Tricuspid valve infective endocarditis in a non-IVDU patient with atopic dermatitis.

A 29-year-old male, with chronic atopic dermatitis (AD), presented with a 2-week history of fatigue, pyrexia and weight loss. Examination showed eczematous patches with lichenified papules, erosions on the right shin and a new murmur. Blood cultures isolated methicillin-sensitive Staphylococcus aureus. Transthoracic echocardiography showed vegetation on the tricuspid valve (TV) that was adherent to the septal leaflet. He was treated for infective endocarditis, attributed to poorly controlled AD, with intravenous Flucloxacillin. Due to ongoing sepsis and pulmonary septic emboli, Clindamycin was added. He underwent TV repair; the septal leaflet was excised, and the remnant two leaflets were brought together with a ring. His patent foramen ovale was closed. His skin was treated with topical steroids and emollients. Right-sided endocarditis of an intact TV is uncommon in a non-intravenous drug user. Therefore, this novel case portrays the importance of aggressively managing AD as it is a risk factor for significant systemic infections.

Epiglottic granular cell tumour: a case report and literature review.

Granular cell tumour is a rare, benign tumour that may arise in the soft tissues of various locations. It is often asymptomatic; hence, it gets misdiagnosed as other conditions. This is a case of an asymptomatic 50-year-old male with an incidental finding of a supraglottic lesion during routine oesophagogastroscopy. Examination under general anaesthetic showed a whitish non-ulcerating exophytic lesion on the laryngeal surface of the epiglottis, sparing anterior commissure and vocal cords. Surgical excision was performed with an open supraglottic laryngectomy approach. Histopathology confirmed GCT, strongly positive for S-100 protein and weakly positive for CD68. Accurate histologic analysis is a key to identify this rare tumour among other differentials. Although benign, ongoing monitoring is advised due to risk of recurrence.

A 15-year mystery resolved: a large bone-boring glomus tumor mistaken as dermatitis.

Glomus tumor (GT) is a rare, benign neoplasm of the glomus apparatus. Being most common in the subungual region, it often misdiagnosed with dermatological conditions. Severe tenderness, paroxysmal pain and cold intolerance symptomatically denote GT. Clinical tests such as Love's pin test and Hildreth's test assist in diagnosing the disease. X-ray, ultrasonography and magnetic resonance imaging can confirm the severity of the lesion. Complete surgical excision is the only treatment available for these subcutaneous nodules. A middle-aged male with a hand pain, who misdiagnosed for dermatitis over 15-year period, has identified as having a large bone-boring GT. Awareness of GT among healthcare professionals is a must to increase the quality of life of patients.

Emphysematous cystitis: a cause of hematuria post angioplasty.

Emphysematous cystitis (EC) is a rare, severe, urinary tract infection caused by gas-producing bacteria. It is characterized by the accumulation of air inside the bladder wall and/or lumen and is common among elderly diabetic females. This case of a 90-year-old female, who underwent bilateral iliac angioplasty and stenting, is the first published correlation between iliac angioplasty and the development of EC. The endovascular procedure performed was a success, but later on, she was confused and developed frank haematuria with a fall in haemoglobin levels. CT revealed severe EC with abundant gas tracking outside of urinary bladder into the extraperitoneal space. She was catheterized and empirical antibiotics were started and converted based on the culture sensitivities. Frequent follow-up ensured the resolution of a conservatively managed case. It is essential to increase the awareness of EC associated with angioplasties among the healthcare staff, particularly those undertaking vascular procedures.

A rare case of acquired benign tracheoesophageal fistula.

Acquired benign tracheoesophageal fistula (TOF) is a rare medical condition that usually results from trauma, foreign bodies or granulomatous infections. This is an unusual presentation of a male patient with a history of laryngectomy who has had over a period of several years inappropriately and vigorously used valve cleaning brushes to clean tracheal secretions, which has led to the formation of a TOF. Due to the patient's obsessive habit, we could not manage him using conventional surgical methods. Instead, we opted for the placement of a salivary bypass tube, which yielded good results and recovery. To the best of our knowledge, no other case of similar aetiology has been published. We would like to highlight the importance of appropriate patient selection and education prior to performing a tracheoesophageal puncture to avoid developing life-threatening complications as demonstrated in our case report.

The association of pregnane X receptor activation with outcomes after liver transplantation-A retrospective study.

BACKGROUND: Many complications following liver transplantation are linked to ischemia-reperfusion injury. Activation of the pregnane X receptor (PXR) has been shown to alleviate this process in animal models. The aim of this retrospective study was to investigate the effect of early activation of human PXR (hPXR) on postoperative complications and survival following liver transplantation. METHODS: The study included deceased donor liver transplants at a single center over 6 years. Estimated hPXR activation value on day 7 (EPAV7 ) was calculated per patient based on potency/total dose of known hPXR-activating drugs administered in the first week post-transplantation. Patients were divided into low and high hPXR activation groups based on EPAV7 . RESULTS: Overall, 240 liver transplants were included. Average EPAV7 was significantly lower in patients who developed anastomotic biliary strictures (17.7 ± 5.5 vs 35.1 ± 5.7 in stricture-free patients; P = .03) and sepsis (16.4 ± 7.1 vs 34.9 ± 5.5; P = .04). Patient survival was significantly improved in the high hPXR group (5-year survival: 88.7% ± 3.8% versus 70.7% ± 5.8% [low hPXR]; P = .023). Regression analysis identified EPAV7 as a significant independent predictor of patient survival. CONCLUSION: hPXR activation within the first week of liver transplantation is a prognostic indicator of patient survival, possibly due to the associated lower biliary stricture and infection rates.

An unusual finding of schwannoma in the columellar area-A case report.

INTRODUCTION: Schwannomas are benign tumours of the nerve sheath that originate from Schwann cells. Less than 4% of these tumours arise in the sinonasal tract. Columellar involvement is extremely rare - three other cases involving the columella have been reported since 1967. PRESENTATION OF CASE: A 25-year-old woman presented with a swelling of the nasal columella from eight months into pregnancy. She presented with right nasal obstruction and discomfort over the nasal bridge. Pre-operative MRI and ultrasound were performed. The mass was surgically excised using an external septorhinoplasty approach giving a good cosmetic outcome. Histopathologic examination demonstrated schwannoma. DISCUSSION OF CASE: Nasal schwannoma may present with variable symptoms. We discuss the MRI and histological features of schwannoma. A literature review suggests that schwannomas may have accelerated growth in pregnancy. The open rhinoplasty approach is the favoured method for excision of schwannomas near the columellar region. CONCLUSION: Nasal schwannomas are rare in the sinonasal tract, however they need to be considered part of the differential diagnosis for nasal masses. The treatment of choice for these lesions is surgical excision.