NDLI: Multiple myeloma presenting with bilateral ankle pain (microangiopathy) and complicated by streptococcal meningitis and Pneumocystis carinii pneumonia.

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Year: 2017 Volume: 2017

Fluctuating drowsiness following cardiac catheterisation: artery of Percheron ischaemic stroke causing bilateral thalamic infarcts.

Upper lobe cavity with intracavitary mass: an unexpected diagnosis.

Retronychia: clinical diagnosis and surgical treatment.

Late presentation of hypertrophic cardiomyopathy with apical aneurysm.

Congenital anomaly of the posterior arch of the atlas: a rare risk factor for posterior circulation stroke.

Refractory primary immune thrombocytopenia with subsequent del(5q) MDS: complete remission of both after lenalidomide.

Corticosteroid-induced cryptococcal meningitis in patient without HIV.

Acute traumatic renal arteriocalyceal fistula: selective angioembolisation for haemodynamic instability.

ECG changes in hyperemesis gravidarum.

Dabigatran-related leukocytoclastic vasculitis.

Primitive neuroectodermal tumour of the cervix: a rare diagnosis.

TB or not to be? Kikuchi-Fujimoto disease: a rare but important differential for TB.

Hirayama disease; an atypical clinical manifestation of a cervical myelopathy with typical MRI features.

Sepsis and siderosis, Yersinia enterocolitica and hereditary haemochromatosis.

Is haloperidol the wonder drug for cannabinoid hyperemesis syndrome?

Vitreous base avulsion.

Ecthyma gangrenosum in a case of acute lymphoblastic lymphoma.

Pulmonary tuberculosis presenting as post-operative fever of unknown origin.

103-year-old on dialysis: was it worth it?

Contained ruptured abdominal aortic aneurysm presenting as cauda equina syndrome.

Jejunal perforation: an unusual presentation of metastatic cutaneous squamous cell carcinoma (SCC) in an immunosuppressed patient.

Intraoperative OCT assisted descemetopexy with stromal vent incisions and intracameral gas injection for case of non-resolving Descemet's membrane detachment.

Spontaneous rupture of renal angiomyolipoma during pregnancy.

Prominent metalware from pelvic surgery causing dyspareunia.

Hyperbaric oxygen therapy in the management of severe leg ulcers from prolidase deficiency.

First reported case of disseminated Nocardia kroppenstedtii sp nov. infection presenting with brain abscess and endocarditis in an immunocompromised patient with mantle cell lymphoma: challenges in diagnosis and treatment.

Tuberculous scleral abscess with choroidal detachment.

Novel sleep management method in a toddler displaying fear and trauma: the Boss of My Sleep Book.

Optical coherence tomography angiography and fundus autofluorescence in the eyes with choroideremia.

Inadvertently boarding a pirate ship: disease progression in a paediatric patient with relapsed metastatic Ewing sarcoma receiving treatment at a centre for alternative therapy in Mexico.

Rare and unusual case of polyarteritis nodosa involving the gastrointestinal tract leading to bowel gangrene.

Disseminated histoplasmosis presenting as diabetic keto-acidosis in an immunocompetent patient.

Epirubicin extravasation: consequences of delayed management.

Rivaroxaban lessens the number of thrombi in the left atrium and right lower pulmonary vein, as illustrated by transoesophageal echocardiography but not 80-MDCT.

Thumb and index finger macrodactyly with first carpometacarpal and scaphotrapezotrapezoidal joints fusion: inevitable consequence?

Flaccid paralysis in an infant associated with a dirty wound and application of honey.

Contralateral inguinal herniation of a transplant ureter causing obstructive uropathy in a renal transplant recipient.

Dieulafoy's lesion of the oesophagus: a case series and literature review.

Primary non-Hodgkin's lymphoma of the tongue: a diagnostic dilemma of unusual case presentation.

Successful survival of an extreme premature infant with cystic fibrosis.

