Focal myositis of the sternocleidomastoid muscle: a rare and uncommon cause of cervical mass

We report on a 70-year-old male patient admitted to the internal medicine department for evaluation of a right cervical mass. He had been treated with antibiotics as an outpatient by his primary care doctor. Upon admission the patient was asymptomatic, but within a few hours his cervical mass enlarged; this enlargement was confined to the right sternocleidomastoid muscle. Complete blood investigations including serology and autoimmunity were negative. The neck scan and MRI were in favour of myositis. No other lesions were found either in the nasal fibre-optic exam or in the thoracic-abdominal-pelvic scan. The biopsy of the muscle showed a lymphoplasmacytic inflammatory infiltrate of the perimysium. The diagnosis of focal myositis was made. The patient clinically improved during hospitalisation with complete resolution of symptoms without any specific intervention

Haemophagocytic lymphohistiocytosis triggered by cytomegalovirus reactivation in an immunosuppressed patient with pauci-immune glomerulonephritis

We report on a 67-year-old male patient admitted to the Internal Medicine department for fever, joint pain and exertional dyspnoea. Two months before his admission, the patient had been diagnosed with pauci-immune necrotising glomerulonephritis, for which he had been treated with rituximab and corticosteroids. Upon admission the patient was stable, but within a few hours he became unstable as liver failure and acute cytopaenia occurred. Blood investigations revealed cytopaenia, altered coagulation tests, high ferritin, triglycerides, lactate dehydrogenase and C-reactive protein levels, and severe cytocholestasis. A liver echography was normal. The patient had been transferred to the intensive care unit to receive supportive support when the cytomegalovirus polymerase chain reaction (CMV-PCR) test came back positive. The diagnosis of haemophagocytic lymphohistiocytosis associated with a CMV infection and/or reactivation in an immunosuppressed patient was made. Specific treatment was administrated, along with symptomatic treatment. The patient clinically improved during hospitalisation with complete resolution of symptoms

Polymyalgia rheumatica during the course of limited cutaneous scleroderma: an unusual and challenging coexistence

A 50-year-old patient with a history of limited cutaneous scleroderma began with polyarthralgia (left shoulder, elbows and hips) without stiffness or associated inflammatory syndrome. Treatment with oral anti-inflammatory drugs was started on suspicion of peripheral spondyloarthritis with partial response. This progressed with the appearance of stiffness and functional limitation of the hips as well as an increase in the inflammatory syndrome two weeks after onset. It was decided to perform an 18F-FDG-PET scan compatible with polymyalgia rheumatica. The patient was treated with oral corticosteroids with an excellent response after one week of treatment

Symptomatic postoperative compressive pneumocephalus after cholecystectomy

A 75-year-old woman with a history of chronic hydrocephalus due to stenosis of the aqueduct of Sylvius was examined at the emergency department for altered mental status. There was placement of a ventriculoperitoneal shunt in 1970 complicated by meningitis, leading to removal of the material and ventriculociternostomy as definitive treatment in 2004. About one month previously, she had undergone a laparoscopic cholecystectomy complicated by an intra-abdominal collection. Clinical examination at the emergency department revealed a Glasgow score of 8 (E3 V1 M4). In the emergency department the patient presented a tonic-clonic seizure before a cerebral CT scan was performed showing a massive compressive pneumocephalus, then a second seizure. The patient was finally admitted to the neurosurgery department and underwent surgery

Prevalence of submicroscopic malaria parasitemia among migrant pregnant women: A prospective cohort study

Objectives: This study aimed to determine the prevalence of submicroscopic malaria parasitemia (SMP) in a cohort of pregnant women (PW) with recent migration history. Methods: PW with a recent migration history from a malaria-endemic area and attending a prenatal outpatient clinic were prospectively included. Plasmodium falciparum detection was performed using complementary techniques (rapid diagnostic test, thick drop and loop-mediated isothermal amplification) on both maternal (prenatal and postnatal) and cord blood samples. Pathological examination of the placenta was performed. Results: Maternal and umbilical blood samples were collected from 96 PW and their 106 neonates. SMP was present in 5.2% (95% CI, 0.76–9.65) of patients. PW with SMP had left their endemic area more recently (p <0.05), had higher reticulocyte counts in both maternal prenatal (p <0.02) and cord blood (p <0.02) and had higher lactate dehydrogenase levels in cord blood (p <0.05). No impact of SMP on birth weight and term of birth was detected. No placental malaria was identified. Conclusions: In a selected population of PW with recent migration history, SMP prevalence is non-negligible and associated with maternal and cord blood laboratory abnormalities. More data are required to assess the consequences of SMP on maternal and birth outcomes

Malignant hypercalcemia revealing a diffuse large B‐cell lymphoma in a patient with a previous diagnosis of chronic myelomonocytic leukemia: An uncommon hematological coexistence

Key Clinical Message A 76‐year‐old patient previously admitted to the cardiology department for replacement of a right ventricular lead on a double‐chamber pacemaker was admitted to the internal medicine department 15 days after for bronchopneumopathy. His past medical history was relevant for Type 2 diabetes mellitus, heart failure due to dilated hypokinetic heart disease, transcatheter aortic valve implantation (TAVI), and chronic myelomonocytic leukemia (CMML‐0) diagnosed in 2021. Twenty‐four hours after admission, the patient's general condition deteriorated abruptly, with the onset of drowsiness and psychomotor retardation. Laboratory exams revealed hypercalcemia at 4.18 mmol/L. Intensive hydration, calcitonin, and zoledronic acid were initiated and the patient was transferred to the nephrology intensive care unit where he underwent two sessions of hemodialysis to normalize serum calcium levels before readmission to internal medicine. Laboratory exams revealed low parathyroid hormone, normal 1‐25‐OH vitamin D, and increased parathyroid hormone‐related peptide. Thoracoabdominal and positron emission tomography (PET) scan showed diffuse abdominopelvic peritoneal carcinosis associated with low‐grade pleural effusion and multiple supra‐ and sub‐diaphragmatic adenopathies, leading to a search for a solid tumor. The patient's clinical condition worsened leading to a transfer to the intensive care unit. The biopsy of a peritoneal carcinosis nodule confirmed the diagnosis of diffuse large B‐cell lymphoma. Specific treatments were unsuccessful and the patient expired