A 25-year-old previously healthy female patient experienced new-onset psychosis and showed suicidal behavior after contracting COVID-19. Based on the International Statistical Classification of Diseases and Related Health Problems (ICD-10), the diagnosis of an acute and transient psychotic disorder (ATPD) was appropriate. Due to poor insight into illness, the patient received an oral solution containing 2 mg/mL haloperidol and fully recovered after the first month of treatment. This is the first case of a COVID-19-associated psychotic episode showing full recovery with late intervention, which occurred nearly 45 days after exhibiting the first psychotic symptoms. Additionally, the patient would require long-term follow-up owing to an ultra-high risk of relapse.

Introduction: Pediatric gastric adenocarcinoma (GAC) is sporadic with limited relevant data, and gastric adenocarcinoma, which presents as submucosal, has seldom been reported. The clinical presentation and outcome have not yet been thoroughly understood.

Case presentation: Two boys (10 and 14-year-old) were admitted to the hospital with severe malnutrition. Abdominal CT demonstrated the tumor protruding into the stomach, irregular border, and peritoneal metastasis. Gastric biopsies showed pleomorphic cells, variable size, and increased N/C ratio. These cells were arranged into sheet growth patterns, clusters of cells or incomplete tubules with neutrophils infiltrating. The malignant cells showed strong expression of CK, negativity for CD99, NSE, myogenin, CD3, CD20, ALK, and CD30. Both cases were consistent with poorly differentiated gastric adenocarcinomas, diffuse type with lymphovascular invasion.

Discussion and Conclusion: Pediatric GAC presented with a more advanced stage and poor differentiation. However, the clinical presentation is similar to adult GAC. Because of data limitations, the diagnosis and treatment of pediatric GAC remain a significant challenge. GAC should be kept in mind, especially when a submucosal tumor-like lesion appears in the stomach. Additional molecular investigations, including E-cadherin or HER2 testing of the tumor samples, may offer more treatment choices for these patients. 

Pyoderma gangrenosum is a rare inflammatory cutaneous condition characterized by the rapid progression of painful ulcers. Pyoderma gangrenosum is usually associated with a systemic disease. A 34-year-old female with a history of ulcerative colitis presented with hematochezia and multiple leg ulcers after stopping her medication for 3 months. A diagnosis of pyoderma gangrenosum with acute severe ulcerative colitis (ASUC) was made based on the clinical characteristics of the ulcers and their histopathologic features. The patient did not respond to intravenous corticosteroid. Therefore, oral cyclosporine was prescribed. Her bowel movements returned to normal after a week. Her ulcers healed after 2 months, leaving cribriform scars. Pyoderma gangrenosum should be considered in the differential diagnosis of skin ulcers, especially in patients with an underlying systemic disease such as inflammatory bowel disease. Oral cyclosporine may be considered for the management of patients with steroid-refractory pyoderma gangrenosum and ASUC. 

Eosinophilic gastrointestinal disorders are rare inflammatory conditions marked by eosinophilic infiltration of the gastrointestinal tract. Endoscopic manifestations vary from patient to patient. However, ulcerative lesion is a rare occurence. A 57-year-old patient presented with chronic diarrhea and significant peripheral blood eosinophilia. During endoscopy, multiple ulcers were discovered throughout the stomach, duodenum, and colon. Biopsies showed excess tissue eosinophilia suggestive of eosinophilic gastroenteritis and colitis. The patient responded dramatically with corticosteroid. However, he developed steroid dependency necessitating the use of azathioprine. In conclusion, a rare case of eosinophilic gastroenteritis and colitis presented with multiple ulcerative lesions was described. Physicians should be aware that eosinophilic gastroenteritis and colitis may be a cause of chronic diarrhea, particularly, in patients presented with peripheral blood eosinophilia. Corticosteroid is the mainstay of treatment. In steroid dependency case, azathioprine may be an option. 

Introduction: COVID-19 in children has a diverse clinical presentation, most of which is asymptomatic or mildly symptomatic. In addition, after 2-6 weeks of being infected with COVID-19, children may have the multisystem inflammatory syndrome in children (MIS-C), which is rare but serious condition, death has also been reported despite active treatment. We describe a severe clinical case of MIS-C treated at our hospital in the early stage of the 4th wave of COVID-19 in Vietnam.

