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1.  Forgotten but not gone - Scrofuloderma in a migrant student from India 
The Australasian Medical Journal  2013;6(7):371-373.
A 34-year-old Indian student who immigrated to Australia five years ago presented with a four-week history of neck pain. Physical examination revealed two firm fixed cervical lymph nodes in the anterior triangle and midline region which were tender on palpation and erythematous on inspection. Cording phenomenon was found on ZN staining of FNA sample and mycobacterium tuberculosis (M.tb ) PCR confirmed the diagnosis with incomplete resistance to isoniazid. Patient was treated with other three first line antituberculosis medications for nine months with an excellent outcome. Prednisolone was also used as adjunctive therapy and tapered during the course of treatment.
doi:10.4066/AMJ.2013.1759
PMCID: PMC3737763  PMID: 23940498
Scrofuloderma; Tuberculosis; Cording phenomenon
2.  Unusual complication of Mycoplasma pneumonia in a five-year-old child 
Mycoplasma pneumoniae is common agent causing community acquired pneumonia in children. However, the course of illness is usually benign and is rarely associated with pulmonary complications. We report a five-year-old child with massive pleural effusion and empyema secondary to Mycoplasma pneumonia infection. This potential yet rare source of infection should be considered in young patients where resolution of symptoms from pneumonia is delayed.
doi:10.4066/AMJ.2013.1543
PMCID: PMC3593522  PMID: 23483100
Mycoplasma pneumoniae; Pleural Effusion; Empyema
3.  Umbilical endometriosis mimicking as papilloma to general surgeons: A case report 
The Australasian Medical Journal  2012;5(5):272-274.
Introduction
Cutaneous or umbilical endometriosis is a rare entity that is often overlooked because of chronic abdominal pain. We present a case of umbilical hernia that presented to the general surgeons due to chronic abdominal pain and nodule in the umbilicus, which was clinically diagnosed as umbilical papilloma.
Case presentation
A 48-year old multiparous Caucasian woman presented with painful nodule in the umbilicus for two and half years. The nodule was excised and the histopathological diagnosis was umbilicus endometriosis.
Conclusion
Umbilical endometriosis is a very rare disease but should be considered as a differential diagnosis in women presenting with umbilical swelling.
doi:10.4066/AMJ.2012.1198
PMCID: PMC3395284  PMID: 22848323
Endometriosis; Umbilical endometriosis; Papilloma
4.  Laryngeal tuberculosis: A case of a non-healing laryngeal lesion 
The Australasian Medical Journal  2012;5(3):175-177.
We report a case of laryngeal tuberculosis in a 47-year-old Korean man. Laryngeal tuberculosis is rare and currently accounts for less than 1% of all cases of tuberculosis. Clinical features of laryngeal tuberculosis include hoarseness, odynophagia and dyspnoea. Macroscopically, laryngeal tuberculosis may mimic laryngeal carcinoma, chronic laryngitis or laryngeal candidiasis. The diagnosis is often delayed due to a low index of clinical suspicion and hence may pose a significant public health risk. Laryngeal tuberculosis should be considered in the differential diagnosis of patients who present with any form of laryngeal lesion.
doi:10.4066/AMJ.2012.1101
PMCID: PMC3422717  PMID: 22952563
Larynx; Tuberculosis; Diagnosis
5.  An unusual branching pattern of common and external carotid artery in a human cadaver: a case report 
The Australasian Medical Journal  2011;4(4):180-182.
During a routine dissection in the Department of Anatomy of the Rural Medical College, Loni, we found a rare variation in branching pattern of the common carotid artery (CCA) and external carotid artery (ECA) bilaterally. The knowledge of possible anatomical variations of CCA and ECA are especially important in the surgeries of head, neck and face; and also for the radiologist to understand and interpret carotid system imaging when undertaking cerebral angiography. This case and the clinical significance of this variation are reported in this paper.
doi:10.4066/AMJ.2011.637
PMCID: PMC3562896  PMID: 23393509
Common carotid artery; external carotid artery; superior thyroid artery,; linguo-facial trunk; ascending pharyngeal artery; occipital artery
6.  Congenital middle mesocolic hernia: A case report 
The Australasian Medical Journal  2014;7(11):432-435.
