Clinical Medicine Insights. Case Reports最新文献

The virus SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) causes COVID-19, a potentially fatal disease. The COVID-19 vaccine is indicated for active immunization to prevent COVID-19 caused by SARS-CoV-2. We reported the case of a 66-year-old woman with a medical history of hypertension and anxious-depressive syndrome who developed Guillain Barré Syndrome (GBS) 4 weeks after receiving the COVID-19 vaccine. During the patient's hospital stay, they received cycles of high-dose intravenous immunoglobulin (IVIG) and plasmapheresis treatments.. Despite the treatment, a deterioration of respiratory function led the patient to premature mortality.

Introduction: Cardiac hemangioma is one of the rarest tumors, with only a few cases described. Unlike other cardiac tumors, its symptoms are nonspecific, making misdiagnosis easy. Cardiac hemangioma can present with various clinical manifestations, including valve disorder, arrhythmia, pericardial effusion, and embolism. Echocardiography is the most direct examination, and surgical resection the simplest and most effective treatment.

Patients and methods: We present a new case of lobulated cardiac hemangioma causing tricuspid regurgitation and discuss the clinical features, diagnosis, and treatment of this rare tumor.

Results: After surgical resection and tricuspid valve replacement, the patient recovered well.

Conclusion: For cardiac hemangiomas involving the tricuspid valve, tumor resection combined with valve surgery is an effective treatment option.

Heart tumors are sporadic. Secondary heart tumors are 30 times more common than primary ones. Depending on the location and origin of the tumor, clinical pictures vary from asymptomatic to severe manifestations such as arrhythmia, heart failure, pericardial effusion, and cardiogenic shock. We report hereby a rare case who presented with faint clinical symptoms, rapidly progressing to right heart failure within a month. Echocardiography and computed tomography of the chest revealed a tumor in the right heart chamber of 72.0 × 43.0 mm, in addition to large mediastinal lymph and left supraclavicular lymph nodes, cardiogenic shock appeared 4 days after admission. Through examination, it was suspected that this was a cardiac lymphoma. The patient was treated with 2 mg methylprednisolone per kg body weight. Symptoms of cardiogenic shock improved significantly and disappeared after 6 hours of treatment. After supraclavicular lymph node biopsy and immunohistochemistry, the final result was diagnosed as diffuse large B-cell non-Hodgkin lymphoma with large lymphoma in the right heart. The patient received chemotherapy with the R-CHOP regimen (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisolone). Re-examination before the 5th chemotherapy cycle showed no signs of right heart failure, normal self-activity, and no dyspnea on exertion, and the tumor size in the heart on the echocardiogram was 23.8 × 19.1 mm. The report shows that a large right heart tumor with a clinical picture of cardiogenic shock in a patient with diffuse large B-cell non-Hodgkin's lymphoma was well-responded to initial treatment with methylprednisolone at a dose of 2 mg/kg body weight and R-CHOP chemotherapy.

Purpose: We report a case of a patient experiencing paroxysmal supraventricular tachycardia after infusing doxophylline.

Methods: Clinical evaluations and the electrocardiogram were performed by specialists.

Findings: Our patient felt palpitations and chest distress after intravenous Doxophylline. The electrocardiogram showed paroxysmal supraventricular tachycardia. There was no evidence to prove that there was any problem with his heart, liver, and kidney. According to the Naranjo Adverse Drug Reaction probability scale, paroxysmal supraventricular tachycardia has a probable relationship with Doxophylline.

Implications: The paroxysmal supraventricular tachycardia is a rare but reasonable adverse reaction of Doxophylline, which should be paid more attention.

Ventricular septal defect (VSD) represents a severe complication that may manifest after a myocardial infarction (MI), typically occurring between 2 and 7 days later. Due to advancements in reperfusion management, the incidence of VSDs after MI has become very rare, occurring in approximately 0.2% of MIs. The current guidelines recommend urgent post-infarction VSD (PI-VSD) closure. We report a case of a patient with a VSD, which was diagnosed 2.5 years after MI. At the time of acute inferior MI, the patient was managed with primary percutaneous intervention in the culprit artery, and 1 month later coronary artery by-pass grafting (CABG) was completed. Twenty and thirty months after AMI patient presented with ventricular tachycardia (VT). Following the second VT episode patient was hospitalized for further examination. Echocardiography revealed the presence of VSD at the site of inferioseptal wall aneurysm. An ICD was implanted owing to recurrent malignant rhythm disorders. In conclusion, although the PI-VSD might have been overlooked and the patient missed the chance of concomitant CABG and VSD repair, this case has reached a 3-year survival, which appears to be the longest survival recorded in a medically treated patient with PI-VSD.

