30 research outputs found
Pulmonary tuberculosis and COVID-19 coinfection : Hickam’s Dictum revisited
No full textCOVID-19 and pulmonary tuberculosis (PTB) coinfection is associated with increased mortality and presents a unique diagnostic challenge to the clinician. We describe three cases of newly
diagnosed PTB in COVID-19 patients treated at our centre and their clinical and radiological
features. The challenges associated with diagnosis and management are also explored. Patient 1
was a case of smear positive, endobronchial tuberculosis incidentally diagnosed due to CT
changes, and eventually made good recovery. Patient 2 was a case of COVID-19 who succumbed
but was diagnosed posthumously due to a positive sputum culture for tuberculosis. Patient 3
showed radiographic features of PTB and was treated empirically for TB. In conclusion, COVID-19
and PTB coinfection should be suspected in the presence of constitutional symptoms, prior
immunocompromised states, prolonged respiratory symptoms or fever, or unresolved radiological
abnormalities, more so in regions where TB is endemic.
List of abbreviations
TB tuberculosis
PTB pulmonary tuberculosis
CT computed tomography
WHO World Health Organization
NPOP nasopharyngeal and oropharyngeal
CTPA computed tomography pulmonary angiogram
HRCT high resolution computed tomography
GGO ground glass opacities
ATT anti-tuberculous therapy
IGRA interferon-gamma release assay
* Corresponding author. Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia.
E-mail addresses: [email protected] (L.E. Nyanti), [email protected] (Z.H. Wong), [email protected] (B. Sachdev Manjit Singh),
[email protected] (A.K.W. Chang), [email protected] (A.T. Jobli), [email protected] (H.H. Chua).
Contents lists available at ScienceDirect
Respiratory Medicine Case Reports
journal homepage: www.elsevier.com/locate/rmcr
https://doi.org/10.1016/j.rmcr.2022.101653
Received 5 February 2022; Received in revised form 12 March 2022; Accepted 13 April 202
Chilaiditi’s sign, a cause of pseudo-pneumoperitoneum: A case report
No full textThe differentiation between a pseudo-pneumoperitoneum and true pneumoperitoneum on an initial chest radiograph is challenging but essential to clinical practice. The former is managed conservatively whereas the latter may require surgical intervention. Chilaiditi’s sign describes a rare incidental radiological finding of gas filled bowel interpositioned between the right hemi-diaphragm and the liver, which is visible on a plain abdominal or chest radiograph. It is often misdiagnosed as a pneumoperitoneum. Correct diagnosis of Chilaiditi’s sign in an asymptomatic patient can prevent unnecessary procedures. We have reported one incidental chest radiograph with Chilaiditi’s sign in a patient presenting and treated for pneumonia. The report aims to illustrate the diagnostic dilemma experienced by clinicians in distinguishing a true versus pseudo-pneumoperitoneum on a chest radiograph
Chilaiditi’s sign, a cause of pseudo-pneumoperitoneum:A case report
No full textThe differentiation between a pseudo-pneumoperitoneum and true pneumoperitoneum on an initial chest radiograph is challenging but essential to clinical practice. The former is managed conservatively whereas the latter may require surgical intervention. Chilaiditi's sign describes a rare incidental radiological finding of gas filled bowel interpositioned between the right hemi-diaphragm and the liver, which is visible on a plain abdominal or chest radiograph. It is often misdiagnosed as a pneumoperitoneum. Correct diagnosis of Chilaiditi's sign in an asymptomatic patient can prevent unnecessary procedures. We have reported one incidental chest radiograph with Chilaiditi's sign in a patient presenting and treated for pneumonia. The report aims to illustrate the diagnostic dilemma experienced by clinicians in distinguishing a true versus pseudo-pneumoperitoneum on a chest radiograph
Systemic lupus erythematosus in Sarawak General Hospital: A 10-year update
No full textBackground/Purpose: Systemic lupus erythematosus (SLE) is a complex autoimmune disease with heterogeneous clinical presentation.
We published the Sarawak Lupus Cohort in 2014. Since then there have been many advances in SLE diagnosis and management. We aimed to examine the clinical manifestations and gender differences of an updated SLE cohort in Sarawak General Hospital. Methods: We collected demographics and clinical manifestation data in this prospective observational study from July 2018 until December 2023. All patients fulfilled the 2012 Systemic Lupus Collaborating Clinics (SLICC) Classification Criteria for SLE. Statistical
analysis was performed using SPSS, with means ± SD, Chi-Square or Fisher's exact test. A p-value<0.05 is considered significant.
