American Journal of Case Reports最新文献

BACKGROUND Constrictive pericarditis is a chronic inflammatory process characterized by fibrosis and impaired ventricular filling. The diagnosis is challenging because of overlapping clinical features with other pathologies such as cardiac tamponade, and restrictive cardiomyopathy. We report a case of effusive-constrictive pericarditis with cardiac tamponade in a patient with a history of multiple myeloma, bone marrow transplantation, and colchicine treatment. CASE REPORT A 62-year-old woman was admitted to a hospital in Germany due to cardiac tamponade secondary to bacterial pericardial effusion that necessitated emergency sternotomy and pericardial washout. After a prolonged and complicated hospital course, she flew back to Orlando and presented on her day of arrival because of progressive dyspnea. A computed tomographic angiogram of the chest ruled out pulmonary embolism but showed a moderate pericardial effusion with a mass effect on the right ventricle showing a recurrent cardiac tamponade. Echocardiography suggested the diagnosis of constrictive pericarditis. Cardiac catheterization showed a mean right atrial pressure of 25 mmHg and a simultaneous left and right ventricular pressure waveform of ventricular interdependence, diagnostic of effusive-constrictive pericarditis. Colchicine, along with heart failure core measures, were started and resulted in symptomatic improvement. Her first pericardial effusion was bacterial, while the second was possibly a consequence of the cardiac surgery. CONCLUSIONS Cardiac catheterization has been the criterion standard for diagnosis of constrictive pericarditis. Colchicine may be curative for individuals exhibiting subacute symptoms. This case highlights the presentation and diagnosis of effusive-constrictive pericarditis, which can be associated with cardiac tamponade.

BACKGROUND Although the ingestion of button batteries (BBs) in neonates is exceedingly rare, it poses severe clinical challenges with potentially catastrophic outcomes. The increase in such cases, particularly among toddlers, is largely due to the widespread availability of portable electronic devices. Ingestion of button or disk batteries is notably more dangerous than other foreign bodies, often leading to acute complications such as burns and esophageal perforation. This report details the diagnosis and management of a 21-day-old neonate who presented with a button battery lodged in the esophagus. CASE REPORT We report the case of a 21-day-old neonate who initially presented with 3 days of persistent vomiting. Diagnostic imaging with a chest radiograph revealed a radiopaque foreign body in the esophagus, identified as a button battery. It was suspected that the battery was inadvertently placed in the neonate's mouth by a sibling with an intellectual disability. Initial attempts to remove the battery using 4-, 5-, and 6-mm endoscopes were unsuccessful. However, extraction was eventually accomplished with a 2.5-mm rigid esophagoscope. Following the removal, the neonate developed significant complications, including a tracheoesophageal fistula and esophageal stenosis. Extensive follow-up care led to a full recovery, demonstrating resilience despite the severe initial challenges. CONCLUSIONS This report emphasizes the critical need for swift identification and removal of ingested button batteries. It details the diagnostic and management strategies employed for a neonate, illustrating the urgency and precision required in such cases.

BACKGROUND Pancreatitis in pregnancy is rare but increasing in frequency, posing potentially serious maternal and fetal consequences. Early recognition of its variable presentations is essential for effective management. CASE REPORT We describe a case of recurrent pancreatitis across multiple pregnancies due to severe pregnancy-induced hypertriglyceridemia. This 33-year-old gravida 7 para 5 woman presented at 37 weeks of gestation with epigastric pain, nausea, and emesis after a high-fat meal. She had a history of hypertriglyceridemic pancreatitis in 4 previous pregnancies but only mildly elevated triglyceride levels outside of pregnancy. On presentation, she was promptly diagnosed with pregnancy-induced hypertriglyceridemic pancreatitis and treated with intravenous insulin, bowel rest, niacin, and gemfibrozil, resulting in clinical improvement by hospital day 5. She underwent labor induction, delivering a healthy female infant vaginally without complications. She was discharged on postpartum day 2 with niacin and gemfibrozil, although she later discontinued them. However, she was found to be doing well at her postpartum visits. CONCLUSIONS This case highlights the recurrent nature of pregnancy-induced hypertriglyceridemic pancreatitis, even in the absence of significant baseline hypertriglyceridemia. This report therefore increases awareness of the potential severity of pregnancy-induced hypertriglyceridemia. It also suggests that providers should consider hypertriglyceridemia in pregnant women with pancreatitis, even in the absence of a significant hypertriglyceridemia history. The timely and accurate diagnosis of pregnancy-induced hypertriglyceridemic pancreatitis should lead to effective, expedited treatment that can improve patient outcomes in this life-threatening condition.

