Sildenafil Use and Cigarette Smoking Associated with Intracerebral Hemorrhage: A Rare Case Report.

Background: Intracerebral hemorrhage (ICH) is a serious condition characterized by bleeding within the brain tissue. Although the use of sildenafil, a vasodilator agent for erectile dysfunction, has been associated with rare cases of ICH, the combination of sildenafil usage and smoking as risk factors for ICH has not yet been reported. This case report describes the occurrence of ICH in a patient with a history of both sildenafil usage and heavy smoking. Case Presentation: A 53-year-old male, with a history of smoking and regular sildenafil use, was brought to the emergency department due to loss of consciousness with right-side weakness, he initially experienced with nausea, vomiting and dizziness after taking sildenafil 100mg tablet once. The Glasgow Coma Score (GCS) was 10 with side hemiparesis. Non-contrast CT revealed left thalamic acute hemorrhage with ventricular extension. Furthermore, a head CT angiography ruled out any vascular anomalies after that the patient was admitted to the intensive care unit (ICU) for conservative management. After three days on clinical and neurological improvement, the patient was transferred to the inpatient ward for further management, monitoring and physiotherapy. On day 6, the patient was discharged and planned for flow up. Conclusion: This rare case highlights the need for further research and awareness regarding the potential risks associated with the combination of sildenafil and heavy smoking. Healthcare professionals should carefully evaluate the individual risk factors of patients, educate them about potential complications, and consider alternative treatments if necessary. Additionally, patients should be encouraged to quit smoking and adopt a healthy lifestyle to minimize the risk of cerebrovascular events.

A Late Diagnosis of Visceral Leishmaniasis Using Tru-Cut Biopsy of the Spleen and Malaria Co-Infection - A Diagnostic Challenge: A Case Report in Somalia.

Background: Visceral leishmaniasis (VL) is fatal neglected parasitic illness caused by Leishmania donovani. The diagnosis remains a challenge due to the non-specific clinical symptoms, especially in areas where infections like malaria and limited access to diagnostic tools coexist. Here, we describe a case of late diagnosis of visceral leishmaniasis using tru-cut biopsy of the spleen and malaria co-infection. Case Presentation: Here case report, a 24-year-old patient from an endemic region of Somalia presented with fever, headache, abdominal pain, nausea, vomiting, and weight loss for two months. Initially, the patient received symptomatic treatment and a blood transfusion but showed no improvement. Physical examination revealed fever, pallor, and hepatosplenomegaly. Laboratory tests showed pancytopenia and positive rapid diagnostic test for plasmodium parasite antigen. Despite three days of anti-malarial treatment, the symptoms persisted, and hepatosplenomegaly worsened. Further investigations, including infectious disease tests, were conducted, ruling out HIV, viral hepatitis, Brucella, and Leishmania antibodies. Peripheral blood smear showed pancytopenia and bone marrow aspiration revealed no evidence of infection or malignancy. A tru-cut biopsy of the spleen was performed, confirming the diagnosis of visceral leishmaniasis. The patient received a combination therapy of sodium stibogluconate and paromomycin, leading to significant improvement. After completing treatment, the patient was discharged with normal spleen biopsy results. Conclusion: Visceral leishmaniasis (VL) is a challenging disease to diagnose, especially in areas where it coexists with other infectious diseases, such as malaria. Co-infection with malaria should also be considered in patients with fever and hepatosplenomegaly. A high index of suspicion is necessary for the timely diagnosis of VL, and a tru-cut biopsy of the spleen can be conducted in cases where other investigations are inconclusive in endemic areas. Early diagnosis and prompt treatment of visceral leishmaniasis are crucial to prevent complications and reduce mortality.

Postpartum Cerebral Venous Sinus Thrombosis: A Case Report.

Introduction: Cerebral venous thrombosis (CVT) remains one of the most frequent cause of stroke in young adults although it is a rare disorder. It has a serious emergency manifestation during pregnancy and postpartum. It is frequently under diagnosed and limited publications in developing countries especially sub-Saharan Africa. Case Presentation: Here, we report the case of a 35-year-old female, para 8 and gravida 8, brought to emergency department on her ninth day postpartum, having severe headaches and confusion; during her admission to emergency, she suffered two episodes of generalized seizure. On admission, the patient's blood pressure was 200/120 mmHg. The patient was firstly diagnosed with postpartum eclampsia and managed with magnesium sulfate for seizures and hydralazine for blood pressure control. On ward admission, she continued having seizures and her level of consciousness decreased with left side weakness. An urgent MRI of head and MR venography performed immediately revealed acute thrombosis involving the anterior aspect of superior sagittal sinus and the left transverse sinus. The patient was moved to the ICU. Anti-coagulant LMW enoxaparin and anticonvulsant were started. After improving on clinical and biochemical tests, the patient was transferred to the inpatient ward on fifth day. Another two days later in the ward, she improved significantly, and then a head CT (contrast) angiography/venography was performed before she was discharge and showed no evidence of filling defect in cortical/dural venous sinuses. Conclusion: Cerebral venous sinus thrombosis (CVST) and postpartum eclampsia may have similar manifestations in young women of reproductive age. Early prompt diagnosing and therapeutic intervention of CVST can prevent further neurological deterioration and immediately improve the patient.