Clinical Medicine Insights. Case Reports最新文献

Dengue virus infection is a significant public health concern, particularly in endemic areas. This case report highlights the difficulties in diagnosing expanded dengue syndrome (EDS) in a dengue-endemic region. This case report emphasizes keeping high suspicion of index for (EDS) among patients presenting with fever and neurological manifestations particularly in regions where dengue is endemic. The atypical neurological symptoms and inconclusive initial investigations underscore the diagnostic challenges associated with (EDS). Prompt recognition and appropriate laboratory testing, such as detecting dengue NS1 antigen, can aid in accurate diagnosis and subsequent management of patients with this condition. Increased awareness among healthcare providers in endemic regions is crucial for timely identification and intervention in case of dengue-associated neurological complications. Therefore, a multidisciplinary approach is required for time-effective management.

Introduction: Workplace-related traumatic lip injuries, particularly at the vermilion-cutaneous junction, are challenging due to functional impairment and visible scarring. While typically managed in specialized settings, some cases present in primary care clinics. This report details the successful management of a penetrating laceration at this junction using layered closure and MEBO for optimized healing, with postoperative scar massage therapy to enhance recovery.

Case presentation: A 19-year-old male construction worker sustained a full-thickness laceration from the vermilion-cutaneous junction to the inner mucosa. The injury was repaired in a primary care clinic, where precise vermilion alignment was essential. Layered closure was performed using absorbable (5-0 Vicryl) sutures for mucosal, muscular, and dermal layers, and nonabsorbable (6-0 Prolene) sutures for the vermilion-cutaneous junction. MEBO, a plant-based ointment primarily used for burns, was applied postoperatively to promote healing, and reduce scarring. Scar massage therapy was initiated after wound healing. Follow-ups at 5 days, 1 week, 6 weeks, and 4 months showed excellent cosmetic outcomes, minimal scarring, and full functional recovery.

Clinical discussion: 6-0 Prolene was preferred over nylon sutures due to its superior biocompatibility. Simple interrupted sutures ensured tension-free closure for optimal healing. MEBO supported epithelial proliferation, moisture retention, and reduced inflammation-promoting faster tissue repair and superior scar remodeling compared to standard antibiotic ointments, petroleum jelly, or silicone gels. Postoperative scar massage further enhanced collagen remodeling, reduced fibrosis, and improved lip flexibility.

Conclusion: This case highlights the feasibility of managing complex lip injuries in a primary care setting and emphasizes the importance of precise anatomical repair, proper suture selection, and novel interventions like MEBO and scar massage. Further research is needed to establish MEBO's role in standard postoperative care for traumatic lip injuries.

Introduction: Hypokalemic periodic paralysis (HPP) is a severe yet reversible neuromuscular condition precipitated by profound hypokalemia. Autoimmune disorders can exacerbate renal potassium loss resulting in abrupt muscle weakness. Primary Sjögren's syndrome (pSS), an autoimmune disease characterized by exocrine gland insufficiency, can lead to renal tubular dysfunction and episodes of HPP when distal acidification is compromised.

Case presentation: A 40-year-old woman was admitted with rapidly progressive, painless quadriplegia for over 2 days. Laboratory tests revealed critical hypokalemia (1.4 mEq/L), metabolic acidosis, and alkaline urine pH, which was consistent with type 1 distal renal tubular acidosis (dRTA). Serologic studies confirmed pSS. Corrective measures included intravenous potassium chloride and sodium bicarbonate along with immunomodulation with intravenous methylprednisolone, followed by oral prednisolone.

Discussion: The patient's presentation illustrates how autoimmune-mediated renal tubular dysfunction can precipitate HPP. Failure of distal acid excretion impairs potassium handling, amplifying the risk of potentially life-threatening neuromuscular collapse. Stabilization requires meticulous electrolyte repletion and treatment of the underlying autoimmunity. Restoration of serum potassium levels, acid-base balance, and targeted immunosuppression resulted in rapid clinical improvement.

