Benign Oesophageal Stricture and Chronic Diarrhoea As Atypical Presenting Symptoms of an Advanced Metastatic Pancreatic Gastrinoma: A Case Report and Review of Literature.

Gastrinoma or otherwise known as Zollinger-Ellison syndrome is characterised by hypersecretion of gastrin and gastric acid leading to the formation of recurrent atypical ulcers along the upper gastrointestinal tract. It is extremely difficult to diagnose during an acute presentation both due to its rarity and its lack of pathognomonic symptoms. Its symptoms range from mild to severe to life-threatening and often get mistaken for a different condition such as viral gastroenteritis as seen in our case report.

Persistent Immune Thrombocytopenia Resistant to Immunosuppressive Therapy: What Is the Way Forward?

Immune thrombocytopenia purpura (ITP) involves autoimmune induced platelet destruction and decreased platelet production in part due to autoantibody destruction mechanisms. Most autoantibodies involved in its pathogenesis invoke autoreactive T cells and cytokine imbalance, and most drug therapies target these mechanisms. We describe a man in his late 40s, with a medical history of ITP, who presented with blood blisters on his mucosal surfaces and bruises on all four limbs with petechial rashes.

Sporadic Fusobacterium Bacteremia as an Atypical Cause of Acute Hepatitis in a Young Caucasian Woman.

Fusobacterium species are gram-negative anaerobic non-spore-forming bacteria, which colonize mucous membranes in humans. Over the recent decade, the significance of these organisms has been increasingly recognized. We describe a rare case of acute hepatitis, which was found to be likely due to Fusobacterium nucleatum, grown on blood culture.

The Life-Threatening Risk of a Dirty Wound: A Lesson From the Past.

Tetanus is a severe and potentially life-threatening infection caused by the bacterium Clostridium Tetani. It is a gram-negative anaerobe, often found in soil in spore form and in the gastrointestinal tract of humans and animals. It produces a potent neurotoxin called tetanospasmin.

Not All Facial Droops Are Stroke: Miller Fisher Syndrome Presenting as a Stroke Mimic.

Miller Fisher syndrome (MFS) is a rare acquired neuropathy resulting from an acute infection and is believed to be a variant of Guillain-Barre syndrome (GBS). Its characteristic features are triads of ataxia, areflexia and ophthalmolegia, though involvement of cranial nerves is possible. Our case report describes a middle-aged man who presented as a potential stroke patient with left-sided facial droop, dysphagia and weakness.

Spontaneous Rupture of a Pseudoaneurysm of the Right Hepatic Artery Causing Massive Upper Gastrointestinal Bleeding.

Unlabelled: We describe the case of an 84-year-old woman who presented with right lower chest pain, anaemia and newly deranged liver function which was followed by massive upper gastrointestinal (GI) bleeding with no source of bleeding found on upper GI endoscopy. CT angiography of the GI tract confirmed rupture of a pseudoaneurysm of the right hepatic artery (RHA) that was treated successfully with trans-arterial embolization of the RHA.

Learning Points: If upper gastrointestinal (GI) endoscopy fails to identify the source of upper GI bleeding, CT angiography is required to search for rare causes such as pseudoaneurysm of the right hepatic artery (RHA) with fistula formation with the GI and biliary tract, along with other causes such as aorto-enteric fistula.