International Medical Case Reports Journal最新文献

Purpose: The current standard of care for neovascular age-related macular degeneration is serial vascular endothelial growth factor (VEGF) inhibitor intravitreal injections at varying treatment intervals. SUSVIMO is a port-delivery system of ranibizumab that serves as an alternative, lower-maintenance treatment.

Methods: A case report from a retinal surgery clinic describing the ocular findings, diagnostic workup, and alternative treatment for an 80-year-old man presenting with new-onset neovascular age-related macular degeneration.

Results: Resolved foveal thickness, macular volume, and subretinal fluid after SUSVIMO implantation OD. The patient showed a better response to SUSVIMO than to previous anti-VEGF injections. Before the first refill, the patient began to experience subretinal fluid; however, it was resolved after the refill.

Conclusion: Although effective, real-world management of neovascular age-related macular degeneration is associated with an extensive treatment burden that can compromise treatment adherence. Herein, we describe how the port delivery system (PDS; SUSVIMO) - a refillable ocular implant that can continuously deliver a novel formulation of ranibizumab with refills possible at six months or longer - is a viable early therapy that mitigates the treatment burden of intravitreal injections.

Introduction: Spontaneous focal hemorrhage of optic disc in peripapillary hyperreflective ovoid mass-like structures (PHOMS) is rare. This study reports the image features of two cases of spontaneous hemorrhage of an optic disc in PHOMS.

Methods: Case 1: A 51-year-old woman complained of visual fatigue for 1 week. Small patchy hemorrhage was observed in the optic disc of the right eye. Case 2: A 17-year-old female presented with complaints of experiencing floaters in the left eye for a duration of 1 day. Small patchy hemorrhage was observed in the left optic disc. The patients underwent the color fundus photograph (CFP), fundus autofluorescence (FAF), spectral-domain optical coherence tomography (SD-OCT), optical coherence tomography angiography (OCTA), and Minimum intensity projection (Min-IP) images.

Results: Case 1: The right eye showed a small patchy hemorrhage of optic disc. PHOMS on SD-OCT of both eyes exhibited an ovoid shape and manifested as peripapillary hyperreflective bright regions on en-face Min-IP image, the active blood flow signal of PHOMS was detected on SD-OCT/OCTA and FAF revealed a hypofluorescent. The optic cup-to-disc (C/D) ratio of both eyes was 0.06, respectively. Case 2: Small patchy hemorrhage was observed in the left optic disc and FAF showed hypofluorescence. PHOMS on SD-OCT of the left eye showed an ovoid shape and manifested as peripapillary hyperreflective bright regions on en-face Min-IP image, the active blood flow signal of PHOMS was detected on SD-OCT/OCTA. C/D in the right eye was 0.4.

Conclusion: Spontaneous focal hemorrhage of optic disc may occur in PHOMS. The space-occupying effect of PHOMS may lead to compression of surrounding tissues, resulting in the optic disc congestion and a reduced C/D ratio, thereby involving the microvascular system of the optic disc.

The case report of a young myope (born in 1997) who was diagnosed with bilateral concentric narrowing of the visual field to 15-20 degrees in 2021 is presented. On eye fundus, the findings were normal with central excavation c/d=0.5 and 0.4, respectively. OCT showed loss of retinal nerve fiber layer - in both vertical quadrants, including a reduction in the ganglion cell complex. Electrophysiological examination (PERG) showed normal retinal responses. Visual evoked responses (PVEP) after stimulation squared a 1 degree decrease in amplitudes, with no prolongation of P100 latency. When stimulated with 15-minute squares, responses were normal (see Supplementary Figure). Magnetic resonance imaging of the brain showed a narrowing of the chiasm. In conclusion, optic chiasm hypoplasia may not always have distinct morphological and functional manifestations. In addition to imaging methods, electrophysiological examination of the visual analyser was of great help for its verification.

