SAGE Open Medical Case Reports最新文献

This case report discusses two clinical encounters of a 62-year-old Hispanic woman initially hospitalized with suspected Stevens-Johnson syndrome, later correctly diagnosed with bullous fixed drug eruption during an outpatient visit for a similar eruption. The first encounter involved an extensive evaluation and an 11-day hospital stay, while the second was managed successfully as an outpatient with oral prednisone. This report highlights the importance of differentiating bullous fixed drug eruption from Stevens-Johnson syndrome/toxic epidermal necrolysis and emphasizes the need for a collaborative approach between Primary Care Providers and Dermatology to ensure optimal patient care.

Cutaneous metastases from colorectal cancer are an uncommon but critical finding, typically signaling advanced disease with poor prognosis. This case report describes a 64-year-old woman with a limited past medical history who presented to our outpatient dermatology practice with rapidly spreading erythematous, indurated, and nearly verruciform plaques in the groin, vaginal, and perineal region. Biopsy confirmed metastatic adenocarcinoma of colonic origin, and diagnostic imaging, and colonoscopy revealed stage IV colorectal cancer involving extensive cutaneous, lymphatic, and visceral metastases. Unfortunately, the patient had not received routine colorectal cancer screening, despite a positive family history. Due to extensive disease, palliative radiation was not an option, and systemic chemotherapy was initiated. This case emphasizes the need for awareness of cutaneous metastases as a potential initial presentation of undiagnosed malignancies, the importance of routine colorectal cancer screening, and timely biopsy of suspicious skin lesions for early diagnosis and management.

We present a case of an 82-year-old woman who developed sustained heart failure with left ventricular dyssynchrony after the modified Bentall procedure. Persistent circulatory instability and complete atrioventricular block suggested coronary artery stenosis. Multidetector computed tomography revealed stenosis of the grafted portion of the coronary artery. The patient was successfully treated by coronary artery bypass grafting with simultaneous epicardial cardiac resynchronization therapy system implantation.

We present a case in which renal mixed epithelial and stromal tumor (MEST) was considered in the differential diagnosis based on preoperative imaging findings. A 38-year-old woman was found to have a right renal tumor during an abdominal ultrasound examination conducted as part of a health checkup. Contrast-enhanced computed tomography revealed a 50 × 40-mm mass in the middle of the right kidney. The possibility of papillary renal cell carcinoma was considered. However, given the patient's age, sex, and characteristics of the mass, MEST was also considered a differential diagnosis. The patient underwent laparoscopic radical right nephrectomy. The tumor was diagnosed as MEST.

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare systemic necrotizing vasculitis marked by eosinophilia and extravascular granulomas, predominantly affecting the respiratory tract. This report details a unique EGPA case in a 6-year-old girl with extensive cardiac involvement, featuring an atypical intracardiac mass suggestive of endomyocardial fibrosis and a concomitant thrombus. The clinical course unfolded in three phases: an initial prodrome with asthma; subsequent peripheral hypereosinophilia; and ultimately systemic vasculitis. Cardiac involvement, notably an intracardiac mass in the right ventricular apex extending into the interventricular septum, underscored the diverse nature of EGPA. The patient fulfilled sufficient criteria outlined by the American College of Rheumatology and the European Alliance of Associations for Rheumatology for an EGPA diagnosis, displaying hypereosinophilia, obstructive airway disease, and biopsy-confirmed inflammation predominantly characterized by extravascular eosinophils. Treatment included high-dose methylprednisolone and cyclophosphamide, which resulted in clinical improvement and inflammatory marker normalization. To halt right ventricular thrombus progression, therapeutic unfractionated heparin was initiated, and she was transitioned to warfarin, which resulted in complete resolution of the cardiac mass. This case highlights the necessity of a multidisciplinary approach for managing complex EGPA manifestations, particularly in pediatrics, and emphasizes the importance of timely intervention in mitigating the impact of cardiac complications associated with EGPA.

Stevens-Johnson syndrome and drug reaction with eosinophilia and systemic symptoms are severe cutaneous adverse reactions to drugs that are generally considered distinct entities. In addition to identifying the offending medication, distinguishing between these diagnoses is important, as they have differing treatment regimens and prognoses. Distinction between severe cutaneous adverse reactions, particularly in the early stages of disease, can be difficult, and overlapping conditions have been reported in the literature. We present two cases of severe cutaneous adverse reaction, one following initiation of carbamazepine and the other lamotrigine, with extensive mucosal involvement and epidermal detachment, initially diagnosed as Stevens-Johnson syndrome. Despite the use of cyclosporine and repeated doses of etanercept, both cases evolved to have significant edema of the face and extremities, palmar and plantar involvement, and rapid response to systemic corticosteroids, which is more in-keeping with drug reaction with eosinophilia and systemic symptoms. We aim to help clinicians gain awareness of Stevens-Johnson syndrome/drug reaction with eosinophilia and systemic symptoms overlap which may aid diagnosis and guide treatment.