Role of endobronchial ultrasound scan in the diagnosis and management of intrapulmonary bronchogenic cyst misdiagnosed by low-dose CT scan of the chest as lung mass.

Acute colonic pseudo-obstruction associated with abdominal paracentesis.

Delivering patient-centred care in rural family practice: using the patient's concept of health to guide treatment.

Secondary asplenia as a complication of severe Meningococcal Sepsis.

Short-term treatment with oral amiodarone resulting in bilateral optic neuropathy and permanent blindness.

Postoperative Mycoplasma hominis brain abscess: keep it in mind!

Portomesenteric vein thrombosis after laparoscopic sleeve gastrectomy for morbid obesity.

Bilateral indwelling pleural catheter for hepatic hydrothorax.

Proteinase 3-antineutrophil cytoplasmic antibody-positive ulcerative colitis presenting with abducens neuropathy.

Hypotension induced by the concomitant use of a calcium-channel blocker and clarithromycin.

Bluish nodules of the breast in an adolescent girl.

Prolonged indirect hyperbilirubinemia in a moderately preterm boy with Mediterranean glucose-6-phosphate dehydrogenase and glutathione S-transferase Mu 1 null mutations.

Donor-derived mycosis fungoides following reduced intensity haematopoietic stem cell transplantation from a matched unrelated donor.

Delayed diagnosis of fractured anterior arch of the atlas in a young child.

Pancreatic lymphoma complicating early stage chronic hepatitis C.

Successful treatment of Takayasu arteritis with rituximab as a first-line immunosuppressant.

Benign cystic mediastinal teratoma presenting as a massive pleural effusion in a 17-year-old boy.

Gambling disorder: a side effect of an off-label prescription of baclofen-literature review.

Recurrent angioedema associated with pharmacological inhibition of dipeptidyl peptidase IV.

Successful pregnancy following treatment of recurrent chronic histiocytic intervillositis.

Unexpected complication after radical (inguinal) orchidectomy: trans-sphincteric anoscrotal fistula.

Radial artery pseudoaneurysm: rare complication of a frequent procedure.

Pacemaker pocket infection due to Mycobacterium goodii, a rapidly growing mycobacteria.

Foamy gland variant of adenocarcinoma of prostate: a rare pathological variant.

Superficial temporal artery haemorrhage caused by neurophysiological monitoring: a unique MRI finding.

Healing of pathological fracture in a case of multiple myeloma.

Combined central retinal artery and vein occlusion in lupus.

Splenomegaly in the returning traveller: a diagnostic workup.

Rare case of haemoptysis.

Primary sarcomatoid carcinoma of the small intestine: very rare and aggressive tumour.

'Bizarre' rash: adult-onset cutaneous Langerhans cell histiocytosis.

Persistent anterior interosseous nerve palsy following forearm crutch use.

Severe pulmonary arterial hypertension in a patient with small ventricular septal defect.

Spontaneous retroperitoneal haematoma resulting in bowel ischaemia.

Intracranial infection caused by minor skin contusion associated with previous craniotomy.

Concomitant orbital cavernous haemangioma and schwannoma in a patient.

Strongyloides hyperinfection syndrome and VRE pneumonia.

Unexpected complication of colonoscopy.

Oesophageal presentation of Crohn's disease.

Bilateral presence of radix entomolaris in first and second permanent mandibular molars identified in a Caucasian woman.

Supra and infratentorial ectopic schwannoma mimicking a meningioma.

Not so patchy story of attempted suicide leading to 24â hours of deep sleep and survival!

Disseminated adenovirus infection causing severe ARDS.

Atypical presentation of Bezold's and Citelli's abscesses, with recollection following an incomplete postoperative course of antibiotics.

Ingestion of cylindrical batteries and its management.

Disseminated melioidosis in the head and neck.

Haemodialysis in acute paracetamol poisoning.

