Clinical Medicine Insights. Case Reports最新文献

Age-related macular degeneration (AMD) is a leading cause of significant vision impairment in individuals aged 50 and older, primarily impacting central vision. This study seeks to investigate potential associations between periodontal disease and age-related maculopathy in the analyzed clinical case. A male subject of 66 years old, with age-related degenerative maculopathy and severe periodontal disease, was evaluated and treated. After an initial phase of non-surgical causal periodontal therapy, the periodontal indices were re-evaluated. In addition, the extraction of hopeless teeth replaced by dental implants was performed. A retinal topography was used to assess possible regression of the pathology, and proper anti-VEGF therapy was administered. The results showed a regression of periodontal disease and an improvement of the degenerative maculopathy. These preliminary results, even if encouraging, should be supported by larger prospective trials.

Background: Spontaneous Retropharyngeal Hematoma and cervical hematoma are rare conditions characterized by the accumulation of blood in the retropharyngeal and cervical region and poses a potential life-threatening risk. This complication can occur unexpectedly and without apparent trauma, particularly in patients on vitamin K antagonists.

Case presentation: A 60-year-old man presented to the emergency with acute dysphagia, dysphonia and a right-sided neck ecchymosis. The patient had been on vitamin K antagonists for 7 years following a left intraventricular thrombus. Blood tests revealed an International Normalized Ratio of 7. The diagnosis of Spontaneous Retropharyngeal Hematoma was suspected given the absence of an identified cause and was confirmed by contrast-enhanced computed tomography. The hematoma was attributed to the patient's long-term use of vitamin K antagonists, which predisposed him to spontaneous bleeding. Treatment involved the administration of vitamin K but the patient ultimately passed as a result of respiratory arrest.

Conclusion: Spontaneous Retropharyngeal Hematoma due to VKA-related incidents is a rare but significant complication to consider in patients undergoing anticoagulant therapy. Awareness among healthcare professionals is crucial to ensure early recognition and appropriate management.

This case report presents a rare instance of chronic rib osteomyelitis in a 23-year-old female from Darchula, an underserved rural area in Nepal. Rib osteomyelitis is uncommon and often diagnosed late due to its subtle presentation. The patient initially presented at a primary care center with a 2-week history of a protruding bony mass in the right upper back, accompanied by foul-smelling discharge and low-grade fever. She was referred to a tertiary hospital, where a CT scan, surgical excision, and biopsy confirmed chronic rib osteomyelitis. This case highlights the diagnostic challenges of rare conditions in rural settings and emphasizes the essential role of community-based healthcare in early identification and referral. It underscores the need for accessible diagnostic facilities, community health education, and a multidisciplinary approach to support patients in resource-limited environments.

A case of spontaneous bilateral internal carotid artery dissection (ICAD) in a 36-year-old male, potentially linked to COVID-19, is reported. Initially presenting with excessive daytime sleepiness, an atypical symptom for ICAD, the patient lacked focal neurologic deficits. Diagnostic evaluation revealed severe stenosis and dissecting aneurysms in both carotid arteries. Treatment included anticoagulation, corticosteroid therapy, and subsequent endovascular stent placement. This case underscores the importance of considering ICAD as a potential complication of COVID-19, especially in patients with atypical symptoms. Further research is needed to understand the underlying mechanisms and optimize treatment strategies.

Background: Renal infarction is an uncommon complication of Blunt renal artery injury (BRAI) following abdominal trauma. Diagnosis of infarction is difficult and mostly delayed due to non-specific symptoms. Early diagnosis can lead to appropriate and effective treatment, which prevents further complication.

Case presentation: We report a case of 21-year-old man falling from a height of 9 m. A contrast-enhanced CT scan in the nephrogram phase showed no evidence of absorption in the right kidney and significantly decreased absorption in the left kidney. The pyelogram phase showed no secretion in the right kidney and decreased secretion in the left kidney suggesting segmental renal infarction. Subsequently, heparin infusion was initiated immediately. A follow-up contrast- enhanced abdominopelvic CT scan was performed after 1 month and showed no sign of infarction, and all laboratory tests were normal.

Conclusion: Contrast-enhanced abdominopelvic CT scan helps physicians diagnose the renal infarction immediately and start appropriate treatment. Treatment can vary from aggressive surgical procedures to observation and supportive care.

The accurate diagnosis of pathologies with obscure presentations requires comprehensive clinical evaluation, epidemiological context, and consideration of the patient's clinical or hospital course. In this case report, we describe a 30-year-old female receiving antituberculosis therapy who developed multiple signs and symptoms that were unexplained by any single diagnosis, including multiple rashes with different features. The patient was determined to have drug induced lupus with concomitant HIV infection. Physicians should consider the possibility of co-existing disease processes when a single unifying diagnosis that reconciles all aspects of the patient's presentation cannot be identified.