Conclusion: An accurate diagnosis of HPP secondary to dRTA and Sjögren's syndrome requires high clinical suspicion. Prompt recognition and intervention, including immunotherapy and balanced electrolyte replacement, can prevent profound neuromuscular complications and improve patient outcome.

Pneumatosis intestinalis (PI) is characterized by the presence of air within the walls of the small intestine, large intestine, and sometimes the gastric wall. The mechanism and pathogenesis of PI are poorly understood. The discovery of PI can occur in the form of an incidental finding, such as a benign course or a life-threatening condition, such as intestinal ischemia. Point-of-care ultrasonography (POCUS) for pneumatosis intestinalis (PI) is rarely reported in adults, with only 1 previous poster presentation. However, POCUS is well-documented in the pediatric population, particularly for the diagnosis of intussusception. We present a 78-year-old man with longstanding uncorrected severe pulmonary stenosis, right-sided heart failure, atrial fibrillation on dabigatran, diabetes, and cirrhosis who presented with progressive abdominal distension. POCUS and computerized tomography of the abdomen showed ascites, diffusing small-bowel wall thickening with edema, and pneumatosis intestinalis, without portal venous gas or vascular occlusion. Patient was transitioned to palliative care on diuretics, lactulose; follow-up ultrasound showed only mild ascites but persistent small-bowel PI. This case report marks the second instance of POCUS being utilized for PI in an adult population. POCUS can play an essential diagnostic role at the bedside, ruling out serious underlying etiologies and guiding physicians in further diagnostic testing.

Methemoglobinemia is a rare but potentially life-threatening condition characterized by the oxidation of hemoglobin iron from ferrous (Fe²⁺) to ferric (Fe³⁺) state, impairing its oxygen-carrying capacity. Acquired forms can be triggered by exposure to oxidizing agents, such as nitrobenzene. We present the case of a 32-year-old female who developed symptomatic methemoglobinemia following oral ingestion of a commercial stimulant product containing nitrobenzene. She presented with peripheral cyanosis, breathlessness, and hypoxia unresponsive to oxygen therapy. A diagnosis of methemoglobinemia was confirmed, and prompt administration of intravenous methylene blue led to rapid clinical improvement. This case emphasizes the importance of early recognition of acquired methemoglobinemia in the context of toxic exposure, especially when conventional respiratory or cardiac pathology is excluded. Methylene blue remains the first-line antidote, offering effective and timely reversal of symptoms.

Background: Lumbar interbody fusion (LIF) is a widely used surgical technique for treating degenerative spinal conditions. However, challenges such as pseudarthrosis and implant migration remain significant concerns. This case report presents the use of a novel trabecular titanium cage combined with a biocomposite hydrogel containing stromal-vascular fraction and BMP-2 to enhance osseointegration and accelerate bone fusion.

Case presentation: A 61-year-old female patient with severe chronic lumbar pain, functional impairment, and grade II anterolisthesis of L4 underwent lumbar interbody fusion. A custom-designed trabecular titanium cage was implanted, featuring an optimized porous structure for enhanced fixation and bone ingrowth. To further promote bone regeneration, a biocomposite hydrogel synthesized from adipose-derived stromal-vascular fraction and BMP-2 was applied. Postoperative assessment demonstrated significant pain reduction, improved functional activity, and early bone fusion formation. Radiological imaging confirmed stable implant positioning, progressive trabecularization, and successful osseointegration. No complications, such as implant migration or material loosening, were observed.

Conclusions: This case highlights the potential benefits of combining advanced implant design with bioactive materials in spinal fusion surgery. The approach resulted in early and stable bone integration, reduced pain, and improved functional recovery. Further studies with larger patient cohorts and extended follow-up periods are needed to validate these findings and assess long-term outcomes.

