International Journal of Medical and Pharmaceutical Case Reports

Herpes simplex encephalitis (HSE) is a medical emergency associated with high mortality and morbidity. Definitive diagnosis is established by history, clinical examination, neuroimaging studies, supportive electroencephalogram (EEG) findings, and cerebrospinal fluid (CSF) analysis.

A 7-year-old Malay girl with known case of right hemiplegia secondary to herpes encephalitis presented to the neuropediatric ward, in General Hospital with refractory seizure. She had a moderate learning disability and diagnosed as right hemiparesis secondary to herpes encephalitis complicated with epilepsy. She was planned for the positron emission tomography (PET) scan and to undergo operation if PET scan was feasible (Hemispherectomy). However, the patient refused for operation.

Prompt clinical recognition is important in the HSE to prevent progressive brain tissue damage, haemorrhagic changes, and worsening of the encephalitis. Diagnosis is usually confirmed through an extensive evaluation, including a thorough clinical examination with attention to findings on mental status changes, cerebrospinal fluid (CSF) analysis, electroencephalogram (EEG) testing and findings on neuroimaging.

Once HSE is suspected, high-dose acyclovir should be started immediately before lumbar puncture (LP), and only stopped once a definitive alternate diagnosis has been established.

This case is reported because the patient has generalized epilepsy with right hemiparesis secondary to herpes encephalitis. Herpes encephalitis with right hemiparesis cases are quite rare.

Light emitting diode (LED) bulb is an unusual cause of foreign body aspiration. We present a case of a 6-year-old boy who reported with a four-day history of difficulty in breathing and cough following a LED bulb aspiration retrieved via rigid bronchoscopy. This present case suggests that LED bulb should be considered in the differential diagnosis of foreign body aspirations in our environment.

Blastomycosis is a chronic granulomatous and suppurative mycoses caused by Blastomyces dermatitidis. The majority of cases show a primary pulmonary disease. We report a 65-year-old male patient with two painless, violaceous nodules over the left chest wall and right inner thigh. Initially, differential diagnoses of disseminated Blastomycosis, Pneumonia, and Diffuse large B-cell lymphoma made based on past and present clinical history and presentation. The final diag-nosis of disseminated with secondary cutaneous Blastomycosis in a followup case of Diffuse large B-cell lymphoma made based on skin biopsy, broncho-alveolar lavage, and bronchial brushing showing budding yeasts of Blastomyces. The patient responded well to therapy with Amphotericin B and Itraconazole along with intravenous methylprednisolone.

A preterm neonate delivered at 28 weeks gestation, mother had antenatal steroid. Blood counts showed leukemoid reaction, blood culture, procalcitonin and peripheral blood film was normal. Baby was stabilized in the NICU, recovered and the WBC count done serially showed a downward trend.  The leukemoid reaction was presumed to come from antenatal steroid use. The diagnostic and management challenges encountered in managing the infant in resource constrained environment like ours is presented alongside.

Mycobacterium avium complex (MAC) is a non-tuberculous mycobacteria (NTM) that causes subacute or chronic nodular bronchiectasis, cavitary or fibro-cavitary pneumonia in patients with chronic structural lung pathology including emphysema, chronic bronchitis, and bronchiectasis. It is also known to cause pulmonary and extrapulmonary infections in patients with impaired cell mediated immunity such as transplant recipients, (Acquired Immune Deficiency Syndrome) AIDS where it can cause disseminated infections. Empyema from MAC has been reported in immunocompromised patients and is a rare phenomenon. Here we report a patient who presented with chronic left pleural effusion and a left lower lobe lung mass that went undiagnosed for 2 years, despite extensive work-up. Later in his course, he presented with a large effusion complicated by a bronchopleural fistula and was diagnosed as MAC empyema. To our knowledge, this is the first case of MAC empyema, that presented as a chronic lung mass, complicated by a bronchopleural fistula. In this article, we present the clinical, laboratory, and radiological features, with emphasis on a combined medical and surgical approach in the management of MAC empyema. We also provide a brief overview of cases of MAC associated pleurisy and empyema that have been reported in literature.