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Metastatic breast cancer involving the skin treated as shingles: A case report and call to action

Medical Reports

Pub Date : 2025-01-31 DOI: 10.1016/j.hmedic.2025.100165

Muhammad Ramish Irfan , Zobia Ishtiaq Abbasi , Asim Mehmood , Usman Baig , Saeeda Yasmin

We report a case drawing attention to a potentially misleading presentation of cutaneous metastasis of breast cancer after modified radical mastectomy as a result of residual disease. The patient presented with as a pruritic rash extending across the chest and back. It was papulovesicular with surrounding well-defined erythema along the suture sites of the reconstructed breast. Initially treated as shingles, the case points to a boxed approach to patients without adequate consideration of pertinent information gathered from their history and examination, analyzed in appropriate context. Clinicians would benefit from refraining from adhering to the typical and being ready to make personalized assessments of their patients. Additionally, consulting colleagues from an educational perspective without breaching patient privacy in matters that pose an atypical challenge may lead to accurate assessments and better overall care. We also emphasize the importance of establishing state-of-the art care standards and better quality-control mechanisms in regions without universal practice guidelines applicable to all institutions.

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引用次数: 0

Hepatits-B associated crescentic glomerulonephritis: A rare case report

Medical Reports

Pub Date : 2025-01-31 DOI: 10.1016/j.hmedic.2025.100172

Anindya Chowdhury , Kavya Varshney

Hepatitis B virus infection is a global health challenge with high morbidity and mortality. Hepatitis B virus-associated glomerulonephritis is immune complex glomerulonephritis mediated by deposition of HBsAg and HBV antibody in the glomeruli. Hepatitis B virus infection related kidney disease has wide spectrum of presentation, most commonly presented as membranous nephropathy, membranoproliferative glomerulitis (MPGN), and polyarteritis nodosa. It can also present as mesangial proliferative glomerulonephritis, IgA nephropathy and focal segmental glomerulosclerosis but crescentic glomerulonephritis without cryoglobulinemia is extremely rare. HBV-GN most commonly found in endemic areas among infants and early childhood age. Treatment with antiviral therapy, entecavir, a nucleoside analog and corticosteroids along with widespread use of Hepatitis B vaccination has significantly reduced the incidence of HBV- associated glomerulonephritis.

引用次数: 0

Hypertensive crisis unveils hidden celiac disease: A rare case report

Medical Reports

Pub Date : 2025-01-30 DOI: 10.1016/j.hmedic.2025.100173

Majed Ali , Maria Azzi , Mohammad Labban , Karam Karam , Ihab I. El Hajj , Elias Fiani

Celiac disease (CD) is a chronic autoimmune disorder of the small intestine triggered by the ingestion of gluten, a protein found in wheat, barley, and rye. This case illustrates the importance of considering atypical presentations of celiac disease, particularly in patients presenting with hypertensive crises and unexplained symptoms such as anemia and abdominal discomfort. The early recognition of such presentations can prevent delayed diagnosis and further complications.

引用次数: 0

Squamous cell carcinoma in a patient with inflammatory bowel disease: A case report of complications with long-term Azathioprine use

Medical Reports

Pub Date : 2025-01-29 DOI: 10.1016/j.hmedic.2025.100171

Ali Niksirat , Ali Kiaee , Mohadeseh Jafari Sedehi , Fatemeh Abbasi

Background

Inflammatory Bowel Disease (IBD) is associated with an increased risk of malignancies, particularly in patients receiving long-term immunosuppressive therapy. This case report presents a 79-year-old male with a long-standing history of IBD who developed squamous cell carcinoma (SCC) following prolonged use of Azathioprine.

Case presentation

A 79-year-old male with a 20-year history of IBD presented to Shahid Rajaei Hospital in Tonekabon, complaining of abdominal pain and hematochezia. He had been on Azathioprine since the diagnosis of IBD. Five years prior, he developed scalp lesions, which was biopsied and confirmed as SCC. Despite undergoing three surgical interventions to excise the lesions and receiving adjuvant chemotherapy and radiotherapy, the patient exhibited persistent disease without improvement. Recent clinical evaluations revealed recurrent infection and purulent discharge at the surgical site, raising concerns regarding the underlying malignancy.

Discussion

The patient’s history indicates that the development of SCC may be attributed to the long-term immunosuppressive effects of Azathioprine, which can predispose individuals to skin cancers. This case underscores the importance of vigilant monitoring for malignancies in patients on long-term immunosuppressive therapy, particularly those with pre-existing conditions like IBD.

Conclusion

This case highlights the potential complications of long-term Azathioprine use in IBD patients, including the risk of developing SCC. Clinicians should consider alternative management strategies and regular surveillance for skin lesions in similar patient populations to mitigate the risks associated with immunosuppressive therapies.

