Cerebral Mucormycosis Mimicking a Brain Tumor-Juniper Publishers

JUNIPER PUBLISHERS- OPEN ACCESS JOURNAL OF CASE STUDIES

 Cerebral Mucormycosis Mimicking a Brain Tumor

 Authored by Yin Liu

  

Abstract

We describe a case of intracranial mucormycosis in an immunocompetent child with perfusion features mimicking a brain tumor. Saksenaea species has previously been reported in immunocompetent patients. The source of the infection in our patient was unknown. On brain MRI, the unusual curvilinear and nodular enhancement pattern may reflect the angioinvasive nature of the organism, not previously reported. The finding of increased CBV is typically associated with neoplasms, with CNS infections typically demonstrating decreased CBV. This case demonstrates that fungal infection may present with increased CBV.

Case Report

4-year-old healthy male presented to the emergency room with intractable vomiting, worsening right frontal headaches for one month, and drowsiness for one day. Head CT demonstrated an ill-defined hyperdense right frontal lobe lesion (Figure 1). MRI showed an irregularly enhancing right frontal lobe lesion which extended to the corpus callosum. Subtle associated diffusion restriction was noted with increased cerebral blood volume (Figure 2). A high-grade, hypercellular tumor was suspected, although the enhancement pattern was unusual. A generous brain biopsy was performed with intraoperative pathology revealing granulomatous fungal encephalitis and the lesion was grossly illdefined. Tissue culture confirmed growth of Saksenaea species.

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Retroperitoneal Duodenal Foreign Body Perforation - A Novel Laparoscopic Approach-Juniper Publishers

JUNIPER PUBLISHERS- OPEN ACCESS JOURNAL OF CASE STUDIES

Retroperitoneal Duodenal Foreign Body Perforation - A Novel Laparoscopic Approach

Authored by Sunder Balasubramaniam

  

Abstract

Gastrointestinal perforation from foreign bodies can lead to life threatening sepsis, and pose a significant challenge given the need to drain the septic source as well as safely extract the offending object. A 71-year-old Chinese lady presented with abdominal pain without peritonitis or fever. A computed tomographic (CT) scan of the abdomen revealed two contiguous retroperitoneal abscesses with a 4cm fishbone. One of the cavities was surrounding the right external iliac artery and had a visible connection from the third portion of the duodenum to the superior abscess cavity. 

She underwent radiology-guided drainage of the collections, followed by a gastrografin swallow which did not demonstrate a leak. Retrieval of the fishbone was first attempted endoscopically by placing a 5 mm laparoscopic port into the cavity to insufflate it with gas, followed by introduction of a flexible choledochoscope. Unfortunately, the bone could not be visualised, and the procedure was converted to open retroperitoneal approach via a 4 cm incision. The bone was successfully retrieved, and a repeat CT done post-operatively showed near resolution of the abscess and complete removal of the fishbone. The patient was fit for discharge on the 4th post-operative day.

To our knowledge, this is the first such report of retroperitoneal abscess due to a foreign body managed by minimally invasive techniques. Fluoroscopic extraction by the radiologist was considered in this case but deemed unsuitable due to the risk of fragmentation and having pieces left behind. The retroperitoneal approach combined with interventional radiology allowed us to avoid the morbidity of laparotomy and speed the patient’s recovery.

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