International Medical Case Reports Journal最新文献

This case series highlights the feasibility and tolerability of using controllable pulse parameter Transcranial Magnetic Stimulation (cTMS) in individuals with painful diabetic neuropathy (pDN). cTMS delivers repetitive monophasic pulses, which allows for greater and longer lasting effects compared to traditional repetitive TMS (rTMS). All participants (N = 2) tolerated 10 sessions of cTMS over a two-week period (five days per week) with no discomfort from the stimulation. They reported no pain from the stimulation despite their heightened pain sensitivity as a result of pDN. The cTMS intervention improved their pain and quality of life as determined through questionnaires evaluating pain, depression, anxiety, and other related measures. Notably, cTMS has never been evaluated in diabetic neuropathy, and our data suggest that it is feasible and tolerable in this clinical population. It further proposes a potential therapeutic treatment option for individuals with pDN.

Meckel's diverticulum is one of the most common congenital anomalies of the gastrointestinal tract in pediatric populations worldwide. Although Meckel's diverticulum itself is usually asymptomatic, patients often present with complications such as gastrointestinal bleeding, Meckel's diverticulitis, intestinal perforation, and other associated symptoms. Notably, Meckel's diverticulum is relatively uncommon in adults, with cases complicated by acute massive gastrointestinal bleeding being particularly rare. We report the case of a 41-year-old man presenting with hematochezia for one day. Upon admission, his hemoglobin level dropped significantly from 98 g/L to 62 g/L within 24 hours. Contrast-enhanced computed tomography strongly suggested contrast media extravasation, indicating active bleeding. Subsequent gastrointestinal endoscopy, including colonoscopy, failed to identify obvious pathological findings. Mesenteric angiography successfully localized the bleeding vessels, but multiple embolization attempts were unsuccessful. The initial imaging and endoscopic modalities may not pinpoint the source of bleeding in this rare condition. Ultimately, a combined laparoscopic and endoscopic approach was employed, which successfully identified and localized the bleeding site in the Meckel's diverticulum. Laparoscopic intestinal resection was then performed, and postoperative pathological examination confirmed Meckel's diverticulum with ectopic gastric tissue. Meckel's diverticulum-induced bleeding in adults is severe yet rare, with nonspecific diagnostic features that often complicate timely identification. In managing the case of massive gastrointestinal hemorrhage, we achieved a successful outcome through combined laparoscopic intestinal resection and endoscopic surgery, with timely diagnosis and targeted intervention leading to complete recovery. This case underscores the critical role of a multimodal diagnostic and therapeutic strategy, particularly the integration of laparoscopy and endoscopy, in overcoming the challenges of nonspecific presentations. It serves as a valuable reference for clinicians, emphasizing that persistent diagnostic uncertainty in severe lower gastrointestinal bleeding should prompt consideration of rare etiologies like Meckel's diverticulum, and that a combined surgical-endoscopic approach can be pivotal in achieving definitive diagnosis and curative treatment.

Background: Post-COVID-19 Syndrome, marked by systemic immune dysregulation, has been linked to various ocular manifestations, including conjunctivitis, anterior uveitis, and vitritis. Emerging evidence highlights the role of inflammatory mediators, cytokines, and abnormal immune cell activation in post-viral complications, which may contribute to corneal damage. This case report describes immune-related peripheral keratopathy in a patient with Post-COVID-19 Syndrome, emphasizing that it may influence the ocular surface immune microenvironment.

Case presentation: We describe a woman in her 30s who has a history of mild dry eye disease. After her third COVID-19 infection, she experienced eye redness, dryness, and a foreign body sensation. Ophthalmic examination revealed a corneal ulcer at the limbal region in both eyes. Treatment with topical antibiotics, corticosteroids, anti-inflammatory agents, and lubricating eye drops, led to substantial improvement and complete healing within two months.

Conclusion: Systemic immune dysregulation following COVID-19 infection may alter the ocular surface immune microenvironment, thereby predisposing patients to ocular surface complications.