Internal hernia is herniation of a viscus, usually in the small bowel, through a normal or abnormal aperture within the peritoneal cavity. Its incidence has been reported to be one to two per cent. Internal hernias are classified based on location, and the hernial orifice can be either congenital or acquired. Paraduodenal hernias are the most common type (53 per cent). Paraduodenal hernia is often a misnomer and is referred to as a mesocolic hernia. Left and right mesocolic hernias are common, while middle and transverse types are rare. We are reporting a rare congenital middle mesocolic hernia presenting as a complete transection of the small intestine due to blunt injury to the abdomen.
doi:10.4066/AMJ.2014.2179
PMCID: PMC4259206  PMID: 25550713
Paraduodenal; internal hernia; blunt injury abdomen
7.  Cryptogenic invasive Klebsiella pneumoniae liver abscess syndrome (CIKPLA) in Western Australia? 
The Australasian Medical Journal  2014;7(11):436-440.
Virulent serotypes of Klebsiella pneumoniae are recognised to cause metastatic infections at various sites. Prevalence of this invasive syndrome has been observed worldwide with predominance in Asian series. However, reports in an Australian setting have been limited. We report two cases of fulminating community-acquired invasive Klebsiella pneumoniae liver abscess syndrome occurring in two Caucasian patients, from two different, distant suburbs in Western Australia with no known clinical comorbidities prior to the hospital presentation and no history of recent travel overseas. The interval between both admissions was 18 days, where only one patient survived.
doi:10.4066/AMJ.2014.2188
PMCID: PMC4259207  PMID: 25550714
Interventional radiology; invasive liver abscess syndrome; Klebsiella pneumoniae
8.  Dengue co-infection in a blood stream infection caused by Stenotrophomonas maltophilia: A case report 
The Australasian Medical Journal  2014;7(11):441-444.
Stenotrophomonas maltophilia (S. maltophilia) is an emerging opportunistic bacterial pathogen with resistance to several commonly used antibiotics. Owing to its multidrug resistance (MDR), management of S. maltophilia blood stream infection (BSI) is challenging and requires the selection of appropriate antibiotic therapy. The presence of thrombocytopenia and shock are independent risk factors associated with increased mortality in patients with S. maltophilia BSI. We describe an unusual case of S. maltophilia BSI in a middle-age female complicated by dengue fever. We highlight the importance of early recognition of both dengue and S. maltophilia infection in management of such cases.
doi:10.4066/AMJ.2014.2205
PMCID: PMC4259208  PMID: 25550715
Stenotrophomonas maltophilia; Dengue fever; Blood stream infection
9.  Miliary tuberculosis with left brachial monoplegia: A case report 
The Australasian Medical Journal  2014;7(10):400-404.
Tuberculoma of the brain is a major neurological problem in developing countries accounting for 12 to 30 per cent of all intracranial masses. It often presents with focal neurological symptoms or seizures. Simultaneous occurrence of brain tuberculoma with miliary mottling in the lungs is uncommon in the immunocompetent patient. We report only the second case of monoplegia and miliary tuberculosis, wherein the patient presented with acute onset left brachial monoplegia, upper motor neuron facial palsy, and fever with an MRI of the brain showing multiple granulomas and chest x-ray showing miliary mottling. The patient’s neurological deficit started to resolve with corticosteroids and anti-tubercular treatment.
doi:10.4066/AMJ.2014.2169
PMCID: PMC4221775  PMID: 25379061
CNS tuberculoma; Miliary tuberculosis; Monoplegia
10.  Jejuno-jejunal intussusception: An unusual presentation of malignant melanoma 
The Australasian Medical Journal  2014;7(10):416-418.
Jejuno-jejunal intussusception is a rare mode of metastatic melanoma presentation, with only six cases being reported in the English medical literature to date. We present a case of a 55-year-old female who presented to us with features of obstruction. On exploration, it was discovered that she had jejuno-jejunal intussusception, with enlarged blackened mesenteric lymph nodes. Resection and anastomosis were performed. On further histopathological examination, a lesion was found to be a metastatic malignant melanoma.
doi:10.4066/AMJ.2014.2190
PMCID: PMC4221777  PMID: 25379063
jejuno-jejunal; intussusceptions; malignant; melanoma; metastasis
11.  An unorthodox innervation of the gluteus maximus muscle and other associated variations: A case report 
The Australasian Medical Journal  2014;7(10):419-422.
