American Journal of Case Reports最新文献

BACKGROUND Pulmonary abscess is an uncommon complication of pneumonia in pediatric patients. Diagnosis is challenging because early manifestations frequently overlap with those of community-acquired pneumonia. Despite advances in imaging modalities and antimicrobial therapy, pediatric pulmonary abscess remains clinically relevant due to its variable presentation and the difficulty of early identification. This report of pediatric pulmonary abscess highlights clinical features and diagnostic tools that may inform clinical management. CASE REPORT We describe 2 pediatric patients with pulmonary abscess complicating pneumonia. The first was a 4-year-old girl with community-acquired pneumonia who developed a cavitary lesion in the left lower lobe accompanied by empyema, persistent fever, and progressive respiratory compromise despite initial therapy. The second was a 17-month-old boy with right multilobar pneumonia that was complicated by a large right upper lobe abscess and pleural effusion after prolonged febrile illness and multiple evaluations at other hospitals before referral to our institution. In both patients, limited conventional microbiological testing failed to identify a bacterial pathogen, underscoring the diagnostic challenges. Both patients were exclusively treated with intravenous antibiotics followed by oral therapy; surgical and interventional drainage were omitted. Outpatient follow-up at 2 to 6 months confirmed complete clinical recovery and full radiological resolution. CONCLUSIONS These cases emphasize the importance of considering pulmonary abscess as a complication of persistent or worsening pneumonia in children. Early recognition, appropriate imaging, and timely antimicrobial therapy adjustment are essential to prevent complications and support recovery. Individualized follow-up incorporating clinical and radiological assessment ensures complete resolution and appropriate therapeutic response monitoring.

BACKGROUND Intramural esophageal hematoma (IEH) is a rare disease characterized by clinical manifestations such as chest pain, hematemesis, dysphagia, or odynophagia. Patients who have undergone coronary stent implantation often have several high-risk factors that can predispose them to IEH. Therefore, special attention should be paid to the etiology of chest pain after percutaneous coronary intervention (PCI). CASE REPORT We report the case of a 67-year-old man who presented with acute chest pain after PCI. He had stents implanted in the left circumflex artery and the right coronary artery in 2019, followed by another stent placed in the right coronary artery in 2022. He was readmitted due to chest pain and underwent coronary angiography, during which a stent was placed in the left anterior descending artery. He developed chest pain within 24 hours after PCI, which was subsequently accompanied by nausea, vomiting, diaphoresis, and hiccups. An electrocardiogram showed no dynamic changes, and cardiac injury biomarkers were negative. Chest computed tomography (CT) was later performed, raising suspicion of intramural esophageal hematoma, which was ultimately confirmed by gastroscopy. The patient recovered and was discharged after pharmacological treatment. CONCLUSIONS Post-PCI chest pain can indicate complications such as coronary artery occlusion or pericardial effusion. This case demonstrates that IEH can also occur after PCI. As patients receiving stents require antithrombotic therapy, their risk is elevated, underscoring the importance of early diagnosis and management.

BACKGROUND Miliary tuberculosis (TB) carries an increased risk in immunosuppressed patients. Extrapulmonary manifestations include hemophagocytic lymphohistiocytosis (HLH) and iliopsoas abscess. The coexistence of multiple extrapulmonary involvements can result in a significant diagnostic challenge. In the treatment of TB-associated HLH, the use of immunosuppressive agents remains controversial because of the risk of exacerbating TB. This report describes the case of a 70-year-old woman with rheumatoid arthritis presenting with an iliopsoas abscess, pulmonary miliary tuberculosis, and secondary HLH. CASE REPORT A 70-year-old Japanese woman with a history of rheumatoid arthritis treated with immunosuppressive therapy including golimumab and iguratimod presented with fever, dyspnea, cough, and weight loss. Imaging demonstrated an iliacus muscle abscess and possible pulmonary miliary tuberculosis. Clinical manifestations, laboratory findings, and bone marrow biopsy results were consistent with a diagnosis of HLH. Acid-fast bacilli cultures were positive for Mycobacterium tuberculosis from the abscess, bronchoalveolar lavage fluid, urine, and blood, confirming the diagnosis of miliary TB. The patient received the HLH-94 treatment protocol and antituberculosis therapy for TB-associated HLH, but unfortunately died of multi-organ failure. CONCLUSIONS In immunosuppressed patients presenting with multi-organ involvement, such as iliopsoas abscess and HLH, clinicians should maintain a high index of suspicion for miliary TB and pursue proactive diagnostic evaluation. Given the limited evidence supporting immunomodulatory therapies in TB-associated HLH, management should be individualized and guided by multidisciplinary discussion.