Stentriever thrombectomy with distal protection device for carotid free floating thrombus: a technical case report.

Multiple pregnancy in a primigravida with uncorrected Pentalogy of Fallot.

A rare cause of constrictive pericarditis.

Primary squamous cell carcinoma of the thyroid with complete response to radical radiotherapy and concurrent cisplatin-based chemotherapy.

Pain in the neck.

Mucormycosis pulmonary abscess, containment in a patient with uncontrolled diabetes mellitus.

Clostridium hastiforme bacteraemia secondary to pyometra in a 64-year-old woman.

Atrophic pityriasis versicolor occurring in a patient with Sjögren's syndrome.

Perioperative management of a large, late presenting phaeochromocytoma.

Late spontaneous decapsulation of the kidney graft in a patient with hepatitis C and treated with sirolimus: possible pathophysiological association in a rare complication.

Ocular surface squamous neoplasia treated with topical interferon 2b.

Acute mania after levothyroxine replacement for hypothyroid-induced heart block.

When dizziness becomes sinister: oropharyngeal carcinoma presenting as a paraneoplastic neurological disorder.

Gastrointestinal stromal tumour (GIST) presenting as a strangulated inguinal hernia with small bowel obstruction.

Paradoxical insomnia in a patient taking zopiclone.

Traumatic septal coronary perforation after a motor vehicle collision.

Novel approach for independent control of brain hypothermia and systemic normothermia: cerebral selective deep hypothermia for refractory cardiac arrest.

Pouch pseudoaneurysm: a rare cause of recurrent haemorrhage following ileal pouch-anal anastomosis.

Cephalic tetanus as a differential diagnosis of facial nerve palsy.

De novo 2p16.1 microdeletion with metastatic esophageal adenocarcinoma.

Autoimmune hepatitis and eosinophilic granulomatosis with polyangiitis: a rare association.

Child with multiple fractures: a rare presentation of a common disease.

Angioedema in a patient with neuroendocrine tumour.

Unilateral interstitial lung disease in a woman aged 35 years.

Surgical resection of a rare cutaneous manifestation of Scedosporium apiospermum in a patient who underwent renal transplant.

Deceiving proteins! A case of lymphoma and high creatinine.

Concurrent pityriasis rosea and Bell's palsy.

Residual terminal bowel fistulating into the alimentary tract: a hitherto unreported complication of surgery for anorectal malformation.

Atraumatic splenic rupture secondary to Epstein-Barr virus infection.

Successful treatment of tumour-induced osteomalacia after resection of an oral peripheral ossifying fibroma.

Lymphoma presenting as a toothache: a wolf in sheep's clothing.

Painful purpura associated with exposure to levamisole-adulterated cocaine.

Cystic lymphangioma of spleen in adults.

Gluteal compartment syndrome with sciatic nerve palsy caused by traumatic rupture of the inferior gluteal artery: a successful surgical treatment.

Interesting association of neurofibroma with diffuse cystic lung disease (NF-DLD).

Hereditary leiomyomatosis and renal cell cancer syndrome: a family affair.

Basilar stroke from a persistent hypoglossal artery.

Lumbo-costo-vertebral syndrome with inguinal hernia and other anomalies.

Rumpel-Leede phenomenon in a patient with adult-onset Still's disease.

Indian erythrodermic postkala-azar dermal leishmaniasis.

Metastatic endometrial endometrioid carcinoma mimicking pilomatrixoma of the distal vagina.

Migrating coil.

Peril of missing a double gall bladder: report of a patient who needed cholecystectomy two times over.

Very late rupture of a post-traumatic abdominal aortic pseudoaneurysm.

Topical timolol for the treatment of pyoderma gangrenosum.

Limited cutaneous systemic sclerosis arising in a patient with Graves' disease.

Giant renal oncocytoma with classic stellate scar.

Pulmonary actinomycosis: a clinical surprise!

