International Medical Case Reports Journal最新文献

Background: Treating patients with human immunodeficiency virus (HIV) integrase strand transfer inhibitors (INSTIs) resistance and concurrent Talaromyces marneffei (T. marneffei) infection poses a significant clinical challenge, requiring precise antiretroviral adjustments, timely anti-infection, and management of complex drug interactions.

Case presentation: Interrupted antifungal therapy and INSTIs resistance in an HIV patient coinfected with T. marneffei resulted in severe immunosuppression. Initial voriconazole/imipenem treatment improved peritonitis. However, the symptoms recurred. Antiretroviral therapy (ART) was switched from elvitegravir to zidovudine, lamivudine, dolutegravir, and albuvirtide. Antifungal therapy adjusted from voriconazole to itraconazole. During the follow-up process, HIV RNA turned negative and the CD4⁺ T cell count increased, but fungal antigens persisted until the 10-month follow-up period.

Conclusion: This case emphasizes genotype resistance testing-guided ART modification and rigorous opportunistic infection management in drug-resistant HIV patients. Coordinated care and timely interventions can enhance the outcomes in high-risk cases.

Osteoporotic vertebral compression fracture (OVCF) is a common complication of osteoporosis, often resulting in vertebral collapse, chronic pain, and increased mortality. Vertebroplasty (VP) is a minimally invasive procedure used to alleviate pain by injecting bone cement into fractured vertebrae. However, bone cement leakage is a frequent complication, typically occurring in the extradural space with minimal clinical symptoms. In contrast, intradural cement leakage is rare but can lead to severe consequences such as neural compression and neurological deficits, necessitating urgent intervention. We present a case of a 70-year-old woman who developed intradural cement leakage after VP for a T12 compression fracture. The patient experienced immediate lower limb weakness, numbness, sensory loss, and urinary/defecation dysfunction following the procedure. MRI revealed posterior cement leakage compressing the spinal cord at the T12 level. She underwent surgical decompression and cement removal at our institution, including posterior fixation from T11 to L1, total laminectomy, and durotomy. Due to intraoperative neurophysiological monitoring, complete removal of intradural cement was not achieved. Postoperatively, the patient showed gradual improvement in lower limb muscle strength and sensory function, with near-complete recovery at one-month follow-up. Consequently, to prevent intradural cement leakage, surgeons must be vigilant about this rare complication and perform precise puncture and cautious cement injection. In cases of catastrophic leakage, prompt cement removal and thorough spinal canal decompression are essential. Preoperative CT imaging is crucial for confirming intradural leakage and planning precise surgery to reduce risks and improve outcomes.

Major abdominal surgeries including pancreatic resection are rarely performed in patients on chronic dialysis due to perioperative morbidity associated with end-stage renal disease. This case report presents a 71-year-old female on hemodialysis with pancreatic head cancer who underwent successful pancreaticoduodenectomy. The patient had the following severe comorbidities: type 2 diabetes mellitus, hypertension, and chronic kidney disease. Therefore, meticulous preoperative preparation, intraoperative care and postoperative management including hemodialysis and nutritional support were performed. Postoperative recovery was uneventful, bowel function was restored on day 5, and the patient was discharged in good condition. This case provides the feasibility of pancreaticoduodenectomy (also known as Whipple procedure) in carefully monitored patients, particularly those on dialysis, despite the increased risk of complications like cardiovascular, immune, and coagulation disorders. Brief literature review confirms that patients with end-stage renal disease can be considered for abdominal surgery with acceptable morbidity and mortality in complex surgical procedures.

Purpose: Ameloblastic fibroma (AF), an exceedingly rare benign mixed odontogenic tumor, scarcely occurs in the anterior region of the maxilla. This case report aims to delineate the formidable challenges faced during the early diagnosis of such cases, with the ultimate goal of averting missed diagnoses.

Methods: A 6-year-old female patient presented with the delayed eruption of bilateral maxillary central incisors. As early as 2 years old, tooth 62 was found to be impacted, accompanied by a supernumerary tooth in the anterior maxilla upon X-ray examination at another facility. Currently, for supernumerary tooth extraction, the child visited our hospital. Cone-beam Computed Tomography (CBCT) disclosed a supernumerary tooth between 11 and 21, along with a well-defined 5mm×6mm×6mm low-density shadow encircling the crown of impacted permanent tooth 62. The clinical diagnosis was anterior maxillary supernumerary tooth, impacted 62, and dentigerous cyst.

Results: Maxillary mass resection, extraction of impacted 62, and removal of the supernumerary tooth were carried out. Post-operative pathology confirmed AF, and long-term follow-up revealed no tumor recurrence.

Conclusion: Despite its rarity, AF should be contemplated in pediatric patients with tooth eruption delay and radiographic low-density lesions with irregular edge. This case offers invaluable insights for clinicians in diagnosing and managing small, early-stage lesions. Probing into the causes of non-erupted deciduous teeth may contribute to early lesion detection.

Blastocystis hominis (B. hominis) is a protozoan parasite that inhabiting the gastrointestinal tract of humans and animals. Often considered a commensal parasite, severe manifestations are uncommon and isolated. This case report describes a case of B. hominis infection in an HIV-seropositive individual manifesting as dysentery. The diagnosis was confirmed through both microscopic and quantitative Polymerase Chain Reaction (qPCR), which proved to be highly sensitive and specific for detecting this parasite. The patient was treated with cotrimoxazole and metronidazole in addition to antiretroviral therapy. The findings underscore the importance of utilizing advanced diagnostic techniques to accurately identify B. hominis in immunocompromised patients, thereby facilitating prompt and appropriate management.

