American Journal of Case Reports最新文献

BACKGROUND Extracorporeal blood purification strategies were recently developed as adjunctive treatments for sepsis. CytoSorb® is an approved medical device designed to reduce blood levels of inflammatory cytokines. The oXiris high-adsorption membrane filter is used in continuous hemofiltration adsorption. We describe the case of a 67-year-old man with recurrent septic shock, requiring treatment with antibiotics, vasopressors, inotropes, mechanical ventilation, continuous renal replacement therapy (CRRT), and adjunctive treatment with an oXiris filter and hemadsorption using the CytoSorb device. CASE REPORT A 67-year-old man was admitted to the Intensive Care Unit (ICU) with septic shock. He received antibiotics, fluids, vasopressors, and inotropes and was mechanically ventilated. Acute kidney failure was treated with CRRT. His condition improved, and he was transferred to the general ward. On day 3 in the ward, he developed a new episode of septic shock and was readmitted to ICU. Standard therapy with fluids, vasopressors, and empiric antibiotics was started. Despite treatment, his condition deteriorated dramatically. CRRT with an oXiris filter in combination with hemoadsorption using CytoSorb was started. After CRRT initiation and integration of the CytoSorb adsorber, rapid improvement in the patient's condition was observed. Daily laboratory test results showed significant decreases in procalcitonin and CRP. The patient was discharged from ICU on day 5 after initiation of CytoSorb therapy. CONCLUSIONS Although no guidelines and large clinical trial data are yet available to support the use of CytoSorb and oXiris, this report supports the findings from previous reports and small studies, that they can be considered as adjunctive treatments for patients with sepsis.

BACKGROUND Post-transplant lymphoproliferative disorder (PTLD) encompasses a group of disorders ranging from hyperplastic to malignant lymphoid proliferations in the post-transplant period owing to immunosuppression, often in the setting of EBV transformation. PTLD is a rare complication of immunosuppression that, like lymphomas, can have a variable presentation based on disease localization. We report a case of PTLD mass effect at the porta hepatis for the first time in the literature, resulting in hepatic artery stenosis (HAS) and common hepatic duct obstruction. CASE REPORT A 54-year-old woman presented with cholestasis 4 months after receiving a deceased donor liver transplant. MRCP revealed a mass at the porta hepatis causing biliary compression, which resolved with subsequent biliary stenting. The woman presented again 3 weeks later with a similar presentation. CT revealed that the mass had enlarged, causing HAS, which resolved with subsequent hepatic artery stenting. The biopsy revealed PTLD, and the patient was successfully managed with rituximab and a reduction of her immunosuppressive regimen. CONCLUSIONS This case report describes a rare occurrence of PTLD, which particularly impacting the porta hepatis, resulting in HAS and compression of the bile duct. PTLD should be considered in the differential diagnosis for obstructive jaundice and hepatic artery compression, even in the early post-transplant months, when these symptoms are often attributed to surgical factors.

BACKGROUND Acute urinary retention (AUR) is relatively rare in non-pregnant women and is usually associated with lower urinary tract dysfunction, neurological issues, or pelvic organ compression. Adenomyosis is a common gynecologic condition characterized by the invasion of endometrial glands and stroma into the myometrium, often accompanied by symptoms such as dysmenorrhea and heavy menstrual periods. Although adenomyosis is common, its involvement in causing urinary retention is rare but deserves clinical attention. CASE REPORT We report the case of a patient with recurrent urinary retention due to adenomyosis, who had a 20-year history of dysmenorrhea and menorrhagia. Imaging revealed significant thickening of the posterior uterine wall and a globular increase in size. Due to the ineffectiveness of conservative treatment, the patient ultimately underwent a total hysterectomy via laparoscopy. After the operation, the patient's urinary retention symptoms completely disappeared, her urinary function quickly returned to normal, and her postoperative follow-up showed no recurrence of urinary retention or other urinary-related symptoms. CONCLUSIONS Although adenomyosis is common in women, acute urinary retention remains rare. This case report suggests that clinicians should consider adenomyosis as a potential cause alongside other common causes of recurrent or unexplained urinary retention in female patients, particularly in those presenting with classic symptoms such as prolonged dysmenorrhea and menorrhagia. The successful treatment of this case further highlights the importance of an individualized treatment plan, as total hysterectomy can effectively relieve symptoms and improve the patient's quality of life.

