We describe a case of a chronic obstructive pulmonary disease patient with stable chronic bronchitis who experienced improved quality of life and reduced symptoms during daily long-term Mucinex® (extended-release guaifenesin) use. Through a validated patient-reported outcome, the cough and sputum assessment questionnaire (CASA-Q), cough impact and symptoms scores showed improvements of 37.5 and 50 points, respectively, at week 11 compared to baseline. Similarly, sputum impact and symptoms scores improved by 37.5 and 41.7 points. While these observations support a potential benefit of adjunctive mucoactive therapy in chronic respiratory conditions, they should be interpreted cautiously and considered hypothesis-generating, highlighting the need for further controlled studies.
{"title":"Adjunctive long-term use of Mucinex® leading to improvement in stable chronic bronchitis and patient’s quality of life: A case report","authors":"Selwyn Spangenthal , Connie Divel , Oktawia Borecka , Samuel Llewellyn","doi":"10.1016/j.hmedic.2025.100384","DOIUrl":"10.1016/j.hmedic.2025.100384","url":null,"abstract":"<div><div>We describe a case of a chronic obstructive pulmonary disease patient with stable chronic bronchitis who experienced improved quality of life and reduced symptoms during daily long-term Mucinex® (extended-release guaifenesin) use. Through a validated patient-reported outcome, the cough and sputum assessment questionnaire (CASA-Q), cough impact and symptoms scores showed improvements of 37.5 and 50 points, respectively, at week 11 compared to baseline. Similarly, sputum impact and symptoms scores improved by 37.5 and 41.7 points. While these observations support a potential benefit of adjunctive mucoactive therapy in chronic respiratory conditions, they should be interpreted cautiously and considered hypothesis-generating, highlighting the need for further controlled studies.</div></div>","PeriodicalId":100908,"journal":{"name":"Medical Reports","volume":"14 ","pages":"Article 100384"},"PeriodicalIF":0.0,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145362209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-15DOI: 10.1016/j.hmedic.2025.100383
A.A. Sharif , N. Adhikari, M.B. Foroozesh
Objective
To review the diagnostic findings following local anesthetic systemic toxicity (LAST) with articaine and assess the prognosis given appropriate management.
Background
Articaine is widely used in the dental field due to its relatively safe profile, fast onset, and short half-life. We present a case of LAST following articaine administration.
Case report
A 61-year-old female with a past medical history of essential hypertension, prediabetes, and nontoxic multinodular goiter presented with acute onset altered mental status and generalized tonic clonic seizure requiring intubation in the field from her dentist’s office following the administration of articaine for a root canal. Diagnostic studies, including MRI, echocardiography (ECHO), and electrocardiogram (EKG), were consistent with the suspected diagnosis of LAST. Notably, her left ventricular ejection fraction (LVEF) declined from 60 % to 65 % (per ECHO nine days prior) to 20 to 25 % on the second day of hospitalization. Brain MRI demonstrated multifocal areas of gyriform cortical restricted diffusion seen in both cerebral hemispheres. She was successfully treated with lipid emulsion therapy with continued supportive care and subsequently discharged 10 days later to continue physical therapy and rehab after her LAST episode.
Conclusion
LAST acutely presents with dramatic findings including cardiac and neurologic manifestations. Our patient presented with tonic clonic seizure, acute encephalopathy, Severe reduction in LVEF, and brain MRI showing multiple watershed lesions. Treatment with lipid emulsion therapy and supportive measures led to substantial recovery, with a near-complete return to baseline function within six months.
