American Journal of Case Reports最新文献

BACKGROUND High-risk pulmonary embolism (PE) refers to a subset of massive PE that can lead to sudden cardiac arrest (SCA) or hemodynamic collapse. It is crucial to identify the clues that might precede high-risk PE in resuscitated SCA. The presence of right bundle branch block (RBBB) with a QR pattern in V1 on the electrocardiogram (ECG) has a high positive predictive value for diagnosing cardiac arrest caused by high-risk PE. Therefore, we present a case study of SCA caused by high-risk PE. CASE REPORT A 44-year-old woman with no medical history presented to the emergency room due to SCA. The first ECG showed sinus tachycardia and RBBB with a QR pattern in V1. The clinical manifestations, particularly the abnormal ECG findings, led to the consideration of high-risk PE. Urgent thrombolytic therapy was administered before confirmation with computed tomographic pulmonary angiogram (CTPA). The patient was eventually diagnosed with antiphospholipid antibody syndrome and treated with warfarin. CONCLUSIONS RBBB with a QR pattern in V1 on ECG has a high positive predictive value for the diagnosis of cardiac arrest caused by high-risk PE. Furthermore, the presence of a QR pattern in V1 performs as an independent predictor for high-risk PE patients who may require advanced treatments, including systemic thrombolysis or invasive embolectomy. It is worth further exploring the prioritization of thrombolysis for high-risk PE patients before confirmation with CTPA, when ECG findings strongly suggest the diagnosis.

BACKGROUND Internal hernias, a rare type of herniation, occur through deficits of peritoneum or mesentery/mesocolon. Herniation of the small intestine into the mesosigmoid fossa is an extraordinary situation. A possible diagnostic delay may lead to intestinal ischemia, perforation, or even necrosis. CASE REPORT A 47-year-old woman was admitted in our Emergency Department with a 24-hour colic pain that started at the epigastrium and then moved to the left pelvic region. Small-bowel obstruction due to internal herniation was diagnosed based on clinical, radiological, and laboratory examination results. We encountered a loop of jejunum that was herniated into the mesosigmoid fossa, making this a unique case, as in most such cases the internal herniated loops are loops of ileum. CONCLUSIONS The key role of computed tomography (CT) is highlighted and the characteristic sign of "C-shaped cluster" is mentioned in the literature for intersigmoid hernia. Although internal mesosigmoid hernia is rare, it should be always kept in mind when the patient's digestive tract is affected. Our main purpose here is to highlight this rare entity for our fellow surgeons.

BACKGROUND We report a case of neurotrophic keratopathy (NK) following micropulse cyclophotocoagulation (MP-CPC), presenting as a ring infiltrate. We describe this clinical presentation after MP-CPC with diagnostic challenges. We provide an approach to how a proper diagnosis was reached and highlight the importance of preoperative assessment of corneal surface health in patients at risk. CASE REPORT A 36-year-old diabetic woman was referred to our cornea clinic for a new onset of a ring infiltrate in her right eye, after undergoing MP-CPC for an uncontrolled neovascular glaucoma. She had no pain or discharge, but was bothered by photophobia. After obtaining a proper medical history, best corrected visual acuity was 3/200 in the affected eye, corneal sensitivity was reduced, and slit lamp examination showed a large inferior corneal epithelial defect with a peripheral anterior stromal ring infiltrate. Corneal scrapings were obtained and differential diagnoses were excluded until a proper diagnosis of NK was reached. As conservative medical treatment with prophylactic antibiotics and frequent lubricating eye drops failed to achieve complete healing of the epithelial defect, amniotic membrane grafting was performed and resulted in complete healing with residual corneal scarring. CONCLUSIONS Neurotrophic keratopathy presenting as a corneal ring infiltrate can be confused with infectious keratitis and result in diagnostic challenges. As cases of NK after MP-CPC are more frequently reported, a routine preoperative assessment of corneal sensation is recommended, especially in patients at risk, such as diabetics. Preoperative counselling, customized treatment protocols such as shortening the treatment time, and close monitoring of postoperative ocular surface health should be implemented following MP-CPC to prevent the occurrence of serious ocular complications such as corneal scarring, melting, or perforation.

This publication is being retracted due to challenges to the patient's consent for publication and omission of a key author. Reference: Mariana Cristina Barrón-Márquez, Rogelio González-González, Lucina Bobadilla-Morales, Victor Ulises Rodriguez-Machuca, Ronell Bologna-Molina, Nelly Molina-Frechero, Omar Alejandro Tremillo-Maldonado, Sandra López-Verdín: Cowden Syndrome and Oral Lesions: A Case Report Using MLPA. Am J Case Rep 2025; 26: e943740. DOI: 10.12659/AJCR.945876.