Results: There were 637 patients in our cohort, with 567 (89%) women and 70 (11%) men. The mean age at SLE diagnosis was 31.17 ± 13.6 years. There were 234 (36.7%) Chinese, 224 (35.2%) Malay, 107 (16.8%) Iban, and 58 (9.1%) Bidayuh patients. Common SLE clinical manifestations were acute cutaneous lupus in 420 (65.9%), followed by renal in 309 (48.5%) and leucopenia or lymphopenia in 307 (48.2%) patients. The common immunological SLE manifestations
were antinuclear antibody (ANA) in 619 (97.2%) and anti-double stranded DNA (anti-dsDNA) in 366 (57.5%) patients. 285 (44.7%) patients had severe disease at presentation. There were 217 (34.1%) patients with a score of SLE Damage Index (SDI) >1, indicating the presence of at least one item of damage. There were 70 (11%) deaths in this cohort. The notable differences between men and women with SLE was a statistically significant higher percentage of men had
renal manifestation (men 41 (58.6%) vs women 268 (47.3%), p = 0.04) and serositis (men 18 (25.7%) vs women 91 (16.0%), p = 0.04). There were more women than men with oral ulcers (women 220 (38.8%) vs men 15 (21.4%), p = 0.004) and alopecia (women 278 (49.0%) vs men 13 (18.6%), p < 0.001). More men had severe disease at presentation
(men 42 (60%) vs women 243 (42.9%), p = 0.006). Among patients with SDI>1 (n = 217), there were more men with end-stage renal failure (ESRF) (men 7 (28%) vs women 11 (5.7%), p = 0.002), myocardial infarction (men 2 (8%) vs women (0), p = 0.01) and extensive skin scarring (men 3 (12%) vs women 4 (2.1%), p = 0.04). There was no gender difference in death in this cohort.
Conclusion: This updated SLE cohort showed acute cutaneous lupus, renal, ANA and anti-dsDNA as the most common SLE manifestations. Men had more severe disease at presentation, with more renal and serositis SLE manifestation. Men had more ESRF, myocardial infarction and extensive skin scarring in the SLE Damage Index
Clinical features of patients with rheumatic diseases and COVID-19 infection in Sarawak, Malaysia
No full textWe read with great interest the article by Ye et al1 describing the clinical features and outcomes of patients with rheumatic diseases and COVID-19 in Wuhan, China. It concluded that length of hospital stay and mortality were similar between patients with rheumatic diseases and non-rheumatic groups, while respiratory failure was more common in patients with rheumatic diseases infected with COVID-19. D’Silva et al2 and Zhao et al3 subsequently highlighted the differences of clinical severity and outcomes in their respective cohorts of patients with rheumatic diseases and COVID-19. Fredi et al4 presented data from northern Italy which supported an association of elderly age and the presence of comorbidities with a poor outcome of COVID-19 infection, rather than the type of rheumatic disease or background medications. The Global Rheumatology Alliance5has recently published data of characteristics associated with hospitalisation for COVID-19 among patients with rheumatic diseases. We would like to share the clinical course of COVID-19 among patients with rheumatic diseases in Sarawak
Pulmonary tuberculosis and COVID-19 coinfection: Hickam’s Dictum revisited
No full textCOVID-19 and pulmonary tuberculosis (PTB) coinfection is associated with increased mortality and presents a unique diagnostic challenge to the clinician. We describe three cases of newly diagnosed PTB in COVID-19 patients treated at our centre and their clinical and radiological features. The challenges associated with diagnosis and management are also explored. Patient 1 was a case of smear positive, endobronchial tuberculosis incidentally diagnosed due to CT changes, and eventually made good recovery. Patient 2 was a case of COVID-19 who succumbed but was diagnosed posthumously due to a positive sputum culture for tuberculosis. Patient 3 showed radiographic features of PTB and was treated empirically for TB. In conclusion, COVID-19 and PTB coinfection should be suspected in the presence of constitutional symptoms, prior immunocompromised states, prolonged respiratory symptoms or fever, or unresolved radiological abnormalities, more so in regions where TB is endemic
Arthritis as an initial presentation of malignancy: two case reports
No full textAbstract
Background: Arthritis is rarely reported as a paraneoplastic manifestation of occult malignancy. We report herein two cases of paraneoplastic arthritis due to occult malignancy.