Wilson's disease (WD) is a genetic disorder of copper metabolism that is inherited as an autosomal recessive (AR) due to mutations in the ATP7B gene, which is involved in intracellular copper transport. Approximately 40% to 50% of the patients present with neurological symptoms as their first symptom. The most common neurological symptoms are dysarthria, gait abnormalities, ataxia, dystonia, tremor, parkinsonism, and drooling. This case report aims to present a diagnostically challenging case of WD presenting with neurological symptoms. The 38-year-old male patient was admitted with complaints of imbalance, gait disturbance, weakness in the legs, speech impairment, tremors in the hands, syncope, and drooling. The MRI primarily revealed FLAIR, T1, and T hyperintensities in the bilateral globus pallidus of the basal ganglias. At first, the patient was evaluated according to the Leipzig scoring and received one point from the serum ceruloplasmin level and two points from the neurological symptoms and was evaluated as "possible WD" with a total of three points. 24-hour urine copper was collected during and after the D-Penicillamine challenge. After the test, there was an increase of more than 5 times the upper limit. The Leipzig score was recalculated, and a diagnosis of WD was made with a score of five. Even cases without important diagnostic findings such as Kayser-Fleischer ring or high 24-hour urine copper should be evaluated according to the Leipzig score. It is vital to distinguish WD in patients with young-onset movement disorder and neurological symptoms.

A patient who was 39 weeks pregnant was admitted to the hospital to be expecting labor and performed labor analgesia when the uterine orifice was opened to 2 cm. We successfully performed L2.3 epidural puncture in the lumbar space and equipped her with a self-controlled epidural analgesia infusion pump (100mL, 10mL 1% ropivacaine + 50ug sufentanil + 89mL normal saline) with a load of 8mL for continuous delivery. Continuous infusion of 8mL/h, patient controlled analgesia (PCA) 6 mL/ time at 15 minute intervals. The analgesic effect is good. In the following 40 minutes or so, due to fetal monitoring, fetal heart rate variation deceleration accompanied by late deceleration, the minimum was reduced to 85 times/min, and there was no improvement after treatment, and then the obstetrician prepared to perform an emergency cesarean section. The anesthesiologist evaluated the patient and then chose an epidural. The epidural dose was 3mL 1% lidocaine +0.5% rox mixture, and 7mL 1% lidocaine +0.5% rox mixture was administered 3 minutes later. During the administration, the patient complained of unbearable headache and rapid loss of consciousness. Immediate organization rescue, uterine dissection, pressure oxygen, preparation of tracheal intubation, cardiopulmonary resuscitation, cardiovascular active drugs, etc. After about 1 minute, the patient regained consciousness, responded smoothly, the vital signs were stable, the anesthesia plane T8 was measured. The patient's surgery went smoothly, and there were no complications during postoperative follow-up. They were discharged 5 days later. Such cases are relatively rare, especially during cesarean section surgery has not been reported, so it is published for everyone's reference.

Urticarial vasculitis is characterized by persistent urticarial lesions lasting over 24 h. Urticarial vasculitis is often triggered by medications, infections, and autoimmune disorders. However, vaccinations against viral and bacterial pathogens have recently been documented to induce urticarial vasculitis. We describe the case of a 67-year-old woman who was presented with an extensive erythematous and purpuric rash without systemic symptoms 3 days after an influenza vaccination. She was diagnosed with normocomplementemic urticarial vasculitis based on clinical findings, normal complement levels, and histopathological findings of leukocytoclastic vasculitis. After receiving oral histamines, she showed complete resolution 3 months after receiving the influenza vaccination. Although vaccination-associated vasculitis is common, urticarial vasculitis following vaccinations is rare. We reviewed 13 cases of urticarial vasculitis following a wide range of vaccines, including those against Bacillus Calmette-Guérin, serogroup B meningococcus, influenza, and coronavirus disease. We conducted a comprehensive review of various aspects, including age, sex, past medical history, type of vaccination, number of vaccinations, onset time, cutaneous symptoms, place of eruption, systemic symptoms, laboratory disorders, treatment period, and treatment of urticarial vasculitis. Two patients developed hypocomplementemic urticarial vasculitis after vaccination, and both experienced systemic symptoms such as arthralgia and fever. In this review, no significant differences were found in the data, which may be attributed to the small number of cases. The mechanisms underlying the induction of urticarial vasculitis by vaccines remain unknown; however, in addition to immune complex deposition and complement activation due to vaccine components, molecular mimicry may trigger urticarial vasculitis by producing vaccine-derived pathogenic antigen antibodies. This case study emphasizes the need for heightened awareness and further investigation of urticarial vasculitis as a rare adverse effect of vaccination.

