SAGE Open Medical Case Reports最新文献

We report a case of endovascular treatment of bone cement embolism after percutaneous vertebroplasty. The patient underwent percutaneous vertebroplasty for acute L1 compression fracture. Two weeks later, the patient developed symptoms of pulmonary embolism. Computed tomography pulmonary angiogram confirmed the presence of a bone cement foreign body in the pulmonary artery. Endovascular treatment was performed, and the cement embolism was caught, pulled to the level of the iliac vein, and fixed with stents. At the 1-year follow-up, the patient did not have any complaints, postoperative computed tomography pulmonary angiogram showed no obvious manifestations of pulmonary embolism, and angiography showed that the bone cement was fixed in place and that the iliac veins were normal.

Multiple fractures of the femur, defined for the purposes of this study as the association of three or more non-contiguous fractures on the same bone segment, is an exceedingly rare condition with an unknown incidence in the literature. A limited number of studies, mainly consisting of case reports or small case series, have addressed this topic, and no shared consensus or guidelines exist on what the ideal timing and sequence of multiple fracture fixation is. The present paper reports the clinical case of a 36 years old man who sustained a blunt chest injury, a non-concussive head injury, a displaced intracapsular fracture of the left femur (AO 31B2), a left diaphyseal multifragmentary fracture (AO 32B3), a supradiacondylar fracture of the distal end of the left femur (AO 33C1.1), a Hoffa fracture of the lateral left femoral condyle (AO 33B3.2 f), and a multifragmentary fracture of the left patella with bone loss (AO 34C3) due to a vehicular high-energy trauma. The patient was surgically treated by open reduction and internal fixation according to a proposed algorithm of treatment and reported excellent clinical and radiological outcomes at 32 months follow-up. The primary aim of this study is to describe our experience in the treatment of such complex fractures, by presenting our clinical and radiological results, and to propose a treatment algorithm. The secondary aim is to provide a comprehensive review of the literature on this topic.

Piperacillin/tazobactam is a widely used anti-infective agent. However, prolonged use can lead to adverse drug reactions, primarily presenting as fever and various abnormal laboratory test results. Certain abnormal test outcomes may mislead clinical assessments. We present a case of a 50-year-old Chinese woman who developed a fever and abnormal blood tests after receiving piperacillin/tazobactam for more than 2 weeks. These tests showed elevated levels of C-reactive protein, procalcitonin, transaminases, myocardial enzymes, and a significant increase in D-dimer. After stopping piperacillin/tazobactam, all relevant test results returned to normal within 10 days. It is imperative for clinicians to be vigilant of this adverse effect in patients undergoing extended piperacillin/tazobactam treatment, as early recognition can prevent unnecessary diagnostic tests and therapeutic interventions.

We present the case of a 63-year-old male with known rheumatoid arthritis, diabetes, hypertension, and peripheral neuropathy who developed drug-induced subacute cutaneous lupus erythematosus secondary to Dupilumab for his chronic hand dermatitis.

This case study investigates the use of a 40-gene expression profile to independently predict the risk of metastasis in an immunocompromised 75-year-old male patient with cutaneous squamous cell carcinoma of his left cheek. The patient's previous medical history included non-melanoma skin cancer. Traditional staging methods, such as those from the American Joint Committee on Cancer 8th edition and Brigham and Women's Hospital, suggested a high risk of metastasis for this patient. However, the 40-gene expression profile test identified the patient as having a low risk (Class 1 result) of metastasis within 3 years. The patient successfully underwent Mohs surgery, and pathology was notable for positive perineural invasion of large caliber nerves. This case highlights the potential of the 40-gene expression profile as an independent predictor in assessing metastatic risk compared to traditional staging methods.

Pilomatricoma is an uncommon benign adnexal tumor of childhood. We report a case of pilomatricoma presenting as a large, recurrent painful cutaneous horn on the neck of an 8-year-old boy treated with surgical excision. On histopathology, classical features of pilomatricoma along with transepidermal elimination and perforation were shown. We propose that perforating pilomatricoma and pilomatrical horn represent equivalent clinical and pathological entities. The diagnosis of perforating pilomatricoma should be considered in pediatric patients presenting with a cutaneous horn.

