Auhors: Abdul Kadir Amirul Ashraf, Boay Heong Eyrique Goh, Kok Keat Tee, Joon Hi Tham, Gerrarde Paul Aaron.

ABSTRACT

Actinomycosis is a chronic infection caused by filamentous gram-positive anaerobes, typically presenting in cervicofacial regions. We report a rare case involving the lower limb of an immunocompetent male, initially suspected to have soft tissue sarcoma based on imaging. The diagnosis was confirmed histologically with characteristic sulfur granules and the Splendore-Hoeppli phenomenon. Despite antibiotic therapy, non-compliancy led to disease progression and necessitated a below-knee amputation. This case emphasises the importance of early diagnosis, patient compliance, and a multidisciplinary approach in managing rare infections mimicking malignancies.

Citations: IeJSME 2025 Vol 19 (2): 37-42

Authors: Valliammai Valliyappan, Ashok Veerappan, Nishkkriyaa Gopal.

ABSTRACT

Tuberous sclerosis complex (TSC) is a rare, multisystem genetic condition marked by the development of benign tumours in multiple organs. TSC is the second most common neurocutaneous disorder and is inherited in an autosomal dominant pattern, although the rate of spontaneous mutation is high. Although the condition is often identified in paediatric neurology settings, the first clues can emerge in primary care. This case report describes the presentation, diagnosis, and initial management of a child with TSC in a general practice, highlighting the pivotal role of primary care in recognising early signs and initiating multi-disciplinary care.

Keywords: Genetic disorder, hypopigmented macules, paediatric epilepsy, primary care, seizures, tuberous sclerosis.

Citations: IeJSME 2025 Vol 19 (2): 43-46

Authors: Sivakumar Arunachalam, Indumathi Sivakumar, Jitendra Sharan, Sabarinath Prasad

ABSTRACT

Tooth eruption is a localised event whereby the signals for eruption for a given tooth are synthesised in the dental follicle of that tooth with a possible cross talk of signals coming from the adjacent stellate reticulum. The eruption process requires alveolar bone resorption that is primarily regulated by the dental follicle. This is reflected by the fact that failures of eruption often can be traced to either osteoclast deficiencies or to dental follicle abnormalities. Recent advances in application of molecular techniques to animal models allowed for better understanding of gene regulatory events involved in the physiology of tooth eruption. This article attempts to consolidate and organise the facts that offshoot from animal studies.

Keywords: Tooth Eruption, Dental Follicle, Molecular Biology, Eruption Mechanism

Citations: IeJSME 2025 Vol 19 (1): 54-62

DOI: https://doi.org/10.56026/imu.19.1.54

Authors: Kok Jen Yong, Keat How Teoh

ABSTRACT

Introduction
A neuroendocrine neoplasm (NEN) is a type of heterogenous tumour originating and spreading from neuroendocrine cells and peptidergic neural crest Kulchitsky cells (silver-addicted cells). The occurrence of gallbladder NEN (GB-NEN) is extremely rare and accounting for only 0.5% of all neuroendocrine tumours and 2.1% of all gallbladder tumours.

Case Presentation
A 60-year-old female with chronic cholecystitis and cholelithiasis, presented with septic shock and clinical condition suspicious of perforated viscus. The CT examination and laparotomy findings were suggestive of gallbladder carcinoma. The diagnosis of GB-NEN was later confirmed by histopathological examination and immunohistochemical studies. Following laparotomy, the patient’s condition deteriorated and succumbed to death.

Discussion
The diagnosis of GB-NEN is challenging due to ambiguous clinical manifestation and existing limitations of diagnostic techniques. Immunohistochemical staining is effective in diagnosing GB-NEN and highly specific markers have been identified. Surgery remains the mainstay of treatment for GB-NEN and following adjuvant therapy may prolong survival.

Conclusion
Current literature on GB-NEN is scarce and the standard treatment plan is under exploration. Early detection of GB-NEN improves prognosis and is encouraged for patients with chronic cholecystitis
and cholelithiasis. Individualised treatment plan should be emphasised to maximise patients’ benefits
in clinical practice.

