Introduction: Non-Hodgkin’s lymphomas (NHLs) are a varied group of malignancy originating in the lymphatic system. As a subset of lymphomas, primary spinal epidural lymphomas are diagnosed when there are no other recognizable sites of lymphomas at the time of diagnosis. It mimics other spinal diseases making the diagnosis difficult to establish as well as in obtaining tissue diagnosis. We present an atypical case of a 45-year-old female who presented initially with back pain then eventual loss of sensory and motor function of the lower extremities, further work up showed primary spinal epidural NHL. Case: This is a case of a 45-year-old female with chief complaint of back pain. Magnetic resonance imaging (MRI) of the thoracic spine showed nonspecific epidural soft tissue mass at T5 to T6 level compressing the spinal cord. Operative procedure was done with histopathology of the epidural lesion consistent of NHL. Immunohistochemical staining showed CD20 (+), thus a diagnosis of diffuse large B cell lymphoma (DLBCL) was made. Patient underwent six cycles of cyclophosphamide, doxorubicin, vincristine, prednisone (CHOP) regimen. Conclusion Signs and symptoms of primary spinal epidural NHL often overlaps its manifestations with other spinal diseases. A high index of clinical suspicion warrants inclusion of such neoplastic condition in determining the exact and definitive diagnosis of cases manifesting spinal compression.
Back Pain

Introduction: Typhoid fever usually presents with prolong fever associated with constitutional symptoms of headache and abdominal pain. Patients living in far flung areas often downplayed this condition with a viral infection causing delay in diagnosis. We present a case of a 30-year-old male diagnosed with typhoid fever who developed upper gastrointesitinal bleeding with intraoperative finding of periappendicitis. Case presentation: This is a case of a 30-year-old male patient presented in the emergency room with abdominal pain and high fever for three weeks. Physical examination showed he was fairly dehydrated with dry lips and tongue and abdominal examination revealed epigastric pain on deep palpation. Initially, his laboratory tests were unrevealing. Over the course of his confinement he was given multiple transfusion due to profused hematochezia and with sudden reduction in hematocrit count thus was referred to surgical service for emergency laparotomy. Intraoperative findings showed bleeding ulcers in the ileum accompanied by histologic findings of periappendicitis which originally thought of as acute suppurative appendicitis. Conclusion It is important to consider in patients with three or more weeks with typhoid fever its complications of intestinal bleeding. However, the finding of periappendicits contributes a rare and not easily diagnosed pathology which is not within the context of an enteric infection.
Typhoid Fever ; Salmonella

Introduction: Cryptococcus neoformans (C. neoformans) is a fungus which infects the lungs, meninges, skin and the nervous system. In tropical countries prevalent with tuberculosis (TB), initial clinical presentations of a C. neoformans infection can normally be mistaken as a TB infection. The C. neoformans infection shall then form part of the differential diagnosis. Exposure to C. neoformans does not usually manifest as an infection however, in immunocompromised patients this results to cryptococcosis. Case: This is a case of a 33-year-old male who was admitted due to febrile seizures. He was suspected to be in an immunocompromised state due to multiple sexual partners. A non-tender, mobile left cervical lymphadenopathy was subjected to FNAB (fine needle aspiration biopsy) surprisingly came out to be cryptococcal in nature. He was managed as a case of disseminated cryptococossis with meningeal extension. He was given amphotericin B and fluconazole. Conclusion The most common suspected cause of lymphadenitis in the Philippines is attributed to TB. The high index of suspicion based on sound medical history and physical examination can lead the clinician into considering an uncommon cause of lymphadenopathy most especially in patients with high likelihood of immunocompromised state.
Cryptococcosis ; Meningitis, Cryptococcal ; HIV