Pub Date : 2024-08-26eCollection Date: 2024-01-01DOI: 10.1177/2050313X241272711
Ghassane El Omri, Anas Taghouan, Hamza Rais, Malak Snoussi, Hafida Naoui, Abdeljalil Heddat
This is the first case of urinary myiasis in the Morocco region caused by Clogmia albipunctata. Also known as Telmatoscopus albipunctata, is a fly species in the Psychodidae family. These flies thrive in unsanitary environments like bathrooms and sewers. Transmission occurs when flies lay eggs on moist surfaces such as urogenital discharge. The larvae hatch and can traverse the urethra, entering the bladder. Clogmia albipunctata larvae and adults decompose organic matter and pose health risks as vectors of pathogens and allergens. In our case, larvae were discharged through urine by a 46-year-old female cleaner from a low socioeconomic background who presented with intermittent emission of worms in her urine. She had mild hypogastric tenderness and a history of lower urinary tract symptoms without fever. Initially misdiagnosed with cystitis, her symptoms persisted, leading to the discovery of small, mobile vermiform organisms in her urine. Living in fly-infested conditions, she had no recent travel or medical history. Urine analysis confirmed the presence of Clogmia albipunctata larvae, diagnosing urinary myiasis. Treated with ivermectin and hydration, her symptoms resolved within a week. A follow-up cystoscopy showed no larvae, confirming a complete cure.
{"title":"Human urinary myiasis due to larvae of Telmatoscopus (Clogmia) Albipunctata in Morocco: A case report.","authors":"Ghassane El Omri, Anas Taghouan, Hamza Rais, Malak Snoussi, Hafida Naoui, Abdeljalil Heddat","doi":"10.1177/2050313X241272711","DOIUrl":"10.1177/2050313X241272711","url":null,"abstract":"<p><p>This is the first case of urinary myiasis in the Morocco region caused by <i>Clogmia albipunctata</i>. Also known as <i>Telmatoscopus albipunctata</i>, is a fly species in the Psychodidae family. These flies thrive in unsanitary environments like bathrooms and sewers. Transmission occurs when flies lay eggs on moist surfaces such as urogenital discharge. The larvae hatch and can traverse the urethra, entering the bladder. <i>Clogmia albipunctata</i> larvae and adults decompose organic matter and pose health risks as vectors of pathogens and allergens. In our case, larvae were discharged through urine by a 46-year-old female cleaner from a low socioeconomic background who presented with intermittent emission of worms in her urine. She had mild hypogastric tenderness and a history of lower urinary tract symptoms without fever. Initially misdiagnosed with cystitis, her symptoms persisted, leading to the discovery of small, mobile vermiform organisms in her urine. Living in fly-infested conditions, she had no recent travel or medical history. Urine analysis confirmed the presence of <i>Clogmia albipunctata</i> larvae, diagnosing urinary myiasis. Treated with ivermectin and hydration, her symptoms resolved within a week. A follow-up cystoscopy showed no larvae, confirming a complete cure.</p>","PeriodicalId":21418,"journal":{"name":"SAGE Open Medical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11348352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142081391","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}
Pub Date : 2024-08-24eCollection Date: 2024-01-01DOI: 10.1177/2050313X241274243
David A Zarrin, Jessica K Campos, Benjamen M Meyer, Alexander S Himstead, Fahad Laghari, Jonathan C Collard de Beaufort, Kiarash Golshani, Narlin B Beaty, Matthew T Bender, Geoffrey P Colby, Alexander L Coon
Osteogenesis imperfecta (OI) predisposes individuals to easy bone fracture, vessel fragility, and platelet dysfunction. We report the first known case of neurointerventional treatment with flow diversion of intracranial aneurysms in a patient with OI. A 62 year-old female with known OI Type I, history of >40 lifetime bone fractures and hypertension, underwent workup for transient ischemic attacks revealing a 4-mm right A1 segment aneurysm in 2016. Perioperative dual antiplatelet therapy was aspirin 81 mg and clopidogrel 37.5 mg daily. Tri-axial access was utilized to deploy a 3.5 × 16-mm Pipeline Flex device without complication. Two-month follow-up revealed Raymond I (O'Kelly Marotta I) obliteration of the aneurysm. Five-year follow-up revealed a de novo left-sided 3-mm A1-A2 junction aneurysm. A 4 × 12-mm Surpass Evolve was placed without complication. Six-month follow-up revealed Raymond I (O'Kelly Marotta I) obliteration of the second aneurysm. The patient remained asymptomatic at all follow-up visits.
