with autoimmune illnesses, extra-gastrointestinal carcinoid coexisting with SLE has been documented only once, and coexistent GBS and SLE with pituitary carcinoid have never been reported previously to the best of our knowledge. Greater knowledge of how inflammation causes cytological alterations that contribute to the formation of a carcinoid might help explore newer pathological mechanisms and therapies. Objectives: We report a middle-aged female who presented with sudden onset of weakness in all four limbs, long-standing history of arthralgia, flushing, dizziness, and a malar rash. Materials and methods: The initial evaluation led to the diagnosis of GBS and SLE, for which the patient was treated. Further workup of patient revealed the presence of a carcinoid tumor in the pituitary. Results: Patient was successfully treated with plasmapheresis, steroids, and injection octreotide. Conclusion: In patients with SLE, neuropsychiatric illness may have a plethora of presentation including GBS. Recognizing such rare presentations and evaluating the possibility of a carcinoid tumor in presence of symptoms like a long-standing history of intermittent palpitation, dizziness, profuse sweating, and flushing, should alert the physician of an underlying carcinoid tumor, which could prove detrimental if left untreated.

Idiopathic Intracranial Hypertension Presenting as Seizures

Idiopathic Intracranial Hypertension is a condition characterised by raised cerebrospinal fluid pressure of unknown etiology seen predominantly in obese, middle aged patients. The typical clinical features include headache, pulsatile tinnitus, diplopia and transient visual obscurations. Seizures are a rare symptom seen in IIH patients. We present a case of a young, obese female patient who presented with headache and seizures. Imaging showed evidence of Idiopathic Intracranial Hypertension with temporal lobe encephalocoeles and brain herniation into arachnoid granulations. The diagnosis was subsequently confirmed by clinical workup and she was started on treatment for the same.

18F-Flurodeoxyglucose Positron Emission Tomography/Computed Tomography Findings in a Rare Case of Trichoptysis.

Trichoptysis or coughing of hairs is a rare symptom, but is pathognomonic for a teratoma with tracheobronchial communication. We present such a rare case with 18F-flurodeoxyglucose positron emission tomography/computed tomography (PET-CT) imaging findings in a 20-year-old female. The diagnosis was made with PET-CT and she underwent curative surgical resection after that.