A pregnant woman with antiphospholipid syndrome presented with repeated venous thromboembolism (VTE) in the first and second trimesters of pregnancy despite receiving combination therapy with low-molecular-weight heparin and aspirin. The addition of hydroxychloroquine prevented further VTE recurrence, thus demonstrating its potential antithrombotic effects.
Antiphospholipid Syndrome ; Pregnant Women

A 71-year-old lady with rheumatoid arthritis developed painful peripheral vasculitic neuropathy of the lower limbs and was treated with high dose steroid and cyclophosphamide. Eight months later, she presented with left hip and back pain for a week, with minimal relief from regular analgesia. Although the initial pelvic radiograph was normal, a repeat film performed two weeks later showed a destructive lytic lesion in the left pubic bone, confirmed as osteomyelitis with intramuscular collection by MRI. Cloxacillin was started empirically, and when the blood culture isolated methicillin-sensitive Staphylococcus aureus (MSSA), it was planned to be given for six weeks via a peripherally inserted central catheter. Despite an initial response, she became febrile on the fifth week of antibiotic therapy. Subsequent blood culture isolated Trichosporon asahii. Her condition deteriorated, and she succumbed on the fourth day of antifungal therapy. In conclusion, the diagnosis of osteomyelitis pubis, a rare complication of MSSA bacteremia, could be delayed in an atypical presentation.
Bacteremia ; Osteomyelitis ;

Kimura disease is a rare benign chronic inflammatory disorder of the soft tissue with predominant occurrences in young Asian male adults. However, there is limited information of Kimura disease in Southeast Asia. Hence, the clinical characteristics and outcomes of Kimura disease in Malaysia was investigated. Published Kimura disease cases from Malaysia were comprehensively searched in PubMed and Google Scholar up to December 2020 using the keywords “Kimura Disease” and “Malaysia”. Twenty-three papers were identified for review and case series of seven Kimura disease patients from a hospital in Malaysia were descriptively analyzed. A total of 60 cases were obtained from both sources. Eighty-seven percent were men with a male:female ratio of 6.5:1 and majority of the cases were Malays (77.1%). Median age of onset was 22.0 (IQR 12.5-31.5) years, while the median duration before diagnosis of Kimura disease was 2.0 (IQR 0.8-5.0) years. Head and neck region (95%) were the most frequently involved anatomical site. Peripheral eosinophilia was detected in 88.9% of the cases at presentation and renal involvement was observed in four (22.2%) patients. Surgery (57.5%) was the commonest first choice of treatment, followed by a combination of surgery and steroid (29.8%), steroid alone (10.6%), and a combination of steroid and immunosuppressive agent (2.1%). Local recurrences were observed in 28.6% of the cases. In conclusion, a much younger age of disease onset was found among Malaysians. A high recurrence rate of one in every four patients was observed, indicating the need for further evaluations of treatment strategies.
Kimura Disease