Journal of investigative medicine high impact case reports最新文献

We describe a 28-year-old Caribbean-Black female with polymyositis-associated atrial flutter during an acute flare episode for which she was successfully managed with guideline-directed medical therapy and noninvasive positive pressure ventilation. The clinician should be cognizant of this rare association, especially in young patients who present with symptomatic arrhythmias and chronic, preexisting idiopathic inflammatory myopathies.

Angioedema (AE) is a potentially life-threatening condition involving swelling under the skin. The most common pharmacologic cause of this reaction is angiotensin-converting enzyme (ACE) inhibitor (ACEi) therapy, but other medications may contribute to the development of AE. This case describes a 68-year-old male who presented to the emergency department with tongue and lip swelling and was diagnosed with AE, initially attributed to lisinopril use. However, outpatient follow-up revealed that the only recent medication change was an inadvertent supratherapeutic 60 mg daily dose of simvastatin. Furthermore, the patient was found to have a medical history of AE secondary to atorvastatin use 13 years prior. Based on his history, the ACEi was discontinued, and the statin dose was reduced with symptom resolution. The patient's clinical course adds to the limited literature on statin-induced AE, particularly in the setting of concurrent ACEi use. It also underscores the importance of thorough medication reconciliation and avoiding premature diagnoses of the most common etiology.

Lung adenocarcinoma (LUAD) is the most common subtype of non-small-cell lung cancer and a leading cause of cancer-related mortality worldwide. Although it typically presents as a solitary pulmonary nodule or mass, it can rarely mimic interstitial lung disease, complicating diagnosis and delaying appropriate treatment. We report a 55-year-old male firefighter who presented with a 3-month history of persistent nonproductive cough, predominantly nocturnal, and recent onset of hoarseness. He denied hemoptysis, weight loss, or fever, and his past medical history included ischemic heart disease, hypertension, and a prior brief episode of cough. He was a heavy smoker. Initial laboratory investigations and bronchoalveolar lavage excluded eosinophilic pneumonia and drug-induced pneumonitis. Chest computed tomography revealed mediastinal lymphadenopathy and multiple left-sided pulmonary nodules. The patient underwent right video-assisted thoracoscopic surgery with wedge resection of the right upper lobe, mediastinal lymph node biopsy, and pleural biopsy. Histopathology confirmed invasive moderately differentiated LUAD, with mediastinal and pleural involvement. Immunohistochemistry showed positivity for CK7, CK20, and TTF-1 and negativity for CDX2. This case underscores the diagnostic challenge of LUAD presenting with atypical radiological features resembling pulmonary fibrosis and highlights the importance of integrating clinical, radiological, and pathological findings, with early tissue sampling critical when conventional therapy fails. Molecular testing and personalized therapy, including targeted agents and immunotherapy, are essential in guiding management and improving outcomes. Clinicians should maintain a high index of suspicion for malignancy in patients with unusual respiratory presentations to ensure timely diagnosis, accurate staging, and optimal therapeutic intervention.

Empyema is a complication of pneumonia, characterized by pus accumulation in the pleural space. It is more common in patients with comorbidities such as older age, diabetes, cancer, or immunocompromised states. Aspiration or oral cavity infections are more common in older adults with significant risk factors; therefore, the pathogen Streptococcus constellatus is usually rare. S. constellatus is mainly known for its ability to produce abscesses and pyogenic invasive infections, with most of the infections being found in the orofacial and gastrointestinal regions. The patient is a 58-year-old female who presented with weakness, fatigue, nausea, anorexia, diarrhea, and subjective fever for two weeks. Investigation revealed that there was left-sided empyema, and the pleural fluid grew S. constellatus on culture. The management included antibiotics, chest tube drainage, and finally decortication. The patient's recovery further demonstrates how rare and complex empyema caused by S. constellatus is in a healthy person.

