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Pseudomonas monteilii bacteremia and sepsis following insertable cardiac monitor implantation: a case report. 植入可插入式心脏监护仪后的单端假单胞菌菌血症和败血症:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-18 DOI: 10.1186/s13256-024-04832-5
Dongwhane Lee, Kyung Hwa Jung, Hyo-Ju Son, In Tae Moon

Background: Insertable cardiac monitor implantation is a simple and safe procedure commonly performed in patients with embolic stroke with undetermined source. Routine periprocedural antibiotic use is not recommended, because infection rate is very low, although some local infection or gram-positive bacteremia have been reported. We report a case of Pseudomonas monteilii sepsis immediately after insertable cardiac monitor implantation.

Case presentation: A 55-year-old Korean male with embolic stroke of undetermined source presented with gram-negative sepsis immediately after implantable cardiac monitor implantation as a first reported complication after the procedure. Pseudomonas monteilii was identified in the blood culture, and no other infection source was seen. He was treated with intravenous antibiotics without removing the device.

Conclusions: Prompt diagnosis and adequate management is required in such a patient with sepsis post-insertable cardiac monitor implantation procedure. It can be managed with adequate antibiotic treatment without device removal if there is no sign of inflammation at the insertion site. Further reports or studies should be investigated to reinforce this finding.

Learning objectives: The infection rate after insertable cardiac monitor insertion is extremely low; however, sepsis may occur without pocket infections. Physicians should be aware of signs of systemic infection, particularly when the procedure is performed outside the catheterization room. Sepsis after insertable cardiac monitor implantation can be managed with adequate antibiotic treatment without device removal if there is no sign of inflammation at the insertion site.

背景:植入式心脏监护仪是一种简单而安全的手术,通常用于来源不明的栓塞性脑卒中患者。虽然有局部感染或革兰氏阳性菌血症的报道,但由于感染率很低,因此不建议在手术前常规使用抗生素。我们报告了一例插入式心脏监护仪植入术后立即发生假单胞菌败血症的病例:一名 55 岁的韩国男性因不明原因的栓塞性中风在植入式心脏监护仪后立即出现革兰氏阴性败血症,这是植入式心脏监护仪术后首次报告的并发症。经血液培养确定为假单胞菌,未发现其他感染源。他接受了静脉抗生素治疗,但没有移除装置:结论:对于此类植入式心脏监护仪术后败血症患者,需要及时诊断并采取适当的治疗措施。如果植入部位没有炎症迹象,则可以通过适当的抗生素治疗来控制病情,而无需移除装置。应进一步调查报告或研究,以加强这一结论:插入式心电监护仪插入后的感染率极低;然而,败血症可能在没有口袋感染的情况下发生。医生应注意全身感染的迹象,尤其是在导管室外进行手术时。如果插入部位没有炎症迹象,可通过适当的抗生素治疗来控制插入式心电监护仪植入术后的败血症,而无需移除设备。
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引用次数: 0
Correction: Helsmoortel-Van der Aa syndrome in a 13-year-old girl with autistic spectrum disorder, dysmorphism, a right solitary kidney, and polycystic ovaries: a case report. 更正:一名患有自闭症谱系障碍、畸形、右侧单肾和多囊卵巢的 13 岁女孩的 Helsmoortel-Van der Aa 综合征:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-17 DOI: 10.1186/s13256-024-04838-z
Ebtesam Al-Enezi, Mohannad Alghamdi, Khaled Al-Enezi, Mohammed AlBalwi, William Davies, Wafaa Eyaid
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引用次数: 0
Uncommon triple vessel spontaneous coronary artery dissection in the setting of polyarteritis nodosa: a case report. 结节性多动脉炎引起的罕见三血管自发性冠状动脉夹层:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-17 DOI: 10.1186/s13256-024-04841-4
Nouhaila Lahmouch, Raid Faraj, Soukaina Cherkaoui, Omar Nafii, Mohamed Sarsari, Oualid Kerrouani, Idriss Allalat, Jamila Zarzur, Mohamed Cherti

Introduction and importance: Spontaneous coronary artery dissection is a rare cause of acute coronary syndromes not related to atherosclerosis. It involves the sudden tearing of the coronary artery wall, separating the inner intimal lining from the outer vessel wall, typically affecting a single coronary vessel. In 20% of cases, the cause of spontaneous coronary artery dissection is unknown. The other cases often occur in pregnant or postpartum women or in individuals with conditions such as connective tissue disorders or vasculitis.

