Journal of Medical Case Reports最新文献

Background: Wilms tumor, or nephroblastoma, arises from embryonal metanephric blastemal cells and is the most common renal malignancy in the pediatric population. However, its occurrence in adults is extremely rare, with only a limited number of cases documented in the literature. In adults, renal masses most commonly turn out to be renal cell carcinomas, which can closely mimic Wilms tumor on imaging, posing a significant diagnostic challenge. Particularly in resource-limited settings, definitive diagnosis is often established only after histopathological evaluation of nephrectomy specimens.

Case presentation: We present the case of a 24-year-old Indian woman who presented with a progressively enlarging lump in the right flank. The subsequent investigations revealed a right renal mass, suspected to be malignant, for which the patient underwent a right radical nephrectomy. Histopathological examination confirmed the diagnosis of adult Wilms tumor (nephroblastoma).

Conclusion: This case highlights the rare occurrence of Wilms tumor in an adult female and underscores the diagnostic challenges it poses. We aim to contribute to the limited body of literature on adult nephroblastoma and promote awareness of this rare entity among clinicians and pathologists.

Background: Type 2 diabetes mellitus predisposes to opportunistic pulmonary infections. We report sequential invasive pulmonary candidiasis followed by tuberculoma in a patient with newly diagnosed type 2 diabetes mellitus and summarize diagnostic pitfalls and management lessons.

Case presentation: A 67-year-old Han Chinese man with no previously known diabetes presented with cough and severe hyperglycemia (random glucose 36.3 mmol/L; HbA1c 12.7%). Initial chest computed tomography showed right‑upper‑lobe consolidation. Bronchoalveolar lavage metagenomic next‑generation sequencing detected abundant Candida albicans and sputum Gram stain showed Gram‑negative bacteria predominance; sputum culture yielded no definite pathogen, blood cultures were negative, and human immunodeficiency virus test was negative. After intravenous then oral fluconazole plus intensive insulin therapy, the consolidation regressed. Suspected secondary organizing pneumonia was treated with tapering methylprednisolone. One month later, a new 1.5 cm × 1.3 cm solid nodule appeared in the prior lesion bed. computed tomography‑guided biopsy revealed necrosis, and tissue metagenomic next-generation sequencing confirmed Mycobacterium tuberculosis; standard anti‑tuberculosis therapy was initiated.

Conclusion: In patients with diabetes and pulmonary lesions, concomitant or sequential fungal and tuberculous infections should be actively sought with stepwise microbiology (including bronchoalveolar lavage and tissue‑based methods) and early molecular testing (metagenomic next-generation sequencing/Xpert). Steroid exposure for organizing pneumonia may worsen or unmask tuberculosis and must be weighed against infectious risk. Multidisciplinary care (endocrinology-pulmonology-infectious diseases) and rigorous glucose control are essential.

Background: Prosthetic joint infections are most commonly caused by staphylococci and streptococci, while commensal Neisseria species are exceedingly rare etiologic agents.

Case presentation: We report a 71-year-old white male with multiple comorbidities who presented with progressive left knee pain 9 years after total knee arthroplasty. Synovial fluid analysis showed an elevated leukocyte count with neutrophil predominance, and cultures subsequently grew Neisseria sicca/subflava. Given the concern for prosthetic joint infection, he underwent prosthesis explantation and received intravenous ceftriaxone 2 g daily for 6 weeks. Poor dentition was identified as a suspected potential source of hematogenous seeding. The patient demonstrated clinical improvement with surgical intervention and targeted antimicrobial therapy.

Conclusion: Neisseria sicca/subflava should be recognized as a rare but clinically significant cause of prosthetic joint infection.

Introduction: Duplication cysts are rare congenital malformations arising from developmental anomalies of the primitive foregut, with an incidence of approximately 1 in 8200 live births. These cysts may present at any point along the esophagus but most commonly occur in the upper thoracic region.

Case presentation: This report presents a rare case of a large thoracic duplication cyst in a 3-month-old female Asian infant who presented with respiratory distress and cyanosis. Imaging studies, particularly computed tomography scans, revealed a large cystic mass in the posterior mediastinum. Surgical excision was performed via retropleural thoracotomy, which allowed for complete removal without the need for chest tube placement. Histopathology confirmed the diagnosis of an enteric duplication cyst. The patient had excellent postoperative recovery with resolution of symptoms.

Conclusion: Duplication cysts are rare congenital anomalies. Early differentiation from other malignant tumors is highly recommended in the beginning. Computed tomography imaging is the preferred initial diagnostic modality. Retropleural thoracotomy in this case successfully helped to remove the cyst from the thoracic region without any complications.

Background: Acute cardiac tamponade is a rare but fatal complication after video-assisted thoracoscopic surgery. This case is noteworthy for its novel mechanism of injury and underscores the critical importance of multidisciplinary management in achieving a successful outcome against high historical mortality rates.

Case presentation: A 64-year-old Han Chinese male underwent an uncomplicated video-assisted thoracoscopic surgery right upper lobe wedge resection for lung adenocarcinoma. At 3 hours postoperatively, he developed sudden obstructive shock. Echocardiography confirmed cardiac tamponade. Emergent pericardiocentesis and venoarterial extracorporeal membrane oxygenation stabilization were followed by sternotomy, which revealed a needle-like aortic perforation caused by a malformed staple that had eroded from the pulmonary staple line. The aortic injury was surgically repaired. The patient was successfully weaned from extracorporeal membrane oxygenation on postoperative day 2 and extubated on day 7, making a full recovery, and was discharged on day 19.

