Clinical Medicine Insights. Case Reports最新文献

Background: A growing number of patients suffering from neurocognitive symptoms related to COVID-19 were observed as the pandemic progressed. This article addresses severe neurological manifestations in healthy individuals with COVID-19, which were not previously identified in the absence of comorbidities or respiratory symptoms.

Case presentations: The 3 patients, aged between 15 and 27 years old, had no relevant medical history and were not on any chronic treatments. They presented different neurological symptoms (pseudobulbar affect, excessive crying, paracusia, fatigue and sleep problems, anxiety, depression, alexithymia, dementia, aggressive behavior, panic attack, etc) for a period of 2 weeks to 4 months and were treated with different medications. Clomipramine, Zolpidem and Clonazepam were effective in treating these patients.

Conclusion: Even in healthy young individuals with COVID-19, severe neurocognitive manifestations could appear with possible long-term consequences. Further research is needed to expand the knowledge on mechanisms, targeted therapeutic strategies and predictors identifying at-risk groups.

Introduction: Adult-Onset Still's Disease (AOSD) is a rare inflammatory disease. It usually causes high fevers, joint pain, a fleeting rash, and very high ferritin levels. The symptoms can mimic infections, autoimmune disorders, or cancers, so it can be hard to diagnose. Liver involvement is common but usually mild. Severe hepatitis is rare.

Case presentation: We report a 24-year-old woman who had 3 weeks of daily high fevers, a temporary salmon-pink rash, sore throat, muscle pain, and joint pain. Her blood tests showed high white blood cells with mostly neutrophils, persistent monocytosis, severely elevated liver enzymes, and very high ferritin. Tests ruled out infections, autoimmune diseases, and cancers. She met criteria for AOSD, and her glycosylated ferritin was low. The patient responded rapidly to intravenous methylprednisolone, but relapsed with polyarthritis upon tapering, which resolved completely within 48 hours of initiating anakinra.

Discussion: This case highlights the diagnostic challenges of AOSD presenting predominantly with hepatic involvement and atypical laboratory features such as persistent monocytosis. Recognition of extreme hyperferritinemia as a diagnostic clue can prevent delays in diagnosis. The dramatic response to IL-1 blockade underscores cytokine dysregulation as a central pathogenic mechanism.

Conclusion: Clinicians should consider AOSD in patients with febrile hepatitis and extreme hyperferritinemia. Early initiation of biologic therapy targeting IL-1 can achieve rapid remission, improve quality of life, and prevent complication.

Introduction: Calcium channel blocker (CCB) overdose, particularly with dihydropyridines like amlodipine, can cause profound vasodilatory shock and multi-organ dysfunction. Such poisoning often requires aggressive critical care interventions.

Case presentation: A 23-year-old Ethiopian man attempted suicide by ingesting ⩾300 mg of amlodipine (plus diclofenac). He developed refractory hypotension, bradyarrhythmia, acute kidney injury, and non-cardiogenic pulmonary edema. He subsequently required intubation and suffered a cardiac arrest.

Management and outcome: He received standard supportive therapy: Intravenous (IV) crystalloid boluses, calcium gluconate, escalating vasopressors (norepinephrine/epinephrine), and high-dose insulin-glucose infusion with potassium supplementation. Despite multiorgan failure (renal failure, pulmonary edema) and arrest, he recovered gradually over 2 weeks with full neurologic return. Corticosteroids, diuretics, and broad-spectrum antibiotics were adjunctively used.

Conclusion: This case illustrates that even a massive amlodipine overdose with multiorgan failure and arrest can be survived with early, multimodal intensive care. It showcases the need for early recognition of CCB toxicity and prompt use of therapies such as high-dose insulin and extracorporeal support if needed.

