International Medical Case Reports Journal最新文献

Introduction: Mycetoma is a chronic, progressive, granulomatous inflammatory disease affecting subcutaneous tissues, most commonly caused by traumatic inoculation of certain fungi (eumycetoma) or bacteria (actinomycetoma). Common etiological agents for eumycetoma include Madurella mycetomatis and Trematosphaeria grisea, while actinomycetoma is frequently caused by Nocardia or Streptomyces species. It is endemic in tropical and subtropical regions, including Somalia. The clinical triad of a painless subcutaneous mass, multiple draining sinuses, and the presence of grains in the discharge is characteristic.

Case presentation: We report the case of a 38-year-old female from Baladweyn, Somalia, who presented with a three-year history of a slowly growing, firm, nodular swelling on the ventral aspect of her right wrist. The lesion was accompanied by mild pain and a discharge containing black grains, which are clinically characteristic of dematiaceous fungi such as Madurella species. Her vital signs and preliminary laboratory investigations, including viral screenings, were unremarkable. The patient underwent complete en bloc surgical excision of the 3x2x1 cm mass. Histopathological examination confirmed the diagnosis of eumycetoma, revealing fungal grains surrounded by a dense neutrophilic and granulomatous inflammatory infiltrate.

Conclusion: This case illustrates the classic clinical and histopathological presentation of eumycetoma. In a resource-limited setting where species-specific identification via culture or PCR and extensive antifungal therapy may be unavailable, complete surgical excision for localized lesions proved to be a successful and curative management strategy. This report underscores the importance of early diagnosis and surgical intervention in preventing the significant morbidity associated with advanced mycetoma.

Background: Ramsay Hunt syndrome is a form of acute herpes zoster caused by reactivation of the varicella-zoster virus in the geniculate ganglion. It presents with peripheral facial paralysis and characteristic vesicular lesions in the ear or oropharynx. This report highlights diagnostic challenges associated with delayed care.

Patient information: We describe a 67-year-old woman who had no prior medical history. She first reported increasing right ear pain two weeks ago, which was followed by fever, headache, and left-sided facial paralysis. The facial weakness was manifested by her being unable to completely close her left eye and the drooping of the left side.

Clinical findings: The patient has a healed right auricular rash (see Figures 1 and 2) and Grade IV right facial paralysis. After ruling out other possible causes by CT and lab tests, a clinical diagnosis of Ramsay Hunt syndrome was made.

Intervention: While the patient came two weeks after the onset of symptoms, the key window for effective antiviral and corticosteroid therapy (usually within 72 hours) had already passed. As a result, these known treatments were not administered. The patient was given supportive treatment, which included eye drops to prevent corneal problems from incomplete eye closure and analgesics to control pain.

Outcome: After a month, the patient demonstrated functional improvement, including improved mouth symmetry when smiling and full eye closure with little effort. Her facial nerve function was therefore classed as House-Brackmann Grade IV. This case highlights the long-term morbidity associated with RHS when immediate intervention is not possible.

Conclusion: Despite being uncommon, Ramsay Hunt Syndrome requires a high level of suspicion from healthcare providers, particularly among patients who present with facial palsy along with vesicular rash and ear pain. To ensure prompt intervention and avoid long-term neurological consequences, early and precise diagnosis is crucial.

Bullous systemic lupus erythematosus (BSLE) is a rare autoantibody-mediated subepidermal blistering disease that affects fewer than 5% of systemic lupus erythematosus (SLE) patients. While oral involvement is generally mild, extensive oral lesions as the predominant manifestation are exceptionally uncommon and present significant diagnostic and therapeutic challenges. This report describes a unique case of BSLE with dominant and extensive oral involvement, a presentation rarely documented in the literature. A 29-year-old female presented to the Oral Medicine Clinic with severe, diffuse oral ulcerations of one week's duration (VAS pain score 8/10), which impaired swallowing and were accompanied by fever, without any history of new medication or food exposure. A 29-year-old female presented to the Oral Medicine Clinic with severe diffuse oral ulcerations for one week (VAS pain score 8/10) that impaired swallowing and were accompanied by fever, without any history of new medications or food exposure. Clinical examination identified widespread erythematous bullae and erosions across the oral mucosa, as well as non-scrapable white plaques on the dorsum and lateral tongue. Histopathological analysis revealed subepidermal separation with predominant neutrophilic infiltration, confirming BSLE and distinguishing it from other vesiculobullous disorders in the absence of direct immunofluorescence (DIF) testing. Management consisted of a multimodal approach, including topical therapy (dexamethasone ointment, antiseptic rinses, saline compresses, and protective emollients) and systemic therapy with high-dose intravenous methylprednisolone and oral cyclosporine, supported by antibiotics and analgesics under dermatology supervision. Notably, all oral lesions resolved completely within four weeks without the need for more aggressive systemic treatment. This case highlights the diagnostic value of a multidisciplinary, clinicopathological approach in confirming BSLE with dominant oral involvement, even when advanced immunofluorescence testing is unavailable, and demonstrates the effectiveness of a tailored, minimally invasive therapeutic strategy that achieved complete healing without the need for aggressive systemic therapy.

