International Medical Case Reports Journal最新文献

Nevirapine, a non-nucleoside reverse transcriptase inhibitor (NNRTI), is widely prescribed in antiretroviral therapy (ART) for HIV treatment. Although effective, it is associated with rare but severe adverse drug reactions, including Stevens-Johnson syndrome (SJS), a life-threatening mucocutaneous disorder. This case report describes a Middle age HIV-positive man who developed SJS following nevirapine initiation, highlighting the importance of timely recognition, management, and the need for clinician vigilance to prevent adverse outcomes in antiretroviral therapy.

Ovarian cancer remains a significant cause of morbidity and mortality in women worldwide. Olaparib, a poly ADP-ribose polymerase (PARP) inhibitor, has been shown in studies to increase the time that people with cancer do not get worse. However, reports have indicated rare adverse effects, like myelodysplastic syndrome (MDS). In this report, we highlight the case of a 42-year-old female patient who was diagnosed with ovarian endometrioid carcinoma, FIGO Stage IIB. Following surgery and chemotherapy, the patient commenced maintenance therapy with Olaparib. After two years, she experienced abnormal blood test results, which ultimately led to a diagnosis of myelodysplastic syndrome (MDS), confirmed through a bone marrow biopsy. Despite initial obstacles, the patient underwent stem cell transplantation as a treatment for MDS. After undergoing stem cell transplantation, the patient experienced a notable improvement in their condition. Upon reevaluation, the transplantation proved successful as it resolved the abnormalities related to MDS. Furthermore, the ovarian cancer status showed a positive response, with no signs of disease progression during the follow-up period. This particular case emphasizes the importance of being vigilant for uncommon adverse effects, such as MDS, in ovarian cancer patients undergoing Olaparib maintenance therapy. Early diagnosis and treatment, which may include stem cell transplantation, can lead to favorable results, not only in managing MDS but also in possibly slowing down the progression of ovarian cancer that is causing it. Additional research is necessary to understand the risk factors and the most effective management approaches for these complications in this specific group of patients.

In the previous guideline recommendations, patients who have had a stroke within 3 months are excluded from intravenous thrombolysis (IVT) regimens. Some studies have suggested that IVT with alteplase (rt-PA) may be effective and safe in such patients, but evidence supporting the use of tenecteplase (TNK) is not sufficient. This paper includes an 80-year-old male patient readmitted for recurrence of ischaemic stroke (IS) after 48 days, who received TNK IVT as a bridging therapy prior to thrombectomy, with favourable results at 8-week follow-up. This case highlights that TNK alone or IVT as a bridging therapy prior to thrombectomy can also benefit patients with recurrent stroke within 3 months.

This report presents a healthy 2.5-year-old child exhibiting headache, ptosis, exotropia, and left mydriasis. Initial neuroimaging, including computed tomography (CT), computed tomography angiography (CTA), and standardized magnetic resonance imaging (MRI), failed to identify any lesions; however, high-resolution MRI revealed an ovoid mass adjacent to the left proximal oculomotor nerve within the superior cavernous sinus. This case underscores the necessity for advanced imaging techniques and a thorough diagnostic approach to enhance understanding of this rare pediatric condition. Moreover, it highlights the limited documentation of pediatric oculomotor schwannomas, leading to an inadequate understanding of their diagnosis and management, and emphasizes the need for enhanced awareness and research to establish effective diagnostic protocols, particularly utilizing advanced neuroimaging techniques.

Introduction: Ileosigmoid knotting is the wrapping of an active component of either the ileum or the sigmoid colon over each other. It is an unusual cause of intestinal obstruction, accounting for 1-2% of cases of all mechanical obstruction in the majority published literatures. A viable knot is a unique phenomenon of this seldom cause of bowel obstruction.

Case presentation: A sixteen-year-old female patient presents with a complaint of central abdominal distension and obstipation of 12-hour duration. Later, she also developed abdominal cramps and vomiting of ingested matter. Her vital signs were all in the normal range, and the abdominal examination was positive for a grossly distended abdomen with mild upper and central abdominal tenderness. The ileosigmoid knotting was clearly visible on the computed tomography. Emergency exploratory laparotomy was performed, and a viable ileosigmoid knot was identified. Unknotting, derotation, and decompression of the sigmoid colon were performed. The postoperative course was uneventful.

Discussion: Ileosigmoid knotting is a rare, life-threatening cause of intestinal obstruction with rapid progression to intestinal vascular compromise and gangrene. It is a hyperactive segment of ileum that winds around the pedicle of the redundant sigmoid colon, resulting in a closed-loop obstruction. There are different classification schemes of ileosigmoid knotting depending on the active component of the knot and based on the viability of the bowel and physiology of the patient. Preoperative diagnosis of this condition is often challenging and usually confirmed intraoperative.

Conclusion: A high index of suspicion and prompt surgical exploration are crucial for the best outcome of the patient. Despite being a rare cause of intestinal obstruction, ileosigmoid knotting poses a significant morbidity and mortality to the patient. Management of a patient with viable ileosigmoid knotting is controversial, as some scholars suggest non-resective options and others recommend resective treatment as a recurrence preventive measure.

