Case ID

Sex

Age (years)

Medical and surgical history

Clinical features

Key investigation findings

Interventions

Length of stay (days)

1

F

32

Obesity, atypical endometrial hyperplasia, intrahepatic cholestasis in pregnancy

Fever, right sided abdominal pain, right iliac fossa peritonism, nausea, constipation.

Later during admission patient experienced right upper quadrant tenderness and chest pain.

CRP 132 mg/L, WCC 10.2, mildly deranged liver function tests.

CT scan showed inflammatory changes and significant lymphadenopathy within the mesentery of the right lower quadrant and tracking superiorly and medially with the superior mesenteric vein. The largest node measured 18 mm.

Cardiac troponin peak 7800 ng/L, moderate to severe global systolic dysfunction on echocardiogram.

IV antibiotics, ICU admission and vasopressor requirement, IVIG infusion, IV Methylprednisolone, oral prednisolone.

17

2

F

29

Asthma (well controlled), appendicectomy

Fever and right iliac fossa pain.

CRP 469 mg/L, WCC 9.2, mildly deranged liver function tests.

CT scan showed bowel wall thickening in the proximal ascending colon, terminal ileum, and sigmoid colon. Multiple enlarged right-sided mesocolic lymph nodes were noted, largest measuring 12 mm.

Cardiac troponin peak 1048 ng/l. T-wave inversion at inferior leads. Normal left ventricular size and systolic function on echocardiogram. Myocarditis on cardiac MRI.

IV antibiotics, IV Dexamethasone, oral Prednisolone. Did not require ICU admission.

 6