Case presentation: Here, we describe a case of a 69-year-old African female presenting with non-ST-segment elevation myocardial infarction. Coronary angiography revealed an unusual triple-vessel spontaneous coronary artery dissection affecting peripheral segments, with further investigations suggesting polyarteritis nodosa.

Conclusion: While triple-vessel spontaneous coronary artery dissection and polyarteritis nodosa (PAN) are individually rare, their coexistence is exceptionally uncommon and presents diagnostic and therapeutic challenges. Clinicians should be alert to vasculitic causes in patients with spontaneous coronary artery dissection, especially with atypical clinical features.

导言和重要性:自发性冠状动脉夹层是急性冠状动脉综合征的一种罕见病因,与动脉粥样硬化无关。它是指冠状动脉壁突然撕裂,内膜与血管外壁分离,通常只影响一根冠状动脉。在 20% 的病例中,自发性冠状动脉夹层的原因不明。其他病例通常发生在孕妇、产后妇女或患有结缔组织病或脉管炎等疾病的人身上:在此,我们描述了一例 69 岁非洲女性非 ST 段抬高型心肌梗死病例。冠状动脉造影显示,患者有不寻常的三血管自发性冠状动脉夹层,并影响到外周节段,进一步检查显示患者患有结节性多动脉炎:结论:虽然三血管自发性冠状动脉夹层和结节性多动脉炎(PAN)各自罕见,但它们同时存在的情况却极为罕见,给诊断和治疗带来了挑战。临床医生应警惕自发性冠状动脉夹层患者的血管炎病因,尤其是不典型的临床特征。
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引用次数: 0
Leukocytosis and thrombocytosis after splenectomy: expected finding, infection, or something else: a case report. 脾切除术后白细胞和血小板增多:预期发现、感染或其他原因:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-17 DOI: 10.1186/s13256-024-04744-4
Nicolas Gonzalez, Jeffry Nahmias, Lisa X Lee, Matthew Dolich, Michael Lekawa, Allen Kong, Areg Grigorian

Background: Leukocytosis and thrombocytosis often follow splenectomy in blunt trauma patients, complicating the postoperative identification of infection. While the platelet count to white blood cell ratio provides diagnostic assistance to discern between expected laboratory alterations and infection, diagnoses such as leukemia are often overlooked.

Case presentation: A 53-year-old Hispanic male presented with abdominal pain, nausea, tachycardia, and focal peritonitis 4 days after being assaulted and struck multiple times in the abdomen. Initial white blood cell count was 38.4 × 109/L, platelet count was 691 × 109/L, and lipase was 55 U/L. Computed tomography abdomen/pelvis demonstrated a hematoma encasing the distal pancreas and abutting the stomach and colon. Emergent laparotomy revealed a nearly transected pancreas and devascularized colon, necessitating a distal pancreatectomy, splenectomy, and colonic resection with primary anastomosis. Postoperatively, he had a persistently elevated leukocytosis, thrombocytosis, segmented neutrophils, eosinophilia, and basophilia (peak at 70, 2293, 64, 1.1, and 1.2 × 109/L, respectively). Despite sepsis workup, including repeat computed tomography, no source was identified. Hematology/oncology was consulted for concern for hematologic etiology, with genetic testing and bone marrow biopsy performed. The diagnosis of breakpoint cluster-Abelson gene-positive chronic myeloid leukemia was made based on genetic tests, including polymerase chain reaction and fluorescence in situ hybridization analysis, which confirmed the presence of the Philadelphia chromosome. Bone marrow biopsy suggested a chronic phase. The patient was treated with hydroxyurea and transitioned to imatinib.

