Clinical Case Reports最新文献

Severe, unexpected pain during botulinum toxin injection is a critical red flag for reconstitution error. Using sterile water instead of normal saline may cause atypical, wider-spread effects like proximal muscle weakness, even at standard doses. Strict adherence to saline reconstitution is essential to prevent this complication.

Pregnancy-related luteal stromal proliferation can mimic ovarian neoplasia; recognizing this benign change prevents misdiagnosis and unnecessary treatment.

Liposomal amphotericin B (L-AmB), as a modified formulation of traditional amphotericin B, have better targeting and lower toxicity. However, clinicians have limited experience with the use of L-AmB for the treatment of Aspergillus flavus (A. flavus) at present. We described two cases of immunocompetent adults; despite undergoing various antibacterial treatments, the symptoms were persistent. Based on the clinical characteristics and results of metagenomic next-generation sequencing and (or) pathology, pulmonary A. flavus infection was confirmed. Subsequently, L-AmB was added to the treatment. Following the initiation of antifungal therapy, the patients' symptoms and images were significantly improved. In conclusion, even in immunocompetent individuals, pathogen detection and pathological examination are crucial when treatment is not effective. In pulmonary A. flavus infection, L-AmB may deserve greater attention and confidence in clinic.

Takayasu arteritis (TAK) is a rare large-vessel vasculitis affecting the aorta and its major branches. Although autoimmune mechanisms are central, prior mycobacterial infections have been hypothesized to contribute to the disease onset. A 55-year-old South Asian woman with a history of vitiligo and treated multibacillary leprosy presented with right upper limb claudication and absent radial pulse. Angiography demonstrated thickening and narrowing of the right subclavian artery. Based on the 2022 ACR/EULAR classification criteria, TAK was diagnosed with a cumulative score of eight. Initial immunotherapy with intravenous prednisolone and methotrexate, followed by oral leflunomide, failed to achieve clinical improvement, following which endovascular stenting was planned. This case emphasizes the potential role of prior mycobacterial infections in TAK pathogenesis and highlights the need for early recognition, comprehensive vascular imaging, and individualized management in atypical or postinfectious presentations.

Streptococcal infection-induced narcolepsy is a rare neurological disorder that may be accompanied by severe psychiatric symptoms and social dysfunction. In this case, delayed diagnosis and treatment were followed by progressive symptom worsening, including marked cognitive decline. The report underscores the importance of considering infectious triggers in narcolepsy and the therapeutic dilemma in managing psychiatric comorbidities-wake-promoting agents may exacerbate psychosis, while antipsychotics risk tardive dyskinesia. Early recognition and individualized treatment are crucial to improving outcomes.

Conjoined twinning is a rare and severe complication of monozygotic pregnancies. Assisted reproductive technologies (ART), including in vitro fertilization (IVF), may increase the risk of such anomalies. We report a case of thoraco-omphalopagus conjoined twins following a day 5 embryo transfer after IVF with intracytoplasmic sperm injection (ICSI). The diagnosis was made by ultrasound at 8 weeks' gestation and confirmed the presence of fused thoracic and abdominal structures with a shared heart. The pregnancy was managed through multidisciplinary counseling, and termination was performed following spontaneous fetal demise. This case underscores the importance of early imaging, detailed embryologic understanding, and coordinated care in managing rare IVF-associated anomalies.

Tolosa-Hunt syndrome could be considered in patients with painful ophthalmoplegia following COVID-19 infection, but caution should be exercised in attributing causality. Careful exclusion of alternative diagnoses is essential. Corticosteroids usually produce quick clinical relief. Ultimately, any association with COVID-19 is regarded as speculative and unproven.

Patients with Graves' disease may develop delayed heart failure with reduced ejection fraction even after achieving biochemical euthyroidism. Vigilance for cardiac complications and early referral to cardiology are essential.

We present two novel cases of aseptic sinusitis resulting from PDL-1 checkpoint inhibitor use. Prompt identification and diagnosis and a multidisciplinary approach with oncology and rheumatology are imperative. High-dose steroids are preferable to antibiotics or antihistamines due to primary cancer treatment outcomes.

The most common adverse events associated with ceftazidime include hypersensitivity reactions, gastrointestinal disturbances, and transient abnormal liver function tests, whereas neutropenia is a rare complication. We present a case of ceftazidime-induced agranulocytosis in an 89-year-old Chinese woman who presented with right upper quadrant abdominal pain, nausea, and vomiting. Imaging confirmed choledocholithiasis, cholecystitis, and hepatic cysts, and laboratory tests revealed elevated inflammatory markers. Treatment with intravenous ceftazidime initially improved her symptoms and inflammatory markers; however, severe neutropenia subsequently developed, progressing to agranulocytosis. After excluding other potential causes, ceftazidime was discontinued, and granulocyte colony-stimulating factor (G-CSF) was administered, leading to hematological recovery. This case underscores that ceftazidime, albeit rarely, can cause severe drug-induced agranulocytosis. Clinicians should consider this possibility in cases of unexplained cytopenia, as prompt drug cessation and G-CSF therapy may facilitate timely hematological recovery.