Journal of Clinical Case Reports

Simvastatin as an effective cholesterol-lowering medication is widely prescribed to treat cardiovascular diseases. Despite definite safety and efficacy, myopathy and liver dysfunction are the common adverse effects of simvastatin. Little information is available regarding the symptom starting and recovery period for a patient undergoing the side effect. We present here a 65-year-old male patient with both liver dysfunction and myositis due to the concomitant use of itraconazole 400 mg and simvastatin 40 mg daily.

Bowen’s disease, an intraepitelial neoplasm of keratinocytes, is characterized by a sharply demarcated, asymptomatic, scaly or crusted, erythematous plaque that is slow growing. It may progress into invasive squamous cell carcinoma. It most commonly affects sun-exposed surfaces of elderly females. Herein we report a case of Bowen’s disease in the web-space of both feet for 1 year who was initially diagnosed as tinea pedis. The rarity of this presantation in dermatology is emphasized.

Hepatocellular carcinoma usually metastasizes to the lung, bone, adrenal glands, diaphragm and lymph nodes. In this study, we present a case of hepatocellular carcinoma that metastasized to the ovary. To the best of our knowledge, there are very few reports of such cases published in English and none in which the patient survived more over 7 years. A 72-year-old postmenopausal Japanese woman had been diagnosed with type C chronic hepatitis. Screening ultrasonography revealed a low echoic small nodular lesion located on S6 of the liver. Tiny hepatocellular carcinoma was diagnosed by needle biopsy and the patient was treated with percutaneous ethanol injection therapy. Two years later, she underwent a work-up because of an elevation in serum alpha-fetoprotein level, and whole body Computed Tomography scan revealed a large solid pelvic mass. At laparotomy, a large right ovarian tumor was revealed. No other lesion was found. A bilateral salpingo-oophorectomy was performed. On microscopic examination, the tumor showed predominantly solid and trabecular patterns. Pseudo-glandular patterns were also observed. The final pathological diagnosis was hepatocellular carcinoma metastatic to the right ovary. Postoperatively, the serum alphafetoprotein concentration decreased to within the normal range. Although, we resected an implantation in her right thoracic wall seven months post laparotomy, she did not show any evidence of recurrence during her 7 year follow up period. Metastatic hepatocellular carcinoma to the ovary is very rare. If a patient presents with findings similar to those describing our patient, the examining physician should be aware of the risk of potential ovarian metastases from hepatocellular carcinoma. Surgical resection may be the only effective treatment strategy for static ovarian cancer.

Mirizzi syndrome is an unusual complication of chronic cholelithiasis due to impacted gallstone in the cystic duct or neck of the gallbladder causing Common Bile Duct (CBD) obstruction. Here, we report a case of middle aged female presenting with acute abdominal pain and jaundice. Endoscopic Retrograde Cholangio Pancreatography (ERCP) revealed a large gallstone in the cystic duct compressing the common bile duct suggestive of Mirizzi syndrome which was managed surgically.

Poorly Differentiated (Insular) Thyroid Carcinoma (PDITC) is an uncommon thyroglobulin producing neoplasm, intermediate in aggressiveness, morphologically and biologically placed between Well-Differentiated Carcinomas (WDC) of follicular cell origin and undifferentiated anaplastic carcinoma and first described by Sakamoto et al. and Carcangiu et al. The tumor occurs in an older group than the WDCs (also it can occur in adolescents. It is described with higher mortality than WDC. The present cancer staging system (TNM) for thyroid cancer considers differentiated and undifferentiated tumors while ignoring this intermediate type, which is also called poorly differentiated tumor.

Hereditary hemorrhagic telangiectasia (HHT) is usually under recognized. It is a rare genetic disorder characterized by telangiectasia and epistaxis. Visceral involvement by HHT is common but frequently asymptomatic and remains undiagnosed. However, once the visceral manifestation of the disease occurs, it can result in significant morbidity and mortality. This case report demonstrates the rare complications of pulmonary hypertension and hepatic encephalopathy in HHT.

Fibrodysplasia Ossificans Progressiva (FOP) is a rare Autosomal Dominant disease that is characterized by deep ossification that ankyloses joints. The diagnosis confusion and the treatment dilemma are discussed in this case report of a 3 year old Saudi male. Literature review revealed that no FOP cases reported in Saudi Arabia. This case report is the first documentation of FOP in Saudi Arabia and reviews the literature for the latest treatment protocol.

In Kounis-Zavras syndrome, vasospastic medaiators released from mast cells as response to allergic stimulus lead to coronary vasospasm and result in acute coronary syndrome or angina pectoris. In this case report, anesthesia management in a 35 year old female patient with Kounis-Zavras syndrome who had Samter triad and multiple drug allergy and had arrest previously due to drug allergy and hence who has implantable cardioverter defibrillator is presented.

A 59-year old man was admitted with severe pustular psoriasis all over his body that was triggered by a flu vaccine injection 8 days before admission. Until then, his psoriasis was under control and was noticed slightly only on extensor tendons of the hands and around the elbows. He was treated with steroids and the skin eruption disappeared slowly within 3 days. This is the first report of a patient with psoriasis who had a flare up of the autoimmune skin disease following vaccination.