Conclusions: Thrombocytosis following splenectomy is a common complication and a plate count to white blood cell count ratio  < 20 indicates infectious etiology. A significantly elevated white blood cell count (> 50 × 109/L) and thrombocytosis (> 2000 × 109/L) may suggest something more ominous, including chronic myeloid leukemia , particularly when elevated granulocyte counts are present. Chronic myeloid leukemia workup includes peripheral smear, bone marrow aspiration, and determination of Philadelphia chromosome. Post-splenectomy vaccines are still indicated within 14 days; however, the timing of immunization with cancer treatment must be considered. Tyrosine kinase inhibitors are the first-line therapy and benefits of pretreatment with hydroxyurea for cytoreduction remain under investigation. Additionally, tyrosine kinase inhibitors have been associated with gastrointestinal perforation and impaired wound healing, necessitating heightened attention in patients with a new bowel anastomosis.

背景:钝性外伤患者脾脏切除术后往往会出现白细胞和血小板增多,从而使术后感染的鉴别变得复杂。虽然血小板计数与白细胞比值有助于诊断鉴别预期的实验室改变和感染,但白血病等诊断往往被忽视:病例介绍:一名 53 岁的西班牙裔男性在腹部遭到袭击和多次击打 4 天后出现腹痛、恶心、心动过速和局灶性腹膜炎。初始白细胞计数为 38.4 × 109/L,血小板计数为 691 × 109/L,脂肪酶为 55 U/L。腹部/盆腔计算机断层扫描显示血肿包裹着胰腺远端,并与胃和结肠相邻。紧急开腹手术显示胰腺几乎被横切,结肠血管断裂,因此必须进行胰腺远端切除术、脾切除术和结肠切除术,并进行主吻合术。术后,他的白细胞、血小板、中性粒细胞、嗜酸性粒细胞和嗜碱性粒细胞持续升高(峰值分别为 70、2293、64、1.1 和 1.2 × 109/L)。尽管进行了败血症检查,包括重复计算机断层扫描,但仍未找到病源。因担心是血液学病因,血液科/肿瘤科进行了会诊,并进行了基因检测和骨髓活检。根据基因检测,包括聚合酶链反应和荧光原位杂交分析,确诊为费城染色体阳性的慢性髓性白血病。骨髓活检显示患者处于慢性期。患者接受了羟基脲治疗,并转为伊马替尼治疗:脾切除术后出现血小板增多是一种常见的并发症,血小板计数与白细胞计数之比为 50 × 109/L)和血小板增多(> 2000 × 109/L)可能暗示着更不祥的预兆,包括慢性髓性白血病,尤其是粒细胞计数升高时。慢性髓性白血病的检查包括外周涂片、骨髓穿刺和费城染色体测定。脾切除术后疫苗仍应在 14 天内接种;但必须考虑癌症治疗的免疫时机。酪氨酸激酶抑制剂是一线疗法,羟基脲预处理对细胞减少的益处仍在研究中。此外,酪氨酸激酶抑制剂还与胃肠道穿孔和伤口愈合受损有关,因此需要高度关注有新肠道吻合术的患者。
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引用次数: 0
Successful administration of cetuximab using dose escalation method: a case report. 使用剂量递增法成功施用西妥昔单抗:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-17 DOI: 10.1186/s13256-024-04815-6
Shasha Li, Yanjuan Zhang, Jiandong Zha, Wenqi Chen

Introduction: Cetuximab, used to treat head and neck squamous cell carcinoma and metastatic colorectal cancer, can cause severe infusion reactions.

Case presentation: We report an 87-year-old East Asian woman with stage IV ileocecal signet ring cell carcinoma who experienced severe allergic reactions to cetuximab despite pre-treatment. A dose escalation method, involving weekly incremental doses with comprehensive pre-treatment and close monitoring, was employed, successfully reducing allergic reactions and allowing safe administration.