The Marcus-Gunn jaw-winking phenomenon (MGJWP) is an uncommon congenital oculofacial synkinesis resulting from abnormal innervation between the fifth cranial nerve (trigeminal, CN V) and the third cranial nerve (oculomotor, CN III). This case report presents a 5-month-old girl with characteristic left eyelid elevation during suckling movements, highlighting the importance of clinical observation in early diagnosis. The condition was confirmed based on clinical findings, with no associated neurological or structural abnormalities. Management involved observation and follow-up to monitor potential complications such as strabismus or anisometropia. MGJWP remains an essential consideration in cases of unusual eyelid movement, emphasizing the role of multidisciplinary consultation for comprehensive care.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency, a sex-linked chromosomal disorder, is the most common enzymopathy in humans. This enzyme, which protects red blood cells, when deficient, predisposes individuals to hemolysis under oxidative stress. Several chemicals and drugs have been commonly known to cause hemolysis in G6PD deficiency. However, an uncommon substance, henna, a plant-based dye used in Africa and Asia, has also been described to trigger hemolysis in G6PD-deficient individuals. It shares similarities in the structural ring and properties with other well-described G6PD hemolytic agents. We present a rare case of severe intravascular hemolysis following topical henna application in an 8-year-old girl with G6PD deficiency, successfully managed at the Upper West Regional Hospital in Ghana.

Background: GeneX^® allows adsorption and aggregation of molecules and proteins to promote bone formation. According to reports in the literature, it is used in bone defect reconstruction and percutaneous vertebroplasty to promote bone formation.

Case report: We designed a prospective cohort study to evaluate the outcomes following of percutaneous vertebroplasty using GeneX in patients with osteoporotic vertebral compression fractures. Vertebroplasty was performed at seven vertebrae in the first seven patients. Overall, there were four leaks in four (57%) of the seven patients. Asymptomatic leak of the GeneX material into the intradiscal and paravertebral structures at the treated vertebral level was observed in three patients (43%). However, the material leaked into the intradural and epidural space in the seventh patient (14%), causing severe neurological deficits. Primary diagnosis was bone cement implantation syndrome. The patient's neurological status improved gradually during the month after surgery. She was able to resume her activities of daily living and had regained her urinary function by 3 months after surgery.

Conclusion: Owing to its physicochemical characteristics, even with sophisticated surgical techniques, GeneX cannot be recommended for use in percutaneous vertebroplasty for OVCF. The long-term safety and efficacy of GeneX need to be further validated through Phase II clinical trials. Lumbar cistern drainage can significantly improve neurological deficits in patients caused by GeneX implantation syndrome.

Background: Plasmodium falciparum Malaria and Thrombocytopenic Purpura (TTP) are serious diseases associated with thrombotic microangiopathic anemia (TMA) pathogenesis. Therefore, clinical treatment is usually delayed because of the overlapping clinical manifestations. This case describes Plasmodium falciparus infection causing markedly elevated von Willebrand factor (vWF) levels but normal ADAMTS13 activity, which closely mimics the presentation of TTP.

Case presentation: There is overlap in laboratory and clinical presentations, such as fever, thrombocytopenia, severe anemia, and intravascular coagulation between malaria and TTP. We present the case of a 51-year-old Chinese man who initially presented with fever that quickly progressed to a disturbance of consciousness. Laboratory tests showed a decreased platelet count, elevated lactate levels, and elevated indirect bilirubin levels. The patient's PLASMIC score for TTP was 7, suggesting a high possibility of TTP. There was markedly elevated vWF, but normal ADAMTS13 activity. Therefore, TTP was excluded. However, we found a large amount of P. falciparus in the peripheral blood smears. The patient's condition gradually improved after intravenous artesunate treatment.

Conclusion: Malaria and TTP have obvious laboratory and clinical resemblances, owing to the presence of TMA. It is important to quickly perform a differential laboratory diagnosis between malaria and TTP, which may lead to the early initiation of lifesaving treatment in some patients.

The decision to place a loved one with dementia in a specialized facility is often associated with significant psychological distress among family caregivers, which often manifests itself in feelings of guilt, helplessness, and emotional tension. We conducted a pilot implementation of a seven-session psychoeducational group program designed to support family caregivers during the critical transition from home care to nursing home placement. The intervention included weekly modules addressing fundamental topics such as how nursing homes operate, managing behavioral disorders, end-of-life considerations, and sources of stress for caregivers. Among the 12 initial participants enrolled in the program, we present three illustrative cases that reflect distinct impact trajectories depending on caregiver profiles. Two caregivers showed substantial psychological and relational improvement, characterized by greater acceptance of institutional placement and enhanced coping strategies. In contrast, the third case highlighted the program's limitations in addressing more complex emotional and relational dynamics. These results suggest that, while psychoeducational intervention can facilitate emotional adaptation and promote reevaluation of the relationship between the caregiver and the care recipient, its effectiveness may be limited in cases requiring individualized psychological support. Adapting the intervention to include more flexible and personalized components, such as optional individual or family consultations, could enhance its relevance and effectiveness in meeting the diverse needs of caregivers.