SAGE Open Medical Case Reports最新文献

We present a case of a 16-year-old boy with asthma referred to pediatric gastroenterology for nausea and chronic cough. Esophagogastroduodenoscopy and bronchoscopy revealed parakeratosis/hyperkeratosis in the esophagus and nontuberculous mycobacteria pulmonary infection, respectively. Presumed reflux as a unifying cause for his symptoms was confirmed with intra-esophageal pH monitoring, and he was successfully treated with a proton pump inhibitor and a four-drug antimicrobial regimen.

Although anatomical variations in pulmonary arterial branching are relatively common, the presence of an anterior truncal basal pulmonary artery is extremely rare. We herein report a unique case of right lower lobe lung cancer associated with an aberrant mediastinal A7 + 8 + 9 + 10(b + c) artery, successfully managed with thoracoscopic right lower lobectomy. A 76-year-old man presented with a gradually enlarging part-solid ground-glass opacity in segment 10 of the right lower lobe, clinically diagnosed as stage cT1aN0M0, stage IA1 adenocarcinoma. Contrast-enhanced imaging was not possible due to an allergy to iodinated contrast; however, high-resolution CT revealed an aberrant basal pulmonary artery that originated from the right main pulmonary artery and coursed medially into the lower lobe. Three-dimensional preoperative reconstruction was limited due to the lack of contrast enhancement. Video-assisted thoracoscopic right lower lobectomy was performed after wedge resection confirmed malignancy. Pathological staging was pT1aN0M0, stage IA1. The patient had an uneventful postoperative course and remains recurrence-free at 1 year. This case highlights the importance of detailed preoperative imaging review, particularly when contrast-enhanced computed tomography is contraindicated. A careful assessment of High-resolution computed tomography in multiple planes and an awareness of radiographic signs are essential for detecting rare vascular anomalies and ensuring safe surgical outcomes.

Influenza A infection is most commonly associated with pulmonary disease. However, viral infection can also rarely induce extrapulmonary complications, such as myocarditis, neuropsychiatric pathologies, and rhabdomyolysis. Influenza-A-induced rhabdomyolysis is an uncommon complication, and failure to appropriately address this pathology can quickly lead to deterioration into acute kidney injury. Recognizing this clinical presentation and differentiating it from viral myalgias is often difficult, as muscle aches are a common feature of Influenza A infection. This challenge is further exacerbated by the broad differential of rhabdomyolysis, including various medications such as antipsychotic and serotonergic medications. We report a case of an adult taking risperidone and trazodone presenting with profound myalgias and dark urine following Influenza A viral illness, who was found to have creatine kinase levels exceeding 60,000 U/L. We highlight relevant literature, discuss various proposed pathophysiological mechanisms, and highlight appropriate management strategies. Fluid resuscitation is a mainstay of management; however, iatrogenic fluid overload, such as pulmonary edema, is a possible complication that must be appropriately addressed. This case underscores the importance of maintaining a high index of suspicion for rhabdomyolysis in patients with Influenza A and presents a novel narrative of rhabdomyolysis resulting from a potentially additive interplay of pharmacological (use of trazodone and risperidone) and nonpharmacological predisposing factors.

A 65-year-old Japanese man presented with right-sided abdominal pain. Findings from computed tomography, esophagogastroduodenoscopy, and endoscopic ultrasound-guided tissue acquisition led to a diagnosis of ampullary cancer with para-aortic lymph node metastasis. To treat the biliary obstruction, a metallic stent was placed endoscopically. Combination therapy comprising gemcitabine-, cisplatin-, and durvalumab-induced marked regression of the lymph node metastases, and the patient's carbohydrate antigen 19-9 levels decreased to within normal limits. After eight gemcitabine, cisplatin, and durvalumab therapy cycles, the treatment was switched to maintenance durvalumab monotherapy. This monotherapy was continued for four cycles without adverse effects, and it maintained the metastatic lymph node's regression and the decreased carbohydrate antigen 19-9 levels. No stent occlusion was observed. Histopathological examination of the biopsy specimen obtained before treatment initiation revealed intestinal-type ampullary cancer, and programmed cell death ligand 1 expression was positive in 10% of tumor cells and 5% of immune cells. Despite the limited evidence regarding the long-term efficacy of gemcitabine, cisplatin, and durvalumab therapy in ampullary cancer, this case report demonstrates its sustained effectiveness over 18 months in a patient with intestinal-type ampullary cancer.

Anti-synthetase syndrome is a rare systemic autoimmune disease characterized by aminoacyl-tRNA synthetase autoantibodies. As an overlap disease, it can present heterogeneously with Raynaud's phenomenon, rash, arthritis, interstitial lung disease, or myositis. Rhabdomyolysis is not commonly seen. Diagnosis of anti-synthetase syndrome is based on autoantibody positivity and clinical presentation and may be supported by muscle biopsy. We describe an unusual case of a 28-year-old woman with anti-Jo-1 anti-synthetase syndrome presenting with isolated rhabdomyolysis without lung or skin involvement. Our case also describes concurrent influenza infection as a potential trigger for anti-synthetase syndrome. This case illustrates the variability and potential severity of this rare syndrome.

