International Medical Case Reports Journal最新文献

Background: Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease with various complications, making its management difficult. Glucocorticoid not only plays an essential role in the pathogenic therapy of SLE but also causes side effects such as oral lesions, especially when administered long-term or at high doses.

Purpose: This case report aims to describe the management of glucocorticoid-induced side effects that cause oral lesions in SLE patient.

Case presentation: A 30-year-old woman complained of a sore mouth and mouth-opening difficulty ten days prior. Previously, the patient complained of swelling in the legs and stomach, joint pain, hair loss, and skin redness on exposure to sunlight. Extra-oral examination revealed multiple red-black erosions and crusts on the zygoma region bilaterally over the nasal bridge, well-demarcated with an irregular shape, while the lips bled easily with hemorrhagic crusts that developed into serosanguineous crusts. Intra-oral examination showed scrapable white plaques on the palate, leaving erythematous areas, pain, and ulcers throughout the oral mucosa. The antinuclear antibody (ANA) examination revealed reactive results, positive anti-HSV-1 IgG, and positive hyphal on KOH examination. Based on the examination results, the diagnosis was SLE with herpes virus-associated oral involvement and acute pseudomembranous candidiasis.

Case management: Comprehensive therapy, including non-pharmacological and pharmacological therapy, was involved. All oral lesions improved within one month.

Conclusion: Various oral lesions may appear as manifestations of the disease and side effects of glucocorticoid therapy in SLE patients, thus requiring multidisciplinary monitoring and therapy from various fields.

Emerging symmetrical limb weakness, altered sensory perception, and absent or reduced deep tendon reflexes are the hallmarks of Guillain-Barre syndrome (GBS). There are numerous studies that indicate up to two-thirds of patients with GBS may also have autonomic dysfunction. One uncommon presenting characteristic of GBS before motor weakness is evident is paralytic ileus, a sign of gastrointestinal dysautonomia. Here we describe the case of a 55-year-old man who was brought to the emergency room of our hospital with paralytic ileus, a less common symptom of early-stage GBS. The patient was initially treated with prokinetic drugs and total parenteral nutrition with no clinical improvement. The patient quickly developed ascending lower limb weakness that progressed to quadriplegia, which ultimately affected respiratory muscles, leading to respiratory failure requiring mechanical ventilation and intensive care unit hospitalization. A nerve conduction study showed demyelinating sensorimotor polyneuropathy. Analysis of cerebrospinal fluid revealed albumin-cytological dissociation. The patient was treated with intravenous immunoglobulin (IVIG) and other supportive treatments. Even though the patient's enteral feeding support was uncomfortable due to a profound infection complicating lack of stomach emptying during the hospital stay, the patient passed away two months after being admitted. Lack of awareness about GBS gastrointestinal dysautonomia may cause delays in treatment initiation, and as a result, GBS may lead to life-threatening events. Reducing mortality and morbidity from GBS requires prompt diagnosis and treatment. This case reminds us that GBS may present as gastrointestinal dysautonomia.

Pelvic congestion syndrome (PCS) is a chronic condition primarily characterized by pelvic pain and heaviness, with vaginal bleeding being a rare but significant symptom. We present two cases of PCS-related vaginal bleeding, emphasizing the necessity of considering PCS in differential diagnoses for abnormal vaginal bleeding. A 28-year-old Chinese woman presented with abnormal vaginal bleeding exacerbated by abdominal pressure during activities like squatting or defecation. Imaging revealed a dilated right ovarian vein, and transcatheter venography confirmed Nutcracker syndrome. After undergoing transcatheter foam sclerotherapy, her symptoms resolved. The second case involves a 29-year-old Chinese woman with similar symptoms; imaging and venography identified a dilated left ovarian vein. Following sclerotherapy, her symptoms also alleviated. These cases underscore the importance of recognizing PCS as a potential cause of abnormal vaginal bleeding and demonstrate the efficacy of transcatheter foam sclerotherapy in managing this condition. Integrating clinical presentation with imaging findings is crucial for timely diagnosis and effective treatment, ultimately improving patient outcomes.

Choroidal osteoma is a rare, benign, osseous choristoma presenting as an orange-yellow, well-defined fundus mass. It presents unilaterally in most cases, has a predilection for the female sex, and favor a juxtapapillary location, becoming clinically manifest when it involves the macula. Almost 60% of eyes with osteoma may suffer significant visual loss. Choroidal osteomas can easily be mistaken for other conditions with similar presentations. We herein report two rare cases presentation of choroidal osteoma: a 74-year-old male with 2-year blurred vision in the right eye (RE) initially misdiagnosed with age-related macular degeneration received intravitreal injections and after a multimodal evaluation, following cataract surgery in RE, confirmed to be choroidal osteoma and a 19-year-old female with a history of choroidal hemangioma presented with blurred vision in her left eye (LE), with examination revealed an irregular orange-yellow lesion along the superotemporal arcade with serous macular detachment, later diagnosed as choroidal osteoma.

Background: Community-acquired pneumonia (CAP) is a common infectious disease that can lead to complications such as rhabdomyolysis (RM), a rare but potentially life-threatening condition involving muscle breakdown. RM can further complicate the clinical course by causing acute kidney injury (AKI). We present a case of Community-acquired pneumonia with AKI complicated by rhabdomyolysis in a resource-limited setting.

Case presentation: A 67-year-old male presented with high fever, cough, and shortness of breath. He had no significant medical history. On examination, he was febrile, tachypneic, and tachycardic, with right-sided lung crackles. Lab tests showed elevated inflammatory markers and impaired kidney function. Chest radiography revealed right upper lobe consolidation, confirming pneumonia and AKI. He was treated with fluids, antibiotics, and supportive care, but his condition worsened, requiring intensive care unit (ICU). In the ICU, dark urine and elevated creatine kinase confirmed rhabdomyolysis. After aggressive fluid therapy and antibiotics the patient improved over six days and was transferred to the ward. By day 10, he fully recovered and was discharged with follow-up.

