The case is reported of a man shot with a distress flare from a range of about 3 m. The flare caused a large cavity deep in the pectoral muscles. There should be a high index of suspicion about the extent of the injury in all types of penetrating trauma.

This brief case report describes an unusual presumed association of chronic HIV infection with multiple cerebral arteriovenous malformations. An adult male patient presented with recurrent spontaneous brain intracranial hemorrhages and neurologic deficits requiring surgical evacuation. The diagnosis was delayed because of lack of a high index of suspicion of this unexpected and previously unrec...

Takayasu arteritis can have myriads of presentation, depending on site and extent of disease. As no age is immune for this disease, it is important to keep a high index of suspicion, otherwise the diagnosis can be missed. We hereby describe a case of Takayasu arteritis, which presented as dilated cardiomyopathy.

Emphysematous cholecystitis (EC) is a distinct clinical disease that carries a high rate of morbidity and mortality. Maintaining a high index of suspicion, especially in the right patient population, combined with emergency bedside ultrasound can lead to rapid diagnosis and initiation of treatment for this life threatening condition.

Disseminated histoplasmosis and hemophagocytic lymphohistiocytosis show overlapping features, which require careful contextual interpretation. Histopathologic evaluation can potentially rapidly identify cases of possible histoplasmosis. A high index of clinical suspicion, particularly in endemic areas and in a setting of immunosuppression, is critical to appropriate diagnosis and treatment.

Gallstone ileus is an uncommon complication of cholelithiasis, with a high morbidity and mortality rate, usually related to the delayed diagnosis of intestinal obstruction. Diagnosing gallstone ileus needs a high index of suspicion. A case of a gallstone ileus is reported. The clinical presentation, radiological features, intra-operative findings, operative procedure and literature review are p...

A series of 7 patients with granulocytic sarcoma is presented to illustrate its varied clinical picture. In particular, this condition may present with features which suggest a non-Hodgkin lymphoma. The diagnosis will only be made if a high index of suspicion is maintained and special histopathological methods are used. Granulocytic sarcoma should be treated like an acute myeloid leukaemia.

Posterior reversible encephalopathy syndrome is commonly associated with factors like hypertension, immunosuppression, uraemia, volume overload and electrolyte disturbances in post renal transplant patients. We report a case of (posterior reverssible encephalopathy syndrome) PRES in young post renal transplant patient where all these common associations were absent. High index of suspicion, cli...

BACKGROUND Macrophage activation syndrome is a rare and life threatening complication of childhood rheumatic disorders. CASE CHARACTERISTICS 6-year-old male child with macrophage activation syndrome complicating systemic onset juvenile idiopathic arthritis. OBSERVATION He developed pericardial effusion, hyponatremia and deranged renal function. OUTCOME Improvement on intravenous cortico s...