BACKGROUND Large-cell calcifying Sertoli cell tumor (LCCSCT) belongs to the category of sex cord stromal tumors and is extremely rare. Testicular LCCSCTs show benign or malignant behavior, appear sporadically, or are associated with genetic syndromes. Benign LCCSCTs are more commonly bilateral and multifocal and present in younger patients. The prognosis is poor when patients have advanced or metastatic disease. However, due to its rarity, the literature provides only weak evidence concerning their clinical course and treatment options. This report describes a 37-year-old man suffering from a multifocal, bilateral malignant testicular LCCSCT presenting as painless testicular masses. CASE REPORT A 37-year-old man presented with bilateral painless testicular masses. Imagery showed bilateral macro-orchitis with multifocal intratesticular hyperechoic and hypointense lesions. He underwent testis-sparing surgery with the enucleation of 1 testicular lesion. The anatomopathological analysis revealed an LCCSCT whose histological characteristics indicated a benign tumor. A simple follow-up was therefore recommended. Six years after diagnosis, the patient developed lymph node metastases, and radical bilateral orchiectomy and radical lymphadenectomy were performed. A few months later, pleural, pulmonary, and bone metastases occurred. Chemotherapy and immunotherapy did not control the disease. The patient died 7 years after the initial diagnosis. CONCLUSIONS This case highlights the importance of the histopathology diagnosis in cases of testicular masses, and that sporadic, multifocal, and bilateral LCCSCTs present in younger men can be malignant despite the benign characteristics of the primary tumor.

BACKGROUND Necrotizing herpetic retinopathies associated with varicella zoster virus (VZV) occurs sporadically and typically presents with acute retinal necrosis (ARN) features. This report presents an incident of ARN in an immunocompetent patient who was referred to the hospital for acute vision loss. CASE REPORT A 56-year-old previously healthy man presented to the Emergency Department with acute vision loss in his left eye. Four weeks before admission, he had an upper respiratory tract infection and received a diagnosis of VZV infection, based on skin examination and medical history. On ophthalmological examination in our hospital, the left eye showed exudative retinal detachment with necrotizing retinitis and profound uveitis. Blood tests for infectious diseases and opportunistic infections were performed. Intravenous antiviral treatment was started empirically, due to high suspicion of ARN. Five days after presentation, vision deterioration necessitated pars plana vitrectomy (PPV). Surgical procedure included retinectomy, endolaser photocoagulation, and high-viscosity silicone oil tamponade. One week after PPV, the patient's best corrected visual acuity measured with the Snellen chart was 0.25. Three weeks later, best corrected visual acuity was 0.16. Three months later, dilated fundus examination indicated an attached retina and emulsified silicone oil. CONCLUSIONS This case report highlights VZV retinitis severity and emphasizes the importance of considering VZV retinitis in the differential diagnosis of progressive outer retinal necrosis, also in immunocompetent patients. The complications of the disease's course should raise awareness about the need for prophylactic vaccination against VZV. When the course of the disease develops to retinal detachment, the decision of vitrectomy should not be postponed.

BACKGROUND Infantile acute dacryocystitis is due to congenital nasolacrimal duct obstruction (NLDO) in newborns and infants, which involves acute bacterial infection of the lacrimal sac. This report describes a 37-day-old male infant with acute dacryocystitis and lacrimal abscess managed with a modified decompression and nasolacrimal duct probing. CASE REPORT We report the case of a 37-day-old male infant who presented with acute dacryocystitis complicated by a giant lacrimal abscess. On day 30 of life, his parent brought him to a local clinic due to inferior eyelid edema and hyperemia. He was diagnosed with acute dacryocystitis and was treated with tobramycin eye drops and ointment. However, severe erythema, swelling, and tenderness over the lacrimal sac area persisted. The parent refused a head CT, ultrasound examination, and systemic antibiotics, and brought the infant to our emergency unit for a second opinion on day 37 of life. A modified decompression and probing approach was employed, which involved gentle decompression of the abscess to relieve tension, followed by probing of the nasolacrimal duct to restore proper drainage. After a repeat decompression and probing procedure, the dacryocystitis and giant lacrimal abscess disappeared gradually, with good esthetic results. The infant responded well to the treatment, with resolution of symptoms and no recurrence of the abscess during follow-up. CONCLUSIONS This case demonstrates that our modified decompression and probing approach provides a practical and an alternate option to treat acute dacryocystitis in infants complicated by a giant lacrimal abscess.

