AME Case Reports最新文献

Background: Painful thyroiditis (PT) combines several variants of pathology. The most common is subacute thyroiditis (ST). Despite the prevailing view that the factors underlying the development of ST have an infectious origin, its viral and bacterial pathogeneses remain unclear. Moreover, the hypothesis of genetic predisposition to ST is non-absolute. In previous studies, approximately 24-40% patients with ST manifested unilateral thyroid disease; however, the assessment of the pathogenesis of ST did not consider this fact.

Case description: This case of unilateral PT in a pregnant woman has become an illustrative example for revising the idea of its pathogenesis. Laboratory data did not show obvious signs of inflammation, which is typical for pregnant women and does not exclude ST. At the same time, rare in the literature illustrations of the ultrasound picture of unilateral PT are shown. Pathological parallels with other unilateral thyropathies have been drawn. A possible source of unilateral thyroid changes may be the nerve-conducting mechanism.

Conclusions: The involvement of the nervous system in the inflammatory process and the possibility that unilateral nerve conduction affects only one of the thyroid lobes, as demonstrated in the present case, indicate that the autonomic nervous system (ANS) plays a leading role in PT development.

Background: Arrhythmogenic cardiomyopathy (ACM) is an inherited cardiac disease characterized by fibrofatty replacement of ventricular myocardium. Ventricular arrhythmia and sudden cardiac death (SCD) are the main clinical manifestations. ACM was previously called arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D). However, recent studies have shown that this disease is not limited to the right ventricle; biventricular involvement occurs in 50% of ACM patients. The left-dominant subtype was subsequently identified, which supported the adoption of the broader term "ACM". The clinical literature includes more extensive reports on ARVC, but reports on arrhythmogenic left ventricular cardiomyopathy (ALVC), which is likely to be underrecognized, are limited.

Case description: In this report, we describe a case of secondary syncope in a patient with ALVC who developed right bundle branch block with ventricular tachycardia (RBBB-VT), with VT originating in the left ventricle (LV). Cardiac magnetic resonance (CMR) revealed significant enlargement of the LV, with LV dysfunction. Late gadolinium enhancement (LGE) and fat sequencing revealed that most of the free wall of the LV was replaced by fibrofatty tissue.

Conclusions: This report could help improve the understanding of this rare disease, and its management. CMR plays a key role in the diagnosis of ACM.

Background: Urolithiasis (kidney stone) is a common condition that often leads patients to urgent or emergency care services. Urinary calculi are generally found in the kidneys, ureters, or bladder. Urethral calculi are uncommon and can result from the migration of a calculus in the upper urinary tract or vesicle or may be primary of the urethra. Prostatic calculi are a rarity.

Case description: A 34-year-old male was admitted to the emergency service of a university hospital reporting dysuria and pain in the hypogastrium with a 4-day history. The patient reported that the pain sometimes irradiated to the left flank, accompanied by micturition effort, a weak urinary stream, pollakiuria, and urine output with a crystal appearance. The clinical history revealed urinary difficulty since 10 years of age. The patient was submitted to radiological investigation. Pelvic computed tomography revealed a voluminous calculus with slightly lobulated contours in the intravesical topography in the interior of the prostatic urethra. Urethrocystography revealed a prostatic calculus and the tapered passage of contrast through the prostatic urethra. After the diagnosis, the rectal examination confirmed the presence of a hardened calculous mass in the prostatic topography. Considering the complementary evaluation of the patient, perineal prostatotomy was planned. Prostatotomy was performed longitudinally in the prostatic capsule for the removal of the calculus after its release by dissection.

Conclusions: In cases of patients with urinary retention treated at an emergency service, the following diagnostic hypotheses should be investigated: benign hyperplasia of the prostate, urethral stenosis, prostatic urethral calculus, and prostatic calculus. In prostatic calculus, regarding access for definitive surgery, in this case, the perineal route proved to be the best therapeutic option.

Background: Auditory hallucinations, commonly associated with psychiatric conditions such as schizophrenia, can arise as side effects to certain medications. Several drug classes are commonly implicated in the causation of hallucinations, such as anticholinergics. Medication associated with disruption of steroid production may lead to neuropsychiatric disruption. One such drug class, statins, may also have psychiatric sequelae. Wide prescribing of common medication such as atorvastatin, allows the unveiling of uncommon medication-related adverse events.

Case description: We detail a unique case-report of a 60-year-old man experiencing auditory hallucinations post-initiation of atorvastatin. The content of the hallucinations consisted of voices of deceased family members. These were frequently accompanied by predominantly frontal headaches. Subsequently, during the treatment of a chest infection utilizing cefalexin, the auditory hallucinations intensified in clarity and increased in frequency. Despite initial concerns related to a family history of meningiomas, magnetic resonance imaging ruled out structural abnormalities. Comprehensive viral screening excluded infectious as the causative factor and there were no signs of concurrent delirium. Following termination of the course of cefalexin, the hallucinations reduced in intensity. The cessation of atorvastatin led to the resolution of hallucinations.

