Clinical Case Reports最新文献

Posttransplant lymphoproliferative disorder (PTLD) can mimic infectious processes in the head and neck. A high index of suspicion for PTLD must be maintained in pediatric transplant patients, and minimal response to antibiotics/corticosteroids should prompt timely biopsy of suspicious tissue to expedite the diagnosis and treatment of PTLD.

Ovarian dysgerminomas are malignant tumors that are infrequently associated with pregnancy. These tumors are typically detected in cases of abdominal pain or during routine imaging such as ultrasound or magnetic resonance imaging. However, we report a case of ovarian dysgerminoma in an ongoing pregnancy, discovered as a result of hemoperitoneum. A 33-year-old patient at 23 weeks of gestation presented with hemorrhagic shock and hemoperitoneum, requiring emergency surgery. During the operation, a large tumor measuring 24 × 29 cm was found in the left ovary, which was completely invaded by the mass but showed no adhesions to adjacent organs. The condition was accompanied by abundant ascites (4.5 L) mixed with blood, caused by bleeding from an ovarian vessel on the surface of the tumor. Histological examination confirmed the diagnosis of dysgerminoma. Haemoperitoneum is a rare but severe complication that can lead to discovering ovarian dysgerminoma. Owing to the low malignancy of this tumor, adnexectomy is an effective emergency treatment, offering favorable maternal and fetal outcomes in early-stage cases. However, larger case series are required to assess the prognosis of pregnancy associated with dysgerminoma better.

There are a couple of references in literature reporting the incidence of acute appendicitis during pregnancy, and the incidence rate is 0.4–1.4 per 1000 pregnancies. Acute appendicitis and perforated acute appendicitis in the postpartum period are rare incidences. Fever and abdominal pain are very common symptoms in acute appendicitis. Here, we are presenting a case of postpartum acute perforated appendicitis. A 34-year-old female was admitted in the department of obstetrics and gynecology with abdominal pain and severe abdominal tenderness. The cervical os was dilated, so the patient was taken to the labor room where she delivered a very low birth weight baby at 22 weeks. After delivery, patient developed respiratory distress and there was a sudden deterioration in her condition. She was then shifted to the critical care unit. The case was managed and the patient's respiratory distress lessened but the abdominal pain and tenderness still persisted. Plain radiography was done and it showed “gas under diaphragm.” The CT scan also showed pneumoperitoneum and a decision was taken to perform an emergency laparotomy. On laparotomy, perforated appendicitis was found. Diagnosis of acute abdomen in pregnancy and the early postpartum period is very confusing, but an early diagnosis is always important. In antenatal screening, an ultrasound of the whole abdomen should be mandated in 30+ years old pregnant women. Surgery is the recommended treatment in such cases.

Congenital long QT syndrome (LQTS) is a genetic disorder causing prolonged QT intervals and an increased risk of arrhythmias and sudden cardiac death. With 25% of cases lacking known genetic mutations, diagnosis and treatment can be challenging. We present a successfully managed case of late-onset genotype-negative phenotype-positive LQTS presenting as palpitations, complicated by a single event of polymorphic ventricular tachycardia, followed by a review of the literature. This case underscores the gaps in understanding congenital long QT syndrome, especially in genotype-negative cases, and highlights the need for ongoing research for risk assessment and effective management to prevent fatal cardiac events.

Treating recurrent or cisplatin-refractory germ cell tumors remains a clinically problematic situation. Although testicular cancer has a good overall cure rate, some patients with metastatic GCTs who did not respond to initial treatments have few therapeutic alternatives and face significant fatality rates. This case showed the successful implementation of radical surgery for patients with refractory seminoma in clinical practice.

Severe thrombocytopenia in secondary antiphospholipid syndrome (APS) presents a significant management challenge. This case highlights the complexity of managing APS-related thrombocytopenia, requiring a nuanced approach to balancing bleeding and thrombotic risks. Intravenous immunoglobulin, followed by a short course of steroids, successfully increased platelet counts without adverse bleeding or thrombotic events. Initiating therapeutic anticoagulation with Warfarin was delayed until platelet counts exceeded 50 × 10^3/μL, emphasizing the cautious approach required in such cases to mitigate thrombotic risks while avoiding bleeding complications.

In patients with myocardial infarction, left ventricular pseudoaneurysm is uncommon and may present insidiously. Left ventricular apical thrombosis may accompany the left ventricular apical pseudoaneurysm and may be an early alarming indicator. Accordingly, close follow-up of patients with left ventricular apical thrombosis in the context of myocardial infarction via appropriate imaging modalities may be required.

Autoimmune inner ear disease (AIED) is characterized by bilateral, asymmetric, and fluctuating sensorineural hearing loss (SNHL) with no identifiable cause that responds to immunosuppressive therapy. Diagnosis can be challenging due to a lack of standardized diagnostic criteria and pathognomonic tests. The mainstay of treatment is corticosteroids; however, only a small number of patients remain responsive after prolonged use. There are no agreed treatment protocols for AIED following corticosteroids, as there is limited data from randomized controlled trials. We report a case of a 27-year-old man with secondary AIED on a background of ulcerative colitis (UC) who experienced frequent relapses and deterioration in his hearing despite multiple courses of high-dose corticosteroids. He received methotrexate and azathioprine but did not show clinical or audiometric improvement. After the commencement of infliximab infusions, his symptoms of AIED and UC improved, and his hearing remained stable without further use of oral corticosteroid therapy. The available studies on the efficacy of biologic therapy are limited and have produced variable results, with the majority of the data relying mainly on case reports and case series. Large, multicenter randomized controlled trials are required to confirm its efficacy in the management of AIED.

Choledochoduodenal fistula secondary to pancreatic lymphoma is a rare phenomenon, reflecting the complex relationship between lymphoproliferative disorders and gastrointestinal complications. Fistula formation should be suspected in patients with persistent liver function abnormalities and a history of treated hematological malignancies.

Abnormal uterine bleeding (AUB) is a common gynecological concern often attributed to hormonal disorders, malignancies, or infections. While bacterial and viral infections are frequently investigated, fungal infections, such as aspergillosis, are often overlooked. This case report highlights a rare instance of endometrial aspergillosis caused by Aspergillus quadrilineatus in an immunocompetent woman. A 64-year-old woman presented with persistent vaginal bleeding. Histopathological examination of endometrial tissue revealed septate hyphae consistent with fungal infection. Molecular analysis identified the causative agent as A. quadrilineatus. The A. quadrilineatus isolate demonstrated susceptibility to various antifungal agents, including azoles and amphotericin B. This report emphasizes the need for increased awareness of fungal infections, including aspergillosis, as a potential cause of AUB. Further research is needed to enhance understanding of the epidemiology, risk factors, and clinical manifestations of endometrial aspergillosis.