A rare case of pancreatic head hydatid cyst
Learning points for cliniciansHydatid cysts are a common pathology encountered in routine practice. However, these are usually found in liver and less commonly in lungs. The presence of hydatid cyst in pancreas is quite a rare phenomenon and should be suspected in patients from endemic areas and typical imaging features. (Source: QJM)
Source: QJM - May 12, 2023 Category: Internal Medicine Source Type: research

Necrotic lymphadenopathy in Epstein –Barr virus-positive diffuse large B-cell lymphoma
An 87-year-old woman presented with a 2-month history of low-grade fever and weight loss. Contrast-enhanced computed tomography (CT) of the neck, chest, abdomen and pelvis revealed generalized lymphadenopathy. Most of the lymph nodes were well-demarcated and had peripheral enhancement (Figure  1A and B, arrows). A cervical lymph node biopsy revealed large lymphoma cells which were positive for CD20, MUM1 and CD30 and negative for CD3 and CD10. Epstein –Barr virus (EBV)-encoded small ribonucleic acidin situ hybridization (EBER ISH) of the large lymphoma cells returned positive. Based on these pathological findings, EBV-p...
Source: QJM - May 10, 2023 Category: Internal Medicine Source Type: research

The decreased medical utility in asthma patients with traditional Chinese medicine: correspondence
We read with great interest the retrospective cohort study by Liaoet al.1 entitled ‘Traditional Chinese medicine use may reduce medical utility in patients with asthma’. Based on large-scale population-based data, the authors discover a significantly decreased medical utility of emergency visits and admissions in patients having traditional Chinese medicine, especially those w ho take more than 60 days of traditional Chinese medicine, by using the propensity score matching relevant measurable covariates; the study results bring us a helpful insight into clinical practice. We also agree with the comments of Chouet al....
Source: QJM - May 3, 2023 Category: Internal Medicine Source Type: research

Zoonotic orf virus infection during the mpox global outbreak
A 35-year-old otherwise healthy male shepherd was presented with a 5-day history of solitary cutaneous lesion on the forefinger of his left hand with slight pain. Systemic symptoms, including fever, lymphadenopathy and malaise, are all denied. He reported scab-like and ulcerative cutaneous lesions around the lip and mouth of the sheep he raised (Figure  1A). Physical examination showed solitary swelling and erythematous cutaneous lesion with a central ulcer involving the forefinger of the left hand (Figure  1B). No positive evidence has been shown in further laboratory evaluation, including whole blood cell count and inf...
Source: QJM - May 3, 2023 Category: Internal Medicine Source Type: research

Pellagra and peripheral neuropathy secondary to tuberculosis treatment
National High Level Hospital Clinical Research Funding2022-P UMCH-B-045 (Source: QJM)
Source: QJM - May 2, 2023 Category: Internal Medicine Source Type: research

Risk of stroke following antivenom use after venomous snakebite: correspondence
We read with great interest the epidemiological study by Hunget al.1 on the risk of stroke with antivenom use after venomous snakebite in Taiwan. According to the national medical claims data, the authors provide us with useful information and disclose that venomous snakebite is associated with an increased risk of hemorrhagic stroke after the use of antivenom after using the matching propensity score in relevant measurable covariates. We strongly agree with the comments by Yehet al.2 on the unmeasured confounders associated with stroke in the present study. Furthermore, we are concerned that other residual confounders rel...
Source: QJM - April 26, 2023 Category: Internal Medicine Source Type: research

Spinal epidural lipomatosis
An 87-year-old man presented with a 1-week history of progressive low back pain radiating into the posterior aspect of the right thigh. Two years previously, he had been diagnosed with microscopic polyangiitis and treated with prednisone at a 5-mg daily dose. Physical examination was notable for muscle weakness in the right lower limb and intermittent claudication, with bilaterally exaggerated patellar and Achilles tendon reflexes. Supine positioning exacerbated his back pain. A spinal magnetic resonance imaging (MRI) scan showed an overgrowth of epidural fat compressing the dural sac at L2 –L4 (Figure  1), which confir...
Source: QJM - April 25, 2023 Category: Internal Medicine Source Type: research

