Clinical Case Reports最新文献

We present the case of a man in his 70s who developed acute confusion from hypertensive encephalopathy triggered by indomethacin. He was recently prescribed indomethacin, a non-steroidal anti-inflammatory drug (NSAID) for headaches. However, his headaches were in the context of worsening hypertension that was treated with trandolapril. The use of indomethacin consequently worsened his underlying condition. On presentation to the emergency department, his blood pressure was 190/110 mmHg. Bloodwork including electrolytes, glucose, metabolic studies, renal and liver function were within normal limits; infectious workup including blood and urine cultures subsequently returned negative; and brain computed tomography and magnetic resonance imaging revealed no acute process to explain his presentation. Indomethacin was discontinued and the patient's hypertension was treated with amlodipine. Both his confusion and underlying headaches resolved as his blood pressure normalized. The patient was diagnosed with hypertensive encephalopathy triggered by indomethacin. NSAID use can trigger blood pressure decompensation, especially in patients with underlying hypertension; this effect is particularly pronounced in patients treated with anti-hypertensive medications that inhibit the renin-angiotensin-aldosterone (RAS) system. Symptomatic treatment with NSAIDs is not without potential harm; it is important to carefully consider a patient's underlying diagnosis, indication for therapy and risk for adverse effects.

In post-liver transplant patients, esophagitis presents a diagnostic and management challenge due to the potential for opportunistic infections. This case describes a 59-year-old female with primary sclerosing cholangitis who underwent orthotopic liver transplantation six years prior. She presented with dysphagia, and her medical history included immunosuppression with prednisone, tacrolimus, and mycophenolate and a history of achalasia treated with esophageal peroral endoscopic myotomy. Esophagogastroduodenoscopy (EGD) revealed severe esophagitis with extensive ulcerations, raising suspicion for infectious etiologies such as cytomegalovirus (CMV) and herpes simplex virus-1 (HSV-1). The biopsy confirmed a rare coinfection of CMV and HSV-1, which was characterized histologically by viral cytopathic effects and immunohistochemical staining. Treatment with valganciclovir and temporary cessation of mycophenolate led to symptom resolution and viral clearance. Follow-up EGD demonstrated healing of esophageal ulcers, with subsequent findings of Candida esophagitis but no evidence of CMV or HSV recurrence. This case highlights the importance of early endoscopic evaluation and biopsy in immunocompromised patients with esophagitis. CMV and HSV-1 coinfection, while rare, should be considered in this population due to its association with severe complications such as perforation and bleeding. Timely antiviral therapy and immunosuppression adjustment are critical for favorable outcomes.

Arterial occlusive events (AOE) are rare adverse event in patients with chronic myeloid leukemia treated with tyrosine kinase inhibitor such as ponatinib. We treated a 47-year-old woman with chronic myeloid leukemia. She was failed to achieve optimal molecular response in prior two lines tyrosine kinase inhibitors treatment (dasatinib and bosutinib) for first 30 months. Finally, she was treated with ponatinib and achieve complete molecular remission in 28 months. However, she was suffered from AOE, in bilateral stenosis of the middle cerebral arteries. The patient's responsible vascular lesions of AOE were atypical site rather than usually affected lesions in common arteriosclerosis.

Autoimmune pulmonary alveolar proteinosis (PAP) is characterized by antibodies to granulocyte–macrophage colony-stimulating factor (GM-CSF), alveolar macrophage dysfunction, and surfactant accumulation. Whole lung lavage (WLL) is the treatment of choice in patients with PAP and severe hypoxemia. In resource-limited settings, WLL can be performed in the intubated, anesthetized patient who is being one lung ventilated using a Y-type bladder irrigation catheter for saline instillation and drainage.

Primary intimal sarcoma of the pulmonary artery is a rare and aggressive malignancy that presents significant diagnostic and therapeutic challenges due to its nonspecific symptoms and propensity for late detection. This case report aimed to elucidate the diagnostic journey, surgical intervention, and multidisciplinary management of this rare entity. In September 2023, a 42-year-old male presented with dyspnea on exertion and retrosternal chest pain, classified as NYHA FC II. Initial investigations, including ECG and lab tests, indicated tachycardia and elevated troponin and NT-pro-BNP levels. Transthoracic and transesophageal echocardiography identified a multilobulated mass in the right ventricular outflow tract and main pulmonary artery. Cardiac MRI and CT angiography confirmed a high-grade pleomorphic spindle cell tumor, leading to surgical resection in October 2023. Histopathology confirmed intimal sarcoma. Postsurgery, the patient underwent chemotherapy and radiotherapy, showing significant clinical improvement and no recurrence on follow-up PET-CT. This case highlights the importance of a multidisciplinary approach in diagnosing and managing primary intimal sarcoma of the pulmonary artery, emphasizing the role of advanced imaging, timely surgical intervention, and combined chemotherapy with radiotherapy in improving patient outcomes.

This report discusses the diagnostic and therapeutic complexities encountered in resource-limited environments when assessing patients suspected of cardiac amyloidosis (CA). The study describes a case involving a patient who initially presented with heart failure symptoms and eventually received a CA diagnosis after 13 months and four primary physician visits, primarily based on discrepancies observed between electrocardiographic and echocardiographic findings, alongside elevated cardiac troponin levels. The case underscores the limited awareness of CA among primary healthcare providers in Ethiopia, contributing to a higher likelihood of misdiagnosis and inappropriate treatment approaches. Additionally, the report discusses the specific challenges associated with diagnosing and managing CA patients. It advocates for essential resources such as heightened clinical suspicion, proficiency in recognizing the characteristic electrocardiogram (ECG) and echocardiographic indicators of CA, and prompt referral to cardiologists.

Trichodysplasia spinulosa is a rare dermatological condition caused by a virus that predominantly affects immunosuppressed individuals. In this patient population, including organ transplant recipients, it is essential to maintain a high index of suspicion for possible infectious causes of persistent dermatologic conditions. Early diagnosis can facilitate treatment and help avoid disease progression and complications.

Bilateral mandibular premolar agenesis is rare, and it is essential to retain the primary teeth until they can be replaced with dental implants. Although internal root resorption and periapical lesions in primary teeth have a poor prognosis, MTA dressing and restoring teeth with SSC impede the progress of internal resorption.