Acute Generalized Exanthematous Pustulosis (AGEP) is a relatively rare but severe dermatological adverse reaction characterized by the rapid onset of generalized erythema, coupled with numerous sterile nonfollicular pustules. Agents commonly implicated in triggering AGEP include antibiotics, antifungals, antimalarials, and diltiazem. We present a case of a isotretinoin induced AGEP in a young female patient known to have guttate psoriasis, inverse and scalp psoriasis. She was started on Isotretinoin as she had inflammatory acne as well. Three days later, she developed pruritic, erythematous lesions, some vesicles with a yellowish exudate over the armpits, upper chest, upper arms, and legs. A skin biopsy was performed, which, in conjunction with the clinical presentation, was suggestive of AGEP. In 2010, Filho et al described the first case of isotretinoin-induced AGEP in a female patient diagnosed with Hidradenitis Suppurativa. The EuroSCAR tool was utilized to assess the lesion morphology, clinical course, and histological outcomes, which validated the diagnosis. Using the same criteria, our patient was categorized as "definite AGEP", further supporting the isotretinoin-induced AGEP hypothesis. This report highlights isotretinoin as a possible trigger for AGEP, emphasizing the crucial role of a thorough history and vigilant clinical assessment in early identification and management of such reactions.

Background: Fluoroquinolones and macrolides are the preferred antibiotics for treating Legionnaires' disease. However, the limited utility of these antibiotics in cases of organ dysfunction is a major problem. Omadacycline is a novel tetracycline antibiotic with a good safety profile and in vitro antibacterial activity against Legionella, but it lacks validation by clinical data.

Case description: Here, we report a case of severe pneumonia caused by Legionella infection. The patient was empirically treated with antibiotics, after admission but had a poor clinical outcome with severe hepatic and renal insufficiency. After Legionella infection was confirmed by metagenomic next-generation sequencing, the patient was switched to omadacycline antibiotic therapy and eventually discharged after recovery.

Conclusion: The results of this study suggest that metagenomic next-generation sequencing can facilitate early diagnosis of Legionnaires' disease, and omadacycline can be an alternative antibiotic treatment for severe Legionnaires' disease, especially in patients experiencing multiple organ failure.

Palmoplantar pustulosis (PPP) is a chronic condition characterized by the presence of sterile pustules on the palms and soles of the feet. As we all know, there is currently no gold standard for the treatment of this intractable disease. Currently, interleukin-36 receptor (IL-36R)-targeted biologics are emerging as promising treatments for PPP. Here, we were the first to report a Chinese male with PPP who received an intralesional injection of spesolimab. We found that only a small intralesional injection volume of spesolimab could effectively suppress PPP in this case.

Pure neuritic leprosy (PNL) is a rare clinical variant of leprosy, especially in children. This variant of leprosy only involves peripheral nerves without skin involvement or acid-fast bacilli (AFB) found on slit-skin smear examination. The challenging diagnosis and establishment of PNL due to the absence of skin lesions often lead to disability. A case of PNL with grade 2 disability of hands and feet in a 16-year-old boy was reported. The patient has been living in a leprosy-endemic area and has a history of contact with people who have symptoms of leprosy. On physical examination, there were finger contractures on both hands and feet, accompanied by bilateral ulnar, common peroneal, and posterior tibial nerve enlargement without any skin lesions. No AFB was found on the slit-skin smear examination. The diagnosis of PNL was established by the mononeuritis multiplex detected on the nerve conduction examination and the histopathological examine from the biopsy of the left ulnar nerve, which showed lymphocyte infiltration. The patient was treated with multidrug therapy for multibacillary leprosy and consulted with the Department of Physical Medicine and Rehabilitation and the Department of Orthopaedics and Traumatology for contracture management. Clinicians need to be aware of the signs and symptoms of PNL in order to avoid delays in diagnosis and treatment, as the diagnosis and establishment of PNL remain challenging.

Introduction: Pyogenic granulomas are benign, painless vascular tumors on the skin and mucosal surfaces. They are commonly found in the head and neck region, although their occurrence in the larynx is rare. The term "lobular capillary hemangioma" is now used to describe the histological appearance of these tumors more accurately. Predisposing factors for pyogenic granuloma of the larynx have been linked to prior traumatic injuries, such as intubation, previous surgeries, or laryngopharyngeal reflux.

Case presentation: A 33-year-old male visited our clinic with complaints of progressive dysphonia and choking for two months. The patient did not experience dysphagia or dyspnea. There was no history of previous intubation, gastroesophageal reflux disease, or other chronic illnesses. Upon laryngoscopic examination, a polypoid lesion measuring 25×8 mm was found on the posterior commissure of the right vocal cord. No abnormalities were observed during the ear and nose examinations.

Discussion: Pyogenic granuloma, or lobular capillary hemangioma, is a hyperplastic lesion that develops on the skin and mucous membranes. It often occurs in response to trauma or hormonal factors. Histologically, pyogenic granulomas differ from granulation tissues due to their lobular arrangement of capillaries in the deeper portions of the lesion. The term "lobular capillary hemangioma" has been recently introduced to emphasize this phenomenon. Some of the conditions considered in the differential diagnosis include hemangioma, hemangioendothelioma, angiofibroma, angiosarcoma, Kaposi sarcoma, Wegener's granuloma, Crohn's disease, granulomatous infections such as tuberculosis and histoplasmosis, traumatic granuloma, carcinosarcoma, as well as verrucous and squamous cell carcinoma.

Conclusion: We present a case report of lobular capillary hemangioma of the larynx, including its histopathological diagnosis and management course.