International Medical Case Reports Journal最新文献

Introduction: Septic pulmonary embolism is a serious and rare complication of orbital cellulitis. Orbital infection usually arises from adjacent soft tissue or hematogenous infections.

Case: A 2-year-old girl presented with high-grade fever, cough, and bilateral eyelid swelling for 5 days preceded by edema and a perinasal facial skin furuncle. Examination revealed bilateral axial proptosis and orbital and thoracic CT bilateral orbital cellulitis, septic pulmonary embolism, and bilateral pneumothorax.

Discussion: A rare but potentially fatal complication of periorbital cellulitis is septic embolism, which carries a high rate of morbidity and mortality. The infections that cause orbital cellulitis can be transmitted to the orbit through dehiscence of the bone wall or through venous drainage. This can lead to septicemia and subsequent serious complications, including septic pulmonary embolism, Cavernous sinus thrombosis, meningitis, and cerebral ischemia. Advanced and timely imaging is crucial to diagnose both orbital cellulitis and its thoracal complications.

Conclusion: Early diagnosis of orbital cellulitis, timely investigations of its extracranial complications, and multidisciplinary involvement in patient management are crucial to prevent or treat complications such as septic pulmonary embolism and may improve patient prognosis.

A 60-year-old woman was admitted to the hospital with "repeated loss of consciousness for 20 years." An electrocardiogram performed revealed sinus rhythm, and echocardiography, head/chest CTs, and a laboratory examination yielded no significant abnormalities. Besides, there were no positive results from the head-up tilt test. The subsequent decrease in heart rate and blood pressure following the ingestion of chili pepper indicated a potential case of vasovagal syncope(VVS) with cardioinhibition. Following cardioneuroablation, there was an observed increase in heart rate compared to pre-procedure levels. Furthermore, no recurrence of similar symptoms was reported during the one-year follow-up period.

A new lump in patients with a history of gastrointestinal stromal tumor (GIST) may indicate resistance to medication and recurrence. It is important to monitor for recurrence or metastasis after surgery for GIST, especially in cases of high-risk GIST, as it determines the subsequent treatment. However, it is difficult to differentiate between GIST and DF by imaging. Tissue biopsy and final diagnosis through pathological analysis are usually required. Here, we report 2 cases of primary diagnosis with high-risk GIST and suspected tumor recurrence during Imatinib treatment. The mass was not located where the previous GIST lesion had been. After the complete excision of the mass through laparoscopic surgery, the pathological findings revealed that it was not a recurrence of GIST, but a desmoid-type fibromatosis.

Background: Thyroid hormone resistance syndrome (RTH) is a rare hereditary endocrine disease that can manifest as hyperthyroidism, hypothyroidism, or remain asymptomatic. It can easily be confused with other types of thyroid diseases. The diagnosis of the disease depends on genetic testing.

Case report: We report a 19-year-old male patient with elevation of thyroid hormones. Serological examination showed elevated thyroid hormone levels, and thyroid-stimulating hormone levels within the reference interval. The patient was finally diagnosed with RTH after genetic testing that identified a gene mutation inherited from his mother. Due to timely diagnosis, the patient's condition has been well controlled, and his prognosis is good.

Conclusion: The clinical manifestations of RTH lack specificity, and serological examination typically shows elevated thyroid hormone levels and unsuppressed thyrotropin levels. Differential diagnosis requires a combination of serological examination, imaging studies, and functional tests to distinguish RTH from other conditions. The purpose of this treatment is to improve symptoms and should not involve the blind administration of antithyroid drugs, thyroid surgery, or radiotherapy.

Purpose: To describe the history, clinical presentation, investigation, and management of a case of insidious myopic comitant esotropia (IMCE).

Methods: Demonstration of a rare case report of IMCE, including history of onset, angle of deviation, refractive error, and treatment.

Results: We report a case of a 15-year-old patient presenting with progressive horizontal diplopia first at distance and eventually at near for 2 years. He had a history of 6 hours of smartphone usage per day. Orthoptic examination showed esotropia of 35 prism diopters (PD) at distance and 30 PD at near. Neuroimaging was normal. The patient underwent bilateral medial recession of 5.5 mm. After 8 months of follow-up, the patient was orthophoric, and full stereopsis was restored.

Conclusion: Our case demonstrated the insidious onset of myopic comitant esotropia in a teenager in whom excessive smartphone use could have accelerated the onset of the disease. Augmented bilateral medial rectus recession yielded a good outcome.

Introduction: Tricyclic antidepressants (TCAs) were once commonly used to treat major depressive disorder (MDD), but are now considered second-line options after SSRIs and SNRIs. Additionally, TCAs are used to treat other conditions such as chronic pain and enuresis in children. Due to their numerous side effects and potential for drug interactions, cases of poisoning and death from TCA overdose, particularly amitriptyline, are on the rise. Therefore, this article revisits the overview and describes the clinical progression regarding blood gases, ECG, and electrolytes of the patient, as well as the use of 4.2% sodium bicarbonate and 2% lidocaine to treat cases of amitriptyline overdose poisoning.

Case presentation: A 49-year-old female patient was admitted to the hospital due to cardiac and respiratory arrest. The patient had a past medical history of untreated cervical cancer and sleep disorders. Prior to admission, the patient had taken about 20 tablets of amitriptyline 25mg and was in a drowsy state with gasping breaths. During transportation to the hospital, the patient experienced cardiac arrest once and was successfully resuscitated, with a total arrest and resuscitation time of approximately 10 minutes.

