Obesity is an epidemic and a major public health concern, with 800 million obese people worldwide and 27 million in the Philippines. Several guidelines have recommended that all adults be screened for obesity and that obese patients be offered intensive, multi-component behavioral interventions. Barriers to addressing obesity include insufficient time during visits, a lack of available referral services, the perception that patients will not be willing or able to make lifestyle changes, poor reimbursement for nutrition and weight-management counseling, a reluctance to discuss weight among physicians, and uncertainty about whether interventions will have a positive impact. Lifestyle medicine interventions and smartphone diet-tracking apps may help individuals lose weight, manage chronic conditions, and understand dietary patterns. This is a case report of a 31-year-old obese Filipino male who sought consultation at the Health and Lifestyle Institute with a complaint of 11 kg of weight gain over the past 4 years. He had previously been diagnosed with Hodgkin’s lymphoma and had previously undergone chemotherapy and radiation therapy. He was currently working as a resident physician at a private institution. He considered himself physically active and was thus concerned with his gradual weight gain and the resultant decrease in body image, as well as his overall health. A detailed history and physical examination were done, as were the examinations of the six pillars of lifestyle medicine, namely, diet, exercise, sleep, stress, relationships, and substance use. The GAD 7 and PHQ 9 screening questionnaires were given. Lifestyle prescription and setting of goals were then done, and the patient was followed up at a 4-month interval. On all visits, body fat analysis using a Karada scan was done, and the results were discussed with the patient. On the second follow-up consult, the patient reported the usefulness of a diet-tracking application he found called Lifesum. The patient lost a total of 13 kg and improved his overall sense of well-being.
Obesity ; case report ; Asian ; male

Anaplastic large cell lymphoma (ALCL) is a rare subtype of T-cell non-Hodgkin lymphoma (NHL) primarily involving the lymph nodes; however, extra-nodal manifestations are also common. Diagnosis can be confirmed by a combination of histopathology and immunohistochemical staining. Complete workup and staging include imaging and bone marrow examination. This presents a case of a 55-year-old male with anaplastic lymphoma kinase (ALK) - negative ALCL presenting with an alar mass. ALCL patients often present with rapidly progressing lymphadenopathy. Extra-nodal manifestations commonly involve the skin, liver, lung, and gastrointestinal tract. Biopsy of the mass showed small to medium-sized anaplastic lymphoid cells that stained positive for CD30, LCA (CD45), CD99, and negative for CD20, ALK (CD246), neuron-specific enolase, CD34, CD5, PAX5, TdT, MPO, CD138, EMA, pancytokeratin, CD3 and synaptophysin. These findings were most compatible with an ALK-negative ALCL. The patient was started on a combination of brentuximab vedotin, cyclophosphamide, doxorubicin, and prednisone (BV + CHP) every 21 days for 6 cycles. There was a progressive decrease in the size of the mass, and a resolution was noted after the 5th cycle. FDG-PET/CT scan was done after the 6th cycle of chemotherapy and 6 months after completion of treatment. Both scans showed no evidence of metabolically active nodal or extra-nodal lymphomatous disease. This case showed a unique extra-nodal manifestation of an ALK-negative ALCL presenting as an alar mass with a good response to BV + CHP. However, more evidence is necessary to further establish the role of BV as the first-line treatment regimen for CD30-positive peripheral T-cell lymphoma (PTCL), including ALK-negative ALCL.
lymphoma ; anaplastic large cell lymphoma ; brentuximab vedotin ; case report