Conclusions: This case emphasizes the importance of drug history evaluation in neuropsychiatric presentations and prompts further exploration into the neuropsychiatric effects of commonly prescribed drugs.

Background: Central retinal artery occlusion (CRAO) is a rare but critical complication that might appear after percutaneous coronary intervention (PCI) with a high risk of blindness. The report on the nursing management of CRAO patients after PCI is rare.

Case description: This patient is a 50-year-old female patient who was admitted to the Cardiovascular Department with repeated chest tightness. Initial assessment diagnosed as unstable angina and received a PCI. The patient complained of white patches in the left eye and blurred vision ten minutes after returning to the ward. The nurse found patient's symptoms at once and reported to the attending doctor for the first time of diagnosis. Fundus photography results confirmed the diagnosis of CRAO. The patient received high-flow oxygen inhalation and hyperbaric oxygen chamber treatment for days. Nitroglycerin sublingual administration and nitroglycerin intravenous micropump were used to improve retinal microcirculation. Finally, arterial thrombolysis was given to remove the embolism in the central retinal artery. The nurse played an important role in disease observation, risk identification, early detection, cooperation with doctors, post-thrombolytic care, and psychological care. The patient's left eye vision showed significant recovery, and she was discharged successfully. The patient reported gradual improvement in left-eye vision during the follow-up assessment.

Conclusions: This case report presents the interventions taken by nurses in early detection and care for a CRAO patient after PCI and expands the literature describing nursing management for patients with postoperative complications of PCI.

Background: There are few reports about the one-stage surgery of transcatheter aortic valve replacement (TAVR) + mitral valve transcatheter edge-to-edge repair (M-TEER) around the world. TAVR + M-TEER surgery is usually performed under the simultaneous guidance of digital subtraction angiography (DSA) and echocardiography. There is no report of TAVR surgery assisted only by echocardiography all over the world. This case shows a novel one-stage transesophageal echocardiography-guided TAVR + M-TEER surgery, which provides a new idea for minimally invasive therapy.

Case description: A 75-year-old man with recurrent chest tightness was diagnosed with bicuspid aortic valve malformation and severe regurgitation of aortic and mitral valves. The symptom was not relieved by medications. After evaluation with transthoracic echocardiography and computerized tomography angiography (CTA) of the aorta, transapical TAVR and M-TEER were performed simultaneously with satisfied clinical results. The patient's activity tolerance and cardiac function were improved.

Conclusions: In the past, this surgery needs to be performed in a specific operating room equipped with an X-ray machine, and there are many steps in the whole procedure that requires more medical staff. Transesophageal echocardiography-guided minimally invasive valvular surgery reduces the reliance on the hybrid operating room, mitigates the impact of radiation on physicians and patients, and also provides a treatment chance for gravidas with valvular disease.

Background: Many reports described the importance of multidisciplinary meetings in providing oncologic patients with the best treatment strategies. This item improved overall survival, accuracy of staging and adherence to guidelines. For mediastinal neoplasms, collaboration between different surgical skills allows to deal with challenging/impossible surgical procedures. We report a series of four patients with a mediastinal-localized tumor with extensive infiltration of adjacent major structures. All cases were discussed at our multidisciplinary meeting where surgical indication was assessed. The presence of several surgical specialists, the role of anesthesiologists and sub-intensive clinicians was essential for proper operative and postoperative planning.

Case description: A 70-year-old patient with type-A thymoma underwent a via sternotomy thymectomy with an end-to-end caval anastomosis and an end-to-side anastomosis with the left brachiocephalic trunk by prosthesis. A 52-year-old patient with malignant peripheral nerve sheath tumor of left sternocleidomastoid muscle underwent surgical excision and chest wall reconstruction by Teflon prosthesis and pedicled flap from the rectus abdominis. A 41-year-old woman diagnosed with monophasic synovial sarcoma of the anterior mediastinum. After chemotherapy without benefit, she underwent debulking surgery with excision of this huge mass and right phrenic nerve reconstruction by neural graft from the contralateral phrenic nerve. A 23-year-old woman affected by myasthenia gravis (MG) with a type-B3 thymoma diagnosis. After chemotherapy without benefit, she underwent a thymectomy and left pneumectomy with reconstruction of the superior vena cava (SVC).

Conclusions: Multidisciplinary evaluation and surgical team are crucial in such complex cases to customize the most appropriate surgical planning and treatment.