Conclusion: This approach demonstrates a viable alternative for patients with hypersensitivity to cetuximab, warranting further research for personalized treatment optimization.

简介:西妥昔单抗用于治疗头颈部鳞癌和转移性结直肠癌,可引起严重的输液反应:西妥昔单抗用于治疗头颈部鳞状细胞癌和转移性结直肠癌,可引起严重的输液反应:我们报告了一名 87 岁的东亚妇女,她患有回盲部标志环细胞癌 IV 期,尽管预先接受了西妥昔单抗治疗,但仍出现了严重的过敏反应。我们采用了剂量递增法,即每周递增剂量,同时进行全面预处理和密切监测,成功减少了过敏反应,实现了安全用药:这种方法为对西妥昔单抗过敏的患者提供了一种可行的选择,值得进一步研究,以优化个性化治疗。
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引用次数: 0
Treatment switch from multiple daily insulin injections to sulphonylureas in an African young adult diagnosed with HNF1A MODY: a case report. 一名被诊断为 HNF1A MODY 的非洲年轻人从每日多次胰岛素注射转为磺脲类药物治疗:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-17 DOI: 10.1186/s13256-024-04850-3
Jean Claude Katte, Mesmin Y Dehayem, Kevin Colclough, Eugene Sobngwi

Background: Maturity onset diabetes of the young is one of the commonest causes of monogenic diabetes and can easily be mistaken for type 1 diabetes. A diagnosis of maturity onset diabetes of the young can have direct implications for genetic counseling, family screening, and precision diabetes treatment. However, the cost of genetic testing and identifying individuals to test are the main challenges for diagnosis and management in sub-Saharan Africa. We report the very first documented case of HNF1A maturity onset diabetes of the young in the sub-Saharan African region.

Case presentation: A 20-year-old female Black African young adult diagnosed with type 1 diabetes aged 14 presented for routine out-patient diabetes consultation. She was on multiple daily insulin injections; total combined dose 0.79 IU/kg/day with an HbA1c of 7.7%. The rest of her laboratory examinations were normal. On extended laboratory analysis, she had good residual insulin secretion with post-meal plasma C-peptide levels at 1150 pmol/L. She tested negative for glutamic acid decarboxylase (GAD65), islet antigen-2 (IA-2), and zinc transporter 8 (ZnT8) islet autoantibodies. Targeted next-generation sequencing (t-NGS) for monogenic diabetes was performed using DNA extracted from a buccal sample. She was diagnosed with HNF1A maturity onset diabetes of the young, with the c.607C > T; p.(Arg203Cys) pathogenic variant, which has never been reported in sub-Saharan Africa. Her clinical practitioners provided genetic and therapeutic counseling. Within 10 months following the diagnosis of maturity onset diabetes of the young, she was successfully switched from multiple daily insulin injections to oral antidiabetic tablets (sulphonylurea) while maintaining stable glycemic control (HBA1c of 7.0%) and reducing hypoglycemia. She expressed a huge relief from the daily finger pricks for blood glucose monitoring.

Conclusion: This case reveals that HNF1A maturity onset diabetes of the young (and probably other causes of monogenic diabetes) can present in sub-Saharan Africa. A diagnosis of maturity onset diabetes of the young can have significant life-changing therapeutic implications.

