Journal of medical cases最新文献

Anomalous pulmonary vein drainage is a rare but clinically relevant variant of the cardiovascular anatomy. We present a case report of a 22-year-old male who was incidentally found to have anomalous pulmonary vein drainage into the innominate vein. The patient had a known history of seizures and was brought to the emergency department following a simple tonic-clonic seizure. He was subsequently intubated for airway protection and admitted to the medical intensive care unit (MICU). While in the MICU, a left internal jugular central venous catheter (CVC) was placed; however, post-procedural chest radiography showed the tip of the CVC in the left chest. An arterial blood gas (ABG) was concerning for arterial blood. Due to the uncertainty of line positioning, a computed tomography pulmonary angiography revealed a rare abnormal connection between the left innominate vein and the left pulmonary vein. This case underscores the importance of potential variations in pulmonary venous drainage as they may have implications for post-procedural decision-making and potentially clinical outcomes.

Fluoroquinolones (FLQs) are commonly prescribed for infections in both the inpatient and outpatient setting. Though typically well-tolerated, FLQs have been associated with central nervous system adverse effects, especially in older adults and those who metabolize medications at suboptimal rates. Rarely, these drugs can cause serious neurotoxic manifestations, such as seizures, psychosis, or encephalopathy. Although new quinolone derivatives like levofloxacin are most associated with neurotoxic side effects, we show that these unwanted side effects can occur with ciprofloxacin as well. Clinicians should be aware of the neurotoxic side effects of FLQs and its predisposing risk factors, as this is a commonly prescribed class of medication. We aim to contribute to the limited body of literature describing neurotoxic clinical manifestations of FLQs. Herein, we present a case of an 88-year-old male with underlying dementia who presented to the emergency department for evaluation of acute encephalopathy.

Some women infected with Chlamydia trachomatis (CT) are asymptomatic, while others experience lower abdominal discomfort when the inflammatory process extends to the fallopian tubes. Without treatment, salpingitis can progress to pelvic peritonitis and subsequently, peritonitis in the upper abdomen, a condition known as Fitz-Hugh-Curtis syndrome, in some cases. A nucleic acid amplification assay is required for diagnosing CT infection. However, this assay may yield a negative result even in the presence of CT infection. This report presents a case of a 45-year-old woman with a history of hydrosalpinx and no history of lower abdominal pain who underwent endometrial cytology at a local gynecology clinic because of irregular bleeding. The following day, she developed peritonitis. A nucleic acid amplification assay for CT yielded a negative result at the onset of peritonitis. Hence, the patient received tazobactam/piperacillin as a treatment option. However, this drug was ineffective. Subsequently, the patient was found to be positive for serum CT IgG and IgA antibodies. Her peritonitis could have developed as a result of endometrial cytology performed in the presence of a chronic CT infection in the uterus; through this procedure, CT-infected endometrial cells may have spread into the abdominal cavity via the fallopian tubes. Nevertheless, the addition of minocycline hydrochloride markedly improved the symptoms of peritonitis. This case shows that when dealing with chronic CT infections in the female internal genitalia, the standard nucleic acid amplification testing screening test for CT might not be entirely effective in detecting the infection. Additionally, it is important to recognize that in cases of chronic CT infection of the uterus that involved genital bleeding, examining the uterine cavity could lead to peritonitis in a short timeframe.

Heyde syndrome is a triad of aortic stenosis (AS), gastrointestinal (GI) bleeding from angiodysplasia, and acquired von Willebrand disease (vWD). It is hypothesized that stenotic aortic valves cleave von Willebrand factor (vWF) multimers, predisposing patients to bleeding from GI angiodysplasias. This hypothesis is supported by the observation that aortic valve replacement often leads to the resolution of GI bleeding. Heyde syndrome is typically described in the context of AS and small bowel angiodysplasias (Dieulafoy's lesion, intestinal vascular malformation, and arteriovenous malformations). However, data on AS and gastric antral vascular ectasia (GAVE) association are scarce. GAVE is a vascular anomaly characterized by ectatic capillaries, arterioles, and venules, which can lead to upper GI bleeding. The paucity of data on GAVE-AS association may lead to underdiagnosis and/or under-reporting. Herein, we describe two cases of GAVE-AS that were diagnosed and treated at our institution. This case series focuses on patient presentations and clinical outcomes and aims to raise awareness about this rare association.

Immunocompromised patients, especially those receiving B-cell depleting therapies, are at risk for developing atypical presentation with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, with the potential for diagnostic delay and adverse outcomes if such delay occurs. A 66-year-old female with history of granulomatosis with polyangiitis (GPA) with previous pulmonary involvement, treated with rituximab and low-dose prednisolone, presented with prolonged fever and cough after having been treated at home for a mild SARS-CoV-2 infection in early July 2023. The patient had a prolonged course over several months with constitutional symptoms such as fever, cough and malaise. During the investigation, which encompassed a wide range of microbiological and immunological tests, the patient was initially thought to have a flare of GPA which she was treated for without appreciable improvement, then for multiple microbiological organisms without appropriate resolution of the patient's symptoms. The differential diagnosis of prolonged SARS-CoV-2 infection was reconsidered in October 2023, and then confirmed by the presence of SARS-CoV-2 viremia through polymerase chain reaction (PCR) testing of the blood. The patient received a prolonged course of antiviral therapy with complete clinical, virological and radiological resolution. Prolonged SARS-CoV-2 infection with viremia in immunocompromised individuals needs to be considered on the differential diagnosis list in such patients presenting with constitutional symptoms, with PCR testing of the blood as a simple and effective way to establish the diagnosis.

