International Medical Case Reports Journal最新文献

Background: Neurocysticercosis (NCC) and Acquired Human Immunodeficiency Syndrome (AIDS) are both highly prevalent in Africa. Clinical presentation of NCC ranges from asymptomatic to manifestations, including epileptic seizures, severe progressive headache, and focal neurological deficits. It is influenced by the number, size, location, and stage of the cysts, as well as the parasite's potential to cause inflammation and the immunological response of the host. So far, little is known about how Human Immunodeficiency Virus (HIV) co-infection modifies clinical NCC presentation. We report the case of a person living with HIV presenting with extensive calcified NCC on neuroimaging without any associated signs/ symptoms.

Purpose: To contribute to the medical literature and enhance understanding of the disease's manifestation and progression by providing a thorough documentation of a specific case of extensive inactive neurocysticercosis.

Case presentation: A 47-year-old male African patient was recruited in the CYSTINET Africa study at Chunya District Hospital, Mbeya. He was an artisan and has been living with HIV since 2012, and he has been compliant with antiretroviral treatment, hence with undetectable viral load during 2018, 2020, and 2021. Taenia solium serology was done by LDBIO Cysticercosis IgG Western Blot test, which tested positive for antibodies, but the apDia Cysticercosis Antigen (Ag) ELISA antigen test was negative. His computed tomography (CT) scan of the brain showed approximately 138 calcified neurocysticercosis typical lesions, 108 being located in the parenchyma, 15 in the extra parenchyma, and 15 in the subarachnoid space, consistent with a diagnosis of extensive calcified NCC. He reported no history of headaches or epileptic seizures. Neurological examination did not reveal any deficit.

Conclusion: Intensively, patients with a large number of neurocysticercosis lesions may be completely asymptomatic throughout the disease. In our patient,the HIV co-infection might have contributed to the high lesion load and/or to less severe clinical signs/symptoms due to modulation of the immune system.

Background: Coexistence of autoimmune encephalitis (AE) with multiple autoantibodies is of particular concern because overlying antibodies may cause variation of clinical manifestations. Coexistence of anti-glutamic acid decarboxylase (GAD) and anti-Gamma-aminobutyric acid-α-receptor (GABAAR) antibodies in AE was rare.

Case presentation: A 44-year-old female patient presented to our hospital due to cognitive decline for 4 years, seizures, slowed speech and depression for 2 months. Based on her clinical manifestations and laboratory assessment results (positive anti-GAD and anti-GABAAR antibodies), she was diagnosed as AE with coexisting anti-GAD and anti-GABAAR antibodies. After treatment with intravenous methylprednisolone (at dose of 1000mg/d, 500mg/d, 250mg/d, 120mg/d, 80mg/d for 3 days respectively) and intravenous immunoglobulin (400 mg/kg/d for 5 days), her symptoms gradually improved with exception for the slowed speech. Oral prednisone acetate was continued after discharge, her symptoms of slowed speech improved at 6-month follow-up.

Conclusion: We report a case of AE co-existing with anti-GAD and anti-GABAAR antibodies, which has different characteristics from previous cases. Coexistence of neural auto-antibodies should be considered when patients suspected with autoimmune encephalitis.

Introduction: Rhabdomyosarcoma (RMS) originates from undifferentiated mesenchymal cells that give rise to striated muscles. The symptoms of para-meningeal RMS often resemble those of allergic rhinosinusitis, including nasal congestion, mucus discharge, headache, and occasional nosebleeds. We report a child with atypical clinical presentation of ocular hypertropia secondary to para-meningeal RMS.

Case presentation: A child presented with an upward deviation of the left eye. He had a history of blunt trauma to the face before 5 days. Computed tomography (CT) of the head revealed a soft tissue density involving the left maxillary sinus. The magnetic resonance imaging (MRI) showed a 37.6 mm x 38.4 mm lesion within the left maxillary sinus extending to the orbit, nasal cavity, and premaxillary and retro maxillary areas with a heterogeneous signal and mild heterogeneous enhancements. A biopsy and histopathology confirmed alveolar RMS. The child was treated with chemotherapy and radiotherapy.

Conclusion: Pediatric RMS with orbital extension mimicking benign conditions is challenging to diagnose and manage. Hypertropia following eye trauma can obscure severe underlying conditions, such as para-meningeal RMS. The inferior rectus lesion mimicking inferior rectus palsy stresses a thorough evaluation, including imaging and biopsy. Early and accurate diagnosis is crucial for the effective management of children with such aggressive malignancy.

Purpose: To compare the outcomes of two different surgical planning strategies for topography-guided repair of post-LASIK ectasia.