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引用次数: 0

Corrigendum to “Evans syndrome: An uncommon hematological conundrum in a young adult: A case report” [Medical Reports, Volume 8, December 2024, 100121]

Medical Reports

Pub Date : 2024-12-01 DOI: 10.1016/j.hmedic.2024.100139

Faryal Afridi , Tooba Fida , Muhammad Usama Bin Shabbir , Husban Ahmad Halim , Ishwa Ghouri , Muhammad Fawad Ashraf

引用次数: 0

Thalamic and dentate nuclei involvement in an infant with propofol related infusion syndrome: A case report 异丙酚相关输液综合征患儿丘脑和齿状核受累1例

Medical Reports

Pub Date : 2024-12-01 DOI: 10.1016/j.hmedic.2024.100141

Tomas Leng , Bowen Song , Benjamin L. Hamel , Matthew Di Giusto , Marc Patterson

Propofol related infusion syndrome is a rare and potentially lethal complication of propofol infusion. The syndrome is clinically characterized by multiorgan failure and brain injury has also been reported. We report the case of symmetric thalami, innominate substance and dentate nuclei involvement with left middle cerebral artery stroke in a five-month-old infant who presented with multiorgan failure concerning for propofol related infusion syndrome.

异丙酚相关输液综合征是一种罕见且具有潜在致命性的异丙酚输液并发症。该综合征的临床特征是多器官功能衰竭和脑损伤也有报道。我们报告一例对称丘脑，无名物质和齿状核累及左大脑中动脉中风的五个月大婴儿，他表现为多器官衰竭，涉及异丙酚相关输注综合征。

引用次数: 0

Gorlin-Goltz syndrome – Report of a case with review of literature 戈林-戈尔茨综合征--一例病例报告及文献综述

Medical Reports

Pub Date : 2024-11-17 DOI: 10.1016/j.hmedic.2024.100137

Snehanjan Sarangi , Basudev Mahato , Samir Mandal , Shreya S. Saha

Gorlin-Goltz syndrome (GGS), also known as the basal cell nevus syndrome (BCNS), or nevoid basal cell carcinoma syndrome (NBCCS), is a multisystem autosomal dominant disorder, characterized by the presence of numerous odontogenic keratocysts (OKC), along with variable cutaneous, dental, skeletal, muscular, neurological, sexual and ophthalmologic anomalies. Mostly mutation of the patched 1 (PTCH1) gene is responsible, while in a few instances germline mutation of suppressor of fused homolog (SUFU) gene is evident. Timely diagnosis and proper management of the various systemic abnormalities associated with NBCCS, is of utmost significance, owing to its susceptibility towards malignant transformation to basal cell carcinoma (BCC). Herein, we describe GGS in a 22 years old male patient, with relevant diagnostic aspects.

戈林-戈尔茨综合征（GGS）又称基底细胞痣综合征（BCNS）或痣样基底细胞癌综合征（NBCCS），是一种多系统常染色体显性遗传病，其特征是存在大量牙源性角化囊肿（OKC），同时伴有不同程度的皮肤、牙齿、骨骼、肌肉、神经、性和眼科异常。大多数情况下，病因是斑块 1（PTCH1）基因突变，少数情况下，融合同源基因抑制剂（SUFU）基因的种系突变也很明显。由于 NBCCS 易恶变为基底细胞癌 (BCC)，因此及时诊断和妥善处理与 NBCCS 相关的各种系统异常至关重要。在此，我们描述了一名 22 岁男性患者的 GGS 以及相关诊断方面的情况。

引用次数: 0

Overlap of nephrotic syndrome with nephritic syndrome and its relation to microscopic polyangiitis in a seventeen-year-old young female 一名 17 岁年轻女性的肾病综合征与肾炎综合征的重叠及其与显微镜下多血管炎的关系

Medical Reports

Pub Date : 2024-11-15 DOI: 10.1016/j.hmedic.2024.100133

Bilawal Abbas , Fiza Shafi , Muhammad Usama bin Shabbir , Sijel Husseini

The medical condition termed as nephrotic syndrome (NS) is defined by excessive excretion of proteins in the urine, called proteinuria, and lack of circulating albumin, called hypoalbuminemia. The value for proteinuria in NS is more than 40 mg/m^2 per hour, and the cut-off value for albumin is less than 30 g/L. A rare form of vasculitis, called microscopic polyangiitis mainly affects the kidneys and lungs. We have an instance of a seventeen-year-old girl with the involvement of the renal and central nervous systems as a manifestation of microscopic polyangiitis on the background of overlap. Renal biopsies and perinuclear anti-neutrophil cytoplasmic antibody (p-ANCA) suggested microscopic polyangiitis. After receiving cyclophosphamide and pulse steroids, the patient's symptoms resolved, and the patient was discharged. To help with early disease detection and treatment, this case emphasizes the importance of considering ANCA-associated vasculitis during diagnostic processes and highlights the concept of nephrotic-nephritic overlap.

