SAGE Open Medical Case Reports最新文献

Ovarian tumours occur at an incidence rate of 2.6 cases per 100,000 children, and their frequency escalates proportionally with age. These tumours typically have an organic origin and are seldom functional. The frequent presence of pain primarily characterizes the clinical manifestation of ovarian cysts. The complexity inherent in analyzing this pain can complicate diagnosis, necessitating a thorough evaluation that could potentially require resorting to a pelvic ultrasound to confirm the diagnosis and determine the optimal management. Additional imaging techniques and tumour marker assays aid in specifying the nature of this mass, where surgery remains the sole therapeutic option. The histopathological analysis further confirms the precise nature of the mass or cyst to establish a prognosis and guide the management strategies and progression follow-up. Our case is for a girl aged 15 years old without notable medical history, presenting at admission with a 6-month history of a gradually enlarging abdominal mass associated with abdominal pain and tumour markers (BHCG was negative). In addition, LDH, CA125, Inhibin, CEA and CA19.9 were negative. Radiologically, the ultrasound revealed a huge cystic abdominopelvic mass occupying the entirety of the abdomen and pelvis with posterior compression of the intestines without visualization of the left ovary; the right ovary appeared normal. MRI confirmed the presence of a voluminous intraperitoneal abdominopelvic cystic formation measuring 31 × 20 × 8 cm. The patient underwent laparoscopic surgery, revealing a large cystic mass with septations filling the abdomen and pelvis and displacing the gastrointestinal tract. After draining 6 L of clear fluid, the entire cyst was removed while preserving some left ovarian tissue, with the right ovary appearing normal. The follow-up is still ongoing, with the last consultation being 8 months post-operative.

This case report describes an exceptional case of aortic aneurysm co-occurring with type II dissection, bicuspid aortic valve, and severe aortic valve regurgitation in a patient with aortic coarctation. A 39-year-old man without any medical history was admitted to the hospital with chest pain. Physical examination revealed a holosystolic murmur and a noticeable blood pressure difference between the upper and lower extremities. Imaging studies unveiled the presence of aortic dissection, aortic coarctation, and a bicuspid aortic valve. The patient underwent an urgent single-stage surgical intervention performed via a median sternotomy approach: the procedure involved patch angioplasty, a mechanical prosthetic valve, and a Dacron tube graft. The patient's follow-up assessments indicated successful outcomes. This case report highlights the complexity of managing concurrent pathologies, suggests a unique surgical approach, and underscores the importance of tailored interventions in rare presentations of cardiovascular diseases.

Inflammatory myofibroblastic tumor and liposarcoma very rarely present as tumors of the chest wall. Never have both been reported together in the same lesion. We present a case wherein a 72-year-old man with a rapidly progressing lesion initially mistaken for a local infection underwent resection with diagnosis of inflammatory myofibroblastic tumor. He experienced recurrence less than 6 months before radical resection revealed well to dedifferentiated liposarcoma with areas of inflammatory myofibroblastic tumor. He is now doing well with over 4 years of follow-up.

Nail psoriasis occurs in approximately half of all cases of plaque psoriasis and manifests with onychodystrophy, which includes morphological features of onycholysis, subungual hyperkeratosis, oil drop sign, pitting, splinter hemorrhages, leukonychia, and crumbling of the nails. Nail psoriasis can have a significant adverse impact on quality of life. However, nail psoriasis is often refractory to both local and systemic therapies, making it challenging to treat. Topical and oral phosphodiesterase-4 inhibitors have been successfully used to treat multiple different subtypes of psoriasis. Topical roflumilast, a phosphodiesterase-4 inhibitor cream, has recently received United States Food and Drug Administration and Health Canada approval for the treatment of plaque psoriasis. In this case report, a 25-year-old female with a 20-year history of nail psoriasis achieved complete resolution of her onychodystrophy after 5 months of daily application of topical roflumilast, without experiencing any side effects. This case report suggests that topical roflumilast may be a useful and well-tolerated therapy for psoriatic nails.

The patient, a 30-year-old woman, presented with a sudden, painless, and severe decrease in vision in both eyes. The ophthalmological examination revealed a normal anterior segment and intraocular pressure, but a fundus examination showed bilateral macular hemorrhage. In the absence of a known history, a metabolic and hematological biological assessment was conducted. The assessment revealed megaloblastic anemia with a significantly reduced serum vitamin B12 level. Further examination confirmed Biermer's disease as the cause of her anemia. The patient was started on a regimen of monthly vitamin B12 supplementation, which she will continue for life. This case report highlights the importance of recognizing megaloblastic anemia as a potential cause of spontaneous bilateral retinal hemorrhages. Moreover, it underscores the urgency for healthcare practitioners to promptly investigate and determine the root cause of megaloblastic anemia.

