Journal of Medical Case Reports最新文献

Background: Inflammatory pseudotumor of the spleen and lepidic adenocarcinoma of the lung are uncommon slow-growing malignancies that have not been previously reported to occur concurrently.

Case presentation: We present the case of a 63-year-old Caucasian man who presented with a splenic inflammatory pseudotumor-like dendritic cell sarcoma and was found to have a concomitant invasive lepidic adenocarcinoma of the lung. The patient underwent laparoscopic splenectomy to address the splenic mass. Three months later, he underwent video-assisted thoracoscopic surgery, wedge resection, superior segmentectomy, and mediastinal lymph node dissection to manage the lung lesion. Final pathology revealed pT1c, N0, M0, stage IA3 lepidic adenocarcinoma. The patient received his post-splenectomy vaccinations and will repeat a computed tomography of the chest 6 months postoperatively for pulmonary surveillance.

Conclusions: This report highlights the indication for surgical intervention in the management of splenic masses, as well as the importance of early operations for low-grade splenic lesions. The simultaneous occurrence of inflammatory pseudotumor of the spleen and lepidic adenocarcinoma of the lung sheds light on the need for comprehensive evaluation and multidisciplinary treatment strategies for patients with rare concurrent malignancies. This case report may also be corroborated by future similar reports that may unfold a discovery of a genetic association or syndromic disorder. This case underscores the critical role of surgical intervention and thorough evaluation in patients with rare concurrent malignancies, such as splenic inflammatory pseudotumor and lepidic adenocarcinoma. Future cases may reveal potential genetic or syndromic links, further guiding treatment and surveillance strategies.

Introduction: Greater occipital neuralgia is the syndrome of pain and abnormal sensation in its distribution area caused by anatomical nerve entrapment. Patients with greater occipital neuralgia experience not only limited head and neck movement, but also posterior occipital pain. However, treatment options are restricted and usually linked to adverse reaction.

Case presentation: A 33-year-old ethnic Han woman received structure-based medical acupuncture therapy for greater occipital neuralgia. On the basis of clinical examination, visual analogue scale, and six-point behavioral scale, the patient had rear occipital pain the whole day and felt enormous pressure and was uncomfortable. Visual analogue scale score and six-point behavioral scale score were 9 and 4, respectively. After 4 weeks of structure-based medical acupuncture therapy, the patient reported that the symptoms of pain and stress were greatly improved without any discomfort.

Conclusion: Structure-based medical acupuncture could greatly alleviate clinical symptoms in patients with greater occipital neuralgia. Moreover, structure-based medical acupuncture is a safe, accurate, and efficient complementary and alternative treatment.

Background: Pernicious anemia, also called Biemer's disease, is an autoimmune disease and the most common cause of cobalamin deficiency globally. Various genetic, environmental, and immunological factors interplay to lead to its presentation. Pernicious anemia has a myriad of presentations, which can range from hematological and skin-related to neurological. Pernicious anemia has been reported among people of all ages worldwide, especially those over 60 years old. Its prevalence in the general population is about 0.1% and 1.9% for elderly patients over 60 years old. Like most other autoimmune diseases, females are more affected than males. However, there are case reports of pernicious anemia occurring in individuals at 40 years of age. The prevalence of pernicious anemia in Africa has been reportedly low, possibly owing to underdiagnosis.

Case presentation: This case identifies a 51-year-old Ugandan man from the tribe of Ankole who presented with lower limb weakness for about 2 months. He had a similar presentation 7 years prior for which he was treated for vitamin B12 deficiency. Initial blood counts revealed macrocytic anemia. Considering the recurrence of symptoms, serum cobalamin levels and serum intrinsic factor autoantibodies were tested and the diagnosis of pernicious anemia was confirmed. The patient improved on parenteral methylcobalamin therapy.

Conclusion: This case report highlights the importance of a high index of suspicion in early diagnosis of vitamin B12 deficiency as a cause of neurological symptoms and in considering the diagnosis and empiric therapy for pernicious anemia in a resource-limited context.

Background: Vertebrobasilar insufficiency revascularization has long been a preventive treatment for cerebral infarction. However, no studies have demonstrated the efficacy of revascularization in patients with cerebellar ischemia.

Case presentation: We present the case of a 77-year-old Japanese man who experienced seven recurrent cerebellar infarctions over 2 years. Severe stenosis was noted at the origin of the common trunk of the posterior inferior cerebellar artery and anterior inferior cerebellar artery. Patients with cerebral infarctions are resistant to medical treatment. Blood flow evaluation showed that the area of reduced cerebrovascular reactivity corresponded to the area where repeated small infarctions occurred. An occipital artery-posterior inferior cerebellar artery bypass was performed to prevent another infarction. Postoperative single-photon emission computed tomography showed an improved cerebrovascular reactivity. No ischemic events occurred during 2 years of a postoperative follow-up period.