Methods: This is a case report of a patient presenting with post-LASIK ectasia. A retrospective chart review was used to collect details of the ophthalmic exam, as well as ocular imaging such as anterior segment optical coherence tomography and Scheimpflug corneal tomography. Treatment planning was performed initially with the Phorcides analytical engine, and then an enhancement was performed with the LYRA/San Diego Protocol. Epithelium-off corneal cross-linking was performed at 3.0 mW/cm for 30 minutes.

Results: The patient initially presented with a remote history of LASIK and progressive left eye blurring. His uncorrected distance visual acuity (UDVA) was 20/40, with a corrected distance visual acuity (CDVA) of 20/25 with a manifest refraction of -1.25 +1.75 × 180. His central corneal thickness was 529 μm, and corneal topography/tomography demonstrated inferior steepening of the left eye consistent with post-LASIK ectasia. He underwent simultaneous PRK and epithelium-off corneal cross-linking with a treatment plan by Phorcides of -0.14 -0.87 × 001. His vision stabilized at post-operative month 7 to a UDVA 20/40, CDVA 20/20, and manifest refraction of -2.75 +3.50 × 005. He underwent PRK enhancement with a treatment plan by the San Diego Protocol of +0.00 -1.15 × 094, with an outcome of UDVA 20/20, CDVA 20/20, and manifest refraction of -1.00 +0.75 × 174.

Conclusion: The LYRA/San Diego Protocol outperformed Phorcides in a case of corneal ectasia. With appropriate planning, patients with irregular corneas can achieve excellent refractive outcomes.

Anogenital warts (AGW) including multiple types of human papillomavirus (HPV) are prevalent. In this context, oncogenic HPV infection leads to anogenital cancers and the lesion is more persistent. Several research on AGW therapy with measles, mumps, and rubella (MMR) vaccine injections have been successful without adverse effects. However, the effects of MMR immunotherapy for AGW on multiple HPV infections have not been reported. This research is a case report of AGW in a 17-year-old male treated with MMR. The inclusion criteria specified young age, indicative of a strong immunological status. Meanwhile, the exclusion criteria comprised immunocompromised conditions, such as HIV confirmed to be negative. Dermatological examination showed that the pubic region and penile shaft presented 51 verrucous papules for 6 months, with histopathological results supporting the diagnosis of AGW. Polymerase chain reaction (PCR) examination reported the inclusion of HPV types 6, 11, and 16. The subcutaneous MMR vaccine was injected into the deltoid area every 2 weeks for three sessions. Meanwhile, the treatment response was assessed by counting the number and measuring the size of the lesion. After three sessions of MMR immunotherapy, there was no improvement in the size or quantity of lesions. Based on previous reports, a higher clearance rate for MMR immunotherapy was found in warts with a duration of < 6 months, while oncogenic HPV genotypes, particularly HPV type 16, take longer to clear than others. The efficacy of subcutaneous MMR injection for AGW treatment was unfavorable due to oncogenic HPV types. AGW treated with MMR immunotherapy should investigate oncogenic HPV genotype. However, further research needs to be carried out to justify this conclusion due to the limitations.

Background: Grieving is an experience of deep mental suffering. It is a very individual process. Grief over the loss of a spouse can have an impact on both physical and mental health. In the case of an acute or critical event, it will be harder for the spouse to adjust to and accept death, which can lead to mental health problems. Gender is one of the factors that influence the grieving process. There is a more profound understanding of grief in men than in women.

Purpose: The study aims to understand widows' perception, experience, and meaning of loss and grieving.

Methods: A case report reviewed the life experiences of loss and grieving of Indonesian wife who had lost their husbands because of a critical illness. Data were collected through in-depth interviews with Individuals. It was conducted using Zoom and recorded. The analysis method uses thematic analysis.

Results: Four major themes were described in the case: experiencing the pain of the loss, searching for the meaning of being lost, embracing the new being, and exploring unmet needs in a widow. From this case, it can be concluded that grieving is a complex and dynamic process.

Conclusion: In grieving, women express solid and varied emotions and focus on their need to be understood and accompanied. They experience a transition from an experience of anger and emptiness to a sense of finding meaning in their loss and becoming more able to engage with life. The child is an essential factor in the grieving process, as it keeps participants engaged in the world even when faced with the immediate effects of grief.

Introduction: Opportunistic infections (IO) are infections of microbiota (fungi, viruses, bacteria, or parasites) that generally do not cause disease but turn into pathogens when the body's defense system is compromised. This can be triggered by various factors, one of which is due to a weakened immune system due to Diabetes Mellitus (DM), which increases the occurrence of opportunistic infections, especially in the oral cavity. Fungal (oral candidiasis) and viral (recurrent intraoral herpes) infections can occur in the oral cavity of DM patients. Recurrent intraoral herpes (RIH) is generally a recurrent herpes virus infection with one of the triggers being stress.

Objective: To determine the role of stress and silent type 2 DM and which is thought to trigger opportunistic infections in oral cavity.