{"title":"Diagnostic findings after local anesthetic systemic toxicity with articaine: A case report","authors":"A.A. Sharif , N. Adhikari, M.B. Foroozesh","doi":"10.1016/j.hmedic.2025.100383","DOIUrl":"10.1016/j.hmedic.2025.100383","url":null,"abstract":"<div><h3>Objective</h3><div>To review the diagnostic findings following local anesthetic systemic toxicity (LAST) with articaine and assess the prognosis given appropriate management.</div></div><div><h3>Background</h3><div>Articaine is widely used in the dental field due to its relatively safe profile, fast onset, and short half-life. We present a case of LAST following articaine administration.</div></div><div><h3>Case report</h3><div>A 61-year-old female with a past medical history of essential hypertension, prediabetes, and nontoxic multinodular goiter presented with acute onset altered mental status and generalized tonic clonic seizure requiring intubation in the field from her dentist’s office following the administration of articaine for a root canal. Diagnostic studies, including MRI, echocardiography (ECHO), and electrocardiogram (EKG), were consistent with the suspected diagnosis of LAST. Notably, her left ventricular ejection fraction (LVEF) declined from 60 % to 65 % (per ECHO nine days prior) to 20 to 25 % on the second day of hospitalization. Brain MRI demonstrated multifocal areas of gyriform cortical restricted diffusion seen in both cerebral hemispheres. She was successfully treated with lipid emulsion therapy with continued supportive care and subsequently discharged 10 days later to continue physical therapy and rehab after her LAST episode.</div></div><div><h3>Conclusion</h3><div>LAST acutely presents with dramatic findings including cardiac and neurologic manifestations. Our patient presented with tonic clonic seizure, acute encephalopathy, Severe reduction in LVEF, and brain MRI showing multiple watershed lesions. Treatment with lipid emulsion therapy and supportive measures led to substantial recovery, with a near-complete return to baseline function within six months.</div></div>","PeriodicalId":100908,"journal":{"name":"Medical Reports","volume":"14 ","pages":"Article 100383"},"PeriodicalIF":0.0,"publicationDate":"2025-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-10-10DOI: 10.1016/j.hmedic.2025.100380
Abdulaziz Hussein , Ali A. Obaid , Nadia M. A Almikhlafi
Cornual ectopic pregnancy is a rare and potentially life-threatening form of ectopic gestation that occurs within the uterine cornua, often presenting diagnostic and management challenges. Early detection is crucial to prevent catastrophic hemorrhage and preserve future fertility. This report describes a 30-year-old woman presenting with lower abdominal pain, vaginal spotting, and amenorrhea at seven weeks of gestation. Ultrasonography revealed a complex mass in the right uterine cornua with features suggestive of cornual pregnancy. The patient underwent a carefully planned surgical intervention involving laparotomy and excision of the ectopic tissue, with meticulous preservation of uterine integrity. The case spots light the importance of high clinical suspicion and detailed imaging for prompt diagnosis, especially in patients with uterine anomalies such as septate uterus. Early surgical management in this case effectively prevented rupture and hemorrhage, improving her prognosis and future reproductive potential. This case underscores the significance of prompt diagnosis and tailored surgical approaches in managing cornual ectopic pregnancies, particularly when complicated by uterine anomalies.
{"title":"Coexistence of cornual ectopic pregnancy and septated uterus anomaly: A case report of ultrasound diagnosis and surgical intervention","authors":"Abdulaziz Hussein , Ali A. Obaid , Nadia M. A Almikhlafi","doi":"10.1016/j.hmedic.2025.100380","DOIUrl":"10.1016/j.hmedic.2025.100380","url":null,"abstract":"<div><div>Cornual ectopic pregnancy is a rare and potentially life-threatening form of ectopic gestation that occurs within the uterine cornua, often presenting diagnostic and management challenges. Early detection is crucial to prevent catastrophic hemorrhage and preserve future fertility. This report describes a 30-year-old woman presenting with lower abdominal pain, vaginal spotting, and amenorrhea at seven weeks of gestation. Ultrasonography revealed a complex mass in the right uterine cornua with features suggestive of cornual pregnancy. The patient underwent a carefully planned surgical intervention involving laparotomy and excision of the ectopic tissue, with meticulous preservation of uterine integrity. The case spots light the importance of high clinical suspicion and detailed imaging for prompt diagnosis, especially in patients with uterine anomalies such as septate uterus. Early surgical management in this case effectively prevented rupture and hemorrhage, improving her prognosis and future reproductive potential. This case underscores the significance of prompt diagnosis and tailored surgical approaches in managing cornual ectopic pregnancies, particularly when complicated by uterine anomalies.</div></div>","PeriodicalId":100908,"journal":{"name":"Medical Reports","volume":"14 ","pages":"Article 100380"},"PeriodicalIF":0.0,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145324042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-30DOI: 10.1016/j.hmedic.2025.100382
Fadi Fares , Layal Abou Zeki , Omar Aawar
Elderly patients with cervical spinal fractures present unique challenges in management due to the increased risk of respiratory complications. This case report highlights the significance of age as a major risk factor for early tracheostomy in a 90-year-old healthy male patient who sustained a cervical spine fracture following a fall. Despite presenting with mild neurological deficits and no major comorbidities, the patient experienced significant respiratory issues postoperatively, including difficulty clearing lung secretions and developing type II respiratory failure. These complications necessitated re-intubation and, ultimately, the insertion of a tracheostomy. This case emphasizes that advanced age, even without other typical risk factors, can lead to a higher likelihood of respiratory failure and the need for prolonged airway support. While anterior cervical spine surgery itself carries inherent risks of postoperative respiratory compromise, this case highlights the added impact of advanced age as an independent predictor of respiratory failure. Early tracheostomy intervention in elderly patients with cervical spinal fractures may be crucial for reducing complications, improving outcomes, and facilitating early recovery thus decreasing the hospital length of stay.
