World Journal of Clinical Cases最新文献

Background: Streptococcus bovis (S. bovis) bacteremia and infective endocarditis have a well-established association with colorectal cancer (CRC), though the mechanisms underlying this potentially bidirectional relationship remain poorly understood.

Case summary: This case report describes a 55-year-old male with a history of hypertension and hemicolectomy due to advanced colorectal adenomas who presented with syncope, septic shock, and a 12-pound weight loss over 3 weeks. Subsequent blood cultures grew S. bovis, with a transthoracic echocardiogram revealed mobile vegetations on both the aortic and mitral valves. A sessile, non-obstructing cecal adenocarcinoma was also observed on colonoscopy. The patient was started on 6 weeks of intravenous ceftriaxone, followed by surgical repair of both heart valves and a laparoscopic right hemicolectomy.

Conclusion: This presentation underscores how CRC-induced mucosal disruption may predispose to bacterial translocation, resulting in systemic infection and endocarditis.

Background: The management of stage IV pressure ulcers (PUs) in elderly, high-risk surgical patients remains a formidable clinical challenge, often limited by the invasiveness and risks of standard surgical options. Although Aloe vera has known wound-healing properties, clinical evidence of its efficacy in complex, severe PUs is scarce. This case report details a novel, non-invasive combination therapy centered around an aloe-derived micellar emulsion dressing (Aloe vera barbadensis extract R, AVBER) and demonstrates its potential as a viable palliative strategy for this vulnerable population.

Case summary: A 90-year-old, severely malnourished female (body mass index 13.3 kg/m²) presented with extensive, bilateral stage IV ischial PUs following a femoral fracture. Given her frailty and high surgical risk, a conservative regimen was initiated. This regimen comprised the topical application of an AVBER dressing, targeted red light therapy, and intensive nutritional support, all guided through telemedicine. Over a period of 8.5 months, this treatment was associated with complete healing of the left ulcer and near-complete resolution (from 15 cm × 15 cm to 0.8 cm × 3.0 cm) of the right ulcer, with no serious adverse events reported. The PU scale for healing score for the right ischial ulcer decreased markedly from 17 to 6.

Conclusion: AVBER-based combination therapy represents a promising non-invasive option for managing severe PUs in surgically ineligible patients.

Background: Histiocytic sarcoma (HS) is a rare lymphohematopoietic malignancy with nonspecific clinical manifestations, diagnostic challenges, high aggressiveness, and a poor prognosis. Primary HSs arising in the spleen are extremely uncommon, with few cases reported globally. Here, we present the clinical course of a patient with splenic HS.

Case summary: A 67-year-old woman was admitted to our hospital because of a large splenic mass that was detected during a routine health examination 1 month before presentation. Abdominal computed tomography revealed a large occupying lesion in the spleen, which was possibly a lymphangioma. The patient underwent splenectomy, and postoperative pathological examination confirmed the diagnosis of splenic HS. At the 6-month telephonic follow-up, the patient reported feeling well.

Conclusion: Given the paucity of cases and the poor prognosis of splenic HS, whose definitive diagnosis hinges exclusively on pathology, and given that all current therapeutic strategies are based on isolated case reports, it is imperative to enhance our understanding of this disease to improve patient diagnosis and management.

Background: Postdural puncture headache (PDPH) is a significant complication of neuraxial procedures. Although conservative treatments and the invasive epidural blood patch (EBP) are currently standard approaches, the sphenopalatine ganglion (SPG) block is emerging as a promising, less-invasive alternative. The pathophysiology of PDPH involves cerebrospinal fluid leakage, resulting in reduced intracranial pressure and compensatory cerebral vasodilation, which is partially mediated by SPG stimulation. The SPG block aims to interrupt this vasodilation using local anesthetics, thereby alleviating headache symptoms.

Aim: To provide a comprehensive overview of current evidence regarding the use of the SPG block in treating PDPH, explores the anatomical and physiological basis of this intervention, describes various administration techniques for administering the block, and critically assesses the efficacy and safety data from clinical studies.

Methods: A systematic literature search was conducted on PubMed and the Cochrane Database to identify systematic reviews and meta-analyses published up to April 2025, using the keywords "sphenopalatine ganglion block" and "post-dural puncture headache".

Results: The SPG block is a simple, noninvasive, and effective bedside procedure. Clinical studies have demonstrated that it provides rapid pain relief, with high success rates and an onset of action typically within 10-30 minutes. The most used technique is the transnasal approach, which is associated with minimal and transient adverse effects such as nasal discomfort and bitter taste.

Conclusion: Although EBP remains the preferred treatment for severe PDPH, the SPG block is a viable alternative for mild-to-moderate cases, often allowing patients to postpone or avoid EBP. Comparative studies suggest that SPG block has a quicker onset than EBP, though in some cases, it provides shorter duration relief. Overall, the SPG block is a safe, effective, and readily accessible treatment for PDPH. Its minimally invasive nature and high success rate in providing rapid pain relief make it an excellent first-line alternative to more invasive procedures. Further large-scale, standardized randomized controlled trials are required to optimize protocols and fully integrate the SPG block into mainstream clinical practice.

Background: Familial Mediterranean fever (FMF) is the most common autoinflammatory disease, characterized by uncontrolled activation of the innate immune system that manifests as recurrent fever and polyserositis (e.g., peritonitis, pleuritis, and arthritis). However, diagnosing atypical cases remains challenging.

