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Background: The diagnosis of acute myocardial infarction is straightforward when it presents with typical symptoms. However, some patients can be asymptomatic, and some can present with atypical symptoms. Case presentation: We present a very rare case of acute myocardial infraction that presented with headache and right upper limb numbness of 2-day duration in a 61-year-old female Middle Eastern patient. The patient underwent percutaneous coronary intervention to a totally occluded right coronary artery with two drug-eluting stents. The headache and numbness immediately disappeared after revascularization, and the patient was discharged on anti-ischemic medications. This report concerns a case of cardiac cephalalgia. Conclusion: Myocardial infarction can present in several different ways and should be included in the differential diagnosis for headache. [ABSTRACT FROM AUTHOR]

Pathogenic Leptospira species are the source of leptospirosis, a common zoonotic infection that can cause a wide range of clinical manifestations, from minor flu‐like symptoms to severe multiorgan failure. We present two peculiar cases of leptospirosis; they highlight the need for clinical awareness to improve patient outcomes and further knowledge of leptospirosis epidemiology and therapy by illuminating the difficulties in diagnosis and treatment. The first case involved a 30‐year‐old male presented with jaundice. Although he had no history of chronic illnesses, an exhaustive investigation was warranted due to his recent travel history and occupational contact. Laboratory tests revealed significantly increased levels of AST and ALT and positive Leptospira IgM serology. Remarkably, the patient refuted the traditional theory of leptospirosis transmission by denying direct animal interaction. After starting therapy with dexamethasone initially and adding doxycycline later, the patient's condition significantly improved; his jaundice resolved and his liver enzyme levels returned to normal. An outpatient follow‐up after discharge was advised to assess liver and kidney function. The second case involved an 87‐year‐old woman with a fever, weakness and hypertension. Investigations revealed hepatosplenomegaly, raising the possibility of hypersplenism. She reported exposure to animals, particularly her dogs in her urban house. Surprisingly, her AST and ALT levels were normal. Lab tests also revealed thrombocytopoenia with normal APTT and prolonged PT. Serological tests indicated positive Leptospira IgM. Along with intravenous infusions, the patient's treatment plan comprised dexamethasone, enalapril and ceftriaxone to treat inflammation, hypertension and bacterial infection, respectively. Following a 20‐day hospital stay, the patient's laboratory results and symptoms improved, leading to her discharge. Continuous follow‐up recommended to monitor her recovery and prevent recurrence. These case studies emphasise the significance of taking leptospirosis into account when treating patients who do not have normal exposure histories yet present with unusual symptoms. [ABSTRACT FROM AUTHOR]

Abstract Background The diagnosis of acute myocardial infarction is straightforward when it presents with typical symptoms. However, some patients can be asymptomatic, and some can present with atypical symptoms. Case presentation We present a very rare case of acute myocardial infraction that presented with headache and right upper limb numbness of 2-day duration in a 61-year-old female Middle Eastern patient. The patient underwent percutaneous coronary intervention to a totally occluded right coronary artery with two drug-eluting stents. The headache and numbness immediately disappeared after revascularization, and the patient was discharged on anti-ischemic medications. This report concerns a case of cardiac cephalalgia. Conclusion Myocardial infarction can present in several different ways and should be included in the differential diagnosis for headache.

Fahr's disease, also known as primary familial brain calcification, is a progressive neurological disorder that follows an autosomal dominant inheritance pattern, characterized by calcifications primarily located within the basal ganglia of the brain. This condition typically affects middle-aged individuals, who present with a combination of neurological and psychiatric symptoms; however, this case report discusses a 16-year-old male patient. The patient initially exhibited general signs of infection, including fever and jaundice, before developing specific neurological symptoms, which progressed to systemic encephalopathy characterized by altered consciousness, seizures, and hypoglycemia, necessitating his admission to the ICU. Tragically, despite receiving intensive medical treatment, the patient succumbed to the disease, highlighting the challenges associated with diagnosing and managing Fahr's disease, particularly in younger patients.

Background: Atypical presentations of ACS delay its recognition and treatment in the older adults. During hospitalization, depression and functional decline, which is unique to older adults, leads to poor clinical outcome. Steps taken for its prevention is unlikely to become a priority for the Cardiologist. This study was conducted to identify depression among older adults who developed ACS during hospitalization for noncardiac illness and their outcome. Methods: 310 older adults with ACS were included from 26 June 2020 to 13 October 2020. Subjects were divided into those admitted primarily due to an ACS (Group I, n = 94) and those developing ACS after admission for noncardiac illness (Group II, n = 216). Co morbidities, medications, investigations, management, clinical outcome, Geriatric Depression Scale was compared between the two groups at the time of admission, after 30 days and after 6 months. Results: Majority of them were admitted due to acute kidney injury (27.1%) in group II and had a non ST elevation ACS (90.2%). Optimum management was given to a lesser extent because of the clinical condition of these patients. Depression during hospitalization, during follow up and poor clinical, functional and cognitive outcome was more in group II. Conclusion: Optimum medical management was not given to considerable number of patients because of atypical presentations, clinical condition, along with functional and cognitive decline which resulted from depression. Clinicians must be vigilant for the development of depression when an older adult is admitted to the hospital, as early detection and optimum management provides better clinical outcome.