Guillain-Barré syndrome (GBS) stands out as the most prevalent and severe acute immune-mediated paralytic neuropathy. Approximately 30% of patients experience respiratory failure necessitating admission to the intensive care unit (ICU) and invasive mechanical ventilation. The management of diseases concomitant with acute respiratory distress syndrome (ARDS) poses significant challenges. This case report illustrates the swift development of ARDS in a patient with GBS, explores the utility of the biomarker neurofilament light chain, and highlights the unexpected advantages of proactive ARDS intervention.

Background: Fulminant hepatitis is a rare and severe form of acute liver failure (ALF) characterized by rapid and massive destruction of liver cells and associated with a high mortality rate. Infectious factors, in particular viral hepatitis, take a prominent place in the etiology of ALF, however, the presence of chronic liver pathology can play a significant role in the disease progression and development of ALF.

Case presentation: A 2-year-old child was hospitalized on the 4th day of the disease with manifestations of jaundice and general intoxication. The examination revealed markers of active hepatitis A virus infection and Epstein-Barr virus infection. From the seventh day of the disease, the child's condition began to progressively deteriorate due to manifestations of ALF. Despite the use of immunomodulatory and replacement therapy, the disease ended fatally on the 9th day. Pathohistological examination revealed manifestations of viral necrotic hepatitis on the background of autoimmune sclerosing cholangitis.

Conclusion: The case is novel as regards the occurrence of two viral hepatitis with different modes of transmission on a background of unidentified liver disease.

Background: Currently, the push-in technique through the corneal tunnel using a blunt-tip spatula is used to insert an artificial corneal endothelium (EndoArt) into the anterior chamber (AC). The device is useful for patients with bullous keratopathy; however, it may be difficult to manipulate the very thin implant through hazy cornea. Unlike DMEK graft, it cannot be stained and the F-mark is faint. So, visualizing and orienting the implant is a real challenge especially through a hazy cornea and inadequate AC visualization. Therefore, alternative EndoArt implantation techniques are needed in patients with advanced endothelial dysfunction to avoid complications.

Purpose: To report an alternative technique for EndoArt implantation using a Busin glide.

Technique: The EndoArt was loaded onto the Busin glide with the concave side of the EndoArt facing upward and was then pulled/pushed into the Busin glide opening. After the Descemet's membrane and endothelium were detached and removed in a circular fashion in a patient with advanced corneal endothelial decompensation, the Busin glide was inserted into the corneal incision, and the EndoArt was slowly pulled into the AC using retractor forceps. Finally, the air was injected into the AC.

Conclusion: The Busin glide-assisted pull-through technique smoothly and securely inserted the EndoArt into the AC without upside-down attachment. This alternative technique can be useful for patients with a history of repeat intraocular surgeries or trauma with severe corneal edema to avoid potential complications such as epithelial implantation cysts or downgrowth.

Recurrent chest infections can present diagnostic challenges, especially when the underlying cause remains elusive despite initial evaluations and treatments. This case report details the clinical journey of a patient experiencing recurrent chest infections over several months, during which conventional diagnostic approaches initially failed to provide lasting relief. Here, we present the case of a 16-month-old female child who had been experiencing recurrent chest infections since the age of 10 months, ultimately diagnosed as a case of Partial Anomalous Pulmonary Venous Return (PAPVR).