A 46-year-old man with de novo acute myeloid leukemia (AML) M1 achieved complete remission after induction therapy and received consolidation treatment. Due to intermediate-risk classification and positive minimal residual disease at 6 months after consolidation treatment, he underwent haploidentical hematopoietic stem cell transplantation (HSCT) from his son. Post-transplant, he had successful neutrophil and platelet recovery without transfusion support and experienced cytomegalovirus reactivation that was effectively managed. On day +108 post-transplant, he developed fever and diarrhea. The differential diagnosis included opportunistic infection, neoplastic infiltration, and chronic on acute gastrointestinal (GI) graft-versus-host disease, given the timeframe and clinical presentation. Further investigations, including imaging and biopsies, led to a diagnosis of extranodal NK/T-cell lymphoma (ENKL). Despite adjustments in therapy, his condition worsened, and he succumbed to GI bleeding and multiorgan failure on day +144 post-transplant. This case illustrates the rare occurrence of ENKL following haploidentical HSCT in an AML patient, highlighting the diagnostic challenges and the highly aggressive clinical course of ENKL. It reinforces the importance of vigilant post-transplant monitoring, not only for infectious and relapse-related complications but also for secondary lymphoid malignancies and unusual presentations, to enable prompt diagnosis and timely intervention.

Actinomycosis is a rare chronic granulomatous infection caused by Actinomyces species. We report the case of a 47-year-old man with no previous medical history, who presented with a slowly growing abdominal mass extending to the abdominal wall, initially mimicking a malignant tumor. A diagnosis of an Actinomyces abscess was confirmed through surgical resection and histopathological examination. This case is presented to highlight the morphological characteristics and emphasize the diagnostic difficulties of this disease.

Patients with a history of drug abuse and right-sided endocarditis are particularly susceptible to developing septic pulmonary emboli. Rarely, septic pulmonary emboli can cause severe lung injury resulting in parenchymal loss despite appropriate antibiotic therapy. We present 2 cases of severe lung injury associated with septic pulmonary emboli stemming from right-sided infective endocarditis, emphasizing 2 rare complications: bilateral spontaneous pneumothorax and pneumatocele formation.

The introduction of screening mammograms has revolutionized the early detection of breast cancer. However, it remains the most common cancer in women in the United States, excluding skin cancer. As the incidence rates continue to rise, unusual presentations have become more frequent. Additionally, healthcare barriers can lead to delayed detection of breast cancer, resulting in unexpected complications. The occurrence of pyogenic liver abscess (PLA) in diabetic cancer patients, due to the synergistic effect of insulin-like growth factor-1 in tumorigenesis and abscess formation, is well documented. PLA is also prevalent in hepatocellular, colorectal, and pancreato-biliary tumors. However, the occurrence of PLA as an initial presentation of isolated advanced breast cancer without these comorbidities is understudied. This may be due to direct spread of infection from affected skin or spread via lymphatics or vasculature in the setting of immunosuppression from cancer. We present an exceedingly rare case of PLA, complicated by pulmonary embolism, in an elderly female with newly diagnosed stage IIIB breast carcinoma.

Guillain-Barré Syndrome (GBS) is an acute immune-mediated polyneuropathy causing rapidly progressive muscle weakness and often respiratory failure, requiring mechanical ventilation in 30% of cases. Successful weaning and extubation are crucial, focusing on readiness for spontaneous breathing trials, optimal timing, and minimizing complications such as ventilator-associated pneumonia and extubation failure. This case report describes an 83-year-old male with multiple comorbidities who was intubated after his negative inspiratory force dropped below -30 cm H₂O and treated with plasmapheresis, leading to partial improvement. Despite not meeting standard extubation criteria, he was successfully extubated, maintained stable respiratory function, and was safely discharged. This case highlights the challenges of extubation in GBS patients, where advanced age, decreased physiological reserve, and comorbidities increase the risks of prolonged intubation and complications. This case also highlights the need for individualized extubation strategies in GBS, particularly in elderly patients who may not meet standard criteria. Tailored approaches can still lead to successful outcomes. Based on our institutional experience, we propose factors that predict the success or failure of extubation in these patients. Further research is needed to refine predictive markers and improve extubation success in this population, ultimately enhancing outcomes and reducing ICU and hospital stays.