Pena-Shokeir Syndrome (PSS) is a rare autosomal recessive disorder characterized by dysmorphic features, camptodactyly, arthrogryposis, intrauterine growth restriction, polyhydramnios, and pulmonary hypoplasia. Two types of this syndrome have been defined, differentiated by distinct clinical and genetic features. PSS is a potentially life-threatening condition, with most cases expected to be diagnosed prenatally via ultrasound. Genetic counseling is crucial to inform parents about recurrence risks and management strategies for future pregnancies. We report a case of PSS in a dichorionic diamniotic (DCDA) twin pregnancy. Despite normal prenatal ultrasounds, 1 twin was diagnosed postnatally with severe craniofacial anomalies, limb deformities, and pulmonary complications, consistent with PSS. In contrast, the second twin exhibited normal growth and development, with no anomalies identified. To the best of our knowledge, this is the third reported case of PSS in a twin pregnancy and the second involving a normal co-twin. This case aims to contribute to the existing literature by detailing the unique dysmorphic and clinical findings associated with PSS and emphasizing the diagnostic challenges in twin pregnancies.

Introduction: Scabies is a parasitic skin condition, with crusted scabies (CS) being a severe and highly contagious variant characterized by thickened skin lesions and a high mite count. CS is typically associated with immunocompromised individuals but can also develop in those suffering from malnutrition, as malnutrition weakens immune responses and impairs skin integrity.

Case presentation: We report a case of CS in a 50-year-old malnourished male with no history of scabies or systemic disease, recently incarcerated. He presented with widespread itching, hyperkeratotic papules on the palms and soles, and secondary impetigo. The patient showed signs of malnutrition, with a BMI of 15.6 kg/m² and muscle wasting. Sarcoptes scabiei mites, eggs, and scybala were identified microscopically. The case was classified as Grade 3 CS. Treatment included two doses of ivermectin (8 mg) one week apart, 10% sulfur ointment, and benzyl benzoate soap. Follow-up was incomplete, highlighting challenges in managing socially vulnerable patients.

Discussion: This case emphasizes the importance of early recognition, accurate diagnosis, and effective treatment of CS, especially in settings with poor sanitation and overcrowding. The patient's malnutrition likely contributed to the severity of the condition, as compromised immunity can facilitate mite proliferation.

Conclusion: A holistic approach addressing malnutrition, sanitation, and patient education is crucial in managing CS in resource-limited settings.

Introduction: During the COVID-19 pandemic, incidence of brain abscesses is difficult to assess. Numerous studies reported benign and severe post SARS-CoV-2 vaccine side effects, including rare cases of brain abscesses associated with COVID-19 or Anti-SARS-CoV-2 vaccines. Here in, we report what we believe to be, up to date, the fourth known case in the medical literature of a streptococcus salivarius brain abscess, the first intra parenchymatous or supra-tentorial streptococcus salivarius brain abscess and also the first that occurs following an anti-SARS-CoV-2 vaccine.

Case presentation: We describe the case of a north african 63-year-old man with an unremarkable medical history except for recent anti-SARS-CoV-2 vaccinations. Following the administration of a third anti-SARS-CoV-2 booster vaccine, the patient developed neurological symptoms, including left hemiparesis, facial palsy, vertigo, and balance issues. Imaging studies revealed a right temporo-parietal lesion consistent with intracranial suppuration. Stereotaxic cerebral biopsy confirmed the presence of purulent content, indicating a brain abscess caused by multi-sensitive streptococcus salivarius.

Conclusion: Sepsis-induced immunodepression appears to be a consequence of severe inflammatory state, as it dysregulates leukocytes population and results in serious infections. A plausible hypothesis is that a previous stress such as anti-SARS-CoV-2 vaccination could lead to the development of a streptococcus salivarius septicemia. In light of the available evidence and research findings, no definitive conclusion can be drawn regarding any potential link between anti-SARS-CoV-2 vaccines and the physiopathology of sepsis-induced immunodepression.

Biliary tract carcinomas (BTC) are malignant epithelial neoplasms subdivided anatomically into: gallbladder carcinomas and carcinomas of the bile duct or cholangiocarcinomas (CCA); including intrahepatic, hilar/perihilar, and distal CCA. Adenocarcinoma accounts for the most common BTC (over 90% of all carcinomas), while other histological subtypes represent rarer forms including: poorly cohesive/signet ring cell carcinoma, which has a greater malignant potential than conventional BTC and a poorer prognosis. Only few cases have been reported in the literature to date. The positive diagnosis remains on histology. Herein, we describe a new case of poorly cohesive carcinoma of bile duct extending to the gallbladder in a 60 years old women with a fatal outcome, to raise awareness of this rare entity and to provide data for larger series.