Autoimmune progesterone dermatitis (APD) is a rare skin condition with a varying morphology, which appears on a monthly basis during the luteal phase of the menstrual cycle and resolves spontaneously with the endogenous decrease in progesterone during menses. We present the case of 39-year-old multiparous Caucasian woman with generalised, self-limited urticaria in her perimenstrual period. APD was diagnosed in light of the cyclical nature of the symptoms. An intradermal test with the administration of 0.5 mg/mL of medroxyprogesterone acetate showed a positive result. She started using vaginal hormonal contraceptive that paradoxically exacerbate the symptoms, which ceased after the removal of the device. An oral combined contraceptive was initiated instead, with complete resolution of the symptoms. We share the case because of the rarity of the situation, emphasising the importance of a multidisciplinary team for differential diagnosis and patient follow up.
Poly arteritis nodosa (PAN) is a necrotizing vasculitis of medium caliber arteries in which the involvement of small vessels is not typical.The most affected organs are skin, gastrointestinal tract and peripheral nerves. In our case report, PAN presented with pain, swelling and altered sensation of the left leg, mimicking deep vein thrombosis, soft tissue infection or even a compartment syndrome. We present this case to raise awareness to this rare but possible form of PAN presentation, that will need a distinct approach.
Herpes simplex virus type-1 pneumonia is unusual and rarely described without any degree of immunosuppression. We share a case of herpes simplex virus type-1 pneumonia in an immunocompetent patient, not only by its rarity, but to call attention to the importance of thinking about this entity when respiratory symptoms persist despite various antibiotic schemes, especially in the presence of ground glass or multifocal pulmonary infiltrates, regardless of patients' immune status.
Pituitary apoplexy (PA) is a possible complication of pituitary adenoma but is rarely followed by cerebral infarction. The mechanism by which this occurs is not totally understood but is believed to have multiple aetiologies such as arterial compression due to mass effect, vasospasm induced by the presence of blood or by vasoactive agents. In this report, we present a man in his 80s with known pituitary adenoma with a sudden onset of left central facial palsy, left hemiparesis, paresis of the VI left pair and previously unrecognised atrial fibrillation in the ECG. At first, the signs of haemorrhage on imaging were unnoticed, which led to a diagnosis of ischaemic stroke that was submitted to thrombolysis. Due to complications during hospitalisation, the team suspected of PA with panhypopituitarism, confirmed by brain MRI and blood tests. The patient underwent conservative management with glucocorticoids with resolution of the acute adrenal insufficiency related symptoms.
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