International Medical Case Reports Journal最新文献

Introduction: Rheumatoid arthritis (RA)-associated interstitial lung disease (ILD) is a serious complication of RA, characterized by progressive pulmonary fibrosis. Diagnosing and managing RA-ILD can be particularly challenging in resource-limited settings, where access to advanced diagnostic tools and treatment options may be limited. Early detection and intervention are critical for improving outcomes.

Case presentation: A 40-year-old female with a six-year history of RA (rheumatoid factor positive) presented with a three-month history of worsening cough, shortness of breath, and chest pain. On examination, she exhibited signs of respiratory distress and digital clubbing. Baseline oxygen saturation was 81% on 5 L/min supplemental oxygen. Chest X-ray revealed bilateral reticular opacities, while a CT scan showed bilateral fibrotic changes and ground-glass opacities, suggestive of an NSIP-like pattern, although formal HRCT classification could not be confirmed. Anti-CCP testing and pulmonary function tests were unavailable due to resource limitations. The patient was managed with supplemental oxygen therapy, corticosteroids, and methotrexate, along with lifestyle modifications and pulmonary rehabilitation. Follow-up over two months showed marked symptomatic improvement.

Conclusion: This case emphasizes the challenges of diagnosing and managing RA-associated ILD in resource-limited settings. It highlights the importance of clinical suspicion, pragmatic use of available resources, and the need to strengthen diagnostic capacity in low-resource environments.

Orbital Alveolar Soft Part Sarcoma (ASPS) is an extremely rare malignancy, with limited case reports. Diagnosis is challenging owing to its slow-growing nature and non-specific symptoms. Furthermore, standardized treatment protocols are lacking, and the long-term outcomes remain poorly understood. We aimed to address these gaps by presenting a rare case of orbital ASPS and outlining the diagnostic challenges, treatment approach, and long-term follow-up to inform the clinical management. A 28-year-old male presented with diplopia, restricted ocular movements, and orbital swelling. Magnetic resonance imaging revealed a 3.81 × 1.99-cm mass adjacent to the left medial rectus muscle, which was histopathologically confirmed as ASPS. A personalized therapeutic approach involving surgery and radiotherapy achieved stable disease, preserved vision, and no recurrence over a 3-year follow-up period. These findings contribute to the existing body of knowledge regarding the clinical management of orbital ASPS, underscoring the importance of individualized treatment strategies. Routine long-term surveillance and multidisciplinary care are essential in the management of rare cases. This case further emphasizes the need for continued research and documentation to enhance the diagnostic accuracy and refine the treatment guidelines for ASPS.

We present a case of a 21-year-old woman diagnosed with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), characterized by recurrent optic neuritis and progressive vision loss. Despite multiple immunosuppressive therapies-including corticosteroids, intravenous immunoglobulin (IVIG), azathioprine, mycophenolate mofetil, and rituximab-the patient continued to experience disabling relapses, particularly during steroid tapering. Ongoing disease activity, combined with significant steroid-related side effects, prompted a trial of subcutaneous tocilizumab, an interleukin-6 (IL-6) receptor inhibitor. Following its introduction, the patient remained relapse-free, and her steroid dose was successfully reduced. This case highlights the complexity of managing refractory MOGAD and underscores the potential role of IL-6 inhibition in treatment-resistant cases. There are sparse reports about the use of subcutaneous tocilizumab (TCZ) in MOGAD, and this case contributes to the growing body of real-world evidence supporting its use. As no standardized treatment protocol currently exists, reporting such cases is vital for advancing future therapeutic strategies and guidelines.

Toxoplasmosis is a significant opportunistic infection among people living with HIV (PLHIV), primarily manifesting as cerebral disease. Cardiac involvement, while rare, significantly complicates clinical management. This report describes an unusual presentation of concurrent cerebral and cardiac toxoplasmosis in a 50-year-old HIV-positive male initially treated for severe malaria. Despite initial symptomatic relief, the patient rapidly deteriorated neurologically and subsequently succumbed. The autopsy revealed characteristic cerebral and myocardial lesions confirmed by histopathology. The case underscores the diagnostic complexities and the necessity for high clinical suspicion in managing PLHIV with atypical presentations, especially in malaria-endemic areas.

Background: Aspergillus species are relatively rare and typically occur in immune compromised individuals such as those undergoing organ transplantation, chemotherapy, or long-term corticosteroid therapy. Renal Aspergillosis is an uncommon manifestation that generally occurs as part of a disseminated infection in immunocompromised patients.

Case: A 22 yrs male patient came to emergency department of Manipal Teaching Hospital with the chief complaints of right flank pain, 3-4 episodes of vomiting for last 4 days, had acute onset, gradually progressive non-radiating aggravated pain and no history of any other medical conditions. His urine sample showed plenty of red blood cell in routine microscopy and other blood laboratory tests were within normal limit. Computed tomography of the kidneys, ureter and bladder showed multiple bilateral stones in both kidneys. Kidney stones were surgically removed by bilateral retrograde intrarenal surgery with total lithotripsy. After surgery, the renal calculi were received in microbiology laboratory for microbial analysis. The crushed material of renal stone was used for microbial culture and direct microscopy using 10% KOH wet mount which showed hyphae. Both bacterial culture media and Sabouraud's Dextrose Agar showed growth of molds which was identified as Aspergillus fumigatius. The patient was treated with voriconazole intravenously with the loading dose of 6mg/Kg IV 12 hourly for 2 days followed by 4mg/Kg 12 hourly for 7 days. After 7 days of treatment, patient recovered well. Post-operative follow-up and post-operative radiography did not show evidence of any recurrence.

