Clinical Case Reports最新文献

Giardiasis, an intestinal infection caused by Giardia duodenalis, remains a significant global health concern. Although standard treatments such as metronidazole are typically effective, there are increasing reports of treatment resistance, highlighting the need for alternative therapeutic strategies for which established guidelines do not exist. This case report illustrates the challenges in diagnosing and managing treatment-refractory giardiasis. A 32-year-old male presented with chronic symptoms of watery diarrhea, abdominal pain, and significant weight loss, despite multiple rounds of standard therapies, including metronidazole and albendazole. The persistent presence of Giardia lamblia in stool samples despite appropriate treatments, underscores the necessity for clinicians to recognize treatment failures and explore alternative strategies in the absence of standard protocols. This instance, prolonged combination therapy with metronidazole and albendazole proved effective after previous treatment failures, resulting in symptom resolution and negative stool tests. Clinicians should consider treatment-refractory giardiasis as a differential diagnosis in patients with chronic gastrointestinal complaints and a history of giardiasis treatment, enabling earlier diagnosis and intervention. This case emphasizes the need for ongoing monitoring of treatment-refractory giardiasis and calls for further study of resistant strains. It also provides an effective approach for managing cases of treatment-resistant giardiasis.

Taking into consideration the effects of pneumoperitoneum on kidney function, anesthesiologists should diligently monitor potassium levels during robotic-assisted radical cystectomy, particularly during prolonged ureter clamping, in the presence of chronic kidney disease, administration of renin-angiotensin-aldosterone system-blocking medications, or when there is a high risk of rhabdomyolysis.

Pituitary apoplexy is a rare clinical syndrome. This report presents a case with initial symptoms of oculomotor nerve palsy and headache. A 48-year-old patient reported blurred vision in the right eye for 1 month, followed by a sudden onset of left eyelid ptosis and a 1-day headache. Laboratory tests revealed normal pituitary function, except for an elevated growth hormone level (> 36.600 μg/L). Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) scans indicated space-occupying lesion in the sellar region. The lesion was subsequently resected via transnasal subtotal surgery. Histopathological and immunohistochemical analyses confirmed a pituitary adenoma with infarction. The patient received hydrocortisone preoperatively and prednisone and levothyroxine postoperatively. On the second postoperative day, the headache resolved, and the left eyelid regained normal function within 2 weeks. Pituitary apoplexy is extremely rare, with initial presentations of oculomotor nerve palsy being exceptionally uncommon. Early diagnosis and prompt surgical intervention are essential to preserve pituitary function and rapidly alleviate cranial nerve dysfunction.

Mucormycosis is an infrequent fungal infection commonly seen in immunocompromised individuals. However, it can also occur in immunocompetent patients, especially following trauma. We present a case of a 15-month-old girl with increasing swelling and redness in her left eye after a minor traumatic injury. Imaging showed sinusitis with orbital involvement. Histopathology validated the diagnosis of mucormycosis caused by Rhizopus species. The patient had emergency surgery, followed by antifungal and antibiotic therapy. Despite febrile reactions to the treatment, the infection was managed, and the patient was discharged after 2 months. This case highlights the importance of considering mucormycosis in immunocompetent patients with unexplained ocular symptoms after trauma. Early diagnosis and aggressive treatment are essential for improving outcomes, especially in pediatric patients.

Actinomycotic vertebral osteomyelitis is a rare but severe condition, even in immunocompetent individuals, following routine dental procedures. Prompt recognition, multidisciplinary management, and tailored antibiotic therapy are crucial for optimizing outcomes. Clinicians should maintain a high index of suspicion for Actinomyces in patients with unexplained spinal infections and recent dental interventions.

Necrotizing pancreatitis is an extremely rare but serious complication of systemic lupus erythematosus (SLE). Early recognition and appropriate treatment, including steroids and immunosuppressive therapy, are critical for improving outcomes in SLE patients with this condition.

This case report underscores the diagnostic challenge of copper-deficiency myelopathy (CDM) and subacute combined degeneration (SCD) due to their similar clinical presentations. A 32-year-old male farmer initially treated for SCD with normal vitamin B12 levels showed no improvement, leading to a delayed diagnosis of CDM. His symptoms included sensory ataxia, spasticity, and sensory loss in the lower extremities, which resolved with oral copper supplementation. Clinicians should maintain a high index of suspicion for CDM, especially in patients who are unresponsive to B12 therapy. This case also highlights that marginal copper deficiency can cause significant neurological symptoms and that early intervention with copper supplementation can lead to full recovery, preventing irreversible damage. It also emphasizes the need for comprehensive testing, including copper levels, in cases of atypical myelopathy to avoid a delayed diagnosis.

The S1Q3T3 pattern on the electrocardiogram is often associated with right heart strain in pulmonary embolism, pneumothorax, and acute lung diseases causing acute cor pulmonale. The S1Q3T3 pattern during acute massive empyema in the setting of a liver abscess has not been reported in theliterature. We present a case report of a 41-year-old Iranian female patient with a sudden onset chest pain, dyspnea, sinus tachycardia, and electrocardiography findings of S1Q3T3 pattern, who was revealed to have an expanding pyogenic pleural effusion as a result of trans-diaphragmatic extension of a liver abscess. The other causes of S1Q3T3 were excluded. The patient underwent the insertion of a chest tube to remove the pus. After chest tube insertion, the S1Q3T3 pattern resolved. Despite initial improvement, the patient developed complications, including pleural adhesions and lung collapse, and required a posterolateral thoracotomy with decortication. This resulted in dramatic clinical improvement. Rapidly expanding massive pyogenic pleural effusion can lead to the S1Q3T3 pattern on the electrocardiogram.

MOSD is a rare and disabling immune-mediated inflammatory Astrocytopathic disease characterized by demyelination and axonal destruction, typically involving the spinal cord and the optic nerve. Here we present a case report of a 53-year-old female patient who had a pertinent history of treatment for optic neuritis a few months back, currently diagnosed with Neuromyelitis Optica after she presented with a three-week history of weakness of lower extremity, headache, and neuropathic pain. She was pulsed with methylprednisolone and started on azathioprine, which significantly improved her clinical condition. When patients with optic neuritis and transverse myelitis occur, a high index of suspicion for NMOSD is essential. Establishing a diagnosis based on clinical and MRI findings is crucial for initiating therapy quickly, halting more harm, and avoiding a delay in diagnosis. Our experience treating our patient shows that Azathioprine is still a practical choice in resource-limited setups.

Takayasu arteritis is a rare systemic inflammatory condition that primarily affects medium and large arteries, mainly in young Asian women with an estimated incidence of 1–2 per million. Diagnosis is challenging due to nonspecific early symptoms, resulting in an insidious clinical course until vascular complications arise. A 30-year female presented with progressive easy fatigue over 4 years. She developed recent visual disturbances, headaches, and dizziness. Examination revealed unrecordable blood pressures and vascular bruits. Imaging revealed vascular involvement including stenosis of arch of aorta and its all branches. The available treatments can ease symptoms and slow progression, but the late diagnosis caused lifelong morbidity, with no procedure to resolve persistent fatigue. TA poses diagnostic challenges due to its nonspecific early symptoms and risk of severe vascular complications. This case highlights the importance of considering TA in young women with vague systemic inflammatory symptoms.