Case report: A six-year-old boy admitted to Thu Duc City Hospital on August 27th, 2021. He had a history of COVID-19, which was diagnosed by a positive RT-PCR SARS CoV-2 test on July 24th, 2021. He had no symptoms and was concentrated quarantine with his family. He was discharged on August 12th, 2021. Four weeks after SARS-CoV-2 infection, he had symptoms such as sustained fever (5 days), stomachache (6 days), erythema multiform (8 days), eye and lip swelling (7 days), edema of hands and feet (10 days), dyspnea (5 days), hepatomegaly and shock. After then, he was diagnosed with MIS-C and treated with intravenous methylprednisolone 2 mg/kg/day (3 days), then tapered 1 mg/kg/day (5 days), maintained with prednisone 1 mg/kg/day for 14 days. The patient had no clinical symptoms, was discharged after 14 days of treatment, and continued treatment with aspirin 3 mg/kg/day and prednisolone 1 mg/kg/day.

Conclusion: The MIS-C manifestation following SARS-CoV2 infection needs prompt attention and treatment. Intravenous immunoglobulin plays an important role in treatment. However, when intravenous immunoglobulin is not available where limited resources, early appropriate use of methylprednisolone may be beneficial. 

Spontaneous hemopneumothorax is a rare condition and may be a life-threatening condition that needs prompt diagnosis and urgent intervention. In this study, we reported three male cases of spontaneous hemopneumothorax, two cases presented with chest pain and one with epigastric pain. All cases were successfully treated by early surgical intervention. Total blood drainage was ranged from 1400 to 2000 mL. Video-assisted thoracoscopic surgery was performed successfully in two cases, however, one case was transferred to urgent thoracotomy due to excessive blood clotting in the pleura cavity and continuous bleeding. Leukocytosis was observed in two cases, mostly due to pneumonia or sepsis. The bleeding point was identified in all cases, however, the air leak area could not be identified in two cases. Length of hospital stay after admission was ranged from five to seven days. We recommend that video-assisted thoracoscopic surgery should be considered as a first choice due to its effectiveness in reducing postoperative complications and facilitating rapid recovery.

Type B Hepatic encephalopathy (HE) due to a congenital extra-hepatic porto-systemic shunt is an extremely rare condition. We report the case of a 57-year-old woman, with recurrent episodes of confusion and neuropsychiatric symptoms, who had an elevated serum ammonia level and a superior mesenteric-caval shunt documented on abdominal computed topography (CT) scan. There was no evidence of cirrhosis or portal hypertension. A diagnosis of non-cirrhotic, non-portal hypertension hepatic encephalopathy was made after excluding other causes of confusion and cognitive impairment. The patient was successfully treated by radiologically guided endovascular shunt closure and during 9 months follow up, her neuropsychiatric symptoms did not recur and repeated serum ammonia level results were normal.

Hydatidosis is a zoonotic disease caused by the tapeworm Echinococcus granulosus. It mostly involves liver and lungs whereas the unusual sites are spleen, kidney, peritoneal cavity, skin, muscles, heart, brain, vertebral column, ovaries, pancreas, gallbladder, thyroid gland, breast, and bones.  Herein, we describe a unique case of intrapleural hydatid cyst which was solely confined to the pleural space without involvement of lung parenchyma and other associated structures. Despite the fact that Pakistan is an endemic country for hydatid disease, we could not identify any single documented case of intrapleural hydatid disease from Pakistan. The purpose of our case report is to promote awareness among fellow healthcare professionals about this rare variant of hydatid disease and to prevent any missed diagnosis and life-threatening complications. Hence, once the diagnosis was established, we performed a right-sided thoracotomy. Intraoperatively, the lung was collapsed due to the pressure effects of hydatid cysts. The hydatid cysts were evacuated completely from the pleural cavity and postoperatively the patient had an uneventful recovery and remained asymptomatic during all the follow-up visits. Conclusively, the hydatid disease may involve unusual sites such as the pleural space. A strong clinical suspicion, supportive radiological findings, and positive serological evidence play a critical role in the establishment of the diagnosis.