BACKGROUND Pylephlebitis is a septic thrombosis in the portal or mesenteric venous system that occurs as a complication of an intra-abdominal inflammatory process. We present the case of a 43-year-old man with a septic thrombosis of the portal drainage area and a colo-venous fistula complicating a sigmoid diverticulitis. CASE REPORT The patient presented after collapsing at home with unspecific symptoms such as diffuse abdominal pain. On physical examination, he was tachycardic (140 beats/minute), with chills and fever to a temperature of 38.3°C. The remaining examination findings were unremarkable. Initial laboratory investigations were significant for an infection. Computed tomography (CT) with contrast of the abdomen and pelvis showed a sigmoid diverticulitis with covered perforation, forming a colo-venous fistula to the superior mesenteric vein, with gas trapped in the hepatic portal branches and a pylephlebitis of the superior mesenteric vein. An en bloc resection of the sigmoid and segmental resection of adherent ileum were performed, preserving intestinal continuity. Pylephlebitis was treated conservatively with antibiotics and anticoagulation. The patient recovered completely. CONCLUSIONS Pylephlebitis is the term used for septic thrombophlebitis of the portal veins. It is a rare but potentially fatal complication of an intra-abdominal infection, which can lead to septic shock, intestinal ischemia, or liver abscesses. The unspecific symptoms make early diagnosis difficult. Surgical removal of the inflammatory process, antibiotic therapy, and anticoagulation form the cornerstones of therapy. Although the unrestricted use of anticoagulation in pylephlebitis continues to be the subject of controversy due to conflicting results in the literature.

BACKGROUND Polycystic ovarian syndrome (PCOS) is one of the most prevalent endocrine disorders affecting women of reproductive age. PCOS has a typical presentation with obesity, hirsutism, and menstrual irregularity but can also be associated with insulin resistance and an increased risk of type 2 diabetes mellitus. This report presents the case of a 24-year-old underweight woman with a body mass index (BMI) of 15.9 kg/m2 with insulin resistance, hirsutism, and a diagnosis of PCOS. CASE REPORT A 24-year-old woman presented with hyperandrogenic signs, hirsutism, acne, and irregular menstrual cycles. During the clinical examination, acne vulgaris on the face was recorded, but not alopecia or acanthosis nigricans. Blood pressure was 110/70 mmHg, WHR (waist-to-hip-ratio)=87 and BMI (body mass index)=15.9. Ferriman-Gallwey's scoring system was used to assess for hirsutism. All hematological and biochemical results were normal. Hormonal tests revealed elevated testosterone, androstenedione, and 17-OH progesterone levels, confirming the diagnosis. Conditions such as Cushing's syndrome, hyperprolactinemia, and thyroid disorders were excluded based on normal levels of adrenocorticotropic hormone, cortisol, prolactin, triiodothyronine, thyroxine, and thyroid-stimulating hormone. Despite the patient's underweight status, insulin resistance was identified with OGTT (oral glucose tolerance test), making it the primary treatment target. Treatment addressed the underlying pathology with metformin and dexamethasone. Significant improvement in menstrual cycle, acne, and hirsutism was observed after 6 months. CONCLUSIONS This report has highlighted that when patients with PCOS also have insulin resistance, they may be of normal weight or underweight and require a multidisciplinary approach to diagnosis and management.

BACKGROUND Post-orgasmic illness syndrome (POIS) is a rare disease with an unknown etiology and pathophysiology. Several publications have previously reported successful results with various treatments, including antihistamines, selective serotonin reuptake inhibitors, and non-steroidal anti-inflammatory drugs. Here, we report the successful treatment of POIS with omalizumab in a patient with negative skin tests for self-semen with complete resolution of symptoms. So far, there has been only 1 previous report of omalizumab treatment for this syndrome. CASE REPORT A 22-year-old man with constitutional, neurological, gastrointestinal, and allergic-like symptoms after ejaculation presented to our clinic. The patient had a negative intradermal test for self-semen, normal tryptase levels (pre- and post-ejaculation), and elevated total IgE. Several treatments had been prescribed. The most efficient combination treatment prior to omalizumab included high-dose antihistamines plus anti-inflammatory medications (steroidal or non-steroidal). This regimen alleviated some but not all his symptoms. Due to the nature of the symptoms, we hypothesized that IgE and mast cells could be involved in the pathophysiology of POIS in this patient. He was started on omalizumab, with complete resolution of symptoms. After 7 months, a treatment cessation attempt resulted in recurrence of the symptoms. Currently, while on omalizumab, the patient is symptom-free and feels comfortable engaging in sexual activity. CONCLUSIONS Omalizumab may be considered for the treatment of POIS in patients with allergy-like symptoms and symptoms that cannot be controlled with other medications, even in the absence of a positive skin test to semen. Lower doses may be ineffective.

