Pyomyositis in a patient with systemic lupus erythaematosus and a review of the literature.

Pyomyositis (PM) is a common masquerading disease that is frequently misdiagnosed. A concurrent state of immunodeficiency is observed in up to 75% of tropical PM cases. PM in systemic lupus erythaematosus (SLE) is a relatively rare disease. I report a case of PM that was caused byKlebsiella pneumoniaein a patient with SLE who presented with leg pain, fever and a lupus flare-up. The patient was correctly diagnosed using a CT scan. Immediate surgical drainage was performed, and empirical antibiotics were administered. The patient was discharged while in a recovering condition. The clinical features, the results of radiographic investigations and the management of PM in SLE are synopsised in this article to underscore the importance of considering this relatively rare disease during differential diagnosis in patients with SLE with muscle pain with or without fever. I also emphasise the need to exclude mycobacterial infection in patients with SLE with PM.

Pancreatic tuberculosis with acquired immunodeficiency syndrome: a case report and systematic review.

Pancreatic tuberculosis (TB) is a relatively rare disease that can mimic carcinoma, lymphoma, cystic neoplasia, retroperitoneal tumors, pancreatitis or pseudocysts. Here, I report the case of a 31-year-old immigrant Burmese woman who exhibited epigastralgia, fever, weight loss and an epigastric mass. The patient was diagnosed with pancreatic TB and acquired immunodeficiency syndrome, and was treated with antituberculous drugs and percutaneous catheter drainage without a laparotomy. The clinical presentation, radiographic investigation and management of pancreatic TB are summarized in this paper to emphasize the importance of considering this rare disease in the differential diagnosis of pancreatic masses concomitant with human immunodeficiency virus infection. I also emphasize the need for both histopathological and microbiological diagnosis via fine-needle aspiration.

Septicemia of unknown origin causing by Streptococcus agalactiae primary psoas abscess: a case report.

Staphylococcus aureus is the commonest organism resulting in primary psoas abscesses. However non-staphylococcal primary psoas abscesses have increasingly been published in the literature. Here, the author reports a case of primary psoas abscess in a type II diabetic woman previously diagnosed Streptococcus agalactiae septicemia of unknown origin, which rapidly responded to penicillin plus clindamycin and prompt surgical drainage. Diabetic patients are not only susceptible to soft tissue infection but also primary psoas abscess caused by Streptococcus agalactiae.

Subungual squamous cell carcinoma masquerading as chronic common infection.

Subungual squamous cell carcinoma is a rare disease that has been frequently misdiagnosed as benignity due to lack of awareness among doctors. The author reports a typical case of subungual squamous cell carcinoma in a 49-year-old Thai farmer who presented with a 4-year history of chronic persistent discharging ulcer at the nail bed of the left middle finger after experiencing a minor trauma to the hyponychium. Initially, he was treated as benign infection but the condition did not improve. The nail bed was biopsied and subungual squamous cell carcinoma was finally diagnosed. One small left epitrochlear lymph node and one large left axillary lymph node were palpable. He underwent amputation of the neck of the middle phalanx of the left middle finger and biopsy of ipsilateral epitrochlear lymph node and dissection of the affected axillary tissue. The histological examination confirmed the diagnosis of subungual squamous cell carcinoma with left epitrochlear and axillary lymph node metastasis. Radiotherapy was planned.

Groove pancreatitis: report of one case in Thailand.

Groove pancreatitis is a rare form of chronic pancreatitis affecting the head of the pancreas localized within the pancreatoduodenal groove. Fibrous scar in this specific topography sometimes makes it hard to differentiate from pancreatic cancer preoperatively. The author reports the case of a 44-year-old man with a long history of alcoholic abuse and experienced intermittent epigastric and nausea vomiting for 2 years. Abdominal ultrasound showed an irregular mixed echogenic mass at the pancreatic head. A computed tomography revealed a poorly enhanced solid mass with small low density cystic areas in the groove, thickening and luminal narrowing of the descending part of the duodenum. Magnetic resonance imaging demonstrated the same mass that was hypointense on T1 weighted images, isointense on T2 weighted images and delayed, progressive inhomogeneous enhancement on dynamic contrast study. MRCP defined a prominent smooth tapering of the common bile duct. Endoscopy disclosed an inflammed sessile mass at the second part of the duodenum. Microscopic examination of the biopsy specimens suggested only chronic inflammation. Then, the patient was treated conservatively and evaluated periodically.

Results of laparoscopic splenectomy for immune thrombocytopenic purpura.

OBJECTIVE: To study the safety and efficacy of Laparoscopic Splenectomy (LS) for Immune Thrombocytopenic Purpura (ITP). MATERIAL AND METHOD: Twenty-five consecutive adult patients with chronic ITP who did not achieve sustained remission or refractory to medical treatment underwent elective LS between March 1995 and July 2005. The perioperative course was documented and the follow up data were recorded. RESULTS: All 25 patients underwent successful LS by a single surgeon. Twenty patients were available to analyze with a median follow-up time of 739 days (range, 18-3,555). The mean age was 29.8 years (range, 15-44) and 17 patients were female. The median preoperative platetlet count was 16,500/microL (range, 2,000-180,000). Accessory Spleens (AS) were removed in three patients (15%). A female patient died 24 days after LS from fungal brain abscesses. Fifteen patients (75%) had platelet count > 100,000/microL at initial response. Thirteen patients (65%) are in Complete Remission (CR) (platelet count > 100,000/microL). The probability of staying in CR after LS was 60.2% by Kaplan-Meier analysis. All failures occurred within 218 days of the operation. The mean age of the patients with CR was 27.2 years (range, 15-43) while the mean age of the nonCR was 34.7 years (range, 21-44). CONCLUSION: LS should be considered as a safe and effective therapy when elective splenectomy is indicated for chronic ITP patients.