International Medical Case Reports Journal最新文献

Keloids are characterized by excessive growth of fibrous tissue resulting from abnormal wound-healing processes. They may lead to functional impairments, aesthetic deformities, pruritus, and a decreased quality of life. Various therapies, including intralesional corticosteroid injections, cryotherapy, laser therapy, surgical excision, and radiotherapy, have been used to manage keloids, but the recurrence rates remain high. Therefore, this study aimed to report combination therapy for patients with giant keloids in auricula. This report presents a 35-year-old man who had lumps in both ears that got bigger over about 10 years. Surgery was done to remove the keloids and to fix both ears. After surgery, the patient got some radiotherapy, specifically a kind called superficial brachytherapy, to try to lower the chances of the keloids coming back. A combined way of doing surgery and giving radiotherapy showed it could work well for handling big ear keloids and keeping them from coming back. The extra radiotherapy after surgery helped a lot in lowering the chances of the keloids showing up again.

Purpose: Ozurdex^® is a dexamethasone intravitreal implant approved for the treatment of macular edema secondary to branch or central retinal vein occlusion, non-infectious uveitis affecting the posterior segment of the eye, and diabetic macular edema.

Patients and methods: We report a case of an accidental injection of the implant into the crystalline lens, successfully managed by surgery afterwards. The case description is supported by Anterior Segment Optical Coherence Tomography (AS-OCT) images.

Results: A 69-year-old male was observed for bilateral diabetic macular edema. He had previously been treated with bevacizumab and aflibercept, with an incomplete anatomical response (<20% reduction in central macular thickness). The patient consented to undergo a bilateral intravitreal dexamethasone injection (dexamethasone intravitreal implant (0.7 mg)). The procedures were uneventful, except for an extensive conjunctival hemorrhage in the right eye. An appointment was scheduled for fifteen days later, however the patient missed it. Four months later, he referred OD vision loss, which occurred a few days after the injection, and the implant was found within the right crystalline lens. An AS-OCT was done to better understand the implant's location and entry point. Due to decreased visual acuity, the patient was scheduled for surgery. A phacoemulsification surgery with a three-piece hydrophobic intraocular lens implantation in the sulcus associated with anterior vitrectomy was done.

Conclusion: The injection of a dexamethasone implant is becoming increasingly common. Nonetheless, it must always be carried out carefully, to avoid complications. If the implant is accidentally injected into the crystalline lens, the AS-OCT can help determine its exact location, which is important for preparing the surgical plan and determining the appropriate timing.

Scorpions are a group of arthropods known to be highly toxic to humans. We report the case of a previously healthy 61-year-old male who sustained a sting from an Androctonus crassicauda scorpion to his right eye. The patient was admitted to the intensive care unit (ICU) in a comatose state immediately after the sting. A few days later, he suffered from tearing right-eye pain and loss of vision, which persisted despite initial treatment. The patient was subsequently diagnosed with keratitis and admitted to King Abdullah University Hospital (KAUH). He was prescribed various antibiotics, which initially improved his condition. However, the patient experienced subsequent deterioration and recurrent episodes of keratitis. The patient's visual acuity improved after treatment with a combination of antifungal and antibiotic medications, suggesting a polymicrobial infection. Despite the improvement in his condition, the sting left a central corneal scar, necessitating corneal transplant surgery as a definitive treatment. To the best of our knowledge, this scenario has not been previously documented.

In this case, the patient had uterine adenocarcinoma with a huge necrotic mass prolapsed from the vagina, complicated by necrotic infection and massive bleeding. Based on ultrasound results preoperatively, uterine prolapse with infected necrosis was considered due to significant vaginal bleeding, prompting emergency surgery and blood transfusion. Postoperatively, pathology review indicated a misdiagnosis. This article aims to analyze the reasons for misdiagnosis through case review and literature review.

Background: Post-dural puncture headache (PDPH) is a common complication of obstetric anesthesia. There are still no convenient and effective methods to control the PDPH.

Case presentation: Three cases of parturients with accidental dural puncture who suffered post-dural puncture headache (PDPH) after labor analgesia or cesarean section. They were treated with epidural hydroxyethyl starch (HES) through an epidural catheter and achieved well therapeutic effect.

Conclusion: Treatment of PDPH by epidural HES is a promising method that may benefit the parturient and doctor.

Introduction: Transthyretin protein-related familial amyloidosis polyneuropathy (TTR-FAP) is an autosomal dominant genetic disease caused by mutations in the TTR gene. The disease is characterized primarily by peripheral and autonomic nerve damage. Disease progression is associated with frequent involvement of the heart, lungs, kidneys, eyes, and other organs. The most common TTR mutation is c.148G>A (p.Val50Met), although the FAP resulting from the mutation rarely involves the spinal cord.

Patient concerns: A 68-year-old man was diagnosed with the TTR c.148G>A (p.Val50Met) mutation by ultrasound, pathological, and genetic analyses. He presented with a late-onset, complicated spinal cord injury. The diagnostic process was tortuous, and despite the administration of regular treatment (conventional drugs, cardiac pacemaker, and the specific drug clofenadifen), the patient died.

Interventions: To confirm TTR-FAP, ultrasound, MRI, pathological, and genetic tests were performed.

Outcomes: The patient ultimately died of heart failure 7.5 years after the initial onset of symptoms.

Conclusion: The patient presented with unusual symptoms of spinal cord injury, and despite a long and arduous diagnostic process and administration of standard treatment for over seven years, the outcome was poor. It is thus recommended that clinicians pay attention to the identification of rare diseases with timely imaging, pathological, and genetic testing, to avoid poor outcomes.

