http://casereports.bmj.com This feed contains articles for BMJ Case Reports Subject Collection "Public health" BMJ Case Reports http://casereports.bmj.com http://casereports.bmj.com/cgi/content/short/2013/jun13_1/bcr2013009885?rss=1 A 21-year-old woman presented to the hospital with 3 days of headache, fever, mood disturbance and nausea. She had recently emigrated from India, and was noted to have a positive screening purified protein derivative tuberculosis skin test with normal chest x-ray. Meningeal signs were noted prompting lumbar puncture and initiation of presumptive treatment for bacterial meningitis. While tuberculous meningitis (TM) was entertained at admission, diagnosis was clouded by the rapid onset of symptoms and recent major psychosocial stressors. She developed severe hyponatremia. Brain MRI revealed tuberculomas, and she was started on treatment for TM, a diagnosis confirmed by culture. On review, several lessons were learned: (1) globalisation of society makes uncommon diagnoses present in unlikely locations, (2) hyponatremia is a common complication of TM, (3) MRI can aid in diagnosis of TM and (4) cognitive and mood changes can be prodromal symptoms of TM. Benson, S. M. Narasimhamurthy, R. 2013-06-13 doi:10.1136/bcr-2013-009885 Severe hyponatremia and MRI point to diagnosis of tuberculous meningitis in the Southwest USA BMJ Publishing Group Ltd JUN13_1 2013 201300988 2013-06-13 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/may24_1/bcr2013009252?rss=1 An Asian man presented to the Foot and Ankle Clinic with a 5-month history of right ankle pain of gradual onset. He had a non-fluctuant swelling around the Achilles tendon insertion with a tender palpable lump. Radiograph demonstrated Haglund's deformity and also possible calcification at the attachment of the Achilles tendon for which he had an injection of a local anaesthetic and a steroid to treat the insertional Achilles tendinitis. A few months later, he developed acute anorexia, abdominal distension secondary to ascites and groin lymphadenopathy. Histology of the lymph node biopsy revealed granulomatous lymphadenitis consistent with tuberculosis (TB) and started on quadruple agent anti-TB treatment. The sample was not cultured. He developed constant ooze from his groin lymph node biopsy site and also fluctuance around the Achilles tendon and heel. Pus from the heel stained positive for auramine indicating TB calcaneum with subsequent culture for acid fast bacilli (AFB) confirming diagnosis of TB calcaneum. Gillott, E. Ray, P. 2013-05-24 doi:10.1136/bcr-2013-009252 Tuberculosis of the calcaneum masquerading as Haglund's deformity: a rare case and brief literature review BMJ Publishing Group Ltd MAY24_1 2013 201300925 2013-05-24 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/may24_1/bcr2013009538?rss=1 A grossly obese woman was wrongly diagnosed throughout her adult life of having lymphoedema. Her condition was subsequently confirmed as lipoedema, an entirely different condition, which is noted in medical text books but is seldom taught to medical students or to general practitioners. The condition is caused by abnormal deposition of adipose tissue in the extremities (usually the lower limbs) and almost exclusively affects women. It often starts at puberty or may occur after pregnancy. The exact aetiology is not yet understood but genetic and hormonal factors may be implicated. The problem is that misdiagnosis leads to inappropriate tests and improper treatment to the patient. When recognised it is often too late to do anything for the patient and they become highly dependent on social care. This case describes how the diagnosis can be confirmed through an ultrasound image and illustrates the need for early recognition to facilitate specialist care. Goodliffe, J. M. Ormerod, J. O. M. Beale, A. Ramcharitar, S. 2013-05-24 doi:10.1136/bcr-2013-009538 An under-diagnosed cause of leg swelling BMJ Publishing Group Ltd MAY24_1 2013 201300953 2013-05-24 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/may22_1/bcr2013009933?rss=1 The coexistence of painless jaundice and a space-occupying lesion in the head of the pancreas usually signifies a diagnosis of pancreatic cancer. We present a case, where the cause of a pancreatic mass turned out to be related to tuberculosis. Tuberculosis affecting abdominal organs in isolation is uncommon, and more often forms part of disseminated disease. Pancreatic tuberculosis is very rare, especially in immunocompetent individuals. While every effort should be made to ensure that potentially operable pancreatic cancers undergo prompt surgical excision, the challenge for the future will be to make a preoperative diagnosis of pancreatic conditions that require medical rather than surgical therapy. Naisbitt, C. J. Filobbos, R. Bonington, A. O'Reilly, D. 2013-05-22 doi:10.1136/bcr-2013-009933 A space occupying lesion masquerading as pancreatic carcinoma BMJ Publishing Group Ltd MAY22_1 2013 201300993 2013-05-22 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/apr19_1/bcr2013008713?rss=1 In 2009-2010, we investigated four legionella cases notified over an 8-month period in two adjacent villages in South East England. Molecular techniques enabled us to conclude that three of the cases had distinct infections. The absence of an adequate respiratory sample in one case necessitated epidemiological investigations to exclude a potential common environmental source of further infections. One of the cases had spent a part of their incubation period in a country in South East Asia. DNA-sequence-based typing of their isolate showed it to be of the Legionella pneumophila serogroup 1 (LP1) DNA-sequence type (ST) 481. Intriguingly, the only other two ST 481 isolates in the European Working Group for Legionella Infections database were among Dutch travellers to the same country in 2003 and 2006. This case makes clear the value of molecular diagnostics and the importance of obtaining adequate clinical specimens. The potential future uses for typing data are discussed. Yates, T. A. Bruin, J. P. Harrison, T. G. Mannes, T. 2013-04-19 doi:10.1136/bcr-2013-008713 Molecular diagnostics and the public