Medical Reports最新文献

Placenta increta is an uncommon yet clinically significant complication that can result in maternal morbidity and mortality. It is primarily seen during the third trimester. There have been very few reports of it being discovered in the first trimester of pregnancy. However, the presentation was even more unique in our patient who was initially diagnosed with molar pregnancy via pelvic sonogram.

Case presentation

A 30-year-old G4P3, with three previous C-sections, presented with per vaginal bleeding at 13 weeks and 4 days of gestation. Pelvic sonogram suggested molar pregnancy, which led to a suction and curettage. During the planned procedure, severe uncontrolled hemorrhage ultimately resulted in a total abdominal hysterectomy. Subsequent histopathology revealed placenta increta with less than 50 % invasion of villi and trophoblasts into the myometrium, thus giving us our final diagnosis.

Conclusion

This case showcases how placenta increta can be found as early as first trimester- rare though it may be. This unique condition, which could result in major morbidity, should be among the differential diagnoses when unexpectedly profuse hemorrhage is encountered in a woman with previous C-section scar.

Background

The classification of amyloidosis is determined by the type of defected protein. Amyloidosis type AA is induced by chronic inflammatory processes, such as long-standing infections or inflammations. However, it is seldom caused by inflammatory bowel disease (IBD). Gastrointestinal (GI) involvement in AA amyloidosis typically lacks specific symptoms, with most cases remaining subclinical. Furthermore, colonoscopy findings such as mucosal fragility and ulcerations can be easily mistaken for ulcerative colitis (UC). We present a case of AA amyloidosis in which GI symptoms closely resembled those of UC.

Case presentation

A 33-year-old male was admitted with symptoms of diarrhea, headache, blurry vision, and weight loss. He had been diagnosed with amyloidosis one month prior. The renal biopsy revealed secondary AA amyloidosis. However, two weeks after admission, the patient developed severe bloody diarrhea, and a colonoscopy revealed an ulcerated and fragile mucosa consistent with ulcerative colitis (UC). The patient received treatment for a UC flare-up as well as for infectious colitis, which led to a temporary improvement. Nevertheless, histopathological examination ruled out IBD and confirmed the presence of AA amyloidosis. Furthermore, a follow-up biopsy after two months revealed the absence of UC-related features.

Conclusions

GI amyloidosis can manifest as severe and potentially life-threatening colitis, clinically mimicking features of IBD, both during physical examination and endoscopy. However, histopathological analysis plays a crucial role in the diagnosis. Moreover, an early diagnosis can lead to improved outcomes, enhancing the quality of life for amyloidosis patients by effectively managing the associated diarrhea.

Sarcoidosis is a systemic granulomatous disorder affecting individuals worldwide. It can affect all organs to a varying extent. Involvement of the prostate gland is extremely unusual with only 18 cases reported yet in literature. We hereby, present such a rare case of a 60-year-old male with severe urinary symptoms and elevated PSA levels upto 5.12 ng/ml. On radiological evaluation, the lesion was reported as suspicious of prostate cancer (PIRAD-4). The patient underwent prostatic biopsy, which revealed a non-caseating granulomatous lesion destroying the prostate parenchyma. With the history of previous diagnosis of pulmonary sarcoidosis, the diagnosis of prostatic sarcoidosis was rendered.

Background

Sedative/hypnotic withdrawal syndrome remains challenging in intensive care units, particularly after prolonged exposure. The sparse literature on this subject makes managing these cases an ongoing challenge. This case report explores phenobarbital's potential as an alternative treatment for sedative-hypnotic withdrawal syndrome, especially when traditional adjunctive treatments prove ineffective.

Case presentation

We describe a case of a 26-year-old female admitted with Tuberculous meningitis, who, due to extended sedation, exhibited signs of sedative/hypnotic withdrawal. Phenobarbital was introduced after the patient resisted typical weaning protocols, and her response was closely monitored. Phenobarbital highlighted a rapid onset of action and effective management of withdrawal symptoms. It facilitated the successful weaning of sedation within a short time frame, allowing the patient to transition from ICU without additional sedative treatments.

Conclusion

Phenobarbital is a promising alternative in managing sedative/hypnotic withdrawal syndrome, especially in patients who do not respond to standard treatment protocols. However, its usage warrants careful monitoring due to potential side effects. More extensive studies are needed to validate these findings.