Alien Hand Syndrome (AHS) is a rare neurological condition characterized by involuntary, goal-directed movements of a limb without conscious control. It is most often associated with stroke in specific brain regions, including the medial frontal and parietal cortices. We report the case of a 33-year-old male with no previous medical history who presented with involuntary movements of the left upper limb, describing it as "moving on its own." Neurological examination was unremarkable, but MRI revealed multiple cortical infarcts in the right frontal and parietal lobes, with both acute and subacute features. Extensive workup ruled out vascular stenosis, dissection, and hypercoagulable states. Transthoracic echocardiography showed normal left ventricular function and a hypermobile interatrial septum. Transesophageal echocardiography confirmed the presence of a tunnel-shaped patent foramen ovale (PFO; 0.4 mm × 0.3 mm) without thrombus. No deep vein thrombosis or other embolic sources were found. A diagnosis of cardioembolic stroke due to paradoxical embolism through a PFO was established. The patient underwent successful percutaneous closure and started dual antiplatelet therapy. At follow-up, AHS symptoms improved significantly. This case highlights an atypical initial presentation of ischemic stroke in a young adult and emphasizes the need for early neuroimaging and comprehensive cardiac evaluation in cryptogenic strokes.

Kawasaki disease (KD), a febrile vasculitis primarily affecting young children under 5, is commonly associated with coronary artery complications. This report describes the case of a 2.5-month-old infant presenting with a persistent 15-day fever, initially misidentified as pharyngitis and otitis media. Laboratory tests indicated significant leukocytosis, thrombocytosis, and increased C-reactive protein (CRP) levels. Echocardiography revealed coronary artery dilation and pericardial effusion, confirming a KD diagnosis. The infant received intravenous immunoglobulin (IVIG) and high-dose aspirin, which resolved the fever. Symptom recurrence necessitated additional IVIG and corticosteroid treatment. Subsequent imaging showed ongoing coronary dilation, emphasizing the risk of lasting vascular complications. This case underscores the diagnostic challenges of KD in infants, especially those with atypical presentations. Prompt diagnosis and treatment are critical to prevent serious complications such as coronary aneurysms. Healthcare providers should consider KD in infants with prolonged unexplained fevers to improve prognosis and minimize heart-related risks.

We report a case of acrocephalosyndactyly, Pfeiffer syndrome type 1 with a mutation in FGFR2 c.758C>G (p.Ser253Trp) in a newborn with mild midfacial hypoplasia, significant brachydactyly and syndactyly in the hands and feet. One of the hallmark features of Pfeiffer syndrome is webbing or fusion (syndactyly) of the fingers and toes, which can vary in severity affecting both hands and feet. This variable expressivity of Pfeiffer syndrome makes classification of the condition challenging. Diagnosis was confirmed by genetic testing. Imaging investigations, clinical observation and physical examination further highlights the importance of interdisciplinary care involving orthopedic, neurosurgeons, geneticists, and pediatricians. Long-term follow-up is essential to monitor growth and development, while addressing associated complications including hearing loss and tracheal stenosis. This case underscores the complexity of acrocephalosyndactyly and its varying presentation. The baby was born at 35 weeks to non-consanguineous parents, with craniosynostosis, midfacial hypoplasia, broad thumbs, and toes.

Acute lymphoblastic leukemia (ALL) rarely presents with initial liver failure. We describe a 9-year-old boy with no past medical history who presented with jaundice, hyperbilirubinemia (total bilirubin 13.1 mg/dL), and significantly elevated transaminases (ALT 1283 U/L, AST 1325 U/L). Bone marrow aspiration confirmed precursor B-cell ALL. Despite severe hepatic dysfunction, full-dose induction chemotherapy was administered following corticosteroid therapy, leading to rapid improvement in liver function and normalization by day 29. No complications were observed, and at the end of induction, minimal residual disease was 0.001%. This case of successful unadjusted chemotherapy, with leukemic infiltration identified as the etiology of hepatitis, underscores the importance of early diagnosis, multidisciplinary management, close monitoring, and highlights the need for further investigation into safe treatment protocols in such cases.