Clinical Case Reports最新文献

Familial multiple lipomatosis (FML) is a rare autosomal dominant disorder characterized by the progressive development of encapsulated nodules predominantly on the trunk and extremities. Its genetic basis is linked to HMGA-2 gene over-expression. The condition is diagnosed via clinical history, ultrasound findings, and histological studies, and management mainly comprises surgical excision. This case report highlights the clinical characteristics, diagnostic challenges, and management of FML in a 38-year-old male.

Cold agglutinin disease (CAD), a rare autoimmune hemolytic anemia (AIHA), is characterized by hemolysis triggered by activation of the classical complement pathway. AIHA is estimated to affect one in 100,000 people in the general population; however, its incidence in pregnant women is unclear due to the scarcity of published studies. Here, we present the case of a 37-year-old female (G2P1102) who presented for a repeat Cesarean section. Her peripartum course was complicated by anemia (hemoglobin 7.9 g/dL, hematocrit 29.4%) attributed to cold agglutinin disease, necessitating the transfusion of 20 units of blood during this pregnancy. She had been receiving prednisone 10 mg daily for anemia. Cold temperatures can trigger the activation of cold-reactive antibodies, leading to red blood cells agglutination (clumping together). Preventing hypothermia reduces the likelihood of cold-induced hemolysis, which is the primary therapeutic strategy for cold agglutinin disease. Anesthetic management for the cesarean section was accomplished via spinal anesthesia, complemented by pain control through bilateral transversus abdominis plane (TAP) blocks. This multidisciplinary approach facilitated effective pain management while considering the patient's underlying condition.

The simultaneous occurrence of acute myeloid leukemia (AML) and autoimmune hemolytic anemia (AIHA) is exceedingly rare, with an incidence of less than 1%. We report the case of a 50–year–old patient newly diagnosed with this uncommon combination. This case underscores the complexity and infrequency of this dual diagnosis, highlighting the diagnostic and therapeutic challenges it presents.

Toxicity from methotrexate overdosing is life threatening condition that requires prompt recognition and early treatment. A 71-year-old man from rural Bhutan with diabetes mellitus had symmetrical small joint pain for 3 years associated with early morning stiffness. He was evaluated and diagnosed with seropositive rheumatoid arthritis in a hospital in neighbouring India. He was initiated on Methotrexate and Hydroxychloroquine. The patient had inadvertently taken Methotrexate 10 mg OD for 2 weeks. Following this, he developed painful ulcers on the lips preventing him from swallowing and ulcers around the corona on the penis. He also had intermittent fever with chills. On examination, he had fluid responsive hypotension and pancytopenia without bleeding manifestations. He was managed with intravenous folinic acid, subcutaneous granulocyte colony stimulating factor and intravenous cloxacillin. He had an uneventful recovery and methotrexate has been restarted following adequate patient education. Education of patient and family members is key in preventing medication errors. Early identification and timely management of methotrexate toxicity is key in preventing mortality.

HSV encephalitis is a common cause of sporadic fatal encephalitis, affecting persons of all ages. It is also a medical emergency because the prognosis is primarily determined by early treatment initiation, necessitating a rapid and accurate diagnosis. CNS vasculitis complicating HSV encephalitis is a rare phenomenon. We present a case of a 28-year-old right-handed male patient diagnosed with HSV meningoencephalitis complicated with vasculitis, the challneges in the diagnosis and treatment response.

Diagnosis of Q fever endocarditis is challenging since clinical findings are non-specific and diagnosis is mainly made by indirect methods such as serology. A progressive constitutional syndrome, severe asthenia, anorexia with no fever and histopathological findings of non-necrotizing gastric granulomas in a gastric biopsy were found preceding a cardiac failure in our case report. Prolonged treatment with doxycycline and hydroxychloroquine is mandatory, and cardiac valve surgery may be needed.

Primary vulvar diffuse large B-cell lymphoma is a diagnostically challenging malignant tumor due to its low incidence and diverse clinical presentations. It has a good prognosis and is usually radio-chemotherapy-responsive. This case report emphasizes considering lymphoma as a differential in vulvar inflammatory conditions.

Sympathetic ophthalmia (SO) is a rare, bilateral, granulomatous, panuveitis following perforating trauma or surgical intervention in one eye. Here, and to the best of knowledge, we report the first case of SO following an evisceration surgery in Pakistan. A 32-year-old, Pakistani, female presented with pain and decreased visual acuity in her right eye, at Civil Hospital, Karachi, 1 week after an evisceration surgery was performed on her left eye, following corneal perforation due to unresolved keratitis. Diagnosis of SO was made on the basis of clinical presentation and confirmed by slit lamp examination which revealed mutton fat keratic precipitates, posterior synechiae, and optic disc swelling. She was administered high-dose corticosteroids to which she did not respond. She was then prescribed methotrexate which resolved the inflammation and improved visual acuity. Initiating prompt treatment for the sympathizing eye led to effective management of the patient and prevented complete blindness.

Reversible cerebral vasoconstriction syndrome (RCVS) is a rare neurological disorder characterized by transient constriction and dilation of cerebral arteries, leading to severe headaches and neurological deficits. This case report describes a 41-year-old woman with chronic anemia, acute chronic kidney disease, type 2 diabetes mellitus, and rheumatoid arthritis who developed RCVS following transfusion of packed red blood cells (PRBCs). She experienced sudden-onset seizures and a thunderclap headache 5 days post-transfusion. Diagnostic imaging, including computed tomography (CT) and magnetic resonance imaging (MRI), revealed the characteristic features of vasogenic edema. The patient was treated with blood pressure control and symptomatic relief for pain, resulting in gradual improvement. This case highlights the importance of recognizing RCVS as a potential complication of blood transfusions, particularly in patients with significant comorbidities. Understanding the possible mechanisms, including rapid hemoglobin correction, and the effects of residual plasma and storage lesions in transfused blood, is essential to prevent and manage this rare but serious condition.

Acupuncture, an increasingly popular alternative medical therapy, has heightened the demand for information on its safety profile. This is a case report involving a 28-year-old female who presented with intense right-sided chest pain and breathlessness after an acupuncture session where needles were inserted into her chest wall. The immediate medical evaluation revealed a tension pneumothorax with radiographic evidence of a mediastinal shift, compelling, urgent intervention via chest tube insertion. The patient's symptoms persisted for 2 days before the pneumothorax diminished, facilitating the removal of the chest tube. This case emphasizes the atypical presentation of pneumothorax after acupuncture, suggesting a delayed onset of symptoms possibly related to the size of the bronchopleural fistula formed by the acupuncture needle. While acupuncture-related adverse events are uncommon, serious life-threatening complications like tension pneumothorax underscore the necessity for rigorous safety standards. Amidst the growing popularity of acupuncture, this report urges healthcare professionals to be aware of and report such incidents for enhanced patient education and safety.

Trial Registration: This is not an interventional study. We only reported the patient's findings from our database as a case report