A Case of Cutaneous Botryomycosis of the Lower Leg in a Young Adult Male.

We present a case of cutaneous botryomycosis of the lower leg in a young adult male. Botryomycosis is a chronic granulomatous response to bacterial infection. As a cutaneous lesion, it can easily be mistaken for a malignant, autoimmune or inflammatory mass. We were able to successfully treat our patient with primary surgical excision, vacuum-assisted closure (V.A.C.™) dressing and subsequent split thickness skin graft (STSG). Use of a V.A.C. dressing with subsequent grafting has not previously been reported in the literature.

Large Intermuscular Lipoma Presenting as a Groin Hernia.

Lipomas are the commonest benign mesenchymal tumours, commonly seen as a subcutaneous lump. However, intermuscular lipomas are uncommon and can remain asymptomatic until they attain larger sizes. We discuss a rare case of a large symptomatic intermuscular lipoma in a 34-year-old woman who presented with acute on chronic groin pain. Clinical examination findings were consistent with an incarcerated inguinal hernia and imaging confirmed a large intermuscular lipoma of the anterior abdominal wall, the tip of which herniated into the inguinal canal. She underwent open primary repair of the hernia along with excision of the lipoma. An intermuscular lipoma presenting as an incarcerated inguinal hernia at the first instance is an uncommon finding. Due to lack of obvious clinical findings, uncomplicated intermuscular lipomas can be challenging to diagnose until they become symptomatic, and a high degree of suspicion in patients reporting atypical abdominal and groin pain, or abdominal wall fullness is required.

Atlas shrugged: cervical myelopathy caused by congenital atlantoaxial dislocation aggravated by child labor.

BACKGROUND: Symptomatic atlantoaxial dislocation is common in predisposing genetic or acquired disorders. However, an isolated atlantoaxial dislocation frequently is congenital and silent unless discovered during course of evaluation for neurological symptoms of cervical spinal cord injury attributed to minor or chronic, repetitive trauma. PATIENT: A 12-year-old girl working as a farm laborer developed calf pain provoked by walking, which increased in severity and progressed to involve the upper limbs. It was followed by progressive ascending quadriplegia. The illness resembled acute inflammatory demyelinating polyneuropathy with respiratory involvement. Presence of "claw" hands bilaterally and wasting of intrinsic muscles of the hands led to the suspicion of a cervical myelopathy. RESULT: Neuroimaging confirmed a congenital atlantoaxial dislocation with basilar invagination. The absence of abnormal signals in the cervical spinal cord was unusual. The symptomatic congenital atlantoaxial dislocation was postulated to be precipitated by chronic trauma suffered while habitually carrying heavy loads on the head and leading to spinal cord injury without radiographic abnormalities. Correction via surgery was successful. CONCLUSIONS: Congenital atlantoaxial dislocation should be suspected in a clinical setting of neurological symptoms of cervical spinal cord injury without obvious trauma or predisposing primary diseases. Prompt cervical spine imaging reveals the correct diagnosis. Physicians in countries in which child labor is rampant should be aware of the potential complications of cervical cord injuries from child labor.