World Journal of Clinical Cases最新文献

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease that extends beyond joint inflammation, affecting pulmonary and metabolic pathways. Interstitial lung disease (ILD) is one of its most serious extra-articular complications, while type 2 diabetes mellitus (T2DM) frequently coexists with RA and may exacerbate inflammatory and fibrotic processes. This editorial discusses the study by Sutton et al, the largest population-based analysis to date exploring the link between T2DM and ILD in patients with RA, and reflects on its mechanistic and clinical implications. In a nationwide cohort of more than 120000 hospitalized RA patients, Sutton et al demonstrated that the coexistence of T2DM nearly doubles the odds of developing ILD (odds ratio = 2.02; 95% confidence interval: 1.84-2.22), with additional increases in pulmonary hypertension, pneumothorax, and length of stay. These findings reinforce the concept of a metabolic-pulmonary-autoimmune axis, in which chronic inflammation promotes insulin resistance and metabolic dysfunction, while hyperglycaemia and advanced glycation end-products amplify oxidative stress and fibrogenesis. This reciprocal interaction may induce a self-perpetuating cycle of "metaflammation", fibrosis, and organ damage. Conclusion: Recognizing diabetes as a silent amplifier of RA-associated ILD redefines the interface between rheumatology, pulmonology, and endocrinology. Early detection and integrated management of metabolic and pulmonary comorbidities should be prioritized, while future studies must determine whether optimizing glycemic control can attenuate pulmonary fibrosis and improve long-term outcomes.

Background: It is challenging to diagnose isolated hyperbilirubinemia with rare and complex etiologies under the constraints of traditional testing conditions. Herein, we present a rare case of coexisting Gilbert syndrome (GS) and erythropoietic protoporphyria (EPP), which has not been previously documented.

Case summary: We present a rare case of coexisting GS and EPP in a 23-year-old Chinese male with a long history of jaundice and recently found splenomegaly. Serial non-specific hemolysis screening tests yielded inconsistent results, and investigations for common hemolytic etiologies were negative. However, Levitt's carbon monoxide breath test, which measures erythrocyte lifespan (the gold-standard marker of hemolysis), demonstrated significant hemolysis, revealing a markedly shortened erythrocyte lifespan of 11 days (normal average 120 days). Genetic testing subsequently confirmed EPP with a homozygous ferrochelatase gene mutation and GS with a heterozygous uridine diphosphate glucuronosyl transferase 1A1 gene mutation.

Conclusion: The rapid, non-invasive Levitt's carbon monoxide breath test resolved the diagnostic challenge posed by a rare and complex cause of hyperbilirubinemia.

Hodgkin lymphoma (HL) is a heterogenous lymphoproliferative disorder of B-cell origin and represents one of the most common malignancies in children and young adults. In addition to well-known underlying factors - such as Epstein-Barr virus infection - the familial aggregation demonstrated in large population studies suggested a genetic predisposition. First-degree relatives of patients with HL have an approximately threefold increased risk of developing the disease compared to the general population. These observations have recently prompted several whole-genome studies in affected families, identifying variants possibly implicated in lymphomagenesis, including alterations in DICER1 (a member of the ribonuclease III family), POT1 (protection of telomeres 1), KDR (kinase insert domain receptor), KLHDC8B (kelch domain-containing protein 8B), PAX5 (paired box protein 5), GATA3 (GATA binding protein 3), IRF7 (interferon regulatory factor 7), EEF2KMT (eukaryotic elongation factor 2 lysine methyltransferase), and POLR1E (RNA polymerase I subunit E). In this article, we review current insights into the etiopathogenesis and risks of familial HL, and present case reports involving two sisters diagnosed with HL nearly 17 years apart. Recognizing the risk for first-degree relatives may potentially increase awareness of early symptoms among family members of HL patients, leading to earlier diagnosis and better outcomes. Conversely, understanding that the hereditary risk, though higher than in the general population, remains relatively low may provide reassurance for affected families.

Background: Edwardsiella tarda (E. tarda) belongs to the family Enterobacteriaceae and is generally seen to cause infections mainly in fish, but is also capable of infecting humans. Extraintestinal infections occur in patients with certain risk factors, including immunocompromised status. We recently diagnosed a case of spontaneous bacterial peritonitis (SBP) due to E. tarda in an immuno-compromised dialysis patient.

