We report on an atypical clinical course of a patient with the very rare diagnosis of an apocrine sweat gland carcinoma with a lymphatic metastasis, metachronous distant metastasis and a now reached survival time of more than four years and give a review about the current literature. There are only a very small number of cases described. The recommendations for diagnostics and treatment of this tumor therefore are not based on prospective randomized studies but upon case reports and on new immunohistochemical and genetic markers

Introduction: Valproate acid (VPA) is a very common treatment in neurology and psychiatric pathologies. Valproate-associated Hyperammonemic Encephalopathy (VHE) is a rare and serious side effect of the VPA treatment.

Case report: We present the case of an adolescent with a recent diagnosis of schizophrenia, hospitalized for psychotic decompensation and generalized epileptic seizures, with no personal or family history of epilepsy. After progressive introduction of VPA, the patient developed an acute mental state characterized by lethargy, cognitive deceleration, confusion and verbal response lentification, suggestive of encephalopathy. Laboratory tests showed a hyperammonemia with normal hepatic function, and the electroencephalogram (EEG) showed severe diffuse slowing with bifrontally predominant triphasic waves, a characteristic pattern of metabolic encephalopathies.

Conclusion: This case shows an important and infrequent secondary effect of VPA, as well as the importance of EEG in the study of patients with altered state of consciousness.

Pyomyoma is a rare and potentially fatal suppurative complication of leiomyoma, with less than 100 known cases reported since it was first described in literature in 1871. A case is described of the presentation, management, and outcome of a patient who developed a pyomyoma following a septic abortion and uterine instrumentation. We then perform an extensive literature review encompassing 75 known reported cases of pyomyoma since 1945, analyzing 10 different factors, including patient age, pregnancy and menopausal status, clinical presentation, known etiological causes, isolated causative organisms, blood culture results, presence of leukocytosis, treatment implemented, and patient survival. This review will help to further expound on and characterize pyomyomas, allowing for better understanding of the condition and improved clinical assessment and patient management in the future

Letter to Editor:

The introduction of drug coated balloon (DCB) and subsequently modifications of this device from the first to the second generation, improving the mechanism of drug delivery in the coronary segment and release on the vessel walls as well as its trackability have lead to obtain interesting results in the treatment of specific setting of patients

Facial diplegia or bilateral facial nerve palsy is an extremely rare condition, caused in the majority of patients by an underlying condition. The broad differential diagnosis of facial diplegia causes may present a diagnostic challenge. We report the case of a 71-year-old patient with sudden onset of bilateral facial nerve palsy and mild hypoglossal nerve paresis. The diagnosis of Guilain-Barré syndrome was the most likely and the patient recovered after intravenous immunoglobulin administration