World Journal of Clinical Cases最新文献

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.

With fungal infections rising worldwide, the use of azoles, polyenes, and echinocandins, the mainstay of antifungal therapy has expanded markedly. With broader use, uncommon adverse effects are increasingly being identified. Azoles, the most widely prescribed class of antifungal agents, inhibit several cytochrome P450-dependent steps in human steroidogenesis, leading to disruption of endocrine pathways. Adrenal and gonadal dysfunctions with ketoconazole, and mineralocorticoid excess with posaconazole and itraconazole, are well-documented. Uncommon manifestations, such as voriconazole-induced syndrome of inappropriate antidiuretic hormone secretion or salt-losing nephropathy, and fluoride-related periostitis associated with voriconazole and itraconazole, have also been reported. The adverse reactions may be further influenced by drug interactions with enzyme inducers or inhibitors. Amphotericin B is known to cause electrolyte disturbances due to tubular damage. Echinocandins differ from azoles and polyenes in that they rarely affect endocrine pathways, making them a safer option when endocrine toxicity is a concern. Clinicians must remain vigilant to the endocrine adverse effects and pharmacological interactions of antifungal agents to enable timely recognition and management.

Disseminated herpes simplex virus infection in erythrodermic psoriasis remains exceedingly uncommon, yet it poses substantial diagnostic and therapeutic challenges in patients receiving biologic therapy. The recent case by Berjawi et al illustrates an atypical presentation of widespread herpes simplex virus-1 in a patient undergoing treatment with ixekizumab and topical corticosteroids, highlighting diagnostic uncertainty, cumulative immunosuppression, and therapeutic decision-making in severe psoriasis. This correspondence aims to emphasize the challenges of early herpes simplex virus recognition, discuss the potential but associative role of interleukin-17 inhibition in antiviral defence, and underscore the lack of clinical guidance regarding interruption and safe reintroduction of biologic therapy following viral clearance.

Background: Although hepatic adenomas (HA) account for less than 0.04% of all liver neoplasms, their occurrence in young women is rare but strongly associated with oral contraceptive use, particularly in the 20-40 years age group, with an annual incidence estimated at approximately 3 to 4 cases per 100000 population.

Case summary: We report the case of a previously healthy 30-year-old female patient, a regular user of combined oral contraceptives, who presented with acute hemorrhagic abdomen due to spontaneous rupture of a HA. The clinical presentation occurred after physical exertion and was with evidence of intra-abdominal bleeding. Initial management included selective hepatic arterial embolization as a conservative approach. Due to ongoing hemorrhage, an urgent left partial hepatectomy was indicated.

Conclusion: The operation was completed without adverse events, and postoperative recovery was favorable. This report emphasizes the significance of prompt diagnosis and immediate surgical intervention when hemodynamic compromise occurs due to HA rupture.

Background: Intraosseous lipomas are rare developmental anomalies that present with visual impairment. Due to their infrequency, they often pose diagnostic challenges, particularly in differentiating them from more common optic nerve pathologies. Magnetic resonance imaging (MRI) plays a crucial role in the early identification and management of these lesions.

Case summary: We present the case of a 41-year-old male with a history of dyslipidemia who developed sudden onset headaches and decreased vision in his left eye. MRI revealed a T1-hyperintense fat-containing lesion within the left anterior clinoid process of the sphenoid bone at the optic canal, causing extrinsic compression of the left optic nerve, initially interpreted as a lipoma. Intraoperatively, the previously thought lipoma lesion was actually shown to be adipose tumor of the bone and pathological examination confirmed the diagnosis. The left optic nerve was successfully decompressed, and the patient's vision improved significantly post-op. This case highlights that while MRI is essential in evaluating optic nerve compressive lesions, radiologic findings alone may be insufficient, and surgical and pathological correlation remains crucial for accurate diagnosis.

Conclusion: This case highlights the importance of considering intraosseous lipoma of the sphenoid bone as a rare cause of optic nerve compression and emphasizes the pivotal, but not definitive, role of MRI, which must be complemented by surgical and histopathological correlation to prevent irreversible visual loss.

Background: Erdheim-Chester disease (ECD) is an ultra-rare non-Langerhans cell histiocytosis driven by clonal proliferation of lipid-laden histiocytes. With fewer than a thousand documented cases globally, it remains largely unreported in South Asia.

Case summary: A 46-year-old male presented with chronic leg pain, polyuria, and visual disturbances. Radiologic findings revealed symmetric osteosclerosis of long bones and absent pituitary shadow with thickened stalk of pituitary gland. Histopathology showed foamy histiocytes positive for CD68 and CD163 but negative for CD1a and Langerin. Detection of BRAF V600E mutation confirmed the diagnosis. The patient was treated with corticosteroids and interferon-alpha, with significant symptomatic improvement at six months.

Conclusion: This case represents the first case of ECD reported from Pakistan. Awareness of its distinct imaging and histologic patterns can facilitate diagnosis even in resource-limited settings. National rare disease registries and access to molecular diagnostics are essential for improving outcomes.

Background: Scorpion envenomation in pregnancy is a rare but potentially fatal obstetric emergency, with limited evidence on optimal management and antivenom safety. Neurotoxic venom induces autonomic storms, threatening maternal cardiovascular stability and uteroplacental perfusion, which can lead to fetal distress or demise.

Case summary: A 31-year-old gravida 4, para 3 woman at 36 weeks' gestation presented 30 minutes after a confirmed Parabuthus maximus sting to her right foot. She manifested systemic envenomation, including agitation, profuse sweating, tachycardia (142 bpm), and hypertension (168/102 mmHg). Cardiotocography revealed fetal tachycardia (175-180 bpm). A multidisciplinary team initiated intravenous morphine, midazolam, and species-specific antivenom (South African Vaccine Producers Polyvalent Scorpion Antivenom), resulting in the resolution of maternal and fetal symptoms within 12 hours. Critically, antivenom was administered within 40 minutes of the sting, which likely contributed to the rapid reversal of the catecholamine surge. A key factor enabling this rapid and targeted response was the patient's action of capturing the scorpion, allowing for precise species identification. The pregnancy progressed uneventfully to term, culminating in an uncomplicated vaginal delivery of a healthy infant.

Conclusion: This case illustrates that scorpion envenomation in late pregnancy poses a dual threat to both maternal and fetal well-being. Prompt recognition, continuous fetal monitoring, and the very early administration of antivenom-buttressed by multidisciplinary care-can avert catastrophic outcomes. This case provides supporting evidence that antivenom can be safe and effective during the third trimester, even in resource-constrained environments. Public education on safe first aid, including bringing the scorpion for identification, is essential.