Aplasia cutis congenita (ACC) is a rare congenital defect described by the absence of skin and occasionally subcutaneous tissues or bone. The management of ACC varies depending on the lesion size, location and associated abnormalities. Small lesions often heal spontaneously, whereas larger lesions are significant and usually associated with additional anomalies in other organs. This paper reports three cases, which describe large lesions of ACC, presented with other abnormalities (Adams–Oliver syndrome, intestinal obstruction and heart defect). Particular attention should be paid to the patient with large lesions of ACC to investigate more congenital anomalies.
Necrolytic Acral Erythema (NAE) is a rare cutaneous sign for hepatitis C
virus, which generally presents as circumscribed keratotic plaques on
the extremities. Many studies reported NAE in the absence of HCV. This
case presents a female diagnosed with NAE and hypothyroidism in the
absence of HCV infection.
Necrolytic acral erythema (NAE) is a rare cutaneous sign of hepatitis C virus (HCV), which generally presents as circumscribed keratotic plaques on the extremities. Many studies reported NAE in the absence of HCV. This case presents a female diagnosed with NAE and hypothyroidism in the absence of HCV infection.
Introduction and importance:
Congenital renal anomalies are a sequence of defective renal parenchymal or collecting system development and migration that may be discovered during the prenatal period or incidentally among adults. Duplex collecting system diagnosing in adults represents a challenge to physicians. Long-term history of urinary tract infections besides vaginal mass in pregnant women should raise the suspicion of underlying urinary tract malformation.
Case presentation:
In this case, a 23-year-old pregnant woman at 32 weeks came to the clinic for a routine check-up. A vaginal mass had been noticed during the examination and was punctured, revealing unknown fluid. Further investigations revealed left duplex collecting system consisted of an upper moiety opening with a ureterocele in the anterior wall of the vagina and a lower moiety ending with an ectopic orifice near the right ureter orifice. Therefore, the modified Lich–Gregoir procedure was done to reimplant the ureter of the upper renal moiety. Postoperative following-up investigations affirmed improvement without complications.
Clinical discussion:
The duplex collecting system disease may remain asymptomatic until adulthood or present with unexpected symptoms. The subsequent workup in the duplex kidney disease depends on the moieties’ function and the ureter orifice opening site. Although the Weigert–Meyer rule is usually used to describe the typical pattern of duplex collecting system ureters opening sites, it has many expectations in the literature.
Conclusion:
This case shows how some common symptoms may lead to finding an unexpected urinary tract abnormality.
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