2009

Ng KH, Peh WCG
Correspondence: Prof Ng Kwan Hoong, dwlng@tm.net.my

ABSTRACT
In part two of “Preparing effective illustrations”, the other three categories, viz. photographs, radiological images and diagrams, are discussed. Illustrations provide visual information to supplement the results in a scientific paper, and create a visual impact that can improve the readability of a paper. This article provides some basic guidelines to assist authors in preparing effective photographs, radiological images and diagrams.

Keywords: diagrams, illustrations, radiological images, medical writing, photographs, scientific paper
Singapore Med J 2009; 50(4): 330-335

Teo THP, Ho GH, Chaturverdi A, Khoo BKJ
Correspondence: Dr Tze Hern Patrick Teo, thteo76@gmail.com

ABSTRACT
A 33-year-old woman presented with a painless right breast lump of four weeks’ duration. There were no symptoms such as fever or night sweats. Mammogram revealed an elliptical lesion in the retromammary region. Ultrasonography showed a hypoechoeic collection deep in the right breast. As the lesion was localised to the chest wall, computed tomography of the thorax was performed. This confirmed a fluid collection in the right anterior chest wall and also bilateral upper lobe consolidations, suggestive of pulmonary tuberculosis with an abscess in the anterior chest wall. Ultrasound-guided core needle biopsy confirmed a Mycobacterium tuberculosis infection. It is unusual for a tuberculous abscess of the chest wall to present as a painless breast lump. We also present a companion case of tuberculous mastitis to illustrate their distinct imaging features.

Keywords: breast mass, chest wall tuberculosis abscess, Mycobacterium tuberculosis, retromammary lesion, tuberculosis
Singapore Med J 2009; 50(3): e97-e99

Chong VH, Telisinghe PU, Yapp SKS, Jalihal A
Correspondence: Dr Chong Vui Heng, chongvuih@yahoo.co.uk

ABSTRACT
Obstructive jaundice is common and in most cases due to stone diseases or malignancies. Malignancies are important causes and are often unresectable at the time of diagnosis. Similarly, it is also important to consider infective causes such as tuberculosis (TB), particularly in endemic areas or in patients with risk factors. Although rare, the possibilities for the coexistence of different pathologies need to be considered as the treatment required will be different. We report a 67-year-old man with unexpected findings of obstructive jaundice secondary to biliary TB and an early ampullary tumour.

Keywords: ampullary tumour, biliary tumour, biliary stricture, biliary tuberculosis, obstructive jaundice, tuberculosis
Singapore Med J 2009; 50(3): e94-e96

H’ng MWC, Kwek JW, Teo CHY, Cheong DMO
Correspondence: Dr Jin Wei Kwek, kwek.jin.wei@nccs.com.sg

ABSTRACT
We present a 54-year-old Chinese man with a tumour at the pancreatic tail associated with a presumed cystic splenic lesion. Histological examination showed a pancreatic ductal adenocarcinoma with extensive cystic degeneration and invasion of the spleen, a rare imaging presentation for such a tumour.

Keywords: ductal adenocarcinoma, pancreatic ductal adenocarcinoma, pancreatic tumour, pancreatic cyst degeneration, splenic cystic lesion
Singapore Med J 2009; 50(3): e91-e93

Bukulmez A, Koken R, Melek H, Ozturk F, Konakci R, Dogru O
Correspondence: Dr Aysegul Bukulmez, aysegulbukulmez@yahoo.com

ABSTRACT
In recent years, tuberculosis has re-emerged as a serious public health problem, raising the possibility that tuberculous eye disease may also have become more prevalent. Ocular tuberculosis usually occurs in apparently healthy individuals. It is rarely observed in patients with active pulmonary disease. An eight-year-old boy was admitted to our department because of chronic granulomatous anterior uveitis on his left eye. His medical history was unremarkable. There were no systemic symptoms of tuberculosis. He had a positive purified protein derivative test reaction. In our case, the diagnosis of ocular tuberculosis was presumptive and depended upon indirect evidence. The patient was started on anti-tuberculosis therapy with three drugs, which were continued for 12 months, with complete healing of the ocular lesions, including a marked improvement in the gait of the patient. Tuberculosis remains one of the most important causes of morbidity and mortality in developing countries.

