International Medical Case Reports Journal最新文献

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.

Infective endocarditis is a severe infectious disease that, in addition to cardiac complications such as heart failure and arrhythmias caused by valve damage, may also lead to extracardiac complications such as septic embolization, metastatic abscesses, and mycotic aneurysms. Here, we report a rare case of splenic infarction resulting from infective endocarditis, subsequently leading to the development of a splenic artery aneurysm three weeks post-surgery confirmed both by CTA and DSA. Following arterial embolization of the aneurysm, the patient eventually recovered completely.

Hydatid disease is a zoonotic parasitic infection predominantly caused by the tapeworm Echinococcus granulosus. It remains endemic across various regions globally. In nearly 90% of cases, hydatid cysts develop in the liver and lungs; however, other organs, including the spleen, may rarely be affected, particularly in regions with high disease prevalence. A 15-year-old female patient was referred to our pediatric surgery emergency department with a complaint of a splenic cystic mass. The patient had a history of previous surgery for a hepatic hydatid cyst. Clinical evaluation confirmed the diagnosis of a splenic hydatid cyst. During surgical procedure, the cyst was found to be infected, containing straw-colored fluid, with significant adhesions to the diaphragm and surrounding tissues, complicating the procedure. A splenectomy was performed, and the patient had an uneventful postoperative recovery. Diagnosing splenic hydatid cysts can be challenging due to their nonspecific clinical presentation and the rarity of the condition. If left untreated, these cysts may lead to serious complications, including rupture and secondary infection. This case highlights an unusual location of the hydatid cyst in a patient with limited access to appropriate and definitive treatment.

Palmoplantar psoriasis is a rare, chronic, localized variant of psoriasis. It represents 3-4% of all psoriasis cases and is characterized by hyperkeratotic or desquamative erythematous plaques with fissures and erosions exhibiting acral distribution. Occasionally, superimposed sterile pustulations may also occur. New-onset psoriasis and various clinical subtypes of psoriasis exacerbation have been reported following the administration of messenger ribonucleic acid (mRNA)-based coronavirus disease 2019 (COVID-19) vaccines, with plaque-type psoriasis being the most common. However, palmar psoriasis has not yet been reported in association with COVID-19 vaccination. Herein, we present a case of new-onset palmar psoriasis along with nail changes following mRNA COVID-19 vaccination, which was further exacerbated following successive vaccine doses.

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.