World Journal of Clinical Cases最新文献

Background: Kawasaki disease (KD) is an acute systemic vasculitis in young children that may cause coronary aneurysms, thrombosis, myocardial infarction, and sudden death if diagnosis is delayed.

Case summary: We report a 19-month-old male patient who presented after 25 days of progressive illness culminating in sudden cardiac arrest. Initial episodes of fever, cough, and rash were misdiagnosed as viral infection and pneumonia, delaying recognition. On admission following prolonged resuscitation, he was comatose with severe metabolic acidosis, multiorgan dysfunction, and periungual desquamation. Echocardiography demonstrated giant bilateral coronary aneurysms with right coronary artery thrombosis, consistent with KD complicated by myocardial infarction. Management included mechanical ventilation, high-dose vasopressors, intravenous immunoglobulin, corticosteroids, anticoagulation, and antibiotics. Continuous renal replacement therapy, targeted temperature management, and therapeutic plasma exchange were employed to control cytokine storm and organ failure. The patient stabilized hemodynamically, was extubated by day 12, and subsequently transferred for cardiology care. Follow-up imaging confirmed persistent aneurysms without thrombosis, preserved cardiac function, and favorable neurological recovery.

Conclusion: This case underscores the challenges of recognizing atypical KD and highlights the importance of early suspicion, rapid resuscitation, and multimodal therapies, including Continuous renal replacement therapy and therapeutic plasma exchange, in improving survival and neurological outcomes.

Background: Fasciola hepatica (F. hepatica) (liver fluke) is a parasitic trematode that infects humans through the consumption of contaminated aquatic plants harboring the infective stage of the parasite. Despite being a neglected tropical disease, a World Health Organization report estimates that it affects approximately 2.4 million people worldwide, with high endemicity in regions characterized by poor sanitation and limited access to clean water. Clinical manifestations range from asymptomatic infection to severe complications such as liver abscess and multi-organ involvement.

Case summary: We report 4 cases with varied and unusual presentations. Case 1: A 41-year-old woman with an initial presumptive clinical diagnosis of liver malignancy. Case 2: A 34-year-old woman who presented with urticaria and eosinophilia, initially suspected to be vasculitis. Case 3: A 67-year-old man who presented with dyspeptic symptoms, easy fatigability, headache, and fever. Case 4: A 60-year-old patient who presented with an eosinophilic liver abscess after prolonged antibiotic treatment failure.

Conclusion: Hepatic fascioliasis is frequently misdiagnosed due to its non-specific symptoms and limited diagnostic tools, especially in resource-limited settings. It is crucial to enhance awareness among healthcare professionals regarding its recognition and appropriate management. This case report aims to contribute to the growing body of literature on F. hepatica infection to facilitate timely diagnosis and empiric treatment with triclabendazole or nitazoxanide, as these are effective and reduce unnecessary interventions.

Background: Liposarcoma is the most common soft tissue tumor in adults. Liposarcoma commonly occurs in the lower extremities and retroperitoneum but rarely in the mediastinum. To the best of our knowledge, this is the first report of bilateral single-port video-assisted thoracoscopic surgery (VATS) for giant mediastinal liposarcoma and the first report of esophageal fistula after this surgery.

Case summary: We present the case of a 71-year-old male patient with a giant posterior mediastinal tumor. Chest computed tomography and magnetic resonance imaging showed that the tumor completely involved the esophagus. The patient underwent bilateral single-port VATS and the tumor was completely removed. An esophageal fistula was detected 9 days after surgery and 2 days after eating. Emergency debridement surgery was performed, and a drainage tube was placed. The fistula healed gradually after the second surgery.

Conclusion: VATS is safer than thoracotomy for treating giant mediastinal liposarcoma. For tumors extensively involving the esophagus, preventive measures against esophageal fistula are necessary.