成骨不全症(OI)易导致骨折、血管脆性和血小板功能障碍。我们报告了第一例对 OI 患者进行颅内动脉瘤血流分流的神经介入治疗。一名 62 岁的女性患者已知为 OI I 型,终身骨折史超过 40 次,患有高血压,2016 年因短暂性脑缺血发作接受检查,发现右侧 A1 段动脉瘤 4 毫米。围手术期的双联抗血小板疗法是每天服用阿司匹林 81 毫克和氯吡格雷 37.5 毫克。利用三轴入路部署了一个 3.5 × 16 毫米的 Pipeline Flex 装置,未发生并发症。两个月的随访显示,动脉瘤已被雷蒙德I型(奥凯利-马罗塔I型)阻塞。五年随访发现左侧新发 3 毫米 A1-A2 交界动脉瘤。在无并发症的情况下,植入了一个 4 × 12 毫米的 Surpass Evolve。六个月的随访显示,第二个动脉瘤已被雷蒙德 I 型(奥凯利-马罗塔 I 型)阻塞。患者在所有随访中均无症状。
{"title":"Flow diversion of cerebral aneurysms in Type I osteogenesis imperfecta: A case report of the first two treatments in humans.","authors":"David A Zarrin, Jessica K Campos, Benjamen M Meyer, Alexander S Himstead, Fahad Laghari, Jonathan C Collard de Beaufort, Kiarash Golshani, Narlin B Beaty, Matthew T Bender, Geoffrey P Colby, Alexander L Coon","doi":"10.1177/2050313X241274243","DOIUrl":"10.1177/2050313X241274243","url":null,"abstract":"<p><p>Osteogenesis imperfecta (OI) predisposes individuals to easy bone fracture, vessel fragility, and platelet dysfunction. We report the first known case of neurointerventional treatment with flow diversion of intracranial aneurysms in a patient with OI. A 62 year-old female with known OI Type I, history of >40 lifetime bone fractures and hypertension, underwent workup for transient ischemic attacks revealing a 4-mm right A1 segment aneurysm in 2016. Perioperative dual antiplatelet therapy was aspirin 81 mg and clopidogrel 37.5 mg daily. Tri-axial access was utilized to deploy a 3.5 × 16-mm Pipeline Flex device without complication. Two-month follow-up revealed Raymond I (O'Kelly Marotta I) obliteration of the aneurysm. Five-year follow-up revealed a de novo left-sided 3-mm A1-A2 junction aneurysm. A 4 × 12-mm Surpass Evolve was placed without complication. Six-month follow-up revealed Raymond I (O'Kelly Marotta I) obliteration of the second aneurysm. The patient remained asymptomatic at all follow-up visits.</p>","PeriodicalId":21418,"journal":{"name":"SAGE Open Medical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11344899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056353","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}
Pub Date : 2024-08-22eCollection Date: 2024-01-01DOI: 10.1177/2050313X241274855
Jillian Lamb, Kerri Purdy, Ashley Sutherland
Bullous pemphigoid is an autoimmune blistering disease affecting the dermo-epidermal junction, most commonly seen in older patients. First-line treatment includes systemic, topical corticosteroids and/or steroid-sparing immunosuppressants. Treatment with these medications may be limited by their safety profile. Dupilumab is a humanized monoclonal antibody targeting interleukin-4 and interleukin-13 cytokines currently indicated for moderate-to-severe atopic dermatitis, severe asthma, chronic rhinosinusitis with nasal polyposis, and moderate-to-severe prurigo nodularis. We report a case of a patient with recalcitrant bullous pemphigoid effectively treated with dupilumab.
