Clinical Case Reports最新文献

Ecthyma gangrenosum (EG) is a rare but severe cutaneous infection, often caused by Gram-negative organisms. It may indicate sepsis or underlying immunodeficiency, although cases in immunocompetent preterm infants are uncommon. We report the case of a preterm male neonate born at 34 + 5 weeks of gestation from a twin pregnancy, weighing 2030 g. He was initially treated for presumed early-onset neonatal bacterial infection with cefotaxime and gentamicin, showing good initial improvement. On Day 7 of life, erythematous plaques appeared in the right inguinal region and on the scrotum, rapidly progressing to necrotic ulcerations. Laboratory findings showed thrombocytopenia with negative C-reactive protein. Ultrasound revealed scrotal and thigh infiltration without abscess or thrombosis. Skin cultures grew Klebsiella pneumoniae and Enterococcus faecium, and blood cultures isolated Enterococcus faecium. Targeted antimicrobial therapy combined with daily wound care led to complete healing with minor residual scarring. Immunologic evaluation was normal. EG can occur in preterm neonates without immunodeficiency, and early microbiological diagnosis with targeted therapy leads to favorable outcomes.

Hyperimmunoglobulin E syndrome (HIES) is a rare primary immunodeficiency disorder characterized by eczema, recurrent staphylococcal infections, and significantly elevated serum IgE levels. An 18-year-old female presented with acute abdominal pain and was diagnosed with a retroperitoneal abscess. She had a history of recurrent skin abscesses, otitis media, and eczema since infancy, skeletal fractures, and retained primary teeth. Laboratory findings showed a serum IgE level above 20,150 U/L and a CRP of 180.30 mg/L. Methicillin-sensitive Staphylococcus aureus was cultured from the abscess drainage. The NIH-HIES score was 60 points. Genetic testing identified a heterozygous STAT3 variant (NM_139276.3: c.1145G>A, p.(Arg382Gln)), confirming autosomal-dominant HIES. This rare clinical presentation emphasizes the importance of considering HIES, even when deep-seated infections develop outside typical cutaneous or pulmonary sites.

Methanol toxicity is an emergency that doctors come across all around the globe, requiring immediate treatment or it can cause life-threatening conditions affecting the central nervous system, causing toxic optic neuropathy and metabolic acidosis. We present a case of an 18-year-old boy, who presented in the medicine emergency with sudden bilateral visual loss and vomiting. He did not have any significant past medical history and all of his examinations were normal except bilaterally dilated pupils and the fundus examination showing bilateral optic disc pallor and cup to disc (C/D) ratio 0.5 and his visual acuity was no perception of light (NPL). He was admitted and treated conservatively with high-dose steroids and ethanol. Later on, a diagnosis of methanol toxicity was made based on toxicology report and imaging studies. His ABGs remained normal throughout and his vision improved to hand movement (HM) over the course of 2 weeks. Methanol toxicity can vary in presentation and could lead to toxic optic neuropathy causing sudden total visual loss. It usually occurs as an outbreak so cases like these should be reported to have a general awareness about it; aiding in early detection, timely management and better public health strategies.

Tubulointerstitial nephritis with uveitis (TINU) is an immune-mediated systemic disorder most commonly described in adolescents and young adults, and its recognition in older patients remains challenging. We report the case of a 58-year-old woman who presented with systemic symptoms and rapidly progressive acute kidney injury. Renal function deteriorated significantly, necessitating emergency hemodialysis. Renal biopsy demonstrated acute tubulointerstitial nephritis with diffuse interstitial inflammation and minimal fibrosis. During hospitalization, ocular symptoms were identified, and a comprehensive ophthalmologic examination confirmed intermediate uveitis, establishing the diagnosis of TINU syndrome. Treatment with standard-dose corticosteroid therapy resulted in rapid clinical improvement, recovery of urine output, and discontinuation of dialysis within a short period. Renal function and ocular inflammation improved in parallel. Corticosteroids were gradually tapered without relapse. At long-term outpatient follow-up on September 15, 2025, the patient remained clinically stable, with serum creatinine levels ranging from 60 to 70 μmol/L and no recurrence of uveitis. This case highlights an atypical presentation of TINU in an older patient complicated by severe acute kidney injury requiring dialysis and underscores the importance of considering TINU in patients with unexplained acute kidney injury and ocular manifestations, regardless of age. Early recognition and appropriate immunosuppressive therapy are essential for favorable renal and ocular outcomes.

