This case report discusses the challenges in diagnosing and treating Langerhans cell histiocytosis (LCH) in a 6-month-old infant. LCH is a rare malignancy affecting only a few children each year, with a diverse range of clinical symptoms making it challenging to diagnose. The report emphasizes the importance of conducting differential diagnosis, genetic testing, and tissue sampling to accurately diagnose and treat LCH. The case study highlights the difficulties encountered during treatment and the significance of personalized treatment plans based on precise diagnosis. The patient responded well to trametinib treatment, underscoring the importance of accurate diagnosis in treating LCH.
Background Hydatid disease is caused by Echinococcus granulosus organisms. The liver is the most affected organ followed by the lungs. The pleural cavity being the primary location of hydatid cysts is rare and should be discussed further. This paper documents a rare case of primary pleural hydatidosis which can present with a mere isolated cough followed by dyspnea. The diagnosis and surgical treatment along with post-operative medications are vital in this case. Case presentation We present a case of a 45-year-old who suffered from a cough for one week which did not subside after taking medications. This symptom was followed by dyspnea for which an X-ray was done which showed left-sided pleuraleffusion, a complication of pleural hydatidosis. Computed tomography was performed to confirm the diagnosis of primarypleural hydatidosis. It revealed multiple cysts in the pleural cavity without them being present at other sites. Blood work revealed eosinophilia which is significant in parasitic diseases. A left posterolateral thoracotomy was performed and the cysts were surgically removed. Additionally, empyemectomy and pleurectomy were done. The patient was then treated with anti-parasitic therapy and was advised to get X-rays during the follow-up visits. The X-rays were normal and indicated that there was no disease recurrence. Conclusion This case implies the significance of a cough of more than a week that is not relieved by medications. This should be carefully evaluated and followed in cases that have a rare diagnosis requiring surgery. A diagnosis of primary pleural hydatidosis with left-sided pleural effusion and atelectasis with mediastinal shift to the right side was made which was treated with a surgical procedure.
Objective: A rare case of FMF with atypical presentation of fever attacks lasting 7 days predominantly evident after the war has been described. Usually, the FMF bouts last for 3-4 days but the unusual presentation of our patient led to the initial misdiagnosis of PTSD (Post traumatic stress disorder). Patient and Method: A case of a 38-year-old former Armenian soldier who participated in a 44-day long war with Azerbaijan showing symptoms of recurrent fever, thoracic and abdominal pain predominant only on the left hypochondriac, lumbar and inguinal region. The changes in the laboratory examination were not significant. A wide range of diagnostic tests like X-Ray, CT, and MRI performed all of which were inconclusive. Result: The diagnosis was confirmed after 5 years by positive molecular genetic testing for the MEFV gene. The patient was given colchicine 1 mg/kg/day which reduced the severity and frequency of attacks. Conclusion: The atypical presentation of FMF with prolonged fever lasting up to 7 days, no familial history, post-war trauma, and pain only on the left side led to the differential diagnosis excluding FMF.FMF was suspected when his blood analysis showed acute phase reactants returned to normal after the 7-day attack period. He was started on colchicine therapy and showed a positive response which led to the diagnosis of FMF. The positive MEFV genetic testing confirmed the diagnosis. Clinicians should not exclude the possibility of FMF in patients who do not show the classic fever attack period of 3 to 4 days.
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