European Journal of Clinical and Experimental Medicine T.22, z. 2 (2024)
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- PozycjaUnmasking the nature of granulomatosis with polyangiitis – a diagnostic odyssey revealed through a compelling case report(Publishing Office of the University of Rzeszow, 2024-06) Sajdak, Piotr; Krużel, Aleksandra; Stodolak, Marcel; Bednarski, Artur; Ziajor, Seweryn; Turski, Mikołaj; Żurowska, Klaudia; Kłos, Kamil; Tomasik, Justyna; Dębik, Marika; Szydłowski, ŁukaszIntroduction and aim. Granulomatosis with polyangiitis (GPA), formerly known as Wegener’s granulomatosis, presents a formidable challenge in the realm of autoimmune diseases. Granulomatosis, characterized by vasculitis and granuloma formation, exhibits diverse clinical manifestations. The rarity of GPA is evident, with an estimated incidence between 0.4 and 11.9 cases per 1 million person-years. The aim of this report is to show the complex diagnostic challenges inherent in GPA, demonstrating the diagnostic process from initial symptoms. Description of the case. This case report unfolds the diagnostic journey of a 52-year-old Caucasian male. The presented case, initially suspected as a respiratory infection, led to a comprehensive investigation owing to persistent symptoms, abnormal blood counts, and elevated inflammatory markers. This narrative aims to depict the patient’s diagnostic journey. Key diagnostic tools include ANCA testing, imaging studies, and tissue biopsy. Pulmonary nodules, lymphangitic changes, and renal involvement culminating in a GPA diagnosis confirmed by positive ANCA and anti-PR3 antibodies. The successful management of this case involved a tailored therapeutic regimen, including cyclophosphamide and methylprednisolone, addressing both vasculitic and renal components. Conclusion. This case contributes to the understanding of atypical presentations of GPA, emphasizing the importance of a holistic and dynamic diagnostic approach.
- PozycjaCombined non-surgical and surgical management of misdiagnosed cutaneous sinus tract of endodontic origin – 15 months CBCT follow-up(Publishing Office of the University of Rzeszow, 2024-06) Makkar, Sameer; Rohilla, Smriti; Gupta, Sandeep; Negi, Shabnam; Makkar, MonikaIntroduction and aim. An extraoral cutaneous sinus tract of endodontic origin represents a skin condition that appears due to an infection that could be primary or secondary to trauma accompanied by alveolar bony changes. It may be easily misdiagnosed and inappropriately treated due to lack of inadequate expertise on part of medical professionals followed by faulty treatment which can complicate the case further. Description of case. This case report intends to highlight a case of a sixteen-year-old male patient referred for an extraoral cutaneous sinus tract misdiagnosed and insufficiently treated by a general physician followed by general dentists for more than a month due to lack of proficiency in the field of endodontics. The clinical and radiographic examinations confirmed the pulpal origin due to trauma related to permanent mandibular incisors. A combination of non-surgical root canal therapy followed by periapical surgery was performed leading to a significant healing of the lesion. Conclusion. Accurate diagnosis is the key to treat draining sinus tracts of endodontic origin. Root canal treatment and endodontic surgery should be used judiciously for effectively eliminating the pathogens thus providing healing and repair mechanisms a chance to achieve the desired result.
- PozycjaEvaluation of primary musculocutaneous Hodgkin’s lymphoma with the aid of 18F FDG PET/CT – a rare entity(Publishing Office of the University of Rzeszow, 2024-06) Kakkar, Lavish; Singh, Man Mohan; Deswal, Satyawati; Thakur, Priyamedha BoseIntroduction and aim. Primary musculocutaneous lymphoma is extremely rare and associated with poor prognosis. Here, we present a case of refractory primary muscular lymphoma with overlying cutaneous involvement with the aid of 18F-Fluorodeoxyglucose positron emission tomography/computed tomography (18F FDG PET/CT) for staging and treatment. Description of the case. We present the case of a 52-year-old man presented with musculocutaneous Hodgkin’s lymphoma having swelling and discolored areas over the left leg and right arm associated with itchiness. Upon examination, there was scaling, erythema over the body with Gottron’s papules on knuckles and heliotrope rash. Skin and muscle biopsy were suggestive of Hodgkin’s lymphoma. This patient was had primary musculocutaneous lymphoma. His diagnosis was delayed. PET/CT was performed for staging and response to treatment, which was suggestive of refractory disease. Conclusion. PET/CT plays a vital role in diagnosis, staging, response to therapy and helps in optimized treatment for these specific patients.
- PozycjaNovaluron and indoxacarb induced methemoglobinemia – unveiling a rare poisoning(Publishing Office of the University of Rzeszow, 2024-06) Shaji, Ijas Muhammed; Mohanty, Chitta Ranjan; Radhakrishnan, Rakesh Vadakkethil; Siddique, Ruby NahanIntroduction and aim. In India, the utilization of agricultural pesticides for intentional self-poisoning is a prevalent method, and it is associated with substantially higher fatality rates compared to other self-poisoning approaches. Plethora, an agricultural insecticide containing novaluron (5.25%) and indoxacarb (4.5%), has recently been introduced and widely used in India and various other regions for its broad-spectrum lepidopteran control. While there have been documented cases of isolated self-poisoning involving indoxacarb, there is currently no literature reporting incidents of human poisoning specifically related to novaluron. Description of the case. An 83-Year-old male was presented to the emergency department (ED) with a history of consumption of 50 mL of an insecticide suspension concentrate called ‘PLETHORA’ to commit suicide. He had one episode of vomiting and dizziness after the ingestion. There was associated cyanosis, and the patient was put on high-flow oxygen at 10 L/min through a face mask. The patient was diagnosed to have methemoglobinemia and was successfully treated with methylene blue and ascorbic acid. One hour post methylene blue injection showed a methemoglobin level of 1%, and the patient gradually improved. Patients presenting with novaluron and indoxacarb poisoning require supportive treatment as there is no specific antidote. There should be a high index of suspicion for methemoglobinemia in such patients, and timely management is necessary to prevent further complications. The patient was successfully managed and discharged after the 3rd day of admission. Conclusion. The management of patients with novaluron and indoxacarb poisoning primarily involves supportive care, as there is currently no specific antidote available for these substances. Maintaining a high suspicion index for the development of methemoglobinemia and timely management of other complications is crucial for the best possible patient outcomes.
- PozycjaAn anomalous case report of canine impaction resultant of supernumerary fusion to mandibular incisor(Publishing Office of the University of Rzeszow, 2024-06) Marushko, Olesya; Kraiz, Aya; Marushko, Olena; Błochowiak, KatarzynaIntroduction and aim. Anomalies in dental characteristics such as size, shape, number, structure, and eruption are commonly observed in clinical conditions. One such anomaly is the presence of supernumerary teeth found in various regions of the dental arch. Although frequently asymptomatic, supernumerary teeth are routinely identified during radiographic evaluations. Among the most common causes of impacted maxillary incisors is the presence of supernumerary teeth. Description of the case. Herein, we present a rare case of lower left canine impaction subsequent to a supernumerary fusion to the mandibular left incisor in a 10-year-old Caucasian female. Conclusion. This case contributes to the current knowledge regarding supernumerary fused teeth, emphasizing the importance of early intervention and multidisciplinary collaboration in effectively managing such developmental dental irregularities.