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Extralobar pulmonary sequestration is generally located in the left thoracic cavity and is often identified prenatally or in infants. We experienced a rare case of multiple extralobar pulmonary sequestrations in the thoracic and abdominal cavities, incidentally detected in a 60-year-old woman by cancer screening. The patient underwent surgery by thoracoscopic and laparoscopic approaches simultaneously, and extralobar sequestration was histologically confirmed in each lesion. Preoperative diagnosis was difficult because of unusual multiple localization and an undetectable aberrant artery on imaging examinations.

We reported an exceedingly rare adult case of intracardiac teratoma with a bicuspid aortic valve. A small mass was discovered in the right ventricle of a 37-year-old man by accident after he was referred to our hospital due to chronic chest distress and aggravated palpitation. We performed a surgical exploration with excision of the lesion after a repeat transthoracic echocardiography suggested a space-occupying lesion in the interventricular septum. A mature cystic teratoma was pathologically confirmed. During the half-year follow-up, no symptoms were reported. This case constitutes the first report of the smallest primary intracardiac teratoma in an adult with a bicuspid aortic valve.

Unilateral absence of pulmonary artery is a rare congenital disorder that can remain asymptomatic until adulthood. Absence of left pulmonary artery (ALPA) has been reported in one‐third of these patients. We are the first to introduce an adult case of ALPA associated with partial anomalous pulmonary venous connection.

Atypical teratoid/rhabdoid tumor (AT/RT) is well documented in children but less so in adults because of its rarity.We report a series of five cases, a literature review and quantitative analysis of the survival outcome of adult AT/RT patients.Seventy-four patients including our five cases (male: female = 16: 58) were evaluated, whose median age was 32.5 years (18-80 years). The commonest location was the sellar region. Median overall survival (OS) was 12.5 months (0.5-204.00 months). Chemotherapy was associated with OS (HR: 0.349, 95%CI: 0.176-0.694,Adult AT/RT is commoner in females and tends to recur rapidly after surgical resection. Chemotherapy may provide a survival benefit. Surgery combined with postoperative chemotherapy and radiotherapy was associated with better prognosis for adult AT/RT patients, though the overall prognosis was still poor.

Highlights • Ureterocele is rare especially with collecting system duplication in the nonorthotopic (extravesical) position in adult. • Ureterocele has a variety of clinical manifestations and complications. • Endoscopic treatment was performed to decompress hydroureteronephrosis. • In this case, laparoscopy heminephrectomy is needed due to dysfunctional uppers moiety. • Renal scintigraphy is a gold standard to assess function in the duplex kidney., Introduction Ureteroceles is a developmental anomaly with cystic dilation of the distal aspect of the ureter and are often associated with some urological anomaly such as a duplicated system or stenotic ureteric orifice. Presentation of case This study reports an ectopic ureterocele in duplication of collecting system associated with double ureters and ureteral ectopia in a woman aged 24 years with minor flank pain. Cystoscopy deroofing of the ureterocele performed and followed by secondary surgery laparoscopic heminephrectomy. Discussion Ureteroceles have various clinical manifestations and complications. Treatment for ureterocele depends on age, type of the ureterocele, obstruction to the draining system, and complications. No single method is sufficient for all cases, and management must be individualized. Endoscopic treatment has gradually broadened as a safe, minimally invasive, and effective procedure, but there is no consensus on its effectiveness for treating ectopic ureterocele. However, it is reported that 50–80% of cases after initial endoscopic treatment require secondary surgery. Conclusions Ureterocele is reported rarely in adults, especially with duplication of the collection system in the nonorthotopic (extravesical) position in women. Cystoscopy deroofing of the ureterocele can be performed to decompress the hydroureteronephrosis, and laparoscopic heminephrectomy can be performed due to dysfunctional uppers moiety. Long-term follow-up is required to monitor renal function, symptoms, and occurrence of vesicoureteric reflux.