BACKGROUND Arterial hypertension in pediatric patients often presents complex diagnostic and therapeutic challenges. The diagnosis of hypertension in children is based on different guidelines than in adults, with arterial hypertension in children defined as systolic and/or diastolic blood pressure values at or above the 95th percentile for age, sex, and height. Unlike adult populations, it is predominantly secondary in etiology, with conditions such as renovascular hypertension as common causes. Fibromuscular dysplasia and Takayasu arteritis are frequent underlying causes of renal artery stenosis associated with this patient population. CASE REPORT This case report details the successful management of a 15-year-old girl with severe symptomatic hypertension. Plasma renin and aldosterone concentration analysis, Doppler ultrasonography, and angiography were crucial in assessing the severity and nature of the renal stenosis, leading to a diagnosis of renovascular hypertension associated with fibromuscular dysplasia. The patient underwent 2 successful percutaneous transluminal renal angioplasties, achieving blood pressure control without the need for long-term pharmacological therapy. CONCLUSIONS In children with elevated blood pressure, secondary hypertension should always be considered and investigated. The diagnosis of renal artery stenosis necessitates a multidisciplinary approach, combining laboratory tests and invasive and non-invasive imaging techniques. Ultrasound is often insufficient for comprehensive and detailed imaging of the renal arteries, being susceptible to error. Careful and comprehensive management of similar cases in specialized centers is essential for ensuring optimal patient care.

BACKGROUND Meckel's diverticulum is a congenital diverticulum that contains all normal layers of the gastrointestinal wall. In adults, Meckel's diverticulum can present with bowel obstruction, the most common presentation, in 35.6% of cases. In addition, complicated Meckel's diverticulum can present with small bowel obstruction. Sjögren syndrome is a rare systemic autoimmune disorder. The theory behind Sjögren syndrome is that lymphocyte-rich mononuclear cell foci infiltrate exocrine glandular tissue, and humoral factors, such as antibodies and cytokines, cause dysfunction to the exocrine glands, leading to diminished saliva and tear production and skin, tracheobronchial, and vaginal dryness. Sjögren syndrome can present with intestinal pseudo-obstruction as a rare complication. CASE REPORT A 25-year-old woman with a known case of Sjögren syndrome presented to the Emergency Department with abdominal pain. Laboratory investigations were sent, and all results were within reference values. Multiple imaging studies were done, and findings indicated the presence of ileus, rather than bowel, obstruction. Consequently, she was admitted under general surgery, and laparoscopic exploration was done, which showed Meckel's diverticulum. The patient was discharged home in a stable state. Two weeks later, a colonoscopy was done, showing a normal study. CONCLUSIONS It is important to consider Meckel's diverticulum as a possible cause of sudden abdominal pain in adults, as it can have catastrophic consequences. Furthermore, studies have shown that Meckel's diverticulum and Sjögren syndrome are distinct entities. Yet, both conditions can present with symptoms of intestinal obstruction.

BACKGROUND Internal root resorption (IRR) is a rare dental condition characterized by the progressive resorption of dentin within the root canal, often resulting from infection, trauma, or orthodontic treatment. When IRR progresses to perforation, it creates a communication pathway with periodontal tissues, necessitating effective endodontic therapy and perforation repair. Bioceramic sealers, known for their biocompatibility and flowability, have emerged as a promising alternative to traditional materials for filling and sealing the root canal system. Although commonly used in conventional root canal treatments, their application in filling resorptive defects is novel and unexplored in existing studies. CASE REPORT In the case report presented, a perforating IRR was evaluated and treated. The diagnosis was confirmed using a combination of periapical radiographs and cone-beam computed tomography (CBCT), ensuring precise lesion identification. The treatment involved root canal debridement with ultrasonic activation of irrigants and the application of calcium hydroxide as an intracanal medicament. Bioceramic sealers were utilized for obturation instead of traditional obturation techniques, effectively sealing the resorptive defects and repairing root wall perforations. CONCLUSIONS The case report highlights the novel use of bioceramic sealers in managing perforating IRR. While these sealers are gaining recognition in conventional root canal therapy, their application in resorptive defects represents an innovative approach, underscoring the need for further randomized clinical trials to validate their clinical effectiveness.

BACKGROUND Acalculous cholecystitis is a rare form of gallbladder inflammation that occurs without the presence of gallstones. It primarily affects critically ill patients and warrants prompt treatment given its association with high mortality. Pericarditis, an inflammation of the pericardium, typically arises from viral infections but can also be secondary to rheumatological, malignant, or bacterial causes. The concurrent presentation of both these conditions is rare and should prompt clinicians to investigate for a potential underlying cause. Previous case reports have shown that systemic lupus erythematosus, malignancies, and parasitic or bacterial infections are possible underlying causes of this dual presentation. CASE REPORT We describe a unique case in which acute viral pericarditis initially presented with clinical and imaging findings consistent with acute acalculous cholecystitis. A man in his 40s presented with epigastric pain and community ultrasound findings consistent with acalculous cholecystitis. As part of the workup, a CT scan showed an incidental finding of a pericardial effusion, and transthoracic echocardiogram revealed no evidence of cardiac tamponade. Despite treatment, the patient continued to spike fevers. Consequently, an extensive workup was performed, including pericardial and pleural biopsies, which were negative for rheumatological, bacterial, and malignant causes. After ongoing treatment with non-steroidal anti-inflammatory medications, the patient made a full recovery. CONCLUSIONS This case highlights the importance of recognizing acalculous cholecystitis as an atypical manifestation of acute viral pericarditis. When these 2 conditions occur together, identifying a possible underlying cause is paramount, as the management differs greatly. This case report is one of the few describing the presence of both conditions not due to a primary bacterial, malignant, or rheumatological cause. Viral illnesses can cause inflammatory responses leading to both conditions.