Conclusion: This case underscores the importance of early recognition and prompt management of CAP complicated by AKI and rhabdomyolysis, even in resource-limited settings. Timely intervention can lead to favorable outcomes despite challenges.

Background: The placenta extract is used as a dietary supplement. We aimed to investigate the effects of placenta extract on periodontal disease.

Case presentation: In this study, placenta extract supplements were found to improve the oral environment of young and middle-aged Japanese women undergoing maintenance; after three months of taking placenta extract, bleeding upon probing was reduced. In addition, two parameters, white blood cells and protein, improved in the SillHa test, suggesting that the placenta extract contributes to the reduction of gingival inflammation through its anti-inflammatory effect. No adverse events were observed with the placenta extract.

Conclusion: Placenta extract may lead to better management, including oral rehabilitation and pharmacotherapy. However, its effect on gingival inflammation requires further investigation in a larger number of cases.

The presentation of vitamin A deficiency (VAD)-induced ocular complications can be challenging to diagnose in elderly patients, particularly due to the overlap with age-related macular degeneration (AMD) symptoms. This case report details the presentation, diagnosis, and management of an 88-year-old female with vision loss, highlighting the ocular manifestations of presumed VAD. Despite vitamin A levels being at the lower end of the normal range, the patient's symptoms and spectral domain optical coherence tomography (SD-OCT) findings suggested insufficient levels, leading to thinning of the outer nuclear layer. This case underscores the necessity of considering VAD in differential diagnoses of unexplained vision impairment, particularly in individuals with a history of intestinal malabsorption, while also emphasizing the importance of distinguishing VAD from AMD in elderly patients.

Introduction: The incidence of post-pandemic psychiatric disorders has increased globally in recent decades. Generalized anxiety disorder (GAD) is one of the psychiatric disorders that are partially associated with emotional factors. It can affect the quantity and quality of saliva, present as xerostomia, and trigger the emergence of the geographic tongue (GT).

Purpose: This case report aims to discuss the management of xerostomia and geographic tongue in a patient with GAD.

Case: A 26-year-old male patient complained of dry and sore mouth for one month after taking medication from the psychiatry department, was diagnosed with GAD, and had already consumed the antidepressant sertraline. Extraoral examination showed dry and exfoliative lips. Intraoral examination showed white plaque with depapilation on the dorsal tongue, frothy saliva, buccal mucosa and dorsal tongue sticking to the dental mirror. The unstimulated salivary flow rate was <0.2 mL/min (sialometry method). The Depression, Anxiety, and Stress Scale-21 (DASS-21) questionnaire was used to estimate the psychological condition and showed an extremely severe level of anxiety (score = 13). The established oral diagnoses were GT with mild xerostomia and exfoliative cheilitis.

Case management: For two months, patients received hyaluronic acid gel and mouthwash, as well as a non-pharmacological approach to healthy lifestyle counseling. There was an improvement in xerostomia, and the GT became asymptomatic, with a reduction of DASS score in this patient.

Conclusion: Improved psychological conditions will improve xerostomia, but the clinical appearance of the geographic tongue is more difficult to eliminate.

Background: Jaundice and hyperbilirubinemia are common clinical problems characterized by the presence of bile pigments in the blood and their deposition in body tissues. This clinical condition can be associated with a broad spectrum of potential benign and malignant causes, including hepatic inflammation, biliary obstruction, impaired bilirubin conjugation and bilirubin overproduction Therefore, the hyperbilirubinemia diagnostic work-up sometimes can be highly challenging and its therapeutic management can require a multidisciplinary approach.

Case report: We report on a unique case of life-threatening jaundice and hepatic failure in a 20-year-old female who presented to the emergency room with complaints of fever, constant left abdominal pain and generalized profuse fatigue. A complete and detailed medical history, multiple tests for various infection, radiologic investigations and histological tests were performed in order to clarify the etiology of that rapidly progressive clinical condition. Based on the results, the patient jaundice was caused by an Epstein-Barr virus (EBV) infection and secondary cold agglutinin syndrome. Given the rare and complex diagnosis, multiple clinical specialists were asked to carry out the best patient management.

Conclusion: This rare case highlights how challenging the differential diagnosis and treatment of hyperbilirubinemia can be, presenting a unique case of life-threatening multifactorial hepatic failure treated successfully with rituximab.

Background: Cryptococcal meningitis (CM) is a central nervous system (CNS) infection that occurs mainly in immunocompromised individuals such as those with human immunodeficiency virus (HIV) infection. However, the prevalence of CM in immunocompetent patients has increased. Although CM has been reported in patients with hepatitis C virus (HCV) infection, it has not yet been fully established whether there is an association between both conditions. CM has also been reported in patients with intravenous drug use (IVDU), which is related to the immunosuppression caused by these drugs.

Case presentation: We report the case of a 24-year-old man who presented with meningitis secondary to Cryptococcus gattii infection. He had a history of IVDU and HCV infection, was HIV-negative and without antiviral treatment. The patient received adequate antifungal treatment during induction, consolidation, and maintenance phases. His condition relapsed, requiring dose adjustment, with an excellent response during clinical follow-up for both meningitis and HCV infection. A brain biopsy was requested during relapse to rule out other co-infection.

Conclusion: The case of an individual diagnosed with cryptococcal meningitis, who had a history of IVDU and HCV infection, is presented. The coexistence of such events could shadow the prognosis of this group of subjects, related to immunosuppression that can be caused through different pathways. Having HCV and being a IVDU simultaneously could increase the risk of Cryptococcus infection.