背景:青年期成熟型糖尿病是单基因糖尿病最常见的病因之一,很容易被误诊为 1 型糖尿病。幼年成熟型糖尿病的诊断会对遗传咨询、家庭筛查和糖尿病精准治疗产生直接影响。然而,在撒哈拉以南非洲地区,基因检测的成本和确定检测个体是诊断和管理的主要挑战。我们报告了撒哈拉以南非洲地区第一例有记录的 HNF1A 成熟型青年糖尿病病例:一名 20 岁的非洲黑人女性青年在 14 岁时被诊断为 1 型糖尿病,前来进行糖尿病常规门诊咨询。她每天多次注射胰岛素,总剂量为 0.79 IU/kg/天,HbA1c 为 7.7%。她的其他实验室检查结果均正常。在扩展实验室分析中,她的胰岛素剩余分泌良好,餐后血浆 C 肽水平为 1150 pmol/L。她的谷氨酸脱羧酶(GAD65)、胰岛抗原-2(IA-2)和锌转运体8(ZnT8)胰岛自身抗体检测结果均为阴性。利用从口腔样本中提取的 DNA 进行了单基因糖尿病的靶向新一代测序(t-NGS)。她被诊断为 HNF1A 成熟型青年糖尿病,致病变体为 c.607C > T; p.(Arg203Cys),该变体从未在撒哈拉以南非洲地区报道过。她的临床医生为她提供了遗传和治疗咨询。在确诊为成熟型青年糖尿病后的 10 个月内,她成功地从每天多次注射胰岛素转为口服抗糖尿病药片(磺脲类药物),同时保持了稳定的血糖控制(HBA1c 为 7.0%)并减少了低血糖。她表示,每天扎手指监测血糖的工作大大减轻了她的负担:本病例揭示了 HNF1A 成熟型青年糖尿病(也可能是其他原因导致的单基因糖尿病)可能出现在撒哈拉以南非洲地区。幼年成熟型糖尿病的诊断可能会对治疗产生重大影响。
{"title":"Treatment switch from multiple daily insulin injections to sulphonylureas in an African young adult diagnosed with HNF1A MODY: a case report.","authors":"Jean Claude Katte, Mesmin Y Dehayem, Kevin Colclough, Eugene Sobngwi","doi":"10.1186/s13256-024-04850-3","DOIUrl":"https://doi.org/10.1186/s13256-024-04850-3","url":null,"abstract":"<p><strong>Background: </strong>Maturity onset diabetes of the young is one of the commonest causes of monogenic diabetes and can easily be mistaken for type 1 diabetes. A diagnosis of maturity onset diabetes of the young can have direct implications for genetic counseling, family screening, and precision diabetes treatment. However, the cost of genetic testing and identifying individuals to test are the main challenges for diagnosis and management in sub-Saharan Africa. We report the very first documented case of HNF1A maturity onset diabetes of the young in the sub-Saharan African region.</p><p><strong>Case presentation: </strong>A 20-year-old female Black African young adult diagnosed with type 1 diabetes aged 14 presented for routine out-patient diabetes consultation. She was on multiple daily insulin injections; total combined dose 0.79 IU/kg/day with an HbA1c of 7.7%. The rest of her laboratory examinations were normal. On extended laboratory analysis, she had good residual insulin secretion with post-meal plasma C-peptide levels at 1150 pmol/L. She tested negative for glutamic acid decarboxylase (GAD65), islet antigen-2 (IA-2), and zinc transporter 8 (ZnT8) islet autoantibodies. Targeted next-generation sequencing (t-NGS) for monogenic diabetes was performed using DNA extracted from a buccal sample. She was diagnosed with HNF1A maturity onset diabetes of the young, with the c.607C > T; p.(Arg203Cys) pathogenic variant, which has never been reported in sub-Saharan Africa. Her clinical practitioners provided genetic and therapeutic counseling. Within 10 months following the diagnosis of maturity onset diabetes of the young, she was successfully switched from multiple daily insulin injections to oral antidiabetic tablets (sulphonylurea) while maintaining stable glycemic control (HBA1c of 7.0%) and reducing hypoglycemia. She expressed a huge relief from the daily finger pricks for blood glucose monitoring.</p><p><strong>Conclusion: </strong>This case reveals that HNF1A maturity onset diabetes of the young (and probably other causes of monogenic diabetes) can present in sub-Saharan Africa. A diagnosis of maturity onset diabetes of the young can have significant life-changing therapeutic implications.</p>","PeriodicalId":16236,"journal":{"name":"Journal of Medical Case Reports","volume":"18 1","pages":"506"},"PeriodicalIF":0.9,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11488176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142485666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Heart failure misdiagnosed as acute cholecystitis: a case report. 心力衰竭误诊为急性胆囊炎:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-16 DOI: 10.1186/s13256-024-04829-0
Qing Yu, Wen Lai

