American Journal of Case Reports最新文献

BACKGROUND Primary cutaneous lymphomas (PCL) are a multifaceted spectrum of cutaneous T cell lymphoma (CTCL) and cutaneous B cell lymphomas (CBCL). Mycosis fungoides (MF) is a rare subset of CTCL that primarily affects adults, and its occurrence in children is exceedingly rare. Most pediatric MF manifests as hypopigmented patches resembling other benign dermatoses, causing diagnostic challenges. This report outlines a case of pediatric MF in a 7-year-old Malaysian boy. CASE REPORT A 7-year-old boy exhibited progressing skin lesions characterized initially by erythematous, papular rashes over the face and upper limbs, then to the whole body, becoming hypopigmented, with pruritus and scaling for 1 year. Multiple clinics treated him for eczema and pityriasis alba but he responded poorly to courses of various topical steroids and emollient treatment. Due to the refractory nature of the lesions, he was subsequently referred to a dermatology clinic, where 2 skin biopsies were performed. The first biopsy revealed epidermotropism of atypical lymphocytes, consistent with MF. Immunohistochemical analysis revealed positive CD3+ expression with slightly reduced CD4+, CD7+, and CD8+ expression, and normal CD2+ and CD5+ expression at the epidermis level. Nevertheless, due to the rarity of MF in children, a second biopsy was performed, validating the diagnosis. CONCLUSIONS Pediatric MF is a rare and challenging diagnosis. This case report highlights the importance of close monitoring of unresolved hypopigmented lesions and increased vigilance on lesions not responding to standard treatment. Timely diagnosis with support of skin biopsy is crucial to avoid potentially serious disease progression and helps provide appropriate management leading to improved outcomes.

BACKGROUND Mondor's disease (MD), or sclerosing superficial thrombophlebitis of the veins of the anterior thoracic wall, is a rare condition of unknown cause that usually involves the superior epigastric vein, producing a visible and palpable Mondor cord. This report describes a 27-year-old Japanese woman presenting with left chest wall pain due to palpable and visible sclerosing superficial thrombophlebitis. CASE REPORT We present the case of a 27-year-old Japanese woman who presented with 8 days of left chest wall and upper abdominal pain. Physical examination revealed a firm, palpable cord in the painful area. Chest wall ultrasound revealed a tubular and anechoic superficial cord. Doppler imaging demonstrated normal blood flow surrounding the cord, with no blood flow within. Computed tomography (CT) revealed a subtle structure beneath the lower left breast skin and without breast or lung involvement. We diagnosed her as having MD, and she was treated with non-steroidal anti-inflammatory drugs (NSAIDs). Her pain gradually improved in 3 weeks and the cord disappeared after approximately 2 months. CONCLUSIONS Mondor's disease can be distressing and painful for patients. Clinicians should be aware of this rare and benign disease when a longitudinal painful cord is found in the torso wall. Pain relief and reassurance are typically adequate until resolution. In addition to ultrasonography, CT is also important for diagnosing MD. This report of a rare diagnosis of MD highlights the importance of accurate and timely diagnosis and investigating the patient to exclude superficial and deep venous thrombotic disease.

BACKGROUND Carotid artery injury has an incidence of 0.2% in the National Trauma Data Bank. The true incidence of intracranial carotid injury is unknown but can be estimated at less than one in 1000 trauma-related inpatient admissions in America. Operatively managed penetrating carotid trauma has a mortality rate approaching 20%, and the selection of the appropriate operative approach is not straightforward. We present a case of penetrating carotid trauma successfully managed via combined approach by neurosurgery and otolaryngology teams. CASE REPORT A 74-year-old woman fell into a honeysuckle bush. She presented with a branch embedded in the left cheek and blindness of the right eye. Further workup revealed the branch had penetrated the maxillary bone, pierced the right optic nerve, and lodged near the intracranial portion of the right internal carotid artery. She underwent emergent operative intervention via right pterional craniotomy with microsurgery and endoscopic transsphenoidal surgery with repair of the skull base. The foreign body was removed and the traumatic carotid laceration was repaired. The patient recovered successfully and was discharged on postoperative day 14. CONCLUSIONS The management of facially penetrating foreign bodies begins with assessment for neurologic deficits and vascular injury. We recommend leaving such objects in place and not removing them until definitive imaging is obtained. We present an interesting case of penetrating trauma to the intracranial carotid artery in which a retained foreign body was removed with satisfactory patient outcome using a combined endoscopic and open surgical approach.

