ANCA-associated vasculitis presenting with isolated neurological manifestations in a patient with cocaine abuse: a case report and literature review.

Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of rare conditions predominantly affecting small vessels of skin, musculoskeletal, pulmonary, renal, and rarely central and peripheral nervous systems. Isolated neurological manifestations of AAV are uncommon and challenging to diagnose. Cocaine has been reported as a potential trigger for the development of AAV. There are only a few case reports of isolated neurological involvement in cocaine-induced AAV with poorly characterized histopathological features. We present a unique case of AAV with isolated neurological manifestations presenting with multiple cranial neuropathies, leptomeningeal enhancement on imaging and histopathologic evidence of small-vessel vasculitis in the leptomeninges and brain and extensive dural fibrosis in a patient with cocaine abuse. The patient's progressive neurological deficits were controlled after starting immunosuppression with rituximab and prednisone. We also reviewed the literature to provide the diagnostic overview of AAV and evaluate intervention options. To our knowledge, this is the first case of AAV with isolated neurological manifestations and histopathologic evidence of small-vessel vasculitis in a patient with cocaine abuse. Patients with multiple cranial neuropathies and meningeal involvement should be screened for AAV, especially if they have a history of cocaine abuse.

Scrotal trichilemmal cysts: a case report.

Trichilemmal cyst (TC), commonly known as the pilar cyst of the scrotum wall, is an uncommon disease. It is a type of epidermoid cyst (EC) with a benign course, and malignant change is quite rare. This disease is unusual in the scrotum; therefore, multiple cysts in the scrotum are much more unusual. There have been reports of TCs in other parts of the body, but this is the first instance of scrotal TCs in Pakistan. Case presentation: We discuss the case of a 60-year-old male patient who presented to the clinic with a right-sided scrotal swelling, which was identified as a right-sided inguinal hernia on examination, and multiple small swellings on the scrotal skin identified as TCs. The patient had scrotoplasty after hernia surgery to remove the cysts and reconstruct the excised scrotum. Following scrotoplasty, the patient's discomfort was resolved, and cosmetic satisfaction was achieved. Clinical discussion: Excision is required if TCs become infected or for esthetic reasons. In the event of big cysts, full scrotal wall resection followed by scrotoplasty is necessary. The thigh fasciocutaneous flap is used to cover the denuded testes after scrotoplasty. The procedure's advantages include a good outcome, low morbidity, early discharge, and great esthetic outcomes. Conclusion: We present a literature review about multiple TCs in the scrotum and their surgical management. This case will guide surgeons and future researchers in dealing with similar cases in the future.