ABSTRACT: Background: Atypical presentations of ACS delay its recognition and treatment in the older adults. During hospitalization, depression and functional decline, which is unique to older adults, leads to poor clinical outcome. Steps taken for its prevention is unlikely to become a priority for the Cardiologist. This study was conducted to identify depression among older adults who developed ACS during hospitalization for noncardiac illness and their outcome. Methods: 310 older adults with ACS were included from 26 June 2020 to 13 October 2020. Subjects were divided into those admitted primarily due to an ACS (Group I, n = 94) and those developing ACS after admission for noncardiac illness (Group II, n = 216). Co morbidities, medications, investigations, management, clinical outcome, Geriatric Depression Scale was compared between the two groups at the time of admission, after 30 days and after 6 months. Results: Majority of them were admitted due to acute kidney injury (27.1%) in group II and had a non ST elevation ACS (90.2%). Optimum management was given to a lesser extent because of the clinical condition of these patients. Depression during hospitalization, during follow up and poor clinical, functional and cognitive outcome was more in group II. Conclusion: Optimum medical management was not given to considerable number of patients because of atypical presentations, clinical condition, along with functional and cognitive decline which resulted from depression. Clinicians must be vigilant for the development of depression when an older adult is admitted to the hospital, as early detection and optimum management provides better clinical outcome. [ABSTRACT FROM AUTHOR]

Candidiasis is an opportunistic fungal infection predominantly caused by Candida species, which can manifest in immunocompromised individuals such as those with aplastic anemia. Aplastic anemia, characterized by bone marrow failure, significantly increases susceptibility to infections, with fungal infections being a leading cause of mortality. Oral candidiasis is one of the most common manifestations, and it typically presents as white pseudomembranes. However, atypical presentations can occur. We report a case of a 26-year-old male with aplastic anemia who presented with general weakness, fever, and painful swallowing. On examination, a blackish plaque was observed on his palate. Laboratory tests, including palatal tissue smear, histological examination, and culture, confirmed an infection of Candida tropicalis. This unusual blackish manifestation of oral candidiasis, resembling mucormycosis, has not been previously described in the literature. The patient was treated with intravenous fluconazole, leading to complete resolution of the oral lesions within 11 days. Through this case, we underscore the importance of recognizing atypical presentations of common infections, particularly in immunocompromised patients, and highlight the need for thorough diagnostic evaluation to guide appropriate antifungal therapy. [ABSTRACT FROM AUTHOR]

Central centrifugal cicatricial alopecia (CCCA) nomenclature describes a typical clinical presentation of cicatricial hair loss that begins on the vertex scalp with progressive, symmetric, and centrifugal evolution. However, atypical presentations have been noted clinically by the authors and reported in the literature. We sought to characterize the distribution of hair loss in published cases of adult patients with CCCA. A 3-step search process was used to evaluate research articles in Cumulative Index to Nursing & Allied Health, EMBASE, Google Scholar, MEDLINE, Scopus, and Web of Science databases. Studies with scalp photography or description of hair loss distribution were included. Three researchers evaluated eligible studies for clinical subtypes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review was used to report results. Ninety-nine studies consisting of 281 cases of CCCA were included. Hair loss distributions included variants of the classic presentation along with distinct subtypes such as patchy, occipital, parietal, frontal, temporal, and trichorrhexis. Studies had significant homogeneity, as the classic distribution of CCCA was commonly reported. Additionally, clinically diagnosed cases may have concurrent diagnoses, and numerous studies did not report trichoscopy findings. CCCA terminology may not always be reflective of clinical presentation. Understanding atypical presentations is essential to inform appropriate and targeted treatment. [ABSTRACT FROM AUTHOR]

The clinical and histopathological features of herpes zoster (HZ) are usually straightforward. Atypical histological presentations, in the absence of the classical viral cytopathic changes, are well documented and can make the diagnosis of HZ extremely difficult. Herein, we review the existing literature on atypical cutaneous histological manifestations of the disease, with emphasis on the subtle clues, use of immunohistochemistry, and potential pitfalls. [ABSTRACT FROM AUTHOR]

Tuberculous Meningitis (TBM) is a rare manifestation of Mycobacterium tuberculosis infection affecting the meninges. We present a case of a 40-year-old male initially presenting with neurological deficits mimicking ischemic stroke. Despite classic signs, including fever, headache, and neck stiffness, TBM was initially overlooked, leading to delayed treatment. Comprehensive assessment, imaging findings, and characteristic cerebrospinal fluid findings, confirming TBM with tubercular stroke. The patient responded positively to antitubercular therapy and steroids. This case underscores the diagnostic challenges of TBM, emphasizing the need for a broad differential diagnosis, particularly in regions with a high tuberculosis prevalence. Recognition of atypical presentations is crucial for timely intervention and improved outcomes.

Key Clinical Message: This pediatric case report underscores the importance of maintaining a high clinical suspicion for polyarteritis nodosa (PAN) in patients presenting with atypical features, such as migratory arthritis and subcutaneous nodules. Importantly, it highlights the focus on the potential relationship between streptococcal infection and cutaneous PAN. Early recognition and prompt, aggressive treatment is critical, as PAN can be a life‐threatening condition if left unmanaged. This case emphasizes the need for a multidisciplinary approach to effectively identify and manage this rare vasculitis disorder in the pediatric population. Polyarteritis nodosa (PAN) is a rare and life‐threatening vasculitis with diverse clinical presentations, posing a diagnostic challenge. Early recognition and prompt intervention are crucial to prevent organ damage. We present the case of an 8‐year‐old boy who exhibited atypical symptoms including migratory arthritis, myalgia, digital discoloration and ischemic changes, and subcutaneous nodules. Initial concerns for septic arthritis were ruled out. A comprehensive evaluation revealed elevated inflammatory markers and a confirmatory skin biopsy demonstrating active leukocytoclastic vasculitis, are highly suggestive of a diagnosis of PAN. Notably, elevated ASO titers suggested a possible concurrent streptococcal infection. The aggressive treatment approach with high‐dose aspirin, steroids, methotrexate, and tocilizumab is justified given the severity of the patient's symptoms and the nature of the disease process. This case underscores the importance of considering PAN in the differential diagnosis for children presenting with atypical features. Early diagnosis and prompt intervention, including addressing potential infectious triggers, are crucial for optimal outcomes in pediatric PAN. [ABSTRACT FROM AUTHOR]