BACKGROUND Although hypomagnesemia is common in type 2 diabetes, clinical presentations with severe hypomagnesemia are rare. A number of oral blood glucose-lowering medications can reduce serum magnesium concentrations, and several severe cases have been reported in the presence of marked glucagon-like peptide-1 receptor agonist (GLP-1RA)-associated gastrointestinal adverse effects. In the present case, an acute presentation with severe hypomagnesemia was likely due to polypharmacy including semaglutide, albeit with a delayed relationship to discontinuation of this GLP-1RA, due to nausea and vomiting. CASE REPORT A 73-year-old woman with type 2 diabetes treated with several oral medications known to reduce serum magnesium (metformin, gliclazide, sitagliptin, esomeprazole) presented after an unwitnessed collapse at home without premonitory symptoms. She had discontinued low-dose semaglutide (0.25 mg subcutaneous weekly) 2 weeks beforehand, and her gastrointestinal adverse effects had largely resolved. She was found to have an undetectable serum magnesium (<0.3 mmol/L) and hypocalcemia. She responded to electrolyte replacement and was discharged well 2 days later. Three weeks after discharge, her serum magnesium and calcium concentrations were within the reference range, on regular oral supplements of both minerals. She spontaneously reported her longstanding muscle cramps had resolved after discharge. Her clinical features and course suggested she had chronic unrecognized hypomagnesemia associated with polypharmacy that progressed to a clinically severe level, with a likely contribution from recent antecedent semaglutide use. CONCLUSIONS Periodic monitoring of serum magnesium concentrations in at-risk individuals with type 2 diabetes is recommended, since the clinical presentation of severe hypomagnesemia can be sudden and without indicative warning symptoms.

BACKGROUND Perineal injuries affecting the scrotum and penis are rare in pediatric patients, owing to the protective anatomy of the male genitalia. However, when such injuries do occur, timely surgical intervention is crucial. This kind of damage might not be life-threatening but could cause functional disorders and have a huge impact on the patients' psychological condition if not treated appropriately, especially as they enter puberty. This case illustrates the successful management of a severe genital injury in a young child. CASE REPORT We present the case of an 8-year-old boy who sustained a penile degloving injury extending from the glans to the penile base, exposing the suspensory ligament, both spermatic cords, and ruptured scrotal skin, due to sliding of an agricultural machine. Immediate surgical intervention involved replantation of the penile skin and closure of the scrotal wound with absorbable sutures. Postoperative care focused on infection prevention with appropriate antibiotics and daily dressing changes. The monitoring of the graft was essential to detect any signs of necrosis. CONCLUSIONS The 6-month follow-up of our patient showed that the performed procedure and appropriate medical approach led to full recovery and satisfactory esthetic results, without dysfunction of the male genitals or urethra. Through this case, we emphasize that, with rapid surgical intervention and proper postoperative care, pediatric patients with similar injuries can achieve full recovery. However, long-term follow-up until adulthood is recommended to monitor for potential complications that can arise later in the patient's life.

BACKGROUND Terminal ileum (TI) anastomoses present challenges due to anatomical features and pressure from the ileocecal valve (ICV). The use of negative-pressure wound therapy (NPWT) is commonly used to treat chronic skin ulcers. Its use for temporary abdominal closure following anastomosis is controversial but has shown promise in patients with inflammatory or vascular disease. This report presents 3 successful cases in which NPWT was used after TI anastomosis surgery. CASE REPORT Case 1: A 65-year-old woman with chronic kidney disease and paroxysmal atrial fibrillation was diagnosed with mesenteric ischemia. Surgical resection removed a segment of the jejunum and ileum, with an end-to-side anastomosis 10 cm from the ICV. NPWT was initiated, and abdominal wall closure was achieved. Case 2: A 73-year-old man with a history of an incarcerated left inguinal hernia, previously treated with herniorrhaphy and intestinal resection, presented with generalized peritonitis and anastomotic dehiscence 70 cm from the ICV. Resection was performed, followed by ileectomy for ischemia 15 cm from the ICV and a 2-layer isoperistaltic side-to-side anastomosis. NPWT was initiated to reduce edema and achieve primary abdominal closure. Case 3: A 69-year-old man diagnosed with mesenteric ischemia underwent resection of 40 cm of ischemic intestine. Follow-up laparotomy revealed the need for manual end-to-end anastomosis 12 cm from the ICV. NPWT was applied due to the inability to achieve primary closure. CONCLUSIONS Despite concerns regarding vascularization and pressure near the ICV, these cases demonstrate that NPWT can be safely utilized following TI anastomosis. This challenges conventional guidelines and supports its use, even in high-risk anastomoses.

BACKGROUND Studies using transgenic mouse models have demonstrated that estrogen is necessary for the development of cervical cancer, particularly in tissues responsive to estrogen. Estrogen also protects cervical cancer cells from apoptosis, suggesting its role in the survival and persistence of cancer cells. CASE REPORT An 84-year-old woman with diabetes mellitus, hypertension, and stage III chronic renal failure was diagnosed with cervical squamous cell carcinoma, FIGO stage IB2. She underwent complete concurrent chemoradiotherapy, but central recurrence was found 9 months later. However, instead of salvage chemotherapy, substitutionary anti-estrogens were given due to her poor medical condition and advanced age. Complete remission was noted after tamoxifen therapy. Since the cervical cancer relapsed again 40 months after tamoxifen use, the anti-estrogen therapy was shifted to letrozole. The SCC-Ag level decreased dramatically after letrozole therapy, and disease stability was achieved until 29 months afterward. After 5 years and 9 months of anti-estrogen use only, the patient died due to noncancer-related pneumonia and heart failure. CONCLUSIONS This report demonstrates the tumor-stabilizing and therapeutic effect of anti-estrogens in the treatment of squamous cervical carcinoma. Further clinical trials are warranted to evaluate the efficacy of anti-estrogen therapy in cervical cancer patients.