Periportal halo in a patient with right atrial myxoma
A 23-year-old woman was referred to our institution due to markedly elevated alkaline phosphatase levels, which was detected when she visited a referring physician for a 6-month history of persistent fatigue and a 3-month history of dizziness during walking. She had no history of illicit drug or alcohol use and did not take any medications. (Source: QJM)
Source: QJM - April 24, 2023 Category: Internal Medicine Source Type: research

Metastatic iris tumor
Learning points for cliniciansMetastatic iris tumors are relatively rare. The main symptoms in patients with iris metastases are pain and blurred vision; however, some patients are likely to have no ocular symptoms. Clinicians should be aware of findings pertaining to iris metastasis in patients with advanced systemic cancer. (Source: QJM)
Source: QJM - April 22, 2023 Category: Internal Medicine Source Type: research

A novel COL3A1 variant associated with vascular Ehlers –Danlos syndrome in a patient presents as recurrent pneumothorax with cavities
National Natural Science Foundation of China10.13039/5011000018098190000282070003Natural Science Foundation of Hunan Province, China2020JJ58052021JJ30943Science and Technology Program of Changshakq1901120Xiangya Medical Big Data of Central South UniversityPulmonary Inflammatory DiseaseNational Key Clinical Specialty Construction Projects of China650 (Source: QJM)
Source: QJM - April 19, 2023 Category: Internal Medicine Source Type: research

Cutis verticis gyrata due to a novel NPR2 variant
A 30-year-old male had difficulty wearing protective helmet and chest gear due to loose scalp and pectoral skin. Examination confirmed cutis verticis gyrata (CVG) of the scalp and mild arachnodactyly (Figure  1) with dolichocephaly, loose neck and pectoral skin. He had a family history of hypermobility. Recognized causes of CVG include Noonan syndrome, Turner syndrome (45 ×), craniosynostosis due to FGFR2 gene and connective tissue disorders including some types of Ehlers Danlos syndromes. He had no features of any of the known CVG etiologies. Exome sequencing confirmed a novel c.2360G>C (Arg787Pro) variant in the NPR...
Source: QJM - April 17, 2023 Category: Internal Medicine Source Type: research

Hypertriglyceridaemia-induced pancreatitis
A 31-year-old male with a body mass index of 30  kg/m2, a history of alcohol use disorder and hyperglycemia presented to the emergency department with sudden onset of severe left upper quadrant (LUQ) abdominal pain. He had no history of pancreatitis or binge drinking episodes before the onset and denied a family history of hyperlipidemia or diabetes mellitus. On examination, LUQ abdomen was tender to percussion and palpation. Abdominal contrast-enhanced computed tomography showed indistinct pancreatic tail margins owing to inflammation and surrounding retroperitoneal fat stranding without evidence of gallstone disease or...
Source: QJM - April 13, 2023 Category: Internal Medicine Source Type: research

Early menarche and enhanced risk for the development of health problems
(Source: QJM)
Source: QJM - December 12, 2022 Category: Internal Medicine Source Type: research

Urinothorax: an under-reported cause of pleural effusions
We present a case of urinothorax to highlight the importance of early recognition to prevent delay in definitive treatment. (Source: QJM)
Source: QJM - September 2, 2022 Category: Internal Medicine Source Type: research

Respiratory syncytial virus pneumonia in an immunocompetent adult: an important differential diagnosis of COVID-19
We present a case of respiratory syncytial virus (RSV) pneumonia in a 36-year-old immunocompetent young female patient having a contacted history of RSV pneumonia from her daughter. Since the clinical and radiological findings were similar, clinicians should consider this classical disease in differential diagnosis, particularly in the pandemic settings of COVID-19. (Source: QJM)
Source: QJM - August 24, 2022 Category: Internal Medicine Source Type: research