BACKGROUND Rhodococcus species is an opportunistic pathogen in immunocompromised conditions, including HIV/AIDS. It primarily causes necrotizing pneumonia and can clinically mimic pulmonary tuberculosis (TB), which is relevant in settings with a high TB burden, such as Pakistan. This case report presents a late diagnosis of HIV/AIDS associated with Rhodococcus lung abscess, which was initially treated as pulmonary TB and lung abscess. CASE REPORT A man in his 30s presented with a 1-month history of fever, weight loss, cough, night sweats, and chest pain. He denied exposure to soil or horses. He received empiric treatment for suspected pulmonary TB and lung abscess, with poor clinical response. A CT-guided lung biopsy confirmed the microbiological diagnosis of Rhodococcus lung abscess approximately 3 to 4 months after the symptom onset. HIV screening was unfortunately delayed due to the rarity and poor awareness of Rhodococcus as an opportunistic pathogen in the HIV population. AIDS was diagnosed 5 months after symptom onset. Antiretroviral therapy and culture-directed treatment for Rhodococcus lung abscess was initiated, with good clinical outcome. CONCLUSIONS Pakistan ranks fifth globally among high-burden TB countries and yet lacks healthcare resources. Prompt recognition of Rhodococcus infection should trigger HIV screening and early multidisciplinary management, to optimize outcomes in resource-limited, TB-endemic settings.

BACKGROUND Most cases of wasp stings are mild and self-limiting; however, some cases present with life-threatening symptoms, including hemolysis, rhabdomyolysis, acute kidney injury, and liver damage. However, neurological and respiratory complications such as stroke and ARDS are rarely reported in the literature. CASE REPORT A 56-year-old woman with hypertension was stung by multiple wasps while working in a field. Laboratory tests showed a white blood cell count of 31.59×10⁹/L and a creatinine level of 270.0 μmol/L. She was treated with 3 days of methylprednisolone, 3 sessions of plasma exchange, and 8 sessions of continuous renal replacement therapy. Eleven hours after admission, her condition worsened, with blood pressure dropping to 64/44 mmHg, necessitating vasopressor support. She then progressed to acute respiratory distress syndrome and required invasive mechanical ventilation. On the eighth day, she developed mild left-sided hemiparesis. Cranial MRI/MRA confirmed acute infarction in the right insular, external capsule, and basal ganglia regions. After treatment with antiplatelet agents, lipid-lowering therapy, and rehabilitation, her neurological function improved, and she was discharged on day 26. At a 6-month follow-up, muscle strength in her left lower limb had further improved to grade 4+. CONCLUSIONS This case illustrates that wasp stings can trigger a catastrophic multi-organ dysfunction syndrome, which includes conditions such as ARDS, AKI, and even cerebral infarction. Clinicians should remain highly vigilant for rare complications following bee stings, with an emphasis on early recognition and prompt intervention.

BACKGROUND Reflex anuria is a rare, underrecognized cause of acute kidney injury (AKI), marked by abrupt cessation of urine output following irritation or trauma to the urinary tract or adjacent pelvic organs. Because of its rarity and diagnostic complexity, it is frequently overlooked in the postoperative setting. CASE REPORT We present the case of a 68-year-old woman who developed anuria and elevated serum creatinine 24 hours after laparoscopic hysterectomy and sacrocolpopexy for uterovaginal prolapse. Imaging and cystoscopy with bilateral retrograde pyelography revealed no obstruction or injury. Other etiologies such as acute tubular necrosis and acute interstitial nephritis were considered less likely based on her clinical presentation, absence of risk factors, and timing of renal injury. Renal biopsy was performed but was non-diagnostic due to performing medullary sampling only. Corticosteroids were briefly administered for possible rapidly progressive glomerulonephritis but discontinued when no clinical improvement was observed. Urine output and renal function improved with supportive care. Follow-up 2 weeks later in the clinic showed the serum creatinine had normalized to baseline levels. Based on the temporal association with surgery and exclusion of alternative causes, reflex anuria was deemed the most likely diagnosis. CONCLUSIONS This case serves as a reminder that reflex anuria is an important cause of AKI after pelvic surgery and highlights the need for structured renal monitoring during the perioperative period.

BACKGROUND Amelogenesis imperfecta is a rare condition with a genetic predisposition that impacts enamel production, mineralization, or maturation. This condition impacts the affected individual's dental aesthetics, functionality, and emotional health. A multidisciplinary approach is recommended for effective management and a positive prognosis for dental treatment. CASE REPORT This case involves a 27-year-old woman diagnosed with amelogenesis imperfecta, characterized by extensive enamel defects, carious lesions, partial tooth loss, and significant aesthetic issues. The patient expressed dissatisfaction with the yellowish hue, uneven morphology, and small dimensions of her teeth. A comprehensive assessment revealed extensive enamel pitting, exposed dentin on several teeth, faulty dental restorations, multiple interdental gaps, misaligned teeth, and a class II malocclusion with a disparity between centric relation and maximum intercuspation. A staged, multidisciplinary treatment strategy was implemented, beginning with preliminary periodontal therapy and risk management, followed by surgical crown lengthening and the extraction of impacted or retained teeth. The final phase consisted of restorative rehabilitation, including posterior porcelain-fused-to-metal crowns, anterior lithium disilicate crowns, and fixed partial dentures. This treatment protocol successfully addressed the patient's aesthetic, phonetic, and functional needs. CONCLUSIONS This case highlights the complex management of amelogenesis imperfecta and underscores the critical need for individualized, interdisciplinary therapeutic approaches. A comprehensive literature review supports preventive interventions in childhood, adhesive and interim restorations in adolescence, and full-coverage prostheses in adulthood as the main components of effective management. When combined with patient motivation and a systematic recall schedule, favorable long-term prognoses can be achieved.

