Journal of Medical Case Reports最新文献

Background: Maxillary canine impaction can result in malocclusion, temporomandibular joint complications, and esthetic concerns, thus influencing craniofacial development. Although cases of impacted canines are not uncommon in clinical practice, the likelihood of simultaneous bilateral impaction is extremely low; very few reports have documented cases of bilaterally symmetrical, inversely impacted canines.

Case presentation: This paper reports a rare case of maxillary canine impaction, a condition characterized by the abnormal eruption of teeth. Potential causes of this condition include genetic, systemic, and localized factors. We analyzed this condition in the skeletal remains of a Taiwanese girl aged 11-14 years. The skeleton, dating 440-598 AD, was recovered from central Taiwan in 2019. Through panoramic X-ray and dental cone-beam computed tomography, we constructed a three-dimensional model of the skull, which exhibited bilateral symmetrical, inversely impacted maxillary canines-a rare clinical observation. On the basis of the current understanding of the dental field, the treatment of maxillary canine impaction is time consuming and labor intensive. Different impacted canine teeth have different difficulty levels of treatment.

Conclusion: The archaeological data in this article show that 1500 years ago humans already had the problem of impacted canine teeth in the upper jaw. Moreover, bilaterally symmetrical maxillary canine impaction is very rare in clinical cases.

Background: Idiopathic CD4+ T lymphocytopenia is a rare immune dysfunction disease that is usually found after opportunistic infections. Mycobacterium abscessus is a rapidly growing mycobacterium that can cause pulmonary infections, lymphadenitis, skin and soft tissue infections, disseminated infections, among others, as a conditional pathogenic bacterium.

Case presentation: We present the case of a 43-year-old Chinese woman who developed disseminated Mycobacterium abscessus infection due to idiopathic CD4+ T lymphocytopenia. The patient exhibited symptoms including skin infections, lymphadenitis, and bacteremia. A tailored multidrug therapy was initiated, guided by drug susceptibility testing. Within a month of treatment, the patient's fever resolved, and she exhibited a significant recovery and was discharged.

Conclusions: Cases of clinical idiopathic CD4+ T lymphocytopenia with Mycobacterium abscessus infection are not common. Clinicians should be vigilant and accurately identify Mycobacterium abscessus as an opportunistic pathogen when dealing with immunocompromised patients, in particular with idiopathic CD4+ T lymphocytopenia.

Background: Ectopic pregnancy, occurring outside the uterine cavity, poses a significant health risk, with Fallopian tube involvement being predominant. Recurrent ectopic pregnancy, particularly in the ipsilateral remnant of a previously removed tube, is a rare and poorly understood phenomenon. Here, we present a case of recurrent ectopic pregnancy occurring in the distal remnant of the right fallopian tube following ipsilateral incomplete salpingectomy in a 22-year-old woman.

Case presentation: A 22-year-old woman of mixed Arab ancestry and African ethnicity, gravida 4, para 1, with a history of one miscarriage and a previous ectopic pregnancy, presented to Elshatby Maternity Hospital, Alexandria, Egypt, complaining of severe lower abdominal pain with a history of an open right salpingectomy one year prior due to the ectopic pregnancy. She exhibited stable vital signs on admission. Ultrasound revealed a 6-week gestational sac in the right fallopian tube, accompanied by hematoma and mild pelvic collection. Despite analgesic interventions, her symptoms worsened the next day, prompting open surgery. Surprisingly, the distal portion of the right tube, which was supposed to have been removed in the prior salpingectomy, contained the ectopic pregnancy. A laparotomy was performed, involving evacuation of the pelvic hematoma, distal ipsilateral tubal salpingectomy, and peritoneal lavage. Postoperative recovery was uneventful, with improvement demonstrated during follow-up.

Conclusion: Caution should be taken when dealing with any woman in the reproductive age group who presents with acute abdomen, especially if she has a previous history of ectopic pregnancy, to exclude the possibility of recurrent ectopic pregnancy. Previous salpingectomy does not exclude the possibility of recurrent ectopic pregnancy on the ipsilateral side, as the inappropriate surgical technique used during salpingectomy can affect the possibility of recurrence. We suggest that careful clinical consideration of the surgical technique used during salpingectomy is essential to minimize the risk of recurrent ectopic pregnancies and prevent serious complications.

