International Medical Case Reports Journal最新文献

Intestinal malrotation, which affects 0.03 to 0.5% of newborns, can induce rare left-sided appendicitis and also go undetected until adulthood because of its unusual clinical signs. Even while it frequently occurs with other congenital defects, it can also manifest in adulthood as a separate abnormality. In this case report, we report on a 33-year-old female patient who has left-sided appendicitis because of intestinal malrotation, an uncommon and challenging illness for which early identification and treatment are essential for a successful outcome.

Background: Twin-to-Twin Transfusion Syndrome (TTTS) is a severe complication in monochorionic pregnancies. Fetoscopic laser photocoagulation (FLPC) is the standard of care for advanced stages. However, data regarding neonatal outcomes following FLPC in resource-limited settings, where neonatal intensive care capabilities may be constrained, remain scarce.

Case presentation: We report the case of a 33-year-old woman (G4P2A1) diagnosed with TTTS Quintero stage II at 21 weeks of gestation. She presented with significant pre-existing uterine contractions. Following a decompressive amnioreduction, she underwent selective FLPC which successfully resolved the "stuck twin" phenomenon in the donor twin. Despite the technical success of the fetal intervention, the patient experienced worsening preterm labor resulting in delivery at 24 weeks and 4 days. Both infants were born alive but succumbed to complications of extreme prematurity given the limited availability of advanced neonatal life support.

Conclusion: This case highlights the critical need for strategies to mitigate iatrogenic prematurity following successful fetal therapy in resource-limited settings. While FLPC effectively corrects fetal pathophysiology, the ultimate survival is heavily dependent on the capacity of the healthcare system to manage the subsequent extreme prematurity.

Thrombocytopenia in pregnancy is most commonly gestational. However, it is important to distinguish it from immune thrombocytopenia (ITP), which carries maternal and fetal risks. The treatment options include corticosteroids, intravenous immunoglobulin (IVIG), and splenectomy in refractory cases. A 38-year-old Syrian woman at 37 weeks of gestation with a history of 6 cesarean sections presented with refractory ITP. The patient's platelet count was 5.1×10³/mL despite receiving corticosteroids for a month. She underwent a cesarean section and splenectomy due to persistent severe thrombocytopenia (3×10³/mL) and labor onset. Pre- and intraoperative platelet transfusions were administered to reduce the bleeding risk. The procedure revealed an accessory spleen, and a healthy neonate was delivered with normal platelet counts. Maternal platelets improved after surgery to 115×10³/mL. First-line therapies such as corticosteroids and IVIG often suffice in ITP cases during pregnancies. Splenectomy is now viable for refractory cases, ideally in the second trimester. This case highlights the possibility of late-term splenectomy combined with the cesarean section in refractory cases to corticosteroids.

Intestinal parasitic infections and Helicobacter pylori are prevalent in low-resource settings, especially in overcrowded areas with poor sanitation and limited healthcare access. These conditions are notably pronounced in internally displaced people (IDP) camps nationwide. Children in such environments are at increased risk of multiple coinfections due to environmental exposures and inadequate preventive measures. Endemic parasites such as Ascaris lumbricoides, Trichuris trichiura, Strongyloides stercoralis, Hymenolepis nana, and Entamoeba spp. are commonly found alongside chronic bacterial infections like Helicobacter pylori, which are associated with gastritis, peptic ulcers, and nutritional deficiencies. The shared transmission routes and risk factors of these pathogens exacerbate the disease burden, particularly in malnourished children, leading to adverse health outcomes. This report describes a six-year-old Somali girl from an IDP camp in Mogadishu who presented with chronic gastrointestinal symptoms and was diagnosed with severe polyparasitism and active H. pylori infection based on laboratory investigations. She was successfully treated with a tailored multidrug regimen targeting both helminths and bacteria, resulting in clinical and parasitological recovery. The case highlights the urgent need for integrated diagnostic, therapeutic, and educational interventions in humanitarian settings. Addressing these coinfections through comprehensive strategies is crucial not only for improving individual health but also for alleviating the broader public health burden in displaced and resource-limited communities.

Introduction: Intramural esophageal hematoma (IEH) is a rare entity in the spectrum of esophageal injuries that often present with symptoms, such as acute chest pain, dysphagia and/or hematemesis. Herein, we present an interesting case of spontaneous IEH in a patient with uncontrolled hypertension, in the absence of established predisposing factors.

Case presentation: 61-years female, with a history of hypertension but no coagulopathy or anticoagulant/antiplatelet use, presented with sudden onset chest pain associated with complete dysphagia for 6 hours. She was found to have uncontrolled hypertension, with a blood pressure of 220/110 mmHg. She underwent computed tomography imaging of the chest followed by upper gastrointestinal endoscopy, which confirmed a diagnosis of spontaneous IEH. Conservative management and aggressive blood pressure control led to complete resolution of IEH within four weeks.

Conclusion: This case highlights the importance of considering spontaneous IEH in the differential diagnosis of acute-onset chest pain with dysphagia in hypertensive patients, particularly in those with atypical presentations.

Background: Henoch-Schönlein Purpura (HSP), also known as IgA vasculitis (IgAV), is a common childhood vasculitis that frequently involves the gastrointestinal tract. Its occurrence in adults, particularly in association with Giardia lamblia infection, is exceptionally rare.