Background We describe diverse clinical characteristics and course of confirmed mpox cases managed in a Nigerian tertiary health facility. Methods Clinical and epidemiologic data were analyzed, highlighting the unusual presentations of polymerase chain reaction (PCR)–confirmed mpox cases observed during the 2022 outbreak. Results Out of 17 suspected cases, 13 (76.4%) were PCR confirmed for mpox. The mean ± SD age for the participants was 28.62 ± 10.29 years (range, 2–55), of which 9 (64.3%) were male. Of the 13 PCR-confirmed cases, 5 (38.5%) had varicella zoster virus coinfection, 2 (15.4%) had HIV coinfection, and 1 (7.7%) had diabetes mellitus comorbidity. All patients experienced rash, with 6 (46.2%) having significant genital lesions and 1 (7.7%) having a severe perianal lesion. A lack of prodromal symptoms was reported in 3 (23.1%), and a prolonged prodrome (>1 week) occurred in 5 (38.5%). Skin lesions were polymorphic in 6 (46.2%), and solitary skin lesions occurred in 3 (23.1%), which persisted for >120 days in 7.7%. Conclusions Clinical recognition, diagnosis, and prevention remain a concern in resource-limited settings. Our findings highlight the need to further evaluate unusual skin lesions and to include mpox screening for genital skin lesions that are presumed to be sexually transmitted infections. Revision of clinical case definition and enhanced surveillance are key to early recognition and prevention of spread. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Rhinovirus infection has the potential to exhibit unconventional symptoms like symptomatic hyponatremia. Health care professionals should remain vigilant about this potential complication, especially in cases with uncommon presentations. Timely identification and effective management of hyponatremia can mitigate potential complications and enhance patient prognosis. The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a prominent contributor to low sodium levels. Various factors can contribute to hyponatremia, affecting the diagnosis and treatment of the condition. Of note, some infections have been identified as potential causes of SIADH. Although rhinovirus infection has been linked to SIADH, it is usually associated with severe respiratory infections. Herein, we present a distinctive case where rhinovirus caused significant hyponatremia symptoms, even in the absence of typical respiratory symptoms or fever. [ABSTRACT FROM AUTHOR]

Abstract Background Older adults have complex medical needs that causes increased use of resources at the emergency department (ED). The prevalence of non-specific complaint (NSC) as a chief-complaint in the ED is common among older adults and is not prioritized even though possibly having worse clinical outcome. The objective was to study hospital admission and mortality for older adults visiting the ED with NSC compared to specific complaints such as dyspnea, chest pain and abdominal pain. Methods A retrospective observational study of older adults visiting the ED with NSC and specific complaints; dyspnea, chest pain and abdominal pain was performed. Chief-complaint were collected from electronic medical records. Fatigue, confusion, non-specific complaints, generalized weakness and risk of falling were defined as non-specific complaint (NSC) when registered as chief-complaint at the ED. Admission rate and 30-days mortality were the primary outcomes. Results A total of 4927 patients were included in the study based on chief-complaint; patients with chest pain 1599 (32%), dyspnea 1343 (27%), abdominal pain 1460 (30%) and NSC 525 (11%). Patients with dyspnea and NSC had the highest hospital admission rate 79% vs 70% compared to patients with chest pain (63%) and abdominal pain (61%) (p =

Abstract Pediatric colorectal cancer, comprising just 1% of childhood cancers, has surged among young individuals, underscoring its significant health impact. Diagnostic challenges arise from atypical presentation and nonspecific symptoms in 90% of cases, leading to delayed detection in 19%. Methods A 2-year retrospective study of pediatric colorectal carcinoma cases was conducted across a specialized surgical pediatric center. Data were gathered, including age, symptoms, diagnostics, treatments, and outcomes. Results Six colorectal carcinoma cases (median age, 16) were documented, mainly in males (66%). Predominant histological types included mucinous adenocarcinoma and signet ring cell carcinoma. Metastasis was present in all cases, with symptoms including hematochezia (83%), abdominal pain (100%), weight loss (66%), and anemia (100%). Diagnosis often faced misidentification, fostering disease progression and metastasis. Various diagnostic and treatment modalities were employed, including surgery and neo-adjuvant or adjuvant chemotherapy. Conclusion Swift detection and intervention for pediatric colorectal carcinoma are pivotal. Efficient diagnostics and heightened awareness among medical professionals and the public are imperative. Early surgical intervention remains a cornerstone, especially for patients with pertinent family histories and characteristic symptoms. Tailored guidelines for pediatric patients are needed to enhance outcomes and survival.

Intussusception is the most common paediatric abdominal emergency in young children. Even though red current jelly stool is the pathognomonic feature, it only presents in less than 15% of cases. The clinical diagnosis is often missed as the presentation can mimics others. A recurrent case within 48 hours of reduction is even rare and can be falsely suspected as a normal post-reductive presentation. We highlighted a recurrence of intussusception in a 3-year-old boy, who was initially well after being discharged to home. Medical attention was sought initially but was informed that the clinical presentation could be resolved in a few days. Nevertheless, a second opinion has been sought in view of the persistent frequency pattern. Without delay, readmission of the child was arranged for surgical reduction. Regardless of the mild severity of gastrointestinal symptoms, the possibility of recurrence of intussusception should be suspected despite the presumed success of the initial intervention. [ABSTRACT FROM AUTHOR]