{"title":"Age-related challenges in the management of cervical spinal fractures: A case report on the need for early tracheostomy in an elderly patient","authors":"Fadi Fares , Layal Abou Zeki , Omar Aawar","doi":"10.1016/j.hmedic.2025.100382","DOIUrl":"10.1016/j.hmedic.2025.100382","url":null,"abstract":"<div><div>Elderly patients with cervical spinal fractures present unique challenges in management due to the increased risk of respiratory complications. This case report highlights the significance of age as a major risk factor for early tracheostomy in a 90-year-old healthy male patient who sustained a cervical spine fracture following a fall. Despite presenting with mild neurological deficits and no major comorbidities, the patient experienced significant respiratory issues postoperatively, including difficulty clearing lung secretions and developing type II respiratory failure. These complications necessitated re-intubation and, ultimately, the insertion of a tracheostomy. This case emphasizes that advanced age, even without other typical risk factors, can lead to a higher likelihood of respiratory failure and the need for prolonged airway support. While anterior cervical spine surgery itself carries inherent risks of postoperative respiratory compromise, this case highlights the added impact of advanced age as an independent predictor of respiratory failure. Early tracheostomy intervention in elderly patients with cervical spinal fractures may be crucial for reducing complications, improving outcomes, and facilitating early recovery thus decreasing the hospital length of stay.</div></div>","PeriodicalId":100908,"journal":{"name":"Medical Reports","volume":"14 ","pages":"Article 100382"},"PeriodicalIF":0.0,"publicationDate":"2025-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145265462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-28DOI: 10.1016/j.hmedic.2025.100381
Anthony Bedran , Ryan Akl , Karam Karam , Elias Fiani , Ihab I. El Hajj
Hypertension is a widespread global health issue, and dietary modifications are an important nonpharmacologic approach to its management. Increasing the consumption of fiber-rich foods, such as fruits, vegetables, and garlic, has been shown to reduce blood pressure and improve cardiovascular health. People consume garlic for proposed benefits, including management of hypertension. Rarely, excessive intake of these foods can lead to gastrointestinal complications, including the formation of phytobezoar, masses of indigestible plant material that may cause severe obstructions. Bezoars are responsible for 0.4–4 % of cases of gastric outlet obstruction. Although rare, these obstructions can result in symptoms like nausea, vomiting, and abdominal pain, and may require surgical intervention. In the absence of treatment, lodged bezoars in the gastrointestinal tract have been associated with mortality rates as high as 30 %. This case report presents a 59-year-old woman with a history of poorly controlled hypertension, whose blood pressure remained high at 180/100 mmHg despite increased doses of antihypertensive medication. In an attempt to manage her condition, she ingested a large garlic clove, unchewed, as a dietary supplement. She subsequently presented to the emergency department with two days of epigastric pain, persistent nausea, and vomiting after eating. Imaging, including an unenhanced CT scan, revealed a fluid-filled stomach with a 2 cm irregular dense mass at the gastric pylorus, suggesting a phytobezoar. Gastroscopy confirmed the presence of a large, undigested garlic clove in the pre-pyloric region, which was successfully removed using a Roth net. The pyloric area showed signs of mild inflammation, with the diameter of the pyloric channel smaller than the garlic clove. The patient was discharged in stable condition. This case highlights the potential gastrointestinal risks of consumption of unchewed foods, such as a garlic clove, and emphasizes the importance of careful dietary management in patients with hypertension.
