Medical Reports最新文献

Introduction

The hepatitis C virus (HCV) is a hepatotropic and lymphotropic virus. Its infection generates a chronic stimulus to the immune system, giving rise to a wide range of systemic diseases with rheumatological, hematological, neurological, renal, and pulmonary manifestations. Interstitial lung disease (ILD) is one of the most common and harmful direct effects of chronic HCV infection in the lung. However, polyarthralgia and arthritis are the most common rheumatic conditions associated with this infection. There are also less common ones, such as myopathies, including anti-synthetase syndrome (ASS). Although immune syndromes are common in patients with chronic HCV infection, their pathogenesis for some illnesses is often unclear. This case report discusses the association between ILD, hepatitis C, and rheumatologic diseases. We cover clinical manifestations, theories of pathogenesis, and the importance of selecting appropriate treatment for these patients.

Cases presentations

Two clinical cases are presented, both diagnosed with ILD associated autoimmune diseases in patients with HCV infection. The first case is a 76-year-old man with progressive dyspnea, dry cough, muscle weakness, and joint pain in both hands. Physical examination revealed dry velcro-type crackles and the presence of clubbing. Laboratory studies showed a hepatitis C viral load detectable by PCR, positive rheumatoid factor (RF), and anti-citrullinated peptide (anti-CCP). Chest CT scan showed a usual interstitial pneumonia pattern (UIP). Therefore, this patient was diagnosed with ILD and concomitant rheumatoid arthritis (RA) due to HCV infection. The second case is a 44-year-old woman complaining of dry cough and dyspnea, chest tightness, odynophagia, itching, and nasal congestion. On physical examination, bilateral subscapularis fine crackles, mechanic's hands. Blood laboratory analyses revealed a positive hepatitis C antibody test with hepatitis C virus viral load undetectable by PCR, RF: (+), anti-Ro-52 (+); anti-PL-12 (+), anti-Ro/SSA 52 (+). Chest CT scan showed a pattern of organizing pneumonia (OP). As a result, we diagnosed the patient with ILD, ASS, and past infection with the HCV.

Conclusions

HCV and autoimmune diseases affect multiple systems, with lung involvement being a poor prognosis in both cases. Our case reports demonstrate positive outcomes in treating challenging diseases through close patient monitoring and individualized treatment decisions based on their needs, despite the absence of treatment guidelines for these patients.

Drug-induced thrombotic microangiopathy due to an immune reaction is idiosyncratic and not dose-dependent. The classic example is quinine-dependent antibodies resulting in thrombotic microangiopathy due to activation of endothelial cells. Eltrombopag is a thrombopoietin-receptor agonist indicated in resistant chronic immune thrombocytopenia (ITP). This is the first report of full-blown biopsy-proven thrombotic microangiopathy with acute kidney injury (AKI) and nephrotic syndrome (NS) in a patient with chronic ITP who was initiated on eltrombopag therapy.

Mitomycin is an alkylating chemotherapeutic agent that is used for the treatment of anal cancers. Pulmonary toxicities associated with mitomycin are broad and have been well described and range from acute bronchospasm, diffuse alveolar damage, interstitial pneumonitis, pleural disease to pulmonary veno-occlusive disease^{1, 2}. The following is a case of a 63-year-old woman who suffered mitomycin-related acute lung injury 14 days after receiving the first dose. She had escalating oxygen needs, which eventually required mechanical ventilation. Treatment included high-dose steroids and broad-spectrum antibiotics; however, her respiratory function never recovered, and she died from cardiopulmonary arrest from hypoxia. This case highlights that patients undergoing therapy with mitomycin who develop respiratory symptoms should have this lung toxicity considered and the need for further research to recognize and treat this rare complication.

Mycobacterium xenopi, a slow-growing non-tuberculous mycobacterium uncommonly recognized pathogenic organism especially in the United States. We present a unique and interesting case of pulmonary cavitary lesions and infection in a young patient with no comorbidities.

Implant treatment presumes that implants are placed in bone, without any contact with root. At ankylosed teeth, complete root removal is often invasive; subsequently, the sites require additional augmentation procedures to complete the treatment. Execution of a proper treatment is an important step for implant procedures. Implant failure occurs when these parameters are not selected properly. Implant failure can be avoided but may occur in few cases. The aim of this report is an unconventional implant placement with ankylosed root fragments, avoiding extractive invasive surgery and bone damage furthermore handling its post operative complications. In this case report an implant was placed in contact with ankylosed root following which patient reported back with exposed implant shoulder which was surgically manged by Coronally advanced flap using nanohydroxyapatite and fish collagen membrane leading to healthy periimplant mucosa. This case report opens up new avenues to implant placement at sites with compromised osteotomy sites to avoid an invasive extraction surgery and management of its post operative complications

One of the adverse complications of familial Mediterranean fever (FMF) is amyloid nephropathy, which usually progresses silently within 10–20 years into end-stage renal disease (ESRD). However, this case presented with rapid progression to ESRD, and the cause is suspected to be an amyloid storm. There are only a few cases that were reported to have developed this condition.

