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Item A Rare Case of Paraneoplastic Limbic Encephalitis leading to Epileptic Seizure in a Patient with Ovarian Carcinoma(EMERGENCY MEDICINE PHYSICIANS ASSOC TURKEY, 2022-01-01) Aytar, Murat Hamit; Kilickan, Levent; Ustun, Cemal; Akkilic, Elvan CevizciParaneoplastic limbic encephalitis (PLE), a rare and diagnostically-challenging encephalopathy, is frequently associated with an underlying malign neoplastic tumor. Epileptic symptoms are uncommon but can be the first sign of the disease. We present a patient admitted to our intensive care unit (ICU) unit with epileptic seizure and a Glasgow Coma Scale (GCS) of six. All tests and investigations that had been utilized for this patient's diagnosis, including blood tests, serological analyses, magnetic resonance imaging (MRI), electroencephalogram (EEG) and cerebrospinal fluid (CSF) test results were evaluated. The patient had been diagnosed with ovarian carcinoma within the last year. The patient's cancer history, her most recent complaints and MRI results were strongly suspicious for paraneoplastic limbic encephalitis. Her neurological condition improved rapidly in a few days with steroid therapy. This case showed that any neurological deterioration based on an ovarian oncologic disease can bring PLE to mind. The possibility of PLE must be taken into consideration in patients presenting with epileptic seizures after neoplastic diagnoses.Item Acute appendicitis coexisting with acute pyelonephritis causing diagnostic dilemma: a case report(SPRINGER, 2021-01-01) Ozkan, Burak; Ustun, Cemal; Coskuner, Enis RaufBackground Acute appendicitis and acute pyelonephritis are the most common diseases admitted to emergency departments. Both conditions have common symptoms such as flank pain, abdominal pain, and fever. Patients' history, physical examination, laboratory evaluation, and imaging methods are used to differentiate these two conditions. Diverticulitis, colitis, gynecological pathologies, and ureteral stones that mimic acute appendicitis should be kept in mind as differential diagnoses. Cases of pyelonephritis mimicking acute appendicitis have been reported in the literature, but there has not been a reported case in which acute appendicitis occurs during management of acute pyelonephritis. In this article, a case report which can cause such a diagnostic dilemma has been presented. Case presentation A 42-year-old female patient presented with clinical features suggestive of acute appendicitis that developed after a diagnosis of acute pyelonephritis. She underwent laparoscopic appendectomy on account of acute appendicitis during medical treatment for acute pyelonephritis. Physical examination showed only right costovertebral tenderness without any rebound tenderness at McBurney's point at the first admission, but during treatment rebound tenderness at McBurney's point was also detected. The Alvarado score of the patient was 5 at the first admission and 7 when acute appendicitis was diagnosed. The patient fully recovered and was discharged after both diseases were completely treated. Conclusions As seen in this case, it should be remembered that both diseases can be seen together which causes a diagnostic dilemma. If clinical or biochemical progression is detected in a patient under treatment, imaging methods should be repeated and additional ones with higher resolutions should be used.Item Importance of Clinical Suspicion in Rapid Diagnostic Test Negativity in Malaria: Two Case Reports(EMERGENCY MEDICINE PHYSICIANS ASSOC TURKEY, 2020-01-01) Gun, Cem; Aldinc, Hasan; Yaylaci, Serpil; Ustun, Cemal; Barbur, ErolIntroduction: Malaria is a life-threatening disease caused by infection with Plasmodium parasites. Rapid diagnostic tests (RDTs) have been used for the diagnosis of malaria without special equipment by unskilled personnel over the last 15 years. The treatment should only be given after the clinical diagnosis confirmed by RDT or microscopy. RDTs' specificity and sensitivity have been reported as >95\% by the World Health Organization - Foundation for Initiative New Diagnostics (WHO-FIND). Case report: A 30-years-old male and a 23-years-old female presented to our emergency department with fever and history of a visit to a malaria-endemic country. Plasmodium trophozoites were seen in the blood smear samples via light microscopy. However, RDTs were negative. The patients were treated according to their pathogens. Conclusion: Rarely, RDT might result in a false negative in the diagnosis of malaria. People travelling to endemic areas should be closely monitored. Emergency department physicians should not neglect microscopy which is the gold standard for diagnosis of malaria.