RESUMO
Introduction: The new clinical and radiological entity of the myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is known as the FLAMES syndrome. It will add to the literature and enhance the understanding of this disease. Case presentation: Our case presented a 25-year-old male patient with no known comorbid presented with a generalized sudden headache of moderate intensity for 10 days who came to our hospital. A right-sided upper motor neuron facial palsy was found on the examination. The diagnosis was further confirmed utilizing the MRI scan and the presence of MOG-IgG antibodies. The patient was started on intravenous methylprednisolone which lead to improvement of his symptoms. In the follow-up contrast-enhancing MRI of the brain, the findings suggested near resolution as compared to the initial MRI. Discussion: The FLAMES have been categorized as a subtype of the MOGAD. It is commonly found in males as compared to females and the mean age in which it commonly affects is 29 years with the common age group of 11-46 years. The clinical symptoms and physical signs along with the findings of unilateral cortical FLAMES on MRI suggest the distinctive findings of the FLAMES syndrome. Patients commonly present with symptoms like fever, headache, and cortical symptoms like aphasia. Conclusion: There is a dire need of improving the understanding of this clinic-radiographic syndrome which makes it critically important to ensure the timely diagnosis and prompt consideration of the required medications.
RESUMO
Pneumocystis pneumonia (PCP) is an opportunistic infection caused by Pneumocystis jirovecii. PCP due to immunosuppressive drugs is rarely reported in the literature. Herein we present a case of PCP in a 49-year-old patient who presented with progressive shortness of breath, dry cough, and low-grade fever. History revealed that he was taking prednisolone daily for his hyperactive airway disease. His temperature was 99oF, and he had bilateral crackles in the lungs with resonant wheezing. High-resolution computed tomography showed diffuse ground-glass haze and cystic lesions in the middle and upper zones of both lungs. He was commenced on intravenous ceftriaxone and methylprednisolone based on provisional diagnosis of interstitial pneumonia. However, his condition worsened. His human immunodeficiency virus (HIV) test was reactive, and his CD4+ count was 275 cells/mm3. Bronchoalveolar lavage revealed PCP by direct immunofluorescent assay. Additional serum testing revealed marked elevation of beta-D-glucan, consistent with PCP diagnosis due to glucocorticoid use. Trimethoprim-sulfamethoxazole and voriconazole were initiated, and his respiratory symptoms started improving. His respiratory condition improved on day 9, and he was discharged with follow-up.
RESUMO
High-grade glioma is also called a malignant glioma because it is fast-growing and spread rapidly through brain tissue. Due to the rarity of high-grade glioma, its diagnosis and management are multi-faceted. We present a case of a 10-year-old girl presented with headache, seizure, and right-sided weakness of upper and lower limbs. Neurological exam revealed reduced power in both upper and lower right limbs with reduced sensation and reflexes. Magnetic resonance imaging revealed an ill-defined altered signal intensity mass involving the left temporal lobe with parenchymal involvement and surrounding perilesional vasogenic edema. Biopsy of the lesion confirmed high-grade glioma. The patient underwent external beam radiation therapy with concomitant daily temozolomide treatment, followed by adjuvant standard temozolomide. However, progressive neurological worsening and an increased lesion size led to partial tumor resection through a craniotomy to remove intracranial hypertension, which was unsuccessful, and the patient could not survive after the procedure.