Journal of investigative medicine high impact case reports最新文献

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.

Peripartum cardiomyopathy (PPCM) occurring in the context of sickle cell disease (SCD) is exceedingly rare, particularly as the initial presentation of undiagnosed SCD. We report the case of a 39-year-old African primigravida at 36 weeks of gestation who presented with a 1-week history of heart failure symptoms. Her antenatal course was largely uneventful apart from severe anemia, for which she was transfused 2 units of whole blood followed by prescription of hematinics. Laboratory investigations revealed hemolytic anemia, a positive sickling test, and confirmatory hemoglobin electrophoresis demonstrating 93% sickle hemoglobin and 4.1% hemoglobin fetal, establishing a new diagnosis of homozygous SCD. Transthoracic echocardiography revealed a severely reduced left ventricular ejection fraction (LVEF 26%) and dilated left heart chambers, consistent with a diagnosis of PPCM. She was admitted to the maternity intensive care unit and managed by a multidisciplinary team, with stabilization on supportive therapy. At 38 weeks, she underwent a successful elective cesarean section, followed by an uneventful postpartum recovery. She was discharged 9 days postpartum in a stable condition (New York Heart Association Class II) on guideline-directed medical therapy and enrolled in outpatient follow-up. At 6 months, follow-up echocardiography showed partial recovery of cardiac function with an LVEF of 38%. She continues to be monitored by cardiology and hematology teams. This case highlights the critical importance of considering underlying hemoglobinopathies in pregnant patients presenting with unexplained heart failure, especially in regions where SCD is endemic.

Atrioventricular block (AVB) is a conduction disorder that can lead to significant bradyarrhythmias with resultant hemodynamic compromise and cardiogenic shock. While most cases of positional AVB that occur during erect posture are attributed to neurocardiogenic mechanisms, complete AVB occurring exclusively in the supine position is an exceedingly rare phenomenon. We present a case of an 87-year-old Caribbean Black male who presented with symptomatic supine-induced advanced heart block, which transiently resolved during standing with unremarkable comprehensive investigations and subsequently underwent successful dual-chamber permanent pacemaker implantation. The clinician should be cognizant of assessing positional vital signs with telemetric monitoring in patients presenting with idiopathic bradyarrhythmias and presyncope.

Spontaneous pneumomediastinum (SPM) is a rare, self-limiting condition that can be complicated by pneumothorax, pneumopericardium, and subcutaneous emphysema. This case describes a 25-year-old man with a chronic marijuana use history who developed SPM after a recent respiratory infection. Imaging showed significant pneumomediastinum, pneumopericardium, and small pneumothoraces bilaterally. Despite these findings, he remained stable and was treated conservatively with oxygen supplementation, analgesics, and close monitoring. By day 6, his condition had nearly resolved, and he was safely discharged. This case emphasizes the importance of considering SPM in young patients with acute respiratory distress and reinforces the value of computed tomography scans in promptly diagnosing and managing the condition without invasive interventions.

Several adverse effects have been reported following the use of the Pfizer-BioNTech mRNA vaccine against COVID-19 infection with acute pancreatitis being one of those. However, a direct relationship between the vaccine and the occurrence of acute pancreatitis has not been confirmed. Hereby, a case of an acute necrotizing pancreatitis resulting in fatal outcome following the administration of the COVID-19 BioNTech Pfizer vaccine is presented. A 70-year-old male presented with abdominal pain 4 days after receiving his fifth dose of the COVID-19 BioNTech Pfizer vaccine. Laboratory examination showed lipase levels of 2000 U/L. A CT scan was performed and showed necrotizing pancreatitis. After detailed evaluation, no etiological cause of pancreatitis could be found in this patient. The patient was admitted to the intensive care unit. After a disease course of ~6 weeks, the patient died due to multiorgan failure. This case presentation takes into account previously reported cases of acute pancreatitis following COVID-19 vaccination. To our knowledge, this is the first case of acute pancreatitis with fatal ending following a COVID-19 vaccination. This highlights the importance of thorough evaluation of patients presenting with abdominal pain following the administration of a COVID-19 vaccine.

