Journal of Medical Case Reports最新文献

Background: Cysticercosis, a parasitic infection caused by the larval stages of the pork tapeworm, Taenia solium, predominantly affects cerebral and ocular tissues. The subcutaneous manifestation of this disease is a relatively uncommon clinical occurrence. Previously very few or no cases of cysticercosis presenting as subcutaneous solitary painful swelling have been reported in the literature. In previous reports, the swelling was described as painless and not solitary.

Case presentation: We present a rare case of subcutaneous cysticercosis in an Indian female in her forties, localized over the left scapular region, exhibiting gradual enlargement over 4 weeks. The patient experienced pain and intense itching without neurological or ocular involvement. Physical examination revealed a well-defined nodular swelling measuring approximately 3.5 cm × 3 cm, painful, nonfluctuating, nonreducible, soft to firm consistency, with no attachment to the underlying muscle, observed at the inferior angle of the left scapula. The overlying skin was tense, glossy, erythematous, and indurated, with mild superficial scaling at a few places and excoriation marks around the swelling. No similar swelling was found elsewhere on the body. The rest of the systemic and physical examination was unremarkable. The clinical diagnosis included an abscess, infected sebaceous cyst, lipoma with inflamed overlying skin, and a remote possibility of subcutaneous cysticercosis. Stool examination for ova, cysts, and parasites was unremarkable. Cysticercus IgG antibody by enzyme-linked immunosorbent assay was negative. A chest X-ray and radiograph of the left scapular region were normal. Fine needle aspiration biopsy of the lesion was planned but could not be completed as the patient did not consent. Local part ultrasonography revealed a well-defined cystic area of 1.9 × 1.1 × 1.6 cm³ (anteroposterior × transverse × craniocaudal) with peripheral calcified streaks (scolex) and surrounding edema suggestive of subcutaneous cysticercosis. The diagnosis was established by the ultrasonography of the lesion suggesting features consistent with cysticercus, and later established by complete resolution after a course of albendazole. Management involved a 3-week course of albendazole and 5 days of paracetamol for pain, leading to the full resolution of swelling and symptoms. On follow-up at 1 month, the swelling had disappeared with no new swelling or symptoms.

Conclusion: Subcutaneous cysticercosis is an unusual presentation of Taenia solium infestation that requires a high index of suspicion for accurate diagnosis. This case report emphasizes the importance of considering parasitic infections in the differential diagnosis of subcutaneous nodules. Early diagnosis and appropriate management are crucial for preventing complications and improving patient outcomes.

Introduction: Breast cancer liver metastasis presents a significant challenge in clinical oncology, with limited treatment options and poor prognosis. This case series study explores the extended survival achieved in breast cancer patients with liver metastases through a combination of surgical and medical interventions.

Case presentation: We present three cases of Javanese female patients with breast cancer (51 years old, 42 years old, and 55 years old) with liver metastases who underwent hepatic resection followed by systemic therapy. The cases illustrate successful outcomes with disease-free survival ranging from 5 to 31 months post-surgery. Key prognostic factors associated with improved survival include prolonged interval between initial diagnosis and detection of liver metastasis, liver-limited disease, positive response to preoperative systemic therapy, and expression of estrogen and progesterone receptors in the metastatic lesions.

Conclusion: These findings underscore the potential efficacy of a multidisciplinary approach integrating local hepatectomy with systemic therapy in selected patients with breast cancer liver metastasis. Further research is warranted to identify optimal patient selection criteria and refine treatment strategies for improved outcomes.

Background: In this article, we report a case of renal cell carcinoma metastasis to the thyroid gland. Occult lesions of the thyroid were treated with a thyroidectomy. The case history presented below describes the patient's pathway and subsequent results.

Case presentation: A routine medical examination of a 58-year-old Ukrainian woman revealed lesions in her thyroid gland. In total, two nodules 3.5 cm and 1.5 cm wide were found in the gland using ultrasound. Features of thyroid nodules were classified as Thyroid Imaging Reporting and Data System 3. A fine-needle aspiration biopsy showed Bethesda category IV thyroid nodules. Before this, the patient had a right-sided nephrectomy. The histopathology report confirmed renal cell carcinoma. The patient underwent a total thyroidectomy 13 years ago with confirmed metastatic renal cell carcinoma to the thyroid gland. Subsequent surgeries aimed at removing the local recurrences and distant metastases of the primary site. The patient got six cycles of Sunitinib (Sutent™, Pfizer) chemotherapy for renal cell carcinoma. Today, she lives in another country as a refugee and visits home occasionally. The patient takes thyroxine and waits for a suitable treatment option to cure advanced renal cell carcinoma.