Primary aldosteronism (PA) is a common disorder, and the condition is underdiagnosed; the prevalence could reach one-third in patients with hypertension, and thyroid carcinoma is the second most common cancer, with papillary thyroid carcinoma (PTC) accounting for 90% of cases. Lymph node metastasis is common in PTC. However, pressure symptoms, including invasion of major local veins and the vagus nerve, are extremely rare. The association between primary hyperaldosteronism and PTC is rare. The interaction between genetic and environmental factors could explain the association. Whether the coexistence of PTC and PA influences the prognosis of PTC is to be explained. The association between PTC and PA with contralateral metastasis, vagus nerve involvement, and invasion to the internal jugular vein is extremely rare. We conducted a comprehensive literature search for relevant articles addressing the possible association of PA and PTC, and we found only 17 cases reported in the literature. The majority were women (10:6 with one study not reporting the gender), the ages ranged from 48 years to 77 years, and perioperative diagnosis was possible in 8 cases. Physicians might need to screen patients with PTC and local invasion for PA.

Background: Celiac disease (CD) is an autoimmune disorder associated with an increased risk of pancreatitis, yet large-scale studies examining long-term risk and specific etiologies in CD patients are scarce.

Aim: To assess the long-term risk of pancreatitis in CD patients.

Methods: We conducted a population-based cohort study with consecutive patients diagnosed with CD using the TriNeTx research network. Each patient was matched to a patient in the control group using a 1:1 propensity score matching to minimize confounding effects. The primary outcomes were the incidence of acute pancreatitis and chronic pancreatitis, and the secondary outcome was to assess the etiologies of pancreatitis. The incidence was estimated using a Cox proportional hazards model with a hazard ratio (HR) and 95% confidence interval (CI).

Results: A total of 160228 patients were identified to have CD, and the remaining 250725 individuals without CD were considered as controls. At 7-year follow-up, CD patients exhibited a significantly higher risk of acute pancreatitis (HR = 2.05; 95%CI: 1.93-2.17) and chronic pancreatitis (HR = 1.42; 95%CI: 1.31-1.54) compared to controls. Elevated risks for alcohol-induced (HR = 1.35), biliary (HR = 1.37), and idiopathic pancreatitis (HR = 1.49) were also observed. Findings remained robust across all follow-up intervals and sensitivity analyses.

Conclusion: Patients with CD have a substantially increased long-term risk of acute and chronic pancreatitis, including alcohol-related, biliary, and idiopathic subtypes. These findings support the routine surveillance of pancreatitis in CD management and highlight the need for further research into disease-specific risk factors and mitigation approaches.

Acute cholangitis (AC) is a heterogeneous disease with considerable variation in clinical presentation and high medical costs. Although the overall mortality rate is decreasing. However, the mortality in severe AC ranged from 10%-30% due to sepsis, multi-organ failure, and systemic inflammatory response syndrome. Assessing the predictors of poor outcomes, including mortality, intensive care unit (ICU) admission, and hospital stay, is vital for early and effective intervention. We assessed the predictors of mortality and ICU admission in patients with AC. We conducted a literature search in PubMed/MEDLINE, Google Scholar, and Cochrane Library for relevant articles. The keywords used were acute cholangitis, biliary cholangitis, predictors, mortality, ICU admission, and Hospital stay. In addition, we assessed the role of early vs late endoscopic retrograde cholangiopancreatography on the outcomes. Old age, end-organ failure, red cell distribution width to albumin ratio, neutrophil-to-lymphocyte ratio, platelet-lymphocyte ratio, the need for ventilator support, diabetes, electrolyte imbalance, procalcitonin-to-albumin ratio, C-reactive protein-to-albumin, Glasgow Coma Scale, and systolic hypertension are predictors of poor outcomes in AC of varying etiology, and concurrent acute pancreatitis was not associated with ICU admission.

