SAGE Open Medical Case Reports最新文献

Leprosy, or Hansen's disease, is a chronic granulomatous infection caused by Mycobacterium leprae, with a broad spectrum of clinical and histopathological manifestations. Histological examination plays a pivotal role in accurately diagnosing its various subtypes. Elastophagocytosis (phagocytosis of elastic fibers by giant cells) is typically associated with annular elastolytic giant cell granuloma and other granulomatous conditions but has rarely been reported in leprosy. We report the case of an 85-year-old male who presented with a solitary, slowly enlarging annular plaque on the trunk. The lesion was asymptomatic and exhibited mild sensory loss without peripheral nerve involvement. Histopathological analysis of the skin biopsy showed granulomatous inflammation with Langhans-type giant cells and a striking feature of elastophagocytosis. Fite-Faraco staining confirmed the presence of acid-fast bacilli, establishing the diagnosis of borderline tuberculoid leprosy. The patient was treated with multibacillary multidrug therapy and demonstrated complete lesion resolution.

Pertussis, caused by Bordetella pertussis, is increasingly recognized in adults who often present with atypical symptoms, leading to underdiagnosis. We report a case of a 64-year-old woman with a persistent cough and sore throat initially treated as refractory community-acquired pneumonia. Despite empirical antibiotic therapy, her symptoms persisted. Conventional diagnostic tests, including sputum and bronchoalveolar lavage fluid cultures, were negative. Metagenomic next-generation sequencing of bronchoalveolar lavage fluid identified Bordetella pertussis with high sequence coverage (7497 reads). The patient showed no clinical improvement with azithromycin, prompting a switch to trimethoprim-sulfamethoxazole, after which she improved and was discharged to complete a 14-day course. At 1-month follow-up, she was asymptomatic with resolved radiographic findings. This case highlights that pertussis can mimic refractory pneumonia in adults without typical features such as whooping cough, and underscores the diagnostic value of metagenomic next-generation sequencing when conventional methods fail. Clinicians should consider pertussis in adults with prolonged cough unresponsive to standard community-acquired pneumonia therapy and be aware of potential macrolide resistance, which may necessitate alternative antibiotics like trimethoprim-sulfamethoxazole.

Psoriasis is an immune-mediated inflammatory disorder with a strong genetic predisposition. However, in some cases, it can emerge as an adverse effect of biologic therapy, particularly interleukin-6 inhibitors such as tocilizumab. This case report describes the unexpected onset of psoriatic dermatitis in a 16-year-old male diagnosed with polyarticular juvenile idiopathic arthritis following treatment with tocilizumab. The patient had no prior personal or family history of psoriasis, highlighting a potential paradoxical reaction to interleukin-6 inhibition. Management strategies included topical corticosteroids and vitamin D analogs, with consideration of dose adjustment or transition to an alternative biologic therapy. This case highlights the importance of recognizing dermatologic adverse effects associated with interleukin-6 inhibitors and emphasizes the need for individualized treatment strategies in juvenile idiopathic arthritis patients receiving biologic therapy.

Multiple primary lung cancer is a very rare type of tumour that occurs when two or more primary malignant tumours develop simultaneously or sequentially in the same patient's lungs. When two or more primary sites are present at the same time, it is called synchronous multiple primary lung cancer. Currently, the pathogenesis, clinical features, and prognostic factors of synchronous multiple primary lung cancer are unclear, and there are no guidelines for diagnosis and treatment. We present a 74-year-old male patient with a combination of three histological types of synchronous primary lung cancer. He underwent partial lobectomy and was diagnosed with synchronous multiple primary lung cancer. The pathological diagnosis revealed adenosquamous carcinoma in the right lower lobe and small-cell lung cancer in the left lower lobe. After comprehensive treatment, the patient is currently stable and is under follow-up. Refining the diagnosis and treatment of multiple primary lung cancers remains challenging. Our case and case studies in the literature may provide some ideas for more standardized diagnosis and treatment.

A 60-year-old female with a 5-year history of infiltrating basal cell carcinoma of the left ala underwent Mohs micrographic surgery requiring seven stages for complete clearance. The resulting 3.5 × 2.5 cm defect affected the entire left ala, nasal sidewall, medial cheek, lower lateral cartilage, and inferior nasal mucosa. Reconstruction involved using a bipedicle mucosal flap for internal lining, a scaphoid cartilage graft for structural support, and a paramedian forehead flap for the overlying cutaneous coverage, followed by a series of staged refinements for optimal cosmetic and functional outcomes. This case highlights principles for multilayered nasal reconstruction emphasizing subunit planning, mucosal lining restoration, and vascularized flap coverage to achieve both airway patency and esthetic integrity.