{"title":"An undigested garlic clove induced gastric outlet obstruction: A case report","authors":"Anthony Bedran , Ryan Akl , Karam Karam , Elias Fiani , Ihab I. El Hajj","doi":"10.1016/j.hmedic.2025.100381","DOIUrl":"10.1016/j.hmedic.2025.100381","url":null,"abstract":"<div><div>Hypertension is a widespread global health issue, and dietary modifications are an important nonpharmacologic approach to its management. Increasing the consumption of fiber-rich foods, such as fruits, vegetables, and garlic, has been shown to reduce blood pressure and improve cardiovascular health. People consume garlic for proposed benefits, including management of hypertension. Rarely, excessive intake of these foods can lead to gastrointestinal complications, including the formation of phytobezoar, masses of indigestible plant material that may cause severe obstructions. Bezoars are responsible for 0.4–4 % of cases of gastric outlet obstruction. Although rare, these obstructions can result in symptoms like nausea, vomiting, and abdominal pain, and may require surgical intervention. In the absence of treatment, lodged bezoars in the gastrointestinal tract have been associated with mortality rates as high as 30 %. This case report presents a 59-year-old woman with a history of poorly controlled hypertension, whose blood pressure remained high at 180/100 mmHg despite increased doses of antihypertensive medication. In an attempt to manage her condition, she ingested a large garlic clove, unchewed, as a dietary supplement. She subsequently presented to the emergency department with two days of epigastric pain, persistent nausea, and vomiting after eating. Imaging, including an unenhanced CT scan, revealed a fluid-filled stomach with a 2 cm irregular dense mass at the gastric pylorus, suggesting a phytobezoar. Gastroscopy confirmed the presence of a large, undigested garlic clove in the pre-pyloric region, which was successfully removed using a Roth net. The pyloric area showed signs of mild inflammation, with the diameter of the pyloric channel smaller than the garlic clove. The patient was discharged in stable condition. This case highlights the potential gastrointestinal risks of consumption of unchewed foods, such as a garlic clove, and emphasizes the importance of careful dietary management in patients with hypertension.</div></div>","PeriodicalId":100908,"journal":{"name":"Medical Reports","volume":"14 ","pages":"Article 100381"},"PeriodicalIF":0.0,"publicationDate":"2025-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145218928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-24DOI: 10.1016/j.hmedic.2025.100378
Ping Xiao, Tao Xu , Ming Zhou , ZhenYu Lei
Background
Acute severe alcoholic pancreatitis has a high mortality rate without blood purification. Patient and method: We used plasma exchange and continuous venovenous hemofiltration to treat a patient with severe acute pancreatitis complicated by multiple organ dysfunction syndrome.
Results
Blood indicators of liver, kidney, coagulation, heart, and inflammation were analyzed during treatment. The blood levels of ALT, TBIL, IB, DB, Cr, WBC, N, HCRP, LDH, CK, and PLT were restored after the patient received treatment with CVVH + PE. PLT, PT, INR, FIB, AT3, and DDI were significantly improved when the coagulation indicators were supplemented by plasma exchange.
Conclusion
Plasma exchange may help remove harmful circulating molecules, mitigate the large-scale systemic inflammatory response, facilitate the restoration of normal coagulation mechanisms, and regulate hemodynamic stability, thereby rebalancing coagulation function and alleviating the progression of irreversible deterioration in multiple organ dysfunction syndrome for patients with acute severe alcoholic pancreatitis. Our case first highlights the potential efficacy of both PE and CVVH in treating MODS in SAP. These treatments play a vital role in improving clinical conditions, especially in keeping coagulation stable. CVVH and PE are effective treatments for the SAP patient.