Introduction: Gitelman Syndrome (GS), a rare autosomal recessive inherited disorder, is frequently unrecognized in the clinical setting. GS typically manifests with severe hypokalemia with debilitating and potentially fatal consequences if untreated. As of writing, confirmatory genetic assays are currently unavailable in the country, and the diagnosis of GS is primarily based on several biochemical laboratory tests. This results in the difficulty with prompt diagnosis of GS in the locality. Case: We present a 52-year-old male who came in with chronic, intermittent paraparesis associated with persistent hypokalemia. A diagnosis of GS was made biochemically based on renal wasting of potassium and magnesium, hypocalciuria, and metabolic alkalosis. Electrolyte correction with lifelong supplementation, and administration of Spironolactone resulted in the resolution of bilateral leg weakness. Electrolyte levels were maintained within normal limits in the outpatient setting. Conclusion GS is an uncommon potentially debilitating disorder that may lead to problematic, potentially fatal consequences to electrolyte abnormalities if left untreated. The lack of awareness and consequent delay in the diagnosis, and the unavailability of confirmatory genetic testing remains a clinical challenge. Timely recognition and initiation of treatment leads to early control of electrolyte levels, and better prognosis.
Gitelman&rsquo ; s Syndrome ; Paraparesis ; Hypokalemia ; Hypomagnesemia ; Spironolactone ; Case Report

INTRODUCTION: Actinomycetoma is a neglected infectious disease that presents with a triad of subcutaneous mass, with sinus formation and seropurulent discharge containing grains. This causes severe functional disability to patients if not treated early and properly. CASE REPORT: We report a case of a 62-year-old adult Filipino farmer diagnosed with actinomycetoma of the left foot. For 8 years, the patient medicated with several antibiotic therapies affording minimal improvement of symptoms. Hence, surgical intervention with combination antimicrobial therapy was done which provided resolution of symptoms, improving the quality of life of the patient. CONCLUSION Treatment of actinomycetoma must be individualized among patients. Although oral antibiotics became the standard of treatment, combining surgical treatment with oral medications may be considered to ensure effective management of the disease.
actinomycetoma ; cotrimoxazole ; dapsone ; surgery ; case report

COVID-19-associated vasculitis is a term used to describe a genuine vasculitis associated with SARS- COV-2 infection when all other possible causes of vasculitis have been ruled-out. We report a case of a 66- year-old-male, reinfected by COVID-19 after 5 months, who presented with a 2-week history of multiple petechiae on bilateral anterior legs that gradually evolved into targetoid purpura with central blisters, spreading to the proximal medial thighs and the trunk, associated with pruritus and a warm sensation over the affected areas. The patient also presented with marked periorbital swelling, abdominal and joint pains, and decreased kidney function. Histopathology of the skin biopsy showed leukocytoclastic vasculitis while direct immunofluorescence study came out positive result for fibrinogen but negative for IgA, IgG, IgM and C3. Skin lesions resolved and kidney function improved prior to discharge after treatment with IV antibiotics (azithromycin 500 mg and ceftazidime 1 g) and IV steroids (hydrocortisone 50 mg). Recurrence of the vasculitic skin lesions occurred 2 weeks after being tagged as COVID-recovered but improved after 14 days of treatment with oral prednisone. We highlight the importance of recognizing cutaneous vasculitis as a possible marker of a severe COVID-19 disease which could be in the form of single-organ damage particularly acute kidney injury.
case report

Background: Human Immunodeficiency Virus (HIV) infection can be complicated by pulmonary arterial hypertension (PAH-HIV) wherein it can occur in approximately 0.5% of HIV patients. The benefit of ART in treating PAH-HIV is unclear in this population. Data on its safety, efficacy, and effect on the progression of PAH are conflicting and limited. In this case report, improvement in PAH was noted after ART was started.

Case: A 43-year-old, male, patient with no comorbidities, consulted due to a five-month history of progressive dyspnea, body malaise as well as weight loss. The patient is heterosexual with multiple sexual partners, an injection drug user, and was previously worked up for HIV, Hepatitis B, and C with unremarkable results. Initially managed as a case of Pneumonia but on CT scan was found to have a suprahilar mass which showed chronic granulomatous features. The positive GeneXpert confirms Pulmonary Tuberculosis (PTB). However, dyspnea was noted to progress thus 2D echocardiography was done which revealed severe pulmonary arterial hypertension with normal left ventricular function. Rescreening for HIV turned out positive thus started on anti-retroviral therapy (ART) with a noted improvement of symptoms as well as improvement and eventual normalization in pulmonary artery pressure. One year after initial diagnosis, undetectable viral load for HIV and Hepatitis C were noted along with improvement in CD4 count.