Mycoplasma pneumonia with mild CNS involvements should be considered of MERS, even in adult. From the case series, splenial single lesions by MRI and prodromal fever with varied neurological manifestations recovered completely by antibiotics were seen.

Traumatic atlantoaxial rotatory subluxation (AARS) is generally found in pediatric patients, rarely found in adults, being a life-threatening condition especially when early diagnosis is not possible, which can lead to severe late neurological deficits. We describe a 38-year-old patient, victim of physical aggression caused by strangulation attempt who developed AARS, an uncommon traumatic cause. During the hospital care, the early diagnosis allowed us to institute a conservative treatment, which made the case uncommon, since most of the time surgical treatment is imperative. With the patient awake and under analgesia, a closed reduction was performed that promoted immediate pain relief, followed by a prescription of wearing a Philadelphia-type collar for 8 weeks. During the follow-up, cervical spine radiographies demonstrated no subluxation after removing the cervical collar. The patient was asymptomatic after 6 months of treatment. This case supports the importance of nonoperative management of AARS in selected cases.

Leishmaniasis is a rare complication in adult cases even in endemic areas. Here, the first report of visceral leishmaniasis in a young woman in northeast of Iran has been described.

A 50-year-old woman presented with coma and hemorrhagic shock. A rapid influenza antigen test revealed influenza A infection; other laboratory examinations ruled out any other suspected infections. She was diagnosed with hemorrhagic shock and encephalopathy syndrome (HSES) induced by influenza A. She was administered methylprednisolone pulse therapy and peramivir. Subsequently, she was discharged without any sequelae. Only a few cases of influenza-induced HSES have been reported, and the clinical outcomes were very poor. We herein report a successfully treated adult case of influenza-induced HSES and review this rare syndrome.

Congenital generalized lipodystrophies are a heterogeneous group of rare disorders characterized by loss of subcutaneous fat, muscular hypertrophy, acanthosis nigricans, hepatomegaly, cardiac arrhythmias, impaired metabolism, and mental retardation. We report a 41-year-old female that presented as a rare adult case of congenital generalized lipodystrophy type 1. She was referred to us as a case of hypertriglyceridemia with features of generalized lipodystrophy and manifestations of associated multiple metabolic disorders. Triglyceride level was tremendously high with reduced high-density lipoproteins. The patient was found to have a pathogenic novel mutation in the AGPAT2 gene, confirming the diagnosis of congenital generalized lipodystrophy type 1.

It is important to recognize the rare manifestations of chronic Lyme disease to prevent permanent disabilities. We present an adult case of chronic Lyme disease, who developed pseudotumor cerebri and who needed supplementary surgical treatment. We compare it to the existing published literature, reviewed by a systematic approach.

Primary leptomeningeal lymphoma (PLML) is a rare disease, comprising less than 1% of all lymphomas. Clinical manifestations include headache, encephalopathy, ataxia, cranial nerve palsy, and myelitis. Diagnosis requires a combination of magnetic resonance images (MRI), cytology, flow cytometry of cerebrospinal fluid (CSF), and an extensive workup to rule out systemic lymphoma. We describe the case of a 49-year-old man who developed subacute onset headache, encephalopathy, and blindness. Whole-body examinations, including a bone marrow trephine biopsy, excluded systemic lymphoma. Brain MRI showed leptomeningeal enhancement. Cytology and flow cytometry of CSF found a clonal B-cell population making a diagnosis of PLML. He began treatment with rituximab and high-dose methotrexate (HD-MTX), with progressive clinical improvement. CSF analysis after two cycles and one intrathecal methotrexate dose was normal. Brain and spinal MRI images plus CSF analysis, along with an extensive workup to exclude systemic lymphoma, are necessary to diagnose PLM. Early treatment with HD-MTX alone or in combination with rituximab improves clinical outcomes.