Statins are a class of drugs that are vital for lowering blood lipid levels and reducing the risk of both primary and secondary cardiovascular diseases. These drugs are generally considered safe; however, some individuals may experience side effects, such as muscle pain, headache, fatigue, myopathy, and gastrointestinal disorders. One of the less frequently reported side effects of statins is visual disturbances. We report the case of a 51-year-old woman who developed persistent headache, blurred vision, and diplopia shortly after initiating Atorvastatin. These visual disturbances recurred when treatment was switched to Rosuvastatin and Lovastatin. Comprehensive neurological evaluation, including brain MRI, was unremarkable. All symptoms resolved completely after permanent discontinuation of statin therapy, indicating a rare but significant statin-associated visual adverse event. Due to the significance of reporting this complication, this study aims to present a case of a patient who experienced visual impairment associated with the use of atorvastatin, rosuvastatin, and, to a lesser extent, lovastatin.

Hypoparathyroidism-induced hypocalcemia represents a rare cause for psoriasis exacerbation through various mechanisms including disruption of calcium-dependent keratinocyte differentiation and proliferation pathways. Epidermal barrier function and normal keratinization processes are normally maintained by normal calcium levels, where its deficiency can end in abnormal inflammatory processes and impaired skin homeostasis. We present a 52-year-old Egyptian male with chronic post-surgical hypoparathyroidism who developed severe psoriatic plaques during periods of profound hypocalcemia (7.2 mg/dL). Marked improvement of skin lesions as well as normalization of calcium levels were achieved through psoriasis therapy along with aggressive calcium, demonstrating the therapeutic importance of addressing underlying metabolic abnormalities in dermatological conditions, especially psoriasis.

Purple Urine Bag Syndrome (PUBS) is an uncommon but notable clinical phenomenon primarily observed in patients with long-term indwelling catheters. This syndrome is characterized by a striking purple discoloration of the urine collection bag, often indicative of an underlying urinary tract infection (UTI) and associated metabolic processes. PUBS occurs due to the breakdown of indoxyl sulfate, a tryptophan metabolite, by specific bacteria present in the urinary tract. In this report, we present the case of a 73-year-old female with a chronic Foley's catheter, later developed PUBS, accompanied by symptoms of lower abdominal pain, fever, and reduced urine output. Urine culture identified Klebsiella pneumoniae, a common uropathogen, as the causative organism. This case highlights the clinical presentation, pathophysiology, and management of PUBS in a patient with long-standing catheterization, along with a brief review of existing literature on the condition. Prompt recognition and targeted antibiotic therapy, alongside supportive measures, were essential in managing the infection and alleviating symptoms.

Background: Acro-osteolysis is a less common radiological condition characterized by resorption of the distal phalanges, presenting as terminal tuft or band-like resorption.

Case presentation: A 37-year-old female housekeeper with a 6-month history of progressive fingertip pain, swelling, dactylitis, and skin tightening affecting the upper limbs, face, and trunk, without Raynaud's phenomenon. Physical examination revealed sclerodermatous changes. Laboratory findings showed normal C-reactive protein, calcium, parathyroid hormone, and vitamin D levels, but positive anti-SSA antibody, suggesting an autoimmune etiology. Nailfold capillaroscopy indicated scleroderma with dilated capillary loops and avascular areas. Radiographs confirmed band acro-osteolysis in the first, second, and fifth digits bilaterally and the third digit of the left hand. A technetium-99m bone scan revealed increased radiotracer uptake in the affected digits. Whole-body imaging and serum protein electrophoresis ruled out malignancy. A deep skin biopsy confirmed systemic scleroderma with dermal fibrosis and collagen deposition. The patient was treated with prednisolone and mycophenolate mofetil, with close outpatient follow-up.

Conclusion: Our report is among the few reported cases of "band acro-osteolysis" without Raynaud's phenomenon in systemic scleroderma. This case highlights an atypical presentation of systemic scleroderma with band acro-osteolysis and dactylitis, emphasizing the importance of recognizing uncommon manifestations for early diagnosis and intervention. The multifactorial pathogenesis, involving vascular dysfunction and inflammation, underscores the need for personalized management to prevent complications.

Introduction: Spontaneous splenic rupture (SSR) is an uncommon and potentially life-threatening cause of acute abdominal pain, often linked to underlying pathology. Because its presentation can mimic more common conditions, diagnosis is frequently delayed. We report a case from a resource-limited setting where SSR initially mimicked peptic ulcer disease, underscoring diagnostic challenges.