Knowledge of peripheral nerve morphology, location, and variation is important for facilitating appropriate diagnosis and intervention. We present a unique case of absence of the inferior gluteal nerve and high division of the sciatic nerve. In this instance, the common peroneal nerve was found piercing the piriformis muscle and emerging distally in the form of two trunks: thin medial and thick lateral. The medial trunk presented an interesting course, supplying the gluteus maximus muscle before joining the lateral trunk to form the common peroneal nerve. Additionally, the arteria nervi ischiadisci was also observed accompanying and supplying the tibial nerve passing inferior to the piriformis. These variations are important for clinicians and surgeons for some radiological diagnoses and surgical procedures in the lower limb.
doi:10.4066/AMJ.2014.2225
PMCID: PMC4221778  PMID: 25379064
Gluteus maximus; sciatic nerve; common peroneal nerve; inferior gluteal nerve; piriformis; arteria nervi ischiadisci
12.  Hymenolepis diminuta infection in a school-going child: A rare case report 
The Australasian Medical Journal  2014;7(9):379-381.
Hymenolepis diminuta (H. diminuta) is a common parasite of rats and mice. It is very rare among humans. The life cycle of this parasite is completed in two hosts. Human beings are accidentally infected due to ingestion of infected fleas. Most of the time human infections are asymptomatic. We report a case of Hymenolepis diminuta infection in a school-going 10-year-old girl from a coastal village in south Tamil Nadu. Demonstration of H. diminuta eggs in the stool is the important diagnostic tool. Absence of polar filaments confirms the Hymenolepis diminuta. Praziquantal is the drug of choice.
doi:10.4066/AMJ.2014.2136
PMCID: PMC4185331  PMID: 25324904
Hymenolepis diminuta; rat tapeworm
13.  Metastatic parathyroid carcinoma treated with radiofrequency ablation: A novel therapeutic modality 
The Australasian Medical Journal  2014;7(9):372-375.
Parathyroid carcinoma (PCA), accounting for less than one per cent of all endocrine malignancies, is a rare cause of primary hyperparathyroidism. A diagnosis of parathyroid carcinoma may be challenging in the presence of localised disease and involves a histological diagnosis based on capsular, vascular, or perineural invasion or the presence of metastasis. Distant metastasis remains a rare presentation, with the lung being the most common site. Surgery remains the treatment of choice as radiotherapy and chemotherapy have proved to be of limited benefit in metastatic disease. This case reports suggests that radiofrequency ablation has the potential to be a novel and effective treatment option in these patients.
doi:10.4066/AMJ.2014.2084
PMCID: PMC4185329  PMID: 25324902
Parathyroid; carcinoma; radiofrequency; metastasis
14.  Acute multiple cranial neuropathy: An oculopharyngeal variant of Guillain-Barré Syndrome 
The Australasian Medical Journal  2014;7(9):376-378.
We report the case of a 20-year-old male who presented to us with acute bilateral multiple cranial neuropathy in the form of bilateral total ophthalmoplegia and bulbar dysfunction. The patient had normal haematological and biochemical investigations, however, cerebrospinal fluid (CSF) analysis showed raised protein (96mg/dl) in the second week of illness. Peripheral nerve conduction studies and an MRI of the brain were normal. The patient showed gradual improvement after three weeks of supportive treatment. Considering the course of illness and the clinical and investigational profile, a diagnosis of an oculopharyngeal variant of Guillain-Barré syndrome (GBS) was made.
doi:10.4066/AMJ.2014.2123
PMCID: PMC4185330  PMID: 25324903
Multiple cranial nerve palsy; Guillain-Barré syndrome; Oculopharyngeal GBS
15.  NK/T cell lymphoma with inverted papilloma: A rare coexistence 
The Australasian Medical Journal  2014;7(8):318-322.
Natural killer/T-cell (NK/T) lymphomas are an infrequent tumour type of NK and NK-T cells commonly occurring in the upper aero-digestive tract. Most reported cases in the literature are random solitary cases of NK/T-cell lymphoma. A 35-year-old male farmer from Sikkim reported to our institution with NK/T-cell lymphoma (nasal type) with coexistent inverted papilloma of the nose. This case is being reported due to the unique and unusual simultaneous occurrence of these two tumour entities.
doi:10.4066/AMJ.2014.2025
PMCID: PMC4157151  PMID: 25279007
NK/T-cell lymphoma; inverted papilloma; nasal; tumour co-existence
16.  Paraneoplastic polyarthritis in association with metastatic neuroendocrince tumour of the adrenal gland 
The Australasian Medical Journal  2014;7(8):345-349.
