nervous system relapse (after two years) died in hospital, four patients continued to improve at the time of their last follow-up (variable period ¼ 3-5 months) and the outcome of the final two was not known. The choice of anti-fungal agents and treatment duration depend on symptoms, disease extension and immune status. The 2007 Update of the Infectious Diseases Society of America (IDSA) recommends initial amphotericin B followed by itraconazole in moderately severe to severe progressive disseminated histoplamosis and itraconazole alone in less severe cases. 4 HIV-infected patients require antifungals for several years or of lifelong duration, 5 depending upon CD4 count, disease severity and the status of anti-retroviral treatment. 4 Although we present seven cases of adrenal histoplasmosis diagnosed and managed over a period of only three years, it is not unlikely that many similar cases remain undiagnosed, misdiagnosed or unreported. Histoplasmosis should be suspected among patients with a history of exposure to a susceptible environment, having fever, weight loss, respiratory symptoms, lymphadenopathy, hepatosplenomegaly, general ill health and adrenal enlargement. 2,3,6 Bilateral adrenal enlargement should raise the suspicion of adrenal histoplasmosis, even in immunocompetent individuals. 6 Informed consent Informed written consent was taken from patients regarding use of their clinical and laboratory data and any accompanying images in this article.
Enterolithiasis, also known as gastro-intestinal concretions, is an uncommon medical disorder that arises from intestinal stasis. Enteroliths are commonly caused by tuberculosis-related constriction and arise from intestinal diverticula. Small bowel obstruction caused by an enterolith is extremely uncommon and might be difficult to diagnose. The mortality rate of uncomplicated enterolithiasis is relatively low, but it rises to 3% in patients who have background comorbid illness, have significant bowel obstruction, and are diagnosed late. We present a rare case of an uncomplicated partial intestinal obstruction caused by an enterolith in an elderly male patient with small bowel diverticular disease who was treated nonoperatively and did not develop further symptoms in the six-month follow-up and discuss the difficulty in diagnosis and its management.
Tuberculosis (TB) is an infectious disease that can affect any organ system of the body. Abdominal TB can be gastrointestinal, lymph nodal, visceral or peritoneal. The gallbladder (GB) is rarely involved in abdominal TB as a primary organ. Extensive research literature on gallbladder TB is limited to case reports. There has been no review on this rare abdominal pathology. GB tuberculosis is a difficult diagnosis preoperatively. It is a rare differential among the more common gallbladder pathologies such as cholelithiasis, or a gallbladder malignancy. Typical histopathology of the resected specimen helps to establish this rare diagnosis. Subjecting every specimen to histopathological examination followed by medical treatment offers the chance of cure. Through this review, the authors attempt to provide an insight into this disease entity.
Collision tumors are two distinct neoplasms seen together in same anatomic site. Management of such rare entity still lacks standardization with unknown prognosis. Here we are presenting one such rare case of invasive ductal carcinoma of breast and squamous cell carcinoma of anterior chest wall in a 31‐year‐old lady.
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