World Journal of Clinical Cases最新文献

The study included all patients at risk for chemotherapy-related cardiotoxicity, without exclusions based on the type of cancer, reflecting the institution's epidemiology with a predominance of breast cancer. Myocarditis was not an exclusion; its absence may reflect underdiagnosis. Age, although a known risk factor, showed no significant differences, and no upper chemotherapy dose limits were imposed to better capture real-world scenarios. A typographical error in the patient count was amended to 195. Limitations include its retrospective design, selection bias, and incomplete dose data. A prospective multicenter registry is underway to enhance diagnostic accuracy, include diverse types of cancer, and improve generalizability.

Background: The frequent occurrence of respiratory diseases in the island reef environment of the navy severely affects the health of personnel and the combat effectiveness of the troops. Current common screening methods can only indicate whether there is an infection with pathogenic microorganisms but not the degree of disease progression. Therefore, it is necessary to identify simple-to-operate and cost-effective methods that indicate the degree of disease progression, based on traditional screening methods.

Aim: To explores correlation between serum concentrations of nicotinamide phosphoribosyltransferase (NAMPT), nicotinamide nucleotide adenylyltransferase 1 (NMNAT1), and the risk of upper respiratory infections in the island reef envirsonment.

Methods: A total of 600 cases of upper respiratory infections among naval officers and soldiers were included. Types of infection were confirmed through sputum culture combined with multiplex polymerase chain reaction. The serum concentrations of NAMPT and NMNAT1 were measured using ELISA, and infection severity was assessed using the pneumonia severity index (PSI). Statistical analysis was performed using nonparametric tests and Spearman correlation analysis.

Results: The serum concentrations of NAMPT and NMNAT1 in high-risk group patients with PSI were significantly lower than those in the medium and low-risk groups (P < 0.05), and the concentrations increased in a stepwise manner with disease progression. However, within the same risk group, the differences in concentrations of NAMPT and NMNAT1 among patients infected with different pathogens were not significant (P > 0.05).

Conclusion: Concentrations of NAMPT and NMNAT1 are closely related to severity of upper respiratory infections, and their common regulatory mechanisms provide new directions for development of broad-spectrum anti-infection strategies.

Background: Posterior shoulder dislocation is a rare injury. It accounts for only 1%-4% of all shoulder dislocation cases. However, this injury is often underdiagnosed. Massive rotator cuff tears associated with posterior shoulder dislocation are exceptionally rare. Early diagnosis and surgical management are crucial for restoring shoulder function and preventing long-term disability.

Case summary: A 60-year-old male with no previous shoulder injuries presented to our hospital with severe right shoulder pain and immobility after a motorcycle accident. He reported that he braced his fall with his right hand. Initial imaging examination revealed posterior shoulder dislocation with minimal glenoid bone loss. Six days after the injury, the patient exhibited pseudoparalysis and active forward flexion limited to 10°. Two weeks after the injury, magnetic resonance imaging revealed complete tears of the supraspinatus, infraspinatus, and subscapularis muscles as well as dislocation of the long head of the biceps tendon. Arthroscopic rotator cuff repair was performed 6 weeks after injury. The tendon quality was acceptable with minimal fatty infiltration. At the 12-month surgical follow-up, the patient had recovered full strength and complete range of motion.

Conclusion: Early diagnosis and tailored repair of massive rotator cuff tears after dislocation are crucial for restoring shoulder function in older patients.

Background: Complications occur in approximately 12% of cases of diverticulitis, with perforation occurring in up to 10% of complications. Typically, patient with perforated diverticulitis present intraperitoneally with abdominal pain and peritoneal signs. By contrast, pneumoretroperitoneum and pneumomediastinum are rare complications and lack typical symptoms, making their diagnosis difficult and often delayed, leading to increased morbidity and mortality.

