The spectrum of mycotic diseases continue to expand, making it challenging for treatment of infections caused by a diverse array of opportunistic fungi especially in immuno-compromised individuals. The species of Cladosporium implicated in human infections is found as causative agents for infections of the central nervous system, lung, liver, keratitis, and dental granulomas. Involvement of a muscle by a fungal granuloma in an immunocompromised individual by Cladosporium species is very rare and has been never reported before to the best of our knowledge. Below we present a novel case of a 34 year old, Post-transplant Immunocompromised male to have developed a lump within the Triceps Brachii muscle which was found to be a Cladosporium Cladosporioides granuloma and was treated successfully with a multimodal approach of Surgery and Voriconazole anti-fungal therapy.
Tuberculosis (TB) is one of the major health problems in developing countries. India has the highest TB burden with approximately 27% of global TB [6]. (India TB Report 2018 Revised National TB Control Programme (2018)). The most common form of tuberculosis constitutes pulmonary tuberculosis. Among extra pulmonary tuberculosis, the musculoskeletal tuberculosis accounts for about 10–15% cases (Mohd Altaf Mir, Imran Ahmad, Mihd Yaseen (2016) World J Plast Surg 5(3):313–318). Hand involvement is seen in 10% of patients with musculoskeletal disease. There has been recent interest in tuberculosis of the hand because of a rising incidence owing to increasing numbers of immigration, an aging population, and immunosuppressed people including affected patients with human immunodeficiency virus [3,7] (Centre for Disease Control (1995) MMWR 14:1–16), Al-Qattan MM, Al-Namla A, Al-Thunayan A, Al-Omawi M (2011) J Hand Surg 36:1413–1422). Tuberculous tenosynovial disease (TBTS) is the most common presentation of hand tuberculosis. In the hand, the flexor tendon sheath and radio-ulnar bursae are the most common sites of tenosynovitis. Tuberculosis of hand is more commonly seen in the dominant hand of the male population (Al-Qattan MM, Al-Namla A, Al-Thunayan A, Al-Omawi M (2011) J Hand Surg 36:1413–1422). Here, we present a case of TBTS affecting extensor compartment of dominant hand in a post renal transplant immunosuppressed individual.
Adrenal Angiomyolipoma's are extremely rare forms of lipomatous tumours of adrenal gland. They may go undetected for years without symptoms. The patient may become symptomatic, once the tumour has gained a signicant size, mainly back pain. We are reporting our case which is a one of a kind benign Adrenal tumour. Adrenal Angiomylipomas are found as incidentalomas in patients, generally presenting with mild to no symptoms, leading to a long delay before they are diagnosed. However, early diagnosis is key, not only to alleviate symptoms but to also prevent a future surgical disaster due to rupture causing cardiovascular shock if large enough. Our patient presented with dull aching ank pain without any systemic symptoms. The diagnosis requires a multifocal approach to be conrmed including hormonal assay and radiological testing whereas following a “clinical only” approach maybe insufcient and often mislead a clinician from establishing an accurate diagnosis. These patients could be offered laparoscopic resection at specialized centres with minimal risk of complication and early uneventful recovery.
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