American Journal of Case Reports最新文献

BACKGROUND Paraduodenal hernia (PDH) is a rare internal hernia, accounting for 50% to 55% of internal hernias but only 0.2% to 0.9% of intestinal obstructions. Right-sided PDH is less common, occurring in approximately 25% of cases. CASE REPORT This case describes a 33-year-old pregnant woman at 20 weeks 6 days gestation who was admitted with a 15-day history of abdominal distension accompanied by nausea and vomiting. The patient had postprandial exacerbation of intermittent abdominal pain, bilious vomiting, and significant weight loss (5 kg), with a history of similar symptoms during previous pregnancies. Abdominal contrast-enhanced computed tomography revealed clustered bowel loops in the right upper quadrant and medial displacement of the superior mesenteric vein, which is consistent with right-sided PDH complicated by intestinal malrotation. After conservative treatment failed, the patient opted for pregnancy termination followed by laparoscopic surgery. Intraoperative exploration confirmed complete absence of fusion between the ascending mesocolon and the posterior peritoneum, resulting in a wide hernia defect through which bowel loops had herniated into the space lateral to the ascending duodenum. The procedure included reduction of herniated contents, adhesiolysis, and fixation of the ascending mesocolon. The patient's recovery was uneventful, and she was discharged on postoperative day 5. At 3-month follow-up, no abnormalities were noted. CONCLUSIONS Given its nonspecific clinical presentation, PDH is frequently misdiagnosed or diagnosed late. Abdominal computed tomography facilitates early diagnosis and timely intervention, while laparoscopic repair offers favorable outcomes.

BACKGROUND This report describes a case in which a 2-stage approach and minimally invasive vitrectomy successfully treated a giant retrobulbar hematoma caused by an ocular perforation injury. CASE REPORT A 22-year-old man sustained an ocular perforation injury from an iron wire. Emergency debridement and suturing of an anterior scleral laceration were performed. B-scan ultrasonography revealed a giant retrobulbar hematoma and posterior scleral laceration after the initial suturing procedure. Ten days later, minimally invasive vitrectomy was performed. During this procedure, intraocular hemorrhage was removed and vitreous traction was released. Laser photocoagulation was applied only to the edges of the posterior chorioretinal wound, and the surgery was completed with air tamponade. Three months after vitrectomy, the injured eye showed satisfactory recovery. B-scan ultrasonography confirmed resolution of the retrobulbar hematoma and closure of the posterior scleral wound. CONCLUSIONS A 2-stage, minimally invasive surgical approach for severe ocular perforation injury was performed at an appropriate time, yielding favorable therapeutic outcomes. In cases of posterior perforating injury of the globe, careful selection of surgical timing is essential; simple vitrectomy combined with air tamponade is safe and effective.

BACKGROUND Hiatal hernia (HH) is a common condition that can present diagnostic challenges when accompanied by complex comorbidities. While HH is associated with obesity and elevated intra-abdominal pressure, its occurrence with eating disorders is not as well documented. We report a rare case of symptomatic HH in a patient with concurrent obesity and bulimia nervosa, a combination not previously reported in the literature. CASE REPORT A 39-year-old woman presented with 2 years of postprandial vomiting, chest pain, dyspnea, and heartburn. Her medical history revealed self-induced vomiting for weight control that progressed to bulimia nervosa, resulting in weight loss of 44 kg. Initial treatments with proton pump inhibitors provided minimal relief. Comprehensive evaluation revealed type III paraesophageal HH (5 cm hernial orifice), grade 2 reflux esophagitis, anemia, and a gallbladder polyp. The patient underwent laparoscopic cruroplasty with Toupet fundoplication and cholecystectomy, combined with psychiatric management including cognitive-behavioral therapy and fluoxetine. At 3-month follow-up, complete symptom resolution was achieved. CONCLUSIONS This case highlights the importance of thorough history-taking in patients with atypical gastrointestinal symptoms and demonstrates that bulimia nervosa can contribute to HH development through repeated increases in intra-abdominal pressure. A multidisciplinary approach integrating surgical and psychiatric interventions is essential for successful management of HH when associated with eating disorders and other complex comorbidities.

BACKGROUND Drug-induced liver injury is a major cause of acute hepatitis and liver failure, with presentations ranging from asymptomatic elevation of liver enzymes to severe hepatic dysfunction. Diagnosis of drug-induced liver injury is challenging because it mimics other hepatic disorders and requires careful exclusion of alternative etiologies. Losartan, a commonly prescribed angiotensin II receptor blocker for hypertension, is generally safe, but rare cases of hepatotoxicity have been reported. CASE REPORT A 59-year-old South African woman with newly diagnosed hypertension was started on losartan 100 mg daily. After 1 month, she presented with a 3-month history of belching, right-sided back pain, right upper-quadrant discomfort, and dyspepsia. She had no fever, jaundice, alcohol use, or exposure to other hepatotoxins. Laboratory test results revealed markedly elevated alanine aminotransferase (640 IU/L) and aspartate aminotransferase (341 IU/L), with mildly increased alkaline phosphatase (247 IU/L). International normalized ratio, albumin, full blood count, renal function, electrolytes, thyroid profile, and coagulation results were normal. Viral, autoimmune, metabolic, and infectious causes were excluded. Abdominal ultrasound and MRCP showed no abnormalities. Losartan was discontinued and replaced with amlodipine. Liver enzymes improved rapidly and normalized within 1 month, with complete and sustained normalization at 6 months. CONCLUSIONS Although rare, losartan-induced hepatotoxicity should be considered in patients with otherwise unexplained liver enzyme elevation. Early recognition, thorough exclusion of other causes, and prompt discontinuation of losartan typically lead to full recovery, emphasizing the need for timely evaluation in patients receiving angiotensin II receptor blocker therapy.

