International Medical Case Reports Journal最新文献

Background: Asthma exacerbations can be life-threatening if not promptly recognized and treated. Although necessary, intubation and mechanical ventilation can cause barotrauma, hemodynamic instability, and increased mortality. Documenting near-fatal asthma case with severe hypercapnia, recovering without intubation is uncommon and offers useful clinical insight.

Case presentation: A 45-year-old Somali woman with poorly controlled bronchial asthma presented to the emergency department with acute severe dyspnea following a three-day prodrome of fever, cough, rhinorrhea, and sore throat. On arrival, she was semi-conscious, in respiratory distress, with a silent chest, hypoxemia (SpO₂ 47%), and hypercapnia (PaCO₂ 106.4 mmHg). She received immediate bag-valve-mask breathing, high-flow oxygen, intravenous corticosteroids, repeated nebulized bronchodilators, inhaled budesonide, and magnesium sulfate. The patient showed remarkable clinical improvement within an hour, including restored awareness, bilateral wheezing, SpO₂ at 99% on oxygen, and normalized arterial blood gases. After monitoring in the ICU, she switched to oral medication and returned home without endotracheal intubation on the fourth day.

Discussion: For life-threatening asthma, GINA, BTS/SIGN, and ERS/ATS recommend systemic corticosteroids, frequent bronchodilators, and intravenous magnesium sulfate as the main treatment, with intubation reserved for respiratory collapse. This case sheds light on how severe hypercapnic respiratory failure patients can recover without invasive airway procedures in resource-limited emergency settings with timely, guideline-adherent care.

Conclusion: Early non-invasive treatments for life-threatening asthma can provide positive outcomes, even in near-fatal asthma cases. Intubation and related risks were avoided through close supervision, timely corticosteroids, nebulized bronchodilators, and intravenous magnesium sulfate.

Background: Lambert-Eaton myasthenic syndrome (LEMS) is a neuromuscular junction disorder which is frequently associated with tumors. Those patients generate pathogenic antibodies such as voltage-gated calcium channel (VGCC) antibodies. Existing studies have established the efficacy of efgartigimod in MG. This article reports the effect of efgartigimod following its administration to a patient with LEMS.

Case presentation: A 73-year-old male was diagnosed with small cell lung cancer two years ago. Gradually he developed difficulties in speaking, eating, and lifting his head, along with limb weakness. The neuroelectrophysiological examination findings were consistent with LEMS. Laboratory tests detected VGCC antibodies and SOX-1 antibodies in the serum. The patient's symptoms continued to worsen after one week of corticosteroids use. Consequently, efgartigimod at a dose of 10 mg/kg was added once a week. After three weeks of treatment, the patient's clinical manifestations had improved significantly. Laboratory tests revealed a decrease in serum VGCC antibody and IgG levels.

Conclusion: This is the first report on the use of efgartigimod in LEMS. The patient demonstrated substantial clinical improvement following treatment. Nevertheless, more clinical studies are required to verify whether efgartigimod offers a novel treatment approach for patients with LEMS.

Background: Alveolar Soft Part Sarcoma (ASPS) is a rare, highly vascular soft tissue sarcoma characterized by the specific ASPSCR1-TFE3 fusion, typically affecting adolescents and young adults. Despite its often-indolent growth, it has a high propensity for late hematogenous metastasis. Management for localized disease is centered on wide surgical excision.

Case presentation: We report a case of ASPS in a 44-year-old female from the Ankole tribe, presenting with a slow-growing 8 cm mass in her right upper arm over two years. This age of presentation is outside the typical peak incidence. The diagnosis was established solely on classic histopathological features-a pseudoalveolar pattern, large polygonal cells with abundant eosinophilic cytoplasm, and PAS-positive, diastase-resistant intracytoplasmic granules-due to resource limitations precluding molecular confirmation (TFE3 IHC/FISH). She underwent wide local excision with negative margins and remains free of recurrence at 12 months post-surgery.

Conclusion: This case highlights the occurrence of ASPS in an older-than-typical patient and underscores the enduring reliability of classic histopathology for definitive diagnosis in resource-limited settings like Uganda. Although surgically cured locally, the patient's large tumor size and age confer a high risk for future metastasis, mandating rigorous, long-term surveillance.