Keywords: chronic granulomatous anterior uveitis, ocular tuberculosis, tuberculosis, uveitis
Singapore Med J 2009; 50(3): e120-e123

Borman P, Gökoglu F, Tasbas O, Yilmaz M, Yorgancioglu ZR
Correspondence: Dr Figen Gökoglu, figengokoglu@mynet.com

ABSTRACT
Familial Mediterranean fever (FMF) is an autosomal recessively-transmitted disease characterised by attacks of fever and serositis. Articular involvement is the second most common manifestation following abdominal pain. Patients with FMF are considered to have an increased risk of sacroiliitis, while the association of such abnormalities with FMF has not been accepted uniformly. We report two cases of FMF with accompanying seronegative spondyloarthropathy, a 18-year-old boy and a 29-year-old man, and review the literature for FMF-related seronegative spondyloarthropathy.

Keywords: familial Mediterranean fever, sacroiliitis, seronegative spondyloarthropathy
Singapore Med J 2009; 50(3): e116-e119

Ali N, Moiz B
Correspondence: Dr Natasha Ali, natasha.ali@aku.edu

ABSTRACT
We report a 45-year-old man with complaints of chest pain and weight loss who was referred for a bone marrow/trephine procedure to the Aga Khan University Hospital. Bone marrow examination showed plasmacytosis of 95% with plasma cells containing coarse Auer rod-like azurophilic inclusions, which failed to stain positively with Sudan Black B or periodic acid Schiff stain. These inclusions have rarely been previously reported as they are more significant morphologically rather than having a prognostic value.

Keywords: azurophilic granules, multiple myeloma, plasma cells
Singapore Med J 2009; 50(3): e114-e115

Kahar-Bador M, Nathan AM, Soo MH, Mohd Noor S, AbuBakar S, Lum LCS, Syed Hassan S, Sam IC
Correspondence: Dr I-Ching Sam, wicsam@doctors.net.uk

ABSTRACT
The rapid diagnosis and subtyping of influenza is particularly important in areas where avian influenza (H5N1) is present. The ability to recognise both typical and atypical presentations of influenza is also critical in such settings. A six-month-old male child who visited a H5N1-affected area subsequently died from a severe febrile diarrhoeal illness with minimal respiratory symptoms, and was initially diagnosed with influenza A of an unknown subtype. The final microbiological results showed a highly unusual combination of influenza A (H3N2) and Campylobacter jejuni infection.

Keywords: avian influenza, Campylobacter jejuni infection, H3N2 subtype, influenza A virus
Singapore Med J 2009; 50(3): e112-e113

Bhargava P, Matthew P
Correspondence: Dr Pavan Bhargava, pavan_bhargava@rediffmail.com

ABSTRACT
Kikuchi’s disease is a rare benign disease that presents with fever and cervical lymphadenopathy. The importance of this disorder, lies in distinguishing it from more sinister disorders, such as lymphoma, in order to avoid unnecessary investigation and treatment. Systemic manifestations are rare in Kikuchi’s disease but are not unknown. We present two cases of varying degrees of systemic involvement due to Kikuchi’s disease. Both these patients, a 22-year-old woman and a 44-year-old woman, were also found to have evidence of recent Epstein-Barr virus (EBV) infection. The evidence of a causative role for EBV in Kikuchi’s is also reviewed.

Keywords: cervical lymphadeopathy, Epstein-Barr virus, Kikuchi’s disease, necrotising histiocytic lymphadenitis
Singapore Med J 2009; 50(3): e110-e111

Hadzri MH, Azarisman SM, Fauzi ARM, Kahairi A
Correspondence: Dr Mohd Hadzri Hasmoni, hadzri@iiu.edu.my

ABSTRACT
Rhinocerebral mucormycosis is an invasive fungal sinusitis with a high mortality rate, especially in immunocompromised patients. A 70-year-old woman, with uncontrolled type 2 diabetes mellitus, presented with a one-month history of non-specific headaches associated with progressive swelling of her left eye. Computed tomography of the brain and orbits showed the extensive involvement of bilateral intranasal sinuses, orbits, extraocular muscle and soft tissues. The diagnosis of invasive mucormycosis was confirmed from a tissue biopsy taken from the internasal septum. Despite the extensive mucormycosis invasion, she was successfully treated with intranasal and systemic amphotericin B and minimal adjunctive intranasal sphenoidotomy.

Keywords: amphotericin B, diabetes mellitus, fungal sinusitis, proptosis, rhinocerebral mucormycosis
Singapore Med J 2009; 50(3): e107-e109