International Medical Case Reports Journal最新文献

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.

Objective: To present a case of intestinal nonrotation in a 26-year-old Indian male and conduct a detailed review of 16 additional cases from the PubMed database.

Case presentation: A 26-year-old male presented with acute right lower quadrant abdominal pain and vomiting. He had a similar episode seven years prior that self-resolved. Physical examination revealed generalized abdominal tenderness, guarding, and mild distention. Imaging studies, including abdominal ultrasound and CECT, confirmed midgut volvulus due to nonrotation. The patient underwent exploratory laparotomy and Ladd's procedure, leading to an uneventful recovery and discharge on postoperative day seven.

Material and methods: A comprehensive PubMed search was conducted for case reports on midgut nonrotation in adults. 15 relevant cases were selected, and including the present case, 16 cases were reviewed.

Results: The mean age at presentation was 55.19 years (range: 26-86), with a slight male predominance (56.2%). The most common symptoms were acute abdominal pain (50%) and vomiting (31.25%). Notably, 50% of cases were identified incidentally during evaluations for unrelated conditions or procedures. CT scans confirmed diagnoses in 87.5% of cases. Positional anomalies included right-sided small bowel and left-sided colon in 37.5% and reversed SMA/SMV relationships in 33%. Ladd's procedure was performed in 25% of cases.

Conclusion: Midgut nonrotation, resulting from abnormal embryonic bowel rotation, can occur at any age, more commonly in males. It may present as a surgical emergency due to bowel obstruction and volvulus or remain asymptomatic throughout life. CT imaging and surgical intervention, particularly Ladd's procedure, are effective management strategies. The frequent incidental discovery of cases suggests that asymptomatic nonrotation may be more prevalent than clinically recognized.

Background: This case highlights the potential of combining intravitreal dexamethasone implants as first line of management with reduced dose of systemic steroid therapy to achieve rapid remission in acute serpiginous choroiditis. To prevent systemic adverse effects and obtain rapid control of serpiginous lesions, as necessary in the case presented, local therapy using a dexamethasone intravitreal implant may be considered as a complement to systemic treatment.

Case presentation: A 42 year old woman with steadily declining vision in her right eye for the previous four months presented to the emergency department. On the Snellen chart, the best-corrected visual acuity was 20/28 in the left eye and 20/100 in the right eye. The intraocular pressure (IOP) of the right and left eyes was 15 and 16 mmHg, respectively. Anterior segment examination was unremarkable. Fundus examination of the right eye revealed a gray finger-like lesion with an active border. The left eye showed a small yellowish-finger-like lesion involving the nasal macula. Disruption in the ellipsoid zone in the right eye and the parafoveal region in the left eye was demonstrated using optical coherence tomography (OCT). Fundus fluorescein angiography revealed bilateral, finger-like branching lesions were seen on fundus fluorescein angiography (FFA). Fundus Autofluorescence (FAF) showed hypoautofluorescence lesions with hyper-autofluorescence edges. Both eyes were diagnosed with active serpiginous choroiditis, after excluding any active infections through blood work-up. The patient was started oral prednisolone 0.5 mg/kg tapering; however, because the patient would be traveling for three weeks, the systemic oral steroid with an intravitreal dexamethasone implant in each eye. After nine days, there was noticeable improvement in the visual acuity of the right eye with normal intraocular pressure. OCT showed minimal restoration of the ellipsoid zone in the right eye, with resolved inflammatory material in both eyes (Figure 1). After starting Azathioprine, disease activity was suppressed for six months without relapsing.

Conclusion: This case raises a question about the benefit of combined therapy for quick vision restoration, inhibiting further destruction of outer retinal layers during the management of acute attack and reduction of overall systemic steroids dose together with its complications versus the risk of local steroids administration and cost-effectiveness. Additional research is required to validate this finding.

Background: Oral Lichen Planus (OLP) is a chronic inflammatory autoimmune disease of oral mucosa that decreases a patient's quality of life because of the inconvenience and pain. Etiology OLP is still unknown but related to T-cell mediated disease. OLP is also related to allergic reaction or hypersensitivity. Nitrosamine commonly found in processed foods, like salted fish, contains nitrite and nitrate compound known to cause chronic irritation and inflammation in oral mucosa.

Purpose: This case report analyzes correlation between OLP and salted fish consumption.