Background: Heart failure is a clinical syndrome characterized by decreased cardiac output, leading to systemic organ hypoxia and resulting in dyspnea, pulmonary edema, organ congestion, and pleural effusion. Owing to the diverse clinical manifestations of heart failure, early diagnosis can be challenging, and misdiagnosis may occur occasionally. The use of echocardiography and blood brain natriuretic peptide can aid in obtaining a more accurate diagnosis.

Case presentation: This article presents two case reports of patients who were misdiagnosed with acute cholecystitis. Both patients were young Mongolia males (age 26 and 39 years) who presented to the emergency department with acute upper abdominal pain, abdominal ultrasound revealed gallbladder enlargement, and blood tests suggested mild elevation of bilirubin levels. However, despite the absence of procalcitonin and C-reactive protein elevation, the patients were admitted to the general surgical department with a diagnosis of "acute cholecystitis." Both patients were given treatment for cholecystitis, but their vital signs did not improve, while later examinations confirmed heart failure. After treatment with diuretics and cardiac glycosides, both patients' symptoms were relieved.

Conclusion: We aim to highlight the clinical manifestations of heart failure and differentiate it from rare conditions such as acute cholecystitis. Physicians should make accurate diagnoses on the basis of physical examinations, laboratory testing and imaging, and surveys while avoiding diagnostic heuristics or mindsets. By sharing these two case reports, we hope to increase awareness to prevent potential complications and improve patient outcomes.

背景:心力衰竭是一种临床综合征,其特点是心输出量下降,导致全身器官缺氧,引起呼吸困难、肺水肿、器官充血和胸腔积液。由于心力衰竭的临床表现多种多样,因此早期诊断具有挑战性,误诊也偶有发生。使用超声心动图和血脑钠肽有助于获得更准确的诊断:本文报告了两例被误诊为急性胆囊炎的患者。两名患者均为蒙古族青年男性(26 岁和 39 岁),因急性上腹部疼痛到急诊科就诊,腹部超声波检查显示胆囊肿大,血液化验提示胆红素水平轻度升高。然而,尽管没有降钙素原和 C 反应蛋白升高,患者还是被送进了普通外科,诊断为 "急性胆囊炎"。两名患者都接受了胆囊炎治疗,但生命体征没有改善,后来的检查证实了心力衰竭。在接受利尿剂和强心苷治疗后,两名患者的症状均得到缓解:我们旨在强调心力衰竭的临床表现,并将其与急性胆囊炎等罕见疾病区分开来。医生应根据体格检查、实验室检测和影像学检查以及调查做出准确诊断,同时避免诊断启发式或思维定势。通过分享这两篇病例报告,我们希望提高人们的认识,预防潜在并发症,改善患者预后。
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引用次数: 0
Uncommon presentation of diffuse large B-cell lymphoma: oral and pulmonary involvements in a young patient: a case report. 弥漫大 B 细胞淋巴瘤的罕见表现:一名年轻患者的口腔和肺部受累:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-16 DOI: 10.1186/s13256-024-04825-4
Fahimeh Rezazadeh, Zahra Mansouri, Asma Sookhakian, Vahid Mohammadkarimi

Background: Diffuse large B-cell lymphoma is the most common subtype of non-Hodgkin lymphomas that remains a major diagnostic challenge due to the variety of its clinical presentations. This case highlights the importance of early biopsy of oral lesions without tendency to heal to attain the diagnosis more quickly. To the best of our knowledge, this study is the first to focus on both oral and pulmonary involvements in a patient with diffuse large B-cell lymphoma.