Osteogenesis imperfecta is a group of rare, genetically inherited, autosomal dominant connective tissue disorders affecting the production of type-1 collagen. The most common cardiovascular manifestations of the pathology include aortic regurgitation and aortic root disease. Other manifestations remain particularly rare, with only 2 previously reported cases of type B aortic dissection in patients with osteogenesis imperfecta described in the literature. The management of vascular pathology in connective tissue disease remains a significant clinical challenge due to the intrinsic fragility of connective tissues and tendencies to bleed with open surgical repair. This is a case of a 69-year-old with a genetically confirmed diagnosis of osteogenesis imperfecta presenting with epigastric pain radiating to the back. She had vascular risk factors of hypertension and hypercholesterolaemia. Imaging revealed an acute, uncomplicated Stanford Type B aortic dissection, which was managed with intravenous and then oral beta-blocker therapy. Close imaging surveillance demonstrated stability in the extent of the dissection, and she remains asymptomatic at 6 months of follow-up. Notably, her inpatient stay was complicated by a reactive pleural effusion, which resolved without intervention. Given the rarity of aortic dissection in patients with osteogenesis imperfecta and the lack of clinical evidence to guide decision-making, this case report emphasizes the importance of an individualized approach to management in the acute phase with intensive outpatient surveillance. Awareness of the risks posed by connective tissue fragility in this patient population is essential in guiding both emergency and elective surgical management and long-term care planning.

Tumor necrosis factor-alpha inhibitors (TNF-αi's) such as Infliximab are effective treatments for various autoimmune diseases. However, in rare instances, they have been implicated in central nervous system demyelination. Typically, this side effect is seen within the first year of medication exposure. This case reports on the rare occurrence of a central demyelinating lesion secondary to Infliximab after several years of uncomplicated use. A 39-year-old, right-handed male with a history of ulcerative colitis (UC) was being maintained on infliximab therapy for several years before presenting to the emergency room. He reported weeks of intermittent, worsening left-sided extremity paresthesia and weakness. Initial workup ruled-out a stroke, but subsequent MRI revealed a strange right-sided cortical enhancement that anatomically corresponded to the patients' complaints. Ruling out other possibilities, the patient's TNF-αi medication became a concern. Treatment with corticosteroids and suspension of the patient's infliximab enabled a swift improvement and gradual full recovery. The patient's UC medication was subsequently changed as he returned to baseline. This case demonstrates a rare complication of a commonly prescribed medication that appeared well outside the timeframe of similar other case reports, highlighting the importance of considering TNF-αi side-effects as possible contributory factors to disease states even after many years of relative stability.

Secondary eosinophilia has recently gained attention as a potential contributor to vascular pathologies, including aneurysms. This case report delves into the intricate relationship between secondary eosinophilia and cerebral aneurysms, a connection yet to be fully explored in medical literature. The case centers on a 31-year-old female who presented with leg pain, a purpuric rash, and gastrointestinal symptoms following an uncomplicated pregnancy. The skin biopsy revealed perivascular and interstitial dermatitis with a significant eosinophilic infiltration of unclear etiology. Laboratory investigations showed a markedly elevated immunoglobulin E (IgE) level at 8400 kU/L. Her condition escalated to a diffuse subarachnoid hemorrhage and the discovery of a left superior cerebellar artery aneurysm. This unusual presentation, combined with the challenge of differentiating secondary eosinophilia from primary eosinophilic disorders, raises questions about the pathophysiological mechanisms and clinical implications of eosinophils in aneurysm formation. We discuss the potential link between eosinophils and vascular damage and emphasize the need for further research in understanding this association. Clinically, this case underscores the importance of considering vascular complications in patients with unexplained eosinophilia. Sharing such cases contributes to a more informed and nuanced approach to similar future presentations, guiding diagnostic and therapeutic strategies.