Nasopharyngeal Tuberculosis.

Tuberculosis is a well-known communicable infectious disease and can involve almost any organ of the body. Upper respiratory tract involvement is seen in only 1.9% and involvement of the nasopharynx is even rarer, accounting for only 0.1%. The occurrence of nasopharyngeal tuberculosis (NPTB) is very rare even in endemic areas. Herein, we report two cases of NPTB in which patients had the previous history of chronic ear infection; and later were found to have NPTB. Initial symptoms of NPTB can be vague and easily be misdiagnosed. The literature is scarce on NPTB. To the best of our knowledge, no such cases have ever been reported from Pakistan. Although the incidence of NPTB is very low since we live in a country where tuberculosis incidence is really high, its possibility should be kept in mind as one of the differential diagnoses. Key Words: Nasopharyngeal, Tuberculosis, Otitis media, Fungal, Infection.

Clinical profile and outcomes of adult oncological patients presenting to the emergency department of a tertiary care hospital.

OBJECTIVE: To determine the clinical presentations, diagnosis, and outcomes of oncological patients presenting to the emergency department of a tertiary care hospital. METHODS: The single-centre, cross-sectional study was conducted at the emergency department of the Aga Khan University Hospital, Karachi, from January 1 to December 31, 2018, and comprised all adult patients with diagnosed solid or haematological malignancy. Demographical and clinical data was recorded from medical record files. The immediate outcomes were reported as hospitalisation or discharge from the emergency department. Data was analysed using SPSS 20. RESULTS: Of the 320 patients, 167(52.2%) were females. Overall, 214(66.9) patients were aged 35-64 years. Most of the patients had solid organ malignancy 276(86.2%), with the most common being breast carcinoma 60(18.8%). Among haematological malignancies, B-cell lymphoma 32(10%) was the most common. The most common symptoms at presentation were vomiting 78(24.4%), fever 77(24.1%), and generalised weakness 66(20.6%). Of the total, 240(75%) patients were admitted and 80(25%) were discharged. The most common discharge diagnosis was chemotherapy-induced vomiting, followed by febrile neutropenia and malignant hypercalcaemia. There were 26(10.8%) deaths among the in-patients. CONCLUSIONS: Cancer patients presented to the emergency department with diverse signs and symptoms. It is essential for physicians in the emergency department to be familiar with their presentations in order to initiate prompt and timely management plans for better clinical outcomes.

Atypical involvement of central nervous system in classic Hodgkin lymphoma: a case report.

BACKGROUND: Hodgkin lymphoma is a systemic disease that commonly involves the cervical, supraclavicular, and mediastinal lymph nodes. The involvement of central nervous system in Hodgkin lymphoma is extremely rare, and diagnosis is usually established using distinct morphological and immunohistochemical staining on the tissue biopsied. Extranodal presentation of HL is a rare occurrence. It has been evident that prognosis is encouraging in patients with disease that is limited to just central nervous system initially or as relapse, compared with involvement of multiple sites of relapse. CASE PRESENTATION: We herein report a case of a 35-year-old South-East Asian male with relapsed Hodgkin lymphoma. The patient developed a parotid gland lesion, cervical lymphadenopathy with significant weight loss, and intermittent night sweats. Along with spread to the central nervous system, there was a high suspicion of tuberculosis. Upon biopsy of his cervical lymph node, the patient was confirmed to have Hodgkin lymphoma. Immediate treatment began with six cycles of chemotherapy consisting of adriamycin, bleomycin, vinblastine, and dacarbazine. The patient received three cycles of chemotherapy consisting of ifosfamide, carboplatin, and etoposide but then was lost to follow-up. Five years later, the patient suffered a road traffic accident. Upon work-up, a right parietal space-occupying lesion with moderate cerebral edema and midline shift was found on computed tomography of the brain. The patient underwent resection of the space-occupying lesion of brain, with features consistent with classical Hodgkin lymphoma on histopathology examination. It is crucial for such lesions to be investigated meticulously to rule out any secondary disease process. CONCLUSION: Relapsed Hodgkin lymphoma with central nervous system involvement is relatively rare with just over two dozen cases reported to date and is observed infrequently in developing nations. Therefore, space-occupying lesion should always be investigated, and biopsy of such lesions is gold standard to establish diagnosis. With timely appropriate therapy, complete remission can be achieved. However, large-scale studies would be prudent to explore the presentation, survival, and treatment options for patients with Hodgkin lymphoma involving the central nervous system.

Polycythaemia Vera Presenting As A Porta Hepatis Mass.

Polycythaemia Vera (PV) is a myeloproliferative disorder in which bone marrow has increased production of red blood cells, white blood cells and platelets. The hallmarks of the disease are veno-occlusive events, secondary to increased blood viscosity. Polycythaemia Vera rarely presents with portal vein thrombosis below age of 55 years especially in absence of any chronic liver disease. We report a case of 30-years-old South Asian male presenting with abdominal pain, weight loss and vomiting for 3 months. On evaluation, he was found to have oesophageal varices. Furthermore, CT scan showed infiltration at porta-hepatis and portal venous thrombosis. Polycythaemia Vera was diagnosed with a positive JAK2 mutation and increased haemoglobin. Laparoscopy was done to perform biopsy of the porta-hepatis mass. Biopsy showed engorged vessels with no sign of malignancy. Patient underwent repeated sessions of upper GI endoscopy for band ligation and multiple sessions of venous phlebotomy which drastically improved his blood indices. He was started on lifelong aspirin and was advised regular follow-ups. With early recognition and prompt management patients can be prevented from potential complications which can prove to be detrimental.

Cough, Hemoptysis and Hair Expectoration: An Intrapulmonary Teratoma.

Teratomas can be found in different organs of the body and may involve gonads, saccrococcygeal region, mediastinum and other sites. Intrathoracic teratomas always occur in mediastinum and less often arise within the lung. As teratomas mostly involve sex organs (gonads), they rarely occur as extra-gonadal tumors accounting for only 3% of all the cases and very small percentage of such tumors occur in mediastinum.We reported an interesting case of middle aged male who presented to us with symptoms of cough, hemoptysis and trichoptysis (hair expectoration).We found that patient had intrapulmonary teratoma that was initially being treated as case of pulmonary tuberculosis. He underwent surgical resection of his cavitatory lesion and diagnosis of intrapulmonary teratoma was confirmed by histopathology as well. The patient made remarkable recovery with complete disappearance of his symptoms. From Pakistan no such case has ever been reported. Although it is very unusual but in patient with cavitatory lesion, intrapulmonary teratoma should always be kept in mind as differential diagnosis.