International Medical Case Reports Journal最新文献

Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used perioperatively and postoperatively in ocular inflammation and pain management. However, NSAIDs may cause ocular adverse effects. Postsurgical complications, including corneal stromal inflammation with or without epithelial ulceration and stromal melts, have been reported after anterior segment surgery, such as cataract surgery, penetrating keratoplasty, and photorefractive keratectomy. However, these drugs are also frequently used in vitreoretinal surgery for several indications, including the prevention and treatment of postoperative cystoid macular edema.

Case presentation: A 61-year-old man with rheumatoid arthritis, with no prior history of ocular surface disease, underwent uneventful combined phacovitrectomy in the right eye for macular pucker and cataract. Postoperatively, diclofenac 0.1% was added to the topical therapy. Within two weeks, the patient reported blurred vision and discomfort. Slit-lamp examination showed diffuse corneal edema with Descemet's membrane striae and a large epithelial defect with stromal ulceration in the inferior paracentral cornea. Best-corrected visual acuity (BCVA) dropped to counting fingers. Corneal topography revealed a wide thinning area. Diclofenac was immediately discontinued, and treatment with preservative-free dexamethasone 0.15%, ofloxacin 0.3%, and artificial tears was initiated. During follow-up, progressive improvement was observed with reduction of corneal opacity and thinning, along with recovery of BCVA. At the final visit, anterior segment OCT confirmed complete re-epithelization, a hyperreflective anterior stromal band, and mild residual thinning. BCVA improved to 20/20 with refractive correction (-3.50 sphere -3.25 cylinder axis 10).

Conclusion: Corneal melting has usually been described after anterior segment surgeries. Our case highlights the need for caution in the postoperative use of topical NSAIDs, particularly diclofenac, also in vitreoretinal surgery. Patients with autoimmune diseases, such as rheumatoid arthritis, may be at higher risk of adverse corneal effects, and careful consideration should be given when prescribing NSAIDs in this context.

Background: While upper gastrointestinal ulcers are a common condition in adults, with well-established surgical approaches such as Billroth I, Billroth II, and Roux-en-Y (RY) reconstruction, their occurrence in the pediatric population is markedly less common and presents distinct diagnostic and management challenges. Consequently, surgical intervention for pediatric ulcers remains relatively infrequent and less studied. Although procedures like Billroth I, Billroth II, and RY are technically feasible options, there is a notable lack of robust evidence and specific guidelines to inform optimal surgical management strategies tailored specifically for children.

Case presentation: We report the treatment of a 13-year-old female patient with a duodenal bulbar ulcer leading to scar stenosis, who was managed with a laparoscopic subtotal gastrectomy and gastro-jejunal Roux-en-Y anastomosis. The patient demonstrated excellent growth and development over a three-year follow-up period, with no significant early or long-term complications.

Conclusion: Although severe complications of peptic ulcer disease (PUD) are uncommon in the pediatric population, gastric resection combined with Roux-en-Y anastomosis represents a safe and efficacious surgical strategy for refractory cases. In this report, we compare the Roux-en-Y procedure with other reconstructive methods, such as Billroth I and II, and discuss the indications and outcomes of various surgical therapies for upper gastrointestinal ulcers in children. We advocate for Roux-en-Y anastomosis as the preferred surgical method for treating complicated upper gastrointestinal ulcers in children, primarily due to its superior long-term outcomes in preventing bile reflux and residual gastritis.

Objective: To present an extremely rare case of atlantoaxial spondyloptosis in a neglected case of odontoid fracture, type-2, with complete anterior displacement. The surgical approach in such cases are always challenging.

Background: C2 fractures are the most common type of spinal traumatic injury. Among them, odontoid fracture represents the most variable and complicated C2 fractures. When non-operative management is planned, close follow-up and patient compliance are mandatory. Neglecting these cases can lead to complications such as malunion, nonunion and subluxation, of which, atlantoaxial spondyloptosis is the most severe form.

Presentation of case: The patient was a 20-year-old male with the chief complaint of neck pain, progressive quadriparesis, and gait disturbance since 8 months prior to presentation, with Japanese orthopedic association score of 11. Imaging studies showed anterior non-reducible, malunited atlantoaxial spondyloptosis, associated with a type-II odontoid fracture.