Citations: IeJSME 2025 Vol 19 (1): 63-66

DOI: https://doi.org/10.56026/imu.19.1.63

Authors: Joshua Shadrach Daniel, Kwee Choy Koh, Thin Thin Win

ABSTRACT

Leprosy caused by Mycobacterium leprae, primarily manifests with cutaneous and neurological symptoms. Bone marrow (BM) involvement without skin lesions is exceedingly rare, particularly in immunocompromised patients. Here is a case of a 40-year-old HIV-infected man with a nadir CD4 count of 29 cells/mm³ who presented with recurrent anaemia, massive hepatosplenomegaly, and no apparent skin lesions. BM analysis revealed epithelioid granulomas with foamy histiocytes containing acid-fast bacilli, confirmed by Wade-Fite staining. This case highlights the rare presentation of lepromatous leprosy, emphasising the diagnostic challenges posed by the absence of typical cutaneous features.

Keywords: Leprosy, HIV, Bone marrow involvement

Citations: IeJSME 2025 Vol 19 (1): 67-70

DOI: https://doi.org/10.56026/imu.19.1.67

Author: Sivakumar Arunachalam

ABSTRACT

Separation of vascular lesions into one of the two groups, namely, hemangioma and vascular malformations can be of considerable significance relative to the treatment of patients. They pose serious bleeding risks. A case report is presented here where a patient with a vascular malformation is treated with fixed orthodontic appliances. A coordinated, interdisciplinary approach can result in enhanced patient satisfaction and successful treatment outcomes.

Keywords: Vascular anomaly, Hemangioma, Nevus flammeus.

Citations: IeJSME 2025 Vol 19 (1): 71-74

DOI: https://doi.org/10.56026/imu.19.1.71

Authors: Eyrique Boay Heong Goh, Surendra A/L Sabramaniam, Serene Soo Lin Teo, Muhammad Syamil Ibrahim, Noorriyanti Fazreen Al Shaari.

Citations: IeJSME 2023 17 (1): 19-21

DOI: https://doi.org/10.56026/imu.17.1.19

Authors: S T Kew, Wei Yen Lim

ABSTRACT

A healthy 30-year-old woman underwent health screening, and was incidentally found to have a well-defined echogenic lesion in Segment VI of her liver, measuring 4.2 X 1.8cm in her ultrasound scan. She was asymptomatic, has no cutaneous lesions, nor stigmata of chronic liver disease. She has no hepatomegaly. CT scan of her abdomen found multiple liver haemangiomas, varying in size from 21 X 28mm to sub-centimeter lesions.

Diagnosis of hepatic haemangioma in this patient is based on typical appearance on contrast imaging. Their appearance is important to recognise as they do not need intervention and attempts at instrumentation for diagnosis or surgery may result in more harm than good.

Keywords: Hepatic haemangioma (HH), Benign tumour of the liver, Conventional ultrasonography (US), Computer tomography (CT).

Citations: IeJSME 2022 16 (3): 22-24

DOI: https://doi.org/10.56026/imu.16.3.22

Authors: Zuraida Zainun, Zamzuri Idris, Muhammad Munzir Zuber Ahmad, Nur Syakirah Bt Che Mat Amin.

ABSTRACT

Pineal region tumours are primary central nervous system (CNS) tumours. Pineal region tumours may cause increased pressure inside the skull due to the production of too much CSF or blockage of its normal flow known as hydrocephalus. Imbalance is one of the features in this case. Vestibular Rehabilitation (VRT) is a specific form of physical therapy designed to habituate symptoms and promote adaptation to and substitution for various aspects of deficits related to a wide variety of balance disorders. Bal Ex is a home-based module of VRT with specific modules that are available in three forms; manual book, poster and DVD. This module was developed with a combination of customized Cawthorned Cookseey Exercise and prayer movements. The patient is a 14-year-old boy, disabled (mute and deaf), known case of pineal gland tumour since 2016, then post tumour removal 2 weeks ago. The patient experienced balance problem 8 years ago before he was diagnosed with pineal tumour. He did not complain of any dizziness and vertigo according to his mother. The patient then underwent intensive BAL Ex therapy inward for 3 sessions starting with Level 1, once per day, 40 minutes each session, and without taking any medicine during the treatment. He underwent one-to-one sessions with the trainer and also followed the balance exercise video in every session. After 1 week of balance exercise only in level 1, the patient showed a small difference and 10% improvement.

Keywords: Bal Ex, Postural improvement, Bal Ex Module, imbalance

Citation: IeJSME 2021 15 (3): 57-60

DOI: https://doi.org/10.56026/imu.15.3.57