Tailgut cysts, also known as retrorectal cystic hamartomas, are rare congenital lesions with the potential for malignant transformation into adenocarcinoma, which presents significant diagnostic and therapeutic challenges. We present the case of a 41-year-old woman with a large presacral mucinous adenocarcinoma that arose from a tailgut cyst. Due to the tumor's size and location, a complete surgical removal was not possible, resulting in an R2 resection. The patient subsequently received adjuvant chemotherapy with the CapeOX regimen, which led to a significant decrease in the size of the primary tumor from 11.5 cm to approximately 2 cm. This was followed by adjuvant radiotherapy. The patient currently has no evidence of radiological progression and remains on close follow-up. This case highlights that in situations where complete surgical excision of a malignant tailgut cyst is not feasible, adjuvant systemic chemotherapy and radiotherapy can be a highly effective treatment option for disease control.

Cavernous malformations are a well-described complication of intracranial radiation; however, have only once previously been described within a vestibular schwannoma following radiotherapy. We report a case of a 78-year-old woman presenting with new hemifacial spasm 16-years following fractionated radiotherapy for a vestibular schwannoma, with imaging suggesting the formation of a cavernous malformation within the tumor. The patient underwent translabyrinthine resection, with final pathology confirming the diagnosis of a cavernous malformation within the vestibular schwannoma. This case highlights the need to maintain a broad differential in patients with new symptoms following radiotherapy for vestibular schwannomas, including hemifacial spasm. Cavernous malformations should be considered among potential radiation-related complications in patients with vestibular schwannoma. Level of Evidence: IV.

Necrotizing myometritis (NM) is a rare but life-threatening postpartum infection. Although most reported cases are attributed to Group A Streptococcus (GAS), NM can also arise as a polymicrobial process in the setting of uterine ischemia, particularly after uterine artery embolization (UAE), and this phenotype often follows a slower, more insidious course that may require different diagnostic and therapeutic strategies. We describe NM due to Enterococcus faecium, Klebsiella pneumoniae, and Eggerthella lenta after retained placenta and UAE. In contrast to the fulminant trajectory typical of GAS-associated NM, this case evolved over 48 days with intermittent symptom remission and ultimately required hysterectomy despite multiple courses of antibiotics and repeated curettage. This case highlights the need to broaden empiric antibiotics to include coverage for anaerobes and enterococci, which are frequently resistant to standard postpartum regimens, and indicates that sonographic findings such as myometrial heterogeneity, hypoperfusion, and tissue discontinuity may provide earlier diagnostic clues than clinical signs alone and should prompt early MRI evaluation. Early recognition of these atypical features is critical to avoid diagnostic delay and improve maternal outcomes.

Metamizole (dipyrone) is a non-opioid analgesic and antipyretic agent belonging to the pyrazolone class. While it is widely used in many countries due to its favourable safety profile compared to non-steroidal anti-inflammatory drugs and opioids, its use has been associated with rare but potentially life-threatening haematologic adverse effects, including neutropaenia and agranulocytosis. These complications typically occur within 6-14 days of treatment initiation but may also arise earlier or significantly later, even after discontinuation of the drug. Given that late-onset neutropaenia after metamizole discontinuation may be underdiagnosed, we present the case of a 92-year-old woman who developed transient, likely drug-induced neutropaenia 10 days later, with spontaneous haematologic recovery. The patient remained asymptomatic, with no signs of infection or evidence of inflammatory or neoplastic systemic disease.

GLP-1 receptor agonists (e.g., semaglutide) and dual GLP-1/GIP receptor agonists (e.g., tirzepatide) are effective for reducing body weight and fat mass, though lean soft tissue loss comprised 26%-40% of weight loss in recent trials. This case series describes three patients (two female, one male; body mass index: 32.9-51.9 kg m^-2) who prioritized lean soft tissue preservation strategies during treatment with semaglutide or tirzepatide. Patients engaged in intentional exercise or structured physical activity 4-7 days·week^-1, including resistance training 3-5 days·week^-1. Typical protein intakes were 0.7-1.7 g·kg^-1·day^-1 relative to body mass and 1.6-2.3 g·kg^-1·day^-1 relative to fat-free mass. Changes in weight, fat mass, and lean soft tissue were: -33.0%, -53.4%, and -6.9% (case 1); -26.8%, -61.6%, and +2.5% (case 2); and -13.2%, -46.9%, and +5.8% (case 3). Accordingly, one patient lost 8.7% of weight as lean soft tissue, while two increased lean soft tissue. These findings highlight the potential for some individuals to preserve or even increase lean soft tissue during treatment with semaglutide or tirzepatide alongside supportive lifestyle strategies.