Conclusion: Occipital artery-posterior inferior cerebellar artery bypass is an effective treatment method for vascular stenosis and decreased blood circulation due to posterior circulation ischemia.

Background: Langerhans cell histiocytosis is a rare disorder characterized by abnormal proliferation of Langerhans cells, primarily affecting children and occasionally adults. Etiology remains enigmatic, with genetic and environmental factors implicated. Diagnosis relies on histopathology and clinical manifestations, often necessitating a multidisciplinary approach.

Case presentation: We report a unique case of Langerhans cell histiocytosis with perianal lesions as initial manifestations in a 41-year-old Chinese deaf male patient with a history of perianal abscess. Examination revealed erosion and plaque-like changes in the mucosa around the anus. Histopathology and immunohistochemistry confirmed Langerhans cell histiocytosis, and a whole-body positron emission tomography-computed tomography scan revealed no other organ involvement, indicating monosystemic disease. Then, 3 months post-treatment, the patient declined a repeated magnetic resonance imaging scan during outpatient follow-up owing to no significant discomfort reported, which resulted in loss to follow-up and discontinuation of treatment.

Conclusion: This case suggests that perianal lesions may be a manifestation of Langerhans cell histiocytosis, and underscores the importance of whole-body positron emission tomography-computed tomography scanning for follow-up in instances of pure skin involvement.

Context: This case report is interesting because it highlights a direction for the treatment of comorbid obesity and cocaine use disorder, which is an increasing clinical condition from an epidemiological point of view, and allows us to identify the possibility of a new strategy to address the problem of substance craving, particularly for cocaine.

Case presentation: This case report discusses the efficacy of semaglutide in a 54-year-old Caucasian patient with a history of cocaine abuse and obesity. Subcutaneous semaglutide was administered, as per guidelines, with a progressive weekly increase for a total of 12 weeks. The patient was monitored with respect to clinical parameters, as well as psychodiagnostic ones. The patient demonstrated significant weight loss and a marked reduction in cocaine craving.

Conclusion: The action of semaglutide on the hunger and reward centers offers a new approach to the treatment of patients with obesity and concomitant substance use disorders. By targeting glucagon-like peptide-1 receptors involved in both metabolic regulation and reward processing, semaglutide could potentially reduce both food intake and drug craving, thereby improving outcomes for these patients. The findings suggest that semaglutide may be a promising therapeutic option for the management of substance abuse in patients with comorbid obesity.

Background: Ascariasis, caused by the parasitic nematode Ascaris lumbricoides, is estimated to affect just under 900 million people globally, the majority of whom are children. Infections are most common in impoverished regions with poor water, sanitation, and hygiene, as transmission is reliant upon the ingestion of eggs excreted in feces found in contaminated soil.

Case presentation: An 8-year-old Black African boy from the Sidama region, southern Ethiopia, presented at Adare General Hospital with a 3-day history of vomiting, abdominal pain, distension, and inability to pass stool or gas. Ultrasound confirmed a small bowel obstruction caused by a bolus of A. lumbricoides, which was successfully removed by surgical intervention via laparotomy and enterotomy. Postoperative treatment included the administration of anthelmintics and antibiotics, which led to stable recovery, with normal bowel function observed 1 month after surgery. The child's socioeconomic status, environmental conditions, and lack of knowledge about ascariasis transmission likely contributed to this severe infection, leading to the occurrence of the small bowel obstruction. Critically, his family lacked sanitation facilities, practiced open defecation, and consumed untreated surface water. The family did not participate in recent mass drug administration campaigns and had poor awareness of hygiene practices, highlighting gaps in the current national neglected tropical disease control program and deficiencies in public health education.

Conclusion: Despite Ethiopia's national deworming program being in existence since 2015, the lack of adequate water, sanitation, and hygiene infrastructure and awareness of risk-reducing behaviors, including participation in mass drug administration campaigns, has culminated in the continuation of A. lumbricoides transmission in many communities in Ethiopia. Enhanced mass drug administration coverage and robust water, sanitation, and hygiene interventions are the major goals of efforts in Ethiopia to reduce the national worm burden and prevent occurrence of severe complications such as small bowel obstruction caused by significant build-up of worms. As the presented case highlights, continuous community health education is essential for long-term control, as it increases mass drug administration participation and emphasizes the importance of good hygiene practices within communities. Fine-scale parasitological mapping and regular epidemiological assessments are necessary to identify high-risk families and communities and implement necessary treatment strategies.