Introduction: Post-stroke mania is a complex neuropsychiatric phenomenon that poses challenges in both diagnosis and management. This paper presents a detailed analysis of three distinct cases, comprising two females and one male, each exhibiting post-stroke mania following cerebrovascular events. Our study aims to provide insights into the varied clinical presentations, contributing factors, and therapeutic interventions in this unique subset of stroke survivors. Case 1: A 71-year-old female experienced a left hemispheric stroke, subsequently displaying manic symptoms characterized by elevated mood, impulsivity, and increased energy. Neuroimaging revealed damage to the parieto-occipital lobe, prompting further exploration into the neural correlates of post-stroke mania. Case 2: A 51-year-old female presented with right hemiparesis. Shortly after the stroke, she manifested manic features, including decreased need for sleep and heightened irritability. Psychosocial factors and pharmacological interventions were investigated to better understand the interplay of biological and environmental influences. Case 3: A 55-year-old male suffered a left hemispheric stroke. Poststroke, she exhibited manic symptoms such as distractibility and excessive goal-directed activity. The impact of lesion location on the manifestation of post-stroke mania was explored in this case. Conclusion:Through a comprehensive analysis of these cases, we aim to contribute to the growing body of literature on post-stroke mania, shedding light on its clinical heterogeneity and paving the way for tailored treatment approaches. Recognizing the nuanced nature of post-stroke mania is crucial for healthcare providers to optimize care strategies and improve the quality of life for stroke survivors grappling with this challenging neuropsychiatric condition. [ABSTRACT FROM AUTHOR]

This study aimed to assess the prevalence of atypical presentations and their association with diagnostic errors in various diseases. This retrospective observational study was conducted using cohort data between January 1 and December 31, 2019. Consecutive outpatients consulted by physicians from the Department of Diagnostic and Generalist Medicine at a university hospital in Japan were included. Patients for whom the final diagnosis was not confirmed were excluded. Primary outcomes were the prevalence of atypical presentations, and the prevalence of diagnostic errors in groups with typical and atypical presentations. Diagnostic errors and atypical presentations were assessed using the Revised Safer Dx Instrument. We performed primary analyses using a criterion; the average score of less than five to item 12 of two independent reviewers was an atypical presentation (liberal criterion). We also performed additional analyses using another criterion; the average score of three or less to item 12 was an atypical presentation (conservative criterion). A total of 930 patients were included out of a total of 2022 eligible. The prevalence of atypical presentation was 21.7 and 6.7 % when using liberal and conservative criteria for atypical presentation, respectively. Diagnostic errors (2.8 %) were most commonly observed in the cases with slight to moderate atypical presentation. Atypical presentation was associated with diagnostic errors with the liberal criterion for atypical presentation; however, this diminished with the conservative criterion. An atypical presentation was observed in up to 20 % of outpatients with a confirmed diagnosis, and slight to moderate atypical presentation may be the highest risk population for diagnostic errors. [ABSTRACT FROM AUTHOR]

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Ectopic pregnancy is a life-threatening condition that occurs when a fertilized egg implants outside the uterine cavity. While the classical presentation involves abdominal pain, vaginal bleeding, and amenorrhea, atypical manifestations can pose diagnostic challenges and lead to delayed intervention. We presented a case of a 26-year-old G2P1+0 female with a history of cesarean section nine months ago. She gave with ten days of lower abdominal pain and brownish vaginal discharge but without the classical triad of symptoms. She exhibited signs of distress on examination, and her pulse and blood pressure were elevated. Transvaginal ultrasonography revealed an empty uterus with a heterogeneous area in the pouch of Douglas. A diagnosis of ruptured ectopic pregnancy was made based on clinical and imaging findings, and exploratory laparotomy confirmed a ruptured right tubal ectopic pregnancy. Additionally, bleeding was observed from tissue attached to the lower posterior part of the uterus, which was excised during surgery. This case highlights the importance of considering atypical presentations of ectopic pregnancy and the necessity of timely diagnosis and intervention to prevent adverse outcomes. Healthcare providers should maintain a high index of suspicion for ectopic pregnancy, especially in women with positive pregnancy tests and pelvic symptoms, even without the classical triad. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Biological Sciences is the property of African Journal of Biological Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Key Clinical Message This pediatric case report underscores the importance of maintaining a high clinical suspicion for polyarteritis nodosa (PAN) in patients presenting with atypical features, such as migratory arthritis and subcutaneous nodules. Importantly, it highlights the focus on the potential relationship between streptococcal infection and cutaneous PAN. Early recognition and prompt, aggressive treatment is critical, as PAN can be a life‐threatening condition if left unmanaged. This case emphasizes the need for a multidisciplinary approach to effectively identify and manage this rare vasculitis disorder in the pediatric population. Abstract Polyarteritis nodosa (PAN) is a rare and life‐threatening vasculitis with diverse clinical presentations, posing a diagnostic challenge. Early recognition and prompt intervention are crucial to prevent organ damage. We present the case of an 8‐year‐old boy who exhibited atypical symptoms including migratory arthritis, myalgia, digital discoloration and ischemic changes, and subcutaneous nodules. Initial concerns for septic arthritis were ruled out. A comprehensive evaluation revealed elevated inflammatory markers and a confirmatory skin biopsy demonstrating active leukocytoclastic vasculitis, are highly suggestive of a diagnosis of PAN. Notably, elevated ASO titers suggested a possible concurrent streptococcal infection. The aggressive treatment approach with high‐dose aspirin, steroids, methotrexate, and tocilizumab is justified given the severity of the patient's symptoms and the nature of the disease process. This case underscores the importance of considering PAN in the differential diagnosis for children presenting with atypical features. Early diagnosis and prompt intervention, including addressing potential infectious triggers, are crucial for optimal outcomes in pediatric PAN.

