International Medical Case Reports Journal最新文献

A 22-year-old incarcerated Saudi man presented with a 2-day history of painful vesicles on the shaft of his circumcised penis that were unrelated to drug use, trauma, exposure to ill persons, or sexual intercourse. Initial laboratory tests were normal, and the patient was initially diagnosed with herpes simplex infection. Due to nonadherence to the initial antiviral treatment, the lesions progressed, leading to a revised diagnosis of chancroid. Subsequent testing ruled out sexually transmitted infections and revealed methicillin-resistant Staphylococcus aureus in the culture of the purulent exudate. Histopathology confirmed balanitis circumscripta plasmacellularis (BCP, zoon's balanitis). The lesion responded well to topical betamethasone, with marked clinical improvement over 2 months. This case highlights that although rare, BCP should be considered in circumcised patients with non-venereal genital lesions. Additionally, it underscores that early histopathological confirmation is essential to avoid misdiagnosis and inappropriate treatment.

The paper presents a case report of a man (born1968) who was examined for unusual changes in the visual fields. During the examination in 2020, the right eye had esotropia, the pupillary reaction was correct. The ocular findings on the anterior segment and the ocular media were normal. The papilla of the right eye was temporally paler with c/d=0.5, the left papilla was pale with c/d=0.6, otherwise the background was normal. IOP: 16/18 mmHg. During the examination, diffuse loss of the nerve fiber layer (50 um, resp. 49 um) was detected using OCT, and similarly low values were also found for vessel density. The visual fields showed left-sided homonymous hemianopia with central sparing, partially extending into the upper right quadrants. Electrophysiological examinations of the retina (pattern electroretinogram) and the entire visual analyzer (pattern visual evoked potential - PVEP) showed bilaterally lower amplitudes. The latencies of the P00 VEP peak were not prolonged. For these changes, a magnetic resonance imaging (MRI) examination of the brain was performed with the finding of agenesis of the corpus callosum, associated trigone of the lateral ventricles on both sides. Malformation of the development of the cerebral cortex temporooccipitally medially on the right, of the nature of plymicrogyria. Heterotopia of gray matter periventricularly occipitally on the right. Bilateral atrophy of the optic nerves and chiasm. In the case report of SOD plus, unusual changes in the visual fields are described - homonymous left-sided hemianopia with central sparing. MRI examination of the brain helped to classify this lesion in the temporo-occipital medial region on the right with polymicrogyria.

Introduction: The annular pancreas is a rare congenital anomaly that typically results in duodenal obstruction during the neonatal period. However, its presentation can be variable, with some cases remaining undiagnosed until adolescence and posing diagnostic challenges, especially in low-resource settings where advanced imaging may be limited.

Case presentation: We report the case of a 13-year-old boy with a three-year history of recurrent non-bilious projectile vomiting and epigastric pain. Despite normal laboratory findings, plain computed tomography (CT) and post-intravenous (IV) contrast CT scans revealed features suggestive of gastric outlet obstruction, including significant stomach distention and abrupt tapering of the duodenum. Owing to the inconclusive imaging results, surgical exploration was pursued. Intraoperative findings confirmed the presence of a band of pancreatic tissue encircling the first part of the duodenum, thereby establishing the diagnosis of an annular pancreas. A gastroduodenostomy was successfully performed, resulting in an uneventful recovery and resolution of symptoms during subsequent follow-up.

Conclusion: This case underscores the importance of maintaining a high index of suspicion for the annular pancreas in patients presenting with chronic gastrointestinal symptoms. Although imaging modalities provide valuable clues, surgical exploration remains the gold standard for achieving a definitive diagnosis when findings are ambiguous. The successful surgical management of this patient underscores the crucial role of timely intervention, particularly in settings with limited diagnostic resources.

