Medical Reports最新文献

Modafinil is a psychostimulant primarily used to manage sleep disorders, multiple sclerosis, and both unipolar and bipolar depression. Despite the risk of precipitating mania and psychosis, it is also employed as a non-antipsychotic augmentation therapy in schizophrenia. Only two case reports documented managing mania and narcolepsy with co-prescribed lithium carbonate. Below we discuss a case of treatment-induced mania in a gentleman diagnosed with Bipolar Affective Disorder (BPAD) comorbid with type I narcolepsy who was prescribed modafinil, venlafaxine and fluoxetine. The successful mood stabilisation with lithium carbonate suggests a potential role for mood stabilisers in such cases. This case report underscores the complexity of treating narcolepsy with comorbid psychiatric conditions and the importance of comprehensive evaluation and tailored management.

Non-small cell lung cancer (NSCLC) is the most common subtype of lung cancer. Among NSCLC, lung adenocarcinoma is majorly characterized by driver activating mutations in the EGFR (Epidermal growth factor receptor) gene, covering exons-18, 19, and 21. The most frequently observed mutations are the classical mutations Exon–19 E746_A750 deletion, and Exon - 21 L858R, EGFR exon-18 G719X than the rare variants of these genes. Besides classical mutations and other rare mutations, compound mutations are not very profound. Here, in this present case report, we identified the rare occurrence of EGFR E709A and L858R in tissue and liquid biopsy sample of the patient. The identified compound mutation had been validated in FFPE (formalin fixed paraffin embedded) tissue sample by Sanger sequencing. In addition, the concordance of the rare variants in tumor tissue as well as liquid biospy strongly suggests the clinical utility of liquid biopsy. The patient had been treated with single agent gefitinib which showed mixed response and later treatment had been upgraded to pemetrexed + carboplatin + gefitinib. The sensitivity and specificity of NGS technology provide an opportunity to identify uncommon variants, which opens up a wider avenue for targeted therapeutics.

Hemophagocytic lymphohistiocytosis (HLH)¹ is a fatal disease that may occur as a primary inherited or secondary due to several causes, including infections such as dengue. Encephalitis and encephalopathy are the most common neurological presentations of dengue. A 17-year-old female, after the critical period of dengue, developed tachycardia, rigidity, deteriorating consciousness level, seizures, and stereotyped movements. Fever did not remit and was subsequently diagnosed as HLH with ferritin more than 30,000 ng/mL and treated with steroids. This case report describes a patient who survived despite having an unusual combination of dengue hemorrhagic fever, encephalitis, and HLH.

Corynespora includes plant pathogenic species with a worldwide distribution and a wide host range, particularly cereals and grass.

We describe a case of black grains eumycetoma of the right foot of 33 years old Sudanese male caused by Corynespora cassiicola after 55 years from the first case reported by Mahgoub ES in 1969. The fungus was successfully identified based on the cultural and molecular techniques as a Corynespora cassiicola. The clinical strain showed low MIC to itraconazole (0.12 µg/ml). Therefore our patient received 200 mg itraconazole BID and folic acid 5 mg once per day. A good clinical response to medical treatment was seen as the sinuses started to heal and the lesions decreased in size. There was no recurrence at the time of the one-year follow up.

In conclusion, updated taxonomy is essential to identify the new causative agents to the species level and is fundamental to elucidate the eumycetoma associated with this unusual fungus and to determine the appropriate therapy.

Ornidazole, a synthetic nitroimidazole derivative, is a commonly prescribed antiparasitic drug for parasitic infestations, including amebiasis, giardiasis, and Trichomonas vaginalis. While rare, ornidazole-related hepatotoxicity has been reported in a limited number of cases. In such cases, it can be challenging to identify whether elevated liver enzymes are a result of drug-induced hepatitis or autoimmune hepatitis. However, differentiating between these two conditions is crucial for determining the most appropriate treatment approach. Our observations indicate that nitroimidazole derivatives can cause hepatotoxic damage similar to autoimmune hepatitis and drug-induced hepatitis.

We describe a case of 72-year-old female patient diagnosed with multiple myeloma (MM) in 2023, who presented with generalized fatigue. Patient was found to have elevated liver enzymes on biochemical workup. Her hepatotoxicity was attributed to Bortezomib therapy after ruling out other etiologies. Initially, patient’s liver enzymes were normal prior to Bortezomib initiation. However, her liver enzymes started trending up at day 3 during her second session of Bortezomib. Liver function tests normalized 2 weeks after discontinuing Bortezomib. This fact points to a drug-induced liver injury (DILI) whereby Bortezomib is the likely culprit. Patient was started on thalidomide-containing regimen thereafter. Her liver enzymes remained within normal range following thalidomide-based regimen.