Bacterial meningitis: a rare complication of an unrecognised nasal foreign body in a child.

Blood, brain and binocular vision.

Mycobacterium chelonae hand infection after steroid injection in a patient with rheumatoid arthritis receiving long-term linezolid therapy.

Cerebral venous thrombosis as the first presentation of classical homocystinuria in an adult patient.

Rare presentation of Brodie's abscess in the acromion process and the value of the penumbra sign.

Complications of dysgerminoma: meeting the health needs of patients in conflict zones.

Lhermitte-Duclos disease associated to Cowden syndrome: de novo diagnosis and management of these extremely rare syndromes in a patient.

Subcorneal pustular dermatosis and episcleritis associated with poorly controlled ulcerative colitis.

Bilateral thigh methicillin-resistant Staphylococcus aureus necrotising fasciitis in a man with newly diagnosed Human Immunodeficiency Virus (HIV).

Wunderlich's syndrome as a manifestation of polyarteritis nodosa.

Idiosyncratic drug reactions and membranous glomerulopathy.

Paralysis that easily reverses: a case of thyrotoxic periodic paralysis.

Non-Hodgkin's lymphoma involving a femur bone and bilateral adrenal glands alone with adrenal insufficiency.

Replaced right and left hepatic arteries: a variation in origin and course.

Hepatitis E virus infection in a patient with suspected drug-induced liver injury.

Aplasia cutis congenita and amniotic band syndrome: an uncommon association.

Taxan-associated nail toxicity.

Two extremes of the clinical spectrum of conjunctival squamous cell carcinoma presenting in the same patient.

Risk of cumulative toxicity after complete melanoma response with pembrolizumab.

Renal cell carcinoma metastasis involving vertebral hemangioma: dual percutaneous treatment by navigational bipolar radiofrequency ablation and high viscosity cement vertebroplasty.

Pregnancy in a patient with congenital analbuminaemia.

Lung consolidation responding to chemotherapy.

Prenatal sonographic diagnosis of meconium peritonitis from duodenal atresia.

Implant-associated ESBL-Klebsiella pneumonia producing small colony variant bone and joint infection in a healthy 40-year-old man.

Yamaguchi syndrome presenting as atrioventricular nodal re-entrant tachycardia in an African-American patient.

Lymphomatoid granulomatosis with pulmonary and gastrointestinal involvement.

Robotic partial nephrectomy for duplex kidney with ectopic ureter draining in the vagina in an adult patient with urinary incontinence.

Non-malignant superior vena cava syndrome in a patient with incidental diagnosis of a congenital vascular defect.

Primary gastric plasmacytoma: a rare entity.

Uncommon cause of adult onset cyanosis: single left ventricle.

Interventional repair of pseudoaneurysm of ascending aorta following prosthetic aortic valve replacement.

Functional mitral stenosis: a result of bacterial endocarditis.

Multiple myeloma presenting with bilateral ankle pain (microangiopathy) and complicated by streptococcal meningitis and Pneumocystis carinii pneumonia.

Morphological features of five-rooted maxillary second molar evaluated by spiral CT.

Avoiding misdiagnosis: cystic calcified brain metastases of uterine cervical cancer mimicking neurocysticercosis.

Duodenocolic fistula diagnosed by endoscopy: a rare complication of colon cancer.

Cervical spine arteriovenous fistula associated with hereditary haemorrhagic telangiectasia.

Sternal stress fracture in a middle-aged woman.

Unusual sites of metastases of carcinoma cervix.

Congenital absence of sternum in an infant.

Cultivated limbal epithelial transplantation and penetrating keratoplasty postchemical injury: a 14-year follow-up.

A complicated multisystem flare of systemic lupus erythematosus during pregnancy.

Minor traumatic retroclival epidural haematoma in an adult.

Cognitive impairment and depressive symptoms coexisting in an elderly man.

Case of Strongyloides hyperinfection syndrome.