{"title":"Use of dupilumab for recalcitrant bullous pemphigoid: A case report.","authors":"Jillian Lamb, Kerri Purdy, Ashley Sutherland","doi":"10.1177/2050313X241274855","DOIUrl":"10.1177/2050313X241274855","url":null,"abstract":"<p><p>Bullous pemphigoid is an autoimmune blistering disease affecting the dermo-epidermal junction, most commonly seen in older patients. First-line treatment includes systemic, topical corticosteroids and/or steroid-sparing immunosuppressants. Treatment with these medications may be limited by their safety profile. Dupilumab is a humanized monoclonal antibody targeting interleukin-4 and interleukin-13 cytokines currently indicated for moderate-to-severe atopic dermatitis, severe asthma, chronic rhinosinusitis with nasal polyposis, and moderate-to-severe prurigo nodularis. We report a case of a patient with recalcitrant bullous pemphigoid effectively treated with dupilumab.</p>","PeriodicalId":21418,"journal":{"name":"SAGE Open Medical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11342423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056358","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}
Pub Date : 2024-08-22eCollection Date: 2024-01-01DOI: 10.1177/2050313X241271887
Santiago A Endara, Gerardo A Davalos, Frans I Serpa, Marta L Cueva, Sebastian Narvaez C, Cesar M Delgado, Ligia M Redroban, Maribel Brito M, Pablo M Caceres
Hydatidosis is a zoonosis, caused by a cestode (Echinococcus). Management will depend on the organs affected by the infection and the response to medical treatment. Therapy may be clinical in early stages, but in case of poor response to drug therapy, surgery is the preferred choice. We present two cases in young females, the first case is with Hydatid cysts in both lungs and liver, she received initial medical treatment with lack of response, and surgery was indicated to resect the pulmonary and hepatic lesions. The second case is of a female with Hydatid cysts in the right lung. She was misdiagnosed at the beginning thinking of pneumonia and pulmonary abscess but after further investigation, hydatid cysts were the diagnosis, due to symptoms consistent with thoracic pain and persistent cough and the size of the cyst, surgery was indicated.
{"title":"Young females affected with hydatidosis, case report.","authors":"Santiago A Endara, Gerardo A Davalos, Frans I Serpa, Marta L Cueva, Sebastian Narvaez C, Cesar M Delgado, Ligia M Redroban, Maribel Brito M, Pablo M Caceres","doi":"10.1177/2050313X241271887","DOIUrl":"10.1177/2050313X241271887","url":null,"abstract":"<p><p>Hydatidosis is a zoonosis, caused by a cestode (<i>Echinococcus)</i>. Management will depend on the organs affected by the infection and the response to medical treatment. Therapy may be clinical in early stages, but in case of poor response to drug therapy, surgery is the preferred choice. We present two cases in young females, the first case is with Hydatid cysts in both lungs and liver, she received initial medical treatment with lack of response, and surgery was indicated to resect the pulmonary and hepatic lesions. The second case is of a female with Hydatid cysts in the right lung. She was misdiagnosed at the beginning thinking of pneumonia and pulmonary abscess but after further investigation, hydatid cysts were the diagnosis, due to symptoms consistent with thoracic pain and persistent cough and the size of the cyst, surgery was indicated.</p>","PeriodicalId":21418,"journal":{"name":"SAGE Open Medical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11342428/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056372","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}
Pub Date : 2024-08-22eCollection Date: 2024-01-01DOI: 10.1177/2050313X241271811
Sehreen Mumtaz, Lisa M Balistreri, Andy Abril, Ernesto Ayala, Ronald R Butendieck, Florentina Berianu
Microvascular remodeling and capillary repopulation can occur after autologous hematopoietic stem cell transplant (HSCT) in patients with systemic sclerosis and systemic lupus erythematosus (SLE). We aim to report evidence for microvascular remodeling after autologous HSCT as observed by nailfold videocapillaroscopy (NVC). We describe a rare occurrence of features consistent with systemic sclerosis and SLE in a 33-year-old female with a complex clinical course refractory to conventional treatments, ultimately requiring autologous HSCT. We performed NVC before and after HSCT using optical video and light microscopy. At the microvascular level, morphologic changes in the capillary vascular bed were observed after HSCT. Pretransplant damage in capillary structure was noted as evidenced on NVC with architectural loss, ramifications, capillary drop, and decreased density. Posttransplant NVC revealed an increase in capillary density with evidence of microvascular remodeling. Further studies on the clinical use and impact of microvascular remodeling on disease progression are needed and looking into the application of NVC scoring to assess clinical response would be meaningful.
