Clinical Case Reports最新文献

Awake VV-ECMO can be a life-saving strategy for patients with near-complete tracheal obstruction where tracheostomy and intubation are not feasible. Early multidisciplinary coordination enables safe airway control, tumor debulking, and stenting, facilitating both immediate stabilization and long-term oncologic planning.

Disseminated Mycobacterium avium complex (MAC) infection can mimic tuberculosis (TB) in immunocompetent individuals, leading to diagnostic and therapeutic challenges. Clinicians should consider nontuberculous mycobacteria (NTM) in patients unresponsive to anti-tubercular therapy (ATT), especially in endemic regions.

Restless legs syndrome (RLS) is a neurological sensorimotor disorder characterized by an irresistible urge to move the legs, typically worsening at night and leading to sleep disturbance. While first-generation antihistamines are recognized as common pharmacological triggers, second-generation nonsedating antihistamines are rarely implicated. We report the case of a 35-year-old man with allergic rhinitis who developed new-onset RLS after 1 month of treatment with fexofenadine 180 mg daily. His symptoms included an uncomfortable urge to move his legs, particularly in the evening and at night, which interfered significantly with sleep quality. Clinical examination and laboratory studies, including renal function and iron indices, were unremarkable. Despite several medical consultations, the symptoms persisted until fexofenadine was discontinued. Remarkably, his symptoms resolved completely within days of withdrawal without pharmacologic intervention and did not recur on follow-up. This case highlights a rare but clinically relevant association between fexofenadine and RLS. Although fexofenadine is classified as a peripherally selective, nonsedating antihistamine, this report underscores that even second-generation agents may contribute to RLS in susceptible individuals. Recognition of this potential adverse effect is important, as prompt discontinuation of the offending medication alone can result in rapid and complete symptom resolution. Clinicians should therefore maintain vigilance when evaluating patients with new-onset RLS and carefully review medication histories, including use of second-generation antihistamines such as fexofenadine.

Anfiye is a traditional herbal remedy commonly used in Iran and several Arabic countries for the treatment of sinusitis and nasal congestion. It is typically administered as a nasally inhaled powder. Various formulations exist under the name Anfiye; however, the most widely used preparation contains root powder of Gypsophila struthium and seeds of Nigella sativa. Inhalation of Anfiye induces sneezing, which in turn helps alleviate nasal congestion and rhinorrhea, thereby contributing to the management of sinusitis. Modifying facial soft tissues volume and contours through dermal injection of botulinum toxin, injectable fillers such as hyaluronic acid, and bovine collagen is a common esthetic procedure these days. Although they may be successfully utilized, there may be possible side effects such as allergic reactions, inflammation, foreign body granuloma formation, and skin necrosis due to incorrect injection techniques. Also, it is a relatively expensive esthetic treatment. In this case report, we present a 41-year-old Iranian woman who developed swelling in the right portion of the palate following injection of facial dermal filler and use of Anfiye for treating sinusitis. An excisional biopsy was performed, and histopathological analysis revealed marked submucosal fibrosis with features reminiscent of oral submucous fibrosis (OSMF). However, the absence of hallmark clinical criteria-namely palpable fibrotic bands, progressive reduction in tissue elasticity, and trismus or limited mouth opening-alongside the patient's denial of areca nut use and spontaneous healing of the lesion after biopsy suggests that the presentation is more consistent with reactive palatal fibrosis secondary to facial filler injection and Anfiye inhalation. This report aims to highlight Anfiye or dermal fillers as potential etiological factors in the development of reactive fibrosis, which can be misdiagnosed as OSMF.

Primary hyperparathyroidism (PHPT) is uncommon in the pediatric population and rarely presents with overt skeletal complications such as brown tumors. This case study describes a 16-year-old female who initially presented with abdominal pain and was subsequently found to have severe hypercalcemia (serum calcium 16.4 mg/dL) and markedly elevated parathyroid hormone (PTH 1700 pg/mL) and bilateral nephrolithiasis. There were no features suggestive of multiple endocrine neoplasias. A history of a previously diagnosed "non-ossifying fibroma" in the proximal tibia was later reinterpreted as a brown tumor following the diagnosis of PHPT. Imaging studies revealed widespread bone tumors with multiple lytic lesions in long bones and the axial skeleton. Localization with a sestamibi scan confirmed a left inferior parathyroid adenoma, which was surgically resected and biopsy confirmed the same. Postoperatively, serum calcium normalized, and radiographs at follow-up showed progressive healing of bone lesions. This case underscores the importance of biochemical and radiological findings for the appropriate diagnosis of PHPT, facilitating definitive surgical management and improved clinical outcomes. This case also illustrates the reversibility of skeletal changes following curative parathyroidectomy.