Hydatid disease is caused by the larval stage of the tapeworm Echinococcus granulosus. The definitive hosts include dogs and canines. Humans are accidental hosts and do not play a role in the biological cycle of the worm. The mode of infection is through ingesting food contaminated with dog feces containing gravid proglottids and free eggs, which hatch in the intestine and form larvae. The larvae then penetrate the intestinal wall, enter the bloodstream, and typically settle in the liver followed by the lungs. However, in rare instances, hydatid cysts can occur in various unusual sites throughout the body and even in a disseminated manner, leading to atypical clinical presentations and diagnostic challenges. Hereby, authors report a series of four cases (three males and one female) of hydatid cysts occurring at unusual sites, mainly the brain, kidney, spleen, and lung. The common age group among the observed cases was the second to fourth decade, showing a male predominance. In cases of splenic and renal hydatid cysts, patients presented with intermittent dull aching pain over the left and right flanks, respectively. In both cases, ultrasonography revealed the presence of multiple cysts in the spleen and kidney. In the case of cerebral hydatid cysts, the patient provided a history of short-term memory loss along with a few non specific symptoms, and Magnetic Resonance Imaging (MRI) revealed a hyperintense cystic lesion. In pulmonary hydatid cysts, the patient presented with symptoms of cough, dyspnoea, chest pain, and expectoration. X-ray examination supported the presence of the cyst. Surgery, preferably radical cystectomy, is considered for treatment, and the diagnosis is always confirmed by histopathology.

Key Clinical Message Rhinovirus infection has the potential to exhibit unconventional symptoms like symptomatic hyponatremia. Health care professionals should remain vigilant about this potential complication, especially in cases with uncommon presentations. Timely identification and effective management of hyponatremia can mitigate potential complications and enhance patient prognosis. Abstract The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) is a prominent contributor to low sodium levels. Various factors can contribute to hyponatremia, affecting the diagnosis and treatment of the condition. Of note, some infections have been identified as potential causes of SIADH. Although rhinovirus infection has been linked to SIADH, it is usually associated with severe respiratory infections. Herein, we present a distinctive case where rhinovirus caused significant hyponatremia symptoms, even in the absence of typical respiratory symptoms or fever.

Abstract Background The respiratory system is the most frequently affected system by COVID-19. However, a variety of extra-pulmonary systems can be influenced by COVID-19 with subsequent morbidity and mortality. Aim This study aim is to report the most frequent extra pulmonary presentations of COVID-19 with comparison to patients with primary pulmonary presentation. Risk factors for ICU admission in both groups were examined. Methods In this prospective comparative cross-sectional study, detailed demographics, medical history, clinical assessment, and computed tomography (CT) scan of the chest were done to all recruited patients with COVID-19. Result This study included a total of 1664 confirmed COVID-19 patients. The patients were categorized into two groups. Patients with pulmonary manifestations included 716 patients while 948 patients presented with extrapulmonary manifestations. Patients in the extrapulmonary group were older. The prevalence of certain chronic comorbid conditions was higher in the extra pulmonary group as cardiac, CNS, hepatic, and renal diseases, while chronic respiratory disorders were more prevalent in the pulmonary group (P value:

Background: COVID-19 has currently well-described signs and symptoms. However, older adults often present with an atypical condition, which can confuse and delay diagnosis and treatment. Summary: A scoping review was performed according to Joanna Briggs Institute methodology and prepared using the PRISMA-ScR. It included 61 studies. The objectives were to identify the atypical symptoms of COVID-19 in older adults and summarize and synthesize the evidence regarding the clinical outcomes of older adults with atypical presentations of COVID-19. Fifty-eight atypical symptoms were identified. Geriatric syndromes were the most prevalent atypical presentations of COVID-19. The prevalence of older adults with atypical presentation was 29 ± 18.45%. The mortality rate of older adults with atypical presentation was 28.3 ± 10.26 (17–37%). Key Messages: This scoping review showed that geriatric syndromes represent a frequent atypical presentation of COVID-19 in older adults. It is necessary to give visibility to those presentations in older populations with COVID-19 to advance the required interventions.

Toxic megacolon denotes an abrupt non-obstructive distension of the colon, accompanied by systemic signs of toxicity. Mortality rates can soar as high as 7.9%. While primarily linked with chronic bowel conditions, the incidence attributed to Clostridioides difficile has surged due to the indiscriminate use of broad-spectrum antibiotics. Surgical intervention becomes necessary in the majority of cases. Herein, we illustrate the case of a 50-year-old female presenting with episodic epigastric pain lasting 9 h, vomiting, and watery bowel movements, devoid of peritoneal irritation findings and lacking a history of chronic intestinal inflammation. Under certain circumstances, toxic megacolon may manifest atypically, underscoring the importance of conducting a comprehensive medical history and clinical assessment. Moreover, it is imperative to solicit pertinent paraclinical investigations to address the patient holistically and foster a favorable clinical outcome. [ABSTRACT FROM AUTHOR]

Malignant melanoma is a highly aggressive cancer with metastatic potential to various locations such as the lymph nodes, lungs, liver, brain, and bone. After the lymph nodes, the lungs are the most common site of malignant melanoma metastases. Pulmonary metastases from malignant melanoma commonly presents as solitary or multiple solid nodules, sub-solid nodules or miliary opacities on CT chest. We present a case of pulmonary metastases from malignant melanoma in a 74-year-old man which presented unusually on CT chest as a combination of patterns like “crazy paving,” upper lobe predominance with subpleural sparing, and centrilobular micronodules. Video-assisted thoracoscopic surgery, wedge resection and tissue analysis were performed, which confirmed the diagnosis of malignant melanoma metastases, and the patient further underwent PET-CT for staging and surveillance. Patients with pulmonary metastases from malignant melanoma can have atypical imaging findings, therefore radiologists should be aware of these unconventional presentations to avoid any misdiagnoses.

