1.A case series of dermatological emergencies – Erythroderma
The Medical Journal of Malaysia 2017;72(2):141-143
Erythroderma can be life-threatening, primarily because of
its metabolic burden and complications. It is mandatory to
establish its etiopathology in order to facilitate precise and
definitive management. This disorder may be the
morphologic presentation of a variety of cutaneous and
systemic diseases. Detailed history and thorough work-up is
therefore essential. Management of erythroderma involves
multi-disciplines with progress monitoring especially on
signs and symptoms suggestive of acute skin failure
induced complications. Early diagnosis and referral of
erythroderma to centres with dermatological services is
crucial and will directly affect the outcome of the patients.
Dermatitis, Exfoliative
2.Fatal Leptospirosis and Escherichia coli co-infection in a post-partum woman
The Medical Journal of Malaysia 2018;73(6):427-429
The occurrence of Leptospirosis and Escherichia coli coinfection
in the post-partum period is a novel case. This
report illustrated a previously well woman from a suburban
area presented with acute neurological deterioration
following a two days history of fever during her puerperal
period. Early interventions with fluids, broad spectrum
antibiotics and intensive supportive care were given.
Despite that, she deteriorated rapidly and developed
pulmonary hemorrhage, disseminated intravascular
coagulopathy, and multi-organ failure. She succumbed
within 12 hours of admission. The knowledge about such
fatal co-infections should be disseminated to medical
practitioners encountering Leptospirosis infection and
general public.
3.Pericardial abscess: The corollary of disseminated Methicillin-resistant Staphylococcus aureus following diabetic foot ulcer infection
Thai Lun Tan ; Soon Hooi Lim ; Mohd Ruslan Mustapa ; Ganeswary Ramaloo
The Medical Journal of Malaysia 2020;75(6):742-744
Methicillin-resistant Staphylococcus aureus (MRSA)
purulent pericarditis, characterised by frank pus collection
or microscopic pyogenic effusion in the pericardium
represents the most serious form of pericardial infection.
The route of MRSA acquisition in pericardial abscess
commonly occurs via the blood stream infection and it is
more commonly observed among immunocompromised
individuals. To date, diabetic foot ulcer infection rarely
disseminates and becomes a nidus for pericardial infection.
Herein, we report an unusual case of MRSA pericardial
abscess in a 44-year-old man who presented at Hospital Seri
Manjung, Malaysia with cardiac tamponade. Past medical
history indicated that he was recently treated for infected
diabetic foot ulcer with MRSA bacteraemia one week earlier.
Despite adequate pericardial drainage and extended
parenteral vancomycin therapy, this case ended in fatality on
day 42 of admission due to nosocomial infection. It is hoped
that this report serves to increase the vigilance among
clinicians that diabetic foot ulcer infections have the
potential to progress to pericardial abscess in the presence
of MRSA bacteraemia, although they may appear seemingly
innocuous at presentation. Systemic vancomycin must be
instituted promptly when MRSA bacteraemia is confirmed in
order to circumvent the propagation of MRSA.
4.Silent microaspirations: The forerunner to the diagnosis of bulbar onset myasthenia gravis in a young woman
Thai Lun Tan ; Hui Jieh Tan ; Chun Fai Cheah ; Kumaresh Raj ; Azzahra Nurul Azman
The Medical Journal of Malaysia 2020;75(3):295-297
Recurrent pneumonia warrants a diligent work-up to identify
the underlying cause that perpetuates the disease process.
Insidious bulbar dysfunction is arguably the most
devastating as it would be diagnosed late after significant
pulmonary complications due to chronic micro-aspiration.
Bulbar disorder should be considered as the potential
aetiology of recurrent pulmonary infections in the young
population after excluding immunodeficiency disorder and
respiratory anatomical anomaly. This report illustrates a rare
case of bulbar onset myasthenia gravis which manifested as
focal bronchiolectasis due to recurrent undiagnosed
aspiration pneumonia three years earlier. Absence of
hallmark features of Myasthenia Gravis (MG) such as ptosis,
opthalmoplegia and proximal muscle weakness contributed
to the diagnostic delay and challenges in this case. The
diagnosis was established with the collaboration of
multidisciplinary teams. Subsequent correct therapeutic
interventions resulted in remarkable recovery in functional
status and prevented her from further aspiration in the long
run.
5.Pre-existing chronic medical illnesses and follow up status among active pulmonary tuberculosis cases in a district population
Thai Lun Tan ; Li Yuan Lee ; Kig Tsuew Yong ; Muhammad Afiq Bin Rohimi ; Shoen Chuen Chiew ; Sing Hoon Cheng ; Hafizah Binti Mohamed Haniba ; Min Tat Ding
The Medical Journal of Malaysia 2020;75(3):204-208
Introduction: The knowledge of pre-existing medical
illnesses and their follow up status among active pulmonary
tuberculosis (PTB) subjects can help in tuberculosis (TB)
control programme. The aims of our study were to examine:
the prevalence of pre-existing chronic medical illnesses, the
follow up status of known pre-existing co-morbid and to
distinguish between diagnosed and undiagnosed preexisting tuberculosis related chronic medical illnesses
among our active PTB subjects.
Methods: We conducted a retrospective review of
demographic and clinical data of active PTB subjects that
were diagnosed between January 2015 and June 2017 in the
district of Manjung, Perak, Malaysia. Among the 302 TB
clinical notes reviewed, 253 patients were included. Subjects
below the age of 18 years and whose follow up centres for
their medical illnesses that were located outside of Manjung
were excluded. Demographic and clinical data were
collected using pre-tested data collection form by trained
investigators. The data was analysed using SPSS Version
20.0.
Results: We identified diabetes mellitus as the most
prevalent pre-existing co-morbid (77 cases) and almost 90%
(68 cases) of these diabetic subjects were diagnosed prior to
active PTB diagnosis. This was followed by Human
Immunodeficiency Virus and Hepatitis C infection which
accounted for 12.0% (30 cases) of the study populations.
Among 132 subjects who had pre-existing chronic medical
illnesses, only 74 subjects (29%) were under regular follow
up at healthcare facilities in Manjung prior to PTB diagnosis.
Conclusion: Overall, our research provides evidence on the
existence of wide variation of clinical background among
active PTB subjects.