Conclusion: This rare case of fungal etiology in patient having renal stones reveals the importance of closely monitoring postoperative patients, even when typical infection risk factors are absent.

Background: The canal of Nuck, the female equivalent of the male processus vaginalis, is a rare site of hernia in infants. In severe cases, incarceration or strangulation may occur, posing the risk of tissue necrosis and requiring urgent surgical intervention.

Case presentation: We report a case of a 13-week-old female infant presenting with a painful, irreducible swelling in the left inguinal region. Surgical exploration revealed a strangulated necrotic left ovary. An oophorectomy and herniotomy were performed.

Discussion: An incarcerated hernia of the canal of Nuck is a surgical emergency, and limited imaging access should not delay the decision. High clinical suspicion of an incarcerated hernia and cost-effective ultrasonography are crucial for early diagnosis and timely surgical intervention to prevent irreversible complications.

Conclusion: This report highlights diagnostic and management challenges in a low-resource setting and underscores the importance of early recognition in preventing irreversible complications.

This single-case study was conducted on a 34-year-old woman diagnosed with therapy-resistant depression and co-occurring atypical autism. The subject had been kept on the same medications for eight years despite her condition not improving and at the same time experiencing side effects. Previous studies and patient experiences suggest that many physicians are reluctant to end prescribed medication even if the patient is experiencing inadequate benefits and questionable effects. Co-occurring diseases often share overlapping symptoms, which can make accurate diagnosis and treatment more challenging, such as for patients with depression and autism. The problem becomes even more complicated when looking into the long-term treatment of depression occurring alongside autism spectrum disorder (ASD). The focus of conducting this case study was to determine the effect of DAT on a patient with confirmed therapy-resistant depression and ASD and if DAT would provide long-term benefit for the subject. The study's results indicate that the patient experienced both quick improvement and long-term positive outcomes of DAT and is now in her 10th-year symptom-free.

Purpose: Currently, there is no standard regimen for third-line therapy in advanced colon cancer. Intratumoral heterogeneity and tumor evolution have been substantiated in multiple cancer types, paving the way for exploratory research into new treatment strategies for pulmonary metastases from colorectal cancer.

Patients and methods: In this report, we present a case of advanced colon cancer with lung metastasis. After multiple lines of therapy (including FOLFOX, FOLFIRI combined with targeted therapy) failed, the patient received a lung cancer-derived regimen to colorectal pulmonary metastases through an evolutionary perspective.

Results: After two cycles, the patient achieved partial response (PR), and after eight cycles, the disease was stable (SD), with a good quality of life.

Conclusion: The application of a lung cancer-derived regimen to colorectal pulmonary metastases through an evolutionary perspective may offer a new therapeutic direction for patients who have exhausted standard options.

Background: Human immunodeficiency virus (HIV)-associated cerebral toxoplasmosis is the most frequent cause of ring-enhancing brain lesions in acquired immune deficiency syndrome (AIDS) patients but is often misdiagnosed as neoplasm due to overlapping clinical and radiological features. Seronegative examinations further complicate diagnosis, risking fatal delays in treatment.

Case presentation: A 32-year-old male with undiagnosed HIV presented with right hemiparesis, dysarthria, and headache. Magnetic resonance imaging (MRI) revealed a 38×54 mm ring-enhancing left frontoparietal mass with significant edema, midline shift, and ventricular compression, initially suggestive of glioblastoma. HIV serology confirmed infection. Toxoplasma antibodies, nucleic acid test and next-generation sequencing were all negative. Despite 17 days of antiretroviral therapy and sulfamethoxazole-trimethoprim prophylaxis, he deteriorated to coma with lesion progression on repeat MRI. Empirical anti-toxoplasma therapy was initiated. Within one week, consciousness and speech improved. At 6 weeks, MRI showed reduced lesion size and edema, and right limb strength partially recovered, enabling discharge.

Conclusion: This case illustrated that seronegative Toxoplasmic encephalitis may mimic aggressive neoplasms radiologically and clinically in advanced AIDS. Empirical anti-toxoplasma therapy should be considered a prioritized intervention over invasive diagnostics for ring-enhancing lesions in severely immunocompromised patients, particularly when brain biopsy is high-risk or contraindicated, even in seronegative cases.

Background: Lung cancer, the most common malignancy in humans, can be classified into a wide range of subtypes and molecular variants. Fetal adenocarcinoma of the lung (FLAC) is an infrequent subtype of lung adenocarcinoma with distinct histological characteristics. However, its incidence is extremely low (0.1-0.5% of primary lung cancers), and its biological features remain poorly understood. In the era of immunotherapy and targeted therapy, characterizing the genetic alterations of FLAC is essential for developing personalized treatment strategies and improving patient outcomes. Here, we report the genetic alterations and PD-L1 expression in a patient with high-grade FLAC (H-FLAC) and review the relevant literature, This is one of the few reported cases describing PD-L1 expression and TP53 mutation status in H-FLAC.

Case manifestations: A 57-year-old man with a 30-year history of smoking presented to our hospital with persistent cough, sputum, and chest tightness for 30 years, which had worsened for 1 month. Computed tomography (CT) of the chest revealed an irregular nodule in the posterior segment of the upper lobe of the left lung. The patient underwent posterior resection of the left upper lung apex, and postoperative pathology suggested H-FLAC with a tumor stage of pT₁N₀M₀.

Conclusion: This case study provides an opportunity to better understand H-FLAC, whose genetic alterations have not been well characterized, and to identify valuable molecular markers for potential targeted therapies. We conducted gene sequencing and PD-L1 expression testing, which are helpful for H-FLAC research.