Background: Leptomeningeal cysts are a rare complication of childhood fractures, being very rare in adulthood and usually related to previous trauma generated in children. Case Presentation: We present a case of “growing fracture” in a 70-year-old woman with a history of head injury in childhood, who clinically debuted with paresthesia-dysesthesia in the left hemicranium and hypersensitivity and pain in the affected area, and who was treated with surgical treatment. Conclusion: We review the pathogenesis, diagnosis and treatment of this injury today.

Introduction and importance Tracheo-bronchial foreign body inhalation is a very common encounter in clinical practice among pediatric patients and rarely seen among adults. When inhalation of foreign bodies occurs in adults then it tends to lodge within the right bronchial tree but in children it lodges in the central airways. Case presentation We present a 58 year old woman, known asthmatic for 20 years and non-smoker who presented to our clinic which history of chronic cough, wheezing and pulmonary infections that did not respond to regular antibiotics and the usual antiasthmatic medications. She reported to have inhaled a foreign body about 18 years earlier. Extraction of the foreign body was performed without complications. Clinical discussion A chest x-ray done was found to be normal and computerized tomography scan (CT scan) of the chest was ordered and revealed bronchial wall thickening with a calcified foreign body seen in the right intermediate bronchus. A combined rigid and flexible endoscopic bronchoscopy was performed and a chicken bone (measuring 2 cm × 1.5 cm) was extracted from the right intermediate bronchus with very minimal bleeding being encountered during and post bronchoscopy. Extraction of the foreign body was performed without complications. Post endoscopic intrabronchial foreign body removal, the patient recovered completely. Conclusion An intrabronchial foreign body being masked for more than a decade by co-existent bronchial asthma is a rare encounter. Moreover, adult patients with chronic cough should be handled with caution to rule out the possibility of FB aspiration., Highlights • FB inhalation is a very common encounter in clinical practice among pediatric patients and rarely seen among adults. • Inhaled FBs in adults tends to lodge within the right bronchial tree and in the central airways in children. • Adult patients with chronic cough should be handled with caution to rule out inhaled FBs. • Co-existing bronchial asthma may mask the diagnosis of FB inhalation in unclear history of its inhalation. • Bronchoscopy remains to be the main stay in management of inhaled FBs.

The case reported is the first case in Morocco to our knowledge. The reason for sharing this case is to facilitate knowledge transfer between physicians, caring for adult patients with HLH, with the aim to improve the outcome of these patients.

Angiographically confirmed complete surgical excision of brain arteriovenous malformations (bAVMs) is conventionally considered curative. Recurrence in adults is rarely encountered; only 18 cases have been reported in the English literature over the past 30 years. The potential for recurrence and consequent need for routine long-term follow-up are important considerations in the management of these lesions. We report a case of a 23-year-old female with a recurrent bAVM discovered incidentally on routine imaging three years after complete surgical excision. We review the existing literature and discuss the options for surveillance and management.

Intradural spinal lipomas with intracranial extension are very rare and are typically diagnosed in childhood. Radical surgical excision usually causes a high rate of morbidity because of the firm adherence between the lipoma and neural tissues. In this report, we present a case of craniocervical intradural intramedullary lipoma in an adult patient. The patient underwent surgery with excision of the mass, leaving a sheet of lipoma on the tumor bed.

Pulmonary artery (PA) sling is a congenital disease in which the left PA abnormally arises from the right PA and is usually diagnosed during the infantile period. We present an adult case of PA sling accompanied by tracheobronchomalacia found in a 49-year-old woman with a history of recurrent pneumonia. Computed tomography of the chest showed that the left lung was nourished by two aberrant PAs. Bronchoscopy demonstrated achondroplasia of the trachea and the right bronchus, which we speculate to have resulted in their stenosis. The recurrent pneumonia was attributable to these tracheobronchial structural abnormalities; we therefore stress the importance of focusing on the anatomic abnormalities in such cases.