Tuberculous pyomyositis is a rare condition, that is commonly associated with, immunocompromised states, such as acquired immunodeficiency syndrome (AIDS), Crohn's disease, multiple myeloma etc. Acute leukaemia, and its treatment is a condition that predisposes patients to several uncommon infections, but even in this setting the occurrence of TB pyomyositis is not commonly reported. There are several challenges to making this diagnosis, with disease relapse being an important differential diagnosis. Here we report the case of a 19 year old female patient, who was diagnosed as a case of TB myositis while she was receiving maintenance therapy, as a part of treatment of Acute Lymphoblastic Leukaemia.

This case report aims to investigate the complications arising from unsupervised self-treatment of methamphetamine addiction and the subsequent role of nonsteroidal anti-inflammatory drugs (NSAIDs) in contributing to severe gastrointestinal damage. The objective is to enhance awareness among emergency physicians regarding the intricacies and challenges inherent in managing patients engaged in self-managed addiction treatment processes. A 35-year-old male, attempting self-directed methamphetamine cessation, presented to the ED with abdominal pain, fatigue, and recurrent ED visits. The patient's reliance on NSAIDs for withdrawal symptoms inadvertently led to severe gastric perforation, requiring emergency surgical intervention. Current literature lacks specific guidelines for managing methamphetamine-related gastrointestinal injuries, often resulting in NSAID administration for symptomatic relief. This case highlights the need for tailored protocols in emergency settings, as methamphetamine-induced intestinal damage may amplify NSAID-related complications. Recent studies indicate that methamphetamine exposure compromises the intestinal mucosal barrier, exacerbating the risk of NSAID-induced damage. Pro-inflammatory cytokines play a role in mucosal damage, and methamphetamine's sympathomimetic effects further contribute to gastrointestinal motility disturbances. Emergency physicians should be alert to the challenges of managing methamphetamine users who attempt unattended withdrawal. Balancing patient confidentiality with recognizing methamphetamine's impact on the gastrointestinal system is crucial, especially when considering NSAID administration. This case report underscores the importance of heightened awareness am.

An 84-year-old genetic Creutzfeldt–Jakob disease with V180I mutation in the prion protein gene (V180I gCJD) woman presented with rapid progressive dementia. Six months before symptom onset, diffusion-weighted imaging (DWI) and T2-weighted imaging (T2WI) were normal; however, voxel-based morphometry (VBM) evidenced volume loss of the right temporal pole and hippocampus. Two months after symptom onset, brain imaging revealed cortical DWI hyperintensities with swelling on T2WI, and hypoperfusion on ¹²³I-IMP single photon emission computed tomography in the right dominant bilateral temporal lobes, and right front-parietal lobes, striatum, and parahippocampus. The VBM loss had spread across the right temporal lobe and hippocampus. Considering spongiform changes and neuron loss, these imagings were useful for understanding the neuropathological mechanisms of V180I gCJD.

Myofibroblastoma of male breast is an uncommon benign tumor of breast arising from the stromal mesenchymal cells. Characterizing myofibroblastoma and differentiating it from other benign or malignant breast tumors is challenging due to the nonspecific imaging features and the existence of multiple histological variants. There are no pathognomonic imaging features specific to myofibroblastoma and the data available in literature is limited to few case reports. In this report we present the imaging and histopathological features of a biopsy proven myofibroblastoma of male breast and review the multimodality imaging features in correlation with clinical and histopathological findings.

We previously reported a case of skin amyloidosis showing improvement after adipose tissue-derived stem cell (ADSC) therapy. This report provides a five-year follow-up on the status of the same site of skin amyloid deposition, demonstrating continued improvement since the initial report. The patient, a dermatology professor, expressed profound satisfaction with the unexpected disappearance of amyloid deposits that had been progressing gradually over several decades. While the cause of this sudden regression remains unclear, attributing it definitively to the effects of ADSCs is challenging.

However, given the absence of interventions, the consistent improvement over the two months following ADSC administration, and the reported abnormal protein-degrading enzyme activity associated with ADSCs, a natural interpretation suggests a potential correlation between ADSC administration and skin amyloidosis improvement. Although caution is warranted in attributing the effects solely to ADSCs, the absence of other specific treatments and the documented enzymatic activities of ADSCs support this hypothesis.

While acknowledging the speculative nature of associating the observed effects with ADSCs, the enduring positive response raises intriguing questions about the duration of ADSC efficacy. This is particularly relevant as ADSCs, beyond their potential impact on skin amyloidosis, hold promise as a novel therapeutic approach for progressive neurodegenerative disorders lacking definitive treatment methods.

Understanding the duration and sustainability of ADSC effects is crucial for evaluating their broader applications, not only in skin amyloidosis but also in the realm of neurodegenerative diseases. This case underscores the need for further investigation into the potential of ADSCs as a novel therapeutic avenue in the context of challenging and progressive medical conditions.