Light chain deposition disease is a rare condition associated with plasma cell dyscrasia and other lymphoproliferative disorders in which there is overproduction and deposition of non-amyloid light chains in various organs, leading to organ dysfunction. It is well-established that the majority of patients with light chain deposition disease exhibit renal involvement. Although awareness of extrarenal manifestations is increasing, cutaneous involvement has rarely been reported. Herein, we present a case of light chain deposition disease with cutaneous manifestations in the absence of any renal disease. A biopsy of the skin revealed amorphous eosinophilic material within the superficial dermis. Using special stains, immunohistochemistry, and direct immunofluorescence, the deposits were confirmed to be kappa light chains.

Inflammatory myofibroblastic tumors (IMTs) are rare mesenchymal neoplasms characterized by spindle-cell morphology with accompanying inflammatory infiltrates. Originally described in 1939, these tumors can arise in various anatomic locations, with the urinary bladder being a rare site of occurrence but the most common within the genitourinary tract. IMTs typically present as polypoid masses or firm submucosal nodules, often with painless hematuria in bladder cases. Histopathologically, IMTs are composed of myofibroblasts with myxoid stroma and mixed inflammatory cells, predominantly lymphocytes and plasma cells. Immunohistochemically, these tumors commonly express anaplastic lymphoma kinase1 (ALK1), vimentin, smooth muscle actin (SMA), and cytokeratin, with ALK1 serving as a crucial marker for diagnosis. This report details the case of a 31-year-old female presenting with hematuria, found to have a soft tissue mass in the urinary bladder (5.0 × 3.0 cm). Imaging revealed a well-defined lesion with vascularity. Histopathological examination confirmed an IMT, with immunohistochemistry showing diffuse ALK1 positivity, patchy SMA staining, and variable desmin expression, consistent with the diagnosis. IMTs are generally considered neoplasms of intermediate malignant potential. While metastasis is exceedingly rare in bladder IMTs, local recurrence has been reported, particularly in cases of incomplete surgical resection. Recent advances highlight the role of ALK inhibitors in managing unresectable cases, enabling partial cystectomy in select patients. This article underscores the importance of achieving complete surgical excision and highlights the role of ALK expression in diagnosis and differentiation from other spindle-cell neoplasms. Further studies are needed to elucidate the molecular and clinical factors influencing prognosis and to refine treatment strategies for IMTs.

[This corrects the article DOI: 10.1177/2050313X241302013.].

Uterine fibroids are benign tumors, arising from uterine smooth muscle cells. They are one of the most common benign tumors of the female genital tract among childbearing women, occurring in 20%-50% of women of reproductive age. The association of uterine myomas with pregnancy is high. This occurrence is constantly increased, linked to the onset of pregnancies, leading to the incidence of myomas gradually rising with age, hence the emergence of ultrasound reveals during routine ultrasound examinations of pregnancies, that were previously asymptomatic. Myomectomy during the second trimester was done and pregnancy continued safely to the third trimester. After successfully repairing it, the pregnant woman followed her antenatal care at Wollega University Referral Hospital, Western Oromia, Ethiopia. We presented the 20-year-old primigravida lady with a complaint of lower abdominal pain and a slight fever. We found a non-pedunculated, attached to the uterus via a broad base) myoma measuring 4 × 4 cm on 2D pelvic ultrasound. We admitted the client and gave her conservative management after we put her on antibiotics. Despite antibiotics, the pain persists we decided to manage it through an operation after we counseled the client about the potential complications. Then we removed the myoma without manipulating the uterus and it was a successful myomectomy without complicating the fetomaternal conditions. Currently, fetomaternal conditions are safe, and the woman is following her antenatal care at Wollega University's Referral Hospital. In the majority of cases of women with fibroids, pregnancy comes with complications, according to literature data, The coexistence of the myoma with pregnancy: increased frequency of spontaneous abortions and premature births, increased risk of bearing ablation, higher incidence of maternal-fetal incommunicability, incorrect position of the fetus, more often performed cesarean surgery, higher probability of postpartum hemorrhage. Prenatal myomectomy can be safely performed in the first and second trimesters of pregnancy; however, it is recommended to deliver the baby via cesarean section, due to fear of intrauterine rupture of the uterus.