Key Clinical Message We present a 55‐year‐old woman with periodic fever and symptoms similar to adult‐onset Still's disease (AOSD). She had a heterogeneous mutation of the MEFV gene and colchicine was effective. Atypical familial Mediterranean fever (pyrin‐associated autoinflammatory disease) should be considered in patients with periodic fever accompanied by symptoms similar to AOSD.

Acute disseminated encephalomyelitis is a rare inflammatory demyelinating multifocal disease of the central nervous system that typically occurs in children following vaccination or exanthematous viral infections and conveys an elevated risk of neurological sequelae unless promptly recognized and treated. We describe an adult case of acute disseminated encephalomyelitis following vaccination against Mumps, Measles and Rubella, presenting with fever and progressive neurological deficits which improved under systemic corticosteroid therapy. Considering the ongoing public debate regarding universal vaccination and the surge of previously controlled infectious diseases, we aim not only to underline the need for a rigorous assessment of vaccination safety on adult patients in order to prevent misguidance of public opinion, but also to alert clinicians for an early diagnosis of acute disseminated encephalomyelitis in these patients, the incidence of which we speculate may be rising.

Highlights • Differential diagnoses of retroperitoneal masses should remain wide in adults. • Teratomas should be considered as a potential cause of abdominal pain and distention in young adults. • Testicular examination and past history of any intervention should be sought inn any retroperitoneal masses., Introduction Teratomas are bizarre neoplasms derived from embryonic tissues typically found in the gonads and sacrococcygeal tissues of adults. Case presentation We report a case of histologically proven metastatic teratoma with an unusual presentation. The 32-year old male patient had a retroperitoneal tumour detected on computed tomography during the workup of abdominal pain. Discussion Retroperitoneal teratomas are uncommon and a challenge to manage. Differential diagnoses could be a dilemma without a thorough history and a high index of suspicion. Conclusions Recurrent metastatic teratoma is one of the rare differential diagnoses of any retroperitoneal mass and can present years after complete resection of the primary tumour.

Background Acute disseminated encephalomyelitis has been understood as a monophasic, often post-infectious illness that predominantly affects the pediatric population. Though that describes the majority of cases, exceptions do exist. In this case report, we present an adult case of recurrent disseminated encephalomyelitis (DEM) and review the available literature on this clinical entity. Methods PubMed search performed using the terms "MDEM" and "Recurrent ADEM" in April 2018. A total of 23 items resulted for the first search and another 142 for the second. We selected articles that described cases of recurrent ADEM with a preference for those publications describing adult cases and those written in English language. Conclusion Recurrent disseminated encephalomyelitis is a distinct clinical entity that has features which overlap with multiple sclerosis, making it imperative to distinguish the two. Our case presentation and accompanying literature review highlights the limited scope of data available on recurrent DEM and the need for further study.

Background Abscesses of the cavum septi pellucidi (CSP) or cavum septi pellucidi et vergae (CSPV) are exceedingly rare with only ten cases previously reported. As so few cases have been published, there is no consensus on optimal management strategies with some recommending operative drainage and some suggesting more conservative approaches. Case description In this study we present the first reported case of a 51-year-old male presenting with syndrome of inappropriate antidiuretic hormone secretion and abscess of the CSPV secondary to otomastoiditis, treated successfully with intravenous antibiotics. A comprehensive review of the literature on CSP and CSPV abscesses was conducted with a focus on management strategies. Conclusions We conclude, clinical condition permitting, that medical treatment should be the initial strategy selected for the management of CSP and CSPV abscesses.

Background Sacrococcygeal teratomas are tumors originating from pluripotent embryonic germ cell layers located in the fetal coccyx. These tumors are highly vascular if they undergo malignant transformation. Typically, they are found in infants and children and occasionally can be diagnosed prenatally. Adult cases are very rare, and represent tumors present since birth with delayed detection. Case presentation We describe a case of a giant sacrococcygeal teratoma in a 25 years old female college student presenting with right gluteal swelling of 4 months’ duration. In addition to the huge disfiguring mass on the perineal area, she also had lower abdominal pain, urinary complaints, and difficulty with ambulation. Discussion Pre-operative impression was of a sacrococcygeal mass and histopathology following complete surgical excision revealed a sacrococcygeal teratoma. She recovered well after surgery with no radiologic evidence of recurrence at six months. Conclusion Although rare, sacrococcygeal teratoma should be considered as a differential diagnosis for female adults presenting with perineal and/or pelvic masses. Complete surgical excision remains the mainstay of treatment.