Case summary: A 9-year-old girl had a history of progressive loss of appetite, weight loss, and myalgia over the preceding three months. She developed high-grade fever over the preceding three weeks, occasionally associated with abdominal pain. The girl is one of a triplet; neither of the other two sisters had similar symptoms. Family history was irrelevant. She presented with cachexia, generalized body aches, and fever without evident arthritis. She had splenomegaly and a markedly elevated erythrocyte sedimentation rate. After exclusion of rheumatological and malignant causes, FMF was suspected. Serum amyloid A was high. The patient received colchicine therapy. There was a significant improvement in her symptoms with normalization of acute-phase reactants. Polymerase chain reaction test for FMF gene mutation returned negative.

Conclusion: FMF can present with atypical symptoms. Detailed history and meticulous clinical evaluation were key clues suggesting the diagnosis.

Prolonged exposure to microgravity profoundly influences ocular physiology, giving rise to spaceflight-associated neuro-ocular syndrome (SANS), a significant concern for astronauts on long-duration missions. This review consolidates current evidence on ocular adaptations to spaceflight, encompassing pathophysiological mechanisms, diagnostic advances, related ocular conditions, and emerging countermeasures. Literature published between 2000 and 2025 was systematically examined across PubMed, Scopus, and Web of Science, integrating both peer-reviewed studies and technical reports from the National Aeronautics and Space Administration and the European Space Agency. Findings indicate that ocular changes consistent with SANS affect approximately one-third of astronauts, with higher prevalence during missions exceeding six months. Hallmark features include optic disc edema, posterior globe flattening, and mild hyperopic shifts, attributed to cephalad fluid shifts, altered cerebrospinal fluid dynamics, venous congestion, and impaired glymphatic flow. Besides SANS, microgravity predisposes astronauts to dry eye disease, immune-related infections, and radiation-induced cataracts. Recent advances in in-flight optical coherence tomography, optical coherence tomography angiography, and ultrasound have enhanced early detection, while countermeasures such as lower body negative pressure, artificial gravity, and artificial intelligence-driven ocular monitoring show promise. Understanding ocular adaptations to space not only mitigates mission risks but also enriches terrestrial knowledge of intracranial pressure regulation and neuro-ophthalmic health.

The recently published case report describing mixed connective tissue disease coexisting with tuberculosis (TB) provides an important contribution to the growing literature on complex autoimmune-infectious disease interactions. This letter expands on the diagnostic challenges highlighted by the authors by defining its added clinical value: Identifying practical diagnostic "red flags", emphasizing parallel consideration of autoimmunity and infection, and proposing a pragmatic approach to evaluation in TB-endemic settings. Early immunological testing, differentiated pulmonary assessment, and multidisciplinary decision-making are essential when overlapping features obscure timely diagnosis and complicate therapeutic choices.

Background: Drug-induced liver injury poses a diagnostic challenge in oncology patients, especially those on immune checkpoint inhibitors, because symptoms often overlap with immune-mediated hepatitis. The increasing use of social media has led people to self-administer veterinary anthelmintics like fenbendazole for cancer, often at high doses and without medical guidance, despite limited data on safety or effectiveness.

Case summary: We report a case of a 47-year-old woman with metastatic colon cancer on nivolumab/relatlimab who developed severe hepatocellular liver injury after increasing her self-administered dose of fenbendazole. A detailed medical and temporal history, supported by a Roussel Uclaf Causality Assessment Method score of 8 (probable), identified fenbendazole as the most likely cause. Rapid biochemical improvement occurred after stopping the drug, with safe reintroduction of immunotherapy and no recurrence of liver injury.

Conclusion: This case emphasizes the importance of thorough medication history-taking and structured causality assessment to distinguish between unregulated drug-induced liver injury and immune-related adverse events in cancer care. The use of social media to promote alternative therapies necessitates proactive patient counseling due to significant liver risks, and careful diagnostic evaluation can prevent unnecessary immunosuppression or treatment delays.

Background: Oral cavity cancers are highly invasive malignancies, typically treated with a combination of surgery, radiation, and chemotherapy. Surgical intervention requires the removal of all affected tissues, including the mandibular basal bone. Reconstructive procedures may involve tissue and skin grafts, such as fibula free flaps in the case of mandibulectomy. These techniques aim to minimize scarring and restore basic oral functions. However, radiation therapy may result in fibrotic scarring of the connective tissues. This case report focuses on the integration of surgical, prosthetic, and complementary therapies - including hyaluronic acid (HA) -based filler - to address both functional and aesthetic deficiencies.

Case summary: The case involves a 70-year-old woman who underwent a right segmental mandibulectomy with fibula free flap reconstruction for pT4aN2b oral squamous cell carcinoma, followed by adjuvant radiochemotherapy. After surgery, she presented to the Odontology Department of Montpellier University Hospital with severe trismus, impaired mastication, and aesthetic concerns, including marked facial atrophy and asymmetry of the face and mouth. The multidisciplinary approach included fluoride trays to address radiotherapy-induced risks, caries treatment, a mandibular partial removable prosthesis for occlusal and soft tissue support, occlusal bonding, and HA injections to restore facial symmetry and improve soft tissue quality. HA was injected into the fibrotic connective tissue to improve skin hydration and counterbalance the asymmetry of the mouth. The combination of prosthetic rehabilitation and HA injections led to significant functional and aesthetic improvements, with a notable positive impact on the patient's sociability and quality of life.

Conclusion: This case highlights how a multidisciplinary, comprehensive, personalized, and biopsychosocial approach can optimize outcomes in complex oral rehabilitation following oncological surgery.