Disseminated intravascular coagulation-like reaction following rituximab infusion.

Homonymous hemianopia in the primary antiphospholipid syndrome.

Chédiak-Higashi syndrome with novel gene mutation.

Bladder calculus leading to acute renal failure in a girl child: a rare cause.

Consequences of delivery at home in a woman without prenatal care.

Pituitary tuberculoma with subsequent drug-resistant tuberculous lymphadenopathy: an uncommon presentation of a common disease.

Interstitial nephritis associated with ulcerative colitis in monozygotic twins.

Mechanical thrombectomy of embolised native aortic valve post-TAVI.

Peritoneal amyloidosis with myopathy in primary systemic (AL) amyloidosis.

Indomethacin therapy effective in a patient with depletion syndrome from secretory villous adenoma.

Fournier's gangrene: diagnosis and management aided by repeated clinical examination and ultrasound.

Hidradenitis suppurativa, neutrophilic dermatoses and diverticular disease in a young African-American patient.

Metformin-associated lactic acidosis treated with continuous renal replacement therapy.

Cerebral cryptococcoma mimicking glioblastoma.

Basal cell carcinoma arising in a congenital melanocytic naevus in an adult.

An unusual vaginal lump.

Tumour thrombus of the inferior vena cava extending into the right atrium in the setting of colon cancer.

Not your usual constipation: stercoral perforation.

Combined use of Neurally Adjusted Ventilatory Assist (NAVA) and Vertical Expandable Prostethic Titanium Rib (VEPTR) in a patient with Spondylocostal dysostosis and associated bronchomalacia.

Small lymphocytic lymphoma with Reed Sternberg cells: a diagnostic dilemma.

Hepatopulmonary fusion: a rare and potentially lethal association with right congenital diaphragmatic hernia.

Cor triatriatum sinistrum: presentation of syncope and atrial tachycardia.

Paget's disease of the anus masking a mixed adenoneuroendocrine tumour of the rectum.

Marked widespread atrophy of the cerebral cortex and brainstem in sporadic amyotrophic lateral sclerosis in a totally locked-in state.

Correction: Delayed diagnosis of a cerebrovascular accident associated with anabolic steroid use.

Hyperactive delirium following administration of intra-articular corticosteroid.

Clinical management of electrical burns in the developing world: a case of electrical burn injury left untreated leading to amputation.

Glioblastoma with primitive neuronal pattern in a girl aged 3 months: a rare diagnosis at an unusual age.

Longitudinal melanonychia on multiple nails induced by hydroxyurea.

Granulocytic sarcoma: a rare cause of sciatica.

Migrated Hem-o-Lok clips in the ureter: a rare cause of recurrent urinary tract infection.

Rete mirabile associated with pial arteriovenous fistula: imaging features with literature review.

Striae gravidarum leukaemia cutis: a rare manifestation of acute myeloid leukaemia.

Unusual case of nasal obstruction.

Isolated pulmonary mucormycosis.

Rare case of pyoderma gangrenosum originating in the spleen.

Case of gluteal haematoma in the setting of dual antiplatelet overlapping with tumoural calcinosis of the hip.

A case of right middle cerebral artery 'tendonectomy' following mitral valve replacement surgery.

Atypical presentation of a spontaneous coeliac artery dissection resulting in jejunal ischaemia.

Severe with dengue coinfection.

Triple-negative breast cancer with brain metastasis in a pregnant woman.

Anticoagulant-related nephropathy in a patient with IgA nephropathy.

Periorbital papules as a presenting sign in multiple myeloma with AL amyloidosis.

Nickel-associated delayed multiple white matter lesions after stent-assisted coil embolization of intracranial unruptured aneurysm.

Simple way to optimise ultrasonographic visualisation of the retinal periphery and anterior segment structures.

Septic arthritis of the pubic symphysis.

Intraoral ulcer due to non-invasive positive pressure ventilation: an overlooked complication.

