World Journal of Clinical Cases最新文献

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.

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.