BACKGROUND Neuroendocrine carcinoma (NEC) of the cervix is rare and has high mortality and recurrence rates. The clinical symptoms of cervical NEC, such as abnormal vaginal bleeding and discharge, are similar to those of other cervical cancers. Here, we describe a case involving a 42-year-old woman with cervical NEC accompanied by an isolated large ovarian metastasis. CASE REPORT A 42-year-old woman had experienced abdominal discomfort for the past 4 months, along with a larger abdominal circumference. Physical examination revealed a 15-cm, solid, mobile, abdominal mass and a smooth cervix. Abdominal computed tomography revealed a hypoattenuating solid mass with a calcified component and indistinct borders, measuring 16.6×15.5 cm. Tumor marker levels were as follows: cancer antigen 125, 803.9 U/mL; carcinoembryonic antigen, 241.9 ng/mL. Preoperatively, we suspected a malignant ovarian tumor without any suspicion of cervical cancer. Intraoperatively, a 25×20-cm solid mass was found on the left adnexa with peritoneal wall and rectosigmoid adhesions. We performed a total abdominal hysterectomy with bilateral salpingo-oophorectomy, followed by peritoneal biopsy and omentectomy. Histopathological examination showed a 2.5-cm endocervical mass and a normal ectocervical epithelium. Immunohistochemistry revealed a small-cell cervical NEC with metastasis to the left ovary. The final diagnosis was a stage IB2 cervical NEC with ovarian metastasis. For treatment, we administered an etoposide-cisplatin adjuvant chemotherapy regimen. CONCLUSIONS NEC of the cervix can manifest as a large ovarian tumor, lack the usual indications for cervical cancer, and spread to the ovaries without metastasis to other organs.

BACKGROUND Surgery involving the right retroperitoneum can result in lymphatic (chylous) leakage from the cisterna chyli located anterior to the L1 and L2 vertebra or from lymph node dissection. This report describes a 46-year-old woman with retroperitoneal lymphatic (chylous) leak following right adrenalectomy for a nonfunctional adrenal adenoma. CASE REPORT A 46-year-old woman presented with a medical history of hypertension. An adrenal tumor (3.2×2.0 cm) was identified by computed tomography (CT). She was admitted for right retroperitoneoscopic adrenalectomy. The drainage volume of the drainage tube increased on the second day after surgery. The fluid had a milky and turbid discharge. She was started on a high-protein fat-restricted diet. In addition, 3 mg somatostatin acetate was administered daily. The chylous discharge dramatically decreased. After confirming that there was no increase in discharge, the drainage tube was removed on the 11th postoperative day. There was no recurrence of chylous fluid in 5 months. CONCLUSIONS This report shows that lymphatic (chylous) leak can be a complication of retroperitoneal surgery. The most important factor is the prevention of chylous complications. Even if no lymphatic leakage is found, it is necessary for the laparoscopic surgeon to fully coagulate the lymphatic channels. In most cases, it can be managed with conservative treatment.

BACKGROUND Gestational trophoblastic diseases (GTDs) are a group of benign and malignant tumors that arise from placental tissue. Ectopic pregnancies most commonly occur within the fallopian tubes. The estimated incidence of ectopic gestational trophoblastic diseases (GTDs) is approximated at 1.5 per 1 000 000 pregnancies, which makes it a very rare condition. The diagnosis is challenging since the clinical presentation often mimics conventional ectopic pregnancy, but management approaches are significantly different. CASE REPORT A 41-year-old woman (G7 T4 P0 A2 L4) presented to the Emergency Department with a period of amenorrhea followed by vaginal bleeding and abdominal pain. Right-side abdominal tenderness was noted upon physical examination. Laboratory investigations showed elevated serum ß-hCG level. Ultrasound examination showed a normal-size uterus. No intrauterine gestational sac was identified. An echogenic mass with central lucency was noted in the right adnexa, measuring 2.1×1.8 cm, with minimal free fluid present in the pouch of Douglas. The findings were suggestive of a ruptured right-side ectopic pregnancy. The patient underwent laparoscopic salpingectomy. Histopathological examination of the specimen revealed a complete hydatidiform mole with vascular invasion. The patient was treated conservatively and was followed up by a serial ß-hCG level until she achieved 3 consecutive negative ß-hCG titers. CONCLUSIONS Invasive moles located in the fallopian tube are very rare in the literature, and further research is needed to ascertain the proper management of such cases. Histopathological examination of the salpingectomy specimen has an essential role in confirming the diagnosis of ectopic GTDs and guiding the management.