Non-identification of serious bacterial infection (SBI) in febrile infants is a common occurrence in clinical practice, culminating in catastrophic presentations. Six infants who initially presented to the clinician with fever without a focus, and were lately diagnosed with bacterial meningitis were analyzed for clinician-related factors contributing to the non-identification of meningitis. In a febrile neonate and a febrile young infant, lack of comprehensive evaluation was contributing to the non-identification of SBI; in four infants above the age of 3 months, meningitis was missed in spite of clinicians practicing treatment guidelines. Inadequate symptom characterization in two febrile infants and inappropriate interpretation of hemogram in three febrile infants also contributed to the non-identification of meningitis. Except for one, all infants developed complications. We conclude that the characterization of clinical features of SBI-like meningitis, interpretation of lab data, and adherence to the treatment guidelines are crucial in the management of an infant presenting as fever without a focus.

Since 1883, "tennis leg" has described various acute calf injuries linked to activities such as tennis serving or stair climbing. Current research suggests that tennis leg is caused by the injury of the medial head of the gastrocnemius muscle. This case report details the case of a 35-year-old male who suffered sudden and intense calf pain after a minor leg extension injury. The diagnosis of tennis leg, likely involving gastrocnemius muscle (partial tear), was made using clinical evaluation and ultrasonography (USG). The patient was managed conservatively and regained normal muscle function at the 4-month follow-up. Diagnosis, aided by clinical examination and imaging like USG, is crucial for accurate differentiation from conditions like deep vein thrombosis, as was done in our case. Treatment typically involves conservative measures like rest, ice, compression, elevation, analgesics, and physiotherapy, while surgery may be considered in severe cases. Regular follow-up is vital for monitoring recovery progress and adjusting treatment plans as needed. This case emphasizes the importance of promptly recognizing tennis leg injuries and differentiating it from other disorders with similar presentations.

Iron deficiency anaemia (IDA) is highly associated with insufficient nutrition, chronic renal failure and congestive heart failure. Post-partum anaemia is also very common with a high mortality rate. Ferric carboxymaltose (FCM) is a non-dextran third-generation intravenous (IV)-iron preparation. FCM is an effective means of correcting IDA and improving haemoglobin (Hb) concentration in IDA. Incidence of IDA is common in low socio-economic groups. Clinical research has shown that the risk of hypersensitivity reaction (HSR) with FCM is low. An 18- year-old female has faced post-partum anaemia. IDA is most common due to low socio-economic status. Day 1 of post-partam period, Hb was 6.5 g/dl. One unit of packed red blood cell has been transfused. The next day, the Hb was 7.1, so, IV FCM was advised. The patient had faced a serious HSR. Sudden respiratory distress occurred and chest congestion was present. SpO₂ had dropped to 85%. The case was primarily managed with Injection (Inj) Adrenaline, Inj Hydrocortisone, Inj Promethazine, oxygen and nebulization. In this case report, we are reporting a case of severe HSR due to administration of IV FCM in a post-partum mother. It should be kept in mind that severe HSR can be seen due to IV FCM infusion. During the infusion, proper monitoring is important. FCM should be advised in a well-equipped setup where proper infrastructure and protocols are present to combat the HSR.

Myomectomy for Jehovah's Witnesses presents a unique challenge because of their religious beliefs against blood transfusions. In this case report, we describe the successful management of a Jehovah's Witness patient with 22-week-sized uterine fibroids complicated by menorrhagia, emphasizing a multidisciplinary approach to blood conservation while respecting the patient's faith. She had a presenting hematocrit of 38%, which dropped to 33% just before surgery and subsequently had acute normovolemic hemodilution (ANH) along with meticulous surgical techniques, resulting in minimal blood loss and avoidance of allogeneic blood transfusions. She had good postoperative recovery and was discharged with hematocrit of 34%. This approach highlights the importance of understanding and accommodating patients' religious beliefs in surgical practice. Furthermore, it underscores the effectiveness of ANH as a viable alternative for blood conservation in high-risk surgical procedures.

Catastrophic antiphospholipid syndrome (CAPS) is a very severe form of the classic antiphospholipid syndrome (APS). Although CAPS occurs in less than 1% of all patients with APS, it is considered a life-threatening condition. This report highlights an interesting case of a 45-year-old male diagnosed with CAPS. Unfortunately, the diagnosis was followed by devastating complications. Moreover, this report tried to gather the significant medical information available about CAPS in light of the obvious shortage of epidemiology, signs, symptoms, mechanisms of action and options of treatment in relation to the current guidelines.