International Journal of Medical and Pharmaceutical Case Reports

The authors report two cases of destructive cranial lesions associated with Mycobacterium tuberculosis–HIV coinfection in a male and female cadaver. Both cadavers were of African origin, from the Western Cape, South Africa. The authors present grossly abnormal tuberculosis–associated lesions of the anterior and middle cranial fossae, involving the ethmoid and sphenoid bones. Both individuals presented with tubercular intrasellar masses and obliteration of the paranasal sinuses. Current literature on cases such as these are extremely rare and others typically focus on lesions of the calvarium. Here we report on the gross anatomical findings as well as the relevant anatomical aspects of the probable aetiology. Both cases presented here hold interest for medical professionals in Africa and other geographic regions. It further illustrates the importance of understanding the venous drainage of the paranasal sinuses when considering the manifestation and treatment of extrapulmonary TB.

Background: Acute methanol poisoning is a fatal illness. Several Atypical presentations could make it difficult to suspect the diagnosis.

Case Report: A 50 years old male known chronic alcoholic presented to the emergency department with severe acute abdominal pain nausea and vomiting. He rapidly deteriorated within 2 hours to develop confusion and seizures, was found to have double gap severe metabolic acidosis and elevated serum methanol. The patient was managed with Continuous Renal Replacement Therapy (CRRT) and supportive measures. He gradually improved and was discharged with no neurological or visual complications.

Conclusion and Recommendations: Acute methanol toxicity should be expected if the alcoholic patient develops a rapid neurological deterioration and shows double anion gap acidosis.

Health authorities should provide the serum formic acid test for diagnosis and the fomepizole as a preferable antidote. Until then, supportive treatment, intravenous ethanol and CRRT should be immediately started in these patients.