Case presentation: We report the case of an 18-year-old female, who presented with severe abdominal pain, hematemesis, and a palpable purpuric rash on her lower limbs. Investigations revealed leukocytosis (WBC: 15.5×10³/µL), microscopic hematuria, and elevated serum IgA (3.5 g/L). An upper gastrointestinal endoscopy showed diffuse hemorrhagic mucosa consistent with vasculitis. Stool microscopy identified Giardia lamblia trophozoites. A diagnosed of IgA vasculitis with severe gastrointestinal involvement and concurrent giardiasis was established. The patient was treated with intravenous methylprednisolone and metronidazole, resulting in significant clinical improvement.

Discussion and conclusion: This case highlights a rare association between IgA vasculitis and an active Giardia lamblia infection, and to our knowledge, is the first such case reported from Somalia. It underscores the presence of IgAV in adults and emphasizes the importance of investigating for co-infections in patients presenting with sever GI symptoms. A comprehensive evaluation is vital for ensuring timely and appropriate management.

Pernicious placenta previa (PPP) complicated by placenta accreta spectrum (PAS) is a life-threatening obstetric condition associated with significant maternal morbidity and mortality, primarily due to severe hemorrhage during cesarean section. The 2018 FIGO Guidelines defines placenta accreta spectrum (PASDs) as a group of pathologic disorders. Depending on the depth of placental villous invasion into the uterine wall, PASDs are divided into placenta accreta (grade I), placenta increta (grade II), and placenta percreta (grade III). A 28-year-old gravida 4, para 2 woman with a history of two previous cesarean sections (Pfannenstiel scar) and one scar pregnancy presented with vaginal bleeding and abdominal discomfort at 34+3 weeks gestation. Prenatal ultrasound and magnetic resonance imaging (MRI) confirmed severe PPP with placenta accreta, involving extensive placental invasion into the bladder, cervix, vagina, and parametrial tissues. A multidisciplinary team performed preoperative abdominal aortic balloon occlusion (AABO) to reduce hemorrhage risk, followed by cesarean section under general anesthesia. Despite preventive measures, massive intraoperative hemorrhage (~6000 mL) led to hemorrhagic shock, necessitating aggressive resuscitation and massive transfusion therapy. The patient was successfully resuscitated with stable vital signs. Postoperative management included intrauterine balloon tamponade for hemostasis, prophylactic antibiotics, as well as additional blood transfusions, albumin, and nutritional support. The patient was discharged after showing improvement. This case highlights the importance of early and accurate prenatal diagnosis, rigorous multidisciplinary collaboration, and individualized surgical and resuscitative strategies in managing severe PPP complicated by PAS. Future research should focus on refining diagnostic techniques, preventive interventions, and comprehensive perioperative care protocols to minimize complications and optimize maternal and neonatal outcomes.

Hydatid disease is an anthropozoonosis, caused by the larval stage of parasitic tapeworm Echinococcus granulosus. Every organ of the human body can be affected by the Echinococcus granulosus but mostly the liver is involved. Hydatid disease of the muscles is not common, and the involvement of the psoas muscle is very rare. This is a case of a 45-year-old male presented to the emergency department with left flank pain, fever and left leg weakness since 6 months. A total of three hydatid cysts were found in the psoas muscle, extending to the left iliac fossa across the psoas muscle.

Background: Cholesteatoma is a non-neoplastic but destructive lesion of the temporal bone that can lead to significant complications if not accurately diagnosed and managed. While computed tomography (CT) is the standard for assessing bony erosion, its ability to differentiate cholesteatoma from inflammatory tissue is limited. Non-echo planar diffusion-weighted magnetic resonance imaging (non-EPI DWI MRI) offers high specificity for diagnosing cholesteatoma. In resource-limited settings, access to MRI is often restricted, making a stepwise, evidence-based imaging approach crucial.

Case presentation: A 26-year-old male presented with a decade-long history of chronic, foul-smelling left ear discharge and progressive hearing loss. Clinical examination was suspicious for a left-sided cholesteatoma. An initial non-contrast CT scan revealed a soft tissue mass with significant erosion of the scutum and ossicular chain. To confirm the diagnosis, a subsequent non-EPI DWI MRI was performed, which demonstrated a well-defined lesion with restricted diffusion, characteristic of cholesteatoma. The MRI also identified contralateral otomastoiditis in the right ear without evidence of cholesteatoma. Based on this definitive diagnosis, the patient underwent a left-sided canal wall down mastoidectomy.

Conclusion: This case highlights the pivotal role of a stepwise imaging strategy in a resource-limited environment. While CT identified the extent of bony destruction, the selective use of non-EPI DWI MRI provided a definitive diagnosis, confidently guiding the surgical plan towards an eradicative procedure. This approach ensures appropriate management, prevents potential complications, and underscores the value of integrating advanced diagnostics judiciously when resources are scarce.

Hypoglycemia is a rare but documented adverse effect of linezolid. We report a 72-year-old patient with late-stage gynecologic cancer and abdominal MRSA peritonitis, who developed persistent asymptomatic hypoglycemia after starting linezolid. The patient had type 2 diabetes on metformin-glibenclamide. Fasting blood glucose dropped to 2.08 mmol/L (reference: 3.9-6.1 mmol/L) 1 day post-linezolid initiation; hypoglycemia persisted despite stopping oral hypoglycemics and administering dextrose, but normalized within 24 hours after linezolid discontinuation (replaced with tigecycline). Naranjo ADR Scale scoring (7 points) confirmed a "probable" causal link. We present dynamic glucose trends (reinforcing causality) and review linezolid-associated hypoglycemia literature. This case highlights the need for glucose monitoring in linezolid-treated patients, especially at high risks, even without diabetes or symptoms.