Conclusion: A comprehensive investigation of the patient's case history is crucial for determining a correct diagnosis. In our case, metastases to the thyroid were found 13 years after the initial renal cell carcinoma diagnosis. Moreover, foci of renal cancer cells in other organs indicates advanced disease with subsequent recurrence and distant metastases. Renal cell carcinoma may cause thyroid nodules.

Background: Corrosive substance ingestion is rare but can cause severe injury, especially to the upper gastrointestinal tract, and can be a potentially fatal event. Various surgical procedures have been advocated for gastroesophageal reconstruction, but especially those using the right colon, when the ileocecal valve is preserved for gastric reconstruction, are briefly exposed in literature and have not been studied in humans by controlled studies. Using the right colon is believed to be beneficial because of the anti-reflux mechanism of the ileocecal valve. This study aims to report our experience in the use of right colon interposition for gastric reconstruction in the management of caustic injury, and to assess its influence on patient outcomes.

Case presentation: We describe five cases, all of which included corrosive substances ingested by patients referred to a local tertiary center institution undergoing right colon interposition for esophageal and gastric reconstruction. We evaluated five Iranian patients undergoing ileocolic segment interposition for gastric reconstruction. Of these, two were male patients (patient 1 was 51 years old, patient 2 was 32 years old), and three were female patients (patient 3 was 49 years old, patient 4 was 32 year old, patient 5 was 59 year old), with an age from 32 to 59 years (mean: 57 ± 10.95). The operating surgeon's first to fifth procedures proceeded uneventfully, with only one case of cervical leakage as a complication with spontaneous closure; relative mean operative time of 5.95 ± 1.17 hours, hospital stays of 25 ± 15.29 days for all five patients. No excess morbidity rate was observed.

Conclusion: In this case series, a novel technique for post-gastrectomy reconstruction using right colon interposition along with an ileocecal reservoir with identical advantages in improving eating capacity, and avoiding biliary reflux thanks to the presence of the ileocecal valve, is introduced.

Background: Magnetic therapy has demonstrated beneficial effects for reducing pain, nausea, neuropathy, and various other health concerns in the human body. To our knowledge, limited research has documented the use of auricular static magnetic therapy as a potential treatment for diabetes. This report presents the first evidence of using magnetic discs placed at acupuncture points on the human ear to decrease blood glucose levels and promote the healing of gangrene in diabetic patients. When a magnetic disc was placed at an acupuncture point on the ear, elevated blood glucose levels were reduced, blood circulation improved, and gangrene eventually resolved. This case report presents a new development in auricular acupuncture, providing a novel method for treating diabetes and its complications.

Case presentation: A 59-year-old white male who was diagnosed with type II diabetes and had suffered from this condition for 20 years developed gangrene in his left leg, necessitating amputation. Despite insulin therapy, the patient's blood glucose level remained elevated, and gangrene subsequently manifested in his right leg. The patient was diagnosed with severe end-stage peripheral arterial occlusive disease, and a second amputation became necessary. The patient sought acupuncture treatment to avoid amputation. A magnetic disc was applied to the patient's left ear at the pancreas point. Within 2 days, the patient's blood glucose level decreased from 240 to 120 mg/dl, while the blood flow in his leg increased by 30%. Consequently, the patient was able to reduce the insulin dosage. Over time, the gangrene resolved, and new tissue regenerated in place of the gangrenous tissue. Another case study involved a 33-year-old white female with type I diabetes who used an insulin pump prior to magnetic therapy. Magnetic discs were applied to auricular acupuncture points, resulting in a 30% reduction in insulin dosage, while maintaining the same caloric intake.

Conclusion: Auricular static magnetic therapy has demonstrated efficacy as a beneficial treatment for diabetes. This therapeutic approach has been shown to reduce blood glucose levels, increase blood circulation, and promote gangrene healing. Its noninvasive nature, rapid onset of action, and cost-effectiveness are notable attributes. The novel contribution of this case report resides in its potential application as a complementary therapy for diabetes utilized in conjunction with conventional Western medical practices.