{"title":"Microvascular remodeling after autologous stem cell transplant in an overlap of systemic sclerosis and systemic lupus erythematosus: A case report.","authors":"Sehreen Mumtaz, Lisa M Balistreri, Andy Abril, Ernesto Ayala, Ronald R Butendieck, Florentina Berianu","doi":"10.1177/2050313X241271811","DOIUrl":"10.1177/2050313X241271811","url":null,"abstract":"<p><p>Microvascular remodeling and capillary repopulation can occur after autologous hematopoietic stem cell transplant (HSCT) in patients with systemic sclerosis and systemic lupus erythematosus (SLE). We aim to report evidence for microvascular remodeling after autologous HSCT as observed by nailfold videocapillaroscopy (NVC). We describe a rare occurrence of features consistent with systemic sclerosis and SLE in a 33-year-old female with a complex clinical course refractory to conventional treatments, ultimately requiring autologous HSCT. We performed NVC before and after HSCT using optical video and light microscopy. At the microvascular level, morphologic changes in the capillary vascular bed were observed after HSCT. Pretransplant damage in capillary structure was noted as evidenced on NVC with architectural loss, ramifications, capillary drop, and decreased density. Posttransplant NVC revealed an increase in capillary density with evidence of microvascular remodeling. Further studies on the clinical use and impact of microvascular remodeling on disease progression are needed and looking into the application of NVC scoring to assess clinical response would be meaningful.</p>","PeriodicalId":21418,"journal":{"name":"SAGE Open Medical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11342424/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056354","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}
Pub Date : 2024-08-22eCollection Date: 2024-01-01DOI: 10.1177/2050313X241274970
Jacob A Alaniz, Peyton Armstrong, Alexander Bosley, Vasilis Mavratsas, Randal Reinertson
Adult foreign body aspiration is rare and represents only 15%-25% of all foreign body aspirations and 1 in 400 bronchoscopy procedures. Typically, adults present non-emergently and exhibit non-specific symptoms, which makes the diagnosis of foreign body aspiration especially difficult when a history of aspiration cannot be elicited. We present a 63-year-old male with a past medical history of chronic obstructive pulmonary disease hospitalized for left thoracic empyema caused by the aspiration of a grass bur. Our patient did not recall the aspiration event and the diagnosis was further obfuscated by a lack of radiographic evidence and other distracting disease processes. Thus, this case exemplifies the rationale for maintaining a suspicion of foreign body aspiration even for patients with little historical or radiographic evidence to support the presence of a foreign body. This is particularly salient for patients with a tumultuous hospital course or those who fail to respond to treatment.
{"title":"Unexpected spontaneous expectoration of a grass bur: A case report.","authors":"Jacob A Alaniz, Peyton Armstrong, Alexander Bosley, Vasilis Mavratsas, Randal Reinertson","doi":"10.1177/2050313X241274970","DOIUrl":"10.1177/2050313X241274970","url":null,"abstract":"<p><p>Adult foreign body aspiration is rare and represents only 15%-25% of all foreign body aspirations and 1 in 400 bronchoscopy procedures. Typically, adults present non-emergently and exhibit non-specific symptoms, which makes the diagnosis of foreign body aspiration especially difficult when a history of aspiration cannot be elicited. We present a 63-year-old male with a past medical history of chronic obstructive pulmonary disease hospitalized for left thoracic empyema caused by the aspiration of a grass bur. Our patient did not recall the aspiration event and the diagnosis was further obfuscated by a lack of radiographic evidence and other distracting disease processes. Thus, this case exemplifies the rationale for maintaining a suspicion of foreign body aspiration even for patients with little historical or radiographic evidence to support the presence of a foreign body. This is particularly salient for patients with a tumultuous hospital course or those who fail to respond to treatment.</p>","PeriodicalId":21418,"journal":{"name":"SAGE Open Medical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11342433/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056357","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}
Pub Date : 2024-08-22eCollection Date: 2024-01-01DOI: 10.1177/2050313X241272551
Bryanna Sullivan, Moreen Matti, Gene Cho, Seoyoon Lee, Matthew Nobari
Hypereosinophilic syndrome (HES) is a disorder characterized by elevated levels of eosinophils, which may be associated with multi-organ involvement depending on severity. The recent diagnostic criteria for idiopathic HES require an elevated absolute eosinophil count (AEC) above 1500 cells/mcL with evidence of tissue damage. We present a case of a 37-year-old male firefighter with a purported history of eosinophilic bronchitis who was referred to the hospital with syncopal episodes and a persistent productive cough. The patient showed an AEC of 4500 cells/mcL on admission associated with high inflammatory markers. Cardiac imaging demonstrated acute myocarditis with heart failure and a reduced ejection fraction. Chest imaging was initially suggestive of community-acquired pneumonia. Workup was negative for a malignant etiology; infectious causes similarly were excluded. After a multidisciplinary evaluation, a diagnosis of idiopathic HES was made and steroids were instituted with rapid resolution of symptoms. Our case illustrates the importance of considering hypereosinophilia as a precipitating factor for acute heart failure in an otherwise healthy adult. An expeditious diagnosis can lead to early initiation of steroids to avoid progression toward multi-organ failure.