Ascites represents an infrequent sequela of hypothyroidism, manifesting in fewer than 4% of affected individuals. Herein, we delineate a case characterized by profound hypothyroidism accompanied by substantial ascites, further complicated by cardiac insufficiency. A 29-year-old female, previously diagnosed with postradiation hypothyroidism subsequent to a diagnosis of Grave's disease 11 years prior, presented with exacerbating dyspnoea, abdominal distension, and orthopnea. In January 2024, she was admitted with massive ascites, exhibiting clinical manifestations of both hypothyroidism and cardiac failure. Thyroid function tests were markedly abnormal, with a thyroid-stimulating hormone level of 77.65 mIU/L, triiodothyronine at 2.2 nmol/L, and thyroxine levels below 3.2 pmol/L. Echocardiographic evaluation revealed dilated cardiomyopathy with a significantly reduced systolic (ejection fraction of 25.9%) and diastolic function (E/A ratio of 0.87). Analysis of the ascitic fluid demonstrated a serum-ascites albumin gradient exceeding 1.1 g/L (3 g/L). Ultrasonography of the abdomen ruled out portal hypertension, while computed tomography of the abdomen confirmed extensive ascites without evidence of malignancy. Under the supervision of a specialist, the patient was administered a high dosage of levothyroxine (300 mcg), leading to a significant amelioration in both thyroid function parameters and her ascites. Subsequent thyroid function tests demonstrated a decrease in thyroid-stimulating hormone levels to 11.7 mIU/L and an increase in thyroxine levels to 15.6 pmol/L, indicating a positive response to the thyroid hormone replacement therapy. Subsequent echocardiographic assessment showed improvement in the ejection fraction to 26.9% and diastolic function (E/A ratio of 1.27). Myxedema ascites, though infrequent, is readily amenable to treatment. The serum-ascites albumin gradient exceeding 1.1 g/L may be indicative of hypothyroidism-associated ascites, although the paucity of studies renders it uncertain whether this is a characteristic feature. Further investigation into the etiology, diagnostic criteria, and management strategies for ascites in the context of hypothyroidism is warranted.

A mixed epithelial and stromal tumor of the seminal vesicle gland is an uncommon neoplasm characterized by a dual population of epithelial and stromal cells. In this case report, we present a 59-year-old male patient who presented with a large, 10 cm mass in the left seminal vesicle, which was preliminarily suspected to be a malignant tumor of the seminal vesicle based on magnetic resonance imaging findings. Histopathological evaluation, however, revealed a tumor with biphasic epithelial-mesenchymal differentiation, predominantly displaying mesenchymal characteristics. The epithelium and stroma displayed papillary and foliar structures, respectively. The epithelial cells were bland, arranged in either single or multi-layered cuboidal patterns, and the stromal cells were spindle shaped with a sparse distribution. The patient experienced a favorable postoperative outcome. The diagnosis of mixed epithelial and stromal tumor is challenging based on clinical and imaging findings alone, and definitive diagnosis relies on pathological examination. This case report addresses a rare presentation of low-grade mixed epithelial and stromal tumor in the seminal vesicle gland and aims to expand the understanding of this entity by reviewing the relevant literature.

Autoimmune progesterone dermatitis is considered a rare cyclical autoimmune reaction to endogenous progesterone in fertile females that is characterized by skin lesions ranging from mild urticaria to anaphylaxis. A 30-year-old woman who had an intrauterine device placed, presented to her family medicine clinic with erythema and some edematous lesions, and pruritus. The skin biopsy showed perivascular infiltrate with neutrophils and was diagnosed as autoimmune progesterone dermatitis. Treatment included intrauterine device removal and treatment with tamoxifen. This is the first documented case of autoimmune progesterone dermatitis in occupied Palestine.

This case report presents a rare instance of facial vein thrombophlebitis, a potentially serious complication, following a facial skin infection. A 33-year-old man known to have cerebral palsy, epilepsy on ventriculoparietal shunt, and kyphoscoliosis presented to the emergency department complaining of small facial wound and swelling for 1 week. The wound failed topical management and fever started to develop. His medications included quetiapine and levetiracetam. Investigations, including computed tomography, were carried out to rule out an extension to deep tissue. Management in the emergency department involved initial resuscitation with 500 mL of 0.9% normal saline and 1 L of lactated ringers, antibiotic coverage with piperacillin/tazobactam and vancomycin was given, and analgesia for pain control. This case highlights the potential for facial vein thrombophlebitis as a complication of facial skin infections. Early diagnosis and prompt initiation of appropriate management are crucial to prevent potentially fatal consequences.