Case Reports in Clinical Practice
Volume:4 Issue: 3, Summer 2019

Granulomatous mastitis is a pathological diagnosis with a variety of causes, and its treatment depends on the underlying cause. We report a case of granulomatous mastitis in a 25-year-old woman admitted with erythema nodosum and an unresponded acute inflammatory mastitis to treatment. It was challenging for us to make a definite diagnosis between sarcoidosis and idiopathic lobular granulomatous mastitis for her. In the end, our diagnosis was sarcoidosis because of dactylitis we found in her physical examination which responded dramatically to nonsteroidal anti-inflammatory drug treatment. We started therapy with corticosteroids and immunosuppressant drugs and offered her continuous follow-up.

Gout is a type of inflammatory arthritis that results from the deposition of monosodium urate crystals in the articular or periarticular tissues. In this educational case, we report a middle- aged man who presented with multiple nodules distributed bilaterally over the dorsum of his hands, feet, and elbow joints. Based on clinical and histological findings, the nodules were found to be gouty tophi, and the patient was diagnosed with tophaceous gout characterized by collections of solid urates in connective tissues.

The metastasis to respiratory system secondary to chondrosarcoma is a common finding; however, metastasis to other organs such as skin or bones is much less common. In the current report, we described a case with the history of chondrosarcoma of the mandible that recently referred with the metastatic lesions in her scalp skin. Our case is a female patient that its secondary metastasis occurred only 4 months after her initial tumor diagnosis. More interestingly, among all baseline laboratory parameters, only inflammatory biomarkers increased as the nonspecific diagnostic indices. In other words, the accurate diagnosis of metastasis to bone following chondrosarcoma may be delayed and even masked with early inflammatory reactions. On the whole, in all patients who suffer from chondrosarcoma, early metastasis to skin or bones should be considered, especially when inflammatory indices are high.

Schwannoma is one of the most common benign intracranial tumors which originates from the Schwann cells of neural sheaths in the upper part of vestibular branch of the eighth nerve, especially in patients with neurofibromatosis type 2. Schwannoma in the other parts of head and neck region is, however, relatively uncommon.The present report describes a rare case of schwannoma that was accidentally discovered in the upper lip in asymptomatic patient lasting for more than 10 years with recently size enlargement. Schwannoma could be seen in a variety of anatomic sites. Thus, this diagnosis should be considered in the differential diagnosis of soft tissue tumor in any location.

Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disorder, which rarely presents with pulmonary artery aneurysm. This report presents a 51-year-old female, known case of SLE for 20 years, presented with dyspnea, productive cough, and hemoptysis. The patient was diagnosed as having a pulmonary artery aneurysm, and managed with medical therapy and follow up instead of surgery.

Muscle weakness and rhabdomyolysis have a wide range of differential diagnosis. In many situations, they are induced by seizure, trauma, drugs, and toxins. They could also be due to inflammatory or metabolic myopathies. Identifying the exact cause is crucial and sometimes challenging.

A 23-year-old man was admitted to our hospital with muscle weakness, fatigue, dyspnea, and dark urine, all preceded by flu-like symptoms, myalgia, and fever. Due to reduced muscle strength, dark urine, elevated serum creatine kinase, and serum creatinine, he was diagnosed with rhabdomyolysis and acute kidney injury. Muscle biopsy was performed three years before for the patient, due to a history of similar episodes and exercise intolerance. Because of recurrent episodes of muscle weakness and rhabdomyolysis along with the negative muscle biopsy for inflammatory myopathies, we suspected metabolic myopathy as a cause. Therefore, metabolic screening was performed for the patient, and he was diagnosed with metabolic myopathy known as Carnitine Palmitoyltransferase II (CPT II) deficiency.

In patients with recurrent rhabdomyolysis, we should consider inherited myopathies, especially carnitine palmitoyltransferase II deficiency and glycogen storage disease type V (McArdle disease) as likely causes. CPT II deficiency is regarded as a preventable cause of recurrent rhabdomyolysis. Therefore, by early diagnosis of this disorder we could prevent recurrent episodes of rhabdomyolysis and ultimately avoid life threatening complications like acute kidney injury.

Caroli syndrome is a congenital disorder characterized by multiple segmental or saccular dilatations of the intrahepatic bile ducts associated with congenital hepatic fibrosis.

A 3-year-old boy with abdominal distention was referred to gastroentrology ward of Amiralmomenin hospital (Semnan, Iran) in summer 2018. In his abdominal sonography, multiple cysts were detected in the liver with hepatomegaly, and the portal vein pressure was 10 mm. Also, in liver biopsy, dilated portal bile ducts (trichrome stain) with inspissated bile and congenital hepatic fibrosis were reported. He was discharged after conservative therapy and followed up.

Definitive treatment, i.e surgery, should be offered to prevent future complications.

Lichenoid dermatitis is a rare complication after radiation therapy and is often considered as a delayed hypersensitivity reaction. It is different from lichen planus and is characterized by fine white scale (Wickham’s striae). Here, we report a case of lichenoid dermatitis developed after hypofractionated whole-breast radiation therapy followed by breast-conserving surgery. A 60-year-old female patient underwent hypofractionated whole-breast radiation therapy followed by a boost to the tumor bed. Post-radiation course was uneventful, but violaceous, polyangular, and pruritic papules accompanied by the eruption were noted at the boost site. Clinical findings were consistent with lichenoid dermatitis, so steroid ointment and oral antihistamines were administered. Her lichenoid dermatitis was completely relieved in 2 weeks, and there was no sign of relapse during the 5 years follow-up. There are some reports of lichen planus induced after radiotherapy; however, this is the first report that shows lichenoid dermatitis as a possible complication after hypofractionated radiation therapy for breast cancer.