{"title":"Probable idiopathic hypereosinophilic syndrome: A case report of severe multi-organ eosinophilic involvement in a young male presenting with heart failure.","authors":"Bryanna Sullivan, Moreen Matti, Gene Cho, Seoyoon Lee, Matthew Nobari","doi":"10.1177/2050313X241272551","DOIUrl":"10.1177/2050313X241272551","url":null,"abstract":"<p><p>Hypereosinophilic syndrome (HES) is a disorder characterized by elevated levels of eosinophils, which may be associated with multi-organ involvement depending on severity. The recent diagnostic criteria for idiopathic HES require an elevated absolute eosinophil count (AEC) above 1500 cells/mcL with evidence of tissue damage. We present a case of a 37-year-old male firefighter with a purported history of eosinophilic bronchitis who was referred to the hospital with syncopal episodes and a persistent productive cough. The patient showed an AEC of 4500 cells/mcL on admission associated with high inflammatory markers. Cardiac imaging demonstrated acute myocarditis with heart failure and a reduced ejection fraction. Chest imaging was initially suggestive of community-acquired pneumonia. Workup was negative for a malignant etiology; infectious causes similarly were excluded. After a multidisciplinary evaluation, a diagnosis of idiopathic HES was made and steroids were instituted with rapid resolution of symptoms. Our case illustrates the importance of considering hypereosinophilia as a precipitating factor for acute heart failure in an otherwise healthy adult. An expeditious diagnosis can lead to early initiation of steroids to avoid progression toward multi-organ failure.</p>","PeriodicalId":21418,"journal":{"name":"SAGE Open Medical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11342427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056355","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}
Pub Date : 2024-08-22eCollection Date: 2024-01-01DOI: 10.1177/2050313X241274218
Jacfar Hassan, Christian Hyde, Michael Joiner, Steven Raymond Miller
High-grade gliomas (HGGs) are the most aggressive of brain tumors and are one of the most common primary intracranial malignancies. The poor prognosis after aggressive treatment of HGGs makes these gliomas a challenge to treat with curative intent. Proton radiation therapy is a recent radiation modality that is being explored for the treatment of HGGs. Proton radiation therapy provides improved sparing of critical normal structures while giving an ablative dose of radiation to the tumor, which can be performed more accurately than photon beam radiation therapy. We report a case of a diffuse HGG treated with proton radiotherapy and chemotherapy after previously being treated with photon irradiation. A complete radiographic response was seen on MRI imaging after proton irradiation.
