International Medical Case Reports Journal最新文献

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.

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.