Case 1: The patient was a 65-year-old woman of asian descent who was a former smoker with a history of spine
surgery performed for L4/L5 degenerative disc disease. She presented with a 1-month history of oligoarthritis afecting both ankle joints and early morning stifness of about 3 hours. Laboratory tests were positive for antinuclear antibody at a titer of 1:320 (speckled) but negative for rheumatoid factor. She was treated for seronegative spondyloarthritis and started on prednisolone without much improvement. A routine chest radiograph incidentally revealed a right lung mass which was found to be adenocarcinoma of the lung. She was treated with geftinib and her arthritis resolved.
Case 2: The patient was a 64-year-old woman of asign descent, nonsmoker, who presented with a chief complaint
of asymmetrical polyarthritis involving her right wrist, second and third metacarpophalangeal joints, and ifrst to fifth proximal interphalangeal joints. She was treated for seronegative rheumatoid arthritis (RA) and started on sulfasalazine, with poor clinical response. Six months later, she developed abdominal pain which was diagnosed as ovarian carcinoma by laparotomy. Her arthritis resolved following treatment of her malignancy with chemotherapy.
Conclusion: In summary, paraneoplastic arthritis usually presents in an atypical manner and responds poorly to
disease-modifying antirheumatic drugs. Accordingly, we recommend screening for occult malignancy in patients
presenting with atypical arthritis.
Pulmonary tuberculosis and COVID-19 coinfection : Hickam's Dictum revisited
No full textCOVID-19 and pulmonary tuberculosis (PTB) coinfection is associated with increased mortality and presents a unique diagnostic challenge to the clinician. We describe three cases of newly diagnosed PTB in COVID-19 patients treated at our centre and their clinical and radiological features. The challenges associated with diagnosis and management are also explored. Patient 1 was a case of smear positive, endobronchial tuberculosis incidentally diagnosed due to CT changes, and eventually made good recovery. Patient 2 was a case of COVID-19 who succumbed but was diagnosed posthumously due to a positive sputum culture for tuberculosis. Patient 3 showed radiographic features of PTB and was treated empirically for TB. In conclusion, COVID-19 and PTB coinfection should be suspected in the presence of constitutional symptoms, prior immunocompromised states, prolonged respiratory symptoms or fever, or unresolved radiological abnormalities, more so in regions where TB is endemic
Acute pancreatitis as an initial presentation of SLE: a case report
No full textBackground: SLE is a complex multi- systemic autoimmune disease
capable of affecting any organ system with varying presentations.
Abdominal pain is a common manifestation of SLE and is reported
to occur in about 8% to 40% of patients with SLE. The causes of
abdominal pain are varied and require accurate assessment. Acute
Pancreatitis is a cause of abdominal pain and is a rare initial SLE
presentation. It is characterized by abdominal pain and raised serum
amylase levels. We would like to report a patient diagnosed with SLE
following an initial presentation of Acute Pancreatitis, which was
complicated with a pancreatic pseudocyst.
Case Report: The patient is an 18- year- old lady with no previous
known medical illness who presented with a one day history of acute
central abdominal pain radiating to the back. This was preceded by a
two week history of fever and non- productive cough. Further history
revealed that she had alopecia, malar rash and painless oral ulcers
one year before this presentation but did not seek medical attention.
Physical examination revealed a tender and distended abdomen.
Blood investigations showed leukopenia, elevated amylase with a
positive Anti- nuclear antibody, and coombs test. She was admitted
to the ICU and treated with intravenous cyclophosphamide, methylprednisolone,
immunoglobulin, and antibiotics. During her follow- up
a month after discharge, she was found to have recurrent abdominal
pain and distension. A repeated CT Abdomen showed a pancreatic
pseudocyst, and she underwent an endoscopic cystogastrostomy.
Currently, she is on regular follow- up and is currently maintained on
Hydroxychloroquine, Azathioprine, and Prednisolone.
Conclusion: In summary, Acute Pancreatitis is a relatively rare initial
manifestation of SLE. The causes of Acute Pancreatitis are varied,
and it is essential to recognize and differentiate Acute Pancreatitis
due to active SLE from other causes as it may affect treatment decisions
and subsequent mortality outcomes