Paraneoplastic polyarthritis is a rare manifestation described in association with various solid tumours. We describe the clinical presentation, diagnostic evaluation, differential diagnosis, and management of a 28-year-old woman who presented with fever, weight loss, and symmetrical polyarthritis, subsequently diagnosed to have a metastatic neuroendocrine tumour of the adrenal gland with paraneoplastic polyarthritis. Paraneoplastic polyarthritis must be considered in polyarthritis unexplained by common aetiologies. The unusual presentation of this case, alerts us about the atypical presentation of these tumours. To the best of our knowledge, this is the first case study of a neuroendocrine tumour presenting as paraneoplastic polyarthritis.
doi:10.4066/AMJ.2014.2113
PMCID: PMC4157154  PMID: 25279010
Paraneoplastic polyarthritis; neuroendocrine tumour; metastasis
17.  Follicular bronchiolitis in primary ciliary dyskinesia 
The Australasian Medical Journal  2014;7(7):294-297.
Ciliary dysfunction in primary ciliary dyskinesia (PCD) may be associated with bronchiolitis. Diffuse bronchiolitis has been reported in a subset of PCD patients who have Kartagener's syndrome in Japan. We report a case of follicular bronchiolitis (FB) in a case of PCD presenting with recurrent episodes of cough, dyspnea, and bronchiectasis. This may motivate researchers to study rarer variants and presentations in PCD.
doi:10.4066/AMJ.2014.2102
PMCID: PMC4127960  PMID: 25157269
Follicular bronchiolitis; Primary ciliary dyskinesia; Macrolides
18.  Carcinoid Klatskin tumour: A rare cause of obstructive jaundice 
The Australasian Medical Journal  2014;7(6):243-246.
Carcinoid tumours of the extrahepatic biliary ducts represent an extremely rare cause of bile duct obstruction. We report a case of obstructive jaundice secondary to carcinoid tumour arising at the hilar confluence. Resection of the primary tumour was done and the patient is doing well on follow-up. This case demonstrated that surgery offers the only potential cure for biliary carcinoid and aggressive surgical therapy should be the preferred treatment in cases of potentially resectable biliary tumours.
doi:10.4066/AMJ.2014.1934
PMCID: PMC4082248  PMID: 25031645
Carcinoid tumour; Klatskin tumour; Neuro-endocrine tumour; Biliary tract; Obstructive Jaundice
19.  Isolated hepatic tuberculosis: An uncommon presentation of a common culprit 
The Australasian Medical Journal  2014;7(6):247-250.
Hepatic tuberculosis (HTB) is commonly encountered in patients with widespread miliary disease. Isolated affection of the liver is extremely rare. We present a case of a young woman who presented with a subacute afebrile hepatic failure. Investigations including a liver biopsy proved that the presentation was due to granulomatous hepatitis secondary to mycobacterial infection of the liver. It is important that tuberculosis (TB) be kept in mind especially in endemic areas even in atypical clinical scenarios by clinicians, radiologists, and pathologists. Use of anti-tuberculous drugs in such cases is usually successful and must be instituted early.
doi:10.4066/AMJ.2014.2076
PMCID: PMC4082249  PMID: 25031646
Isolated Hepatic Tuberculosis; Mycobacterium tuberculosis; extra pulmonary tuberculosis
20.  An unusual right popliteal vein aneurysm in an adult cadaver: A case report 
The Australasian Medical Journal  2014;7(6):260-263.
The incidence of venous aneurysm is less than arterial aneurysms. Most are incidental findings with no major clinical significance. However, popliteal vein aneurysms (PVA) may be potentially life threatening, as they can be a source of pulmonary embolism and potentially even death. We report a case of right PVA in a 67-year-old male cadaver. Information from this case study may contribute to an improved understanding of these phenomena, including early detection of these or similar thromboembolic events.
doi:10.4066/AMJ.2014.2128
PMCID: PMC4082251  PMID: 25031648
Popliteal vein; aneurysm; popliteal fossa; pulmonary embolism
21.  Bilateral variations of brachial plexus involving the median nerve and lateral cord: An anatomical case study with clinical implications 
The Australasian Medical Journal  2014;7(5):227-231.
