International Medical Case Reports Journal最新文献

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.

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.