Case presentation: A 41-year-old woman presented with complaints of a painful oral ulcer and redness persisting for six months, with symptoms worsening during eating and speaking. The pain typically intensified following the consumption of salted fish. Intraoral examination revealed multiple reticular white plaques, along with diffuse erosive and ulcerative lesions on the oral mucosa. The patient was diagnosed with reticular, erosive, and ulcerative types of OLP.

Case management: Treatment for the ulcers are antiseptic mouthwash and topical corticosteroid, and also multivitamin to increase patient's health.

Conclusion: Nitrosamine and Formalin that contained in salted fish may be the risk factors of OLP. Eliminating risk factors is necessary to increased successful rate in treatment and prevent OLP's recurrency.

A 22-year-old incarcerated Saudi man presented with a 2-day history of painful vesicles on the shaft of his circumcised penis that were unrelated to drug use, trauma, exposure to ill persons, or sexual intercourse. Initial laboratory tests were normal, and the patient was initially diagnosed with herpes simplex infection. Due to nonadherence to the initial antiviral treatment, the lesions progressed, leading to a revised diagnosis of chancroid. Subsequent testing ruled out sexually transmitted infections and revealed methicillin-resistant Staphylococcus aureus in the culture of the purulent exudate. Histopathology confirmed balanitis circumscripta plasmacellularis (BCP, zoon's balanitis). The lesion responded well to topical betamethasone, with marked clinical improvement over 2 months. This case highlights that although rare, BCP should be considered in circumcised patients with non-venereal genital lesions. Additionally, it underscores that early histopathological confirmation is essential to avoid misdiagnosis and inappropriate treatment.

The paper presents a case report of a man (born1968) who was examined for unusual changes in the visual fields. During the examination in 2020, the right eye had esotropia, the pupillary reaction was correct. The ocular findings on the anterior segment and the ocular media were normal. The papilla of the right eye was temporally paler with c/d=0.5, the left papilla was pale with c/d=0.6, otherwise the background was normal. IOP: 16/18 mmHg. During the examination, diffuse loss of the nerve fiber layer (50 um, resp. 49 um) was detected using OCT, and similarly low values were also found for vessel density. The visual fields showed left-sided homonymous hemianopia with central sparing, partially extending into the upper right quadrants. Electrophysiological examinations of the retina (pattern electroretinogram) and the entire visual analyzer (pattern visual evoked potential - PVEP) showed bilaterally lower amplitudes. The latencies of the P00 VEP peak were not prolonged. For these changes, a magnetic resonance imaging (MRI) examination of the brain was performed with the finding of agenesis of the corpus callosum, associated trigone of the lateral ventricles on both sides. Malformation of the development of the cerebral cortex temporooccipitally medially on the right, of the nature of plymicrogyria. Heterotopia of gray matter periventricularly occipitally on the right. Bilateral atrophy of the optic nerves and chiasm. In the case report of SOD plus, unusual changes in the visual fields are described - homonymous left-sided hemianopia with central sparing. MRI examination of the brain helped to classify this lesion in the temporo-occipital medial region on the right with polymicrogyria.

Introduction: The annular pancreas is a rare congenital anomaly that typically results in duodenal obstruction during the neonatal period. However, its presentation can be variable, with some cases remaining undiagnosed until adolescence and posing diagnostic challenges, especially in low-resource settings where advanced imaging may be limited.

Case presentation: We report the case of a 13-year-old boy with a three-year history of recurrent non-bilious projectile vomiting and epigastric pain. Despite normal laboratory findings, plain computed tomography (CT) and post-intravenous (IV) contrast CT scans revealed features suggestive of gastric outlet obstruction, including significant stomach distention and abrupt tapering of the duodenum. Owing to the inconclusive imaging results, surgical exploration was pursued. Intraoperative findings confirmed the presence of a band of pancreatic tissue encircling the first part of the duodenum, thereby establishing the diagnosis of an annular pancreas. A gastroduodenostomy was successfully performed, resulting in an uneventful recovery and resolution of symptoms during subsequent follow-up.

Conclusion: This case underscores the importance of maintaining a high index of suspicion for the annular pancreas in patients presenting with chronic gastrointestinal symptoms. Although imaging modalities provide valuable clues, surgical exploration remains the gold standard for achieving a definitive diagnosis when findings are ambiguous. The successful surgical management of this patient underscores the crucial role of timely intervention, particularly in settings with limited diagnostic resources.