During the routine dissection of upper limbs of a Caucasian male cadaver, variations were observed in the brachial plexus. In the right extremity, the lateral cord was piercing the coracobrachialis muscle. The musculocutaneous nerve and lateral root of the median nerve were observed to be branching inferior to the lower attachment of coracobrachialis muscle. The left extremity exhibited the passage of the median nerve through the flat tendon of the coracobrachialis muscle near its distal insertion into the medial surface of the body of humerus. A variation in the course and branching of the nerve might lead to variant or dual innervation of a muscle and, if inappropriately compressed, could result in a distal neuropathy. Identification of these variants of brachial plexus plays an especially important role in both clinical diagnosis and surgical practice.
doi:10.4066/AMJ.2014.2070
PMCID: PMC4051358  PMID: 24944720
Brachial plexus; Lateral cord; Coracobrachialis; Median nerve
22.  Reversible lower limb deep vein thrombosis following haemotoxic snakebite—a case report 
The Australasian Medical Journal  2014;7(5):232-235.
Haemotoxic snakebite, presenting with coagulopathy and bleeding manifestations, is quite common. Thrombotic manifestations are infrequently observed. We describe the unusual case of a young male who developed deep vein thrombosis (DVT) of the left lower limb following snakebite, despite an ongoing coagulopathy. Investigations revealed leucocytosis, prolonged 20-minute whole blood clotting time (20’WBCT), prolonged prothrombin time (PT), and activated partial thromboplastin time (aPTT). Doppler study revealed thrombosis of common femoral vein, superficial femoral, and profunda femoris veins. The patient underwent two fasciotomies and received anticoagulation after which patency of the veins was restored. Doppler sonographic imaging in patients with haemotoxic snakebite who present with increasing local swelling may assist with early anticoagulation therapy that has a potential to be limb-saving.
doi:10.4066/AMJ.2014.2075
PMCID: PMC4051359  PMID: 24944721
Snake bite; DIC; DVT; Doppler ultrasound
23.  Malignant melanoma of soft parts with osteoclast-rich giant cells: A rare tumour of the jejunum 
The Australasian Medical Journal  2014;7(4):181-184.
Malignant melanoma of soft parts (MMSP), first described by Franz M. Enzinger, is a rare tumour of unknown cell origin. We describe a case of a 45-year-old male who presented with a one-year history of abdominal pain, weakness, and anaemia. Computerised tomography enteroclysis showed a mass in the jejunum that was suggestive of a gastrointestinal stromal tumour. An ulceroinfiltrative lesion measuring 6.5 x 4 x 2cm was identified. Microscopy revealed typical features of MMSP with numerous osteoclasts-like giant cells. The diverse histomorphology and immunohistochemical characteristics of this case involving a rare tumour at a rare site is presented.
doi:10.4066/AMJ.2014.1970
PMCID: PMC4009879  PMID: 24817912
Malignant melanoma of soft parts; jejunum; osteoclastic giant cells
24.  Vitamin B12 deficiency presenting as pancytopenia and retinopathy in a young boy—Helicobacter pylori, a novel causative agent 
The Australasian Medical Journal  2014;7(3):143-148.
Deficiency of vitamin B12 (cobalamin) is a well-known cause of megaloblastic anaemia. It is a reversible cause of bone marrow failure and demyelinating nervous system disorder, hence early detection and prompt treatment of vitamin B12 deficiency is essential. After diagnosing vitamin B12 deficiency, tracking down its root cause is important in individualising the treatment approach. Helicobacter pylorirelated (H. pylori) B12 deficiency presenting as pancytopenia in pediatric age groups has been reported. However, vitamin B12 deficiency presenting as retinopathy in paediatric age groups has been rarely reported in the medical literature. We herein present the case of an adolescent male with pancytopenia and retinopathy, secondary to vitamin B12 deficiency-associated H. pylori infection.
doi:10.4066/AMJ.2014.1872
PMCID: PMC3973926  PMID: 24719649
Pancytopenia; retinopathy; Helicobacter pylori; vitamin B12 deficiency
25.  Bilateral schizencephaly Type II 
The Australasian Medical Journal  2014;7(3):157-160.
Background
Schizencephaly is one of the most severe forms of neuronal migration defects and is an extremely rare cause of seizure disorder.
Case details
We report a case of bilateral schizencephaly (Type II) presenting as seizure disorder since birth.
Discussion
This case is rare because of the relatively benign features compared to other reported cases.
Conclusion
Compared to other cases, this patient has normal cognitive and motor functioning. Given the scant literature on schizencephaly in India’s paediatric population, this case highlights the possibility of a very rare entity associated with seizures. MRI can detect this condition.
doi:10.4066/AMJ.2014.1924
PMCID: PMC3973928  PMID: 24719651
Bilateral schizencephaly type II; seizure disorder

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