Carcinosarcomas of the salivary gland with osteosarcoma component are very rare, with only 17 cases reported. Despite multiple poor prognostic factors, our patient's outcome was favorable, highlighting the importance of early diagnosis and aggressive treatment in improving prognosis for this aggressive tumor variant.

We present a case study of a 34-year-old man with morbid obesity and a suspected Bartter–Gitelman spectrum tubulopathy (without genetic confirmation), weighing 135 kg, and with a BMI of 42.5 kg/m², who was referred to the metabolic and bariatric surgery department due to morbid obesity to address abnormal electrolyte levels. The clinical presentation suggested renal tubular salt wasting. Post-sleeve gastrectomy, the patient had sustained and prolonged normalization in his electrolytes without the use of any medications. This provides evidence of a possible relationship between metabolic surgery and renal tubular function. This case supports recognizing a suspected tubulopathy in candidates for metabolic surgery.

After a unilateral midbrain hemorrhage, clinicians should recognize that bilateral hypertrophic olivary degeneration may occur, presenting as palatal myoclonus, dysarthria, or tinnitus. This highlights the necessity for timely diagnosis and effective symptom management.

Bilateral discoid medial menisci are an exceptionally rare anatomical variant, and their coexistence with a parameniscal cyst has only been described in isolated cases. We present the case of a 13-year-old male with activity-related medial knee pain initially affecting the right knee. Imaging confirmed an incomplete discoid medial meniscus associated with a parameniscal cyst, which was treated with arthroscopy, open cyst excision, and meniscocapsular repair. A subsequent symptomatic retear required revision saucerization and combined meniscal fixation techniques. Months later, the patient developed similar symptoms in the contralateral knee, where MRI revealed a discoid medial meniscus with a horizontal tear, successfully treated with saucerization and partial meniscectomy. At final follow-up, the patient remained pain-free and fully active. This case highlights the importance of early recognition and preservation-focused surgical treatment for this rare bilateral presentation.

Tubercular lymphadenitis (TBL) is the most common form of extrapulmonary tuberculosis (EPTB), accounting for 20%–40% of EPTB cases. We present you a case of a 45-year-old male presented with gradually progressive swelling in the lower right side of the jaw for 2 months. At his initial consultation at another center, a diagnosis of carcinoma of the right lower alveolus was suggested. However, the histopathological examination (HPE) performed at the same center revealed a tubercular granulomatous lesion. As the patient's symptoms didn't seem to correlate with this diagnosis, he didn't initiate his treatment there and sought further evaluation at our institution. In course of further investigation, Fine Needle Aspiration Cytology (FNAC) suggested for TBL but Acid-Fast Bacilli (AFB) and Gene Xpert showed negative results for mycobacterium tuberculosis. After 2 months of antitubercular regimen, the patient responded well to drugs with significant reduction in swelling. This case highlights the diagnostic challenge of atypical presentations of TBL in the head and neck region, emphasizing the role of rapid and minimally invasive FNAC for the early diagnosis of TBL even with negative Gene Xpert and AFB stain.

Extravasation is a rare but serious complication of intravenous injections, particularly with irritant or vesicant drugs, which can lead to significant tissue damage. In this case report, we describe a 14-year-old boy who developed calcinosis cutis due to extravasation of calcium gluconate, resulting in extensive tissue necrosis. Although surgical debridement and grafting were performed, the patient subsequently experienced iatrogenic post-surgical graft calcinosis cutis, leading to severe hand disability. This case underscores the importance of prompt recognition and management of extravasation to prevent long-term complications.