Background: Severe acute respiratory syndrome coronavirus 2 was found first in Wuhan and declared a pandemic by the World Health Organization. Coinfection with other respiratory viruses may occur, complicating the diagnosis and treatment of coronavirus disease 2019 . Herein, we identified a Karolinska Institute polyomavirus Stockholm 60 present in a nasopharyngeal swab of a patient with severe acute respiratory syndrome coronavirus 2 infection using next-generation sequencing with an enrichment method.

Case presentation: A 24-year-old Indonesian woman was admitted to our institution due to a cough, cold, and sore throat. She had no family history of hypertension and diabetes mellitus, and she was well. Her vital signs were as follows: heart rate, 84 beats per minute; respiratory rate, 22 breaths per minute; temperature, 39 °C; and pulse oximetry, 96% on room air. She had runny nose and slightly inflamed pharynx. Her nasopharyngeal swab and real-time polymerase chain reaction were positive for the coronavirus disease 2019 nucleocapsid and open reading frame genes, with cycle threshold values of 32.33 and 33.74, respectively. Whole-genome sequencing of severe acute respiratory syndrome coronavirus 2 was performed using the Nextera DNA Flex for Enrichment using the Respiratory Virus Oligos Panel, Illumina MiSeq instruments, and Illumina MiSeq reagent v3 150 cycles (2 × 75 cycles). The full genomes were aligned to the reference genome (NC_045512.2) by the Burrow-Wheeler aligner algorithm. The whole-genome sequencing showed coinfection of Karolinska Institute polyomavirus Stockholm 60 (NC_009238.1) with an overall coverage of 3561x. The patient was given acetaminophen, vitamin C, vitamin D, and zinc for the treatment and discharged uneventfully from the hospital 4 days after admission. Then, 2 weeks after discharge, she visited the outpatient clinic without any further concerns.

Conclusion: This report presents a case of Karolinska Institute polyomavirus and severe acute respiratory syndrome coronavirus 2 coinfection in a patient with nonspecific clinical manifestation. Further studies with a larger sample size are mandatory to clarify the association between severe acute respiratory syndrome coronavirus 2 and Karolinska Institute polyomavirus coinfection, particularly on patient outcomes. Moreover, the results propose the usefulness of enrichment-based next-generation sequencing in detecting viral coinfection in patients with severe acute respiratory syndrome coronavirus 2.

Background: Leprosy (Hansen's disease) is an infectious disease most common in resource-limited countries caused by the acid-fast bacilli Mycobacterium leprae and Mycobacterium lepromatosis that frequently affects the skin and peripheral nerves. Prompt diagnosis and treatment with multidrug therapy is crucial to reduce disease transmission and sequelae, which include nerve function impairment, ocular injury, and stigmatizing physical deformities. Traditional treatment of multibacillary leprosy consists of 12-24 months of multidrug therapy with dapsone, rifampin, and clofazimine. However, this regimen is associated with high pill burden and side effects that limit adherence.

Case presentation: We report a case of multibacillary leprosy in a previously healthy 30-year-old Hispanic man who recently immigrated to the USA from South America and presented with progressive nodular skin lesions on his face and extremities. He was treated with a monthly regimen of rifampin, moxifloxacin, and minocycline. At follow-up there was significant improvement of his cutaneous lesions without signs of reversal reaction or erythema nodosum leprosum.

Conclusions: This case report adds to the growing repertoire of literature supporting the use of rifampin, moxifloxacin, and minocycline. Further studies are needed to assess the efficacy of this antimycobacterial regimen and monitor rates of relapse and delayed immunologic reactions, which may occur 5-10 years after completion of treatment.

Background: Evans syndrome is a rare disorder characterized by the simultaneous or sequential combination of autoimmune hemolytic anemia and immunological thrombocytopenia, together with a positive direct antiglobulin test. This syndrome, which can be primary or secondary, is a rare initial manifestation of autoimmune diseases, notably systemic lupus erythematosus, with 1.7-2.7% of patients with systemic lupus erythematosus developing secondary Evans syndrome, sometimes preceding the onset of systemic lupus erythematosus symptoms.

Case presentation: A 47-year-old Middle Eastern female presented with symptoms including shortness of breath, chest pain, and weakness. Physical examination revealed pallor, pale conjunctiva, icteric sclera, tachycardia, and tachypnea. She was diagnosed with Evans syndrome owing to hemolytic anemia, thrombocytopenia, and a positive Coombs test, where initial resistance to treatment prompted intensive therapy with methylprednisolone, intravenous immunoglobulin, and rituximab. Subsequent identification of systemic lupus erythematosus on the basis of positive anti-nuclear antibodies and anti-double-stranded deoxyribonucleic acid antibodies led to treatment with mycophenolate mofetil and hydroxychloroquine. Further evaluations uncovered Hashimoto's thyroiditis and pernicious anemia, necessitating thyroxine supplementation and vitamin B12 injections.