Background: Ulcerative colitis (UC) is a chronic inflammatory bowel disease treated with immunosuppressants to control inflammation. Drugs like azathioprine (AZA) and anti-tumor necrosis factor agents increase the risk of extraintestinal malignancies. However, no association has been established between these therapies and endometrial stromal sarcoma. This report presents a rare case of endometrial stromal sarcoma in a patient with UC undergoing immunosuppressive treatment and includes a literature review to explore any possible correlation between the disease, the therapies used, and the development of this rare tumor.

Case summary: Female, 49 years old, with UC pancolitis extension since 2017. She used aminosalicylates and AZA with non-response. She started infliximab and AZA combination therapy in 2020, with optimization in 2021 due to endoscopic activity. In the same year, the patient presented to the emergency room with ascitis and underwent diagnostic paracentesis, which showed serum-ascites albumin gradient < 1.1 g/dL, absence of neoplastic cells, and abdominal and pelvic tomography reported a hypoechoic nodular lesion in the posterior wall of the uterus and elevated carbohydrate antigen 125. Given the suspicion of neoplasia, the suspension of immunosuppressive therapy was indicated. The patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy, and the pathological result reported low-grade endometrial sarcoma. It was decided to introduce vedolizumab for the management of UC; however, even after induction therapy, intense clinical and endoscopic disease activity was maintained, with total proctocolectomy being indicated due to clinical refractoriness and a history of neoplasia.

Conclusion: Patients with inflammatory bowel disease have a higher risk of cancer due to inflammation or treatment. Proper screening with multidisciplinary care can improve outcomes.

Background: Median sternotomy has been considered the gold standard approach for anterior mediastinal tumor resection. However, recent advances in video-assisted thoracoscopic surgery and robotic-assisted thoracoscopic surgery with carbon dioxide insufflation have allowed minimally invasive approaches even for large and locally invasive tumors of the upper-anterior mediastinum. The subxiphoid robotic optical approach is a recently developed technique for accessing the mediastinum. The trans-subxiphoid technique offers excellent exposure of the surgical field, reduces postoperative pain, facilitates specimen retrieval even for large tumors, and potentially improves early surgical outcomes.

Aim: To evaluate the safety, feasibility, and outcomes of a robotic subxiphoid approach for the resecting of large/invasive mediastinal tumors.

Methods: Between July 2024 and September 2025, 12 patients underwent subxiphoid robotic mediastinal resection. The diameter of the operated lesions ranged from 30 mm to 70 mm. A 3 cm subxiphoid incision was made at the subxiphoid level for GelPort placement, allowing for optical port access. Two operating ports were placed at the sixth intercostal space bilaterally. Carbon dioxide insufflations (8-10 mmHg) enlarged the surgical field, improving visualization of critical anatomical landmarks, such as the internal mammary arteries and phrenic nerves. This approach allowed complete resection of large or invasive tumors, preserving thoracic stability and reducing the risk of postoperative myasthenic crisis.

Results: The mean operating time was 170.2 minutes, and the median hospital stay was 3.5 days. No major postoperative complications occurred. Two conversions were necessary: One with a lateral robotic approach due to previous abdominal surgery, and one with a sternotomy for tumor invasion of the aortic arch. Histopathological analysis identified nine thymomas and one solitary fibrous tumor.

Conclusion: Subxiphoid robotic approach is a safe, effective technique for extended thymectomy, fulfilling both oncological and myasthenia gravis surgical objectives.

Background: Immunoglobulin A (IgA) vasculitis, formerly known as Henoch-Schönlein purpura, is a small vessel vasculitis predominantly affecting children. It commonly presents with a triad of purpuric rash, arthralgia, and abdominal pain. However, dermatologic manifestations of IgA vasculitis in black-skinned individuals are poorly documented in literature.

Case summary: This case report describes an 11-year-old black girl with acute onset of rash, joint pain, and abdominal pain, subsequently diagnosed with IgA vasculitis.

Conclusion: The case highlights the importance of early recognition and supportive management in ensuring a favorable outcome, particularly in dark-skinned populations.