Background: Uterine fibroids, or Leiomyoma is a type of Smooth Muscle Tumors of the uterus (SMTs) and are common in the black race. Giant uterine fibroids, on the other hand, are uncommon and may occur during patient dissimulation. Dissimulation may occur because of a dread of surgery and hospitals visits, fear of surgical death, chronic intake of herbal concussion, and a religio-traditional strong belief system on instant healing following prayers, among others. Myths like belief of defecating the uterine fibroids, some herbs that can melt them away, and the belief that such illness may follow ancestral curses can fuel dissimulation. The surgical approach can be a source of challenge, careful case selection considering the size and number of tumors can be helpful.

Case report: We present a 35-year-old nulligravida who presented to the clinic with a 14-year history of progressive abdominal swelling. Examination revealed a firm mass with a symphysio-fundal height of 55 cm. She subsequently had an open abdominal myomectomy with all the myoma nodules weighing 12.9 kg in total! Histology confirmed uterine fibroid.

Conclusion: It is possible to offer open myomectomy in patients with giant uterine fibroid following careful patient selection with a consent for possible hysterectomy. Dissimulation can be minimized with repetitive counseling of patients. The choice of surgery depends on the size and number of uterine fibroids, but surgical approach does not necessarily influence fecundity.

Chilaiditi's sign is a rare radiological finding characterized by colonic interposition between the liver and the right hemidiaphragm. It is a cause of pseudopneumoperitoneum which is often mistaken for true pneumoperitoneum. In this article, we present the case of a 73-year-old female with a previous history of pulmonary tuberculosis, who reported to our hospital with progressive abdominal distension associated with early satiety, bipedal swelling, generalized weakness, worsening fatigue, and weight loss. Following evaluation, she was diagnosed with liver cirrhosis and chronic lymphocytic leukemia. Her chest radiograph also incidentally showed air under the right hemidiaphragm with haustral folds consistent with Chilaiditi's sign. Since she did not have signs of peritonitis, she was eventually treated for liver cirrhosis and chronic lymphocytic leukemia without undergoing any surgical intervention. This case report seeks to create awareness among clinicians about this rare radiological sign in order to prevent misdiagnosis leading to unnecessary surgical procedures.

Calcifying odontogenic cyst, also known as Gorlin cyst is a rare benign cystic lesion primarily found in the jawbones, accounting less than 1% of odontogenic cysts. It can be associated with odontogenic tumors such as odontomas. We report a rare case of COC associated with complex odontoma in a young patient and discuss its clinical features, diagnosis, and treatment options. An 18-year-old female patient presented with a painless radiopaque lesion of the right mandibular bone at Oral Medicine and Oral Surgery department. Radiographs revealed irregular tooth-like structures in the canine-premolar area. The lesion was surgically removed, and histopathology confirmed COC with a complex odontoma. As of the World Health Organization's 2022 definition, COC is a developmental odontogenic cyst characterized by calcified ghost cells. It typically affects individuals during their second and third decades of life, with no gender preference, almost equally in the maxilla and the mandible. The main treatment is total enucleation, with a generally favorable prognosis. Histopathology is essential for diagnosis due to its mimicry of other jaw conditions. Long-term follow-up is needed to prevent recurrences.

Rhabdomyolysis was not reported in clinical trials with Sitagliptin alone. However, several reports in the literature on rhabdomyolysis resulted from the interaction between statins and Sitagliptin. In patients with type 2 diabetes and hyperlipidemia, it is expected to co-prescribe statins and Sitagliptin. Herein, we report the case of a 64-year-old woman with rhabdomyolysis should be caused by a drug-drug interaction between Rosuvastatin and Sitagliptin. The patient denied any history of weakness or myalgia during past medical assessments.

Cases and studies of protruding early gastric cancer (EGC) combined with spontaneous bleeding are relatively rare. The current study present a female patient aged 70 to 75 years old with hemorrhagic shock caused by spontaneous bleeding from EGC type 0-Isp, which was successfully cured by rapid emergency endoscopic submucosal dissection (ESD).