{"title":"Plasma exchange maintains coagulation function to prevent worsening of MODS in a patient with acute severe alcoholic pancreatitis: A case report","authors":"Ping Xiao, Tao Xu , Ming Zhou , ZhenYu Lei","doi":"10.1016/j.hmedic.2025.100378","DOIUrl":"10.1016/j.hmedic.2025.100378","url":null,"abstract":"<div><h3>Background</h3><div>Acute severe alcoholic pancreatitis has a high mortality rate without blood purification. Patient and method: We used plasma exchange and continuous venovenous hemofiltration to treat a patient with severe acute pancreatitis complicated by multiple organ dysfunction syndrome.</div></div><div><h3>Results</h3><div>Blood indicators of liver, kidney, coagulation, heart, and inflammation were analyzed during treatment. The blood levels of ALT, TBIL, IB, DB, Cr, WBC, N, HCRP, LDH, CK, and PLT were restored after the patient received treatment with CVVH + PE. PLT, PT, INR, FIB, AT3, and DDI were significantly improved when the coagulation indicators were supplemented by plasma exchange.</div></div><div><h3>Conclusion</h3><div>Plasma exchange may help remove harmful circulating molecules, mitigate the large-scale systemic inflammatory response, facilitate the restoration of normal coagulation mechanisms, and regulate hemodynamic stability, thereby rebalancing coagulation function and alleviating the progression of irreversible deterioration in multiple organ dysfunction syndrome for patients with acute severe alcoholic pancreatitis. Our case first highlights the potential efficacy of both PE and CVVH in treating MODS in SAP. These treatments play a vital role in improving clinical conditions, especially in keeping coagulation stable. CVVH and PE are effective treatments for the SAP patient.</div></div>","PeriodicalId":100908,"journal":{"name":"Medical Reports","volume":"14 ","pages":"Article 100378"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145218930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-24DOI: 10.1016/j.hmedic.2025.100379
Abdelkader Dib , Johny Salem , Mirna Fares
We report the case of a 35-year-old woman who presented with fever, diarrhea, and respiratory symptoms, and was found to have acute respiratory distress syndrome (ARDS) in the setting of influenza B infection. Her stay was complicated with disseminated intravascular coagulation and Hemophagocytic lymphohistiocytosis (HLH) confirmed on bone marrow aspirate. Despite multiple therapies including antiviral, corticosteroids, and etoposide, the patient deteriorated and succumbed on day 10 of hospitalization. This case highlights the potential severity of influenza B and the need for early recognition to try and prevent complications such as ARDS and HLH.
{"title":"Hemophagocytic lymphohistiocytosis in association with acute respiratory distress syndrome in the setting of influenza B infection","authors":"Abdelkader Dib , Johny Salem , Mirna Fares","doi":"10.1016/j.hmedic.2025.100379","DOIUrl":"10.1016/j.hmedic.2025.100379","url":null,"abstract":"<div><div>We report the case of a 35-year-old woman who presented with fever, diarrhea, and respiratory symptoms, and was found to have acute respiratory distress syndrome (ARDS) in the setting of influenza B infection. Her stay was complicated with disseminated intravascular coagulation and Hemophagocytic lymphohistiocytosis (HLH) confirmed on bone marrow aspirate. Despite multiple therapies including antiviral, corticosteroids, and etoposide, the patient deteriorated and succumbed on day 10 of hospitalization. This case highlights the potential severity of influenza B and the need for early recognition to try and prevent complications such as ARDS and HLH.</div></div>","PeriodicalId":100908,"journal":{"name":"Medical Reports","volume":"14 ","pages":"Article 100379"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145218929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Benign tumors of peripheral nerves, particularly schwannomas and neurofibromas, are rare. Involvement of the vagus nerve remains even more uncommon. The cervical para-pharyngeal region is the most common of the extra-cranial locations. Imaging, particularly MRI, plays an essential role in characterizing the mass, assessing its extent, and studying its anatomical relationships, thus allowing for the planning of the surgical procedure. The standard treatment is based on a complete excision of the tumor to prevent recurrences while minimizing the risk of postoperative complications.We report two cases of sporadic benign vagus nerve tumors: one neurofibroma and one schwannoma, both treated by complete excision requiring vagus nerve sacrifice. The postoperative course was favorable without sequelae in the first case, while a Claude-Bernard-Horner syndrome was observed in the second patient. Furthermore, we propose a clinical, radiological, and therapeutic update on this rare condition.