Background: Recent biomedical research has shown the unusual, multisystem effects of coronavirus disease 2019 in humans. One specific sequela of a primary severe acute respiratory syndrome coronavirus 2 infection is the reactivation of latent viruses in various tissues, such as Epstein-Barr virus. Epstein-Barr virus has been identified in many inflammatory gastrointestinal lesions, such as microscopic gastritides and colitides. One subtype of these diseases is collagenous disease. "Long COVID" may be related to the reactivation of these latent viruses, and the following case describes a patient who developed vague symptoms consistent with "long COVID."

Case presentation: A non-Hispanic white male in his 50s, with previous collagenous gastritis and colitis, developed a 10-kg weight loss and diffuse leg cramps over 3 months. The patient had coronavirus disease 2019 about 3 months prior to presentation. He had iron deficiency and tested positive for human immunodeficiency virus antibody. His heterophile antibody was also positive. Confirmatory testing for human immunodeficiency virus was negative, and his Epstein-Barr virus antibody panel was positive for early antigen immunoglobulin G. His Epstein-Barr virus viral load was undetectable. Minimal improvement was achieved with a 4-week course of oral budesonide, and upper endoscopy showed diffuse gastritis. He is now improving with proton pump inhibitor therapy and ferrous sulfate supplementation.

Conclusion: This case report explores outpatient management of microscopic gastritides and colitides. The evidence around coronavirus disease 2019 causing reactivation of Epstein-Barr virus, and Epstein-Barr virus' presence in chronic gastrointestinal inflammatory lesions, is discussed. Practice recommendations include corticosteroid and acid-suppression therapy for patients suspected of having a recurrence of inflammatory lesions.

Background: Naphthalene is an aromatic hydrocarbon that potentially produces methemoglobinaemia but rarely causes hemolysis, especially in children with underlying glucose-6-phosphate dehydrogenase deficiency. Although ingestion of a single moth ball by an older child may not be life threatening, it can be fatal if ingested by a toddler.

Case presentation: A 2-year-old Singhalese boy developed acute severe hemolysis and methemoglobinaemia following ingestion of a mothball. On admission, the patient was ill and pale. The child was tachycardic and tachypnoiec with oxygen saturation of 76% on air. Blood investigations showed significant anemia, elevated reticulocytes, and evidence of hemolysis in a blood picture, along with elevated lactate dehydrogenase and indirect bilirubin. Child also had ST depressions on electrocardiogram examination with negative troponin-I. He was given four packed red blood cell (PRBC) transfusions and was successfully discharged in 3 days time following optimal supportive treatment. A glucose-6-phosphate dehydrogenase assay confirmed the diagnosis of glucose-6-phosphate dehydrogenase deficiency in this child: 0.9 U/gHb (4.0-13.0 U/gHb).

Conclusion: This case report highlights a rare life-threatening presentation of naphthalene ingestion in a child with previously undiagnosed glucose-6-phosphate dehydrogenase deficiency. Ingestion of even a single moth ball can be fatal in vulnerable children given the altered toxicokinetics of naphthalene in children.

Background: Kaposiform hemangioendothelioma is a rare vascular tumor primarily occurring in infants and children. The most common sites for kaposiform hemangioendothelioma are extremities, with very few cases of abdominal kaposiform hemangioendothelioma reported in neonates. Making a diagnosis of Kaposiform hemangioendothelioma can be challenging when the patient presents with generalized symptoms such as bilious vomiting and constipation that can be attributed to other more common causes of intestinal obstruction.

Case presentation: A 28-day-old Pakistani baby girl presented with bilious vomiting and constipation. The abdomen was distended, and scans showed generalized dilation of bowel loops. A preliminary diagnosis of intestinal obstruction due to volvulus was made, and the patient underwent an exploratory laparotomy. Postoperatively, the patient remained unwell with profuse aspirates in nasogastric and no improvement in ileus. Repeat scans were again suggestive of midgut volvulus, which was initially managed conservatively, but later redo surgery was done. Ischemic bowel was resected with histopathology showing kaposiform hemangioendothelioma. In the meantime, the baby developed an abdominal collection, infection, and short gut syndrome due to resection of the bowel. The family was counseled regarding the prognosis, and the patient was transferred from hospital to home upon request. The baby passed away 2 days later.

