AME Case Reports最新文献

Background: Guillain-Barré syndrome (GBS) is an acute/subacute immune-mediated polyneuropathy characterized by varying degrees of limb or cranial nerve involvement, manifested as limb weakness, absent tendon reflexes, and sensory and autonomic dysfunction caused by demyelination and/or axonal damage of peripheral nerves and nerve roots. Upper respiratory tract infections and gastroenteritis are the most important triggering factors, but the occurrence of explosive GBS after injection of ranibizumab is very rare.

Case description: A 53-year-old female was diagnosed with left branch retinal vein occlusion (RVO) and underwent three intravitreal injections of ranibizumab (0.5 mg) in the left eye. After the third injection, she developed weakness, numbness, and tingling in the limbs, which worsened to respiratory muscle paralysis requiring mechanical ventilation and tracheostomy. Cerebrospinal fluid showed protein-cell dissociation, a positive anti-ganglioside antibody spectrum, and electromyography revealed multiple demyelinating changes in peripheral nerves. The diagnosis was GBS. After treatment with immunoglobulin (25 g) therapy, the patient improved. After two months of treatment, the tracheotomy site healed well, and the patient was able to walk independently and perform basic activities of daily living. After one year of follow-up, the patient did not experience a relapse and was basically cured. This successful outcome highlights the importance of promptly recognizing and treating GBS induced by ranibizumab, which is crucial for optimizing patient outcomes and preventing potential life-threatening consequences in patients with RVO.

Conclusions: This case underscores the potential occurrence of GBS in patients undergoing ranibizumab treatment for RVO. It highlights the importance for clinicians to promptly recognize and diagnose GBS, initiate appropriate interventions, optimize patient outcomes, and prevent potential life-threatening consequences.

Background: Bronchoscopy is widely used in clinical diagnosis and treatment of respiratory diseases. Although it is generally safe, cardiac complications such as acute myocardial ischemia and arrhythmia can also occur in patients especially with comorbidities and in elderly ones. Acute malignant coronary vasospasm as a severe cardiac complication can occur during bronchoscopy. It is essential to observe the occurrence of complications and provide early curing.

Case description: We presented a case of a 52-year-old man who experienced chest pain, dyspnea and even shock during bronchoscopy. Electrocardiogram (ECG) showed an acute muti-leads ST-segment elevation and declined to baseline soon after emergent medication treatment including antithrombotic, expansion of coronary artery and fluid replenishment myocardial infarction. Coronary artery spasm was considered according to the clinical symptom and ECG characteristics. Subsequent coronary angiogram which showed normal coronary artery also supported the diagnosis of coronary artery spasm. The symptom of the patient was discovered timely and was treated successfully with good prognosis.

Conclusions: Bronchoscopy is the main and important method of diagnosis and treatment for respiratory diseases. Coronary artery spasm as a serious cardiac complication should be paid more attention during bronchoscopy. Timely and appropriate treatment may lead to better clinical results. Multidisciplinary cooperation plays a key role in the whole therapy. The potential triggers of coronary artery spasm during bronchoscopy mainly include low oxygen, hypersensitivity reactions and chronic inflammatory.

Background: Splenic rupture associated with trauma is common within the population, however, spontaneous splenic rupture is noted to be a rarity in clinical practice. Spontaneous splenic rupture is usually associated with hematologic, neoplastic, or infectious disorders, with infectious mononucleosis associated with Epstein-Barr virus being the most common cause worldwide. Spontaneous splenic rupture without underlying cause is thought to be exceedingly rare. In this article we present a case involving a true spontaneous splenic rupture.

Case description: We present the case of a 73-year-old female with past medical history significant for hypothyroidism, hypertension, squamous cell carcinoma of the chest, and history of tobacco use who presented to the emergency department with acute onset of left-sided flank pain radiating to her shoulder beginning three days prior. Computed tomography of the abdomen and pelvis without contrast revealed an acute splenic injury concerning for rupture with contour obscured by blood products with associated mild to moderate hemoperitoneum. The decision was made to proceed with emergent exploratory laparotomy and splenectomy. Patient received her post splenectomy vaccinations. On follow-up appointment, patient was noted to be doing well.

Conclusions: This case highlights the importance of early diagnosis and treatment of atraumatic splenic rupture, as delayed diagnosis and treatment is associated with significant morbidity and mortality. Operative intervention including splenectomy remains the mainstay of treatment, in addition to appropriate resuscitation. Some authors have reported cases in which hemodynamically stable patients are able to be treated non-operatively, however, the long-term consequences are unknown. Atraumatic spontaneous splenic rupture is often low on the differential diagnoses due to its rarity. Unfortunately, it carries a high risk of morbidity and mortality, and thus timely diagnosis and intervention is imperative.