{"title":"Two case reports of benign vagus nerve tumors: Diagnosis and treatment approaches","authors":"Achraf Amine Sbai , Oumaima Essadqi , Adnane Benzirar , Drissia Benfadil , Azeddine Lachkar , Fahd El Ayoubi El Idrissi","doi":"10.1016/j.hmedic.2025.100376","DOIUrl":"10.1016/j.hmedic.2025.100376","url":null,"abstract":"<div><div>Benign tumors of peripheral nerves, particularly schwannomas and neurofibromas, are rare. Involvement of the vagus nerve remains even more uncommon. The cervical para-pharyngeal region is the most common of the extra-cranial locations. Imaging, particularly MRI, plays an essential role in characterizing the mass, assessing its extent, and studying its anatomical relationships, thus allowing for the planning of the surgical procedure. The standard treatment is based on a complete excision of the tumor to prevent recurrences while minimizing the risk of postoperative complications.We report two cases of sporadic benign vagus nerve tumors: one neurofibroma and one schwannoma, both treated by complete excision requiring vagus nerve sacrifice. The postoperative course was favorable without sequelae in the first case, while a Claude-Bernard-Horner syndrome was observed in the second patient. Furthermore, we propose a clinical, radiological, and therapeutic update on this rare condition.</div></div>","PeriodicalId":100908,"journal":{"name":"Medical Reports","volume":"14 ","pages":"Article 100376"},"PeriodicalIF":0.0,"publicationDate":"2025-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-23DOI: 10.1016/j.hmedic.2025.100374
Milan Gaihre , Saket Jha , Rahul Pathak , Sujan Ghimire , Prince Baranawal , Aashish Poudel , Ritika Bhatta
Introduction
If unexplained acute liver injury symptoms imply several overlapping etiologies, diagnostic difficulty can ensue. Less frequent diseases like hepatic sarcoidosis and DRESS syndrome need to be included in differential diagnosis, but drug-induced liver injury and viral hepatitis are frequent etiologies.
Presentation of the case
A 28-year-old woman patient presented with pruritic rash, jaundice, and right upper quadrant pain for one month. Laboratory tests showed eosinophilia (520 cells/μL), hyperbilirubinemia (6.20 mg/dL), hepatocellular injury (AST 401 U/L, ALT 351 U/L), and highly raised ACE levels (216 U/L). Imaging revealed mediastinal lymphadenopathy. The patient's liver enzymes and symptoms significantly improved with corticosteroid treatment.
Discussion
Because DRESS syndrome and hepatic sarcoidosis share clinical and biochemical characteristics, the diagnostic challenge of differentiating between the two conditions is brought about in this case. While temporal drug association and eosinophilia predisposed towards drug hypersensitivity, the raised ACE levels and lymphadenopathy pushed in the direction of granulomatous disease. The shared immune-mediated pathophysiology of the two diseases was emphasized by the steroid response.
Conclusion
In the assessment of acute liver injury with systemic manifestations, this case emphasizes the need to rule out both drug hypersensitivity and granulomatous disease. It draws attention towards the need for improved diagnostic markers while also recognizing the utility of serum ACE testing and imaging in these situations. The case highlights the advantage of interdisciplinary management in difficult hepatology patients and the effectiveness of corticosteroids.
Key clinical message
This case demonstrates the difficulty of making a distinction between hepatic sarcoidosis and drug-induced liver damage in cases where the two diseases mimic each other. Both etiologies must be considered in cases of unexplained acute liver injury with systemic symptoms. Although corticosteroids can be an effective treatment of immune-mediated disease, prolonged follow-up is indicated. Interdisciplinary collaboration enhances the treatment of such complex cases and the validity of diagnoses.
