Clinical Medicine Insights. Case Reports最新文献

Introduction: Tracheostomy is a vital airway procedure for critically ill patients with acute respiratory failure. This study presents a rare but serious complication: the fracture and migration of a tracheostomy tube into the tracheobronchial tree, and discusses its management.

Case presentation: A 43-year-old male, with a tracheostomy tube in place for 8 years following a neck blast injury, presented with a foreign body in his airway. Chest X-ray revealed a fractured metallic tracheostomy tube lodged in the left main bronchus. The tube was successfully removed by rigid bronchoscopy under general anesthesia, and the patient was discharged in good condition with a new tracheostomy tube.

Discussion: Tracheostomy tubes, typically made of polyvinyl chloride or metal, can fracture due to prolonged use without regular check-ups, or replacement. Patients may present with mild respiratory symptoms or be asymptomatic. Diagnosis is confirmed by X-ray, and removal is performed via rigid bronchoscopy.

Conclusion: Fractured tracheostomy tubes are a rare but potentially fatal complication requiring urgent bronchoscopy. Regular follow-up, proper care, timely tube replacement, and patient education are essential to prevent such occurrences.

Introduction: Malignant hyperthermia (MH) is a fatal hypermetabolic reaction of skeletal muscle, triggered by exposure to volatile anesthetic agents or depolarizing muscle relaxants. It typically exhibits hypercarbia, muscle rigidity, tachycardia, and hyperthermia. Diagnosis is often confirmed through a muscle biopsy for the in vitro contracture test or by identifying pathogenic genetic variants.

Case presentation: We report 2 cases of suspected MH. The first case involved a 4-year-old female (20 kg) undergoing adenotonsillectomy, and the second involved a 13-year-old female (56 kg) who underwent pedicle screw fixation surgery. Both patients had unremarkable medical histories. During maintenance of general anesthesia with sevoflurane, they developed clinical signs highly suggestive of MH-10 minutes after exposure in the first case and 120 minutes after exposure in the second case. Both cases were managed with dantrolene and supportive care. In the first case, dantrolene was administered 4 hours after the initial signs, by which time significant rhabdomyolysis had already developed. In the second case, early administration within 10 minutes was associated with a much milder degree of rhabdomyolysis.

Conclusion: Early recognition of symptoms and accurate differentiation of MH from similar conditions are essential for favorable outcomes. Prompt administration of dantrolene at the first sign of an MH reaction is critical for effective management.

Introduction: Tirzepatide is a new molecule capable of controlling blood glucose levels by combining the dual agonism of glucose-dependent insulinotropic polypeptide (GIP) and glucose-like peptide-1 (GLP-1) receptors. The Food and Drug Administration approved tirzepatide subcutaneous injections as monotherapy or combination therapy, with diet and physical exercise. Its influence on sexual behavior as an adverse effect is not well known.

Aims: The purpose of this report was to present a case study of an obese female patient who received tirzepatide treatment for sexual dysfunction.

Methods: We performed an extensive clinical evaluation, which included the Female Sexual Function Index (FSFI). Metabolic, hormonal, immunologic, and hematologic etiology of sexual dysfunction was ruled out by laboratory examination. The patient was managed by a multimodal approach, with lifestyle modification, pelvic floor strengthening exercises, pharmacologic management with bupropion sustained release 150 to 400 mg per day and topical lubricants, and psychosexual therapy as needed. FSFI scores were longitudinally followed to assess treatment response.

Results: A 36-year-old woman with obesity class III developed sexual dysfunction after using tirzepatide, a healthy lifestyle with a carb cycle diet, greater physical activity, and exercise for losing weight. All physical, psychological, and hormonal parameters were normal. During treatment, the patient started to complain of decreasing sexual drive, genital dryness, and failure to catch orgasm; female sexual function index (FSFI) = 12.7. Symptoms decreased after stopping the tirzepetide (FSFI = 28.7) and reappeared after retaking the injection (FSFI = 14.7). After 1 month of sexual treatment and support, FSFI = 24.

Conclusion: The drug's impact on hormones and neurological pathways may contribute to decreased sexual desire, through the specific process is unknown. Adjuvant sexual education and therapy support has an imperative role in the plan of management in cases on going in the journey of reducing their weight and complaining of sexual performance affection.

Diverticular disease of the small bowel is a rare, generally asymptomatic condition with a challenging diagnostic approach and the potential for life-threatening complications. While diverticular disease can manifest in any part of the gastrointestinal tract, its occurrence in the jejunum is exceptionally uncommon, with an incidence of up to 1%. Although rare, complications from diverticular disease of the small bowel can arise in up to 10% of cases, usually manifesting as signs and symptoms mimicking other etiologies or an acute abdomen. In this case report, we present the management of an elderly male patient with multiple comorbidities who developed an acute abdomen during his intensive care unit stay. The patient required surgical intervention, which revealed numerous complicated diverticula of the small bowel, affecting the jejunum, as the underlying cause of his symptoms.

Dentigerous cysts are the most common type of developmental odontogenic cysts. Multiple devices has been described for decompression. The current case report describes the use of a custom-made decompression appliance, designed through a digital workflow, in managing dentigerous cysts. A 7-year-old male patient with no prior medical history was referred to our oral surgery department due to swelling on the left side of the lower jaw. Upon intraoral examination and cone-beam computed tomography (CBCT), a provisional diagnosis of an inflammatory dentigerous cyst related to the impacted premolar was made. A digital decompression appliance was planned using EXOCAD (Exocad Gmbh, Darmstadt, Germany), and produced using a stereolithography (SLA) 3D printer. The appliance were delivered on the day of the cystostomy after extraction of the deciduous molar (tooth 85). In this report, the advancements in digital design technologies were explored enabling the creation of customized cyst decompression devices. Various stages of the design process were discussed, including 3D modeling, material selection, and the integration of digital workflows in the fabrication process. Additionally, the benefits of using such devices were addressed, including improved patient outcomes, enhanced precision in treatment, and the reduction of surgical complications.