Case: A 34-year-old man was referred with complaints of white patches in the mouth, sore throat a difficulty swallowing and opening the mouth. Extraoral examination, yellow-black crusts were found on the lips. Intraoral and tongue examination revealed white plaque that could be scraped off, and a mouth mirror was attached. The hard palate showed vesicles that spread to the soft palate. Laboratory tests were abnormal for blood sugar, anti-HSV-1 IgG, and presence of hyphae. Mild anxiety and moderate stress. The working diagnosis was pseudomembranous candidiasis RIH, exfoliative cheilitis, and xerostomia. Differential diagnosis was erythema multiforme.

Case management: Pharmacologic dental management was fluconazole injection, acyclovir, NaCL 0.9%, chlorine dioxide mouthwash, and petroleum jelly. Non-pharmacologic therapy dental included oral hygiene instruction and education on oral therapy and referral to the internal medicine clinic for DM management. After two weeks of collaborative treatment between oral medicine and internal medicine, there was significant improvement.

Conclusion: Silent type 2 DM and stress can cause a decrease in the immune system, triggering opportunistic infections, namely RIH and candidiasis.

Verruca vulgaris is a cutaneous infection predominantly caused by human papillomavirus (HPV) type 1, 2, and 4. In immunocompromised individuals infected with human immunodeficiency virus (HIV) infection, HPV leads to a higher prevalence of infections and also has a greater likelihood of being infected with atypical types such as genital-associated HPV in extragenital sites. This case report describes a 48-year-old male patient who presented with skin-colored verrucous papules on the hands and feet, with no evidence of genital lesions. Polymerase Chain Reaction (PCR) genotyping identified the presence of HPV types 4, 6, and 16 as an etiology of verruca vulgaris, low-risk HPV with genital-associated lesions, and high-risk HPV. This atypical result may suggest a failure of the immune defense system of the body. Therefore, accurately identifying HPV types through PCR testing in immunocompromised patients is essential for appropriate clinical management and monitoring.

A case of fat liquefaction and fat particles in the pacemaker pocket observed in a female patient 12 years after implantation. The patient had no symptoms and no signs of infection or other discomfort of the heart and pacemaker pocket. The biochemical analysis showed a slight increase in cardiac troponin T, 0.026 ng/mL (reference range, <0.016 ng/mL), a high increase in total cholesterol, 8.70 mmol/L (reference range, <5.18 mmol/L), and low density lipoprotein, 5.38 mmol/L (reference range, <3.37 mmol/L). Thick yellow liquid was seen to flow out of the pacemaker pocket when the pocket was opened, and many fat particles were found adhering to the wall of the pacemaker pocket during the pacemaker replacement procedure. Fat and fibrillar connective tissue with a few inflammatory cells, local tissue degeneration and necrosis were shown on immunohistochemical staining and no bacterial growth including anaerobic bacteria was observed. The aseptic necrosis of post-implantation complications is helpful for differential diagnosis in CIED complication. Moreover, the identification of fat liquefaction has important clinical significance for patient management and surgical decision-making.

Introduction: The Behçet's Disease Current Activity Form (BDCAF) is crucial for monitoring the progression and treatment efficacy of Behçet's Disease (BD), an autoimmune disorder that can be triggered or exacerbated by viral infections. Herpes simplex virus type 1 (HSV-1) has long been recognized as a potential trigger for BD, as it can induce systemic inflammation and exacerbate symptoms. In contrast, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has recently emerged and may also initiate or worsen BD symptoms. This report examines three BD cases with oral manifestations specifically triggered by HSV-1 and SARS-CoV-2, comparing their clinical activity and treatment responses.

Case: Three female patients, aged 29, 24, and 41 years, presented to the Oral Medicine Department with complaints of canker sores, along with genital and skin lesions and red eyes. Intraoral examination showed ulcerative, erosive, and white plaque lesions throughout the oral mucosa. The first patient was confirmed to have COVID-19 by the SARS-CoV-2 RNA test. The second and third patients had a two-year history of recurrent oral ulcerations with reactive IgG anti-HSV-1 tests. All patients were diagnosed with BD according to the International Criteria for Behcet's Disease. The BDCAF measurements were conducted, showing a BD activity index score of 4 for the COVID-19-positive patient, while scores of 6 and 7 were recorded for the other two patients with seropositive HSV-1.

Case management: Medications provided include corticosteroid, antimetabolite, analgesic, antiviral, antifungal, antiseptic mouthwash, and multivitamin. All patients showed good clinical improvement after treatment.

Conclusion: The BD activity index scores of a BD patient with COVID-19 were lower than those with HSV-1 infection. This difference may be due to the recent SARS-CoV-2 infection in the patient, whereas reactivation of chronic latent HSV-1 in the other patients likely contributed to a longer history of clinical manifestations, resulting in increased disease activity.