Fanconi-Bickel syndrome (FBS) is a rare genetic disorder characterized by impaired glucose and galactose transport due to mutations in the SLC2A2 gene. It presents a broad phenotypic spectrum with initial nonspecific symptoms, often leading to missing or delayed diagnosis. The most common manifestations include failure to thrive, hepatomegaly, fasting hypoglycemia, postprandial hyperglycemia, significant glycosuria, proximal tubular nephropathy, osteoporosis and nutritional rickets. This study presents a rare case of pregnancy with FBS complicated with intrahepatic cholestasis and postprandial hyperglycemia, highlighting the challenges and complexities involved in managing such a high-risk pregnancy. A multidisciplinary team, including specialists in hepatology, nephrology, endocrinology, maternal-fetal medicine, and neonatology, collaborated to ensure optimal maternal and fetal outcomes. Through meticulous monitoring and individualized treatment strategies, pregnancy was successfully carried out at 37 weeks of gestation, culminating in favorable maternal and neonatal outcomes. All previously published cases of FBS were identified and compared to our case for a comprehensive analysis. This case highlights the critical role of specialized, multidisciplinary care in managing rare metabolic disorders during high-risk pregnancies and expands our current understanding of FBS treatment approaches and the management of specific manifestations. This underscores the need for a systematic approach to patient evaluation and management, ensuring timely identification of complications and tailored interventions to optimize maternal and fetal outcomes.

Introduction: Ischemic stroke secondary to polycythemia is a rare but serious complication, particularly in young adults. Early recognition and intervention can lead to rapid neurological recovery.

Case presentation: A 21-year-old male from Western Uganda presented with sudden-onset right-sided hemiparesis and slurred speech. He had no prior history of thromboembolic events but reported chronic headaches and fatigue. Physical examination revealed facial asymmetry, right-sided weakness (power 3/5), and hyperviscosity signs. Laboratory tests confirmed polycythemia (Hb: 22 g/dL, Hct: 68%). Brain CT showed an acute left middle cerebral artery (MCA) infarct.

Management: Emergency phlebotomy (500 mL) was performed, followed by hydration and low-dose aspirin. The patient showed significant improvement within 48 hours, with near-complete resolution of symptoms at one-week follow-up.

Conclusion: Polycythemia-induced stroke, though rare, should be considered in young patients with unexplained thromboembolic events. Phlebotomy remains a rapid and effective treatment, especially in resource-limited settings.

Introduction: Actinomycosis is a rare, chronic bacterial infection caused by the genus Actinomyces. The cervicofacial form is most common, while gallbladder involvement is exceptionally uncommon, with fewer than 50 cases reported in the literature.

Case report: A 21-year-old diabetic woman presented with one day of nausea, vomiting, and persistent right upper quadrant abdominal pain. Ultrasonography and computed tomography scan revealed an enlarged gallbladder with biliary sludge and a single gallstone. A preoperative diagnosis of acute cholecystitis was made, and cholecystectomy was performed. Histopathological examination confirmed acute cholecystitis and demonstrated numerous filamentous, gram-positive bacteria, consistent with actinomycosis. Following 6 months of penicillin therapy, the patient remains well with no clinical or radiological evidence of recurrence.

Conclusion: This case underscores the importance of routine histopathological evaluation of gallbladder specimens. Although rare, gallbladder actinomycosis should be considered in the differential diagnosis of gallbladder disease, particularly in immunocompromised individuals.

Background: Infantile hemangiomas (IH) are the most common tumors in infancy and childhood. They are characterized by a fast proliferation phase followed by gradual involution. While most IHs follow a predictable course, those involving the parotid gland pose unique diagnostic and therapeutic challenges due to their location and potential for functional impairment. This case illustrates an unusual example of unilateral parotid hemangioma with prolonged growth, requiring alternative management strategies.