Atypical teratoid/rhabdoid tumor (AT/RT) is a highly malignant central nervous system neoplasm predominantly found in children under the age of 3 years, and is extremely rare in adults. There is no specific clinical presentations or radiological features in reported cases of AT/RT. Diagnosis of brain AT/RT is mainly dependent on the classical pathological characteristics. We report a rare case of AT/RT arising from the trigeminal nerve and leading to progressively multiple cranial nerve palsies in a 25-year-old male patient. Microsurgical resection of the tumor has been performed and confirmed the diagnosis by postoperative pathology. To our knowledge, this is the second case of adult-onset AT/RT originating from the trigeminal nerve.

Intussusception in adults is rarer than children and treatment in most cases in adults is surgical. Multiple Intussusceptions in our case with subacute intestinal obstruction and presence of abdominal lymphadenopathy with diffuse bowel wall thickening warrants non-surgical treatment. Presence of multiple intussusceptions is rare findings. We present a case of female aged 35 years presented with palpable abdominal lump associated with loss of weight and appetite. CECT abdomen showed abdominal lymphadenopathy and multisegmental small bowel thickening maximum upto 1.5 cm. Some segments of bowel also show aneurysmal dilatation associated with asymmetrical mural thickening. Telescoping of proximal bowel segment into adjacent distal bowel is seen in at least two places in ascending colon region (colocolic intussusceptions) and another in ileal loops (ileo-ileal). FNAC from the lymph nodes revealed non hodgkins lymphoma.

We report a case of rheumatoid arthritis (RA) developing after parvovirus B19 infection. A 30-year-old Japanese woman, who had no significant medical history admitted for tender erythema in the bil...

Congenital cystic adenomatoid malformation (CCAM) is a congenital pulmonary cystic disease that is mostly detected and diagnosed prenatally or during the neonatal period, while rarely being observed in adults. Here, we report an adult case of CCAM that was diagnosed following surgery for a recurrent pneumothorax. We further review 60 case reports on adult CCAM that have been previously published. The patient was a 29-year-old woman with a severe left pneumothorax. Her computed tomography scan showed the presence of multiple pulmonary cysts at the base of the left lower lobe. Since she had experienced a left pneumothorax twice previously, surgery was indicated. A wedge lung resection of the pulmonary cysts was performed thoracoscopically. The postoperative pathological diagnosis was type I CCAM. From the review, 7 adult CCAM patients (11.7%) out of 61, including the patient in the present case, presented with pneumothorax, while 21 patients (35%) presented with infection. Thirty-nine foci of CCAM (65%) were located in lower lobes. Moreover, malignancies were associated in 8 cases (13.3%). We propose that if multicystic lung lesions are found in pneumothorax patients, particularly in lower lobes, CCAM should be considered during the differential diagnosis, even in adults.

We report a 69-year-old adult case with a monoclonal gammopathy incidentally discovered, associated with a moderate thrombocytopenia of 90 G/L. Study of blood smear revealed the presence of tumor cells presenting Auer rod-like inclusions, although there were not blast cells. Blood cytology as well as immunophenotyping allowed us to make the diagnosis of malignant hemopathy.

Supratentorial cortical ependymoma is a rare primary brain tumor in adults. Only 50 cases are reported in the literature including pediatric and adult patients. We report a 30-year-old male with sensory-type seizures who was found to have a right posterior frontal cortical lesion with large cystic component. The lesion was resected completely and histopathology and immunohistochemistry examinations confirmed anaplastic ependymoma WHO grade III. The patient received radiotherapy treatment post-surgery, and he was tumor free one year after treatment.