This case report explains an extraordinary presentation of chronic myeloid leukemia (CML) in a 39-year-old male with a T315I mutation, presenting with acute bilateral hearing loss and imbalance secondary to myeloid blast crisis. Neurological involvement was confirmed through MRI brain and cerebrospinal fluid analysis. Initial treatment with ponatinib and FLAG (fludarabine, cytarabine, G-CSF) regimen showed promise, but complications necessitated discontinuation. The patient's complex clinical trajectory, marked by complications and intolerance to tyrosine kinase inhibitors, highlights the intricate nature of CML blast crisis with T315I mutation management. Recognizing atypical presentations and early mutation analysis are pivotal for tailored treatment strategies.

Creutzfeldt-Jakob disease (CJD) is a rare, rapidly progressive neurodegenerative disorder, characterized by the accumulation of abnormal prion proteins in the brain. While CJD has some typical clinical features, its presentation can be quite heterogeneous, particularly in the early stages of the disease, posing challenges in diagnosis. Atypical manifestations of CJD can mimic various neurodegenerative disorders, including atypical parkinsonisms. In this case report, we present an 81-year-old man who exhibited an atypical clinical presentation of sporadic CJD, initially resembling progressive supranuclear palsy (PSP). The patient presented with symmetric parkinsonism, postural instability, and ocular motor dysfunction, accompanied by rapid clinical deterioration. Alongside the case report, we also provide a review of the literature on atypical presentations of CJD as PSP, highlighting the importance of recognizing these manifestations in clinical practice.

BackgroundThe objective of this study was to investigate the differences in presenting symptoms between patients with and without diabetes being diagnosed with an acute myocardial infarction (AMI).MethodsA total of 5,900 patients with a first-time AMI were included into the analysis. All patients aged between 25 and 84 years were recorded by the population-based Myocardial Infarction Registry in Augsburg, Germany, between 2010 and 2017. The presence (yes/no) of 12 AMI typical symptoms during the acute event was assessed within the scope of a face-to-face interview. Multivariable adjusted logistic regression models were calculated to analyze the associations between presenting symptoms and diabetes mellitus in AMI patients.ResultsPatients with diabetes had significantly less frequent typical pain symptoms, including typical chest pain. Also, other symptoms like sweating, vomiting/nausea, dizziness/vertigo and fear of death/feeling of annihilation occurred significantly more likely in non-diabetic patients. The only exception was the symptom of shortness of breath, which was found significantly more often in patients with diabetes. In multivariable-adjusted regression models, however, the observed effects were attenuated. In patients younger than 55 years, the associations between diabetes and various symptoms were mainly missing.ConclusionsType 2 diabetes mellitus is a risk factor not only for the development of AMI, but is also associated with an adverse outcome after AMI. Atypical clinical presentation additionally complicates the diagnostic process. It is therefore essential for physicians to be aware of the more often atypical symptoms that diabetic AMI patients report.

Key Clinical Message: Atypical presentations of eumycetoma can pose a challenge in the diagnosis and treatment of the disease. Healthcare providers thorough in their differential diagnosis and investigations, even in the absence of classic symptoms, in order to improve early detection and the case management for such a neglected tropical disease. In this communication, we present a case study of an unusual presentation of eumycetoma; a fungal infection that is considered a neglected tropical disease. The patient, a 28‐year‐old male from Sudan, presented with a recurrent mass in the abdominal wall. Despite two surgeries to remove the mass, it continued to recur. Unlike typical cases of eumycetoma, this patient did not exhibit common symptoms such as painless swelling, sinuses, or grain‐containing discharge. The diagnosis was made incidentally after surgical excision of the mass. The abstract highlights the importance of recognizing uncommon presentations and maintaining a high suspicion for rare diagnoses, even in the absence of classic symptoms. Further research is needed to better understand atypical presentations of eumycetoma and improve early detection. [ABSTRACT FROM AUTHOR]

Central centrifugal cicatricial alopecia (CCCA) is a scarring alopecia seen primarily in women of African descent but rarely reported in men. The etiology of CCCA is unknown, but genetic variants, type 2 diabetes mellitus, and bacterial infections may play a role. We aimed to characterize the demographics, medical histories, and clinical findings of male patients with CCCA with the hypothesis that features may differ from women. This was a case series of adult male patients with biopsy-confirmed CCCA seen at an academic dermatology department between 2012 and 2022. In total, 17 males had a scalp biopsy and clinical findings consistent with CCCA. The average age was 43 years, and 88.2% of cases identified as Black race. Scalp pruritus was the most common symptom, and few patients endorsed high-risk hair care practices. None of the cases had diagnosis of type 2 diabetes mellitus, but 17.6% had history of latent tuberculosis, and 47.1% had a positive family history of alopecia. We observed 8 patients with atypical CCCA, and 29.4% had an overlapping scalp diagnosis. This study is limited by the single center, retrospective design and small sample size. It is important to consider CCCA in the differential diagnosis of alopecia in adult Black males. [ABSTRACT FROM AUTHOR]

Background: COVID-19 has currently well-described signs and symptoms. However, older adults often present with an atypical condition, which can confuse and delay diagnosis and treatment. Summary: A scoping review was performed according to Joanna Briggs Institute methodology and prepared using the PRISMA-ScR. It included 61 studies. The objectives were to identify the atypical symptoms of COVID-19 in older adults and summarize and synthesize the evidence regarding the clinical outcomes of older adults with atypical presentations of COVID-19. Fifty-eight atypical symptoms were identified. Geriatric syndromes were the most prevalent atypical presentations of COVID-19. The prevalence of older adults with atypical presentation was 29 ± 18.45%. The mortality rate of older adults with atypical presentation was 28.3 ± 10.26 (17–37%). Key Messages: This scoping review showed that geriatric syndromes represent a frequent atypical presentation of COVID-19 in older adults. It is necessary to give visibility to those presentations in older populations with COVID-19 to advance the required interventions. [ABSTRACT FROM AUTHOR]

