Clinical Case Reports最新文献

A patient with tricuspid valve atresia and pulmonary artery valve stenosis underwent a total cavo-pulmonary circulation with an unfenestrated intracardiac conduit. He experienced poorly tolerated atrial tachycardia and was referred for radiofrequency catheter ablation (RFCA). No interatrial shunt was evident. Before the procedure, a computed tomography (CT) scan with 3D rendering was performed. At the time of the procedure, the 3D rendering was merged with an electroanatomical map (EAM) performed by CARTO3 in sinus rhythm (SR). The merge guided the identification of the exact target point for a safe transeptal puncture, without using intracardiac and/or transesophageal echocardiography. The EAM during the tachycardia showed a reentrant circuit with a critical isthmus in the lateral portion of the Fontan conduit, and RFCA was performed restoring SR.

Retrograde recanalization of chronic total occlusion can be challenging for its association with a greater risk of device entrapment and fracture. Aggressive advancement of retrograde guidewire through tortuous collateral may increase the risk of guidewire fracture. Stent jailing technique can sometimes be adopted based on the location, length, and morphology of the fractured guidewire when the patient was clinically stable and percutaneous attempts failed to retrieve. Intravascular ultrasound plays a critical role in assessing the length of the retained guidewire and guiding the final stenting to jail the wire filament into the vessel wall.

Trans-diaphragmatic rupture of a hepatic hydatid cyst, can manifesting as a pleural effusion with daughter cysts, which could be an uncommon but serious complication. Prompt diagnosis through imaging and timely surgical intervention are critical to prevent life-threatening outcomes in endemic areas.

Merkel cell carcinoma is an aggressive form of cancer with poor prognosis, particularly for individuals deemed unsuitable for surgical resection. With new immunotherapy agents being used alone or as an adjuvant treatment, improving long term outcomes are being seen, even for those deemed to be treated with palliative intent.

We report the first female case of Goltz–Gorlin syndrome with the PORCN c.1093C>T (p.Arg365Trp) variant, previously described only in a male with Klinefelter syndrome. This case expands the known phenotypic and genotypic spectrum of FDH.

Triplet births, particularly those achieved by assisted reproductive technologies, entail markedly elevated maternal and fetal risks, including hypertensive diseases. Intracerebral hemorrhage is an uncommon but devastating complication during the postpartum period. The main aim of our work is to throw light on the association of intracerebral hemorrhage in pregnancy with severe consequences. We presented and compared similar cases. We present a rare case of a 34-year-old lady who was pregnant with triplets conceived by in vitro fertilization. She had a significant intracerebral hemorrhage 2 h post elective lower-segment cesarean section. Her blood pressure was normal during prenatal and perioperative periods. A postoperative hypertensive emergency (200/110 mmHg) resulted in neurological decline and seizure, necessitating urgent airway protection and neuroimaging. The MRI indicated a substantial intracerebral hemorrhage with intraventricular and subarachnoid extension. Neurosurgical procedures included external ventricular drainage and decompressive craniectomy. The patient exhibited modest neurological improvement throughout neurocritical care. This case shows that women who have triplets are at a greater risk of experiencing a serious increase in blood pressure after giving birth, even if they had normal blood pressure before. High-risk factors like advanced maternal age and the use of assisted reproductive technologies further increase the risk of triplet pregnancy. Our case highlights the importance of frequent blood pressure monitoring postpartum. Immediate neurological consultation and, if necessary, intervention followed by intensive neurocritical care are central to management for better outcomes for the patient. All healthcare teams need to be alert for possible complications from pregnancy, like intracerebral hemorrhage, especially in high-risk groups such as older patients with multiple pregnancies or those who have used assisted reproductive techniques.