A 28-year-old male patient with a proven past medical history of FMF for five years was referred to the nephrology service of Mansoura University Hospitals (MUH) with acute kidney injury (AKI), heavy proteinuria, and high serum inflammatory markers. The condition deteriorated with rapidly increasing serum creatinine during admission and necessitated starting hemodialysis. Renal histopathology reported heavy renal amyloid deposition. The patient became hemodialysis dependent in the follow-up visits three months after discharge. This case raises the importance of suspecting an amyloid storm in FMF patients.

Background

The SARS-CoV-2 epidemic has wreaked havoc on the world's leading healthcare systems, especially in intensive care. While cytomegalovirus (CMV) co-infections are widespread in severely ill patients because of an underlying immune suppression brought on by various causes, their influence on patients riddled with COVID-19 is unknown. Nevertheless, there is a correlation between severe COVID-19 and significant immune suppression, which has an impact on the reactivation of the coronavirus (CMV) and subsequently affects the clinical outcome.

Case presentation

The authors provide a case series of four patients with severe COVID-19-related respiratory failure referred to a high dependency unit (HDU). During their stay in the HDU, all the patients acquired CMV reactivation.

Conclusion

COVID pneumonia and immunosuppressants are used to suppress cytokine storms, but they can also play a role in CMV reactivation and its implications for fatal outcomes.

Chronic granulomatous disease (CGD) is caused by defective phagocyte NADPH oxidase function, leading to recurrent catalase-positive bacterial and fungal infections, granulomas, and hyperinflammatory manifestations. In some cases of CGD, the identified genetic variant may be novel or discordant with the patient presentation. In these cases, assessment of NADPH oxidase specific protein expression may be beneficial. Here, we present a 16-month-old male presenting with Nocardia and Cutibacterium infection and DHR-based flow cytometry with absent neutrophil oxidative burst. Genetic testing revealed a novel intronic variant in CYBB, so further testing was pursued. The patient had decreased gp91phox and p22phox in neutrophils and monocytes, confirming the diagnosis of X-linked CGD. When available, additional studies, including protein expression and/or functional evaluation can improve genotype-phenotype correlations.

Introduction

Testicular cancers account for < 1 % of solid tumors in males. The majority (95 %) of testicular cancers are germ cell tumors (GCTS), and they are histologically subclassified into seminomas and non-seminomas. 70 % of seminoma patients present with localized stage I disease between the ages of 24 and 34. The estimated 5-year survival rate and 15-years cancer-specific survival of 95 % and 99 %, respectively. The overall crude relapse rate is 15.2–19.3 %, with most relapses occurring in the first two years. We present a case of relapsed metastatic mixed GCTS after 13 years of surgical resection of stage I seminoma.

Case description

A 45-year-old male patient with a remote history of localized left testicular cancer was treated with unilateral orchiectomy in 2008. He presented to the ER with a complaint of severe abdominal pain associated with nausea and vomiting. He reported loss of appetite and intentional weight loss of about 15 lbs. over the past six weeks. Computed tomography (CT) of the abdomen and pelvis with contrast showed 14.9 × 11 × 11.3 cm heterogeneous hypodense retroperitoneal mass circumscribes the abdominal aorta and inferior vena cava (IVC). Small bowel obstruction is not excluded.

The patient underwent upper GI endoscopy revealing severe extrinsic stenosis in the third portion of the duodenum. CT-guided biopsy of the retroperitoneal mass results was consistent with poorly differentiated adenocarcinoma. Immunotoxins demonstrated strong stains with CD117, CD30, and CDX2, consistent with mixed germ cell tumors; 85 % seminoma, 5 % embryonal carcinoma, 5 % yolk sac tumor, and 5 % teratoma. Tumor markers testing showed an alpha-feto protein level of 2905 ng/mL (normal level 10–20 ng/mL), Human chorionic gonadotropin serum level of 1062 mIU/mL (normal level 0–3 mIU/mL), and lactic dehydrogenase level of 1554 IU/L (normal level 313–618 IU/L).

Discussion

Our patient presented with relapsed mixed germ cell tumor after 13 years of successful surgical resection and surveillance for unilateral seminoma. Recurrence was in the form of large retroperitoneal mass, most probably arising from micro-metastases to the paraaortic nodes, causing mechanical compression. Similar cases that presented recurrence after a long duration of surveillance have been reported. However, very few cases of recurrent testicular cancer presenting with intestinal obstruction have been reported where a primary testicular cancer initially presented with GI metastases causing mechanical obstruction.

Conclusion

We describe an unusual case of large metastatic retroperitoneal mass originating from a mixed germ cell tumor in a patient who presented with small bowel obstruction after a very long surveillance period. More extended period of surveillance beyond 2–6 years after surgical resection of localized testicular cancer patients may be warranted.