Background: Staphylococcus epidermidis is one of the pathogens most commonly involved in prosthetic joint infections, and when methicillin resistant, poses significant challenges in treatment, owing to its virulence and antibiotic resistance. Intravenous fosfomycin disodium is a broad-spectrum antibiotic recently introduced in clinical practice for treating osteoarticular infections caused by Gram-negative and Gram-positive bacteria, including multidrug-resistant pathogens. Continuous infusion administration of fosfomycin, by an elastomeric pump, is feasible thanks to its good stability at room temperature after reconstitution in aqueous solution. This report describes the case of a methicillin-resistant Staphylococcus epidermidis knee prosthetic infection successfully treated with a two-stage revision coupled with a combination therapy of oral rifampin plus continuous infusion of fosfomycin administrated by an elastomeric pump, filled daily through an outpatient parenteral antimicrobial treatment service.

Case presentation: A 31-year-old Italian woman presented right knee pain and functional limitation. A previous diagnosis of pigmentous villonodular synovitis led to destructive arthropathy requiring total knee arthroplasty and extensive synovectomy. Three months later, a methicillin-resistant Staphylococcus epidermidis prosthetic infection was diagnosed and a two-stage procedure was adopted with spacer cement positioning for 4 months, followed by removal and definitive total knee arthroplasty. The methicillin-resistant Staphylococcus epidermidis infection was successfully treated with a combination therapy of oral rifampin plus continuous infusion fosfomycin by an elastomeric pump. At 1-year postoperative follow-up, no complication was detected and the patient was satisfied.

Conclusion: This case underscores the effectiveness of combining a two-stage revision procedure with continuous infusion fosfomycin and rifampin for managing complex methicillin-resistant Staphylococcus epidermidis prosthetic infection.

Background: The parathyroid-hormone-related peptide has been shown in earlier studies to be secreted by pancreatic neuroendocrine tumors, although its secretion by gastroenteropancreatic neuroendocrine tumors is very rare. In contrast, a number of solid tumors, such as lung cancer and renal cell carcinoma, have frequently been shown to secrete parathyroid-hormone-related peptide.

Case presentation: We describe a case report of a 53-year-old Canadian white patient with refractory parathyroid-hormone-related-peptide-mediated hypercalcemia associated with metastatic pancreatic neuroendocrine tumors and review the available research. Our patient had severe hypercalcemia initially refractory to treatment. Computed tomography scan of the abdomen revealed a pancreatic lesion and multiple hepatic metastases. A liver biopsy confirmed metastatic pancreatic neuroendocrine tumor expressing parathyroid-hormone-related peptide. Circulating parathyroid-hormone-related peptide levels were at the upper limit of normal preoperatively and decreased sharply postoperatively following debulking of the tumor. Blood calcium levels eventually normalized on long-term administration of the somatostatin analog lanreotide in combination with denosumab.

Conclusions: We describe a case with parathyroid-hormone-related-peptide-mediated hypercalcemia in a pancreatic neuroendocrine tumor (parathyroid-hormone-related peptide tumor). Refractory hypercalcemia was likely the result of parathyroid-hormone-related peptide overproduction by the tumor and resolved following normalization of parathyroid-hormone-related peptide levels.

Background: Vitamin D deficiency remains a significant public health concern, particularly among exclusively breastfed infants. Infants born to mothers with vitamin D deficiency, often influenced by cultural factors affecting diet, lifestyle, and clothing, are at increased risk of developing early and potentially fatal complications of hypocalcemic vitamin D deficiency. While seizures and tetany are well-recognized manifestations of hypocalcemia in infants, less common symptoms, such as feeding difficulties and recurrent apnea, are rarely documented. .

Case presentation: We present the case of a 50-day-old Ethiopian full-term infant, born to a Muslim Ethiopian mother, who experienced feeding difficulties, frequent brief episodes of apnea, and cyanosis since birth. The underlying cause was identified as hypocalcemia-induced laryngospasm due to congenital vitamin D deficiency, which resulted from maternal vitamin D deficiency. The mother, who has worn a niqab since childhood, had minimal sun exposure, contributing to her low vitamin D levels. The infant was successfully treated with intravenous calcium gluconate, followed by oral calcium and vitamin D supplementation, leading to complete resolution of symptoms and normalization of biochemical parameters.

Conclusion: Hypocalcemia-induced laryngospasm presenting with feeding difficulties and recurrent apneic episodes is a rare yet serious clinical condition. This report emphasizes the need to consider hypocalcemia as a potential cause of unexplained feeding difficulties or recurrent apnea in newborns and infants. Therefore, clinicians should remain vigilant and maintain a high index of suspicion to ensure timely diagnosis and treatment. It is essential to measure serum calcium and vitamin D levels in both the mother and infant, particularly for newborns of high-risk mothers, such as those who wear conservative religious clothing like a niqab. Furthermore, routine biochemical screening for vitamin D deficiency should be incorporated into antenatal care for all high-risk mothers, with appropriate supplementation to prevent potential complications in both mothers and their infants.