With the improvement of survival in multiple myeloma (MM), therapy-related acute myeloid leukemia (t-AML) has emerged as a clinically relevant second primary malignancy (SPM). We report a case of MM evolving into t-AML after multi-agent chemotherapy and review the literature on therapy-related leukemias in MM. We report a case of a patient diagnosed with primary plasma cell leukemia (IgG-λ type, R-ISS stage III) who achieved complete remission following maintenance therapy with daratumumab, lenalidomide, and dexamethasone after receiving a treatment regimen based on proteasome inhibitors. The patient progressed to therapy-related acute myeloid leukemia 18 months later, and we present the clinical features. Additionally, we conducted a literature review. Given the patient's age and debilitated physical condition, treatment with azacitidine combined with venetoclax was administered. Following the treatment, the patient developed grade IV post-chemotherapy myelosuppression complicated by infection and extensive ischemic stroke. Despite aggressive supportive care, the patient's condition continued to deteriorate and he succumbed in August 2025. This case illustrates the leukemogenic risk of cytotoxic exposure in MM, highlights the adverse genetic profile of therapy-related AML, and emphasizes the need for vigilant monitoring and preventive strategies in long-term MM survivors.

Rasmussen's encephalitis (RE) is a rare, chronic inflammatory neurological disorder affecting one cerebral hemisphere and presenting with drug-resistant epilepsy, progressive hemiparesis, and cognitive decline. This case report describes the clinical course and management of a 21-year-old patient with refractory epilepsy and progressive neurological deterioration due to RE, followed over 12 years. The patient initially presented with persistent focal seizures characterized by automotor features, visual hallucinations, and postictal confusion, along with progressive right hemispheric atrophy and metabolic disturbances, including hypokalemia and bicarbonate deficits. Diagnosis was established through neuroimaging, revealing significant right hemispheric atrophy and EEG findings of frequent multifocal discharges. Management included immunomodulatory therapies, surgical intervention (right temporal lobectomy), and antiseizure medications. Despite partial seizure control, disease progression could not be arrested.

Gastric MANEC (gMANEC) is a rare tumor composed of at least 30% each adenocarcinoma and neuroendocrine carcinoma (NEC) components. A 52-year-old male underwent total D2 gastrectomy for gastric cancer. Final pathology revealed MANEC. We compare outcomes and mortality rates between gastric MANEC and conventional adenocarcinoma. MANEC has poorer disease-free survival (DFS) and post-recurrence survival (PRS), and higher risk of distant recurrence, compared with clear adenocarcinoma. Rigorous follow-up and adjuvant therapy tailored to the more aggressive component are advised.

Epstein–Barr virus (EBV) and Hepatitis E virus (HEV) are two distinct viral pathogens known to affect the liver. While EBV commonly causes mild, self-limited hepatitis, and HEV is the leading cause of acute viral hepatitis globally, co-infection with both viruses is exceedingly rare. This case report describes a 55-year-old previously healthy male who presented with right upper quadrant abdominal pain and generalized fatigue. Laboratory investigations revealed markedly elevated transaminases and slightly increased bilirubin, suggesting mixed hepatocellular and cholestatic liver injury. Initial serologies showed positive EBV IgG and borderline IgM, confirmed by a low positive EBV DNA PCR. While awaiting HEV testing, the patient was managed supportively. On day four, HEV IgM returned positive and EBV DNA rose to 15,500 copies/mL, confirming concomitant infection. Imaging revealed periportal edema and splenomegaly with no biliary obstruction. Supportive care led to a steady clinical improvement and normalization of liver enzymes by day 14. The patient was discharged in stable condition with full clinical and biochemical recovery. This case highlights the importance of considering dual viral infections in patients with significant hepatic enzyme elevation and non-specific systemic symptoms. Although rare, concurrent EBV and HEV infection can present with significant liver inflammation but may still follow a self-limiting course in immunocompetent individuals. Awareness of such co-infections can prevent misdiagnosis, avoid unnecessary interventions, and emphasize the role of supportive care. Additionally, this case underscores the need for comprehensive viral screening when evaluating unexplained hepatitis in otherwise healthy individuals. Early recognition ensures appropriate management and favorable outcomes.