Case summary: A 66-year-old man presented with lower abdominal pain for 3 days. On examination, his vital signs were stable, and the abdomen was soft with mild distension and left lower quadrant tenderness, but no peritoneal signs were noted. Laboratory tests indicated leukocytosis and a markedly elevated C-reactive protein level. Abdominal computed tomography (CT) revealed focal wall thickening and fat stranding near the rectosigmoid junction as well as pneumoretroperitoneum, pneumomediastinum, and minor pneumoperitoneum. Suspecting hollow organ perforation, an emergent exploratory laparotomy was performed which revealed a retroperitoneal abscess with mesocolonic necrosis, likely due to perforated sigmoid diverticulitis. The patient underwent sigmoid resection with Hartmann's procedure and retroperitoneal drainage. Follow-up CT on postoperative day 14 confirmed resolution of the free air, and the patient was discharged on postoperative day 40 with an uneventful recovery.

Conclusion: Pneumoretroperitoneum and pneumomediastinum are rare complications of perforated diverticulitis, often with delayed diagnosis due to the absence of peritoneal signs. CT aids detection, and timely surgical intervention is crucial.

Background: The special physiological changes during pregnancy pose a huge challenge to the diagnosis of cervical cancer in pregnancy (CCIP). However, due to the poor prognosis of advanced-stage CCIP, there is currently no consensus or guideline for diagnosis and treatment.

Case summary: In this case report, we presented the case of a 30-year-old woman at 30 weeks of gestation who presented with irregular vaginal bleeding and was admitted to a local hospital at 35 weeks of gestation with a sudden gush of fluid and underwent a C-section. During the surgery, a rotten fish-like solid mass in the lower segment of the posterior wall of the uterus was excised for biopsy. The patient was referred to our hospital because she experienced heavy vaginal bleeding 13 days after one chemotherapy session. The solid mass was initially misdiagnosed as uterine clear-cell carcinoma at local hospital but later confirmed as cervical adenosquamous carcinoma by a multidisciplinary team. Three months posttreatment, she succumbed to multiple tumor metastases. The infant was healthy at the latest 2-year follow-up.

Conclusion: Obstetricians should expand differential diagnoses when obstetric factors cannot explain symptoms of persistent vaginal bleeding during pregnancy. Atypical and insidious clinical presentations are often concealed by physiological changes during pregnancy, which may increase the difficulty of diagnosis and result in misdiagnosis.

The prognostic impact of obesity in acute liver failure (ALF) remains underexplored in recent United States cohorts despite the global rise in obesity prevalence. The aim of this letter is to appraise and contextualize the findings of Krishnan et al, who examined the association between body mass index (BMI) and ALF outcomes in a large, retrospective United States cohort. Krishnan et al analyzed 196 ALF patients over two decades, demonstrating that both overweight and obesity independently doubled the risk of death or need for liver transplantation after adjustment for confounders. Elevated BMI was also associated with higher grades of hepatic encephalopathy and renal dysfunction; two major contributors to ALF mortality. Future research should consider additional markers of metabolic health beyond BMI to refine prognostication. This study provides timely, robust evidence linking elevated BMI to adverse ALF outcomes and highlights the need for targeted clinical strategies in this vulnerable subgroup.

Background: Acyclovir (ACV)-resistant herpes simplex virus (HSV) strains have emerged and gradually increased in number. Prolonged treatment, such as for immunocompromised patients, has been observed on many occasions to lead to the development of resistance. Additionally, some strains of HSV exist that are ACV resistant, and they can cause severe complications that may be impossible to treat with current therapies. We report the first case of ACV-resistant herpes encephalitis (ARHE) recurring in an immunocompromised adult patient without neurosurgical intervention.

Case summary: A 58-year-old man with a fever of 38°C had tremors. Evaluation revealed 14 points on the Glasgow Coma Scale with 39°C fever but unremarkable physical examination. Diagnosis was infection of unknown origin; fever continued, and the Glasgow Coma Scale worsened to 8. Imaging showing a high-intensity area between the left temporal lobe and insular cortex suggested herpes encephalitis. ACV was started. Cerebrospinal fluid (CSF) was positive for HSV DNA, confirming the diagnosis. However, unresolved symptoms suggested ARHE; therefore, we initiated vidarabine treatment. Later testing confirmed ARHE. Foscarnet was started based on a hospital day 25 blood test revealing pancytopenia, possibly from vidarabine. Consciousness improved, and the patient moved to rehabilitation. However, symptoms worsened, suggesting recurrence. Diffusion-weighted magnetic resonance imaging revealed a high high-intensity area around the right temporal lobe; CSF was positive for HSV DNA, confirming recurrent herpes encephalitis. ACV and foscarnet were initiated. Fever decreased, consciousness improved, and HSV DNA on hospital days 78 and 93 was CSF negative. Treatment was terminated on hospital day 86.