Introduction: Endometriosis is a prevalent chronic gynecological disease, characterized by the growth of endometrial glands and stroma outside the uterus and by the presence of chronic inflammatory lesions. This condition is one of the most common benign endometrioid proliferations, especially among premenopausal women. Although it is considered benign, endometriosis shares biological characteristics with malignant tumors, including invasion, implantation, metastasis, and recurrence. Abdominal wall endometriosis (AWE) refers to the presence of endometriosis lesions within the abdominal wall, with an extremely low incidence. Malignant transformation of AWE is exceptionally rare.

Case presentation: A 39-year-old female was admitted to the hospital on May 11, 2023, due to progressive enlargement of an abdominal mass noticed over a period of 4 months. To our knowledge, malignant transformation of abdominal wall endometriosis (AWE) is extremely rare in clinical practice, and cases of endometrioid adenocarcinoma arising from cesarean section-related AWE are even more scarce. Her medical history included surgery for a left lung teratoma 20 years ago and a cesarean section 6 years ago, with no family history of malignant tumor. This report presents a case of AWE subsequent to cesarean section, demonstrating a rare occurrence of malignant transformation into endometrioid adenocarcinoma.

Conclusion: This article emphasizes the need for heightened vigilance regarding the possibility of malignant transformation in AWE patients and suggests a multidisciplinary team (MDT) approach and individualized treatment to improve clinical outcomes. A summary of the malignant transformation associated with endometrioid adenocarcinoma in cases of AWE has been provided to describe the Pathogenesis, Clinical Manifestation, Auxiliary Examination, Pathological Features, Treatment and Follow-up of this rare condition.

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia and a major contributor to systemic thromboembolism, typically manifesting as ischemic stroke or peripheral arterial occlusion. Although spinal cord infarction (SCI) represents a rare form of ischemic injury, accounting for only 1-2% of all stroke events, its consequences are often devastating. The pathophysiological link between AF and SCI is poorly recognized, particularly in the setting of concurrent pulmonary embolism and hemodynamic instability.

Case summary: We report the case of a 91-year-old woman with chronic comorbidities who presented with first-diagnosed, asymptomatic AF and was found to have a submassive pulmonary embolism. Following initiation of anticoagulation, she developed acute flaccid paraplegia and hypotension. Spinal magnetic resonance imaging revealed a longitudinally extensive anterior-predominant T2 hyperintensity from T6 to the conus medullaris, consistent with acute anterior spinal artery territory infarction. Despite aggressive hemodynamic support, the patient's condition deteriorated and she died shortly thereafter.

Conclusion: SCI is a rare but catastrophic complication of AF. In patients with AF-especially those with concomitant venous thromboembolism or hypotension-new-onset paraplegia should prompt urgent spinal MRI to exclude ischemic myelopathy. Early recognition may guide supportive strategies, although prognosis remains poor in extensive thoracolumbar infarctions.

Mucus Fishing Syndrome (MFS) is a chronic inflammatory condition of the ocular surface characterized by repeated mechanical removal of mucus strands, leading to a cycle of irritation and excess mucus production. MFS is often associated with dry eye disease, meibomian gland dysfunction, blepharitis, and allergic conjunctivitis. Patients typically present with conjunctival hyperemia, irritation, and mucus accumulation. We describe two clinical cases of MFS in which low-level light therapy (LLLT) was used as part of a multimodal management approach. The first case involved a 32-year-old woman with a 2-year history of persistent symptoms despite previous treatments. The second case was a 50-year-old woman with severe discomfort and chronic mucus secretion unresponsive to tear substitutes alone. Both patients underwent conservative therapy including topical corticosteroids, acetylcysteine 5%, eyelid hygiene, and adjunctive LLLT (4 sessions in case #1 and 5 in case #2). MFS remains a challenging ocular surface condition requiring combined management of inflammation, mucin hypersecretion, and behavioral factors. In the cases presented, LLLT was incorporated as an adjunctive intervention within a broader therapeutic plan. Although improvement was observed, the contribution of LLLT cannot be determined based on these findings alone and further studies are needed to clarify its potential role in MFS management.