BACKGROUND Rhabdomyolysis (RM) is caused by drugs, trauma, infection, and high-intensity exercise. As a subtype, exertional rhabdomyolysis (ER) is commonly triggered by high-intensity exercise and clinically manifests as myalgia, dark urine, and other symptoms. Auxiliary tests typically show elevated creatine kinase (CK) and myoglobin (Mb) levels. Aggressive rehydration is the primary treatment for RM. After fluid replacement therapy, serum CK levels usually decline rapidly. CASE REPORT We describe 2 patients with ER who displayed atypical symptoms induced by short-term high-intensity physical labor. Both patients initially presented with limb swelling and asthenia; they showed no myalgia or dark urine. The elevated CK levels in both patients were lower than the levels typically observed in ER cases but remained high for a prolonged period (1-3 months). After aggressive fluid replacement therapy, clinical symptoms gradually improved in both patients, and CK levels slowly decreased. Follow-up evaluations after discharge confirmed full recovery. Each patient presented with atypical clinical symptoms, modest elevation of serum CK, and a slow response to treatment, which collectively posed diagnostic challenges during the initial assessment. CONCLUSIONS This report demonstrates that some patients with ER may have a prolonged disease course, atypical clinical symptoms, lack of clinically significant increase in CK levels, and slow treatment response. Therefore, misdiagnosis may occur in clinical practice, particularly in primary healthcare settings or among clinicians with limited experience. These findings may provide useful data and clinical insight for the diagnosis and management of ER.

BACKGROUND Peritoneal mesothelioma (PM) is the second most common presentation site of malignant mesothelioma. The standard of care for PM is cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC). Because of its insidious manifestations, PM is often diagnosed at advanced, unresectable stages, precluding optimal cytoreduction and diminishing long-term survivability. CASE REPORT We report 2 cases of advanced and unresectable PM (stages III and IV) presenting with symptomatic with low-grade epithelioid disease. Both cases had a high peritoneal cancer index (PCI >30) and extensive small-bowel involvement. The patients underwent pressurized intraperitoneal aerosol chemotherapy (PIPAC) with cisplatin and doxorubicin as downstaging conversion therapy. Patient 1 was a 47-year-old man with a laparoscopic PCI of 34 and progression of disease despite 5 months of systemic intravenous chemotherapy. After 2 cycles of PIPAC, the patient showed disease regression and complete resolution of large ascites; CRS-HIPEC was feasible with complete cytoreduction (CC-0). The patient was discharged after a 60-day hospital stay. Patient 2 was a 43-year-old man with a laparoscopic PCI of 30 and no prior lines of therapy. After a single PIPAC cycle, there was clear disease regression (PCI=23), allowing CRS-HIPEC with optimal cytoreduction (CC-1). The patient was discharged after 10 days. CONCLUSIONS PIPAC is established as a suitable option for palliation of massive ascites in PM; however, in selected candidates with favorable prognostic biomarkers and appropriate fitness for surgery, the procedure can serve as a bridge to definitive open surgery (CRS-HIPEC) aimed at achieving complete cytoreduction.

BACKGROUND Pigmented paravenous retinochoroidal atrophy (PPRCA) is a rare and poorly understood retinopathy, characterized by retinochoroidal atrophy and pigmentation along the retinal veins. Its etiology remains unclear; proposed mechanisms include inflammatory, developmental, and genetic factors. Here, we describe a 56-year-old woman who was diagnosed with PPRCA via multimodal imaging. CASE REPORT A 56-year-old Chinese woman presented with a 3-day history of vision deterioration in her left eye. Dilated fundus examination revealed bilateral pigment clumps and retinochoroidal atrophy along the retinal veins, which was more pronounced and displayed macular involvement in the left eye. Ultra-wide fundus fluorescein angiography showed hyperfluorescence consistent with retinal pigment epithelium degeneration, whereas fundus autofluorescence revealed hypoautofluorescent patches and hyperautofluorescence at lesion borders. Optical coherence tomography angiography demonstrated areas of flow void beneath the retinal pigment epithelium-Bruch membrane layer, suggestive of choriocapillaris hypoperfusion that corresponded with fundus autofluorescence findings. Spectral-domain optical coherence tomography showed absence of the myoid zone, ellipsoid zone, and interdigitation zone in the macular region, along with partial preservation of the retinal pigment epithelium. Based on these findings, a diagnosis of bilateral PPRCA was made. The patient was advised to undergo routine follow-up. CONCLUSIONS Multimodal imaging is essential to confirm the diagnosis of PPRCA. Optical coherence tomography angiography provides valuable insight into disease pathogenesis by demonstrating primary choriocapillaris involvement. Further research into genetic factors and potential therapeutic targets, including vascular endothelial growth factor inhibitors, is warranted to improve understanding and management of this condition.

