World Journal of Clinical Cases最新文献

Ulcerative colitis (UC) is a chronic inflammatory bowel disease that presents significant treatment challenges due to its complexity, especially in terms of the various side effects that traditional medications may bring during the chronic course of the disease. Traditional Chinese medicine (TCM) has emerged as a promising complementary therapy for UC. Based on the latest research, our editorial explored the current issues and potential essential research directions for TCM in treating UC. We anticipate that future high-quality research will pave the way for the optimization of TCM formulas for UC and their broader global application.

This editorial discusses the case report by Kakinuma et al, which details a rare occurrence of uterine artery pseudoaneurysm following hysteroscopic surgery. The case highlights diagnostic challenges and management strategies for this uncommon complication. The editorial explores the implications for clinical practice, emphasizing the importance of early recognition and appropriate intervention to prevent potential severe outcomes. Future research directions to increase the understanding and management of uterine artery pseudoaneurysm in similar clinical settings.

Background: Streptococcus gallolyticus subspecies pasteurianus (SGSP) is a rare pathogen responsible for infant sepsis and meningitis and is potentially overlooked because it is not included in routine group B streptococcal screenings. Hence, we present a case of SGSP-induced infant meningitis and sepsis, accompanied by bronchopneumonia induced by multidrug-resistant Staphylococcus aureus (MRSA), providing insights into the identification, management, and prognosis of this bacterial infection.

Case summary: A 45-day-old female infant presented with two episodes of high fever (maximum temperature: 39.5 °C) and two generalized grand mal seizure episodes that lasted over ten seconds and self-resolved without concomitant symptoms. Postadmission, the patient's C-reactive protein level was 40.73 mg/L, white blood cell count was 13.42 × 10⁹/L, neutrophil ratio was 78.4%, procalcitonin level was 7.89 μg/L, cerebrospinal fluid (CSF) white cell count was 36 × 10⁶/L, multinucleated cell ratio was 95.2%, and protein concentration was 0.41 g/L. Blood and CSF culture revealed that the pathogen was SGSP. The bacterium was sensitive to ampicillin, furazolidone, penicillin, lincomycin, moxifloxacin, rifampicin, vancomycin, and levofloxacin but resistant to clindamycin and tetracycline. Sputum culture revealed the presence of MRSA, which was sensitive to vancomycin. The patient was diagnosed with meningitis and sepsis caused by SGSP, accompanied by bronchopneumonia induced by MRSA. Ceftriaxone (100 mg/kg/d) combined with vancomycin (10 mg/kg/dose, q6h) was given as an anti-infective treatment postadmission. After 12 days of treatment, the infant was discharged from the hospital with normal CSF, blood culture, and routine blood test results, and no complications, such as subdural effusion, were observed on cranial computed tomography. No growth retardation or neurological sequelae occurred during follow-up.

Conclusion: SGPSP-induced infant bacterial meningitis and sepsis should be treated with prompt blood and CSF cultures, and a sensitive antibiotic therapy to ensure a favorable prognosis.

Background: Miller fisher syndrome (MFS) is a variant of Guillain-Barré syndrome, an acute immune-mediated peripheral neuropathy that is often secondary to viral infections. Anti-ganglioside antibodies play crucial roles in the development of MFS. The positive rate of ganglioside antibodies is exceptionally high in MFS patients, particularly for anti-GQ1b antibodies. However, the presence of other ganglioside antibodies does not exclude MFS.

Case summary: We present a 56-year-old female patient who suddenly developed right blepharoptosis and progressively worsening vision in both eyes. There were flu symptoms prior to onset, and a coronavirus disease 2019 test was positive. On physical examination, the patient exhibited bilateral extraocular muscle paralysis, weakened reflexes in both limbs, and impaired coordination. The cerebrospinal fluid examination results showed no obvious abnormalities. Bilateral peroneal nerve F-waves were not extracted. Serum anti-GD1b IgG and anti-GT1a IgG antibodies were positive. The patient received intravenous methylprednisolone (1000 mg/day), with the dosage gradually decreased. Additionally, intravenous high-dose immunoglobulin treatment was administered for 5 days (0.4 g/kg/day) from day 2 to day 6 of hospitalization. The patient's symptoms improved after treatment with immunoglobulins and hormones.

Conclusion: Positive ganglioside antibodies may be used as supporting evidence for the diagnosis; however, the diagnosis of MFS is more reliant on clinical symptoms.

Background: High-dose steroid administration is a common initial therapeutic approach for Vogt-Koyanagi-Harada disease (VKH). Nonetheless, administering substantial doses of steroids to pregnant women necessitates meticulous consideration due to the potential impacts on the mother and fetus. We present a case wherein steroid pulse therapy was administered to a patient who developed VKH during the late stages of pregnancy.

Case summary: The patient was a 26-year-old nulliparous woman. At 33 weeks and 1 day of her pregnancy, she experienced a decline in visual acuity and noticed metamorphopsia in her left eye. Examination revealed bilateral serous retinal detachment, leading to VKH diagnosis. A collaborative effort involving the departments of ophthalmology, internal medicine, and neonatology was initiated. Steroid pulse therapy was administered at 34 weeks and 1 day of pregnancy under hospital supervision. Complications, such as threatened preterm labor and gestational diabetes, emerged, necessitating the initiation of oral ritodrine hydrochloride and insulin therapy. Then, serous retinal detachment was resolved, and visual acuity was restored. Labor pains initiated 32 days post-initiation of steroid pulse therapy (at 38 weeks and 4 days of gestation), culminating in a normal delivery. Mother and newborn experienced an uneventful puerperal course and were discharged from the hospital on the 5th day following delivery.