Background: The respiratory system is the most frequently affected system by COVID-19. However, a variety of extra-pulmonary systems can be influenced by COVID-19 with subsequent morbidity and mortality. Aim: This study aim is to report the most frequent extra pulmonary presentations of COVID-19 with comparison to patients with primary pulmonary presentation. Risk factors for ICU admission in both groups were examined. Methods: In this prospective comparative cross-sectional study, detailed demographics, medical history, clinical assessment, and computed tomography (CT) scan of the chest were done to all recruited patients with COVID-19. Result: This study included a total of 1664 confirmed COVID-19 patients. The patients were categorized into two groups. Patients with pulmonary manifestations included 716 patients while 948 patients presented with extrapulmonary manifestations. Patients in the extrapulmonary group were older. The prevalence of certain chronic comorbid conditions was higher in the extra pulmonary group as cardiac, CNS, hepatic, and renal diseases, while chronic respiratory disorders were more prevalent in the pulmonary group (P value: < 0.0001). No significant difference in CT severity score between both groups. CORAD 5 was predominant in the pulmonary group (P value: < 0.0001). Most cases in both groups required hospital admission either inward or in ICU with higher frequency of ICU admission was observed in the pulmonary group. The significant risk factors for ICU admission in both groups were critically ill category of patients, CT severity, low oxygen saturation level, and the presence of comorbid chronic disease (P < 0.0001 with adjusted Odds ratio). CNS, cardiac, renal, and metabolic dysfunctions exert significant risk for ICU admission in the extrapulmonary group. Conclusion: Atypical or non-respiratory manifestations could be the presentation of a respiratory pathogen as reported in COVID-19. Our work highlights the extrapulmonary presentation of COVID-19. Older male patients were more prone to present with extra pulmonary symptoms. CNS, cardiac, renal, and metabolic dysfunctions were the most affected systems. This could impact the level of care required for patient management and the extent of resource utility. [ABSTRACT FROM AUTHOR]

Key Clinical Message: This case report highlights the importance of recognizing and accurately diagnosing ganglioneuroblastoma, an uncommon variant of neuroblastic tumors in children. Ganglioneuroblastomas have diverse clinical and morphological presentations, and histopathological examination is paramount in guiding treatment decisions, especially in cases with ambiguous symptoms. Early detection is crucial, as the prognosis varies significantly based on the subtype and the presence of metastatic disease. Clinicians should maintain a high index of suspicion and utilize radiological examinations to promptly identify and treat these tumors. Children are frequently affected by neuroblastic tumors, which grow from the sympathoadrenal lineage of the neural crest during its development. However, intermixed ganglioneuroblastomas are far less common within the same tumor spectrum, the diagnosis of which could become challenging amidst an unusual presentation. In our case report, we present a 4‐year‐old boy who had complaints of fever and difficulty in walking, with a supra‐renal mass on ultrasound, which was diagnosed as ganglioneuroblastoma‐intermixed type on histopathological examination. This report aims to contribute to the understanding of the diverse clinical and morphological spectrum of ganglioneuroblastomas and the importance of multidisciplinary collaboration and histopathological examination to enhance decision‐making in such ambiguous scenarios. [ABSTRACT FROM AUTHOR]

Gyrate atrophy (GA) is a hereditary condition characterized by ornithine aminotransferase deficiency-related large areas of retinal pigment epithelium and choriocapillaris lobular-shaped atrophy in the peripheral retina. In this report, we present a case of atypical presentation of GA. The aim of this report is to present two siblings, one of which was associated with a lamellar macular hole and with a history of previous diagnosis of retinitis pigmentosa. The delayed diagnosis of GA was made only after her brother, who was 5 years younger than her was diagnosed with GA. In addition, in this report, we evaluated GA in terms of multimodal imaging findings, differential diagnosis, and treatment of macular complications. [ABSTRACT FROM AUTHOR]

The clinical and histopathological features of herpes zoster (HZ) are usually straightforward. Atypical histological presentations, in the absence of the classical viral cytopathic changes, are well documented and can make the diagnosis of HZ extremely difficult. Herein, we review the existing literature on atypical cutaneous histological manifestations of the disease, with emphasis on the subtle clues, use of immunohistochemistry, and potential pitfalls.

Molluscum contagiosum (MC) is a highly contagious, cutaneous infection caused by a double-stranded DNA poxvirus. Mollusca are characterized by a firm, dome-shaped, flesh-colored, pearly papule with a white, umbilicated center. Generally, lesions occur in clusters and range in size from 1 to 5 millimeters. Although unusual and infrequent, MC occurring in an epidermal inclusion cyst has been reported. This case involves an 83-year-old woman with a flesh-colored, slightly tender papule on the right lower vermillion border, which had been enlarging over several months. Histopathology showed prominent molluscum bodies present in the adjacent epidermis and focally lining the central epidermal cyst. The findings observed in this case support the hypothesized pathophysiological co-inoculation theory for the development of molluscum-infected epidermal inclusion cysts. This is clinically significant given the infectivity of cyst contents and the potential for direct inoculation of the cyst. Given its rarity, treatment protocols for epidermal inclusion cysts containing MC have not been established. However, management requires care to avoid viral transmission. [ABSTRACT FROM AUTHOR]