Conclusion: Hematologic abnormalities play a crucial role in the diagnostic framework of systemic lupus erythematosus. This case highlights a patient initially diagnosed with Evans syndrome, revealing an underlying systemic lupus erythematosus. The presentation underscores the significance of hematologic manifestations as integral components of the diagnostic framework for autoimmune diseases, emphasizing the intricate relationship between Evans syndrome and systemic lupus erythematosus.

Background: Open and crushed forearm injury is a complex and rare injury affecting the upper extremity. It results in damage to various structures, including bones, soft tissues, and neurovascular bundles, ultimately leading to functional impairment. Typically, these injuries occur owing to high-energy trauma.

Case presentation: A 19-year-old South Asian male was seen at our trauma center emergency department following an accident where his arm got entangled in a machine belt. He sustained a serious open injury on his left forearm, spanning from the elbow to the wrist, affecting the proximal radio-ulnar joint, ulna bone, interosseous membrane, and distal radio-ulnar joint. The initial plan of care involved stabilizing the injury using an external fixator, while reconstructive surgery was scheduled for a later date.

Conclusion: Timely intervention for wound debridement and joint stabilization plays a crucial role in the restoration of a crushed forearm. Following this, a collaborative effort from a multidisciplinary team becomes essential. Planning multiple surgeries is important, with the primary goal of achieving early range of motion of the elbow and wrist to prevent stiffness. This comprehensive approach aims at optimizing the recovery and functionality of the affected limb. The combination of early intervention, damage control surgeries, and carefully planned procedures sets the foundation for successful management of a crushed and open forearm injury. Furthermore, early range of motion and physiotherapy rehabilitation has a key role in stiffness prevention and the restoration of function.

Background: Tropheryma whipplei pneumonia is an infrequent medical condition. The clinical symptoms associated with this disease are nonspecific, often resulting in misdiagnosis or missed diagnosis. Therefore, sharing and summarizing the experiences in the diagnosis and treatment of this disease can deepen global understanding and awareness of it.

Case presentation: The patient is a 78-year-old married Han Chinese female who was admitted to the hospital after experiencing fever, dry cough, and fatigue for 4 days. A lung computed tomography scan revealed inflammatory exudation in the lower left lung, accompanied by pleural effusion. The bronchoalveolar lavage fluid was subjected to further analysis using metagenomic next-generation sequencing, which identified 41 genetic sequences associated with Tropheryma whipplei. Consequently, she was diagnosed with Tropheryma whipplei pneumonia. After initiating treatment with doxycycline and biapenem, the patient's symptoms showed significant improvement. Upon discharge, the patient continued treatment with a combination of doxycycline and hydroxychloroquine, which was discontinued after 4 days. At 12-month follow-up, the patient reported overall good health, with no symptoms of fever, cough, or any other discomfort.

Conclusion: Tropheryma whipplei pneumonia is a rare condition with nonspecific symptoms. The application of metagenomic next-generation sequencing technology in pulmonary infections helps to rapidly identify rare pathogens, providing a solid foundation for precise and effective antibacterial treatment for patients.

Background: Immunotherapy, including the use of immune checkpoint inhibitors such as nivolumab, is increasingly common in cancer treatment and can lead to various immune-related adverse effects, including rare cases of diabetic ketoacidosis. This case report highlights an unique instance of nivolumab-induced diabetic ketoacidosis in a patient without prior history of diabetes, emphasizing the importance of careful monitoring even in those without traditional risk factors.

Case presentation: We report a case of a 70-year-old Caucasian male with metastatic esophageal adenocarcinoma who developed diabetic ketoacidosis 3 weeks after stopping nivolumab therapy. The patient had no previous history of diabetes, nor had he used sodium-glucose transport protein 2 inhibitors or corticosteroids. Diagnostic tests confirmed diabetic ketoacidosis, and while he was initially treated following the institutional protocol, he continued to require insulin therapy indefinitely.

Conclusions: This case report underscores the risk of diabetic ketoacidosis linked to nivolumab, even in patients without predisposing factors, emphasizing the need for increased vigilance among both oncologists and physicians. It highlights the importance of monitoring for new-onset diabetes and diabetic ketoacidosis, whether immunotherapy is active or discontinued, and ensuring comprehensive care including hospitalization, insulin management, and diabetes education if diabetic ketoacidosis is diagnosed.