American Journal of Case Reports最新文献

BACKGROUND Periprosthetic joint infection (PJI) is a potentially catastrophic complication after orthopedic surgery. Biofilm formation and infection with multidrug-resistant pathogens significantly increase the difficulty of achieving successful treatment. CASE REPORT A 36-year-old woman presented with a 6-month history of left hip pain. Three months prior to presentation, she had been definitively diagnosed with a pelvic giant cell tumor and undergone hemipelvic resection with custom prosthesis replacement. Chronic PJI developed postoperatively. Etiological examination revealed mixed infection with methicillin-resistant Staphylococcus epidermidis, extended-spectrum ß-lactamase-producing Klebsiella pneumoniae, and Pseudomonas aeruginosa. The patient underwent 8 debridement procedures with targeted antibacterial treatment. Antibacterial dosing was guided by the ratio of the area under the curve to the minimum inhibitory concentration of vancomycin plus rifampicin for biofilm penetration, together with ciprofloxacin against P. aeruginosa. The treatment strategy emphasized antibiotic rotation based on dynamic microbiome monitoring, surgical debridement with negative pressure drainage, and optimization of vancomycin trough concentration to 15-20 μg/mL via therapeutic drug monitoring. Infection did not recur during nearly 4 years of follow-up. The infection was ultimately controlled, and the prosthesis was preserved. CONCLUSIONS Patients with giant cell tumors of the pelvis who undergo prosthesis replacement should be closely monitored for PJI. Combination therapy with vancomycin and rifampicin can eradicate biofilm infections caused by coagulase-negative staphylococci, offering a potentially feasible non-revision treatment strategy for complex PJI in patients with financial constraints.

BACKGROUND Branch retinal vein occlusion (BRVO) is a common cause of vision loss in older adults, and cystoid macular edema (CME) is its most frequent vision-threatening complication. Depending on severity, vitreomacular traction (VMT) is typically managed with observation or surgery. When CME develops during observation (e.g., in BRVO), the therapeutic approach becomes more complex. Anti-vascular endothelial growth factor (VEGF) therapy is a standard treatment for CME secondary to BRVO. Although full-thickness macular hole (FTMH) formation is rare, it has been reported in eyes with preexisting VMT, suggesting a contributory role for tractional forces. CASE REPORT A 72-year-old woman under observation for VMT developed BRVO with CME. Baseline optical coherence tomography revealed VMT, an epiretinal membrane, a lamellar macular hole, and a vertical hyperreflective line at the fovea resembling the "foveal crack sign". The patient received an intravitreal faricimab injection to achieve rapid edema resolution with fewer injections. CME improved; however, an FTMH subsequently developed, accompanied by a decline in best-corrected visual acuity to 20/33. The patient then underwent combined vitrectomy and cataract surgery, which achieved successful hole closure. CME recurred postoperatively but responded well to a second faricimab injection, resulting in visual recovery to 20/22. CONCLUSIONS FTMH may develop after anti-VEGF therapy in eyes with preexisting VMT. This appears to be the first reported case following faricimab treatment for BRVO-associated CME, underscoring the need for careful pretreatment evaluation of the vitreoretinal interface and awareness of potential tractional complications. Individualized treatment strategies may help reduce such risks and improve outcomes.

BACKGROUND Fibrous dysplasia (FD) is a rare skeletal lesion. Current FD therapies center on surgery, the only modality with curative potential. Pharmacologic agents show promise but still lack large-scale evidence of halting disease progression. However, there is currently no unified surgical protocol for FD. Therefore, identifying an effective surgical approach remains important. CASE REPORT We report a case of a 29-year-old Chinese male patient with polyostotic fibrous dysplasia (PFD), presenting with Shepherd's crook deformity and a pathological fracture in the subtrochanteric region of the left femur. We applied a bridging combination internal fixation system for the first time in this patient. The patient adhered to our postoperative rehabilitation protocol for functional recovery and progressive weight-bearing exercises and was followed up regularly. RUSH (Radiographic Union Scale for Hip) scores were 9, 22, and 28 at 1, 3, and 6 months after surgery, respectively. In addition, the left hip function score improved from 28 preoperatively to 88 at 6 months postoperatively. These findings indicate satisfactory fracture healing and excellent recovery of hip function. CONCLUSIONS This novel bridging combination internal fixation system offers the advantages of minimal invasiveness, stable fixation, and easy contouring, and it effectively treats femoral pathological fractures caused by fibrous dysplasia; thus, it is expected to become a viable surgical option for such fractures in the future.

