ABSTRACT Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant vascular disorder that may involve the oral mucosa, providing important diagnostic clues for dental practitioners. This report describes a 54‐year‐old female presenting with recurrent bleeding from multiple red‐purple telangiectatic papules on the dorsal surface of the tongue. Her history included recurrent epistaxis, severe iron deficiency anemia, pulmonary involvement, and a positive family history. The lesions blanched on diascopy. Symptomatic management using electrocautery excision under local anesthesia with prophylactic administration of oral amoxicillin (2 g) was performed. Histopathological examination demonstrated thin‐walled vascular spaces containing erythrocytes beneath the epithelium, confirming the diagnosis of HHT. Although postoperative healing was uneventful with immediate bleeding control, recurrence occurred after 1 year, necessitating repeat surgery. This case highlights the progressive and recurrent nature of oral HHT lesions, the importance of early detection, and the need for careful dental management, including antibiotic prophylaxis before invasive procedures associated with a risk of bacteremia in patients with pulmonary involvement.
ABSTRACT Immersive virtual reality (VR) exposure can produce a range of neurological symptoms, but its possible relationship with prolonged migraine‐related symptoms remains poorly characterized. We report a 32‐year‐old male who developed acute disorientation, vertigo, cognitive clouding, derealization, and sensory disturbances immediately following a 30‐min immersive VR session. Symptoms partially improved but recurred with sensory overstimulation the following day. Despite unremarkable neuro‐otological examinations, the patient experienced a markedly atypical, two‐week period of persistent neurological symptoms featuring hypersomnia, cognitive fatigue, and sensory hypersensitivity. The presentation was considered a migraine with brainstem aura–like presentation, although it did not fulfill ICHD‐3 criteria for definite migraine with brainstem aura. Symptoms gradually resolved completely by approximately 2 weeks, with no recurrence reported at the 3‐ and 6‐month follow‐ups. This case describes a temporal association between immersive VR exposure and a prolonged migraine‐like neurological presentation, highlighting the need for clinical awareness of symptoms occurring after immersive digital exposure.
ABSTRACT Emergency anesthesia requests may underestimate evolving cardiovascular pathology. When bedside findings are discordant with the initial working diagnosis, anesthesiologists should defer induction, reassess independently, and escalate multidisciplinary care before initiating general anesthesia.
ABSTRACT Cervical interspinous bursitis is an important cause of cervical spine pain, with the diagnosis relying on both clinical findings and higher order imaging in the form of MRI. We present a rare case of exercise‐associated cervical interspinous bursitis in a pediatric patient.
ABSTRACT Mixed connective tissue disease is a multisystem autoimmune condition characterized by overlapping clinical and serological features related to anti‐U1‐RNP antibodies of at least two connective tissue diseases. It may present with myocarditis, pericarditis, pulmonary arterial hypertension, and, less commonly, heart failure. We present a 21‐year‐old female with bilateral foot swelling, cough, and shortness of breath 3 months after a vaginal delivery. On examination, she was hypotensive (90/70 mmHg), with an elevated jugular venous pressure, a pulmonary systolic murmur with loud P2, and a tricuspid regurgitation murmur. Bronchial breath sounds and fine crepitations were present in both lower lung fields. She was evaluated initially for suspected postpartum cardiomyopathy. Transthoracic echocardiography was suggestive of a probable moderate to severe PAH. High‐resolution computed tomography showed bilateral moderate pleural effusions, honeycombing with partial atelectasis of the underlying lung, and cardiomegaly. Computed Tomography Pulmonary Angiography (CTPA) showed findings likely consistent with probable mild pulmonary hypertension. An antinuclear antibody panel was performed and was positive for anti‐U1‐RNP, SS‐A, SS‐B, and Jo‐1 antibodies. She was started on Lasix 40 mg, Aldactone 25 mg, lisinopril 10 mg, and heparin. Treatment with 20 mg of prednisolone was started and gradually tapered. Her anasarca and dyspnea improved, and she was discharged with follow‐up arranged with cardiology and rheumatology. Timely identification of MCTD‐associated pulmonary hypertension and its cardiovascular complications is essential and allows early commencement of treatment, which further prevents the patients from developing heart failure.