Case summary: Patient was a 55-year-old male, with a history of diabetic nephropathy being treated with hemodialysis three times a week. He was referred to our hospital due to an increased volume of ascites, and blood examination revealed increased inflammatory reaction. At our emergency department, he developed fever, disturbance of consciousness, abdominal distension, and abdomen-wide pain. In addition, a dialysis shunt was confirmed in his right forearm, and the shunt site showed no signs of inflammation. No wounds were confirmed on or in his body. A blood examination revealed increased values of white blood cells, C-reactive protein, and creatinine. Plain chest and abdominal computed tomography scanning revealed increased ascites volume. Abdominal paracentesis was performed and a Gram stain revealed Gram-negative bacillus. These findings prompted diagnosis of SBP. The patient was admitted and treated with cefmetazole, causing fever resolution and symptom improvements. Later, E. tarda was identified in ascites culture. The patient improved with decreased inflammatory response and was discharged on the 12^th day of hospitalization. The antibiotic was terminated after 14 days of treatment. SBP in this case may have developed from chronic renal failure and diabetes mellitus.

Conclusion: We report the first known case of SBP due to E. tarda in an immuno-compromised dialysis patient.

Background: Primary ileal squamous cell carcinoma (PISCC) is a rare malignant tumor of the ileum. Its development is an exceptional phenomenon, as the ileal mucosa is lined exclusively by simple columnar epithelium, with no native squamous epithelium under physiological conditions. PISCC accounts for fewer than 0.001% of all intestinal malignancies. As of 2025, only 12 confirmed cases have been documented in the global literature, predominantly as isolated case reports.

Case summary: A 47-year-old female developed abdominal pain two years after chemotherapy for ovarian low-grade serous carcinoma (International Federation of Gynecology and Obstetrics stage IC1). Positron emission tomography/computed tomography showed localized thickening of the small intestinal wall in the right pelvic region with increased metabolic activity, suggesting implantation metastasis. The patient underwent partial ileal resection, intestinal anastomosis, appendectomy, omentectomy, and pericolic lymphadenectomy. Histopathological and immunohistochemical analyses confirmed a primary ileal low-grade squamous cell carcinoma. Postoperatively, the patient received intravenous doxorubicin plus carboplatin combined with anti-angiogenic targeted therapy. After six cycles, the regimen was changed to paclitaxel plus carboplatin with bevacizumab. Following five cycles, maintenance therapy with intravenous bevacizumab monotherapy was initiated, supplemented with adjunctive hepatoprotective agents. At the 30-month postoperative follow-up, the patient remained progression-free with no clinical or radiologic evidence of recurrence or distant metastasis.

Conclusion: Accurate diagnosis of PISCC requires integration of clinical history, systemic examination, histopathology, and immunohistochemical profiling to reduce misdiagnosis and missed diagnosis.

Chemotherapy-related cardiac dysfunction (CTRCD) remains a major barrier to optimal cancer survivorship, threatening quality of life and long-term outcomes. Contemporary guidelines emphasize early detection through multimodal strategies, including echocardiographic global longitudinal strain (GLS) and cardiac biomarkers, but their real-world uptake is inconsistent. In this issue, Méndez-Toro et al present a retrospective cohort from Colombia that highlights this gap, reporting a CTRCD incidence of 8.8% in high-risk oncology patients. Although the authors observed clear declines in left ventricular ejection fraction and GLS among affected patients, less than 40% underwent end-of-treatment echocardiography and only one-quarter had biomarker surveillance. The study underscores three critical lessons: Multimodal monitoring is under-utilized, reported incidence likely underestimates the true burden, and low- and middle-income countries face unique challenges in implementing structured cardio-oncology programs. These findings demand a shift from sporadic monitoring to pragmatic, risk-adapted protocols that can translate early detection into meaningful cardioprotection.

Background: Psoriasis is often first recognized by patients through online image searches. However, search engine algorithms influenced by geographic location may still produce results that predominantly feature lighter skin tones, regardless of the region's majority skin type. This underrepresentation may limit recognition and delay care for people of color.

Aim: To examine whether search algorithms tailor region-specific results in terms of skin color for psoriasis imagery.

Methods: This observational study recruited 66 participants from 18 countries who conducted image searches for "psoriasis" across various web browsers. During the meeting, a Google form was posted to record observations, and participants reported the diversity of skin tones in the first three rows of search results using a reference image depicting Fitzpatrick types.

Results: Results showed a global bias toward lighter skin tones, with 94% of participants identifying light skin predominance in the first row and minimal representation of medium or darker skin tones in subsequent results, verified via χ ² analysis. Participants who observed darker or mixed skin tones typically found them further down their results.