BACKGROUND Creutzfeldt-Jakob disease (CJD) is a rare and fatal neurodegenerative disorder caused by the misfolded isoform of the prion protein (PrPSc). The disease is characterized by rapid progression and the absence of effective treatment options, making it particularly devastating. Among its various subtypes, sporadic Creutzfeldt-Jakob disease (sCJD) is the most common in humans. Diagnosing CJD before death is challenging due to its nonspecific symptoms and the difficulty in distinguishing it from other neurodegenerative conditions. CASE REPORT We detail the initial presentation of a 58-year-old woman with suspected sCJD, highlighting the atypical symptoms and prolonged survival. The uniqueness of this case lies in the fact that, despite the patient exhibiting relatively typical clinical features, all laboratory and examination results for CJD consistently returned negative. This led to the patient being transferred between multiple departments, including psychiatry, during the early stages of the disease, making it difficult to receive a correct diagnosis and treatment. The patient's journey through various medical consultations underscores the complexity of diagnosing such a rare condition. It illustrates the importance of a holistic approach that considers both clinical presentation and supplementary examinations. CONCLUSIONS Excessive reliance on supplementary examinations, coupled with insufficient awareness of sCJD across multiple clinical departments and a lack of attentiveness to clinical symptoms, culminated in a misdiagnosis as a psychiatric disorder. This initiated a convoluted and protracted diagnostic process, significantly exacerbating the burden on both the patient and her family. This situation underscores the critical importance of recognizing clinical presentations in rare diseases like sCJD while employing diagnostic tools. Furthermore, it highlights the necessity for enhanced interdisciplinary communication and collaboration among clinical departments to facilitate timely and accurate identification of sCJD.

BACKGROUND Guillain-Barre syndrome (GBS) commonly presents with motor weakness and neurological symptoms and signs that include loss of tendon reflexes. However, patients with GBS also experience nerve pain (radicular pain) and deep muscle pain. This report is of a 73-year-old man presenting with shoulder muscle pain and a diagnosis of Guillain-Barre syndrome. CASE REPORT A 73-year-old man initially sought medical attention for severe left shoulder muscle pain. One week prior, he had experienced a cold and diarrhea, which improved with over-the-counter medication. Physical examination revealed normal shoulder joint motion without swelling or stiffness. Cervical spine magnetic resonance imaging (MRI) revealed osteophytes and disc protrusions from C3/4 to C6/7, leading to an initial diagnosis of cervical spondylosis. Two days later, he developed progressive numbness and weakness in both upper limbs. Upon hospital admission, further evaluation revealed partial cranial nerve dysfunction, elevated cerebrospinal fluid (CSF) protein levels without pleocytosis, and peripheral nerve damage on electromyography (EMG). GM1 antibody was positive, confirming GBS. Treatment with intravenous immunoglobulin (IVIG), gabapentin for pain management, and acupuncture targeting pain and limb symptoms resulted in the complete recovery of pain and limb function within a short period. CONCLUSIONS This report shows that deep muscle pain can be a symptom of Guillain-Barre syndrome. Recognizing such atypical presentations is crucial for timely diagnosis and effective management. This case provides a clinical basis for the diagnosis of atypical GBS and offers insights into pain management in GBS.

BACKGROUND Anal canal duplications (ACD) are rare in children older than 2 years old. While some patients are asymptomatic, others have a variety of nonspecific symptoms. The definitive treatment is surgical removal, but the best technique varies with each case based on the local situation and the location of the lesion. CASE REPORT We present 2 cases of anal canal duplications in pediatric patients. Despite the atypical presentations of a concomitant cystic, a high suspicion of ACD led to surgical management using different techniques based on its location and local situation. The first patient had a sterile perianal abscess in the ischiorectal fossa, unresponsive to antibiotics and recurrent after surgical drainage. MRI revealed a fistula connecting the cyst to the exterior at the pectineal line, prompting a posterior approach for complete resection of the mass from the rectum. The second patient had an incidentally discovered ischiorectal mass. Imaging suggested a homogeneous cyst adhered to the rectal wall and easily accessible, leading to a successful robotic-assisted surgical resection. Both patients achieved complete anal sphincter function and full recovery postoperatively. Histological analysis in both cases presented typical characteristics found in ACD. CONCLUSIONS Although ACD is rare in pediatric patients over 2 years of age, cystic or infected lesions in the ischiorectal fossa should be considered as differential diagnoses. Radiological imaging is crucial for understanding the cyst's location and determining the optimal surgical approach. As presented in our cases, an open posterior approach may be considered when the lesion is or has been complicated by previous infection, associated with a fistula, as opposed to non-complicated cases in which a mini-invasive approach may be ideal.