Radiofrequency ablation (RFA) is a minimally invasive technique that uses high-frequency electrical currents to generate heat, causing controlled destruction of targeted tissues through ionic agitation. RFA-associated neuropathy is a rare but recognized complication. We present a case of cauda equina syndrome and sensorimotor neuropathy following RFA of a sacral bone metastasis. Electromyography confirmed peripheral neuropathy, particularly affecting the peroneal nerve, and MRI revealed degenerative changes and a pelvic mass near the sacrum. The patient was treated with corticosteroids and neurotrophic supplementation and subsequently discharged for oncology follow-up. This case highlights the potential for RFA-induced neuropathy, emphasizing the need for careful procedural planning, post-treatment monitoring, and further research on the role of corticosteroids in mitigating neurological complications. This finding also raises questions about the role of corticosteroids in managing such complications, emphasizing the need for personalized care and further research to improve patient outcomes.

Optic neuritis is one of the diagnostic criteria for Neuromyelitis Optica Spectrum Disorder (NMOSD). However, the presentation of other ophthalmic manifestations in a patient with NMOSD is less common. A case of intermediate uveitis in a patient with anti-aquaporin-4 antibody (AQP4) positivity is detailed in this report. We present here a case of a 17-year-old Southeast Asian woman who presented with segmental fullness of the optic disc margin, small hypopigmented lesion along inferior temporal arcade, trace vitreous cells and inferior snowballs consistent with unilateral intermediate uveitis. The patient subsequently presented with an episode of optic neuritis of the same eye, resulting in diagnostic workup conforming NMOSD including neuroimaging and AQP4 antibody. Our case report highlights that NMOSD should be considered in the differential for intermediate uveitis. Furthermore, the sequence of both intermediate uveitis and optic neuritis in our patient demonstrates the importance of continued ophthalmic exams in patients with NMOSD.

Anogenital warts (AGW) is the most common sexually transmitted infection in the world caused by the Human Papillomavirus (HPV), especially types 6 and 11. Immunotherapy is one of the therapeutic modalities that can be used to treat AGW. The mechanism of Vitamin D3 on AGW is the expression of antimicrobial peptides (AMP) that directly inactivate pathogens and also enhance innate immune responses. One case of AGW type condyloma acuminata was reported in a 29-year-old male. A case of condyloma acuminata-type AGW in a 29-year-old HIV stage 1 male patient was reported. His CD4 level was 500 cells/uL, and treated with anti-retroviral (ARV). Physical examination of the perianal area revealed a skin-colored tumor with a verrucous surface. Acetowhite test and HPV type 11 polymerase chain reaction (PCR) results were positive. The patient received intralesional injection of vitamin D3 60,000 IU per lesion every two weeks four times. The lesions appeared to have shrunk by more than 50% after the fourth injection. This case report shows the potential of intralesional vitamin D3 for the treatment of AGWs in an HIV patient. However, further research is required to confirm both the efficacy and safety of intralesional vitamin D3.

Background: Upper-extremity deep vein thrombosis (UEDVT) is relatively uncommon accounting for roughly 4-10% of all deep vein thromboses but its incidence is rising, largely due to the widespread utilization of intravenous catheters. While central venous catheters are the typical culprits, peripheral IV cannulas are not benign and may provoke thrombosis via local endothelial trauma and venous stasis, especially in individuals with systemic prothrombotic predispositions.

Case presentation: We report a 44-year-old man with bipolar affective disorder on haloperidol, promethazine, and carbamazepine. Five days after placement of a peripheral IV cannula in his right forearm, he developed gradually worsening pain and swelling from the mid-forearm extending into the upper arm. Duplex ultrasonography revealed occlusive thrombus in the antecubital vein, confirming catheter-associated UEDVT.

Intervention and outcome: The patient was initially started on low molecular weight heparin, later transitioned to apixaban. His symptoms resolved within three weeks, and after three months of anticoagulation with normalization of D-dimer levels therapy was discontinued without recurrence.

Conclusion: Even peripheral IV cannulation may precipitate UEDVT when combined with local vein injury and systemic hypercoagulability. Antipsychotics, such as haloperidol and chlorpromazine, may further elevate thrombosis risk. Clinicians must maintain vigilance for UEDVT in patients with unilateral arm swelling post-cannulation, recognizing that prompt ultrasound evaluation and guideline-based anticoagulation are essential to prevent complications.

Introduction: Superior sagittal sinus thrombosis (SSST) is a rare type of cerebral venous sinus thrombosis (CVST) characterized by blood clot formation in the superior sagittal sinus, leading to increased intracranial pressure. This report highlights a case of SSST presenting atypically as a migraine with normal D-dimer levels, emphasizing the need for thorough evaluation despite normal lab results in at-risk individuals.