health management of legionellosis BMJ Publishing Group Ltd APR19_1 2013 201300871 2013-04-19 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/apr09_1/bcr2012008394?rss=1 Enteroviral infection in pregnancy is common and there is growing evidence relating it to congenital anomalies and neonatal mortality. Neonatal disease may range from unapparent infection to overwhelming systemic illness. Passively acquired maternal serotype specific antibodies determine the severity of the disease in the newborn. A fatal case of congenital echovirus 21 infection, confirmed by PCR in the patient's blood and positive culture of the mother's stools, is reported. A sibling had symptoms of respiratory tract infection and their mother had fever, which prompted iatrogenic delivery that same day. The newborn presented with bradycardia and hypotonia in the first minutes of life and later developed respiratory distress, disseminated intravascular coagulopathy, fulminant hepatitis, acute renal failure and necrotising enterocolitis. Death occurred on the 8 day of life. This case highlights the potential severity of Enteroviral infection in the newborn. Since only supportive treatment is available, prevention is paramount. Pedrosa, C. Lage, M. J. Virella, D. 2013-04-09 doi:10.1136/bcr-2012-008394 Congenital echovirus 21 infection causing fulminant hepatitis in a neonate BMJ Publishing Group Ltd APR09_1 2013 201200839 2013-04-09 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/feb18_1/bcr2013008582?rss=1 Laparoscopic gastric banding is considered the safest bariatric procedure, holding satisfactory long-term weight loss results, low rates of early complications and negligible mortality. Long-term follow-up are showing a high prevalence of late complications. We describe the case of a 40-year-old female patient, with a medical history of laparoscopic gastric banding, admitted in the emergency department complaining of haemoptysis, left upper quadrant abdominal pain and a slight tachycardia. After an exhaustive clinical evaluation with laboratorial and radiological assessments, diagnosis of partial thoracic migration of the band's tube was established. Despite the unusual clinical setting, this case emphasises the necessity of awareness for the potential long-term complications of gastric banding either from primary or secondary care providers. Carvalho, C. Milheiro, A. Manso, A. C. Castro Sousa, F. 2013-02-18 doi:10.1136/bcr-2013-008582 Haemoptysis and left upper quadrant abdominal pain: an unusual presentation of partial thoracic migration of an adjustable gastric band's tube BMJ Publishing Group Ltd FEB18_1 2013 201300858 2013-02-18 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2013/jan07_1/bcr2012007769?rss=1 We report a case of gastric perforation in an 18-year-old girl as a result of ingesting an alcoholic drink containing liquid nitrogen. The drink was purchased in licensed premises. The extent of the injury necessitated total gastrectomy with Roux-en Y reconstruction. We review the literature, discuss the mechanism of injury and consider the implications for medical services. The authors believe this case is of educational interest to professionals working in emergency medicine, general surgery and public health fields. It raises awareness of a rare injury, but one that may be more commonly encountered because of developing social trends. It informs surgeons confronted with this type of injury that trauma to the gastrointestinal tract can be extensive and preoperative contact with oesophago-gastric colleagues is advisable. Public health bodies must be aware of, and monitor, the use of liquid nitrogen in this way and consider regulation to prevent further injuries. Pollard, J. S. Simpson, J. E. Bukhari, M. I. 2013-01-07 doi:10.1136/bcr-2012-007769 A lethal cocktail: gastric perforation following liquid nitrogen ingestion BMJ Publishing Group Ltd JAN07_1 2013 201200776 2013-01-07 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2012/dec13_1/bcr2012007250?rss=1 Ascaris lumbricoides is one of the most prevalent parasitic infections, especially in developing countries. Its presence can lead to a multitude of presentations, one of the rarer ones being obstructive jaundice due to migration of the worm in to the biliary tree. We describe a case of a man who presented as an emergency to the general surgeons complaining of abdominal pain, fever, jaundice and vomiting. Ultrasound was used and the diagnosis of biliary ascariasis was made. The patient underwent surgery consisting of a cholecystectomy, common bile duct exploration and T-tube choledochostomy. Our report highlights the varied aetiology of obstructive jaundice and the importance of including biliary ascariasis in the differential diagnosis of the jaundiced patient, especially from endemic areas. Keating, A. Quigley, J. A. Genterola, A. F. 2012-12-13 doi:10.1136/bcr-2012-007250 Obstructive jaundice induced by biliary ascariasis BMJ Publishing Group Ltd DEC13_1 2012 201200725 2012-12-13 CASE-REPORT http://casereports.bmj.com/cgi/content/short/2012/oct19_1/bcr2012006474?rss=1 Soo Jung Hospital in Doti, Far-Western Nepal is a small district hospital founded in 1994 and run as a private hospital with support from charity donations. It is staffed by two doctors, and two health assistants, supported by a team of nurses and nursing students. Approximately 50 people are seen as outpatients each day. There is a four bed emergency department and two inpatient wards which are able to accommodate 16 patients between them. Basic x-ray facilities are available, but for further imagining studies and surgical interventions patients must be referred to a tertiary centre, the nearest being 7-9 h away by road. Cases of major trauma must be managed with these limited facilities for prolonged periods of time. In addition to this, once a decision has been made to attempt an interhospital transfer, this is undertaken in a vehicle ill-equipped, or staffed, to perform medical interventions en route. Mallinson, T. 2012-10-19 doi:10.1136/bcr-2012-006474 Management of paediatric head injury in remote Nepal BMJ Publishing Group Ltd OCT19_1 2012 201200647 2012-10-19 CASE-REPORT