Case presentation: A two-month-old girl presented with a large unilateral parotid hemangioma, first noted on the 15th day of life, which had been rapidly increasing in size. Oral propranolol was initially prescribed, but treatment was not started by the parents, and the patient was lost to follow-up. At 3.5 months of age, the patient underwent an unplanned cosmetic surgical excision at a rural hospital, which resulted in facial nerve paresis and functional facial asymmetry. She re-presented at 7 months with a markedly enlarged lesion. Propranolol (3 mg/kg/day) was reinitiated; however, despite dose escalation, the hemangioma remained unresponsive. Systemic corticosteroids (prednisolone, 1-3 mg/kg/day) at 8 months were added, but the lesion continued to progress. At 9 months of age, metronomic chemotherapy with vinblastine (1 mg/m² IV every 3 days) and cyclophosphamide (50 mg/m² orally for 10 days) was introduced under clinical supervision. This combination resulted in significant tumor regression, as confirmed by serial imaging and clinical examination.

Conclusion: This case reflects the challenges of managing IHs that do not respond to standard treatment guidelines. Early surgical intervention is contraindicated when other alternative medical treatment methods are available. Otherwise, it might result in significant complications, highlighting the importance of conservative management and adherence to treatment protocols. Metronomic chemotherapy has shown to be a useful option for patients who do not respond to standard beta-blockers and corticosteroids.

Background: Iris neovascularization and vitreous hemorrhages are typical sequels of ischemic retinopathies. Here, we report about a patient who developed marked iris neovascularization without signs of posterior retinal ischemia.

Case presentation: A 56-year-old patient developed marked iris neovascularization after surgery for rhegmatogenous retinal detachment due to a giant retinal tear had been performed 40 years earlier. With repeatedly applied intravitreal injections of an anti-VEGF drug being unsuccessful, anterior retinal cryocoagulations with deep indentation by the cryoprobe to somehow touch and coagulate the detached anterior flap of giant tear were carried out. Subsequently, the vitreous hemorrhage cleared without any further intervention, and iris neovascularization subsided. Retinal fluorescein angiogram did not reveal signs of ischemia of the attached central retina.

Conclusion: Marked iris neovascularization can disappear after applying peripheral retinal cryocoagulation and laser coagulation. It may lead to the question whether neovascular AMD, potentially associated with macular ischemia, might theoretically be addressable by ablative procedures of the peripheral retina.

Background: Human Herpesvirus (HHV) is a double-stranded DNA virus with a size of 120 to 260 nm. HHV is divided into three subclassifications including herpesvirus alpha, herpesvirus beta, herpesvirus gamma. The HHV group could infect the human body including the orofacial area with mild to severe symptoms. This case report will discuss the diagnostic approach by recognizing the characteristics of each HHV group infection.

Case presentation: A 23-year-old male patient with complaints of mouth ulcers since 7 day, accompanied by pain when swallowing which was preceded by a fever. Extraoral examination showed vesicles, measuring 5 mm, multiple on the upper and lower lips. Intraoral examination showed multiple ulcers, measuring 5 mm on the left buccal mucosa, tongue, and gingiva accompanied by enlargement of the anterior gingiva and palatine rugae. The diagnosis was Primary Herpetic Gingivostomatitis, with herpangina considered as a differential diagnosis.

Case management: Treatment included acyclovir tablets, nystatin suspension, multivitamins, petroleum jelly, and oral hygiene and dietary instructions. There was improvement in the vesicles on the lips and ulcers on the buccal mucosa, tongue, and gingiva within one week, though white plaque remained on the dorsum of the tongue.

Conclusion: Characteristics of oral manifestations caused by HHV infection include symptoms of fever, vesicles, multiple ulcers measuring less than 1 cm, and gingival enlargement as the basis for establishing a diagnosis of Primary Herpetic Gingivostomatitis related to herpesvirus alpha infection, although ulcers also appear in herpesvirus beta and herpesvirus gamma but usually the ulcers will persist for more than two weeks with a relatively larger size, not accompanied by vesicles, and no gingival enlargement.

We report a case of Horner's syndrome occurring after C5-C6 level anterior discectomy and fusion, with an initially subtle clinical presentation, but a clear and rapid deterioration with right sided ptosis and miosis, over a short period.