Case presentation: A 57-year-old Ethiopian woman with chronic reflux presented after 5 days of severe epigastric pain radiating to the left shoulder, with nausea and vomiting but no trauma or fever. Initial labs showed mild anemia. Abdominal examination revealed localized epigastric tenderness without peritonism. The initial working diagnosis was peptic ulcer disease; proton pump inhibitors were started, and endoscopy was unavailable. After 2 days, she developed hypotension and left upper quadrant pain. Bedside ultrasound (FAST) showed free intraperitoneal fluid, and contrast CT confirmed a ruptured spleen with hemoperitoneum.

Management and outcome: The patient underwent emergency laparotomy, which found a shattered spleen and ~3.5 L of intra-abdominal blood; a splenectomy was performed. She required an intraoperative transfusion and was stabilized. Histopathology confirmed a normal spleen with preserved architecture, supporting a diagnosis of idiopathic rupture possibly related to transient microvascular congestion. Postoperatively, she recovered uneventfully and was discharged on postoperative day 5. She received the vaccinations needed and was counseled about infection risk.

Conclusion: This case illustrates that true spontaneous rupture can occur in a histologically normal spleen and may mimic peptic ulcer disease in presentation. Recognizing atypical features and ensuring timely imaging are crucial, especially in resource-limited settings where delayed diagnosis increases mortality.

Background: Ectopic pregnancy (EP) complicates approximately 1% to 2% of pregnancies. Most EPs implant in the fallopian tube and present in the first trimester; continuation beyond 10 weeks is extremely uncommon.

Case presentation: An 18-year-old primigravida at 12 weeks' gestation presented with acute-onset lower abdominal pain, syncope, and 1 week of dark-red spotting. She was hypotensive (BP 90/60 mmHg) and tachycardic (112 bpm) with pale conjunctivae. Abdominal examination revealed lower-quadrant tenderness; pelvic exam showed a closed cervix and a tender posterior fornix. Transabdominal ultrasound demonstrated an empty uterus, a gestational sac with a fetal pole adjacent to the right adnexa, and moderate free intraperitoneal fluid.

Management and outcome: Emergency laparotomy was performed. Approximately 800 mL of hemoperitoneum was evacuated. The right fallopian tube was found ruptured in the ampullary segment with extrusion of a formed fetus. Right salpingectomy was performed, and hemostasis achieved. The patient received 2 units of packed red blood cells intraoperatively and recovered without complication. A follow-up ultrasound at 6 weeks showed a normal remaining adnexa.

Conclusion: This rare case of a 12-week tubal ectopic pregnancy with an advanced fetus highlights critical diagnostic challenges. Delayed presentation and lack of early prenatal imaging allowed the tubal pregnancy to progress to late gestation. High clinical suspicion and prompt ultrasound evaluation are essential for early detection of atypical ectopic pregnancies, to prevent catastrophic hemorrhage and preserve fertility.

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is an uncommon but potentially fatal hypersensitivity response, commonly triggered by medications such as antiepileptics and antibiotics. It typically presents with rash, fever, hematologic abnormalities, lymphadenopathy, and internal organ involvement-most commonly affecting the liver. We report a case of a 79-year-old woman with hypertension and dyslipidemia who underwent laparoscopic cholecystectomy for acute cholecystitis with early pancreatitis. Postoperatively, she developed persistent cholestatic liver injury without biliary obstruction. Ten days later, she presented with fatigue, a diffuse maculopapular rash, and elevated cholestatic liver enzymes and lipase. Skin biopsy revealed features consistent with drug-induced hypersensitivity. Using the RegiSCAR scoring system, the case met criteria for probable DRESS syndrome (score = 5). Ceftriaxone and metronidazole, the only new drugs introduced perioperatively, were identified as likely triggers using the Naranjo causality scale. The patient was treated with oral prednisone (0.75 mg/kg), with full resolution of clinical and laboratory abnormalities following a 5-week course. This case highlights an atypical presentation of DRESS syndrome mimicking postoperative cholestasis. It underscores the importance of considering DRESS in the differential diagnosis of unexplained cholestatic injury, even in the absence of classical features like fever, eosinophilia, or lymphadenopathy. Early recognition and timely corticosteroid therapy are critical to improving outcomes.