Methods: The patient underwent open reduction and posterior atlantoaxial instrumented fusion using Harm's technique. One-year Follow-up examination and imaging evaluations revealed complete neurological recovery, with Japanese orthopedic association score of 15, and complete fusion in normal alignment.

Conclusion: A posterior-only approach for the management of atlantoaxial spondyloptosis with malunited type-2 odontoid fracture is associated with lower morbidity and fewer complications than anterior or combined approaches, while still achieving all surgical goals. The integrity of the transverse ligament is mandatory in such cases.

Background: Immune thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by low platelet counts, typically presenting with mucocutaneous bleeding. Bernard-Soulier Syndrome (BSS) is a rare inherited platelet disorder associated with thrombocytopenia, giant platelets, and impaired platelet function.

Case report: We present the case of an 8-year-old girl presenting with recurrent epistaxis, mucosal bleeding, and thrombocytopenia. Genetic analysis revealed a heterozygous germline ETV6 mutation associated with thrombocytopenia and leukemia risk, and a GP1BB mutation diagnostic of BSS. She was managed with intravenous immunoglobulin (IVIG) and corticosteroids; Eltrombopag was discontinued due of leukemic risk. The patient's platelet counts stabilized with supportive management and she remains clinically stable without recurrent severe bleeding.

Conclusion: The purpose of this case report is to illustrate the diagnostic challenges and therapeutic considerations in children with coexisting acquired (ITP) and inherited (BSS) thrombocytopenias, particularly in the presence of a leukemogenic predisposition gene (ETV6). This case underscores the importance of comprehensive genetic evaluation in guiding individualized therapy and long-term surveillance.

Hemosuccus pancreaticus (HP) is a rare cause of upper gastrointestinal (GI) bleeding, characterized by bleeding into the GI tract via the pancreatic duct and major papilla. It often occurs in conjunction with chronic pancreatitis and the development of pseudoaneurysms in the vessels near the pancreas. This association is attributed to the close proximity of these vessels, such as the splenic and gastroduodenal arteries, to the pancreatic parenchyma and duct, making them susceptible to pancreatic enzyme damage. The patient was a 50-year-old male with a known history of chronic alcoholism and pancreatitis who had recurrent admissions due to abdominal pain, hematemesis, melena stools, early satiety, and anemia. On admission, his hemoglobin level was 3.6 g/dL, and he exhibited deranged liver function test results. Contrast-enhanced abdominal CT done showed a complex, heterodense mass in the pancreatic head.

Background: Thyroid tuberculosis (TTB), either in its primary or secondary form, is a rare occurrence, even in recent years, with a high incidence of tuberculosis in China. Nowadays, with the increasing morbidity of thyroid nodules, it is apt to be misdiagnosed with malignant tumors. In this case, a suspicious malignant lesion was found on thyroid ultrasound (US), but the result after the surgery showed TTB.

Case presentation: This article reported a 67-year-old woman who was found left thyroid nodules during a physical examination three month ago. Thyroid US showed two suspicious hypoechoic lesions in the left thyroid gland and diagnosed as Chinese Thyroid Imaging Reporting and Data System. (C-TI-RADS) 4A category. The patient underwent US-guided fine needle aspiration of the two lesions, the results of which showed that suspected malignant tumors were not excluded. The patient underwent a left thyroidectomy and central group lymph node dissection. Postoperative pathological examination showed granulomatous inflammation with caseous necrosis in the thyroid gland, and diagnosed as tuberculosis. The patient had nonspecific clinical symptoms, no history of exposition, and no pulmonary involvement. Subsequently, the patient visited the tuberculosis specialist outpatient clinic for treatment.

Conclusion: This case report aims to enhance clinicians' awareness of TTB. With the increasing detection rate of thyroid nodules in US, it is crucial to distinguish between benign and malignant ones. TTB is often overlooked. Considering the existence of tuberculosis, unnecessary surgical treatment can be avoided.