Stress cardiomyopathy in a patient with hypertrophic cardiomyopathy and myocardial bridging.

Traumatic aneurysm of the cortical middle cerebral artery.

Penetrating mitral annular abscess ruptured into the left atrium: a rare cause of mitral regurgitation.

Case of a cerebral abscess caused by in a subject with periodontitis.

Two faces of gamma-delta mycosis fungoides: before and after renal transplantation.

Atypical case of preterm ovarian hyperstimulation syndrome.

Right upper quadrant abdominal pain as the initial presentation of polyarteritis nodosa.

Term neonate with pneumopericardium, pneumothorax while on nasal continuous positive airway pressure (nCPAP).

Case of primary bilateral diffuse large B-cell lymphoma of the ovary with plasmablastic features in an HIV-negative female patient.

Sagittal sinus thrombosis in JAK2-V617F mutation without overt myeloproliferative disorder.

Crohn's disease complicated by Epstein-Barr virus-driven haemophagocytic lymphohistiocytosis successfully treated with rituximab.

Triamcinolone emboli leading to central retinal artery occlusion: a multimodal imaging study.

Vertebral B-cell lymphoma mimicking a Pott's disease in a man aged 63 years coming back from Tunisia.

Use of optical coherence topography for objective assessment of fundus torsion.

Suspected case of chronic bullous disease of childhood in a rural area of Southern Mozambique.

Heart failure complicating with SAPHO syndrome.

Gangliocytoma: outcome of a rare silent pituitary tumour.

Could kinesiology taping help mitigate pain, breathlessness and abdominal-related symptoms in cancer?

Rare association of congenital penile urethrocutaneous fistula with Y-type urethral duplication.

Orbital apex syndrome as a complication of herpes zoster ophthalmicus.

Hypercalcaemia caused by active pulmonary tuberculosis in an elderly person without fever or pulmonary symptoms.

Lattice-like paraproteinemic keratopathy (PPK) of monoclonal gammopathy of undetermined significance (MGUS).

Over 10â years MRI observation of a patient with neuronal intranuclear inclusion disease.

Emergency cricothyroidotomy following tracheobronchial stenting.

Subretinal abscess.

Rupture of the extensor hood of the fifth toe: a rare injury.

Collapsing glomerulopathy in systemic lupus erythematosus.

Uncommon mutation in mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS).

Antithyroid arthritis syndrome.

Duodenal variceal bleed: an unusual cause of upper gastrointestinal bleed and a difficult diagnosis to make.

Duodenal perforation by an inferior vena cava filter.

Disseminated cysticercosis incidentally diagnosed in a patient of fracture shaft of femur.

Intussusception: a rare complication in a patient with acute leukaemia after consolidation chemotherapy.

Codfish vertebra sign.

The bumper technique for advancing a large profile microcatheter.

Non-epileptic attack disorder: the importance of diagnosis and treatment.

A rash and a rare cause of unilateral diaphragmatic paralysis.

Macular hole closure following spontaneous release of vitreomacular traction.

Unusual Morel-Lavallee lesion of the knee region in an elderly patient.

Bilateral incudomalleolar dislocations: an unusual cause of deafness.

Case of polyostotic primary bone lymphoma successfully treated with immunochemotherapy and consolidation radiotherapy.

Gastric malignancy presenting as a neck swelling to the otorhinolaryngologists: a case of internal jugular venous thrombosis.

Takotsubo cardiomyopathy secondary to spontaneous right-sided pneumothorax.

Caterpillar hair in the eye.

Intraprocedural thrombus formation in a patient with anticoagulated atrial fibrillation.

False homozygous HLA genotyping results due to copy number neutral loss of heterozygosity in acquired aplastic anaemia.

Dramatic resuscitation with Intralipid in an epinephrine unresponsive cardiac arrest following overdose of amitriptyline and propranolol.