Key Clinical Message Atypical presentations of eumycetoma can pose a challenge in the diagnosis and treatment of the disease. Healthcare providers thorough in their differential diagnosis and investigations, even in the absence of classic symptoms, in order to improve early detection and the case management for such a neglected tropical disease. Abstract In this communication, we present a case study of an unusual presentation of eumycetoma; a fungal infection that is considered a neglected tropical disease. The patient, a 28‐year‐old male from Sudan, presented with a recurrent mass in the abdominal wall. Despite two surgeries to remove the mass, it continued to recur. Unlike typical cases of eumycetoma, this patient did not exhibit common symptoms such as painless swelling, sinuses, or grain‐containing discharge. The diagnosis was made incidentally after surgical excision of the mass. The abstract highlights the importance of recognizing uncommon presentations and maintaining a high suspicion for rare diagnoses, even in the absence of classic symptoms. Further research is needed to better understand atypical presentations of eumycetoma and improve early detection.

IntroductionBehcet’s syndrome is a rare, chronic, systemic condition often categorized within the group of vasculitides. It presents a diagnostic challenge due to its varied clinical manifestations and the absence of a definitive laboratory test. Its etiology remains unclear but may involve genetic, infectious, and environmental factors.Case presentationWe report the case of a 16-year-old male who presented with deep vein thrombosis, followed by recurrent episodes of breakthrough thrombosis, despite adequate anticoagulant therapy. The patient did not meet the International Study Group (ISG) criteria nor the International Criteria for Behcet’s syndrome (ICBD) due to the absence of characteristic features such as oral aphthous ulcers, genital ulcers, and uveitis. Later in the disease course, after ruling out other causes of breakthrough thrombosis, he tested positive for HLA-B51, an allele associated with Behcet’s syndrome, and exhibited a pathergy reaction.DiscussionThe patient’s clinical course underlines the diagnostic complexity associated with Behcet’s syndrome and highlights the importance of maintaining a broad differential diagnosis in cases of recurrent thrombosis. Although HLA-B51 testing is not routinely recommended, it played a pivotal role in our case, underscoring the value of an integrated diagnostic approach. Furthermore, this case reinforces the potential for atypical presentations of Behcet’s syndrome, necessitating vigilant clinical awareness. After establishing the diagnosis, we successfully treated the patient with immunosuppressive therapy, significantly improving his condition.

Key Clinical Message This case report highlights the importance of recognizing and accurately diagnosing ganglioneuroblastoma, an uncommon variant of neuroblastic tumors in children. Ganglioneuroblastomas have diverse clinical and morphological presentations, and histopathological examination is paramount in guiding treatment decisions, especially in cases with ambiguous symptoms. Early detection is crucial, as the prognosis varies significantly based on the subtype and the presence of metastatic disease. Clinicians should maintain a high index of suspicion and utilize radiological examinations to promptly identify and treat these tumors. Abstract Children are frequently affected by neuroblastic tumors, which grow from the sympathoadrenal lineage of the neural crest during its development. However, intermixed ganglioneuroblastomas are far less common within the same tumor spectrum, the diagnosis of which could become challenging amidst an unusual presentation. In our case report, we present a 4‐year‐old boy who had complaints of fever and difficulty in walking, with a supra‐renal mass on ultrasound, which was diagnosed as ganglioneuroblastoma‐intermixed type on histopathological examination. This report aims to contribute to the understanding of the diverse clinical and morphological spectrum of ganglioneuroblastomas and the importance of multidisciplinary collaboration and histopathological examination to enhance decision‐making in such ambiguous scenarios.

Myasthenia gravis (MG) is a rare condition that impairs function at the neuromuscular junction of skeletal muscles, seen less commonly in children. Causes include autoimmune MG, congenital myasthenic syndromes, and transient neonatal myasthenia gravis. Symptoms of weakness, hypotonia, and fatigability can be reasonably explained by more common causes, thus children with MG disorders commonly experience delays in treatment with severe consequences. This leads to the progression of disease and serious complications including myasthenic crises and exacerbations. We describe 5 cases of MG, which illustrate clinical and genetic challenges in establishing diagnosis and subsequent consequences of delayed diagnosis. [ABSTRACT FROM AUTHOR]

BackgroundOlder adults frequently experience nonspecific clinical features. However, there is limited evidence on how often admission diagnoses for hospitalized older patients are incorrect, potentially leading to treatment delays.ObjectivesTo determine the consistency between hospital admission and discharge diagnoses, and identify factors associated with diagnostic discrepancies in older adults.Design and settingPopulation-based cohort study in the United States. We included adults aged ≥ 18 years who were admitted from emergency departments (EDs) to hospitals, identified using the 2005-2010 National Hospital Ambulatory Medical Survey, a nationally representative survey.MethodsThree admission diagnoses and the principal discharge diagnosis were captured and classified as discrepant if they involved considerably different conditions within the same organ system, or different organ systems altogether.ResultsEach year, 12 million adults were hospitalized following ED visits in the United States; 45% were aged ≥ 65 years. These patients' mean age was 79 years and 58% were women. Diagnostic discrepancies between admission and discharge were more common among adults ≥ 65 years (12.5 versus 8.3%; P < 0.001). Certain admission diagnoses had particularly high rates of diagnostic discrepancies: 26-27% of patients presenting with mental disorders or with endocrine and metabolic diseases had substantial diagnostic discrepancies between admission and discharge. Substantial diagnostic discrepancy was independently associated with longer hospitalization and higher in-hospital mortality.ConclusionOne out of eight older adults hospitalized from EDs was discharged with a principal diagnosis differing considerably from the admission diagnosis. Given that missed or delayed diagnoses are a critical safety problem, clinicians should be vigilant and frequently cogitate alternative diagnostic possibilities.