Acute vertebrobasilar artery occlusion (AVBAO) accounts for only 1-2% of ischemic stroke, but it has high disability and mortality rates. Mechanical thrombectomy (MT) combined with intravenous thrombolysis can quickly achieve vascular recanalization and significantly improve patient prognosis. This report describes a 73-year-old male who was admitted to the hospital in a coma due to AVBAO. After MT, successful recanalization of the basilar artery was achieved; however, the patient subsequently developed the rare but serious complication of bilateral oculomotor nerve palsy. The report emphasizes the need for careful preoperative planning, including detailed assessment of vascular anatomy and thrombus characteristics, and the importance of operator expertise. Improved intraoperative technique and close postoperative monitoring may help prevent complications such as vessel injury or embolic recurrence. Additionally, clinicians should be aware of the limitations of early DWI (Diffusion-weighted imaging) in detecting brainstem infarcts and of the need for clinical vigilance in the postoperative period.

Introduction: Plasma Cell Mastitis (PCM) is a rare, chronic inflammatory breast disorder that primarily affects females, although there are occasional reports in males. This case report details an instance of PCM in a male patient, underscoring the diagnostic and therapeutic complexities associated with this condition.

Patient concerns: The male patient presented with a palpable parapapillary mass, erythema, and localized breast pain.

Diagnoses: Radiological and histopathological assessments confirmed the diagnosis of PCM.

Interventions: Initial management included conservative pharmacological therapy, which was ineffective. Subsequently, the patient underwent a minimally invasive surgical intervention to address the breast lesion. However, 10 months post-surgery, a recurrence necessitated a total subcutaneous mastectomy.

Outcomes: Despite surgical interventions, the recurrence of PCM highlights the challenges in managing this condition. Complete resolution was achieved following the total subcutaneous mastectomy.

Conclusion: This case underscores the importance of recognizing and addressing PCM in male patients. It highlights the absence of a standardized clinical treatment protocol and emphasizes the necessity for personalized management approaches, especially in recurrent cases.

Purpose: Glecaprevir/Pibrentasvir (GLE/PIB) is approved for chronic hepatitis C treatment in both adults and pediatric patients, no data regarding crushing this drug in pediatric populations. This case series evaluate the efficacy and safety of crushed or split GLE/PIB tablets in two pediatric patients at East Jeddah Hospital, Saudi Arabia.

Patients and methods: Two treatment-naïve pediatric patients with normal liver function received weight-based GLE/PIB for eight weeks. The first patient ingested crushed tablets with juice, while the second consumed divided tablets. Viral load, liver function, and coagulation profiles were monitored. Both patients achieved rapid viral suppression, with hepatitis C RNA undetectable or near the lower limit of quantification by day 14. Liver function tests improved, and no adverse effects were observed.

Conclusion: This is the first case series of successful pediatric HCV treatment using crushed or Hepatitis C virus and hepatocellular carcinoma: carcinogenesis in the era of direct-acting antivirals split GLE/PIB. This approach may expand treatment options in resource-limited settings where pediatric formulations are unavailable.

Background: Arnold-Chiari Malformation Type I (ACM-I) is a congenital disorder that can lead to severe neurological symptoms. While decompression surgery is the standard treatment, postoperative complications such as cerebrospinal fluid (CSF) leakage and infections can result in critical outcomes. Here, we report a case of septic shock following decompression surgery in a patient with ACM-I, emphasizing the challenges in postoperative critical care management.

Case presentation: A 45-year-old woman with rheumatoid arthritis and progressive neurological symptoms underwent decompression surgery for ACM-I. On postoperative day five, CSF leakage was noted at the surgical site, accompanied by fever and leukocytosis. Despite broad-spectrum antibiotics, the patient developed septic shock, requiring mechanical ventilation and vasopressor support. CSF cultures revealed Acinetobacter baumannii infection, necessitating surgical debridement and intrathecal colistin. Despite aggressive management, the patient succumbed to septic shock.