肾病综合征（NS）是指尿液中蛋白质排泄过多，称为蛋白尿，而循环白蛋白缺乏，称为低白蛋白血症。肾病综合征的蛋白尿值为每小时 40 毫克/米^2 以上，白蛋白的临界值为 30 克/升以下。一种罕见的血管炎称为显微镜下多血管炎，主要累及肾脏和肺部。我们有一个 17 岁女孩的病例，她的肾脏和中枢神经系统均受累，这是显微镜下多血管炎重叠背景下的一种表现。肾活检和核周抗中性粒细胞胞浆抗体（p-ANCA）提示她患有显微镜下多血管炎。在接受环磷酰胺和脉冲类固醇治疗后，患者的症状缓解并出院。为了帮助早期发现和治疗疾病，本病例强调了在诊断过程中考虑 ANCA 相关血管炎的重要性，并突出了肾病-肾炎重叠的概念。

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引用次数: 0

Unmasking parvovirus B19: An atypical case of hepatitis with rash and arthralgia 揭开 parvovirus B19 的神秘面纱：伴有皮疹和关节痛的非典型肝炎病例

Medical Reports

Pub Date : 2024-11-15 DOI: 10.1016/j.hmedic.2024.100138

Antonio Al Hazzouri , Christopher Sleiman , Rose-Mary Daou , Karam Karam , Elias Fiani

Parvovirus B19 is a common virus, typically known for causing erythema infectiosum in children and polyarthritis in adults. In rare cases, parvovirus can cause hepatitis. We present the case of a 40-year-old previously healthy woman who presented with fever, fatigue, arthralgia, and a reticular erythematous rash. Physical examination revealed mild hepatomegaly and right upper quadrant tenderness. Further laboratory analysis was unremarkable except for elevated liver enzymes. Viral serologies for hepatotrophic viruses were negative, but parvovirus B19 IgM and IgG were positive and suggestive of parvovirus B19-induced hepatitis. In the medical literature, parvovirus B19 has been associated with acute and fulminant hepatitis, especially in immunocompromised patients. The outcomes can range from asymptomatic transaminase elevations to liver failure requiring transplantation. Nonetheless, our case highlights the possibility of atypical infection with no hematological abnormalities. It is important to recognize and treat parvovirus B19 as a potential cause of hepatitis, regardless of classic presentations or hematological results.

Parvovirus B19 是一种常见的病毒，通常在儿童中引起感染性红斑，在成人中引起多发性关节炎。在极少数情况下，副病毒可引起肝炎。我们为您介绍一例 40 岁的健康女性病例，她出现发热、乏力、关节痛和网状红斑皮疹。体检发现轻度肝肿大和右上腹压痛。进一步的实验室分析除了肝酶升高外没有其他异常。肝营养病毒的病毒血清学检测结果为阴性，但 parvovirus B19 IgM 和 IgG 呈阳性，提示为 parvovirus B19 引起的肝炎。在医学文献中，副病毒 B19 与急性和暴发性肝炎有关，尤其是在免疫力低下的患者中。结果可能从无症状转氨酶升高到需要移植的肝功能衰竭不等。不过，我们的病例强调了无血液学异常的非典型感染的可能性。重要的是，无论典型表现或血液学结果如何，都要将 parvovirus B19 作为肝炎的潜在病因加以识别和治疗。

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引用次数: 0

A rare case of neonatal measles: Reevaluating maternal immunity in the vaccination era 新生儿麻疹罕见病例：重新评估疫苗接种时代的母体免疫力

Medical Reports

Pub Date : 2024-11-14 DOI: 10.1016/j.hmedic.2024.100134

Faiqa Taj , Chitturi Sai Sujana , Jawaria Amin , Babar Naeem

Background

Measles is a highly contagious, vaccine-preventable viral disease characterized by fever, rash, and respiratory symptoms. While measles is generally rare in neonates due to the protective effect of transplacental maternal antibodies, cases in early infancy can occur, raising concerns about the efficacy of maternal immunity.

Case presentation

We report a case of a 15-day-old male neonate who presented with high-grade fever, maculopapular rash, and respiratory distress. Despite the mother’s vaccination history, the infant was diagnosed with measles through serological testing. The disease progressed rapidly, leading to severe respiratory compromise and significant ocular involvement, requiring intensive care management.

Conclusion

This case underscores potential gaps in neonatal protection, even in infants of vaccinated mothers, suggesting that waning maternal immunity may result in insufficient antibody transfer. It highlights the need for re-evaluating vaccination strategies in women of reproductive age and emphasizes the importance of stringent infection control measures in postpartum care settings to prevent neonatal measles.

背景麻疹是一种传染性极强、可通过接种疫苗预防的病毒性疾病，以发热、皮疹和呼吸道症状为特征。虽然由于经胎盘母体抗体的保护作用，麻疹一般很少发生在新生儿身上，但婴儿早期也会出现麻疹病例，这引起了人们对母体免疫有效性的担忧。尽管母亲有疫苗接种史，但通过血清学检测，婴儿被确诊为麻疹。该病例强调，即使是接种过疫苗的母亲所生的婴儿，对新生儿的保护也可能存在缺陷，这表明母体免疫力下降可能导致抗体转移不足。它强调了重新评估育龄妇女疫苗接种策略的必要性，并强调了在产后护理环境中采取严格的感染控制措施以预防新生儿麻疹的重要性。

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