The patient is a 36-year-old G2P2 female with a complex gynaecological history, including a previous diagnosis of Asherman’s syndrome. She presented to an outpatient clinic with complaints of increasing pelvic pain, intermenstrual bleeding and subfertility. The patient detailed a 12-month history of increasing pelvic pain. She also reported intermenstrual bleeding, lasting up to one week. The patient reported that her menstrual flow had significantly decreased over the last 12 months. The patient and her husband had a strong desire to have a third child and the ongoing implications of Asherman’s syndrome could be seen to have a significant emotional impact on the couple.
Category: Case Reports
Abstract
Introduction: Abdominal pain is a common presentation in general practice and a systematic approach is required to exclude serious pathology and achieve an accurate diagnosis.
Case overview: We present a case of a 76-year-old male who complained of left lower quadrant abdominal pain to illustrate a systematic approach to managing diagnostic uncertainty. The patient was subsequently diagnosed with epiploic appendagitis (EA).
Discussion overview: Epiploic appendagitis can mimic other acute abdominal conditions including diverticulitis, omental infarction, and appendicitis. The recognition and early diagnosis of epiploic appendagitis helps to avoid unnecessary investigations and treatment.
Learning points
- Abdominal pain is a common presentation in general practice and a systematic approach is important to exclude serious pathology and achieve an accurate diagnosis.
- Murtagh’s diagnostic framework and safety netting are effective strategies in managing diagnostic uncertainties.
- Epiploic appendagitis is a benign condition and an early diagnosis can prevent unnecessary investigations and treatment.
Introduction: Surgical site infections remain one of the most common complications associated with surgery in Australia and the world. Many factors contribute to infection risk, however, immunosuppressive and immunomodulatory drugs such as DMARDs, biological DMARDs and glucocorticoids pose a unique risk.
Case Overview: A 70-year-old female developed a surgical site infection post-repair of a ruptured achilles tendon. She had a background of psoriatic arthritis treated with immunosuppressive agents which were not ceased prior to the surgical treatment.
Discussion Overview: The current literature suggests that biologic DMARDs and glucocorticoids increase the risk of surgical site infections in patients undergoing a procedure. It is therefore imperative to emphasize the importance of careful medication histories and recognition of medication side effects with a risk versus benefit balance.
Abstract
Introduction: Prostate cancer is a leading cause of cancer morbidity and mortality in Australian men. Though prostate cancer is common, rarely does it present with cutaneous manifestations. Metastatic cutaneous prostate cancer represents less than 1% of all cutaneous metastatic disease and occurs in 0.06% to 0.3% of prostate cancer cases. This case report explores the rare presentation of cutaneous metastatic prostate cancer.
Case overview: An 83-year-old male with a history of metastatic castration-resistant prostate cancer presented with nodular chest lesions. The patient had been diagnosed with prostatic adenocarcinoma eight years earlier, and had received a radical prostatectomy, adjuvant radiotherapy, palliative chemotherapy, and androgen deprivation therapy. He was receiving palliative treatment at the time of presentation. The patient reported an eight-week history of firm, fast-growing flesh-coloured nodules over his right pectoral region which were otherwise asymptomatic. A prostate specific membrane antigen positron emission tomography scan demonstrated avidity within cutaneous lesions and was highly suspicious for cutaneous metastatic castration-resistant prostate cancer. The patient declined targeted radionuclide therapy and was managed with palliative superficial radiotherapy. The patient passed away six weeks after diagnosis of cutaneous metastases.
Discussion overview: Metastatic cutaneous lesions can result in diagnostic dilemmas for clinicians due to the rarity of presentations. Most cases will present with a known history of metastatic disease, however, a small number of cutaneous metastases may be the first indication of a clinically silent prostate cancer. Cutaneous metastasis is associated with a poor prognosis as there is often systemic disease present. Treating clinicians, including radiation oncologists, medical oncologists, dermatologists, urologists, and general practitioners, should consider the diagnosis of cutaneous metastasis in the case of skin lesions in prostate cancer patients.
Abstract
Introduction: Rash is one of the commonest presentations that doctors can be asked to review. Studying this case strengthens the understanding about how to review a patient with rash and how to formalise differential diagnosis based on the clinical condition. This is an educational article that seeks to improve medical students understanding and clinical applications around rashes and to establish an approach that will differentiate between medications evoked rash and rash provoked by other causes.
Case overview: This case study will provide a systemic approach when evaluating a skin rash in a patient, especially in a person who cannot communicate and who has been exposed to rash provoking medications.
Discussion overview: Antiepileptic medications are known to evoke rash. It is important to take that in consideration when evaluating rashes in patients who are using those medications; however we should keep in mind that there are other conditions that can be the cause.
A case report of a 26-year-old Aboriginal male in Alice Springs with an unusual presentation of perforated appendix mimicking a liver abscess.
Introduction: Pericardial effusions often occur after cardiac surgery, usually asymptomatically. However, large postoperative effusions may cause cardiac tamponade, which is a medical emergency. Case overview: We report a case of a 62-year-old businessman who presented with worsening paroxysmal nocturnal dyspnoea, orthopnoea, and an episode of near-syncope. Echocardiography revealed evidence of cardiac tamponade, most likely due to recent coronary artery bypass graft and aortic valve replacement surgery. He was treated with pericardiocentesis and ongoing review revealed no recurrence of the effusion. Discussion overview: We discuss the incidence and risk factors for postoperative pericardial effusion and the possibility of tamponade after cardiac surgery. Though rare, recognising tamponade after cardiac surgery is vital and a thorough understanding of the treatment of tamponade is necessary.
Background: Aicardi-Goutières Syndrome (AGS) is a rare genetic neurological disorder that presents as pseudo-TORCH syndrome. There are 350 confirmed cases worldwide. This case report describes a 22-month-old male with Aicardi-Goutières Syndrome who was diagnosed at four months of age. This paper seeks to highlight AGS as a differential for TORCH Syndrome, and to build on the limited knowledge from previous cases to identify key concepts and management strategies that may be of benefit to the medical community.
Case overview: A four-month-old male was admitted to a New Zealand Hospital in status epilepticus.A history of inconsolable crying, subjective fevers and abnormal posturing was elicited. Examination found a spastic quadriplegic cerebral palsy. Investigation excluded infective causes. MRI and CT scans demonstrated atrophy of the cerebral cortex with calcification of the basal ganglia. CSF analysis showed elevated white cells and neopterin, and genetic analysis identified variants of unknown significance in the ADAR1 gene. A diagnosis of AGS was made. Treatment focused on managing complications including seizures, spasticity, and airway clearance.
Discussion overview: This case highlights AGS as a differential for TORCH syndrome. Complication management forms the basis of care. Current literature is limited, and future research is needed to understand the pathophysiology of the disease to develop treatments and management strategies.
The diagnosis of Autism Spectrum Disorder (ASD) in the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 criteria is based on a constellation of symptoms overarching social and communication deficits, behavioural issues, and stereotyped motor and sensory abnormalities. Some studies have raised concerns about overdiagnosis and misdiagnosis of ASD, likely due to the overlapping symptoms of ASD and other psychological and behavioural disorders. This case emphasises the importance of an integrated multidisciplinary diagnostic approach for ASD diagnosis as a single consultation is usually insufficient for paediatricians to reach to the conclusion of ASD. With valuable inputs from different disciplines, including psychology and speech therapy, paediatricians can have a better picture of a child’s underlying issues and provide a more effective management plan for the family.
This article explains and emphasises the importance of oxygen delivery for medical students to apply to clinical practice through the usage of several common clinical cases.