Invasive rhinocerebral mucormycosis: Imaging the temporal evolution of disease in post COVID-19 case with diabetes: A case report.

BACKGROUND: Rhinocerebral mucormycosis (RCM) is a rare, fatal, invasive fungal infection infecting mainly patients with immunocompromised conditions, such as diabetes mellitus, hematologic malignancies, and organ transplantations. Coronavirus disease 2019 (COVID-19) disease in these patients further weakens the immune system due to several factors, including hypoxia, corticosteroid usage (further increasing hyperglycemic status), mechanical ventilation, increased serum ferritin levels, endothelitis due to free radicals, and glucose receptor protein upregulation. Timely diagnosis, judicious treatment decisions, and diabetes control with proper treatment guidelines in patients with coexisting COVID-19 disease can reduce complication rates and improve survival. CASE SUMMARY: A 75-year-old male patient with diabetes and hypertension diagnosed with COVID-19 presented to the emergency department. Laboratory examinations revealed elevated blood glucose levels, as well as ketone bodies in the urine. He was treated with oxygen and steroids, as well as insulin to correct blood glucose levels. He complained of a headache 10 d later, and imaging demonstrated mucosal thickening in bilateral sphenoidal, ethmoidal, and maxillary sinuses with hyperdense foci in the right maxillary sinus but without central nervous system involvement. Surgical debridement was performed, and a histopathological study revealed fungi hyphae. Systemic antifungals (amphotericin b and posaconazole) were administered. Subsequently, on 15th day he developed right lower limb weakness and left lateral rectus palsy. There was slow but steady progress, and he was discharged. However, he presented to emergency department 1mo later with altered sensorium and poor control of diabetes resulted in an intracranial spread of mucormycosis, which ultimately led to the patient's poor prognosis and slow recovery. CONCLUSION: Prompt early diagnosis, judicious treatment decisions, and diabetes control with proper treatment guidelines are necessary in patients with COVID-19 associated invasive RCM to reduce complication rates and improve patient survival.

Bilateral symmetrical stress fractures of femoral neck in HIV patient: case report and brief review of literature.

Osseous changes in HIV positive patients receiving ART are three times greater than in normal individuals. These changes include osteopaenia/osteoporosis, stress fractures, fragility fractures and osteonecrosis. On an average, bone mineral density reduces by 2-6% in the first 2 years after commencement of antiretroviral therapy. High risk for stress fractures is observed in these patients. In present article, we report a case of bilateral femoral neck stress fractures in a known HIV patient.

Rapunzel Syndrome: A Case of Trichobezoar with Small Bowel Complications.

Introduction Rapunzel syndrome is characterized by a large trichobezoar in the stomach with a tail extending beyond the pylorus into the small bowel, causing mechanical obstruction of the small bowel. A 7-year-old girl presented to the emergency room with severe epigastric pain. Computed tomography suggested trichobezoar causing jejuno-jejunal intussusceptions, bowel wall thickening, and dilated small bowel loops proximal to the obstruction. On laparotomy, two concealed perforations were noted at the duodenojejunal (DJ) junction and 40 cm distal to the DJ junction. An enterotomy incision was given at the antimesenteric border of the distal jejunal perforation site, and the mass was successfully extracted. Primary repair was done at the DJ perforation site, and resection was followed by an end-to-end anastomosis at the distal jejunal perforation site. Surgery confirmed a complex mass of tangled hair within the gastric cavity with a tail extending into the pylorus of the stomach and small intestine, consistent with trichobezoar. Conclusion Computed tomography is superior to other radiological imaging modalities for diagnosing trichobezoars as it helps diagnose and demonstrate mechanical bowel complications.

Nonfunctioning adrenal cortical carcinoma with skeletal muscle metastasis: Case report and imaging at limited resource center.

Adrenal cortical carcinoma (ACC) is a rare, aggressive endocrine malignancy with a reported incidence of 1.0-2.0 cases per million population and a poor prognosis due to metastatic spread. About 25% of cases of ACC present with metastases at the time of diagnosis. Metastatic spread of ACC commonly involves lungs, liver, kidney, peritoneum, lymph nodes, venous extension to the renal vein or inferior vena cava and bone. We report a case of a 47-year-old male with a nonfunctioning ACC with metastases to skeletal muscle (subscapularis, paraspinal, iliacus and gluteus maximus muscle) in addition to metastasis to the lung, which was not reported in the literature. Unfortunately, the patient expired prior to the surgery due to respiratory distress.

Magnetic resonance imaging features of "Proximal" hirayama disease: Case report and literature review.

BACKGROUND: Proximal "Hirayama" disease (PHD) is characterized by proximal upper extremity atrophy. It is a rare variant of Hirayama disease (HD) which involves the proximal upper limb. Recognition of PHD's unique magnetic resonance (MR) findings is critical as the treatment options differ versus classical HD. CASE DESCRIPTION: A 17-year-old male presented with gradual progressive upper extremity weakness and atrophy. On MR, PHD was demonstrated by C4-C5 kyphosis with a posterior epidural soft-tissue mass compressing the C4-C5 cord resulting in gliosis. As the patient declined surgery, he was followed for 1 year with a cervical collar during which time his deficit stabilized. CONCLUSION: PHD, characterized by proximal upper extremity weakness and atrophy, has characteristic MR findings of kyphosis associated with cord compression and ischemia/gliosis. Select patients as the one we described who decline surgery may stabilize radiographically and clinically with the protracted utilization of a cervical collar.

Case of cerebral venous thrombosis with unusual venous infarcts.

Cerebral venous thrombosis is a relatively rare condition when compared with vascular accidents of arterial origin representing 0.5-1% of all strokes. Unlike arterial infarcts parenchymal changes are seldom present and when present most of the times are reversible. We present a case report of 28-year-old female with thrombosis of internal cerebral veins and straight sinus and hemorrhagic infarcts in bilateral basal ganglia and bilateral thalami .The findings of bilateral symmetrical hyper intensities in basal ganglia and thalami on MRI may be due to various causes of diverse etiology and cerebral venous thrombosis remains an important cause. Early recognition and prompt anticoagulation therapy helps to reduce the mortality to a great extent. The MRI imaging features of straight sinus thrombosis and other imaging differentials are discussed.

Acute necrotizing encephalopathy in an adult.

Acute necrotizing encephalopathy (ANE) is a rapidly progressing neurologic disorder that occurs in children after common viral infections of the respiratory or gastrointestinal systems. This disease is commonly seen in East Asia. Normal healthy infants and children can get affected. The condition carries a poor prognosis with high morbidity and mortality rates. We report here a case of a 23-year-old female with ANE and describe its neuroimaging findings. Magnetic resonance imaging examination performed showed symmetric lesions involving the thalami, brainstem, and cerebellum.