Purpose: We present a case of levetiracetam-induced corneal edema. To the best of our knowledge, this is the first documented case of bilateral reversible corneal edema secondary to levetiracetam use.

Patients and methods: A 59-year-old woman was referred to the ophthalmology department with a few weeks' history of bilateral blurring of vision. She is a known case of secondary progressive multiple sclerosis, and she was started on levetiracetam by her neurologist a few weeks prior to referral in view of new seizure activity. Examination revealed bilateral clinically evident corneal edema, which was documented on corneal topography.

Results: Upon levetiracetam dose reduction, symptoms started to improve and eventually the medication was stopped altogether. The patient's vision and corneal edema normalized on follow-up.

Conclusion: This novel side effect should be kept in mind when a patient who is on levetiracetam presents with corneal edema as this can avoid misdiagnosis and unnecessary interventions.

Hepatitis B virus (HBV) reactivation is a recognized complication of long-term immunosuppressive or cytotoxic therapy, typically occurring during immunosuppression or within a few months after treatment. To mitigate this risk, hepatological societies recommend the use of nucleos(t)ide analogues (NA) for HBV reactivation prophylaxis, along with post-treatment monitoring; though, these recommendations are not universally consistent across different guidelines. We present a case of late HBV reactivation in a 76-year-old male with occult HBV infection who received rituximab-based therapy for chronic lymphocytic leukemia. In accordance with HBV reactivation guidelines, the patient was prescribed entecavir 0.5 mg daily during chemotherapy and for 18 months following the completion of hematological treatment. Despite adherence to these recommendations, the patient developed HBV reactivation 2 years and 5 months after the cessation of rituximab-based therapy, which progressed to acute HBV hepatitis. Our case emphasizes the need for extended follow-up in patients undergoing rituximab-based immunosuppression. It highlights the critical importance of vigilance for HBV reactivation and the potential consequences of delayed treatment. This case supports evidence on the unpredictability of HBV reactivation timelines and underscores the need for standardized monitoring protocols.

Purpose: To report cytokine/chemokine profiles of ocular fluid in two patients with herpetic uveitis.

Methods: Cytokine and chemokine profiling of ocular fluid was performed in two patients with herpetic uveitis. Ocular fluid findings were correlated with disease manifestations and the patients' clinical course.

Observation: Case 1 was a 45-year-old female, who was evaluated for an 11-day history of recurrent redness, and decreased vision in the right eye (OD) and was diagnosed with acute retinal necrosis. Ocular fluid from anterior chamber paracentesis was positive for varicella zoster virus (VZV) via PCR testing. Subsequently, the patient developed proliferative vitreoretinopathy requiring a pars plana vitrectomy. Ocular fluid sample cytokine/chemokine analysis detected IFN-γ, TNF-α, IL-8, IL-18, MIP-1β, IP-10, and MCP-1 with MCP-1 being the most abundant cytokine. Case 2 was a 30-year-old female with a two-month history of progressive pain and decreased vision OD. She was diagnosed with hypertensive anterior uveitis after diagnostic anterior chamber paracentesis. Despite successful therapy for the anterior uveitis, her intraocular pressure remained elevated and required a glaucoma filtration procedure. Ocular fluid sample was collected at the time of surgery for cytokine/chemokine profiles analysis, and levels of 7 cytokines/chemokines were detected including IL-6, IL-8, IL-18, MIP-1β, IP-10, MCP-1, and IL-1RA with IL-1RA being the most abundant cytokine.

Conclusion: Cytokine/chemokine profiles of two patients with herpetic uveitis showed elevated levels of MCP-1, IP-10, IL-8, and IL-18 while IL-1RA was elevated in the chronic phase of hypertensive anterior uveitis. Further studies of cytokines and chemokines will improve our understanding of soluble mediators and potential targets for herpetic uveitis.

Background: Abdominal pregnancy is a rare but, serious obstetric condition that has continued to pose difficulties in its diagnosis and management. The clinical presentation takes various forms, mostly nonspecific, leading to the delay in diagnosis and management. With a high degree of suspicion, the diagnosis can be made by an abdominal ultrasound particularly in the early trimesters. The objective of this case report is to share our experience in low resource setting dealing with this rare condition diagnosed incidentally during a planned Cesarean section for another obstetric indication.

Case report: Twenty-five-year-old primigravida from the Federal Republic of Somalia at a gestational age of 37 + 3 weeks was admitted for elective cesarean section with a diagnosis of Placenta Previa. She had frequent antenatal visits to nearby health facilities with non-specific abdominal symptoms and spotty vaginal bleeding. Intraoperatively, the uterus and right adnexa were normal, while the fetus, chorioamniotic membrane, and placenta were found in the peritoneal cavity and the diagnosis of abdominal pregnancy was made. A 3.5kg live female fetus was delivered with Apgar score of 9 and 10 in the 1^st and 5^th minutes. Placenta removed through infracolic omentectomy and left adnexectomy. The neonate had facial deformity, bilateral club foot, scoliosis and finger deformities. The mother discharged in good health on the 10^th post-operative day and the neonate was linked to orthopedic surgeon for further management.

Conclusion: This case report demonstrates the continuing challenges in early diagnosis and management of this serious obstetric condition. The rarity of the condition in general, and in low resource settings delayed antenatal care (ANC) booking of women, and lack of experience in meticulous ultrasound scanning, are challenges in making an accurate diagnosis. It is recommended that the location of pregnancy should be confirmed in early trimester, vague and nonspecific complaints should be addressed to rule out or rule in ectopic pregnancy.