Conclusion: VKH management in pregnancy requires multidisciplinary coordination, emphasizing collaboration with ophthalmologists and specialists in internal medicine and neonatology.

Background: Mucosa-associated lymphoid tissue (MALT) lymphoma, a type of non-Hodgkin lymphoma, originates in the mucosal lining of body organs and internal cavities, including the nose, mouth, lungs, and digestive tract. The lymphoma develops when the body produces abnormal B lymphocytes. These lymphomas develop at the edge of the lymphoid tissue, called the marginal zone, and, hence, are classified as a type of marginal zone lymphomas. They are the most common type of marginal zone lymphomas although their occurrence is rare. To date, no previous cases of MALT lymphoma in the buccal fat pad have been reported.

Case summary: We report the case of a patient who presented with a mass on the frontal cheek. Magnetic resonance imaging revealed a tumor in the buccal fat pad, and histopathological and immunohistochemical findings confirmed the diagnosis of MALT lymphoma. The patient had a history of Helicobacter pylori and hepatitis C virus infection, suggesting an association between these infective agents and MALT lymphoma.

Conclusion: Consideration of MALT lymphoma is essential in the differential diagnosis of frontal cheek masses.

Allergic rhinitis (AR) poses a significant global health burden, with the potential to progress to asthma, thereby impacting patients' quality of life. Immunotherapy has demonstrated effectiveness in mitigating clinical symptoms by altering the underlying disease mechanisms of AR. This article provides a thorough review of the current state of immunotherapy for AR, encompassing various facets of immunotherapeutic strategies, elucidating their mechanisms and clinical implications. By presenting a nuanced understanding of the present landscape of immunotherapy for AR, this review aims to serve as a valuable reference for informing clinical treatment strategies. The subsequent analysis of diverse immunotherapeutic pathways offers a comprehensive understanding of their mechanisms and clinical implications. A meticulous examination is conducted on subcutaneous immunotherapy, sublingual immunotherapy, oral immunotherapy, intralymphatic immunotherapy, and innovative intravenous gold-induced autologous serum injection therapy. Each pathway is systematically elucidated, with its distinctive features and potential contributions to managing AR emphasized. In conclusion, synthesizing epidemiological insights, immunotherapeutic nuances, and pathway-specific analyses encapsulates a profound understanding of immunotherapy for AR.

Background: Primary cutaneous anaplastic large cell lymphoma (PC-ALCL) poses significant diagnostic difficulties due to its similarity in the appearance of skin lesions with chronic inflammatory disorders and other dermatological conditions. This study aims to investigate these challenges by conducting a comprehensive analysis of a case presenting with PC-ALCL, emphasizing the necessity of accurate differentiation for appropriate management.

Case summary: An 89-year-old female patient with diabetes and hypertension presented with arm and abdominal ulcerated mass lesions. Diagnostic procedures included skin biopsies, histopathological assessments, and immunohistochemistry, complemented by advanced imaging techniques to confirm the diagnosis. The patient's lesions were determined as PC-ALCL, characterized by necrosis, chronic inflammation, and a distinct immunophenotypic profile, including CD30, CD3, CD4, and EBER, CD56, MUM-1, Ki 67-positive in > 80% of tumor cells, CD10, but negative for anaplastic lymphoma kinase, CD5, CD20, PAX-5, Bcl-2, Bcl-6, CD8, and CD15. Recurrence was not reported at the 6-month follow-up.

Conclusion: Accurate PC-ALCL differentiation from similar conditions is crucial for effective management and requires a multidisciplinary approach.

Background: Pancreatic resection is still associated with high morbidity rates and delayed postpancreatectomy hemorrhage (PPH) is the most feared complication as it may lead to hemorrhagic shock or serious septic complications. Today, endovascular approach represent safe and efficient method for minimally invasive management of extraluminal PPH.

Case summary: We describe four patients whose postoperative recovery after pancreatic resection was complicated by postoperative pancreatic fistula (POPF) and visceral artery hemorrhage. In all cases endovascular approach was utilized and it resulted in satisfactory outcomes. We discuss modern diagnostic and therapeutic approach in this clinical scenario.

Conclusion: PPH is relatively uncommon, but it is a leading cause of surgical mortality after pancreatic surgery. Careful monitoring and meticulous follow-up are required for all patients post-operatively, especially in the case of confirmed POPF, which is the most significant risk factor for the development of a PPH. Angiography as a diagnostic and therapeutic method may be an optimal first-line treatment for the management of delayed PPHs. In our experience, endovascular treatment for hemorrhagic complications of pancreatic resections has shown satisfactory results.

The behavior issues of preschoolers are closely related to their parents' parenting styles. This editorial discusses the value and strategies for solving behavior issues in preschoolers from the perspectives of mindfulness and mindful parenting. We expect that upcoming studies will place greater emphasis on the behavioral concerns of preschoolers and the parenting practices that shape them, particularly focusing on proactive interventions for preschoolers' behavioral issues.