We present a case of breast sarcoidosis with a distinctive radiological presentation. The patient, a 47-year-old asymptomatic woman, underwent a routine screening mammogram that identified a small, slightly denser mass in the right upper quadrants of the breast, not seen in previous exams. Ultrasonography did not detect a breast mass; however, suspicious lymph nodes were noted in the ipsilateral axillary cavity. A fine-needle aspiration (US-FNA) was performed on one of these lymph nodes. Subsequently, digital breast tomosynthesis-guided vacuum-assisted biopsy (DBT-VAB) was conducted on the mammographic finding, confirming the diagnosis of sarcoidosis.

Introduction

Leukocyte adhesion deficiency (LAD) is a rare autosomal recessive disorder characterized by improper primary immune response due to absent or decreased adhesion molecules, leading to impaired neutrophil migration into surrounding tissues. LAD is divided into four subtypes: LAD-I, LAD-II, LAD-III, and LAD-IV, based on the underlying mutations. Clinical presentation typically includes recurrent infections and neutrophilia, and it is confirmed through flow cytometry and genetic testing. However, these diagnostic methods may not be available during wartime. Here, we present a case of LAD in a Syrian infant.

Case presentation

A 2-month-old infant born to consanguineous parents presented with recurrent skin lesions in the groin and axillary region, accompanied by fever, night sweats, anorexia, and milky vomits twice a day. Clinical examination revealed a 3×4 cm umbilical hernia, multiple ulcerated skin lesions with a base of yellow necrotic tissue in the groin, and a 2.5 cm ulcer in the axilla. The laboratory tests confirm the presence of neutrophilia (WBC: 64.07 ×10⁹/L; Neutrophils: 79 %), raising suspicion for LAD. However, confirmation through flow cytometry and genetic testing was not possible due to unavailability. Antibiotics were administered, but the patient was discharged against medical advice.

Conclusion

The scarcity of documented LAD cases from Syria, coupled with the lack of resources to confirm the diagnoses of LAD using flow cytometry, highlights the need for a structured approach to such cases based on clinical presentation and available laboratory findings. This approach is crucial for ensuring timely diagnosis and appropriate management, especially in resource-constrained settings affected by conflict.

Dental implants are long-term successful when the osteointegration is maintained with little yearly loss of crestal bone. The current study assesses the crestal bone loss surrounding Osseo integrated implants by adding a concentrated growth factor as an extra factor to maintain the crestal bone levels. The research comprised single patient with a single edentulous location. Along with the implant, concentrated growth factor is inserted. Three and nine months after the implant was implanted, assessments of soft tissue characteristics such as the sulcus bleeding index and plaque index were conducted. Hard tissue metrics, such as volume and bone density, were measured using cone-beam computed tomography both nine months after implant implantation and immediately following implant placement. baseline and nine-month markers were compared, several hard and soft tissue parameters indicated a significant change at nine months. By elevating the density and volume of bone surrounding dental implants, concentrated growth factor can be used as a breakthrough in customized medicine to promote quicker healing and osseous regeneration.

Background

Fusobacterium necrophorum is an anaerobic gram-negative rod commonly found in humans' gastrointestinal and respiratory tracts. While classically associated with Lemierre's syndrome, F. necrophorum can cause pharyngitis, sinusitis, and otitis, especially in young adults. On rare occasions, it can progress to lifethreatening complications including meningitis, intracranial abscess, and sinus thrombosis.

Case Report

Case Report-An adolescent presented multiple times in one week for persistent right ear pain. Despite treatment, the patient continued to worsen and presented to the emergency department after developing fever, lethargy, and vomiting. Lumbar puncture confirmed meningitis with over 250 white blood cells x10∼3/UL. The patient was transferred to a children's hospital, where cavernous sinus thrombosis was also identified. The patient underwent mastoidectomy and started on heparin intravenously. Upon discharge, he transitioned to enoxaparin and later rivaroxaban for three months. Why should an emergency physician be aware of this? Fusobacterium necrophorum is a rare cause of otitis and meningitis but can be deadly if not treated appropriately. As a gram-negative anaerobe, standard meningitis treatment does not adequately treat this organism. Significant morbidity and mortality are associated with this disease.