BACKGROUND Lipomatous atrial septal hypertrophy (LASH) is a benign but uncommon condition characterized by excessive adipose tissue accumulation within the interatrial septum. Although most cases remain asymptomatic, large lesions may produce superior vena cava (SVC) obstruction. Acute pulmonary embolism as an initial presentation is rare. CASE REPORT A 75-year-old woman with a history of chronic obstructive pulmonary disease and hypertension experienced 7 days of progressively worsening exertional dyspnea, orthopnea, and lower-extremity edema, without chest pain, cough, or fever. Physical examination findings included tachypnea, hypertension, bilateral lower-extremity edema, elevated jugular venous pressure, and bibasilar crackles. Computed tomography pulmonary angiography - prompted by elevated D-dimer - demonstrated bilateral pulmonary emboli and a large LASH causing SVC obstruction with near-complete obliteration of the right atrium. Transthoracic echocardiography confirmed the presence of LASH. The absence of personal or family history of inherited thrombophilia, along with negative deep venous thrombosis findings on lower-extremity Doppler ultrasonography, suggested that pulmonary embolism and right heart failure were related to sluggish right atrial flow secondary to LASH-induced mechanical SVC obstruction. Clinical improvement was achieved with anticoagulation and diuretic therapy, followed by partial surgical resection of the interatrial septum in conjunction with coronary artery bypass grafting. Histopathologic examination confirmed LASH without evidence of inflammation or malignancy. CONCLUSIONS Symptomatic LASH causing SVC obstruction is extremely uncommon and rarely associated with pulmonary embolism. This case underscores the importance of recognizing LASH as a potential contributor to right heart failure and thromboembolism; it highlights echocardiography as an essential diagnostic modality when pulmonary embolism is suspected.

BACKGROUND Fat-dissolving (lipolysis) injections are increasingly performed as non-surgical aesthetic procedures for body contouring. Although generally considered safe, these interventions can rarely result in severe and potentially life-threatening complications, especially in unregulated settings. We report an unusual case of acute respiratory distress syndrome (ARDS) following cosmetic lipolysis injections in a previously healthy woman. CASE REPORT A 41-year-old Vietnamese woman with no significant past medical history developed acute progressive dyspnea and bilateral chest pain about 30 minutes after receiving multiple abdominal, shoulder, and thigh lipolysis injections at an unlicensed cosmetic facility. Chest computed tomography showed diffuse bilateral infiltrates. Pulmonary embolism and macroscopic fat embolism were excluded; however, microscopic intravascular fat embolism could not be definitively ruled out. The patient's condition rapidly progressed to hypoxemic respiratory failure consistent with ARDS. Management with high-flow nasal cannula oxygen, intravenous corticosteroids, and empiric broad-spectrum antibiotics led to significant clinical improvement within days, with near-complete radiological resolution observed on follow-up imaging. CONCLUSIONS This case illustrates ARDS as a rare but serious complication of cosmetic fat-dissolving injections. While macroscopic fat embolism was excluded, the potential role of microscopic fat embolism remains a plausible mechanism. Clinicians should recognize that lipolysis injections, often regarded as minor aesthetic procedures, carry substantial potential pulmonary risks. Greater awareness, early intervention, and stricter regulation are essential to improve patient safety.

BACKGROUND Cranioplasty is a common neurosurgical procedure performed to correct skull defects after prior surgical intervention or cranial injury. Although frequently performed, the rate of adverse events remains relatively high, and seizures are a commonly reported complication. Despite these complication rates, surgical mortality is not typically associated with cranioplasty, and status epilepticus (SE) is a relatively rare occurrence. We report a case of refractory SE after elective revision cranioplasty that ultimately resulted in death. CASE REPORT A 76-year-old man underwent revision titanium cranioplasty due to symptomatic subsidence of a previously implanted acrylic plate. Immediately following an uncomplicated procedure, the patient developed refractory generalized seizures that progressed to nonconvulsive SE. The seizures were unresponsive to maximal medical therapy, and the patient died 4 weeks after the procedure. CONCLUSIONS The causes of refractory SE after cranioplasty are not fully understood and have been proposed to include focal brain injury, alterations in transmantle pressure, and the use of negative-pressure drains. Prophylactic perioperative administration of antiepileptic drugs may reduce the incidence of seizures and SE after revision cranioplasty. Once SE has developed, established treatment modalities include antiepileptic drugs and sedation; consideration may also be given to infusion of dexmedetomidine, removal of the cranioplasty, and insertion of a vagal nerve stimulator.