Clinical Case Reports最新文献

Clinicians should consider eumycetoma, actinomycotic mycetoma, and skin cancers in patients from tropical or subtropical regions who present with painless swelling and discharging sinuses. The early histopathology, microbiological studies in conjunction with imaging, are of critical importance in narrowing the differential and starting appropriate treatment to prevent complications and deformities.

The coexistence of systemic lupus erythematosus (SLE) and Wilson's disease (WD) is exceedingly rare, posing significant diagnostic challenges due to overlapping clinical presentations. Neurological and psychiatric manifestations commonly associated with WD can obscure or mimic symptoms of other systemic diseases, complicating accurate diagnosis and management. We report the case of a 17-year-old female diagnosed with WD and concurrent SLE, treated at Civil Hospital, Karachi, Pakistan. The patient initially presented with neuropsychiatric symptoms typical of WD, confirmed by diagnostic findings indicative of hepatic copper accumulation. She later developed significant proteinuria, hematuria, fever, and positive autoimmune serologies, raising suspicion of concurrent SLE. Despite therapeutic interventions, including methylprednisolone (1 mg), the patient's condition deteriorated, and she unfortunately succumbed to complications from a blood transfusion reaction. This case underscores the importance of heightened clinical vigilance when managing overlapping presentations of WD and systemic autoimmune disorders like SLE. Early recognition of WD-specific neurological and psychiatric symptoms is critical for timely diagnosis and intervention, potentially mitigating the risk of severe complications and poor outcomes.

Intermittent claudication in patients with horseshoe kidneys may arise from sclerotic changes in the aorta due to compression by the renal isthmus. Vascular disease is a relatively lesser-known extrarenal complication of horseshoe kidneys, but it warrants attention.

Necrotizing pneumonia has a high mortality rate of approximately 50%. Its computed tomography findings lack enhancement in areas of consolidation. These findings should be interpreted as potentially indicative of a severe clinical course. Hypermucovisous strains of Klebsiella pneumoniae are often hypervirulent and may cause fatal necrotizing pneumonia.

Dental fluorosis, a condition caused by excessive fluoride intake during enamel formation, can significantly affect patients' quality of life due to aesthetic concerns. Depending on severity, treatment options range from bleaching or resin infiltration to more invasive techniques like veneers or crowns. In this article, a young patient with severe dental fluorosis underwent a stepwise, personalized and minimally invasive treatment including bleaching, micro- and macro-abrasion, resin infiltration, composite resin layering and composite resin injection. The results highlight the positive impact on the patient's quality of life, as evidenced by the reduction in the Oral Health Impact Profile 14 (OHIP-14) score from 23 to 0, and the effectiveness of these conservative techniques in achieving satisfactory aesthetic outcomes. This case report highlights that minimally invasive approaches can effectively restore dental aesthetics in severe fluorosis cases, significantly enhancing patients' quality of life—including psychological and social well-being—while preserving tooth structure.

We aim to describe a case of congenital partial hypoplasia of the lower lip in a 2-year-old child. The presence of a gingival notch, a mucosal bridle, and difficulties with tooth eruption raised the possibility of a modified 28–29 Tessier cleft. However, other hypotheses have been proposed as the anomaly does not conform to standard cleft anatomical findings.

Patients presenting with parkinsonism symptoms such as severe bradykinesia and significant hypophonia, along with an atypical clinical course, should be evaluated for secondary parkinsonism syndromes and other causes of parkinsonism. One of these causes is known as Fahr's disease, which is often overlooked by neurologists and other physicians.

Isolated fracture-dislocation of the second and third carpometacarpal joints (CMC) is very rare, and it is commonly misdiagnosed. Injury to this joint is usually associated with high-energy trauma, like a motor vehicle accident. Despite correct diagnosis, optimal treatment for these injuries is still controversial. We present a 31-year-old male patient with a history of one-month-old injury to his right hand following a motorcycle accident. Initially, he was treated by one of the orthopedic surgeons elsewhere and misdiagnosed as having blunt trauma to the hand. On presentation, he complained of persistent pain and swelling with deformity of the right hand following the initial treatment he received. Apparently, only AP and Oblique radiographs of the hand were taken. Treatment On clinico-radiological evaluation, he was found to have a fracture dislocation of 2nd and 3rd CMC joints. He was managed with open reduction and percutaneous pinning with K-wires. Since the majority of these injuries have a higher chance of misdiagnosis, we recommend careful clinical examination, a high index of suspicion in cases of high-energy injury, and taking all three standard view radiographs of the hand.

Situs inversus totalis is a rare condition characterized by the mirror image of the normal abdominal and thoracic viscera. Since the gallbladder is located in the left upper quadrant in this subset of patients, the diagnosis of symptomatic cholelithiasis poses a difficulty. Similarly, laparoscopic cholecystectomy in these patients is more demanding and presents technical challenges, especially for right-handed surgeons. Herein, we report a case of a 30-year-old female who was a known case of situs inversus totalis and was diagnosed with symptomatic cholelithiasis and subsequently underwent laparoscopic cholecystectomy with an uneventful post-operative period. The challenge while performing laparoscopic cholecystectomy in patients with situs inversus totalis calls for appropriate perioperative preparation and necessary modifications in the operative setup for the safe and successful operation of the patient, which is discussed in this report.

This Case Shows the Rarity of Dyshidrosiform Bullous Pemphigoid (DBP) as it is the first case to be reported from Nepal. Also, this is the first case of a dermatophyte infection in a patient with DBP. This case underscores the need for more extensive studies on DBP to better understand its incidence, risk factors, pathophysiology, systemic associations, diagnostic workup, and treatment options.