1.A case of atrial septal defect presenting with recurrent syncope
Malaysian Family Physician 2021;16(2):90-93
Atrial septal defect (ASD) is a congenital heart disease often encountered in the adult population,
as it is frequently asymptomatic in childhood. In untreated patients with ASD, some may go on
to develop complications such as atrial arrythmias, pulmonary hypertension and Eisenmenger
syndrome. Pulmonary hypertension is seen in 6 – 35% of this group of untreated patients in
adulthood as a result of left-to-right shunting. Symptoms of pulmonary hypertension include
progressive dyspnoea, ascites and syncope. Here, we would like to illustrate a case of ASD
presenting with recurrent syncopal attack.
2.Massive pericardial effusion – An uncommon initial presentation of systemic lupus erythematosus (SLE)
Seng Wee Cheo Wee Cheo ; Qin Jian Low
The Medical Journal of Malaysia 2019;74(5):439-440
Systemic lupus erythematosus (SLE) is a common
autoimmune disease that we see in our daily clinical
practice. It can involve almost every organs in the body.
Cardiac manifestations of SLE include pericarditis,
myocarditis, heart block, coronary artery disease and
others. Here, we report a case of SLE with an uncommon
presentation of massive pericardial effusion as initial
presentation. Here we also highlight that massive pericardial
effusion can also be associated with other complications of
SLE such as heart failure and lupus nephritis.
4.Mesenchymal chondrosarcoma – A rare cause of pleural effusion
Seng Wee Cheo, ; Alicia Dixie Abraham ; Angeline Madatang ; Qin Jian Low
The Medical Journal of Malaysia 2020;75(4):458-460
Mesenchymal chondrosarcoma is a malignant neoplasm arising
from cartilaginous bone or soft tissue. It is uncommon yet
devastating. Our patient was a 21-year-old man who presented
with pleuritic chest pain and weight loss. His chest radiograph
showed left pleural effusion. His pleural effusion analysis was
consistent with exudative pleural effusion. Tuberculosis
workup was negative. Pleural fluid cytology did not yield
malignant cells. Subsequently, his computed tomography of
thorax showed left rib sclerotic lesion with soft tissue
component. Biopsy of the soft tissue eventually confirmed the
diagnosis of mesenchymal chondrosarcoma. He succumbed to
his illness before the diagnosis was confirmed. We hope that
through this case report, we are able to provide some insight
into this rare condition.
5.A case of severe Plasmodium knowlesi malaria in a post-splenectomy patient
Seng Wee Cheo ; Tee Tat Khoo ; Yee Ann Tan ; Whei Chuern Yeoh ; Qin Jian Low
The Medical Journal of Malaysia 2020;75(4):447-449
Malaria is a parasitic disease that is caused by the Plasmodium
parasite. Worldwide, it remains a significant public health
problem especially in the Africa region where it contributes to
more than 90% of cases and malaria death. However, zoonotic
(simian) Plasmodium knowlesi parasite is a widely prevalent
cause of malaria in the South East Asian countries. It is known
to cause severe human disease due to its 24hour erythrocytic
cycles. Thus far, cases of severe falciparum malaria have been
reported in asplenic patients. Here, we report a case of severe
P.knowlesi malaria in a 51-year-old man who is a postsplenectomy patient.
6.Endometriosis - A rare cause of primary spontaneous pneumothorax
Qin Jian Low ; Seng Wee Cheo ; Wen Hao Wong ; Kee San Goh
The Medical Journal of Malaysia 2019;74(5):445-446
Catamenial pneumothorax is a rare condition. We report a
case of a 36-year-old female who presented with dyspnoea
every time before she had her regular menses. Further
investigation confirmed that she had catamenial
pneumothorax. With this case we wish to highlight this rare
diagnostic entity that every clinician should keep in mind.
7.A young lady with dysphagia
Cheo Seng Wee ; Mak Woh Wei ; Low Qin Jian
Malaysian Family Physician 2021;16(2):98-101
Chest radiograph is one of the most commonly employed imaging modalities in primary care. It
may be done for symptomatic patients or routine health screening. Hence, it is important for a
primary care physician to be able to interpret chest radiograph systematically in relation to patient’s
clinical history. Here, we would like to illustrate a case of abnormal chest radiograph detected
during health screening.
8.Erythematous plaques of the vulvo-perineal region
Low Qin Jian ; Lim Tzyy Hue ; Hon Shu Ann ; Cheo Seng Wee ; Noranizah Binti Wagino
Malaysian Family Physician 2021;16(3):101-103
Skin conditions are a common reason for consulting primary health care. The public frequently expects their primary health care providers to be able to recognise and treat common skin conditions with confidence. Primary care providers must be able to identify ‘red flag’ skin conditions that require dermatology referral. However, diagnosis is often delayed due to the non-specific clinical presentation, low incidence, slow evolution and long-term history of such lesions. We report the case of a patient with extramammary Paget’s disease that presented to her primary care provider and subsequently underwent a wide local excision.
9.Fatal subarachnoid haemorrhage in a patient with severe dengue
Seng Wee Cheo ; Qin Jian Low ; Eng Kian Ng ; Yuen Kang Chia ; Giri Shan Rajahram
The Medical Journal of Malaysia 2021;76(1):107-109
Dengue fever is one of the commonest tropical disease in
the tropics. It can present with mild acute febrile illness to
severe organ failure. Reported neurological complications
of dengue include dengue encephalopathy, encephalitis,
transverse myelitis and intracranial haemorrhage.
Intracranial haemorrhage in dengue can present as subdural
haematoma, extradural haematoma, intracerebral
haemorrhage and subarachnoid haemorrhage. We report
here a case of subarachnoid haemorrhage in a patient with
severe dengue. Our patient was a 30-year-old man who
presented with acute febrile illness. He subsequently
developed plasma leakage and upper gastrointestinal
bleeding. He then had reduced conscious level. Computed
tomography of his brain showed subarachnoid
haemorrhage. He eventually succumbed to his illness.
10.Primary splenic hodgkin lymphoma masquerading as splenic abscess
Tee Tat Khoo ; Seng Wee Cheo ; Qin Jian Low ; Yee Ann Tan ; Lily Lee Lee Wong
The Medical Journal of Malaysia 2021;76(1):118-120
Hodgkin lymphoma is a form of malignant lymphoid
neoplasm. It can have various clinical presentations such as
prolonged fever, night sweats, weight loss and
asymptomatic lymphadenopathy. It has a distinct fever
pattern known as Pel Ebstein fever. However, in some
instances, its clinical presentation can mimic some tropical
infections. Here, we present a case of primary splenic
lymphoma masquerading as splenic abscess in a 53-yearold man with underlying dyslipidemia.