Background: The underlying pathophysiology of some occupational diseases such as silicosis involves autoantibodies. An autoantibody, antineutrophil cytoplasmic antibody (ANCA), has been recently reported and is known to be elevated in diseases such as vasculitis; therefore, the disease is currently known as ANCA-associated vasculitis. The risk of ANCA-associated vasculitis is known to be 25 times higher in patients with silicosis than in those without any occupational disease. In this report, the author describes the case of a man who developed ANCA-associated vasculitis after silicosis, leading to severe alveolar hemorrhage and renal dysfunction.

Case description: A Japanese man in his 50s who was engaged in tunnel construction for 33 years presented with the chief complaint of cough with sputum. Based on chest images and his occupational history, a diagnosis of silicosis was made. In November 2008, urinary occult blood was detected; therefore, myeloperoxidase anti-neutrophil cytoplasmic antibody (MPO-ANCA) levels were measured (15.9 U/mL). In September 2009, he experienced systemic fatigue, fever, night sweats, bloody sputum, and difficulty breathing. Chest images showed new shadows, and MPO-ANCA levels had increased to 690 U/mL. His bronchoalveolar lavage fluid was bloody, confirming alveolar hemorrhage. The bloody sputum resolved spontaneously; however, a subsequent short-term increase in serum creatinine levels was observed. Renal biopsy confirmed necrotizing crescentic glomerulonephritis. Therefore, he was diagnosed with MPO-ANCA-associated vasculitis with silicosis, alveolar hemorrhage, and rapidly progressive glomerulonephritis. Treatment with combination therapy of pulse methylprednisolone sodium succinate and cyclophosphamide led to remission.

Conclusions: For patients with silicosis, accompanied by bloody sputum or other symptoms, ANCA-associated vasculitis, besides tuberculosis and lung cancer, should be considered. It is also necessary to pay close attention to the possible onset of rapidly progressive glomerulonephritis because it is sometimes fatal. In addition, when examining a patient with rapidly progressive glomerulonephritis, attention must be paid to whether the patient has had previous exposure to silica dust, regardless of whether or not the exposure was occupational.

Background: There are hundreds of pathogens that cause lung infections. Compared to infections caused by a single pathogen, mixed infections account for a larger proportion of pulmonary infections and have a more severe clinical presentation, while treatment options differ between the two. We aimed to explore the advantages of metagenomic next-generation sequencing (mNGS) in the diagnosis and treatment of mixed infections.

Case description: To investigate the specific pathogens in a 79-year-old male pneumonia patient who had recurrent cough with poor empirical treatment, we collected bronchoalveolar lavage fluid (BALF) from the patient and performed mNGS technology, along with Sanger sequencing and polymerase chain reaction (PCR) was carried out to confirm the authenticity of the pathogens detected by mNGS. The findings showed that rare pathogen Scedosporium boydii (S. boydii, reads: 18) and Mycobacterium avium complex (MAC, reads: 19) were detected, and the patient was subsequently transferred to another hospital for the same mNGS with the same results as the first detection. Therefore, combined treatment with voriconazole, ethambutol, azithromycin, and levofloxacin were given to the S. boydii and MAC for 1 week, and then patient's condition improved and discharged.

Conclusions: mNGS, a non-targeted sequencing technology, could improve the efficiency of clinical diagnosis for mixed infection of rare or atypical pathogens, bring new ideas for clinical pathogen diagnosis, and improve patient prognosis.

Background: Surgical clip migration is a rare complication that can happen many years following a successful cholecystectomy. It has a similar clinical presentation as choledocholithiasis. The diagnosis is usually made using imaging modalities such as ultrasounds, computed tomography (CT) scans, or magnetic resonance cholangiopancreatography (MRCP). If left untreated, complications such as acute cholangitis, acute pancreatitis, clip embolism, duodenal ulcer, and obstructive jaundice can develop. Endoscopic retrograde cholangiopancreatography (ERCP) is the therapeutic modality of choice for extracting the migrated clip with a high success rate. Surgical exploration is rarely required and reserved for complicated situations such as the presence of biliary stricture, fistula or concurrent large stones.

Case description: We are presenting a case of a 51-year-old female who experienced a surgical clip migration 30 years after her laparoscopic cholecystectomy. The patient presented with abdominal pain and found to have deranged liver function test. Abdominal CT showed a dilated common bile duct (CBD) of 1.1 cm with a lodged metallic density within the CBD consistent with a surgical clip. ERCP was subsequently performed, which confirmed the presence of 1 cm free floating clip within the CBD.

Conclusions: Laparoscopic cholecystectomy carries risk of late complications like surgical clip migration, and it should be considered as a differentia in patients presenting with picture of choledocholithiasis.