Conclusion: This case highlights a novel, delayed mechanism of staple-related vascular injury that can occur even after right-sided video-assisted thoracoscopic surgery. It demonstrates that rapid diagnosis, immediate pericardiocentesis, early extracorporeal membrane oxygenation support, and definitive surgical repair within a multidisciplinary framework are paramount for survival. This report advocates for heightened vigilance during stapling near vital structures and reinforces the lifesaving potential of a protocolized rescue approach.

Background: Rhizobium radiobacter is an opportunistic pathogen found in soil. It can cause infections in adults and children. In children, it is most often associated with peritonitis or systemic infections.

Case presentation: We report a rare case of pleural infection with Rhizobium radiobacter. The patient was a 4-year-old girl of Malian origin. She weighed 12 kg and was 95 cm tall. She was immunocompetent, wore no medical devices, and her vaccinations were up to date. She was successfully treated with antibiotics and oxygen therapy for 60 days.

Conclusion: Although Rhizobium radiobacter is considered a contaminant, it can cause pleurisy in children.

Background: Pneumocystis jirovecii pneumonia is a potentially fatal opportunistic infection in kidney transplant recipients under intensified immunosuppression. Although most cases occur within the first post-transplant year, late-onset infections may develop after rituximab therapy or discontinuation of prophylaxis. Trimethoprim-sulfamethoxazole is the preferred agent for prevention and treatment, but allergy or intolerance limits its use. Desensitization protocols may allow reintroduction of this drug in selected patients.

Case presentation: A 37-year-old white female kidney transplant recipient presented with progressive dyspnea and deteriorating renal function 9 years after receiving a living donor kidney transplant from her brother. She had Alport-syndrome-related nephrotic syndrome and chronic kidney disease and had been treated for chronic antibody-mediated rejection with pulse corticosteroids, intravenous immunoglobulin, and rituximab. Pneumocystis jirovecii pneumonia prophylaxis was omitted because of a prior trimethoprim-sulfamethoxazole allergy. On admission, serum creatinine was 4.97 mg/dL, C-reactive protein was 56 mg/L, and chest computed tomography revealed diffuse ground-glass opacities. Other infectious causes were excluded. A presumptive diagnosis of Pneumocystis jirovecii pneumonia was made, and intravenous trimethoprim-sulfamethoxazole was given using a graded desensitization protocol, starting with a 1:1000 dilution and gradually increasing every 30-60 minutes. No hypersensitivity reactions occurred. Clinical improvement was observed within 1 week, and follow-up imaging showed near-complete resolution of pulmonary infiltrates.

Conclusion: This case shows that late-onset Pneumocystis jirovecii pneumonia may develop years after transplantation, particularly after rituximab therapy and without prophylaxis. Intravenous trimethoprim-sulfamethoxazole desensitization can be a safe and effective therapeutic option for transplant recipients with a trimethoprim-sulfamethoxazole allergy, enabling use of the optimal antimicrobial agent.

Background: The etiology of pediatric coccydynia is complex. While it is most frequently caused by trauma, a significant proportion of cases are idiopathic, primarily attributed to poor intercoccygeal joint stability and hypermobility of the coccyx. Herein, we report the first case of pediatric coccydynia resulting from a localized developmental anomaly of the coccyx.

Case presentation: A 13-year-old Asian girl was admitted to the hospital owing to 1 year of coccygeal pain during defecation. A computed tomography scan of the sacrococcygeal region revealed a slender protrusion anterior and slightly to the right of the first coccygeal vertebra, extending obliquely in an anteroinferior direction. Pathological findings confirmed it as a normal bony structure. Due to poor response to conservative treatment, the surgeon performed a partial coccygectomy under general anesthesia on the pediatric patient. The procedure involved resection of all bony structures distal to the midportion of the first coccygeal vertebra, including the abnormal protrusion. Intravenous cefuroxime sodium (1 g) was administered within 24 h postoperatively to prevent surgical site infection. The procedure was performed successfully without complications, and the pediatric patient was discharged on the fourth postoperative day. At the 1-month postoperative follow-up, the child reported no significant discomfort.

Conclusion: This case provides new insights into the etiology and pathogenesis of coccydynia.

Introduction: Malignant glaucoma is an uncommon but serious complication of intraocular surgery, including filtration surgery and phacoemulsification, with an incidence of 2-4%. It arises from an obstruction in aqueous humor flow, leading to elevated posterior pressure and subsequent complications. Delayed or insufficient treatment can result in irreversible vision loss. This case highlights the importance of early surgical intervention and anti-inflammatory management for preventing complications and achieving improved outcomes.

Case presentation: A 56-year-old Chinese woman presented with bilateral malignant glaucoma. The initial treatment of the right eye involved medications for 3 months, followed by yttrium aluminium garnet laser posterior capsulotomy, which offered limited success. Irido-zonulo-hyaloid-vitrectomy was eventually performed, successfully normalizing her intraocular pressure but resulting in macular cystoid edema 6 months later. Her left eye, diagnosed with malignant glaucoma 2 months after the right eye's presentation, received early intervention with cataract extraction, intraocular lens implantation, and irido-zonulo-hyaloid-vitrectomy. This approach yielded excellent outcomes, with optimal intraocular pressure control and preserved vision without complications.

Conclusion: This case underscores the importance of early surgical intervention, particularly irido-zonulo-hyaloid-vitrectomy, in managing malignant glaucoma. Early intervention can prevent postoperative complications such as macular edema and ensure superior visual outcomes. Tailored anti-inflammatory approaches further mitigate associated risks and enhance long-term prognosis in cases of bilateral involvement.