BACKGROUND Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms most commonly originating in the pleura but may also arise in extrapleural sites, including the head and neck region. Subcutaneous SFTs in the chin area are exceptionally rare; only a few cases have been reported. CD34 and Bcl-2 are commonly used immunohistochemical markers in the initial diagnostic workup, and their co-expression is strongly suggestive of an SFT. However, CD34 negativity can be misleading and complicate diagnosis. Accurate identification of SFTs is potentially difficult because of histologic variability and overlap with other spindle cell tumors. CASE REPORT We encountered a rare subcutaneous SFT in the chin of a 22-year-old woman who presented with facial asymmetry and a tender mass. Imaging revealed a well-circumscribed, contrast-enhancing lesion in subcutaneous soft tissue over the anterior mandible. Histologically, the tumor lacked typical staghorn vasculature but showed spindle cell proliferation within a fibrous stroma. Immunohistochemistry demonstrated strong nuclear STAT6 positivity; expression of CD99, Bcl-2, and SMA; and focal H-caldesmon staining. CD34, S100, and ALK1 displayed negative staining. Based on these findings, the patient was diagnosed with an SFT. CONCLUSIONS This case highlights the importance of considering SFT in the differential diagnosis of spindle cell tumors in the head and neck region. It also underscores the critical role of immunohistochemistry, particularly STAT6 staining, in distinguishing SFT from histologic mimics. Vigilant follow-up remains essential, especially in atypical or CD34-negative cases, given their potential for aggressive behavior.

BACKGROUND Bacterial purulent pericarditis is rare and can be fatal if not treated appropriately. Streptococcus anginosus can cause invasive and cryptogenic infections, and purulent pericarditis is an uncommon presentation. Alcohol abuse can be a risk factor for abscesses caused by this agent. Cell-free DNA testing is a noninvasive method that has great potential in cases of serious infections in which pathogens are not easily identifiable by traditional microbiological techniques. CASE REPORT A 27-year-old man reported alcohol abuse and was hospitalized for acute pericarditis without signs of severity. He developed cardiac tamponade on the fifth day of hospitalization, requiring emergency pericardiocentesis. A significant persistent pericardial effusion was observed. Videopericardiectomy revealed a large amount of fibrin and purulent secretion in the pericardial sac. Additional tests and cultures did not identify systemic disease or an etiological agent. A cell-free DNA assay identified S. anginosus. He was discharged after 4 weeks of broad-spectrum antimicrobial therapy. There was no progression to constrictive pericarditis. CONCLUSIONS We present a case of purulent bacterial pericarditis with a cryptogenic focus in a young adult patient with a history of alcohol, marijuana, and e-cigarette abuse. He developed cardiac tamponade but received rapid and appropriate in-hospital therapeutic support, with clinical recovery within a few weeks. Alcohol and smoking may have facilitated bacterial translocation from the oropharynx to the bloodstream and then to the pericardium. S. anginosus was identified only by molecular research.

BACKGROUND Philadelphia chromosome (Ph)-negative B-cell acute lymphoblastic leukemia (B-ALL) is usually treated with intensive chemotherapy, presenting challenges for Jehovah's Witness patients who refuse blood products due to religious beliefs. These regimens often lead to severe cytopenias that require transfusion support. New targeted therapies (eg, inotuzumab ozogamicin and blinatumomab) have become effective options with lower toxicity, particularly for older or frail patients; these benefits may extend to the Jehovah's Witness population. CASE REPORT A 44-year-old Jehovah's Witness man was diagnosed with Ph-negative B-ALL. His comorbidities included hypertension, atrial fibrillation, and a newly identified reduced ejection fraction of 30% to 35%, which precluded the use of anthracyclines. Due to his refusal of blood products and cardiac limitations, he was treated with a chemotherapy-free regimen consisting of inotuzumab induction followed by blinatumomab consolidation. Supportive care included epoetin alfa, romiplostim, iron, and vitamin supplementation. The patient tolerated induction well, with minimal cytopenias and no serious adverse effects. After 2 cycles of inotuzumab, he achieved complete morphologic remission and minimal residual disease (MRD) negativity according to ClonoSEQ. He is currently receiving consolidation with blinatumomab. CONCLUSIONS This is the first known reported case that demonstrates the feasibility and effectiveness of a chemotherapy-free induction strategy using inotuzumab and blinatumomab for frontline treatment of Ph-negative B-ALL in Jehovah's Witness patients. It shows that MRD negativity can be safely achieved without cytotoxic chemotherapy or transfusion support and supports the use of the ALLIANCE A041703 trial regimen as a treatment model for this unique and underserved patient group.