Autoimmune neutropenia (AIN) refers to the immune-mediated destruction of neutrophils. It is a rare condition with an estimated prevalence of less than 1 case per 100,000 per year. Typical treatment involves supportive care with granulocyte colony-stimulating factor (G-CSF) and management of secondary infections with antibiotics. Other therapies targeted at the immune system such as steroids, intravenous immunoglobulin (IVIG), and rituximab have not been thoroughly evaluated, but recently rituximab has shown promising results in one case series. We present a 76-year-old man with the diagnosis of antineutrophil antibody-negative AIN and concurrent immune thrombocytopenic purpura (ITP), whose AIN was treated initially with G-CSF which had a short-lived effect, then treated with rituximab which induced a lasting remission. We then review this case in context of other cases described in the literature, given the paucity of available publications.

Evaluating patients with symptoms suggestive of demyelinating disease such as multiple sclerosis (MS) is common in both the inpatient and outpatient setting but may be difficult if atypical neurological symptoms are present. In this case, a 39-year-old female presented with new onset weakness and paresthesias. The patient reported 3 weeks of progressively worsening left face and hemibody numbness, along with gait abnormality. She was found to have absent lower extremity reflexes, unexpected imaging findings, and a positive anti-Sjogren's syndrome type B (SSB) antibody despite lacking the typical sicca symptoms associated with Sjogren's syndrome (SS). This case report underscores the diagnostic complexity of overlapping MS and SS, highlighting the need for a comprehensive differential diagnosis when atypical neurological symptoms are present. It also emphasizes the importance of considering autoimmune overlap syndromes in such cases, as the co-occurrence of these conditions can significantly impact both diagnosis and treatment strategies, requiring a multidisciplinary approach for optimal patient care.

This is a case report of a previously healthy 26-year-old female with unexplained neurological symptoms that eventually developed malignant catatonia. Because malignant catatonia has a range of clinical manifestations, making prompt diagnosis a challenging task. Due to her relapsing symptoms, the patient was admitted to the inpatient psychiatric unit three times in less than 2 months, and eventually recovered with high doses of lorazepam and several electroconvulsive therapy (ECT) treatments after a stay in the intensive care unit (ICU). This case highlights the importance of avoiding of antipsychotics with dopamine blockade prior to administering a standardized catatonia rating scale in patients with negative symptoms, especially those who have unexplained neurological symptoms or vital sign abnormalities. It also emphasizes the importance of definitive decision-making in pursuing ECT treatment for patients with suspected malignant catatonia, as our patient showed remarkable improvement after ECT. Ultimately, more research is needed to study this rare illness to standardize procedures for treatment of malignant catatonia.

Gastric schwannomas and gastrointestinal stromal tumors (GISTs) are two types of mesenchymal tumors, which represent a group of rare tumors of the gastrointestinal tract. The differential diagnosis between these two tumors is difficult given their very similar appearance and clinical features. The authors present a case of a 63-year-old man with melena and epigastric pain. An upper digestive endoscopy was performed, revealing an ulcerated gastric subepithelial lesion suspected to be a GIST. Further imaging with a computed tomography (CT) scan revealed a well-defined hypodense solid nodular mass, with homogeneous enhancement, measuring 22 × 18 mm, on the anterior wall of the transition between the body and gastric antrum, situated within the submucosal layer. The patient subsequently underwent a laparoscopic atypical gastrectomy, which proceeded without complications. The pathological examination of the excised lesion confirmed it to be a gastric schwannoma, with complete excision. This case report illustrates a rare cause of gastrointestinal bleeding, that requires immediate action, and en bloc resection is usually curative. Given the excellent prognosis after complete resection, a correct diagnosis is essential.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with an increased morbidity and mortality worldwide. Coronavirus disease 2019 (COVID-19) vaccines have shown high efficacy in preventing the infection but with many possible side effects such as hyperglycemia. New-onset diabetes mellitus (DM) and severe metabolic complications have been reported post-vaccination. Here we report a 45-year-old woman who came to the hospital complaining of polyurea, polydipsia, and weight loss 3 weeks after the first activation dose of COVID-19 vaccine. Her hemoglobin A1c (HbA1c) upon presentation was 9% without any prior history of DM. She was diagnosed with type 1 diabetes mellitus (T1DM), as the anti-glutamic acid decarboxylase (GAD) antibody was positive and complicated during follow-up with diabetic ketoacidosis (DKA). This is the first case in Saudi Arabia suggesting that the COVID-19 RNA-based vaccines might cause new onset of T1DM, complicated by late DKA.