Background: Despite its life-threatening nature, serotonin syndrome (SS) often eludes initial recognition and remains an underreported condition that can occur with the administration of serotonergic drugs alone or in combination with other medications known to increase levels of serotonin. The diagnosis of SS relies on clinical assessment, as laboratory tests and imaging studies cannot definitively confirm the condition. The majority of reported cases of SS involve polypharmacy rather than single-drug overdose. Diagnosing SS can be challenging for physicians, particularly in the intensive care unit (ICU) settings where patients often present with multiple comorbidities. Nevertheless, SS should be considered in the differential diagnosis, mainly when the treatment regimen includes multiple serotonergic medications.

Case description: We present a case of SS that developed in a patient following the administration of fentanyl. The patient had a medical history of opioid use disorder and was on buprenorphine, amitriptyline, and pregabalin. Symptoms indicative of SS appeared within four hours after fentanyl was administered and began to improve within six hours after cessation of the potential offending agents, with complete resolution occurring within 24 hours.

Conclusions: Our case underscores the significance of conducting a thorough neurological examination and medication assessment for the prompt diagnosis of SS. Additionally, it examines the medications that could have potentially triggered the events described in this case.

Background: Pancoast tumor resection is associated with severe postoperative pain. In addition to wound pain, patients often complain of shoulder and upper extremity pain due to brachial plexus damage, making pain management difficult. We attempted to perform a continuous brachial plexus block in addition to continuous epidural analgesia.

Case description: For a 58-year-old man, left upper lobectomy and chest wall resection around the pulmonary apex was planned for the left Pancoast tumor. In this case, the appearance of neuropathic pain in the shoulder and upper extremity due to the effects of brachial plexus injury associated with the surgical operation was expected. General anesthesia was introduced after insertion of the epidural catheter, followed by insertion of a catheter for brachial plexus block (interscalene approach) under dual guidance of ultrasound device and nerve stimulator. For continuous epidural analgesia, a combination of 0.15% ropivacaine and fentanyl (8 µg/h) was administered at 4 mL/h. For continuous brachial plexus block, 0.15% ropivacaine was administered at 3 mL/h for 7 days. Postoperative analgesia was maintained at a Numerical Rating Scale of 2-3 for shoulder pain and 0-1 for wound pain.

Conclusions: Satisfactory postoperative analgesia for Pancoast tumor resection was achieved with continuous epidural analgesia and continuous brachial plexus block.

Background: Idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is a rare condition that poses a diagnostic challenge to surgeons and pathologists alike. Our aim is to describe two cases of IMHMV requiring operative intervention. The challenge going forward is accurately and systematically identifying factors from both a pathologic and clinical perspective that guide timely diagnosis and avoid unnecessary treatment.

Case description: A 37-year-old male with no significant past medical history was evaluated for a two-month history of abdominal pain, constipation, diarrhea and recent bleeding per rectum. Computed tomography (CT) scan revealed abnormal wall thickening with surrounding inflammatory changes and mesenteric edema involving the descending and sigmoid colon as well as the rectum. The patient was taken to the operating room where he underwent a laparoscopic-assisted extended left colectomy with end colostomy. The patient did well postoperatively and was ultimately meeting all goals for discharge by postoperative day 9. A 49-year-old male with a past medical history of hypertension, gastroesophageal reflux and recent coronavirus disease 2019 (COVID-19) infection was admitted to another hospital following several months of colitis of unknown etiology; unresponsive to antibiotics and steroids. CT scan revealed concentric, severe mural thickening and intramural edema of the distal descending colon extending to the rectum consistent with proctocolitis. The patient was taken to the operating room where he underwent a laparoscopic-assisted low anterior resection with end colostomy with findings of an extremely indurated, thickened left colon and rectum. The patient recovered from these additional interventions and was discharged home in stable condition on postoperative day 32.

Conclusions: A multidisciplinary team approach to this condition will be vital to administering the appropriate treatment modalities for future cases of IMHMV.

Background: Cardiac arrest is the most dramatic event that compromises the cerebral blood flow with fatal outcomes. Factors like the presence of bystander cardiopulmonary resuscitation, initial rhythm, and arrest time significantly influence outcomes. However, despite these known factors, there are still aspects of cardiac arrest-related neurological complications that remain less understood. As evidenced by limited case reports, the association between posterior reversible encephalopathy syndrome (PRES) and cardiac arrest is not widely known.