如果不明原因的急性肝损伤症状包含多种重叠的病因，则可能导致诊断困难。不常见的疾病如肝结节病和DRESS综合征需要纳入鉴别诊断，但药物性肝损伤和病毒性肝炎是常见的病因。病例介绍：一名28岁女性患者，表现为瘙痒性皮疹、黄疸和右上腹疼痛一个月。实验室检查显示嗜酸性粒细胞增多（520个细胞/μL），高胆红素血症（6.20 mg/dL），肝细胞损伤（AST 401 U/L, ALT 351 U/L）， ACE水平高升高（216 U/L）。影像学显示纵隔淋巴结病变。患者的肝酶和症状在皮质类固醇治疗后明显改善。由于DRESS综合征和肝结节病具有相同的临床和生化特征，因此在本病例中对两种疾病的鉴别诊断带来了挑战。虽然颞叶药物关联和嗜酸性粒细胞增多倾向于药物过敏，但ACE水平升高和淋巴结病变推动了肉芽肿疾病的发展。类固醇反应强调了这两种疾病的共同免疫介导的病理生理学。结论在评估有全身性表现的急性肝损伤时，本病例强调应同时排除药物过敏和肉芽肿性疾病。它提请注意需要改进的诊断标记，同时也认识到在这些情况下血清ACE测试和成像的效用。该病例突出了在肝病困难患者中跨学科管理的优势和皮质类固醇的有效性。本病例表明，在肝结节病和药物性肝损害相似的情况下，很难区分这两种疾病。两种病因必须考虑的情况下，不明原因的急性肝损伤的全身性症状。虽然皮质类固醇可以有效治疗免疫介导性疾病，但需要延长随访时间。跨学科的合作提高了这种复杂病例的治疗和诊断的有效性。
{"title":"A diagnostic dilemma: Differentiating hepatic sarcoidosis from DRESS syndrome in a patient with acute liver injury","authors":"Milan Gaihre , Saket Jha , Rahul Pathak , Sujan Ghimire , Prince Baranawal , Aashish Poudel , Ritika Bhatta","doi":"10.1016/j.hmedic.2025.100374","DOIUrl":"10.1016/j.hmedic.2025.100374","url":null,"abstract":"<div><h3>Introduction</h3><div>If unexplained acute liver injury symptoms imply several overlapping etiologies, diagnostic difficulty can ensue. Less frequent diseases like hepatic sarcoidosis and DRESS syndrome need to be included in differential diagnosis, but drug-induced liver injury and viral hepatitis are frequent etiologies.</div></div><div><h3>Presentation of the case</h3><div>A 28-year-old woman patient presented with pruritic rash, jaundice, and right upper quadrant pain for one month. Laboratory tests showed eosinophilia (520 cells/μL), hyperbilirubinemia (6.20 mg/dL), hepatocellular injury (AST 401 U/L, ALT 351 U/L), and highly raised ACE levels (216 U/L). Imaging revealed mediastinal lymphadenopathy. The patient's liver enzymes and symptoms significantly improved with corticosteroid treatment.</div></div><div><h3>Discussion</h3><div>Because DRESS syndrome and hepatic sarcoidosis share clinical and biochemical characteristics, the diagnostic challenge of differentiating between the two conditions is brought about in this case. While temporal drug association and eosinophilia predisposed towards drug hypersensitivity, the raised ACE levels and lymphadenopathy pushed in the direction of granulomatous disease. The shared immune-mediated pathophysiology of the two diseases was emphasized by the steroid response.</div></div><div><h3>Conclusion</h3><div>In the assessment of acute liver injury with systemic manifestations, this case emphasizes the need to rule out both drug hypersensitivity and granulomatous disease. It draws attention towards the need for improved diagnostic markers while also recognizing the utility of serum ACE testing and imaging in these situations. The case highlights the advantage of interdisciplinary management in difficult hepatology patients and the effectiveness of corticosteroids.</div></div><div><h3>Key clinical message</h3><div>This case demonstrates the difficulty of making a distinction between hepatic sarcoidosis and drug-induced liver damage in cases where the two diseases mimic each other. Both etiologies must be considered in cases of unexplained acute liver injury with systemic symptoms. Although corticosteroids can be an effective treatment of immune-mediated disease, prolonged follow-up is indicated. Interdisciplinary collaboration enhances the treatment of such complex cases and the validity of diagnoses.</div></div>","PeriodicalId":100908,"journal":{"name":"Medical Reports","volume":"14 ","pages":"Article 100374"},"PeriodicalIF":0.0,"publicationDate":"2025-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145157644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-09-22DOI: 10.1016/j.hmedic.2025.100377
Louise Scridelli Tavares, Felipe Augusto Folha Santos, Marianna Pinheiro Moraes de Moraes, Ricardo Pinho Silva, Marcelo de Melo Aragão, Enedina Maria Lobato de Oliveira
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an immune-mediated disorder characterized by a complex neuropsychiatric syndrome and the presence of cerebrospinal fluid antibodies targeting the GluN1 subunit of the NMDAR. While well-documented, its association with demyelinating disorders—such as neuromyelitis optica, myelitis, and acute disseminated encephalomyelitis—remains rare, particularly in pediatric cases. Here, we present an unusual case of a 7-year-old female who initially exhibited area postrema syndrome, followed by acute brainstem syndrome and encephalopathy. Within 2 years, she experienced two relapses marked by longitudinally extensive transverse myelitis, seizures, and diencephalic syndrome. Neuroimaging revealed mild contrast-enhancing lesions in both infratentorial and supratentorial regions. Despite repeated testing, both antibodies to myelin-oligodendrocyte glycoprotein and aquaporin-4 remained negative. Subsequently, a comprehensive antibody testing protocol, including indirect immunohistochemistry on rat brain tissue and an extensive panel of both fixed and live cell-based assays was requested, confirming the presence of anti-NMDAR antibodies, along with superimposed reactivity to cerebellar granular cells. This report explores the diagnostic and therapeutic complexities of coexisting anti-NMDAR encephalitis and demyelinating disorders. The rarity of this overlap and its distinct clinical features underscore the need for further research into the immunological mechanisms underlying these conditions.