Conclusion: This case highlights the critical importance of early detection and aggressive management of postoperative infections in neurosurgical patients. The occurrence of CSF leakage and subsequent septic shock underscores the need for meticulous postoperative monitoring to prevent fatal complications. Timely intervention, including early microbiological assessment and individualized antibiotic therapy, is essential for improving outcomes in high-risk patients.

Fluoroacetamide, a commonly used convulsant rodenticide, can rapidly damage the nervous, digestive, and cardiovascular systems, potentially leading to fatal outcomes if ingested. This study reports the case of a 62-year-old Chinese woman who presented with symptoms of intoxication, including slurred speech, agitation, and seizure-like episodes, accompanied by gastrointestinal symptoms such as vomiting, skin bruising, and mild liver dysfunction. Toxin analysis revealed the presence of fluoroacetate in her blood and urine, and diffusion weighted imaging (DWI) imaging indicated white matter lesions, leading to the diagnosis of rare fluoroacetamide poisoning. This diagnosis facilitated the administration of treatments including vitamin K, hemodialysis, acetamide, and calcium gluconate. The patient subsequently regained consciousness, with improvements in laboratory results and gradual resolution of toxic-metabolic encephalopathy. This case highlights the importance of considering drug poisoning in patients with challenging neurological symptoms, particularly when there is a potential history of drug ingestion. Accurate diagnosis of such conditions is crucial, as timely and appropriate treatment can significantly improve clinical outcomes.

Introduction: Syphilis in pregnancy, caused by Treponema pallidum, can be vertically transmitted, leading to serious neonatal complications such as preterm birth, stillbirth, and neonatal death. Despite global efforts to reduce its prevalence, challenges such as inadequate antenatal screening and delayed treatment persist. Early diagnosis and treatment are crucial to preventing adverse outcomes.

Case illustration: A 24-year-old pregnant woman (G3P2A0) was admitted at 29-30 weeks of gestation with premature rupture of membranes and labor contractions. She had been diagnosed with syphilis at 28 weeks but had not received treatment. The baby boy was delivered prematurely and suffered from severe asphyxia and respiratory distress, requiring resuscitation. Sadly, he passed away three hours after birth. The mother was discharged after receiving the first dose of syphilis treatment.

Conclusion: This case highlights the critical importance of early syphilis screening and timely treatment during pregnancy to prevent adverse maternal and neonatal outcomes. Delayed intervention in this case contributed to a poor prognosis. Comprehensive antenatal screening and prompt follow-up care are essential to reducing the risk of congenital syphilis and its complications.

Guillain-Barré syndrome (GBS), a serious acute neurological disorder that can occur during pregnancy and the postpartum period, poses significant risks to maternal health. Severe cases may rapidly progress to generalized paralysis or life-threatening complications, underscoring the urgency of early rehabilitation interventions to mitigate acute sequelae. This report details the rehabilitation journey of a 27-year-old female diagnosed with GBS following cesarean delivery at 36 weeks of gestation. Initially presenting with limb paralysis, respiratory failure, and dysphagia, she received immunoglobulin therapy and mechanical ventilation; however, persistent deficits necessitated transfer to specialized rehabilitation. A multidisciplinary program integrated respiratory training (sputum clearance, high-flow oxygen, speaking valve use), swallowing rehabilitation (oral motor exercises, laryngeal elevation training), physical therapy (joint mobility, electrical stimulation), and psychological support. Following this regimen, she achieved ventilator independence, extended phonation duration from 10 minutes to 1 hour, and demonstrated safer swallowing with reduced aspiration risk. Despite these gains, residual challenges included incomplete limb motor recovery, food spillage due to weak oral musculature, and persistent sensory disturbances. Her progress highlights the role of early multidisciplinary rehabilitation in restoring critical functions in postpartum GBS, while persisting deficits emphasize the need for long-term adaptive care. This case provides actionable insights for optimizing maternal GBS management, advocating integrated care models addressing physical and psychological recovery to advance global maternal health priorities.