Primary (AL) amyloidosis is a rare systemic disorder caused by extracellular deposition of monoclonal immunoglobulin light chains, resulting in multi-organ dysfunction. SARS-CoV-2 infection may induce persistent inflammatory and immune dysregulation, potentially promoting amyloid formation, although clinical evidence is limited, making the recognition of post-COVID-19 amyloidosis clinically relevant and potentially novel. A 39-year-old Caucasian male presented with progressive weight loss (18 kg over 6 months), epigastric pain, early satiety, and hepatosplenomegaly. Ten months prior, he had recovered from COVID-19 with mild pulmonary involvement. Initial ultrasonography and endoscopy were unremarkable except for mild gastritis. Subsequent imaging revealed hepatosplenomegaly (liver: 200 mm; spleen: 157 mm) and cholestatic liver enzyme elevation. Investigations for sclerosing cholangitis were negative. Liver biopsy with Congo red staining confirmed amyloid deposition, and bone marrow analysis revealed clonal plasma cells, establishing primary (AL) amyloidosis. Echocardiography showed left ventricular hypertrophy (LVH) due to amyloid infiltration. This case underscores a possible association between SARS-CoV-2 infection and primary amyloidosis. Post-COVID inflammatory responses, elevated serum amyloid A, oxidative stress, and hypercoagulability may collectively facilitate amyloidogenic peptide formation and tissue deposition. Molecular dynamics studies further support the plausibility of SARS-CoV-2-induced amyloidogenesis. Primary amyloidosis may develop following COVID-19. Clinicians should consider amyloidosis in patients with unexplained weight loss, hepatosplenomegaly, or cholestatic liver enzyme abnormalities after SARS-CoV-2 infection. Early biopsy and type-specific diagnosis are essential for timely management. This case highlights the potential clinical significance of a post-COVID-19 association, as primary amyloidosis may develop following COVID-19.

Pyoderma gangrenosum (PG) is a rare non-infectious neutrophilic dermatosis which is characterized by a rapidly progressive, painful ulcer. Bilateral manifestation of PG is exceptionally rare and can easily be misdiagnosed as infection or vascular ulceration, delaying proper treatment. A 76-year-old woman presented with painful, crusted ulcers on her bilateral lower legs that developed over 2 weeks. Initially, the lesions erupted as erythematous papules that enlarged rapidly and ulcerated. There was no history of trauma, systemic illness, or prior ulceration. Laboratory tests revealed mild anemia and an elevated C-reactive protein level. Swab culture from the wound site showed growth of Pseudomonas aeruginosa. There was no response to antibiotics, suggesting a non-infective etiology. An incisional skin biopsy revealed dense neutrophilic infiltrate with dermal necrosis in the absence of vasculitis or infection, findings characteristic of neutrophilic dermatosis and consistent with PG. The patient was treated with oral prednisolone and local saline dressings, resulting in significant improvement within 2 weeks and complete healing without recurrence. PG can occur even in the absence of systemic diseases and may mimic infectious or vascular ulcers. Awareness about atypical presentations, early biopsy and timely initiation of corticosteroid therapy is essential to avoid misdiagnosis and achieve favorable outcomes.

We report a rare case of very late dislodgement of a Medtronic SelectSecure 3830 lumenless lead three years after successful left bundle branch area pacing. An 88-year-old patient with permanent atrial fibrillation and bifascicular block underwent VVIR pacemaker implantation in 2022 with excellent initial parameters (threshold 0.8 V at 0.5 ms, impedance 650 Ω) and stable follow-up for three years. The patient presented with pre-syncopal episodes, and device interrogation revealed capture failure with elevated threshold (2.25 V/0.4 ms) and decreased impedance. Fluoroscopic comparison confirmed macro-dislodgement of the lead with coiling in the pacemaker pocket. The SelectSecure lead was successfully extracted and replaced with a conventional stylet-driven lead positioned in the right ventricular mid-septum. This case highlights that late lead dislodgement can occur with lumenless leads even years after successful implantation, emphasizing the need for continued vigilance during long-term follow-up of cardiac physiological pacing systems.

SMART syndrome is a rare, delayed complication of cranial irradiation that can mimic stroke, tumor recurrence, or autoimmune encephalitis. Early recognition based on clinical-radiologic features is critical to avoid misdiagnosis and unnecessary interventions since conservative management often leads to complete recovery.

Extensive hepatic infarction is a rare but potentially fatal complication of HELLP syndrome and is often difficult to recognize because of nonspecific clinical manifestations. A 34-year-old woman developed HELLP syndrome shortly after cesarean delivery for severe pre-eclampsia, presenting with oliguria, marked thrombocytopenia (50 × 10⁹/L), and rapidly rising transaminases (ALT 1077 U/L, AST 1280 U/L). Contrast-enhanced computed tomography (CT) revealed extensive hepatic infarction. Laboratory findings demonstrated microangiopathic hemolysis, severe coagulopathy, and acute kidney injury. Transient elevation of the terminal complement complex C5b-9 raised concern for atypical hemolytic uremic syndrome. The patient was treated with plasma exchange, corticosteroids, organ support, and individualized anticoagulation guided by bleeding risk assessment. Serial follow-up demonstrated sustained hematologic, renal, and hepatic recovery, ultimately excluding atypical hemolytic uremic syndrome. This case highlights the importance of imaging-guided diagnosis, dynamic laboratory evaluation, and individualized therapeutic decision-making in HELLP syndrome complicated by severe hepatic injury.