A 50-year-old male presented with painless swelling in the superonasal sector of his left eye that had appeared a year before and was unresponsive to topical steroids. He had a history of trauma to the affected eye two years prior to presentation. Examination revealed a 1 cm cystic neoformation in the episcleral subconjunctival area near the superonasal orbital margin, with normal ocular motility and no diplopia. Computed tomography (CT) showed a cystic formation between the anterior superomedial orbit and superolateral surface of the medial rectus muscle, without intraconal space involvement. Magnetic resonance imaging (MRI) indicated that the formation was hyperintense on T2 and hypointense on T1, with avid post-contrast enhancement and no extension into the surrounding structures. The neoformation was surgically removed by opening the conjunctiva, isolating the medial rectus muscle, and detaching the mass from uninfiltrated tissues. Histological examination, initially suspected to be a post-traumatic inclusion cyst, revealed an orbitoconjunctival atypical myxoma without signs of malignancy. Complete excision was deemed definitive therapy. Postoperative systemic and cardiac evaluation excluded additional myxomatous lesions. Six months after surgery, the patient remained recurrence-free.

Prion diseases are rare, fatal neurodegenerative disorders caused by misfolded proteins. Sporadic Creutzfeldt-Jakob Disease (sCJD) is the most common form and develops without any identifiable triggers. This case report documents the first probable diagnosis of sCJD in Syria, involving a 72-year-old woman who presented with depressive symptoms for several months before rapidly deteriorating, and eventually succumbing to complications of the disease. Clinical examination findings, exclusion of CJD-mimicking conditions, and specific MRI findings, supported the diagnosis in the absence of biochemical tests or postmortem confirmation. This report emphasizes the challenges of diagnosing prion diseases in resource-limited settings and calls for the development of national surveillance systems in low- and middle-income countries to aid early detection, monitor the global disease burden, and reduce the risk of outbreaks. Raising awareness of prion diseases among physicians in such contexts is crucial for improving disease recognition.

Introduction: Chorionicity is a key determinant of perinatal outcomes in twin pregnancies, with monochorionic gestations carrying greater risks due to complications such as twin-to-twin transfusion syndrome (TTTS) and selective fetal growth restriction (sFGR). Although first-trimester ultrasound can determine chorionicity with near-perfect accuracy, assessment becomes less reliable in late gestation, increasing the risk of misclassification. Such diagnostic errors may lead to inappropriate management strategies, particularly when distinguishing between TTTS and sFGR, which require different clinical approaches.

Case presentation: A 38-year-old woman underwent routine antenatal assessment at 34-35 weeks' gestation, where ultrasound suggested a monochorionic diamniotic pregnancy with suspected TTTS based on the presence of T-sign and discordant amniotic fluid volumes. The diagnostic turning point occurred at delivery, when postnatal evaluation revealed a dichorionic diamniotic placenta, clarifying that the findings were consistent with sFGR rather than TTTS. The first neonate weighed 2610 g with a normally sized placenta (20 × 20×2 cm), while the second weighed 510 g with a markedly smaller placenta (10 × 10×1.5 cm). According to the Delphi criteria, the diagnosis of sFGR was confirmed, as the smaller twin had an estimated fetal weight below the 10th percentile and intertwin weight discordance exceeded 25%.

Conclusion: This case illustrates how late-gestation assessment of chorionicity can lead to diagnostic misclassification, resulting in management strategies that may not align with the underlying pathology. Early and regular ultrasound surveillance-ideally beginning in the first trimester and continued every 2-4 weeks-remains essential for accurate diagnosis and appropriate monitoring of complications such as TTTS and sFGR.

Chronic migraine is a complex neurological disorder that has a significant burden on patient's lives and socioeconomic outcomes, and it is difficult to manage when patients present with comorbid medication overuse headache. This research describes a case of chronic migraine persisting for 20 years, worsening following high-dose biotin supplementation. A female patient with long-standing and well-controlled classic migraine developed a two-month history of daily severe headaches. The patient experienced a significant exacerbation of headaches after initiating biotin 10,000 mcg once daily. The patient developed daily migraines unresponsive to triptans, significantly affecting her quality of life and increasing multiple emergency visits. This may be due to alteration of mitochondrial energy metabolism, which disrupts the synthesis of neurotransmitters, including serotonin pathways and increased oxidative stress and ultimately results in migraine exacerbation. Discontinuation of biotin led to improvement and return to baseline with rare and mild attacks. High-dose biotin may act as a previously unrecognized trigger for migraine exacerbation. Future studies are required to explore the exact mechanisms of high-dose biotin in triggering migraine exacerbation.