BACKGROUND Portopulmonary hypertension (POPH) is part of Group 1 of the clinical classification of pulmonary hypertension and represents 5-15% of patients with pulmonary hypertension, with a 5-year mortality rate of 40%. The implementation of preoperative pulmonary antihypertensive treatment allows liver transplantation depending on clinical response, which constitutes potential curative treatment. Uncontrolled pulmonary hypertension is a major risk factor of perioperative morbimortality in the context of liver transplantation. In case of major hemodynamic instability, extracorporeal membrane oxygenation (ECMO) can be placed to manage circulatory failure. We describe a case of a patient with POPH in whom an emergency ECMO was implanted during liver transplantation complicated by an intraoperative worsening of pulmonary vascular resistances leading to cardiac arrest. CASE REPORT A 16-year-old patient with POPH had an orthotopic liver transplantation (OLT) after management of pulmonary hypertension with a triple antihypertensive therapy, which was complicated by hemorrhagic shock. Management of hemorrhagic shock led to greatly increased pulmonary vascular resistances, which led to a perioperative cardiac arrest, necessitating the implantation of a veno-arterial ECMO, allowing the completion of critical surgical steps before admission to the intensive care unit. CONCLUSIONS POPH is a challenge in the perioperative setting. OLT is a therapeutic option in that setting. ECMO may be necessary for patients with POPH in the perioperative hemodynamic management during OLT. In highly selected cases, VA-ECMO implantation and timing should be discussed by a multidisciplinary team before induction. The emergency perioperative implantation of ECMO is a realistic alternative.

BACKGROUND Rhabdomyolysis occurs commonly in hospitalized patients due to many etiologies. It is characterized by elevated creatine kinase, weakness, and myalgias, with severe forms causing electrolyte imbalances. However, many of these patients have a mild disease course with no symptoms. Those with more severe disease often have associated acute kidney injury. When acute kidney injury occurs solely due to rhabdomyolysis, it is unlikely to cause the patient to require renal replacement therapy. Regardless of how common this disease is, little research has been done to determine prognosticating factors for renal recovery in the patients who do require renal replacement therapy. CASE REPORT We present the case a young patient who developed severe kidney damage from rhabdomyolysis, requiring renal replacement, and who had renal recovery in a relatively short time. Our patient's maximum creatine kinase was 1 353 105 IU/L. Yet regardless of this severe elevation, his kidneys showed full recovery in under 3 weeks. CONCLUSIONS We present a case of a patient with rhabdomyolysis and CK above one million. In our literature review, we found that exertion and genetic defects were found to cause CK elevations above one hundred thousand, but infection is perhaps the most common cause of such extreme elevations. Regardless of how high CK is, there are no consistent factors reported in the literature correlating with degree of and rate of renal recovery in these patients.

BACKGROUND Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure increasingly used to treat severe aortic stenosis, especially in elderly patients and those with significant comorbidities who are at high risk for surgical intervention. While TAVR is generally safe and effective, rare complications can occur, including cerebral air embolism, which can result in acute neurological deficits. This report presents the case of a 75-year-old man who developed a cerebral air embolism following TAVR. CASE REPORT A 75-year-old man with severe aortic stenosis and comorbidities, including atrial fibrillation, prior stroke, diabetes mellitus, and coronary artery disease, underwent transfemoral TAVR. After the procedure, he experienced sudden neurological symptoms, including left-sided visual field loss, facial droop, and limb weakness. Neurological evaluation revealed an NIHSS score of 10, with dysarthria and right gaze preference. Imaging studies identified an air embolism in the right posterior cerebral artery, resulting in an infarction in the posterior cerebral artery territory. Supportive care was provided, and the patient was later transferred to a rehabilitation service for further recovery. CONCLUSIONS Cerebral air embolism is a rare but potentially serious complication of TAVR. Prompt recognition, the use of advanced imaging techniques, and appropriate management are critical in minimizing neurological damage and improving clinical outcomes. This case highlights the importance of procedural vigilance, strict adherence to air-purging protocols, meticulous device handling, and increased awareness among clinicians performing TAVR. Awareness of such rare but significant complications is essential to ensure optimal patient safety.

BACKGROUND Lupus anticoagulants (LA) can interfere with routine coagulation tests such as the activated partial thromboplastin time (aPTT) and prothrombin time (PT). The international normalized ratio (INR) is derived from PT and is used to monitor warfarin therapy. A positive LA result is one of the laboratory criteria of the 2023 ACR/EULAR antiphospholipid syndrome (APS) classification criteria. We report a case in which LA interfered with INR measurement in an APS patient. CASE REPORT Our patient was a 45-year-old man who had experienced multiple episodes of thromboembolism. His INR was consistently high, despite not being on any anticoagulant. Our laboratory used a recombinant PT reagent, Siemens Healthineers Dade® Innovin® on a fully automated coagulometer, the Sysmex CS-2500. PT measurements were repeated using 2 different analyzers, the Sysmex CA-104 and Werfen ACL Top 550 CTS. The PT results were 40.5 s (reference range (RR): 9.3-10.8 s) and 56 s, using Sysmex CS2500 and CS104, respectively. However, the PT was 13.4 s (RI: 10.3-12.7 s) using Werfen ACL Top 550 CTS. We retested the sample using Thromborel® S, a tissue-derived PT reagent, and PT was found to be within the reference range. The patient tested positive for LA, anti-cardiolipin, and anti-beta2 glycoprotein I antibodies. CONCLUSIONS LA can falsely prolong the PT when a recombinant PT reagent is used. When we retested the plasma using a tissue-derived PT reagent - Thromborel® S - PT was within normal limits. Thus, it is important to acknowledge that LA can react differently with different PT reagents.