BACKGROUND Endoscopic bariatric therapies, such as intra-gastric balloons (IGB) offer a less invasive, efficacious, and safe approach to facilitate weight loss in obese individuals. While typically tolerated, rare complications, including intestinal migration of the IGB, can occur and lead to serious sequelae such as mechanical bowel obstruction. This case report details the diagnostic process and successful laparoscopic surgical management of an unusual instance of IGB migration resulting in small bowel obstruction. CASE REPORT We present the case of a 32-year-old woman who developed a small bowel obstruction 1 month following IGB insertion for weight management. Her initial postoperative course was complicated by persistent nausea and vomiting, which progressed to generalized abdominal pain and constipation. A contrast-enhanced computed tomography scan confirmed the diagnosis of a distal small bowel obstruction caused by a deflated and migrated IGB. The patient underwent successful laparoscopic exploration and retrieval of the balloon, followed by an uncomplicated postoperative recovery and discharge by postoperative day 5. Long-term follow-up revealed complete resolution of symptoms and a return to normal bowel function. CONCLUSIONS This case highlights the need for clinicians to maintain a high index of suspicion for rare events such as balloon migration in patients presenting with gastrointestinal symptoms following IGB insertion. Furthermore, it demonstrates that laparoscopic retrieval is a feasible, safe, and potentially advantageous management approach for migrated IGBs causing small bowel obstruction, potentially offering better outcomes compared to open surgery. Further research is needed to refine management guidelines across various IGB types and failure modes.

BACKGROUND Tislelizumab is an immune checkpoint inhibitor (ICI) widely used in various solid tumors. Nevertheless, immune-related adverse reactions can arise during the administration of this medication. Hypophysitis is a relatively uncommon adverse reaction, typically manifesting as lethargy and hyponatremia. Although ICI-induced hypophysitis is reported, cases presenting with somnolence and delirium are extremely rare. This report describes the case of a 69-year-old woman with advanced endometrial cancer who presented with somnolence, delirium, and eosinophilia after commencing treatment with tislelizumab and was subsequently diagnosed with hypophysitis. CASE REPORT A 69-year-old woman with advanced endometrial cancer, following multiple lines of prior therapy, presented to our hospital with somnolence as the primary symptom. The patient developed worsening daytime somnolence and nocturnal delirium following tramadol administration for pain associated with a metastatic tumor in the left axilla. After a complex diagnostic and therapeutic process, it was determined that the patient had hypophysitis induced by tislelizumab. After receiving hydrocortisone treatment, the patient's symptoms of somnolence and delirium vanished. Two weeks later, the patient once more developed an adrenal crisis following an interventional procedure. We treated her anew with glucocorticoids, and she recovered. CONCLUSIONS This case underlines the necessity for timely assessment of the hypothalamic-pituitary-adrenal axis function in patients presenting with neurological symptoms, such as somnolence and delirium, particularly in the presence of elevated peripheral blood eosinophil counts. Simultaneously, it is essential for us to understand that patients with hypophysitis induced by ICIs require long-term hormone replacement therapy due to adrenocortical insufficiency.

BACKGROUND Idiopathic intracranial hypertension (IIH) is an uncommon but serious neurological condition that can precede systemic lupus erythematosus (SLE). Early recognition is essential to prevent complications, such as permanent vision loss. In this report, we describe a case of IIH as the initial presentation of SLE and review the relevant literature. CASE REPORT A 23-year-old previously healthy Saudi woman presented with a 1-week history of persistent headache and blurred vision, along with fatigue and bilateral leg swelling. Neurological examination revealed papilledema and mild left abducens nerve palsy. Brain magnetic resonance imaging and magnetic resonance venography were normal. Laboratory workup showed pancytopenia, positive antinuclear antibody and anti-dsDNA antibodies, low complement levels, and proteinuria. She was given a diagnosis of SLE with lupus nephritis and presumed IIH. Treatment included high-dose corticosteroids, hydroxychloroquine, mycophenolate mofetil, and acetazolamide. While her symptoms initially improved, persistent papilledema and worsening proteinuria were noted during follow-up, indicating ongoing disease activity. CONCLUSIONS IIH can be an atypical and isolated early manifestation of SLE, especially in young women. This case underscores the importance of considering autoimmune etiologies in patients with unexplained intracranial hypertension. Prompt diagnosis and a multidisciplinary approach to treatment are critical to reducing the risk of vision loss and long-term neurological damage. Further research is needed to better understand the pathophysiological connection between SLE and IIH.

BACKGROUND Nocardia species are opportunistic pathogens that primarily cause infections in immunocompromised individuals. Giant-cell arteritis is a granulomatous vasculitis of large- and medium-sized arteries in individuals aged ≥50 years, typically requiring prolonged glucocorticoid therapy, which increases susceptibility to opportunistic infections. CASE REPORT We report the case of a 73-year-old man with giant-cell arteritis treated with prednisolone who developed disseminated nocardiosis. Four months after giant-cell arteritis diagnosis, a new pulmonary nodule was detected on follow-up imaging, followed by acute onset of loss of consciousness. Brain magnetic resonance imaging revealed multiple abscesses, and Nocardia farcinica was identified from aspirated pus. The patient was initially treated with intravenous meropenem and amikacin. Therapy was then transitioned to the first-line oral agent sulfamethoxazole-trimethoprim, but this was discontinued due to renal dysfunction. Long-term oral minocycline and moxifloxacin were subsequently administered, although the latter was later withdrawn because of QT prolongation. He ultimately completed 1 year of antimicrobial therapy and remained recurrence-free without neurological sequelae. CONCLUSIONS This case illustrates that nocardiosis can occur even in the early phase of giant-cell arteritis therapy and at moderate doses of glucocorticoids. Clinicians should maintain vigilance for Nocardia infection when evaluating pulmonary or neurological lesions in patients with giant-cell arteritis. Alternative therapeutic regimens, guided by susceptibility testing, may be required when first-line agents are not tolerated.