抗n -甲基- d -天冬氨酸受体（NMDAR）脑炎是一种免疫介导的疾病，其特征是复杂的神经精神综合征和针对NMDAR GluN1亚基的脑脊液抗体的存在。虽然有充分的文献记载，但它与脱髓鞘疾病（如视神经脊髓炎、脊髓炎和急性播散性脑脊髓炎）的关系仍然很少见，特别是在儿科病例中。在这里，我们提出一个不寻常的病例，一名7岁的女性，最初表现出区域后综合征，随后出现急性脑干综合征和脑病。在2年内，她经历了两次复发，表现为纵向广泛的横贯脊髓炎、癫痫发作和间脑综合征。神经影像学显示幕下和幕上区域均有轻度增强病变。尽管反复测试，髓鞘-少突胶质细胞糖蛋白和水通道蛋白-4抗体均为阴性。随后，一项全面的抗体检测方案，包括间接免疫组化大鼠脑组织和广泛的固定细胞和活细胞检测，证实了抗nmdar抗体的存在，以及对小脑颗粒细胞的叠加反应性。本报告探讨了共存的抗nmdar脑炎和脱髓鞘疾病的诊断和治疗复杂性。这种重叠的罕见性及其独特的临床特征强调了对这些疾病的免疫学机制进行进一步研究的必要性。
{"title":"Exploring the coexistence of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis and demyelinating disorders in a pediatric case","authors":"Louise Scridelli Tavares, Felipe Augusto Folha Santos, Marianna Pinheiro Moraes de Moraes, Ricardo Pinho Silva, Marcelo de Melo Aragão, Enedina Maria Lobato de Oliveira","doi":"10.1016/j.hmedic.2025.100377","DOIUrl":"10.1016/j.hmedic.2025.100377","url":null,"abstract":"<div><div>Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an immune-mediated disorder characterized by a complex neuropsychiatric syndrome and the presence of cerebrospinal fluid antibodies targeting the GluN1 subunit of the NMDAR. While well-documented, its association with demyelinating disorders—such as neuromyelitis optica, myelitis, and acute disseminated encephalomyelitis—remains rare, particularly in pediatric cases. Here, we present an unusual case of a 7-year-old female who initially exhibited area postrema syndrome, followed by acute brainstem syndrome and encephalopathy. Within 2 years, she experienced two relapses marked by longitudinally extensive transverse myelitis, seizures, and diencephalic syndrome. Neuroimaging revealed mild contrast-enhancing lesions in both infratentorial and supratentorial regions. Despite repeated testing, both antibodies to myelin-oligodendrocyte glycoprotein and aquaporin-4 remained negative. Subsequently, a comprehensive antibody testing protocol, including indirect immunohistochemistry on rat brain tissue and an extensive panel of both fixed and live cell-based assays was requested, confirming the presence of anti-NMDAR antibodies, along with superimposed reactivity to cerebellar granular cells. This report explores the diagnostic and therapeutic complexities of coexisting anti-NMDAR encephalitis and demyelinating disorders. The rarity of this overlap and its distinct clinical features underscore the need for further research into the immunological mechanisms underlying these conditions.</div></div>","PeriodicalId":100908,"journal":{"name":"Medical Reports","volume":"14 ","pages":"Article 100377"},"PeriodicalIF":0.0,"publicationDate":"2025-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145120313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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