{"title":"Complete radiographic response after proton radiation therapy in the re-irradiation of a diffuse high-grade glioma: A case report.","authors":"Jacfar Hassan, Christian Hyde, Michael Joiner, Steven Raymond Miller","doi":"10.1177/2050313X241274218","DOIUrl":"10.1177/2050313X241274218","url":null,"abstract":"<p><p>High-grade gliomas (HGGs) are the most aggressive of brain tumors and are one of the most common primary intracranial malignancies. The poor prognosis after aggressive treatment of HGGs makes these gliomas a challenge to treat with curative intent. Proton radiation therapy is a recent radiation modality that is being explored for the treatment of HGGs. Proton radiation therapy provides improved sparing of critical normal structures while giving an ablative dose of radiation to the tumor, which can be performed more accurately than photon beam radiation therapy. We report a case of a diffuse HGG treated with proton radiotherapy and chemotherapy after previously being treated with photon irradiation. A complete radiographic response was seen on MRI imaging after proton irradiation.</p>","PeriodicalId":21418,"journal":{"name":"SAGE Open Medical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11342437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056351","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}
Foreign body (FB) ingestion leading to appendicular perforation, although rare in adults, presents a complex clinical challenge. The clinical presentation may not always be straightforward, necessitating a comprehensive array of diagnostic examinations. In fact, accurate and timely diagnosis is crucial to prevent severe complications. In this report, we present a case where a misleading clinical presentation led to the unexpected discovery of appendicular perforation during surgery, despite initial suspicion of small bowel perforation - a 77-year-old male patient who was edentulous and under follow-up for chronic bronchitis stage IV. He sought medical attention due to a 2-week history of right iliac fossa pain, during which he did not experience vomiting or fever. Upon physical examination, there was a tenderness noted in the sub umbilical region. An abdominal computed tomography (CT) scan was performed, revealing the presence of a dense FB which seems to be a bone located in the last ileal loop. Additionally, the appendix appeared slightly distended. Given the clinical presentation, which strongly indicated acute peritonitis resulting from small bowel perforation, and following consultation with gastroenterologists, it was decided that endoscopic retrieval was not suitable for this case. Therefore, a surgical approach was chosen, involving a midline incision, as laparoscopy was absolutely contraindicated because of patient's respiratory distress. Per-operatively, we identified a clear effusion, and within the wall of the appendix, we discovered a thin, sharp chicken bone that had become lodged, resulting in a phlegmonous and perforated appendix. The 2-cm bone was successfully removed, and an appendectomy was performed. The post-operative period was uneventful, and the patient was discharged on the fourth postoperative day. This case highlights the need for a high index of suspicion for atypical clinical presentations and the ongoing need for research to improve our understanding and management of this rare condition, ultimately enhancing patient outcomes.
异物(FB)摄入导致阑尾穿孔在成人中虽然罕见,但却是一个复杂的临床难题。临床表现并不总是很直接,因此需要进行一系列全面的诊断检查。事实上,准确及时的诊断对于预防严重并发症至关重要。在本报告中,我们介绍了一例因临床表现误导而在手术中意外发现阑尾穿孔的病例,尽管最初怀疑是小肠穿孔--患者是一名 77 岁的男性,无牙齿,因慢性支气管炎 IV 期而接受随访。他因右髂窝疼痛两周而就医,期间没有呕吐或发烧。体格检查时发现脐下区域有压痛。腹部计算机断层扫描(CT)显示,在最后一个回肠襻处有一个致密的FB,似乎是一块骨头。此外,阑尾出现轻微膨胀。鉴于临床表现强烈显示小肠穿孔导致急性腹膜炎,在咨询了消化科医生后,决定内镜取材不适合该病例。因此,由于患者呼吸困难,腹腔镜手术是绝对禁忌症,我们选择了中线切口的手术方式。围手术期,我们发现了清晰的积液,并在阑尾壁内发现了一根薄而锋利的鸡骨头,这根骨头已经卡住阑尾,导致阑尾痰多和穿孔。我们成功取出了这块 2 厘米长的骨头,并进行了阑尾切除术。术后恢复顺利,患者于术后第四天出院。本病例强调了对非典型临床表现高度怀疑的必要性,以及持续开展研究以提高我们对这种罕见病症的理解和管理,最终改善患者预后的必要性。
{"title":"Chicken bones: An etiology of a misleading clinical presentation of a rare case report of appendicular perforation.","authors":"Trabelsi Mohamed Mehdi, Kammoun Neirouz, Nasseh Souhir, Bhouri Souha, Chaouch Mohamed Ali, Oueslati Annouar, Khalfallah Mehdi, Nouira Ramzi","doi":"10.1177/2050313X241275802","DOIUrl":"10.1177/2050313X241275802","url":null,"abstract":"<p><p>Foreign body (FB) ingestion leading to appendicular perforation, although rare in adults, presents a complex clinical challenge. The clinical presentation may not always be straightforward, necessitating a comprehensive array of diagnostic examinations. In fact, accurate and timely diagnosis is crucial to prevent severe complications. In this report, we present a case