Case Reports

Rapidly deteriorating mobility in a young man: Case description and possible differential diagnoses

V Srirangam

A 32 year old gentleman, presenting initially with a ‘dragging’ foot, rapidly progressed to become paraplegic within a year. Here, a case summary is presented initially, followed by the differential diagnosis for the clinical presentation. Investigations primarily showed combined central and peripheral demyelination which could have been secondary to the anti-CRMP5 antibodies found in his serum. Such antibodies are highly associated with malignancy and, as a consequence, our patient was extensively investigated for an occult neoplasm (which was not found). While the central and peripheral demyelination may have been secondary to an antibody-mediated paraneoplastic syndrome, other differentials such as autoimmune combined demyelination must also be considered.

Tongue-tied: Management in Pierre Robin Sequence

Nikita Rajaraman Rajaraman, Elvino Barreto

An 18-month-old male with Pierre Robin Sequence (PRS) presented to A&E with airway obstruction and hypoxia due to retroglossoptosis. The patient was resuscitated immediately and intubated. Gold standard treatment was surgical management by mandibular distraction osteogenesis. However, as the patient was unable to afford the surgery, a simpler and cheaper surgical technique had to be employed. The procedure involved pulling the base of the tongue anteriorly and tying to the hyoid bone. This maintained airway patency and patient was extubated. Mother was given feeding and positioning advice for the child. It is expected that the mandibular growth will eventually catch up with the tongue growth.

Bilateral spontaneous rectus sheath haematoma complicating dengue haemorrhagic fever: a case report.

KJ Bhat MD, HJ Samoon and R Shovkat

The clinical course of dengue haemorrhagic fever in the elderly is rather atypical and it is imperative to be aware of the protean manifestations and complications of dengue febrile illness in this age group. Rectus sheath haematoma, in the context of acute emergency presentations is uncommon, especially in the patients on anti-coagulation therapy. Bilateral  rectus sheath haematoma is rarely seen.

We present the first case of spontaneous and bilateral rectus sheath haematoma complicating dengue haemorrhagic fever in an elderly male. This case emphasizes the fact that serious complications can occur during the defervescence phase, especially in the elderly, and that a high index of supervision and suspicion should be maintained by the clincians.


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