Conclusion: ARHE recurred in the patient following remission; therefore, it is necessary to discuss the length of the treatment period.

Background: Low-grade appendiceal mucinous neoplasms are papillary or flat mucinous tumors with low-grade cytologic atypia. They are the most frequent source of pseudomyxoma peritonei. They can be easily misdiagnosed, due to unspecific symptoms, with acute appendicitis, retroperitoneal tumors or adnexal mass. Cases of huge appendiceal mucinous neoplasms are even more extremely rare.

Case summary: We report a 54-year-old patient who presented with a 10-month history of constant dull distension accompanied by nausea. A surgical procedure of total hysterectomy, bilateral adnexectomy, appendectomy, greater omentectomy and right hemicolectomy was performed as a result of the findings on ultrasound, computed tomography scan and magnetic resonance imaging. Diagnosis was made after the pathological examination, which revealed low-grade appendiceal mucinous neoplasm. The patient received hyperthermic intraperitoneal chemotherapy with cisplatin and was discharged from the hospital.

Conclusion: Low-grade appendiceal mucinous adenomas are rare tumors that are easily misdiagnosed, and a more thorough clinical workup is required to make a definitive diagnosis.

Background: Mixed connective tissue disease (MCTD) is a rare autoimmune disorder characterized by overlapping features of systemic lupus erythematosus, systemic sclerosis, and polymyositis, and presence of anti-U1 ribonucleoprotein antibodies. Coexistence with tuberculosis (TB), a common infectious disease in endemic areas, poses a significant diagnostic challenge due to overlapping clinical and radiological features.

Case summary: We report a 35-year-old Pakistani female presenting with oral ulcers, body rash, worsening dyspnea, and a history of joint pains initially treated as rheumatoid arthritis. She was on antituberculous therapy (ATT) for presumed pulmonary TB. Laboratory findings revealed anemia, leukopenia, raised erythrocyte sedimentation rate, positive anti-Sm/RNP, anti-dsDNA, and anti-SSA/Ro antibodies, confirming MCTD with clinical features of systemic lupus erythematosus, Sjogren syndrome, and systemic sclerosis. The patient was also positive for hepatitis C and active TB. Treatment involved corticosteroids alongside continuation of ATT, resulting in significant clinical improvement over 12 days, with resolution of symptoms and improved laboratory parameters. The patient remained stable on follow-up with hydroxychloroquine and prednisolone.

Conclusion: This case highlights the diagnostic complexity when autoimmune diseases coexist with TB, particularly in TB-endemic regions. Early recognition and integrated management of both conditions are crucial to improving outcomes. Clinicians should maintain a broad differential diagnosis and perform comprehensive immunological workup in patients with overlapping symptoms.

Background: Pelvic squamous cell carcinoma of unknown primary (CUP) is extremely rare, accounting for less than one percent of all CUP cases, and its infrequency has limited the development of standardized diagnostic and treatment guidelines.

Case summary: A 77-year-old female with a history of resected lung adenocarcinoma presented with worsening constipation. Imaging revealed a 2.5 cm mass adjacent to the right levator ani muscle. Biopsy confirmed poorly differentiated squamous cell carcinoma, positive for pancytokeratin and p40, and negative for p16, cytokeratin 7, cytokeratin 20, and neuroendocrine markers. No primary lesion was identified despite extensive evaluation. She underwent five cycles of 5-fluorouracil (1000 mg/m² continuous infusion, days 1-4) and mitomycin-C (10 mg/m² on day 1) with concurrent pelvic radiotherapy (50.4 Gy in 28 fractions). Follow-up imaging demonstrated complete remission sustained for 12 months. Electrocorticography performance status improved from 2 at diagnosis to 1 during follow-up.

Conclusion: This case highlights the potential role of chemoradiotherapy in managing pelvic squamous cell CUP, achieving durable remission in selected patients.