BACKGROUND Simultaneously occuring diffuse large B-cell lymphoma (DLBCL) and Hodgkin lymphoma (HL) is extremely rare. Generally, patients with CD20-positive DLBCL receive rituximab, cyclophosphamide, vincristine, doxorubicin, prednisone (R-CHOP) regimen, while those with HL receive brentuximab vedotin, doxorubicin, vinblastine, dacarbazine (A-AVD) regimen as first-line therapy. Establishing a strategy for treating both lymphoma subtypes concurrently is thus very difficult. We report successful treatment of a patient simultaneously diagnosed with advanced DLBCL and HL. CASE REPORT A 20-year-old man visited the Hematology Department of Kyungpook National University Hospital after the diagnosis of germinal center B-cell DLBCL in the kidney and HL (nodular sclerosis type) in the neck lymph node. His DLBCL was classified as Ann Arbor stage IV with an International Prognostic Index score of 4, a high-risk group. Six cycles of R-CHOP therapy were planned, and central nervous system prophylaxis with intrathecalmethotrexate was added because of the high-risk features of central nervous system involvement. After completing 6 cycles of chemotherapy, without significant adverse events (Deauville score of 1), complete remission was confirmed. Then, the patient decided to undergo consolidative autologous stem cell transplantation (auto-SCT). He received busulfan, cyclophosphamide, and etoposide conditioning regimen, after which auto-SCT was conducted in April 2021. After auto-SCT, the patient was undergoing regular check-ups and doing well, without obvious disease relapse or specific symptoms. He maintained a disease-free status for 40 months to date. CONCLUSIONS Our case showed that R-CHOP regimen was effective not only for DLBCL but also for HL. Notably, consolidative upfront auto-SCT should be considered for a deeper response.

BACKGROUND Varicella-zoster virus (VZV) encephalitis is a commonly reported form of encephalitis that clinically manifests as skin lesions, fever, headache, and neuropsychiatric symptoms. We present a case of a patient with VZV encephalitis complicated by cerebral hemorrhagic transformation, characterized by high levels of inflammation and protein in the cerebrospinal fluid. The aim is to highlight the risk of hemorrhagic transformation associated with VZV encephalitis. CASE REPORT The patient exhibited scattered herpes lesions on the head, neck, and chest. Notably, the cerebrospinal fluid (CSF) protein concentration was markedly elevated at 9049.3 mg/L, with a CSF white blood cell count of 950×10⁶/L, of which lymphocytes constituted 80%. MRI revealed abnormal signal foci in the bilateral temporal lobes and the right frontal lobe, consistent with findings associated with herpes encephalitis. Despite initial treatment with anti-inflammatory agents, acyclovir antiviral, and antiepileptic medications, the patient did not show improvement, prompting the addition of double filtration plasmapheresis. However, the patient experienced hemorrhagic transformation and succumbed to the illness. CONCLUSIONS This case highlights the challenge of managing VZV encephalitis in the context of significant inflammation and protein elevation in the CSF, and underscores the need for further research into more effective therapeutic strategies for this rare but potentially devastating condition.

BACKGROUND The incidence of drug-induced infectious endocarditis is rapidly rising in the United States. Healthcare providers face different challenges in the management of infectious endocarditis in persons who inject drugs, including addiction relapse, non-compliance with treatment, and the associated social stigma. These factors collectively complicate the management of drug-induced endocarditis, requiring comprehensive strategies that address both the medical condition and the underlying substance use disorder, as well as socio-behavioral aspects of patient care. CASE REPORT We present a case of a 33-year-old woman diagnosed with opioid use disorder and a history of tricuspid valve replacement who was transferred from a local emergency room to a general hospital for septic shock secondary to recurrent drug-induced infectious endocarditis. Psychiatry was consulted on day 13 of the admission after the patient was deemed, "not to be a surgical candidate" for second cardiac valve surgery because of a history of non-compliance and a high risk of drug relapse. Throughout her 4-month inpatient hospitalization, she received multiple forms of voluntary and involuntary treatment. The psychiatry consultation/liaison service played a significant role in the patient's care. She successfully engaged in multiple modalities of treatment that led to undergoing a second heart valve surgery. CONCLUSIONS This case highlights the importance of a multidisciplinary approach in management of infectious endocarditis in persons who inject drugs. The use of a civil commitment can allow for the provision of substance use disorder treatment and optimal medical care to an individual who may have lost hope and have temporarily impaired mental faculties.