Subconjunctival hemorrhage (SCH) is a rare complication in spinal surgery and is even more uncommon in endoscopic procedures, which are typically of short duration. We report the case of a 32-year-old male who developed bilateral SCH after an uneventful L4-L5 lumbar endoscopic discectomy performed under general anesthesia. The patient had a history of well-controlled hypertension and was not on anticoagulant therapy. The surgery lasted approximately 50 minutes, with appropriate head protection and smooth airway management. On the first postoperative day, bilateral SCH was observed without pain or visual disturbance. The hemorrhages resolved spontaneously within two weeks without complications. Although the exact mechanism remains unclear, contributing factors may include prone positioning, venous congestion, hemodynamic shifts, and hypertension-related vascular fragility. This case highlights the importance of recognizing subconjunctival hemorrhage as a rare but benign complication of prone spinal surgery, and suggests that patient reassurance and awareness are essential.

Introduction: Encephalomalacia is the loss of brain tissue caused by an insult to the cerebral matter. Encephalomalacia is not frequently described in literature, with most focusing on infants and children, and rarely on the adult population. When described in the adult population, encephalomalacia is most commonly described following a cerebrovascular event. Reports of trauma-induced encephalomalacia in adults are uncommon, making such cases clinically significant. Despite some identified etiology in infants and children, our understanding of adult risk factors besides a cerebrovascular event remains limited. The following report describes a case of encephalomalacia in a young adult resulting from an atypical predisposing etiology.

Case presentation: Our case is of a twenty-eight-year-old male who presented with non-specific and abrupt symptoms of chest tightness, dyspnea, and aphasia after an apparent episode of alcohol intoxication. Further investigations and pertinent history-taking revealed a chronic history of similar symptoms traced back to a severe head trauma five years prior. The symptoms were ultimately attributed to left temporal lobe encephalomalacia, as evidenced by neuroimaging with CT and MRI. The patient received symptomatic treatment for possible alcohol withdrawal and was hospitalized until his symptoms improved. He was then discharged for continued outpatient follow-up care.

Conclusion: This case report aims to identify the unknown cause of neurobehavioral deficits in adults and highlight physical trauma as the probable etiology of encephalomalacia in such patients. It underscores the potential for early identification through neuroimaging and appropriate symptomatic management, offering hope for mitigating the impact on the patient's quality of life.

Background: Loeys-Dietz syndrome (LDS) is a connective tissue disorder that is characterized by vascular and skeletal abnormalities. LDS, classified into six subtypes (LDS1-6), is caused by mutations in the genes encoding proteins involved in the transforming growth factor-beta (TGF-β) signaling pathway. LDS4 is the mild form of the LDS spectrum, considering that aneurysms are observed in the fourth decade and the disease progression is slower than the other forms.

Case presentation: We reported the case of a novel TGFB2 variant c.280_298del p.(Ser94Profs*7), NM_001135599.2 responsible of LDS4 in a family with sudden death and vascular lesions.

Conclusion: The pedigree analysis highlighted the high clinical variability of LDS signs even within the same family. In addition, TGFB2 mutations which do not always lead to vascular phenotype and skeletal signs can be prevalent. We emphasize the relevance of genetic counseling and molecular analysis to identify genetic diseases subtending sudden deaths and to distinguishing heritable connective tissue disorders with phenotypic overlap. Genetic testing can be used to guide clinical management and provide valuable prognostic information.

Ileo-sigmoid knotting (ISK) is a rare and potentially life-threatening condition that results in a double-loop intestinal obstruction involving the ileum and sigmoid colon. This case report delineates the clinical presentation of a female patient aged 38 years, who exhibited significant abdominal discomfort and distension, recurrent attacks of vomiting, and absolute constipation. Clinical and radiologic findings suggested bowel obstruction with signs of volvulus. Exploratory laparotomy confirmed type 1A ISK with gangrene of the distal ileum and a redundant sigmoid colon. Surgical intervention included resection terminal ileum with ileocecal anastomosis and sigmoidectomy and colorectal anastomosis. The patient recovered without complications. Timely identification of medical conditions and immediate implementation of surgical interventions are vital to a favorable prognosis.