Kindler Syndrome (KS) is a rare, autosomal recessive genodermatosis caused by mutations in the FERMT1 gene, leading to skin fragility, blistering, photosensitivity, and progressive poikiloderma. We present a unique case of KS in a 6-year-old boy born to consanguineous parents, exhibiting uncommon dermatological, and systemic features. The patient developed multiple erythematous plaques, hemorrhagic crusting, and purulent discharge after birth, with a family history suggesting genetic predisposition. Uniquely, the patient presented with well-demarcated hyperpigmented macules on the abdomen, a feature rarely seen in KS, which adds to the phenotypic diversity of the condition. Additionally, the patient had extensive lanugo hair growth, nail dystrophy, and gingivitis, typical of KS, but without urinary or mucosal involvement, a departure from more classic presentations. The patient also presented with glucose intolerance, indicated by elevated glucose levels of 222 mg/dL, likely due to infection-induced metabolic dysregulation, which normalized after treatment. The differential diagnosis initially considered porphyria cutanea tarda (PCT) due to overlapping features like photosensitivity and skin fragility. However, laboratory findings, including normal liver function and the absence of specific PCT markers, effectively excluded PCT. Microbiological swabs from purulent discharge identified Staphylococcus aureus, which was sensitive to the prescribed antibiotics. Management focused on symptomatic relief with antibiotics, supportive care, and iron supplementation to address anemia caused by chronic skin erosions. The case highlights diagnostic challenges in resource-limited settings where genetic testing was unavailable. It underscores the need for heightened awareness of atypical KS manifestations, the importance of clinical evaluation and genetic counseling, and contributes to the expanding knowledge of KS, particularly in populations with consanguineous marriages.

Introduction and significance: Hydatid disease, primarily caused by the parasite Echinococcus granulosus, commonly affects the liver and lungs. However, it can also involve other organs, including the pancreas. Pancreatic hydatid cysts are rare, constituting less than 2% of all hydatid cases. Their infrequent occurrence and atypical presentation often pose diagnostic and therapeutic challenges, especially in non-endemic regions.

Case presentation: A 42-year-old man with a cystic lesion in his pancreatic tail who had no notable medical history was seen. The diagnosis of a pancreatic hydatid cyst was validated by serological testing and diagnostic imaging techniques.

Clinical discussion: Due to their uncommon nature, the differential diagnosis of pancreatic hydatid cysts can be challenging. Imaging modalities such as computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound are important for identifying characteristic features. Serological testing further aids in confirming the diagnosis. Treatment typically involves a combination of medical and surgical approaches. Antiparasitic drugs, such as albendazole or mebendazole, are administered to kill the parasite. Surgical intervention is necessary to remove the cyst and reduce the chance of recurrence and complications.

Conclusion: This instance highlights the significance it is to take hydatid disease into consideration when making a differential diagnosis for pancreatic cystic lesions, particularly in people from endemic regions. For the optimal possible patient outcomes and avoiding of complications, early diagnosis and effective treatment are important.

Chorea Hyperglycemia Basal Ganglia Syndrome (CHBG) is an uncommon neurological complication arising in diabetic patients with severe, non-ketotic hyperglycemia. This case report describes a 50-year-old woman presenting with new-onset, choreiform movements in her extremities. Initial workup revealed uncontrolled diabetes (plasma glucose 410 mg/dl, HbA1c 11.2%) with negative serum ketones. Brain MRI findings supported the diagnosis, demonstrating characteristic T1 hyperintensity in the right basal ganglia. Implementation of gradual glycemic control over 48 hours led to significant improvement of her symptoms. This case emphasizes the importance of considering CHBG in the differential diagnosis of movement disorders in patients with uncontrolled diabetes. Early recognition and prompt glycemic management can lead to complete resolution of symptoms, highlighting the crucial role of maintaining proper blood sugar control in diabetic patients.

Spinal teratomas, though rare among spinal tumors, should be considered in the differential diagnosis of intradural-intramedullary lesions, especially in children presenting with urinary and fecal symptoms. Comprehensive imaging evaluation, including CT and MRI with characteristic findings such as cystic and solid components, the presence of fatty tissue, and associated spinal cord abnormalities like syrinx formation, can aid in early diagnosis. Surgical resection remains the mainstay of treatment, and prompt intervention is crucial to prevent progression and alleviate symptoms in affected patients. Here, we discuss a case of an intradural-intramedullary teratoma in a 6-year-old child who was timely diagnosed using CT and MRI and treated with total surgical resection.

Fahr Syndrome or Strio-Pallido Dentate Calcinosis is a rare neurological syndrome characterized by deposition of calcium in basal ganglia, which usually occurs secondary to other underlying endocrinological disorders like hypo/hyper-parathyroidism. Symptoms vary greatly and may range from psychiatric ones like confusion and hallucination to neurological like Tremors, Rigidity, with seizures being the rarest manifestation. Laboratory tests and brain imaging play a crucial role in establishing the diagnosis, while treatment primarily focuses on managing symptoms. Here, we report a case of a 17-year-old female diagnosed with Fahr's syndrome secondary to hypo-parathyroidism, onset of the disease at such young age coupled with uncommon presentation of fits makes this case rather remarkable.