International Medical Case Reports Journal最新文献

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.

Deep brain stimulation (DBS) is an effective treatment for medically refractory essential tremor (ET) and Parkinson's disease. We present the case of a patient treated with thalamic DBS for ET who developed a large right peri-lead cyst with associated edema three months postoperatively, causing symptoms of dysarthria and left-sided weakness. The patient was treated nonoperatively with a course of steroids and serial observation. Over three months, the cyst regressed in size, with resolution of the associated symptoms. The patient was ultimately able to continue bilateral DBS for ET, which provided relief from upper-extremity tremor. By 9 months after the cyst was diagnosed (one year postoperatively from DBS) he was fully recovered back to baseline. We review other cases of peri-lead cysts and edema, of which etiology and presentation remain varied and unclear. Peri-lead cysts are a rare complication of DBS with an estimated incidence of 0.8%. Ultimately, this case shows that appropriately selected peri-lead cysts may be managed nonoperatively, allowing for continued DBS benefit in patients by avoiding lead removal.

Background: In clinical scenarios like wisdom tooth extractions, compressed air may infiltrate tissue gaps or venous vessels. We observed a patient who developed a pulmonary air embolism secondary to subcutaneous emphysema (SE) during a wisdom tooth extraction performed with an air turbine. The patient required immediate cardiopulmonary resuscitation (CPR) and was successfully revived from pulseless electrical activity (PEA).

Case description: This case was a 47-year-old female, and upper and lower pericoronitis on the right side and multiple dental caries were noted. Due to her intellectual disabilities (ID), so the extraction of the upper and lower right wisdom teeth was scheduled under general anesthesia. At approximately 10 minutes after starting the oral surgery, the monitor showed plethysmograph and the end-tidal carbon dioxide (E_TCO₂) waveform disappeared following the sudden drop in SpO₂. Based on these findings, cardiopulmonary arrest (CPA) was diagnosed, and PEA was confirmed on the ECG. CPR was immediately initiated on the dental unit. However, because the dental unit remained in a supine position, it sank with each chest compression. To stabilize the surface and prevent vertical movement, a dental chair was placed under the backrest of the dental unit. Approximately 3 minutes after starting CPR, the SpO₂ plethysmograph reappeared on the monitor during artificial ventilation. A CT scan was performed, and she was diagnosed pulmonary air embolism resulting from SE caused by the use of an air turbine with compressed air.

Conclusion: This case highlights that SE can easily occur when using an air turbine with compressed air in dental procedures. In severe instances, an air embolism resulting from SE may lead to CPA. Therefore, caution is needed when using dental instruments and drills that utilized compressed air during dental procedures.

Patients with cerebral palsy may have intellectual disabilities, convulsions, scoliosis, or thoracic deformities. Scoliosis is a complex deformity of the spine resulting in secondary involvement of the respiratory, cardiovascular and neurologic systems which may affect the anesthesia for those patients We reported a case of a 17-year-old female with cerebral palsy and severe scoliosis who presented for dental caries operation under general anesthesia. General anesthesia was conducted, difficult airway management sets have been prepared, and pressure control ventilation to minimize peak airway pressure was adopted. Anesthetic management was performed without anesthesia-related complications. We recognize that considerable attention is required in patients with cerebral palsy. Perioperative management and general anesthesia of patients with cerebral palsy who have severe scoliosis represent significant challenges. Multidisciplinary approach through team included surgeons, anesthesiologists, neurophysiologists, pediatricians, nurses, nutritionists, and physiotherapists is required.

Trichotillomania disorder is a psychiatric condition characterized by recurrent hair-pulling behaviors that result in substantial distress or impairment. Comorbidity between trichotillomania and adult attention-deficit/hyperactivity disorder (ADHD) is challenging, and an increasing body of evidence suggests a neurobiological overlap between the two conditions, particularly in the areas of executive functioning and inhibitory control. Atomoxetine is a selective norepinephrine reuptake inhibitor approved for ADHD by the Food and Drug Administration (FDA). It has been recommended for ADHD patients comorbid with anxiety disorders. Although most people can tolerate atomoxetine, there have been reports of uncommon side effects, such as sexual problems. This case report describes a 37-year-old man diagnosed initially with trichotillomania and generalized anxiety disorder and started on fluoxetine 20 mg for six weeks with substantial symptoms improvement of both disorders. Unfortunately, the patient exhibited increased impulsivity and irritability, which hindered his daily life functioning. Given this paradoxical response, fluoxetine was terminated. A multisession reassessment revealed lifelong ADHD with inattention, disorganization, emotional dysregulation, and impulsiveness. Consequently, Atomoxetine initiation/titration (25→75 mg) was attempted; however, he experienced spontaneous seminal discharge 6 weeks later. The assessment and workup included a normal urologic exam. We systematically evaluated potential infectious, inflammatory, and endocrine causes, checking testosterone, prolactin, LH/FSH, TSH, and urinalysis, all of which fell within the reference ranges. Subsequently, Atomoxetine was gradually withdrawn, and this rare side effect, seminal discharge, resolved within five days post-cessation of the medicine. After three months of monitoring, we re-evaluated ADHD and trichotillomania, adjusted the therapy, and observed that there was no recurrence of symptoms. This instance shows the importance of careful monitoring for rare side effects in people with complex psychiatric comorbidities.