Journal of Case Reports in Practice
Volume:5 Issue: 4, Oct 2017

Ocular involvement is an infrequent presenting feature in brucellosis; consequently, the exact incidence has not been established. Herein, we report a 29-year-old woman diagnosed with neurobrucellosis presenting with aseptic meningitis and unilateral blurred vision in whom simultaneous asymptomatic papillophlebitis and symptomatic optic atrophy had been established. To the best of our knowledge, this is the first reported case of neurobucellosis associated with papillophlebitis. It is worth to mention that discovering neurobrucellosis especially while manifesting with rare features, requires high suspicious of diagnosis peculiarly in endemic countries as Iran. In our case, positive serum and cerebrospinal fluid (CSF) Wright, Coombs Wright and 2-Mercapto Ethanol (2ME) confirmed neurobrucellosis.

Lupus mastitis, as an uncommon condition in systemic lupus erythematosus (SLE), is a subset of lupus panniculitis. Here, we report a 51-year-old woman who presented with fever, weight loss, low appetite, arthralgia, and cervical lymphadenopathy. She had experienced facial palsy six months earlier to presentation. On physical examination, besides submandibular and axillary lymphadenopathy, several lumps were palpated on the breasts bilaterally. There were no abnormalities on the skin or nipples. Mammography showed diffuse calcifications in both breasts. Further work-up revealed positive anti-double stranded DNA (anti-ds DNA), antinuclear antibody (ANA), anti-Sm antibody as well as leukopenia and lymphopenia, but normal platelet count. A core biopsy of the breast showed active inflammation, leukocyte infiltration, and fat necrosis without evidence of malignancy or fibrocystic changes. Prednisone and azathioprine were initiated for her. One month later, her symptoms had improved substantially and breast ultrasound exam showed decreased size of the lumps. Although lupus mastitis is an uncommon condition, especially when it declares the onset of SLE, it should be considered in the differential diagnosis of breast lesions in lupus patients.

The axillary arch of Langer is the most common muscular variation in the axilla with frequency of 7% to 27%. Due to its frequency, clinicians should be aware of this variant because misidentifications can lead to wrong diagnosis and massive surgical complications, which could easily be avoided by intimate anatomical knowledge of the axillar region and its most frequent variants. A case of an “Axillary Arch of Langer” was reported on a routine Axillary lymphadenectomy procedure of breast carcinoma, which is originated from latissimus dorsi and inserted to biceps brachii. Since knowledge of the mentioned anomaly is important for surgeons to prevent attainable injury to axillary vessels and brachial plexuses, the embryological derivation and clinical significance of this muscle were discussed in this probe.

A 31-year-old lady treated four years prior to the recent presentation from thyroid papillary cancer with surgery and radioactive iodine. She presented with neck stiffness and left C7 radiculopathy and numbness for 6 months. Physical examination revealed left elbow extension weakness, muscle wasting, decreased sensation to pain, and absent left triceps jerk. Cervical MRI showed a 1 x 2 cm well-defined T2 hyperintense mass with heterogeneous enhancement suggestive of a nerve sheath tumor-like schwannoma and a mildly expanded left C6-C7 neural foramen. Surgical intervention included facetectomy and gross total removal of the tumor. Histopathology showed features of Primitive Neuroectodermal Tumor (PNET)/Ewing"s Sarcoma. Accordingly, the patient was treated with chemotherapy. Post-operative MRI cervical spine did not show any residual tumor. The patient is independent at one year following her treatment and is back to work.