Case description: We present a case study of out-of-hospital cardiac arrest (OHCA) involving a patient with multiple comorbidities and factors that could complicate her neurological outcome. Despite experiencing a delayed recovery following the cardiac arrest event and an initial insult to the brain, the patient exhibited remarkable neurological recovery. There has been a complex individualized targeted management that contributed to the favorable outcome.

Conclusions: This case study provides valuable insights into the complexities of managing OHCA patients, the factors influencing recovery, and the importance of a multidisciplinary team for early diagnosis and treatment of conditions like PRES to prevent permanent neurological damage. Further research into this area is necessary to better understand the mechanisms and implications of such associations for improving patient care and outcomes following cardiac arrest.

Background: Systemic Epstein-Barr virus (EBV)-positive T-cell lymphoma of childhood (STCLC) is a rare disease with few clinical reports and high mortality. By exploring the clinical manifestations of a child with STCLC in our hospital auxiliary examination and diagnostic and therapeutic process, to deepen pediatricians' understanding of this disease.

Case description: This paper describes a 5-year-old Chinese girl who presented with acute fever and epistaxis. After admission, relevant ancillary tests indicated the presence of hemophagocytic lymphohistiocytosis (HLH) and the combination of EBV infection in this patient. Pathology of the cervical lymph node biopsy and bone marrow flow cytology examination indicated STCLC, and a diagnosis of STCLC combined with HLH was clear. Although the girl was clearly diagnosed within a few days and treated with chemotherapy and symptomatic support, she eventually died on the 6th day after admission due to progressive worsening of her disease.

Conclusions: STCLC is a rare T-cell lymphoproliferative disorder that occurs primarily in the setting of acute EBV infection, usually presenting as HLH. It is a rapidly progressive and fatal disease of children and young adults characterized by monoclonal expansions of EBV-positive T-cells with an activated cytotoxic phenotype and by malignant proliferation. The mortality rate is close to 100%.

Background: Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy or broken-heart syndrome, is a non-ischemic cardiomyopathy that presents as a transient regional systolic dysfunction of the left ventricle with minimal increase in troponins. The pathogenesis of takotsubo cardiomyopathy is not well understood. Some possible theories include increased catecholamines causing sympathetic overdrive, microvascular dysfunction, coronary spasm, or inflammation. The association of herpes simplex virus (HSV) encephalitis with takotsubo cardiomyopathy has rarely been reported with only two cases being described in literature.

Case description: We present a patient that came in with altered mental status who was found to have herpes simplex virus 1 (HSV-1) encephalitis. During his hospital stay, the patient had developed shortness of breath on hospital day 3. The patient's troponin was found to be mildly elevated and echocardiogram revealed takotsubo cardiomyopathy with left ventricle ejection fraction (LVEF) of 20% and severe hypokinesis of all left ventricle segments except the basal segments. His echocardiogram nine months prior revealed a LVEF 60-65%. He was treated with intravenous (IV) acyclovir and repeat echocardiogram three weeks following hospitalization revealed resolution of his takotsubo cardiomyopathy.

Conclusions: Physicians should keep HSV encephalitis induced takotsubo cardiomyopathy in their differential diagnosis when patients present with HSV encephalitis along with shortness of breath and pulmonary vascular congestion on imaging.

Background: Medullary thyroid carcinoma (MTC) is a rare and aggressive type of thyroid cancer. Patients with this condition typically manifest palpable neck swelling and compressive symptoms. Biochemical evaluation and neck ultrasound play vital roles in diagnosis. The management options differ based on the extent of the disease.

Case description: This paper describes a 47-year-old male patient diagnosed with MTC invading the trachea and larynx. He presented with a 5 cm × 5 cm hard thyromegaly on the right side with right-sided level IV lymphadenopathy, measuring approximately 2 cm. He underwent total thyroidectomy, total laryngectomy, and bilateral neck dissection. Postoperatively, the patient developed a neck abscess and pharyngocutaneous fistula (PCF), which was managed surgically and had a satisfactory outcome. After 128 days of inpatient care, he was discharged in a stable condition with resolution of complications and had no evidence of local recurrence during the 6-month follow-up.

Conclusions: MTC is a rare type of thyroid neoplasia that can manifest with various symptoms resulting from either the primary lesion or secondary invasion. Surgery remains the mainstay of treatment, however, there are limited options and no approved adjuvant therapies for patients with disseminated MTC. Complications that arise after total thyroidectomy and laryngectomy can be noteworthy and demand careful surveillance and immediate treatment to prevent further deterioration.