Yellow fever vaccine-associated neurological disease, a suspicious case.

Pelvic renal ectopia, an incidental finding.

Extraskeletal orbital mesenchymal chondrosarcoma: surgical approach and mini review.

Rare case of severe serotonin syndrome leading to bilateral compartment syndrome.

Multidisciplinary approach to the management of a case of classical respiratory diphtheria requiring percutaneous endoscopic gastrostomy feeding.

Unusual presentation of a late-onset recurrence of malignant peritoneal mesothelioma.

Hydatid cyst: hepatitis B and D coinfection accelerating the course of the disease.

Spontaneous pneumothorax in a patient with pneumocystis pneumonia.

Multiple primary malignancies of laryngeal cancer, small cell lung cancer and squamous cell lung cancer in a patient: how to approach MPMs.

Pulmonary vein mass with extension to the left atrium diagnosed by echocardiography.

Tuberculous periprosthetic infection precipitated by infliximab therapy.

Trousseau syndrome.

Fever, rash and agranulocytosis.

Superior mesenteric artery syndrome in a young woman.

Floppy eyelid syndrome: delayed diagnosis is not desired.

Endovascular retrieval of dental needle retained in the internal carotid artery.

Inappropriate sinus tachycardia in pregnancy: a benign phenomena?

Severe lead toxicity attributed to bullet fragments retained in soft tissue.

Good response of an aggressive rare variant of signet ring cell carcinoma of prostate with hormonal therapy.

Gastric volvulus: a potentially fatal cause of acute abdominal pain.

Heroin-associated anthrax with minimal morbidity.

Brunner's gland hamartoma: a rare cause of iron deficiency anaemia and report of an adapted colonic polyp resection technique.

Reversal of isolated 20q deletion with vitamin B replacement in a patient with pernicious anaemia.

Intellectual disability complicated by sexual addiction: an uncommon presentation of a common condition.

Müllerianosis of the urinary bladder: a rare and problematic bladder tumour.

Out of the blue finger ischaemia and occult colorectal cancer.

Bilateral fixation of a periprosthetic intertrochanteric hip fracture below Birmingham hip resurfacing.

Levetiracetam-induced eosinophilic pneumonia.

Hepatocolic fistula: a rare presentation of pyogenic liver abscess.

Unusual case of hemiarhinia.

Ureteral inguinal hernia: an uncommon trap for general surgeons.

Simultaneous left-sided hypertensive putaminal and thalamic haemorrhages.

Myxoedema in a patient with achondroplasia in rural area of Guatemala.

Bumpy road to the diagnosis of polycythaemia vera.

Paediatric chronic recurrent multifocal osteomyelitis.

Anomalous origin of the circumflex coronary artery presenting with ventricular fibrillation cardiac arrest.

Segmental upper mid-basilar artery sacrifice in a child using a Micro Vascular Plug device for treatment of a basilar arteriovenous fistula compressing the brainstem.

Phentermine induced acute interstitial nephritis.

Unilateral cutaneous congestion induced by Valsalva manoeuvre due to vascular malformation.

Rheumatic fever with severe carditis: still prevalent in the South West Pacific.

Unilateral facial nerve palsy as an early presenting symptom of relapse in a paediatric patient with acute lymphoblastic leukaemia.

infection in the flexor sheath of the right index finger in an immunocompetent patient.

Carotid artery dissection: a rare complication of Eagle syndrome.

Anterior condylar confluence dural arteriovenous fistula: a rare cause of hoarseness.

Cannabis arteritis: ever more important to consider.

Severe hypophosphataemia after intravenous iron administration.

Presentation of in mixed connective tissue disorder: an encounter during hip arthroplasty.

Unusual cause of renal stone following robotic pyeloplasty.

Antepartum uterine rupture at 29â weeks gestation following unilateral salpingectomy and review of literature.

Forensic investigation into a death: post-traumatic amnesia in a worker with a work-related head injury sustained in a coal-fired thermal power plant in India.