Conclusion: This is a rare case of severe pulmonary hypertension as an initial presentation for HIV infection. The approach to patients with incidental PAH may include work-up for HIV especially when risk factors are present. ART treatment may provide a favorable therapeutic option if initiated early.

Subependymal giant cell astrocytoma is a rare tumor that occurs in the walls of the lateral ventricles, foramen of Monro, and less frequently, in the third ventricle. It is one of the intracranial lesions found in tuberous sclerosis complex (TSC) ─ a rare multisystem genetic disease. We present a rare case of an adult Filipino with cutaneous signs of TSC, who initially presented with signs of increased intracranial pressure. The patient underwent right frontal craniotomy, endoport-assisted excision of the tumor with insertion of a ventriculoperitoneal (VP) shunt. Histopathology was consistent with a subependymal giant-cell astrocytoma WHO grade 1. The general status of the patient improved thereafter – there was the relief of headache and improvement in vision and gross hearing. Subependymal giant cell astrocytoma is a rare tumor of the central nervous system especially in adults, whose diagnosis is based on clinical, radiological, and histological, and immunohistochemical stains. It should be included in the differential diagnosis of a mass near the foramen of Monro. Given the hereditary nature of the disease, genetic counseling is essential when encountering patients with this condition.
Astrocytoma ; Tuberous Sclerosis ; Adult ; Case report

Carcinosarcoma of the bladder is a rare malignancy characterized by an intimate admixture of malignant epithelial elements (carcinoma) and malignant soft tissue elements (sarcoma). Patients with carcinosarcoma usually present with high-stage malignancy. Cystectomy or transurethral resection of the bladder tumor (TUR-Bt) is the preferred treatment, often followed by radiation therapy, but the prognosis is very poor1-7). To our knowledge, almost 80 cases have been reported in Japan, usually as case reports or small series6, 7). In almost all cases, the chief complaint was gross hematuria. We herein report a case of carcinosarcoma of the urinary bladder in a patient whose chief complaint was abdominal pain. His pain worsened, and the occurrence of hydronephrosis indicated that extremely rapid tumor growth may have occurred. No evidence of recurrence was noted 30 months after the performance of cystectomy.
Carcinosarcoma ; Bladder ; Malignant Neoplasms ; Rapid ; Case Report

A metastatic focus of small circumscribed carcinoma in an endometrial polyp is extremely rare. Most of these reported cases have a primary carcinoma of the breast. We report a circumscribed metastatic squamous cell carcinoma in an endometrial polyp. This, to the best of our knowledge, is the first case report of metastasis of cervical carcinoma to a benign endometrial polyp.
Polyps ; Neoplasm Metastasis ; Cervical Cancer ; Case Report ; Metastatic to

Neuroendocrine carcinomas of the breast are uncommon tumors known to occur in the elderly. While focal neuroendocrine differentiation may be noted in many ductal and lobular carcinomas, the term neuroendocrine carcinoma is to be applied when more than 50% of the tumor shows such differentiation. This case report details the cytological features of a neuroendocrine carcinoma that was encountered in our hospital. The fine needle aspiration (FNA) smears showed discohesive polygonal cells with abundant cytoplasm, many of which contained eosinophilic granules located at one pole. Histology of the mastectomy and axillary lymph nodes specimen from this patient showed features of neuroendocrine carcinoma--solid type, with metastasis, confirmed with immunohistochemistry. The patient is disease free seven months after surgery. This case highlights the need to closely observe cytological details to identify this rare tumor that may otherwise appear to be invasive duct carcinoma--not otherwise specified on FNA. The implications of diagnosing neuroendocrine differentiation for prognosis and management are also discussed.
Carcinoma, Neuroendocrine ; Fine needle biopsy, NOS ; differentiation ; Case Report ; Breast