Conclusion: While extremely rare, abdominal kaposiform hemangioendothelioma can be an important and potentially lifesaving differential diagnosis to consider in neonates and infants with recurring and nonresolving intestinal obstruction. The management is complex, and prognosis can be poor in diffuse, congested lesions involving a large part of the gut.

Background: Giant prolactinoma (size > 4 cm) is a rare condition and accounts for less than 1% of pituitary adenomas. In even rarer cases, these lesions may involve craniocervical structures requiring surgical intervention. The present case is the largest reported giant prolactinoma (99 × 72 × 57 mm). It led to cranial settling and significant central herniation at the foramen magnum, causing quadriparesis.

Case presentation: The patient was a 39-year-old Iranian man from a village around Hamadan city who presented with quadriparesis and paresthesia as well as loss of libido and impotence. Magnetic resonance imaging and computed tomography showed a huge diffuse avid enhancing infiltrating osteolytic lesion at the skull base. It had spread predominantly extramurally into the skull base resulting in cranial deposition, significant central herniation, myelopathy, and acute exacerbation of quadriparesis. On the basis of the pathology, immunohistochemistry, and elevated serum prolactin levels, the diagnosis of giant prolactinoma was almost definite. In addition to urgent midline suboccipital craniotomy for the central herniation and quadriparesis, he was treated with cabergoline followed by occiput cervical fixation and fusion to control the progressive subsidence.

Conclusion: Prolactinoma that is treatable with dopamine agonists should be considered as a differential diagnosis of skull base lesions, even those that are extradural, diffuse, and infiltrative. Giant prolactinoma can lead to craniocervical settling and central herniation that requires surgery and multidisciplinary management.

Introduction: Primary bone marrow diffuse large B-cell lymphoma is a rare clinical entity, and the "bone marrow-liver-spleen" type of diffuse large B-cell lymphoma is rarer, with only a few published cases in literature. Though bone marrow-liver-spleen-type diffuse large B-cell lymphoma has unique presentations such as fever, cytopenias, and hemophagocytic lymphohistiocytosis, no cases with cold autoimmune hemolytic anemia have been reported.

Case presentation: A 39-year-old Sri Lankan woman, previously healthy, presented with shortness of breath, productive cough, and fever for 4 days. Examination revealed pallor, icterus, and massive hepatosplenomegaly with no peripheral lymphadenopathy. Further investigation revealed pancytopenia (hemoglobin 58 g/L, white blood cell count 1.73 × 10⁹/L, platelets 23 × 10⁹/L, a reticulocyte index of 4.43%, and lactate dehydrogenase levels of 1690 U/L). Blood picture analysis was suggestive of hemolytic anemia, which was confirmed by a positive direct antiglobulin test with anti-C3d. The bone marrow biopsy revealed markedly hypercellular marrow with polymorphic infiltrate of mononuclear cells accounting for about 80-85% of nucleated cells. These cells were predominantly medium to large cells in size with scanty cytoplasm, irregular nuclear margins, prominent nucleoli, and many mitotic figures. These mononuclear cells were positive for immunohistochemical markers of CD20, BCL2, and CD10. The Ki-67 index was 24%. In addition, this patient had cold autoimmune hemolytic anemia. Contrast-enhanced computed tomography of the chest, abdomen, and pelvis revealed homogeneously enlarged liver and spleen with no significant lymphadenopathy. These findings were compatible with the diagnosis of bone marrow-liver-spleen-type diffuse large B-cell lymphoma. The patient was referred for specialized oncological management.

Conclusion: Though there are reported cases of primary bone marrow diffuse large B-cell lymphoma presenting with cold autoimmune hemolytic anemia, no such cases of bone marrow-liver-spleen-type diffuse large B-cell lymphoma have been reported. As this unique entity has a rather grim prognosis, it is of utmost importance to identify it early and treat aggressively. Owing to the limited availability of published accounts of this uncommon disease, we believe it is important to document our case to add to the understanding of this rare condition and its various presentations, which can easily be misinterpreted.