Oral Sweet's syndrome occurring in ulcerative colitis.

Purulent pericarditis as a complication of bacteraemic urinary tract infection.

Diffuse idiopathic skeletal hyperostosis (DISH): an unusual cause of airway obstruction.

Vascular challenges from pancreatoduodenectomy in the setting of coeliac artery stenosis.

Analysis of the psychosocial impact of caretaking on the parents of an infant with severe congenital heart defect.

Clear cell adenocarcinoma of cervix in 1-year-old girl without in utero exposure to diethylstilbestrol: an uncommon tumour at an uncommon age and site.

Rhabdomyolysis-induced compartment syndrome secondary to atorvastatin and strenuous exercise.

Severe co-trimoxazole-induced hypoglycaemia in a patient with microscopic polyangiitis.

Therapeutic challenge of a paediatric case of Graves' disease with severe ophthalmopathy.

Amyand's hernia containing an appendiceal goblet cell carcinoid tumour.

Unusual association of emphysematous cystitis and chronic alcoholism.

Non-recurrent laryngeal nerve with a coexisting contralateral nerve demonstrating extralaryngeal branching.

Cervical diffuse idiopathic skeletal hyperostosis (DISH) causing oropharyngeal dysphagia.

Goodpasture's disease with late presentation of renal abnormality and anti-GBM autoantibody.

Unusual case of venous thrombosis.

Fulminant tracheobronchial aspergillosis.

Improvement in arm and hand function after a stroke with task-oriented training.

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Multiple myeloma presenting with bilateral ankle pain (microangiopathy) and complicated by streptococcal meningitis and Pneumocystis carinii pneumonia.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Singh, Neeraj Dunphy, Louise Keating, Elizabeth
Description	Author Affiliation: Dunphy L ( Department of Anaesthesia and Intensive Care Medicine, Royal Berkshire NHS Foundation Trust, Reading, UK.); Singh N ( Department of Anaesthesia and Intensive Care Medicine, Royal Berkshire NHS Foundation Trust, Reading, UK.); Keating E ( Department of Emergency and Intensive Care Medicine, Royal Berkshire NHS Foundation Trust, Reading, UK.)
Abstract	Multiple myeloma is characterised by the neoplastic proliferation of a single clone of plasma cells producing a monoclonal immunoglobulin. This clone of plasma cells proliferates in the bone marrow, resulting in extensive skeletal destruction with osteolytic lesions, osteopenia and pathological fractures. Additional disease-related complications include hypercalcaemia, renal insufficiency, anaemia and infection. We present the case of a 64-year-old woman presenting with rapid onset, painful distal symmetrical lower limb weakness and an acute kidney injury. Owing to her IgG κ paraprotein (kappa light chain 4620, kappa:lambda ratio 826), she was diagnosed with probable plasma cell myeloma. This diagnosis was confirmed following a trephine biopsy. She required renal replacement therapy, inotropic support and a percutaneous tracheostomy. She became acutely confused with a Glasgow Coma Scale score of 10/15 and a CT head showed no acute pathology. Further investigation with a lumbar puncture confirmed the diagnosis of streptococcal meningitis. She was treated with intravenous acyclovir, ceftriaxone and fluconazole. Her non-bronchoalveolar lavage revealed a diagnosis of Pneumocystis carinii pneumonia and she required treatment with co-trimoxazole. This case report discusses the clinical presentation, diagnostic algorithm and treatment of myeloma. This manuscript offers an important clinical reminder to consider myeloma in the differential diagnosis in patients presenting with bone pain and acute kidney injury.
Journal	BMJ Case Reports
Volume Number	2017
e-ISSN	1757790X
Language	English
Publisher	BMJ Publishing Group Ltd.
Publisher Place	Great Britain (UK)
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Multidisciplinary
Content Type	Text
Resource Type	Article

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