Case presentation: The presented case describes an Iranian 18-year-old girl with chronic cough and dyspnea referred for evaluation of the upper jaw due to bone exposure, bone loss, and soft tissue ulceration. Her medical history revealed mediastinal mass, cavitary lesion, and mediastinal lymphadenopathy. However, cytologic and immunohistochemical analysis did not show any evidence of malignancy. In this case a lymphoproliferative disease was suspected but ultimately the oral biopsy diagnosed diffuse large B-cell lymphoma and chemotherapy could be started.

Conclusions: Systemic conditions should be considered as a possible cause of oral lesions and a biopsy should also be performed immediately if there is any doubt concerning the nature of the lesion. Moreover, some conditions necessitate multiple biopsies to attain an accurate diagnosis.

背景:弥漫大 B 细胞淋巴瘤是非霍奇金淋巴瘤中最常见的亚型,由于其临床表现多种多样,因此仍然是诊断上的一大难题。本病例强调了对无愈合倾向的口腔病变进行早期活检以更快确诊的重要性。据我们所知,本研究是第一例同时关注弥漫大 B 细胞淋巴瘤患者口腔和肺部受累的病例:本病例描述的是一名患有慢性咳嗽和呼吸困难的 18 岁伊朗女孩,由于骨质暴露、骨质流失和软组织溃疡,她被转诊到医院对上颌骨进行评估。病史显示她有纵隔肿块、空洞性病变和纵隔淋巴结病。然而,细胞学和免疫组化分析并未显示任何恶性肿瘤的证据。该病例被怀疑患有淋巴增生性疾病,但最终口腔活检诊断为弥漫大 B 细胞淋巴瘤,并开始接受化疗:结论:全身性疾病应被视为口腔病变的可能原因,如果对病变的性质有任何怀疑,也应立即进行活检。此外,有些病症需要多次活检才能获得准确诊断。
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引用次数: 0
Incidental diagnosis of gastric antral vascular ectasia in a case of chronic kidney disease from Nepal: a case report. 尼泊尔一例慢性肾病患者被误诊为胃前庭血管异位症:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-15 DOI: 10.1186/s13256-024-04813-8
Ashish Acharya, Kritika Bhattarai, Abashesh Bhandari

Introduction: Gastric antral vascular ectasia is an uncommon clinical disease that affects elder people and is characterized by severe chronic upper gastrointestinal bleeding mainly affecting the gastric antrum. It is generally unusual among patients undergoing maintenance hemodialysis for chronic kidney disease.

Case presentation: Here, we aim to present an uncommon case of incidental diagnosis of the gastric antral vascular ectasia and erosive gastritis in a 71-year-old Hindu male patient belonging to the Gurung ethnicity of Nepal undergoing maintenance hemodialysis due to chronic kidney disease. The patient presented with a history of melena and fatigue. On investigation, a low hemoglobin level of 7.3 gm% was used for blood transfusion. The patient was on regular hemodialysis after admission at our institution. Upper gastrointestinal bleeding was suspected after analyzing patient's history and investigations. Therefore, an upper gastrointestinal endoscopy was performed that showed linear ectatic punctuate lesions radiating from the body of the stomach to the antrum, and hence, an incidental diagnosis of the gastric antral vascular ectasia was made. Initial fluid resuscitation, iron therapy, and a triple regimen were administered. Proper management with argon plasma coagulation therapy was scheduled at another institution due to lack of respective facilities in our institution.

Discussion: Gastric antral vascular ectasia is an unusual cause of upper gastrointestinal bleeding, primarily affecting the gastric antrum and pylorus with rare cases affecting the duodenum, jejunum, and gastric fundus. It is generally associated with other chronic disease conditions. Several hypotheses have been proposed for the pathogenesis of gastric antral vascular ectasia, especially its association with chronic kidney disease, as in our case, which is considered to be rare. Management varies from medical to endoscopic interventions to even surgery.