Results: The use of 4.2% Sodium Bicarbonate and 2% Lidocaine, the patient was not used plasma exchange in this case, proved effective in this case. Continuous monitoring of blood gas levels, ECG, and electrolytes was maintained. The patient was able to walk independently and was discharged after 12 days of treatment.

Conclusion: The key factor was the healthcare staff's quick recognition and timely management of TCA poisoning, in this case, amitriptyline.

Purpose: Eosinophilic gastrointestinal diseases represent a rare and diverse group of conditions. Given that the pathogenesis of EoC is not well understood and is often linked to allergic conditions, this case underscores the necessity for further research into such unique presentations. The patient's prolonged gastrointestinal symptoms presented a significant diagnostic challenge, emphasizing the importance of ruling out various potential causes for elevated blood eosinophils. This exploration aims to enhance the understanding of such rare clinical scenarios and improve diagnostic accuracy in similar cases.

Case description: We present a unique case of a 57-year-old patient with a medical history of asthma and allergic rhinitis who presented recurrent abdominal pain, significant blood eosinophilia, and elevated levels of Immunoglobulin G4. After ruling out hematological and secondary causes of eosinophilia, a biopsy of the colon mucosa revealed an excess of tissue eosinophils, confirming the diagnosis of EoC. The patient responded well to corticosteroids and was subsequently maintained on montelukast, with no recurrence of symptoms over 3 months.

Conclusion: This rare confluence of EoC, asthma, and high levels of serum IgG4 in a single patient contributes to our understanding of these complex and interconnected disorders.

Introduction: The Herpes Simplex Virus-1 (HSV-1) infection of the oral cavity is a disease that initiates with prodromal symptoms such as fever and malaise, followed by the emergence of oral and perioral lesions. The common clinical manifestations of HSV-1 infection involve the development of vesicles on the face, oral mucosa and lips, which eventually progress to ulceration. This case report aims to present an atypical clinical manifestation of HSV-1 infection.

History and clinical findings: A 62-year-old woman presented with complaints of a lump at the corner of her left lip, which had disappeared but reappeared. Six weeks ago, the lump started as a white spot, then gradually enlarging, becoming painful, and ruptured. The patient went to the clinic for treatment and was given gentamicin ointment, but there was no improvement. Extraoral examination showed a nodule in the corner of the left lip measuring 1 × 2 cm, filled with purulent exudate. Serological examination revealed reactive anti-HSV-1 IgG results, leading to a diagnosis of Herpes Labialis.

Case management: Pharmacological therapy comprised antivirals and multivitamins. The lesion resolved after 10 days of treatment with no reported recurrence during the three-month evaluation.

Conclusions and recommendations: HSV-1 infection presents with a variety of clinical features, including typical signs of vesicles, ulceration, and also other atypical forms of lesions. A comprehensive history accompanied with supporting examinations is crucial to identifying the diverse clinical manifestations of herpes simplex virus-1 infection.

Traumatic posterior fossa extradural hematoma (PFEDH) is a rare but potentially life-threatening condition. It is characterized by the accumulation of blood between the dura mater and occipital bone, leading to compression of the brainstem. We report the case of a 25-year-old male who presented to the emergency department following a fall, exhibiting confusion and a Glasgow Coma Scale (GCS) score of 14. Imaging revealed a significant acute epidural hematoma with associated mass effect, frontal hemorrhagic contusion, and right transverse sinus rupture. The initial hematoma volume was calculated to be 44.41 cm3 using the ellipsoid formula. Prompt neurosurgical intervention was performed, including craniotomy for hematoma evacuation and suction tube placement. Despite a decline in GCS score postoperatively, subsequent surgical management led to hematoma resolution and neurological improvement. The hematoma volume had decreased to 33.19 cm3 after the second intervention. After 15 days, the patient achieved a GCS score of 15. Our case highlights the importance of early recognition, emergent surgical intervention, and standardized management protocols for the treatment of PFEDH. In addition, it emphasizes the value of quantitative hematoma measurements in guiding treatment decisions. Prompt diagnosis and treatment are crucial to alleviate the potentially fatal consequences of this rare neurological condition.

Purpose: To present a case of bilateral herpes simplex anterior uveitis in an immunocompetent patient.

Methods: Case Report.

Results: A 42-year-old Kenyan female presented with a 2-year history of intermittent painful eye redness associated with blurring of vision of both eyes. Symptoms started after childbirth. There were no associated systemic symptoms. She presented with a best corrected visual acuity (BCVA) of 6/18 and 6/30 on the right and left eyes, respectively. On examination, conjunctival hyperaemia, large keratic precipitates (KPs), posterior synechiae, poorly dilating pupil, anterior subcapsular cataract and +2 anterior chamber (AC) cells and flare were noted on both eyes. Intraocular pressures (IOP) were within normal limits. Optical coherence tomography (OCT) showed bilateral cystoid macular oedema (CMO). Serum herpes simplex virus (HSV) IgM was detected, whereas autoimmune and other infectious aetiologies were excluded. Aqueous humour samples from both eyes tested negative for HSV. Bilateral 16 mg subtenon triamcinolone injection were done. Dexamethasone 0.1% eye drops and atropine 1.0% eye drops were started. Topical anti-glaucomatous medication was started due to IOP >30 mmHg on both eyes and Valacyclovir 1g three times a day was initiated. Final visit showed an improvement of BCVA to 6/9 on both eyes. There was complete resolution of AC cells and flare, and CMO on OCT.

Conclusion: The diagnosis of bilateral herpetic anterior uveitis was based on the criteria set by The Herpetic Eye Disease Study (HEDS). Although the patient was immunocompetent, she was in a state of transient immunodeficiency that is pregnancy, which could have led to bilateral ocular involvement.