Introducción: Los tumores quísticos del cuello son inusuales en los adultos. Sin embargo, se pueden encontrar metástasis a ganglios, quistes branquiales, quistes tiroglosos, linfangiomas, entre otros. Clínicamente, estos últimos son masas blandas de crecimiento lento que se localizan en diferentes espacios del cuello.Reporte de caso: Se reporta un caso de linfangioma en una mujer de 36 años, quien consultó por masa lateral derecha del cuello con evolución de 20 días sin síntomas sistémicos asociados. A pesar de que la recaída es frecuente, la paciente fue tratada con cirugía exitosa sin evidencia de recidiva durante 12 meses de seguimiento. Discusión: Cuando se presentan en niños, los tumores quísticos del cuello se pueden convertir en urgencias quirúrgicas debido a obstrucción de la vía aérea; no obstante, en los adultos solo producen deformidad de contorno y rara vez requieren una intervención apremiante, lo que permite conductas conservadoras como la observación, el drenaje repetido o la escleroterapia. Esta última puede hacerse con el OK-432 (Picibanil); sin embargo, la cirugía es una buena opción de tratamiento sin estar exenta de complicaciones.Conclusión: Se realizó revisión de las diferentes opciones de tratamiento y se concluyó que la resección quirúrgica de los linfagiomas continúa siendo la opción más adecuada para el manejo de esta compleja lesión del cuello.

Aortico-left ventricular tunnel (ALVT) combined with bicuspid aortic valve (BAV) is an extremely rare congenital heart malformation. This article presents an adult case of a special type ALVT combined with BAV which was diagnosed by echocardiography and computed tomographic arteriography (CTA) then successfully performed surgery and cured.

Thiamine-responsive megaloblastic anemia (TRMA) syndrome is a rare disease comprising a classic triad of megaloblastic anemia, diabetes mellitus, and early-onset sensorineural deafness. TRMA can generally be diagnosed in early childhood. Early diagnosis is important to prevent complications that may develop soon. As it is a rare disease, diagnosis may sometimes be difficult. We present a rare case of an adult patient with TRMA who had been mistakenly diagnosed with myelodysplastic syndrome (MDS), whose anemia was corrected only after thiamine treatment was started.

Ventriculoperitoneal Shunt (VPS) placement is one of the most commonly performed treatment modality in patient with hydrocephalus and infection is usually seen in such patients with shunt complication. Multiple shunt revision and its complications are related to various causes including mainly Coagulase negative Staphylococcus (CONS) infection. VPS obstruction occurring in proximal catheter is he most common cause of VPS malfunction. Here we present a case of Venticuloperitoneal shunt infection caused by CONS in a adult patient.

Rapidly growing non-tuberculous mycobacteria (RGM) are a rare, often fatal cause of infective endocarditis. Although surgery has been the cornerstone of RGM endocarditis therapy, we present the first documented adult case of Mycobacterium fortuitum endocarditis cured with antibiotic therapy.

The congenital pulmonary airway malformations (CPAM) are extremely rare malformations which are most frequently diagnosed before birth or during childhood and are extremely rarely diagnosed in adults. Sometimes, type II CPAM can be associated with pulmonary sequestrations (PS), especially those extralobar. We present the case of a 39 years old female without any known previous respiratory symptoms until this age, who has having for approximatively 2 months repeated episodes of haemoptysis. The angio-CT exam showed the existence of multiple cyst-like formations in the left inferior pulmonary lobe (LLL) and 2 arteries starting from thoracic aorta that participated at the vascularization of the LLL. We performed a left inferior lobectomy and the postoperative evolution was favorable. The histopathological exam confirmed the diagnosis of type I CPAM associated with intralobar PS. The particularity of the presented case is given by the fact that this patient of 39 years old had no previous respiratory symptoms and no cases of type I CPAM associated with intralobar PS were cited before.