With hyaluronic acid injectable treatments becoming increasingly popular, more patients are presenting with pre-existing hyaluronic acid creating a poor cosmetic effect, requiring subsequent dissolving with hyaluronidase. We sought to characterize the clinical features and demographics of patients receiving therapeutic hyaluronidase electively and not in the context of an adverse event. We retrospectively reviewed the charts of patients receiving therapeutic hyaluronidase in two aesthetic dermatology practices from 2020 to 2024. There were 35 patients, ranging in age from 23 to 74 years. Fifty-seven percent of patients sought consultation for further injectable treatments and were unaware of the negative impact of their prior hyaluronic acid. Our data highlight the necessity of considering therapeutic hyaluronidase during an aesthetic consultation. Practitioners who seek to provide patients with the most optimal, natural, and balanced cosmetic outcomes must both recognize the signs of excess or poorly placed hyaluronic acid and be comfortable in administering treatment with hyaluronidase.

Immune checkpoint inhibitors, particularly anti-PD-1 agents, are increasingly associated with bullous pemphigoid, a rare yet significant immune-related adverse event. We report a case of immune checkpoint inhibitor-induced bullous pemphigoid in a 74-year-old renal transplant recipient undergoing cemiplimab and later pembrolizumab for recurrent cutaneous squamous cell carcinomas. Bullous pemphigoid developed 23 months after initial immune checkpoint inhibitor exposure and 4 weeks after pembrolizumab reinitiation, presenting with generalized pruritus and tense bullae. Diagnosis was confirmed by histology and direct immunofluorescence. Disease was managed with oral prednisone and topical steroids, with relapses occurring upon tapering. This case highlights the complex interplay between immune checkpoint inhibitors, transplant immunosuppression, and autoimmune toxicity, underscoring the need for personalized, multidisciplinary management strategies in transplant patients receiving immune checkpoint inhibitors.

Vaginal bleeding and pelvic pain are frequently observed after supracervical hysterectomy with preservation of the ovary. In this article, we describe original and successful office hysteroscopic partial epithelial ablation of the cervical stump with a bipolar instrument, in a patient suffering from vaginal bleeding and pain, occurred after supracervical hysterectomy. Hysteroscopy was performed on a 48-year-old Caucasian patient, which was brought to our attention for vaginal bleeding and associated pain 1 year after supracervical hysterectomy. The procedure was carried out in an office setting using the vaginoscopic approach, using the 4-mm continuous-flow operative office hysteroscope with a 2.9-mm rod lens. After introducing the hysteroscope into the cervical canal, a recess with hyperplastic residual epithelial tissue was usually found. We performed partial epithelial ablation with bipolar Versapoint Twizzle Electrode to minimize vaginal bleeding and pain by reducing hormone-responsive tissue. At 4 years of follow-up, the patient reported complete disappearance of pain and only few and irregular vaginal bleeding. Office hysteroscopic treatment of vaginal bleeding and associated pain after supracervical hysterectomy is a simple procedure that can be easily introduced into common clinical practice.

Assessing a patient with a suspected bleeding disorder is a complex aspect of hematology. Prolonged activated partial thromboplastin time often indicates a coagulation factor deficiency or inhibitor and warrants detailed evaluation. Factor XI deficiency, a rare autosomal recessive disorder, shows variable bleeding tendencies with poor correlation between factor levels and bleeding risk. We report a 24-year-old asymptomatic male with an incidentally prolonged activated partial thromboplastin time during preoperative assessment for septoplasty. He had no bleeding or family history suggestive of a bleeding disorder. Mixing studies showed full correction, and factor assays confirmed severe Factor XI deficiency. Given the uncertain bleeding phenotype, a tailored perioperative plan was implemented, including fresh frozen plasma and prophylactic tranexamic acid. Recombinant activated Factor VII was available as rescue therapy, but not required. The surgery and postoperative course were uneventful, highlighting the importance of individualized perioperative management in Factor XI deficiency.

Dermatomyositis is a rare autoimmune condition known to be frequently associated with an undiagnosed malignancy. Although it is strongly linked to adenocarcinomas and other solid tumors, dermatomyositis has been scarcely described with sarcomas. We present a 63-year-old patient with simultaneous presentations of Kaposi's sarcoma and dermatomyositis. This case highlights Kaposi's sarcoma as a potential malignancy associated with dermatomyositis and the complexities of managing multimorbid patients.