Conclusion: Prompt proper diagnosis and treatment for the gastric antral vascular ectasia should be sought, as it is frequently misdiagnosed or missed during upper gastrointestinal endoscopy. Our case report presents a case of gastric antral vascular ectasia in chronic kidney disease undergoing maintenance hemodialysis, which is quite uncommon, as literature has suggested the same point.

简介胃窦部血管异位症是一种不常见的临床疾病,多发于老年人,主要表现为胃窦部严重的慢性上消化道出血。在接受维持性血液透析治疗的慢性肾病患者中,这种病一般并不常见:在此,我们旨在介绍一例罕见病例,该病例偶发诊断为胃窦前血管异位和糜烂性胃炎,患者为 71 岁印度教男性,尼泊尔古隆族,因慢性肾病接受维持性血液透析。患者有血便和乏力的病史。经检查,血红蛋白水平较低,仅为 7.3 gm%,需要输血。入院后,患者一直在接受定期血液透析。在分析了患者的病史和检查结果后,怀疑是上消化道出血。因此,对其进行了上消化道内镜检查,结果显示其胃体至胃窦呈线状异位点状病变,因此偶然诊断为胃窦血管异位。对患者进行了初步的液体复苏、铁剂治疗和三联疗法。由于本院缺乏相应的设施,因此安排在另一家医院进行氩等离子凝固治疗:讨论:胃前叶血管异位症是上消化道出血的一个不常见原因,主要影响胃窦和幽门,少数病例影响十二指肠、空肠和胃底。它通常与其他慢性疾病相关。关于胃窦部血管异位症的发病机理有几种假说,特别是与慢性肾脏病的关系,就像我们的病例一样,这被认为是罕见的。治疗方法多种多样,从药物治疗到内窥镜干预,甚至手术治疗:结论:胃前区血管异位症经常在上消化道内镜检查中被误诊或漏诊,因此应寻求及时正确的诊断和治疗。我们的病例报告介绍了一例接受维持性血液透析的慢性肾脏病患者的胃前庭血管异位,这在文献中并不常见。
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引用次数: 0
Delayed diagnosis and treatment of achalasia: a case report. 贲门失弛缓症的延迟诊断和治疗:病例报告。
IF 0.9 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-15 DOI: 10.1186/s13256-024-04717-7
Sabrina Ginsburg, Chelsea Caplan, Gauri Agarwal

Background: Achalasia is characterized as an esophageal motility disorder with incomplete relaxation of the lower esophageal sphincter. Achalasia can be associated with abnormal peristalsis and symptoms of dysphagia, acid reflux, and chest pain. The exact pathophysiology of achalasia remains unclear, but it is hypothesized to be due to degeneration of the myenteric plexus.

Case presentation: In this case, a 46-year-old Hispanic man presented to the emergency room with a 12-year history of progressive discomfort with swallowing solids and liquids. Due to many years of incomplete follow-up care and lack of understanding of the course of his disease, this patient's symptoms escalated to complete intolerance of oral intake and significant weight loss. He was diagnosed with achalasia during his hospital stay and treated successfully with laparoscopic Heller myotomy.

Conclusions: This case discussion illustrates the importance of follow-up care and patient education so that diagnosis and treatment of achalasia are not delayed.

背景:Achalasia 是一种食管运动障碍,表现为食管下括约肌不完全松弛。贲门失弛缓症可伴有异常蠕动以及吞咽困难、反酸和胸痛等症状。贲门失弛缓症的确切病理生理学尚不清楚,但推测是由于肠肌丛变性所致:在本病例中,一名 46 岁的西班牙裔男子因吞咽固体和液体时逐渐感到不适而到急诊室就诊,病史长达 12 年。由于多年未接受完整的后续治疗,加上对自己的病程缺乏了解,这名患者的症状升级为完全无法忍受口腔摄入,体重明显下降。住院期间,他被诊断为贲门失弛缓症,并成功接受了腹腔镜海勒肌切开术:本病例讨论说明了随访护理和患者教育的重要性,从而避免延误贲门失弛缓症的诊断和治疗。
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Journal of Medical Case Reports
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