BACKGROUND Syphilis is a sexually transmitted infection in which ocular involvement is relatively uncommon. This report describes the clinical presentation, treatment, and visual outcome of a patient with syphilitic uveitis. CASE REPORT A 52-year-old man with a history of sexual promiscuity was diagnosed with bilateral panuveitis secondary to syphilis. He experienced progressively worsening bilateral vision loss over 1 month. The diagnosis was confirmed by serological positivity for Treponema pallidum. The patient displayed human immunodeficiency virus negativity. At presentation, visual acuity in the right eye was light perception and projection; in the left eye, it was 20/630. Ophthalmologic examination revealed non-granulomatous panuveitis, vitritis, chorioretinitis, retinal vasculitis, and papillitis. The patient was treated with intravenous aqueous penicillin G and systemic methylprednisolone for 7 days, followed by 5 weekly applications of intramuscular benzathine penicillin G. Topical therapy included antibiotic-corticosteroid, atropine sulfate, and bromfenac eye drops in both eyes. Two months after initiation of therapy, a periocular injection of methylprednisolone was administered to the right eye. Substantial improvement was observed, with final visual acuity of VOD=20/25 and VOS=20/20 after approximately 14 weeks of follow-up. CONCLUSIONS Ocular syphilis exhibits wide clinical variability. In this case, it manifested as non-granulomatous panuveitis with inflammation of the retinal vessels and optic disc. Early serologic diagnosis and prompt treatment are essential for favorable outcomes. Final visual acuity improved after systemic antibiotic and corticosteroid therapy, complemented by topical antibiotic-corticosteroid agents, cycloplegic drops, and a nonsteroidal anti-inflammatory agent.

BACKGROUND Drug-induced thrombocytopenia (DITP) is a potentially life-threatening adverse drug reaction, representing approximately 20% to 25% of acquired thrombocytopenia cases. Sodium valproate (VPA) and levetiracetam are widely used antiepileptic drugs; reported incidences of VPA-associated thrombocytopenia range from 5% to 32%, depending on serum concentrations. Although both agents are frequently combined in the management of refractory epilepsy, limited information is available regarding their synergistic hematological risks. CASE REPORT We encountered a case of DITP in a 31-year-old man with an epileptic mental disorder who was receiving VPA and levetiracetam in combination. The patient had previously received either VPA or levetiracetam as monotherapy without thrombocytopenia onset. However, after initiation of combination therapy, the patient developed progressive thrombocytopenia, with a nadir platelet count of 47×10⁹/L. Laboratory testing revealed a serum VPA concentration of 112.4 μg/mL, exceeding the therapeutic range (50-100 μg/mL). After VPA discontinuation, the platelet count gradually recovered to 93×10⁹/L, approaching normal levels. CONCLUSIONS This case highlights a potential pharmacokinetic interaction between levetiracetam and VPA, suggesting that levetiracetam can influence VPA metabolism. It underscores the importance of close therapeutic drug monitoring of VPA concentrations during combination therapy and emphasizes the need for further investigation into metabolic interactions between novel and conventional antiepileptic agents.

BACKGROUND Elastofibroma dorsi (ED) is a rare, benign, slow-growing soft tissue pseudotumor typically located beneath the scapula. It predominantly affects older adults and shows a higher prevalence among women, usually in the infrascapular region. Lesions may occur unilaterally or bilaterally. While most cases remain asymptomatic, symptomatic patients may present with pain, swelling, or functional discomfort. CASE REPORT We report the case of a 46-year-old man with a history of abdominoplasty and sleeve gastrectomy who presented with a swelling on the left upper back persisting for more than 1 year. The swelling was initially painless but became painful during the preceding 4 months. He also reported intermittent swelling on the right side, without constitutional symptoms. Physical examination revealed a hard, immobile mass at the lower pole of the left scapula, while the right-sided mass became evident during abduction. Magnetic resonance imaging (MRI) demonstrated bilateral ill-defined lesions in the subscapular and infrascapular regions, measuring 13×3.5×8.5 cm on the right and 10×3×8 cm on the left, with heterogeneous signals and modest post-contrast enhancement, suggestive of elastofibroma. The patient underwent successful bilateral complete excision under general anesthesia through posterolateral subscapular incisions. Postoperative recovery was uneventful, with complete resolution of pain and functional symptoms within 1 week. CONCLUSIONS This case emphasizes how crucial it is to get a complete medical history and perform a physical examination. Characteristic MRI results can help avoid needless biopsies or operations. However, surgical excision is regarded as curative if clinically indicated.