Presentation: A 49-year-old female experienced a severe unilateral headache, photophobia, dizziness, and neck tension. She has a history of migraines and hypertension. The patient uses combined oral contraceptives. Examination revealed neck stiffness, and blood pressure of 150/90. CT and D-Dimer were normal. MRV revealed Superior Sagittal Sinus thrombosis and lacunar infarction. Anticoagulation was initiated, leading to good recovery and discharge after 11 days.

Discussion: This case discusses an adult with a history of migraine presenting with a 5-day right-sided throbbing headache, photophobia, dizziness, and neck tension. Despite resembling a migraine exacerbation, red flags indicated a potential secondary cause. Normal D-dimer levels and unremarkable initial CT imaging delayed the diagnosis, but MRV revealed superior sagittal venous thrombosis (SSST) and a Lacunar infarct. Anticoagulation therapy led to significant improvement, and the patient was discharged after 11 days. The case highlights the need for vigilance regarding cerebral venous sinus thrombosis (CVST), in atypical headache presentations.

Conclusion: Clinical surveillance is vital for atypical headaches; inconclusive tests may delay diagnosis of superior sagittal sinus thrombosis (SSST). Advanced imaging and early anticoagulation improve outcomes, highlighting the need for high suspicion of cerebral venous sinus thrombosis.

The diagnosis of blocked atrial bigeminy may be challenging. It can easily be misinterpreted as sinus bradycardia or sinus exit block leading to unnecessary pacemaker implantation. We report a case of frequent blocked premature atrial contractions leading to episodes of marked bradycardia. A 66-year-old man disturbed with low pulse (42 bpm) measured by an automated blood pressure monitor sought medical attention. The patient also had untreated grade I arterial hypertension. Ambulatory ECG monitoring was performed and very frequent blocked premature atrial contractions were seen. The P wave of the atrial premature atrial contractions was always superimposed on the ST segment or T wave simulating a bifid T wave. Blocked atrial quadrigeminy, blocked atrial trigeminy, and blocked atrial bigeminy were observed. The minimum heart rate associated with blocked atrial bigeminy was 37 bpm. There were multiple episodes of regular ventricular rhythm during blocked atrial bigeminy. NT-proBNP concentration was within normal limits. Echocardiography showed only mild left ventricular hypertrophy, mild left atrial dilation and type I diastolic dysfunction. Therapy with flecainide and amiodarone separately was not effective. Option of radiofrequency catheter ablation was discussed with the patient, but was not accepted due to procedural risks and absence of severe symptoms related to blocked PACs. The patient was reassured and regular follow-up was recommended. The target values of blood pressure were achieved with candesartan at a dose of 32 mg. Thus, blocked atrial bigeminy is a rare cause of bradycardia with a regular ventricular rhythm. Recognition of the P wave superimposed on the ST segment or the T wave may be a clue for a correct diagnosis. Physicians should be aware of this condition to avoid unnecessary pacemaker implantation.

Background: Patients affected by silicosis often exhibit clinical symptoms such as dyspnea, chronic cough, sputum production, hemoptysis, and chest pain. Common complications of silicosis include pulmonary tuberculosis, right-sided heart failure, emphysema, and lung cancer. Some of these complications can cause pleural effusion, however, reports that clearly attribute pleural effusion directly to silicosis are uncommon. We report a case of pleural effusion directly caused by silicosis, confirmed by thoracoscopic pleural biopsy and polarized microscopy.

Case description: We report a case of a 78-year-old man with a history of working in a quarry for over 10 years. He was admitted to our hospital twice due to chest tightness and dyspnea. Both chest computed tomography (CT) scans indicated multiple nodular changes in the lungs, with predominantly right-sided pleural effusion. The results of pleural fluid tests were consistent with exudative effusion. Pleural biopsy specimens obtained by thoracoscopy showed silica particles under polarized light microscopy. Additional tests ruled out heart failure, tumors, and other causes of pleural effusion, based on which a final diagnosis of pleural effusion due to silicosis was made.

Conclusion: This case provides histological proof that silicosis can directly involve the pleura and cause exudative effusion. Furthermore, it highlights the diagnostic value of thoracoscopic pleural biopsy with polarized microscopy in silica-exposed patients with unexplained pleural effusion.