where a misleading clinical presentation led to the unexpected discovery of appendicular perforation during surgery, despite initial suspicion of small bowel perforation - a 77-year-old male patient who was edentulous and under follow-up for chronic bronchitis stage IV. He sought medical attention due to a 2-week history of right iliac fossa pain, during which he did not experience vomiting or fever. Upon physical examination, there was a tenderness noted in the sub umbilical region. An abdominal computed tomography (CT) scan was performed, revealing the presence of a dense FB which seems to be a bone located in the last ileal loop. Additionally, the appendix appeared slightly distended. Given the clinical presentation, which strongly indicated acute peritonitis resulting from small bowel perforation, and following consultation with gastroenterologists, it was decided that endoscopic retrieval was not suitable for this case. Therefore, a surgical approach was chosen, involving a midline incision, as laparoscopy was absolutely contraindicated because of patient's respiratory distress. Per-operatively, we identified a clear effusion, and within the wall of the appendix, we discovered a thin, sharp chicken bone that had become lodged, resulting in a phlegmonous and perforated appendix. The 2-cm bone was successfully removed, and an appendectomy was performed. The post-operative period was uneventful, and the patient was discharged on the fourth postoperative day. This case highlights the need for a high index of suspicion for atypical clinical presentations and the ongoing need for research to improve our understanding and management of this rare condition, ultimately enhancing patient outcomes.</p>","PeriodicalId":21418,"journal":{"name":"SAGE Open Medical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11342422/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056350","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}
Pub Date : 2024-08-22eCollection Date: 2024-01-01DOI: 10.1177/2050313X241272670
Yingjing Shen
In extracorporeal circulation, inflammatory mediators are eliminated through inflammatory cytokine adsorption. By interacting with inflammatory cytokines and removing them from the bloodstream, the adsorber's adsorbent lowers levels of inflammatory mediators and the inflammatory response. We present the case of a 67-year-old Chinese man diagnosed with sepsis due to a bloodstream infection from a catheter. We promptly utilized a cytokine adsorption column in conjunction with continuous veno-venous hemodiafiltration (CVVHDF), resulting in a decrease in interleukin-6 levels and complete removal of bascteria from the bloodstream. A critical turning point in illness management is reached as the levels of inflammatory cytokines drop and the dosage of patients' vasoactive medications improves significantly. In hemodialysis patients with secondary septic shock in the context of catheter-associated bacteremia, the combination of CVVHDF with cytokine adsorption therapy in hemodialysis may be clinically useful and improve or accelerate the patient's improvement.
{"title":"CVVHDF combined with cytokine adsorption column ameliorates severe catheter-related bloodstream infection in a hemodialysis patient.","authors":"Yingjing Shen","doi":"10.1177/2050313X241272670","DOIUrl":"10.1177/2050313X241272670","url":null,"abstract":"<p><p>In extracorporeal circulation, inflammatory mediators are eliminated through inflammatory cytokine adsorption. By interacting with inflammatory cytokines and removing them from the bloodstream, the adsorber's adsorbent lowers levels of inflammatory mediators and the inflammatory response. We present the case of a 67-year-old Chinese man diagnosed with sepsis due to a bloodstream infection from a catheter. We promptly utilized a cytokine adsorption column in conjunction with continuous veno-venous hemodiafiltration (CVVHDF), resulting in a decrease in interleukin-6 levels and complete removal of bascteria from the bloodstream. A critical turning point in illness management is reached as the levels of inflammatory cytokines drop and the dosage of patients' vasoactive medications improves significantly. In hemodialysis patients with secondary septic shock in the context of catheter-associated bacteremia, the combination of CVVHDF with cytokine adsorption therapy in hemodialysis may be clinically useful and improve or accelerate the patient's improvement.</p>","PeriodicalId":21418,"journal":{"name":"SAGE Open Medical Case Reports","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11342434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142056352","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}