Conclusion: There remains a significant gap in global representation of psoriasis imagery. This paper deepens the current understanding of bias in online media and pushes for further exploration of more inclusive dermatologic imagery.

Background: Patients who have undergone pancreaticoduodenectomy (Whipple procedure) often develop complex late complications that may be diagnostically challenging. We report a rare cause of recurrent fever and abdominal pain in such a patient: Fish bone-induced jejunal perforation. This case emphasizes the importance of maintaining suspicion for atypical, non-biliary causes in post-Whipple patients with recurrent symptoms, particularly when conventional tests suggest no biliary obstruction. A thorough linear diagnostic approach and multidisciplinary collaboration are essential. The delay in diagnosis highlights the challenges of interpreting subtle imaging findings and correlating them with clinical symptoms mimicking cholangitis.

Case summary: A 55-year-old female with a Whipple procedure history 10 years earlier presented with recurrent fever and severe abdominal pain. An initial extensive workup, including imaging and laboratory tests, was inconclusive. Only after detailed re-evaluation of the computed tomography images revealed a subtle linear hyperdensity and subsequent deep push enteroscopy was an embedded fish bone in the efferent jejunal limb identified and removed endoscopically.

Conclusion: Clinicians should consider gastrointestinal foreign body perforation in the differential diagnosis of recurrent fever and abdominal pain in patients with altered anatomy after Whipple procedure. Critical image review and advanced enteroscopic techniques are invaluable for diagnosing obscure causes in complex cases.

The influence of obesity on the recovery of patients after laparoscopic surgery is multi-faceted and complex, presenting both challenges and advantages brought by laparoscopic technology. This study assessed clinicopathologic differences and 1-year outcomes following elective laparoscopic cholecystectomy (LC) in patients with obesity and gallstone disease. Generally, obesity increases the difficulty of laparoscopic surgery and the risk of postoperative complications, thereby having a negative impact on the recovery process. However, compared with traditional open surgery, laparoscopic surgery has greatly reduced the surgical trauma and promoted their postoperative recovery. Despite these preoperative differences, obesity did not adversely affect short-term surgical outcomes after elective LC. However, LC can reduce incision-related complications in obese patients and help lower the risk of pulmonary complications. Patients can move around earlier, which is crucial for preventing thrombosis. Laparoscopic surgery has brought more recovery advantages to obese patients. Through meticulous preoperative assessment, precise intraoperative operation and good postoperative management, the negative impact of obesity factors on patients can be reduced.

Background: Lower respiratory tract viral infections are a major cause of mortality in children under five years old, leading to hundreds of thousands of fatalities annually. The highest risk is observed in infants under one year old, underscoring the critical need for safe and effective antiviral protocols.

Case summary: A 9-month-old infant suffered from severe bronchiolitis as manifested by high fever (39 °C), decreased appetite, tachypnea, wheezing, and oxygen desaturation (SpO₂ 84% on room air) and was effectively managed at home using Kelleni's protocol, which includes age-adjusted dose of nitazoxanide (60 mg twice daily), ibuprofen and azithromycin, complemented by selective antihistaminic, antitussive and mucolytic immunomodulatory treatment. The fever resolved, wheezing became more prominent but without respiratory distress, and oxygen saturation gradually increased to 92% by day 10. Nitazoxanide exerts broad antiviral and immunomodulatory effects by enhancing host interferon responses and inhibiting viral replication, potentially attenuating airway inflammation and accelerating resolution of bronchiolitis. The nitazoxanide dose (60 mg twice daily for five days) was carefully adjusted based on the developmental expression and activity of the uridine diphosphate-glucuronosyltransferase 1A1 enzyme, responsible for its metabolism, ensuring safe age-appropriate administration. The infant's clinical status steadily improved, and by day 14 the infant achieved full recovery with normalization of oxygen saturation (96% on room air). No adverse events occurred, and follow-up at day 28 confirmed sustained recovery.

Conclusion: To the best of my knowledge, this report presents, for the first time globally, a potential of nitazoxanide within Kelleni's protocol to early manage infants younger than one year suffering from severe lower respiratory tract viral infection at home. Selective antitussive treatment, using agents such as low dose benproperine, was employed to mitigate troublesome cough and improve patient comfort without compromising respiratory function. Additionally, alpha amylase was used to facilitate pulmonary secretion clearance. The protocol aims to reduce morbidity and mortality from viral lower respiratory tract infections in this vulnerable population.